Pandu Roga in the Charaka Samhita: Chikitsa Sthana 16 on Kamala, Halimaka and the Clay-Eater's Pallor

इस लेख को हिंदी में पढ़ें: पांडु रोग क्या है? चरक चिकित्सास्थान 16 में कामला, हलीमक और मिट्टी खाना

📖 27 min read · Charaka Samhita, Chikitsa Sthana 16, read in Van Loon's handbook (Volume II, printed pages 653 to 669) and in the Sanskrit

Pandu Roga in the Charaka Samhita: What Chikitsa Sthana 16 Covers

Pandu roga has a chapter of its own in the Charaka Samhita: the sixteenth of the Chikitsa Sthana, the section on the management of named conditions. In the Sanskrit of the CSRTSDC edition (the Charak Samhita Research, Training and Skill Development Centre's online text) it runs to a closing line numbered 140. Gabriel Van Loon's Charaka Samhita: Handbook on Ayurveda gives it seventeen pages, PDF pages 31 to 47 of his second volume, printed pages 653 to 669, under the heading "Panduroga (Anemia) and Kamala (Jaundice)". His handbook is notes and lists rather than a running translation; each item ends with a marker such as Ci16#27-30, which means Chikitsa Sthana 16, verses 27 to 30.

The chapter has a plain shape. Verses 3 to 38 describe five kinds of pandu, their causes and signs, the hopeless cases, and kamala. Verses 39 to 43 give principles of management. Verses 44 to 114, Van Loon's pages 34 to 44, are a formulary, which this page leaves out entirely. Then come short passages on adjusting everything to the dosha, on the patient who eats clay, on a kamala whose path is blocked, and on halimaka; then a two-verse summary and the colophon.

Verse numbers follow the CSRTSDC Sanskrit; Van Loon's markers sometimes differ by one. We quote both English versions exactly and give the Sanskrit where it carries the argument.

A Chapter Completed by Dridhabala: What the Colophon of Chikitsa Sthana 16 Says

Every chapter of the Charaka Samhita closes with a colophon saying whose work it is. Chikitsa Sthana 16 closes with this:

Verse 140 (the colophon)
इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने पाण्डुरोगचिकित्सितं नाम षोडशोऽध्यायः
ity agnivesha-krite tantre 'prapte dridhabala-sampurite chikitsa-sthane pandu-roga-chikitsitam nama shodasho 'dhyayah
Our rendering: thus, in the treatise made by Agnivesha, in the part not obtained and completed by Dridhabala, in the Chikitsa Sthana, the sixteenth chapter, named Pandu-roga-chikitsitam.

The word that matters is aprapte, "not obtained". Agnivesha's treatise reached later readers through Charaka's re-edition, parts of it were missing, and Dridhabala supplied them. This colophon says the pandu chapter is one of those parts. The CSRTSDC English puts it as in the work of Agnivesha which was redacted by Charaka and because of its unavailability was supplemented by Dridhabala. The words "redacted by Charaka" are the translator's: the Sanskrit of this colophon does not name Charaka at all.

The neighbours show where the line falls in this edition. Chikitsa Sthana 14, on arsha, closes with agnivesha-krite tantre caraka-pratisamskrite, "re-edited by Charaka". Chikitsa Sthana 15, on grahani, closes like ours, with aprapte dridhabala-sampurite. Van Loon's handbook does not mention any of this. Our observation: by its own account, the Charaka Samhita's chapter on pandu is a supplement by a later hand. That does not make it less classical; it makes the name on the cover less exact.

One new plank in an old door: the colophon says Dridhabala completed the part of the treatise not obtained.

Pandu, Haridra, Harita: A Disease Named for a Colour

The disease takes its name from what it does to the skin. Verse 11 says that pitta, settled between the skin and the flesh, makes many colours appear on the skin:

Verse 11 (second half)
पाण्डुहारिद्रहरितान् वर्णान् बहुविधांस्त्वचि
pandu-haridra-haritan varnan bahu-vidhams tvachi
Our rendering: pale, turmeric-yellow and green colours, of many kinds, on the skin.

Monier-Williams gives pandu as yellowish white, white, pale; haridra as coloured with turmeric, yellow, the adjective made from the word for turmeric; and harita as a range that begins yellowish, pale yellow, fallow, pale red, pale and ends greenish, green. The three words move from a whitish pallor through turmeric to green.

Charaka does not say why the disease is named after the first of the three. He says only sa pandu-roga ity uktah, "that is called pandu roga" (verse 12). Sushruta and Vagbhata do say why. Sushruta (Uttara Tantra 44.4) explains that in every kind, the pale quality is the greater one, "therefore it is pandu roga". Vagbhata (Ashtanga Hridaya, Nidana Sthana 13.3 to 13.4) lists the same three colours and adds:

Ashtanga Hridaya, Nidana Sthana 13.3
पाण्डु-हारिद्र-हरितान् पाण्डु-त्वं तेषु चाधिकम्
pandu-haridra-haritan pandu-tvam teshu chadhikam
Our rendering: pale, turmeric-yellow and green, and among them paleness is the greater.

English has never settled on one disease for the word. Bhishagratna's Sushruta calls the chapter one on Jaundice and explains the name from the fact that a deep yellow (Pándu) colour is imparted to the skin. Monier-Williams, too, gives jaundiced, Car. and jaundice, Car. among the senses of pandu, citing Charaka. Van Loon and the CSRTSDC translators write "anemia". Our reading: the Sanskrit names a colour, not a blood count or an organ, and each translator chose the modern disease that matched his idea of that colour.

Samprapti: Pitta in the Heart and the Ten Dhamanis (Verses 4 to 11)

The chapter states its idea of the disease twice: first as a summary (verses 4 to 6), then as a story (verses 9 to 11). The summary is about decline. When the doshas, with pitta in the lead, are provoked in the dhatus (the tissues), the tissues become loose (shaithilya) and heavy (gaurava); then colour (varna), strength (bala), oiliness (sneha) and the qualities of ojas sink. Verse 6 draws the portrait:

Verse 6 (first half)
सोऽल्परक्तोऽल्पमेदस्को निःसारः शिथिलेन्द्रियः
so 'lpa-rakto 'lpa-medasko nihsarah shithilendriyah
Our rendering: he has little blood, little fat, no essence, and slack senses.

The CSRTSDC English takes nihsara as absence of the vitality of all the tissues (nihsara). Word for word it is "without sara", without the best part of a thing.

The story is about movement. Pitta, provoked and seated in the heart (hridaye samavasthitam), is thrown by a strong vata into the ten dhamanis, the great vessels, and from them into the whole body. It comes to rest tvan-mamsa-antaram, in the space between skin and flesh, where it spoils kapha, vata, blood, skin and flesh, and the colours appear. Van Loon's English: P situated in heart is aggravated and propelled by the strong V in 10 arteries which spread it in the whole body. Vagbhata tells it in nearly the same words (Nidana Sthana 13.1 to 13.2). Our observation: the disease is placed where it is seen. A disease of colour is lodged just under the skin.

Nidana: Food, Day Sleep and a Troubled Mind (Verses 7 to 9)

The list of causes is long and ordinary. First food: too much that is alkaline (kshara), sour (amla), salty (lavana) or too hot (ati-ushna); food that is incompatible (viruddha) or unaccustomed (asatmya); and particular foods, nishpava (a bean), masha (black gram), pinyaka (oil-cake), and sesame oil. Then timing: day sleep (divasvapna) and exertion while the meal is still vidagdha, half-digested. Then cleansing procedures done badly, seasons out of order (pratikarma-ritu-vaishamya) and natural urges held back (veganam vidharana). Last, the mind: desire, worry, fear, anger and grief (kama, chinta, bhaya, krodha, shoka), in one whose mind is struck by them.

One thing stands out. The list says nothing about bleeding: blood loss appears in this chapter only later, in verse 33, as a sign that a case is lost. Our reading: the cause list tells you how the authors thought pitta is provoked, not how they would have explained a particular pale person in front of them. For that person, the chapter turns to signs.

Purvarupa and Rupa: A Throbbing Heart, Ringing Ears and the Stairs

Before the disease shows, verse 12 lists four early signs (purvarupa): hridaya-spandana, the heart throbbing; raukshya, dryness; sveda-abhava, no sweat; and shrama, tiredness. Van Loon: palpitation of heart, roughness, absence of sweat and exhaustion.

Verses 13 to 16 then give the full picture (rupa). It opens with the ears: karna-kshvedi, one whose ears ring. Then hatanala (his digestive fire struck down), weakness, dislike of food, giddiness, aches, fever, breathlessness and heaviness. The limbs feel mriditair iva, "as if kneaded", pressed or churned. There is swelling around the eyes (shunakshi-kuta), a green tinge, shed body hair (shirna-loma), lost lustre, irritability, sleepiness and little speech. The list ends on the stairs:

Verse 16
पिण्डिकोद्वेष्टकट्यूरुपादरुक्सदनानि च । भवन्त्यारोहणायासैर्विशेषश्चास्य वक्ष्यते
pindikodveshta-katy-uru-pada-ruk-sadanani cha, bhavanty arohanayasair visheshash chasya vakshyate
Our rendering: cramps in the calves, and aching and weakness in the waist, thighs and feet, come on with the effort of climbing; its particular signs will be told next.

Van Loon writes on exertion by climbing (stairs etc.) he suffers from cramps in shanks. The stairs are his bracket; the verse says only arohana, going up.

Verse 16 ends its list of signs on the stairs: the effort of climbing, arohana-ayasa.

Some of these entries sit on a modern list. The NHS page on iron deficiency anaemia names noticeable heartbeats (heart palpitations), hearing ringing, buzzing or hissing noises inside your head (tinnitus), tiredness and lack of energy and shortness of breath. Our observation, and only that: four of the chapter's signs appear there, in plain modern words. An overlap of four entries is not an identity. Pandu covers more ground than any one modern disease, and no list of signs, old or new, measures what a blood test measures.

Vataja, Pittaja, Kaphaja, Sannipataja: Four Kinds Told by Colour

Each dosha gives pandu its own colour.

Vataja (verses 17 and 18). Vata produces krishna-panduta, a blackish pallor, with ruksha-aruna-angata, limbs that are rough and ruddy. With it: aches, trembling, pain in the sides and head, dry stool, a bad taste (asya-vairasya) and loss of strength.

Pittaja (verses 19 to 22). Pitta makes the person pita or harita-abha, yellow or with a green cast, with fever, burning, thirst, yellow urine and stool, heavy sweating, a wish for cold things, sour belching, loose stools and tamas, darkness before the eyes.

Kaphaja (verses 23 to 25). Kapha brings shveta-avabhasata, a white sheen, with heaviness, drowsiness, salivation, cough, a voice that catches, and whiteness of urine, eyes and stool (shukla-mutra-akshi-varcas). He craves what is pungent, rough and hot.

Sannipataja (verse 26). In the person who eats everything (sarvanna-sevin), all three doshas are spoiled, all three sets of signs appear, and the case is su-duhsaham, very hard to bear. Van Loon: This type is very troublesome.

Sushruta's Uttara Tantra 44.7 to 44.9 lay out the same colours more strictly: one line said three times, with one word changed:

Sushruta, Uttara Tantra 44.7, 44.8, 44.9 (first quarters)
कृष्णेक्षणं कृष्णसिरावनद्धं (vata)
पीतेक्षणं पीतसिरावनद्धं (pitta)
शुक्लेक्षणं शुक्लसिरावनद्धं (kapha)
krishnekshanam krishna-siravanaddham; pitekshanam pita-siravanaddham; shuklekshanam shukla-siravanaddham
Our rendering: black-eyed and laced with black veins; yellow-eyed and laced with yellow veins; white-eyed and laced with white veins.

Each verse goes on: tad-varna-vin-mutra-nakhananam cha, "with stool, urine, nails and face of that colour". The places are six: eyes, veins, stool, urine, nails, face. Bhishagratna's English adds a seventh place: A black colour of the eyes and of the skin marked by the prominent appearance of black-coloured vein. The skin is implied by the veins, but the verse does not name it.

Mrittika Bhakshana: The Fifth Pandu Roga, From Eating Clay

The count of five is given in the chapter's first verse after the opening:

Verse 3 (second half)
चतुर्थः सन्निपातेन पञ्चमो भक्षणान्मृदः
chaturthah sannipatena panchamo bhakshanan mridah
Our rendering: the fourth from all three together, the fifth from eating earth.

Charaka's Sutrasthana 19 counts the same five (see our reading of Sutrasthana 19). Verses 27 to 30 explain how the earth does it, and they begin with a habit, not a single act: mrittikadana-shilasya, of one whose custom it is to eat clay.

Verse 27 (second half)
कषाया मारुतं, पित्तमूषरा, मधुरा कफम्
kashaya marutam, pittam ushara, madhura kapham
Our rendering: astringent earth provokes vata, saline earth pitta, sweet earth kapha.

The clay is sorted by taste. The middle word is the interesting one. Monier-Williams gives ushara as impregnated with salt, containing salt and, as a noun, saline soil: ground with a white crust of salt. Van Loon has astringent, alkaline and sweet earth respectively; the CSRTSDC English says saline and alkaline mud aggravates pitta.

Verse 27 sorts eaten earth by taste: astringent stirs vata, saline (ushara) pitta, sweet kapha.

Verse 28 says what the clay does inside. Because it is dry it dries what is eaten: Van Loon's The earth, moreover, produces roughness in dhatus, the CSRTSDC's causes dryness in the rasa (nutrients of the digested food). And because it is never digested it clogs: purayaty avipakvaiva srotamsi nirunaddhi cha, It fills up and obstructs the channels without undergoing change. Verse 29 adds that it destroys the strength of the senses, tejas, virya and ojas, and brings on pandu ashu, quickly. Verse 30 gives its signs: swelling of the cheeks, eye-sockets, brows, feet and navel, and krimi in the gut, with what Van Loon calls diarrhoea passing stool with blood and mucus.

Vagbhata repeats the taste rule almost word for word (Nidana Sthana 13.13): mrit kashayanilam pittam ushara madhura kapham. He also counts five kinds, the fifth mrittikadanat, "from eating clay" (Nidana Sthana 13.7).

Mitti Khane Se Kaun Si Bimari Hoti Hai? Charaka, Sushruta and Vagbhata Answer

The question people type, "mitti khane se kaun si bimari hoti hai", asks which illness comes from eating clay. The three classical texts answer it in slightly different ways.

For Charaka and Vagbhata, habitual clay-eating is a cause, and what it causes is the fifth kind of pandu, described above. Sushruta puts clay in his list of causes, beside sour and salty food and day sleep: mridam (Uttara Tantra 44.3). Two verses later it appears again, among the purahsarani, "the ones that walk in front", the signs that come before the disease:

Sushruta, Uttara Tantra 44.5 (first half)
त्वक्स्फोटनं ष्ठीवनगात्रसादौ मृद्भक्षणं प्रेक्षणकूटशोथः
tvak-sphotanam shthivana-gatra-sadau mrid-bhakshanam prekshana-kuta-shothah
Our rendering: cracking of the skin, spitting, weary limbs, eating earth, swelling of the eye-sockets.

So for Sushruta the clay can be a cause and also an early sign. Bhishagratna's English turns the sign into a wish: (desire for) eating clay. The brackets are his; the Sanskrit says only "eating earth". He also notes the disagreement on counting in a footnote: Charaka says that Pándu-roga is of five different types, by adding the clay-eater's kind to Sushruta's four.

Our reading: between them the texts hold the arrow both ways. Clay can bring the pallor on, and an urge for clay can arrive first, as a sign that something is already wrong. Modern medicine recognises that second arrow too: the NHS lists wanting to eat non-food items, such as paper or ice (pica) among the less common symptoms of iron deficiency anaemia.

For multani mitti in particular we have separate pages: Multani mitti khane se kya hota hai (in Hindi) and Can we eat multani mitti? (in English), and one on mrittika and the earth element, about the clay's place on the skin.

Mitti Khane Ka Man Kyon Karta Hai? Laulya, and the Clay Made Hateful

The next question people ask is why: "mitti khane ka man kyon karta hai", why do I feel like eating clay? Charaka does not explain the urge. He names it and plans around it. Verses 117 to 123 first have the clay already eaten removed, then turn to the patient who will not stop:

Verses 121 (second half) and 122 (first half)
मृद्भक्षणादातुरस्य लौल्यादविनिवर्तिनः । द्वेष्यार्थं भावितां कामं दद्यात्तद्दोषनाशनैः
mrid-bhakshanad aturasya laulyad avinivartinah, dveshyartham bhavitam kamam dadyat tad-dosha-nashanaih
Our rendering: to the patient who, out of craving, does not turn back from eating earth, one may give the earth itself, steeped in things that destroy its harm, for the sake of making it hateful.

The urge has a name, laulya. Monier-Williams glosses it eagerness, greediness, passion, ardent longing for. Van Loon chooses the moral word: due to greediness.

The answer has two purposes, and the key word is dveshyartham, "for the sake of the hateful". Monier-Williams gives dveshya as to be hated or disliked, odious, detestable. The clay is to be made unpleasant enough to put the patient off, and at the same time made less harmful. Van Loon's English keeps only the second purpose: the earth should be given to him amply impregnated with drugs which destroy it's harmful effect. The CSRTSDC English keeps both, the aversion and the counter-action: with a view of creating an aversion to clay. These drugs also counter act the adverse effects of eating clay.

Our reading: this is the most human line in the chapter. A physician who could not stop a craving by forbidding it chose to spoil the thing craved, and to make it safer while he did. Verse 124 explains why the clay-eater gets this special handling: kriya-vishesha esho 'sya mato hetu-visheshatah, "a special course is held for it because of its special cause". We leave out the substances verse 122 names. Read as instructions they would be harmful, and they are nothing to try: an urge to eat clay is a reason to see a doctor and ask for a blood test.

Kharibhuta: Seeing Yellow, Turning White (Verses 31 to 33)

After the five kinds, the chapter says which cases it does not expect to succeed. The key word comes first:

Verse 31 (first half)
पाण्डुरोगश्चिरोत्पन्नः खरीभूतो न सिध्यति
pandu-rogash chirotpannah kharibhuto na sidhyati
Our rendering: pandu that arose long ago and has become hard does not succeed.

Khara is a strong word. Monier-Williams gives it as hard, harsh, rough, sharp; the same word names a donkey. Van Loon renders the line Panduroga of a long duration having produced excessive roughness is not curable. The other signs of the lost case are vivid. The patient is swollen with time, yash cha pitani pashyati, "and sees things yellow", Van Loon's having vision of objects as yellow. His limbs look shvetatidigdha, as if smeared over with white. Then verse 33:

Verse 33 (first half)
स नास्त्यसृक्क्षयाद्यश्च पाण्डुः श्वेतत्वमाप्नुयात्
sa nasty asrik-kshayad yash cha panduh shvetatvam apnuyat
Our rendering: that one is beyond help, and so is the pale one who, through loss of blood, reaches whiteness.

Van Loon: if he becomes white due to deficiency of blood is incurable. Our observation: the chapter's colour scale has an end. It runs from a yellowish pallor through turmeric and green, and it stops at white.

Kamala: Turmeric Eyes and the Colour of a Frog (Verses 34 to 36)

Kamala enters the chapter as a second stage of the first disease:

Verse 34
पाण्डुरोगी तु योऽत्यर्थं पित्तलानि निषेवते । तस्य पित्तमसृग्मांसं दग्ध्वा रोगाय कल्पते
pandu-rogi tu yo 'tyartham pittalani nishevate, tasya pittam asrin-mamsam dagdhva rogaya kalpate
Our rendering: but the pandu patient who keeps taking what provokes pitta: his pitta burns blood and flesh and becomes a disease.

Verse 35 gives its colours. The eyes are haridra, turmeric-yellow, and so are the skin, nails and face; stool and urine are rakta-pita, red-yellow; and the person is bheka-varna, frog-coloured, his senses dulled. Van Loon: he looks like a frog. The CSRTSDC English adds a season: complexion develops a color similar to that of a frog (found in rainy season). The bracket is the translator's, not the verse's. Vagbhata keeps the frog too, as bhekabha, frog-like (Nidana Sthana 13.17).

Bheka-varna, frog-coloured, is verse 35's word for kamala; one English version adds the rainy season.

Verse 36 names this kamala by where it lives: kamala bahu-pittaisha koshtha-shakhashraya mata, "this kamala, of much pitta, is held to rest in the koshtha and the shakha", the gut and the outer tissues. Van Loon makes it a choice, located in kostha (belly) or sakha (blood etc.). The compound itself just joins the two, and the CSRTSDC edition names this kind koshtha-shakhashrita.

Where does kamala come from? Here the three texts part company. For Charaka it comes from pandu. For Sushruta (Uttara Tantra 44.10) it follows sour, unwholesome food at the end of an illness, amayante. Vagbhata takes Charaka's line and then adds a half-verse:

Ashtanga Hridaya, Nidana Sthana 13.17 (second half)
भवेत् पित्तोल्बणस्यासौ पाण्डु-रोगाद् ऋते ऽपि च
bhavet pittolbanasyasau pandu-rogad rite 'pi cha
Our rendering: it comes to one in whom pitta is excessive, even without pandu.

Our observation: Vagbhata turns kamala from a stage of pandu into a condition that can stand on its own.

Kumbha Kamala and the Signs the Chapter Fears

Half a verse is enough for the hardened form:

Verse 36 (last quarter)
कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला
kalantarat kharibhuta krichchhra syat kumbha-kamala
Our rendering: grown hard with time, it becomes difficult: kumbha kamala.

The word kharibhuta returns from verse 31. Van Loon glosses the name as Kumbhakamala (jaundice located in belly); Monier-Williams calls it a bilious affection, a kind of jaundice with swollen joints, citing Sushruta. Sushruta's reason is swelling and joint pain (Bhishagratna: a general swelling (edema) of the body and a crushing pain in the joints); Vagbhata's is neglect, upekshaya (Nidana Sthana 13.18).

Verses 37 and 38 list the signs of a kamala patient who, the chapter says, will not last: black-yellow stool and urine, heavy swelling, red eyes and face, blood in what he vomits and passes, a sinking into darkness (tamyati), and the loss of agni and of consciousness. Van Loon stopped at one compound and wrote “feces and urine” (what?). The CSRTSDC English reads the compound sarakta-akshi-mukha-chhardi-vin-mutra as two things: eyes and face red, and vomit, stool and urine with blood. That reading answers his question.

Tila Pishta Nibha: When the Stool Turns the Colour of Sesame Paste

After the formulary comes a second kamala, told through one colour:

Verse 124 (second half) and 125 (first half)
तिलपिष्टनिभं यस्तु वर्चः सृजति कामली । श्लेष्मणा रुद्धमार्गं तत् पित्तं कफहरैर्जयेत्
tila-pishta-nibham yas tu varchah srijati kamali, shleshmana ruddha-margam tat pittam kapha-harair jayet
Our rendering: the kamala patient who passes stool like sesame paste: that is pitta whose path is blocked by kapha, and it is to be won over with what removes kapha.

Tila-pishta-nibha, like sesame paste: the colour verse 124 reads as pitta blocked by kapha.

Verses 125 to 128 explain the mechanism. Rough, cold, heavy and sweet food, too much exercise and held-back urges let vata, mixed with kapha, throw pitta out of its place. Then the eyes, urine and skin turn turmeric-yellow (haridra-netra-mutra-tvak) while the stool turns white (shveta-varchas). Because the pitta now lodges in the outer tissues (pitte shakha-samashrite) and runs short in the gut, weakness, poor digestion and other troubles follow, one by one.

Then the chapter says how anyone will know the path is open again. Measures continue a-pitta-ragach chhakritah, "until the stool takes on pitta's colour", and the turn is marked by colour:

Verse 131 (second half)
स्वस्थानमागते पित्ते पुरीषे पित्तरञ्जिते
svasthanam agate pitte purishe pitta-ranjite
Our rendering: when pitta has come back to its own place and the stool is coloured by pitta.

Our reading: in this passage the stool is the instrument. White means pitta is not reaching the gut; colour coming back means it is. Van Loon's heading for it carries his modern guess in brackets, [Gall-Stone] or other bile-duct obstruction, and his chapter note counts two kamalas, [one of which is gall-stone attack]. Modern medicine reads the same sign as a reason to act at once. The NHS page on jaundice says You may also have itchy skin, darker pee and paler poo than usual, and that jaundice can be a sign of something serious, such as liver disease, so you need to get urgent medical help.

Halimaka: One Word, Five Modern Names

The last condition in the chapter is the hardest to pin down:

Verse 132 (second half)
यदा तु पाण्डोर्वर्णः स्याद्धरितश्यावपीतकः
yada tu pandor varnah syad dharita-shyava-pitakah
Our rendering: but when the pale one's colour becomes green, dusky and yellow...

Verses 133 and 134 add failing strength and drive (bala-utsaha-kshaya), drowsiness, weak digestion, a mild fever and giddiness. Then the name and its cause: halimakam tada tasya vidyad anila-pittatah, "then know it as halimaka, from vata and pitta". Monier-Williams gives shyava as dark-brown, brown, dark-coloured, dark. The summary verse ranks it high: tesham vikalpo yash chanyo maha-vyadhir halimakah, their variant, and another great disease, halimaka.

No one agrees on what it was. We count five modern labels:

1. Van Loon at Sutrasthana 21.46 (his PDF page 29, on untimely day sleep): Halimaka (chlorosis), an old word Wiktionary defines as An anaemia, due to deficiency of iron, characterized by a yellow-green coloration of the skin.
2. Van Loon, three pages later, at this chapter: the other great disease called halimaka [I’m not sure of the Allopathic name for this one].
3. The CSRTSDC English at the same Sutrasthana verse: halimaka (advance stage of jaundice).
4. The CSRTSDC heading in this chapter: Haleemaka (obstructive jaundice), though its previous heading gave the sesame-paste kamala much the same label.
5. Monier-Williams: a partic. form of jaundice (in this sense prob. connected with hariman).

Sushruta adds names, and colours:

Sushruta, Uttara Tantra 44.12 (second half)
तं वातपित्ताद्धरिपीतनीलं हलीमकं नाम वदन्ति तज्ज्ञाः
tam vata-pittad dhari-pita-nilam halimakam nama vadanti tajjnah
Our rendering: that, from vata and pitta, green, yellow and dark, those who know it call halimaka.

The half-verse before it names lagharako 'lasakhyah, "lagharaka, called alasa". Bhishagratna's English moves the second name onto halimaka and drops the colours: This, in its turn, when marked by an excessive preponderance of the deranged Váyu and Pitta is called Alasa, otherwise known as Halimaka. Vagbhata (Nidana Sthana 13.18 to 13.20) agrees with Bhishagratna's grouping. He gives halimaka Charaka's colours, harita-shyava-pita, and two more names:

Ashtanga Hridaya, Nidana Sthana 13.19 (second half)
तन्द्रा बलानल-भ्रंशो लोढरं तं हलीमकम्
tandra balanala-bhramsho lodharam tam halimakam
Our rendering: drowsiness, the loss of strength and of digestive fire; that halimaka they also call lodhara...

and the next line closes with alasam cheti shamsanti, "and alasa, they say". Our observation: the three texts agree on only two things, vata with pitta, and a colour list that begins with green (harita or hari). Van Loon's first guess, chlorosis, is the one label that keeps the green.

Our article on nidra and day sleep in Charaka's Sutrasthana 21 lists the twenty-four troubles of untimely day sleep, halimaka first.

Charaka, Sushruta and Vagbhata on Pandu Roga, Side by Side

Six questions, three texts: Charaka's Chikitsa Sthana 16, Sushruta's Uttara Tantra 44 and Vagbhata's Nidana Sthana 13.

Sushruta's ashtardha-vidha (44.4), "of half-of-eight kinds", is a poet's way of saying four. Bhishagratna notes: A variant reads that Pándu-roga is of eight kinds.

Chikitsa Sutra: The Principles of Chikitsa Sthana 16, Read as History

The chapter's management begins with one verse of principle. It is a physician's procedure in an ancient system, and we give it as history; read as instructions, it would be harmful.

Verse 40 (first half)
तत्र पाण्ड्वामयी स्निग्धस्तीक्ष्णैरूर्ध्वानुलोमिकैः
tatra pandvamayi snigdhas tikshnair urdhvanulomikaih
Our rendering: there, the pandu patient, once oiled, is to be cleansed with sharp measures acting upward and downward.

The kamala patient is to be cleansed only downward, mridubhis tiktair virechanaih, "with mild, bitter purgatives". Afterwards both eat old shali rice, barley and wheat with soups of green gram, pigeon pea or lentil (verses 41 and 42).

The adjustment by dosha comes much later, in verses 115 to 117, after the formulary. The sage's prescriptions, the chapter says, are to be varied by the physician prithag-dosha-balam prati, according to the strength of each dosha: for vata, mostly unctuous (sneha-bhuyishtha); for pitta, bitter and cooling (tikta-shitala); for kapha, pungent, bitter and hot (katu-tikta-ushna); for all three, mixed. For the clay-eater, the physician first removes the clay, weighing bala-abala, strength against weakness, then lays strength down again (bala-adhana).

Our reading: none of this belongs in a home. The chapter names the physician, the bhishak, both where the measures are adjusted (verse 116) and where the clay is removed (verse 117), and asks that he be yuktijna, skilled in reasoning.

Where the English Translations Part Ways

Read against the Sanskrit, the three English versions differ in these places. None changes the chapter much; together they show how much of a translation is the translator.

1. Verse 40. Urdhvanulomika means acting upward and downward. Van Loon's step two is strong emesis, which is only the upward half; the CSRTSDC has strong (tikshna) emetic and purgation therapies.
2. Verse 122. Van Loon drops dveshyartham, "to make it hateful"; the CSRTSDC keeps it.
3. Verse 27. Ushara: "alkaline" (Van Loon), "saline and alkaline" (CSRTSDC).
4. Verse 36. Van Loon's "or" between koshtha and shakha is his; the compound joins them.
5. Verse 117. For kapha the CSRTSDC Sanskrit reads katu-tikta-ushna, pungent, bitter and hot, and marks a variant reading at that word without printing it. Van Loon has in K the treatment should be pungent, rough and hot, the same three words as the kapha patient's craving in verse 25 (katu-ruksha-ushna-kamata).
6. Sushruta 44.5. Bhishagratna's "(desire for)" turns an act into a wish.
7. Sushruta 44.12. Bhishagratna moves "alasa" onto halimaka and leaves out the colours.

Pandu and Kamala Today: Anaemia, Jaundice and the Craving for Clay

The modern words are clearer than the old ones, and they come with a test. The WHO fact sheet on anaemia (10 February 2025) defines it plainly: Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. It also says something the old chapter could not: It is considered a symptom of an underlying condition(s).

The NHS page on iron deficiency anaemia is as plain: Iron deficiency anaemia is caused by lack of iron, often because of blood loss or pregnancy. It lists wanting to eat non-food items, such as paper or ice (pica) among the less common symptoms, and says what a doctor does: The GP will usually do a blood test to find out if the number of red blood cells you have is normal.

On yellow eyes or skin, the NHS jaundice page (reviewed 22 January 2024) does not hedge: Jaundice is when your skin or the whites of your eyes turn yellow. It can be a sign of something serious, such as liver disease, so you need to get urgent medical help.

Our reading: whatever the old texts said, the colour of a person is a reason to measure, not to guess. What the chapter still offers is attention: to colours, to the order of signs, to a craving and to the colour of a stool. The rest belongs to the laboratory.

What This Page Leaves Out

Every preparation in the chapter: the formulary of verses 44 to 114 (Van Loon's pages 34 to 44, twenty-two of the CSRTSDC edition's sub-headings) and the later ones for the clay-eater, the blocked kamala and halimaka. Every ingredient, amount and method, including the substances verse 122 mixes into the clay, the drink of verses 129 and 130 and the foods of verses 128 and 129. Every procedure the chapter names, which are a physician's work in an ancient system and nothing to try. One cause in verse 8, and one sign each in verses 30 and 133, which we leave out by count.

What We Could Not Settle

• What halimaka was; the five labels above disagree.
• Whether koshtha-shakhashraya in verse 36 means "in both" or "in either". The CSRTSDC name for it suggests both.
• Which variant reading lies behind Van Loon's "rough" in verse 117; the CSRTSDC page marks a variant there but does not print it.
• Whether Sushruta's ashtardha, half of eight, was a poet's four or a copyist's eight. Bhishagratna records the second reading and does not choose it.
• Whether the line between Charaka's re-edited chapters and Dridhabala's falls in the same place in every manuscript; the edition we read puts it after chapter 14.

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