CHAPTER-3 DRUG REVIEW

ANNABETHI CHENDURAM (Gunapadam part I & II )(Thiagarajan, 1981) (Murugaesa mudaliyar, 2008)

3.1 Composition of drug 1. Purifed Annabethi (Ferrous Sulphate) 2. Elumichai pazha chaaru (lemon juice) Quantity sufficient Quantity sufficient

3.2 Method of preparation Grind item 1 with 2, make cakes, dry and calcine. Repeat grinding and calcinations once or twice more. Dose Vehicle : : 200 mg (in capsule form) Honey Ghee 3.3 Important Therapeutic Uses Fever, Anaemia, Bacillary Dysentery - Fever and Anaemia - Bacillary Dysentery

Ingredient Profile ANNABETHI (FERROUS SULPHATE) It literally means that it could digest the rice easily. It has been mentioned in Siddha literature that this drug is naturally available in pyrites form in mines in different colors specially black, yellow and white. But currently ferrous sulphate chemicals are used in Siddha system of medicine. Abundant Siddha literatures are available about its uses, the methods of purifications and methods of preparations. From earlier period the Siddhars have used this drug for different ailments. Before subjecting this drug in pharmaceutics, purification is generally done to remove the macro contamination of drug.
Murugaesa mudaliyar, C. (2008). Siddha materia medica Part I 2nd edition . Chennai: Dept of Indian Systems of Medicine and Homeopathy, Govt of Tamilnadu. Thiagarajan, R. (1981). Siddha Materia medica part II 3rd Edition. Chennai: Dept of Indian systems of Medicine and Homeopathy, Govt of Tamilnadu.

Purification (Thiagarajan, 1981)

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The drug is dissolved in water. Add few drops of Sulphuric acid. It is boiled and filtered. Again it is boiled till it is dehydrated. This process can also be done without adding sulphuric acid.

Process There are number of methods to calcine this drug. As found in Siddha Formulary of India Vol 1 published by Government of India.
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The purified ferrous sulphate is added with vinegar sufficiently and ground. This paste is pasted on the mud pan and dried. Calcine this disc twice or thrice till a red color chenduram is obtained.

There are number of other methods of preparations of this chenduram in Siddha literatures and commonly it is prepared with lemon juice instead of vinegar and a potent Annabedi chenduram is obtained. Dosage 200 mg twice a day with suitable adjuvants and vehicles according to diseases. Generally administered with honey as vehicle and Tripala (Three myrobalans) or Trikatu (Three pungents) churnam as adjuvant. Indications Anaemia, Nutritional anasarca, Hypoproteinemia, Ascites, Jaundice, Metrorrhagia, Menorrhagia and Dysentry.

Thiagarajan, R. (1981). Siddha Materia medica part II 3rd Edition. Chennai: Dept of Indian systems of Medicine and Homeopathy, Govt of Tamilnadu.

1.3. SIDDHA- CLASSICAL REVIEW OF ANAEMIA In Siddha system of medicine all the systemic diseases have been classified under three categories based on the vitiation of three humours, predominant symptoms and line of treatment . Veluppu noi is one among the diseases classified based on the symptoms which literally means the Pallor, that may be correlated with Modern classification of Anemia. Aetiology 1. Iron deficiency 2. Trauma 3. Chronic diseases like Ascites, sprue. 4. Excessive intake/consumption of salt and sour tasted items. 5. Due to fever, diarrhoea, vomiting and arthritis. 6. Due to Menorrhagia, Hypertension, blood stained dysentery, haemorrhoids,

Haemetemesis, and trauma/incision. 7. Intake of poisonous drugs for more than the prescribed period. 8. Due to helminthiasis, tuberculosis, amoebiasis and hepatic diseases. 9. Chewing of tobacco, betel nut, sand, ash, sacred ash and camphor. Classification (Annonymous, 2005) This clinical entity has been classified in to 5 types. Among these four types are based on vitiation of humours, one due to toxins. Koorave panduvidap peyaraik kelaiKurippaga inthuvitha magum paru Varave vathamam pandi nodu Markkamam pithathin pandu than um Therave silettumam pandu thanumThirithoda pandodu vidapandagum Arave panduvida vanmai yellam Araindu sollave arinthu kolle (Part I. Page: 359. Stanza: 1- 8) The etiological clusters, like Nutritional deficiency, hemorrhages, worm infestation and the other secondary causes like Tuberculosis, chronic sprue and the disease like piles, metrorrhagia and menorrhagia are also found to be described.

Annonymous. (2005). Yugi vaithya chinthamani,800 2nd edition. chennai: Dept of Indian Medicine and Homeopathy,Govt of Tamilnadu.

Premonitory symptoms (Uthamarayan, 1953)

2.

At first instance due to dietary changes, vitiated pitha affects the colour and consistency of the blood, which will prevent the proper supply of the nutrients to the body and leads the body in to pale in colour. Secondly, while walking small distance leads to dyspnoea and weakness of the lower limbs. Anorexia, nausea, giddiness, blackouts, frequent fainting, palpitation and emaciation.

3.

4.

General symptoms
1. Weakness of the body 2. Unable to walk small distance 3. Headache 4. Palpitation 5. Blackouts 6. Giddiness 7. Fainting 8. Dyspnoea 9. Anorexia 10. Vomiting 11. pallor and Shrinkage of the skin 12.Emaciation and shining of the body 13.Clubbing 14. Fissures, redness and softening of the tongue 15.Sore throat

Specific symptoms according to humours (Kuppusamy mudaliyar, 2007)

Vali paandu Azhal paandu Iya paandu Mukkutra paandu Nanju paandu

(due to consumption of
toxic materials)

Anorexia Stomach ache Thirst Blackish discolouration of blood vessels Redness of eye Constipation Pallor Anasarca

Yellowish discolouration of body Pallor of tongue, hand and foot Eye vision diminished Thirst Dyspnoea Giddiness

Whitish coloura- Dyspnoea tion of body Bronchial asthma Pylo erectation Frequent Cough with micturition expectoration Sneezing Syncope Anasarca Low back ache

Excessive thirst Vomiting Hic cough cough Anasarca

Kuppusamy mudaliyar, K. (2007). Siddha Maruthuvam 7th edition. Chennai: Dept of Indian systems of Medicine and Homeopathy, Govt of Tamilnadu. Uthamarayan, C. (1953). Siddha Maruthuvanga Churukkam. Chennai: Govt Press, Tamilnadu.

Kuppusamy mudaliyar, K. (2007). Siddha Maruthuvam 7th edition. Chennai: Dept of Indian systems of Medicine and Homeopathy, Govt of Tamilnadu.

Treatment

Siddhas intuitions are so high that, the prescription given by them containing herbs, herbo minerals, metallic compounds which are rich in micro and macro nutrients such as calcium, Vit C, zinc and iron. The modern way of treating anaemia goes in par with their intuitions. Siddhas have used iron, ferrous sulphate, magnetite, iron rust predominantly. They have been selected, purified and processed to get the medicine which later evolved as traditional standard operating procedures. The form of iron present in the end product is in the ferrous state which enhances in pharmacokinetics and logistics. To treat worm infestation decoctions are given as preparatory therapy (purgation) before prescribing drug 1.1 CONTEMPORARY TRENDS OF DIAGNOSIS AND MANAGEMENT Complete blood counts are done for diagnosis of an anemia. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Peripheral blood smear also be helpful, now a days four parameters i.e.RBC count, hemoglobin concentration, MCV and RDW are measured, allowing other investigations such as hematocrit, MCH and MCHC to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements. Kinetic approach to anemia is reticulocyte counts, it become more common than in the past in the United States, A reticulocyte count is a quantitative measure of the bone marrow's production of new red blood cells. The reticulocyte production index is a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a "normal" reticulocyte count actually may reflect an inadequate response. If an automated count is not available; a reticulocyte count can be done manually by examination of blood film under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation of erythropoiesis can help assess whether the bone marrow will be able to compensate for the loss. Some other tests: ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12, hemoglobin electrophoresis and renal function tests. Bone marrow examination allows direct examination of the precursors to red cells when the diagnosis remains difficult. The management depends on severity and the cause of anaemia. Mild to moderate iron deficiency anemia is treated by iron supplementation with ferrous sulfate or ferrous gluconate along with vitamin C which aid in the body's ability to absorb iron. Vitamin supplements given orally e.g folic acid or vitamin B-12 will replace specific deficiencies. In anemia of chronic disease, anemia associated with chemotherapy, or renal disease can be treated according to cause, In severe cases of anemia, or with ongoing blood loss, a blood transfusion may be necessary. 1.2
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SOME IMPORTANT SIDDHA FORMULATIONS Kudineer(Decoction)

a. Mandoorathi Adaikkudineer 15-30 ml twice or thrice a day

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Karkam (Herbal paste) a. Karisalai karkam 6-10 gm twice or thrice a day Lehiyam (Confectionaries) a. Karisalai lehyam 5-6 gm twice or thrice a day Churnam (Powder) a. Mandoorathi podi 1-2 gm twice or thrice a day Karpam (Black powder) a. Ayasambeera karpam 100-150 mg twice or thrice a day with honey b. Ayabringaraja karpam 100-150 mg twice or thrice a day with honey Parpam (Calx) a. Aya parpam 50-100 mg twice or thrice a day with warm water or honey. b. Kantha parpam 50-100 mg twice or thrice a day with warm water or honey.