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Anaemia is the world's second leading cause of disability and thus one of the most serious global public health problems. The persons suffering from anaemia are unable to function at their full potential either mentally or physically. Nine out of ten anaemia sufferers live in developing countries. The present study was undertaken to evaluate the role of single drug Haritaki (Terminalia chebula) in the patients of anaemia. The clinical trial was conducted on 45 patients who were divided in three groups of 15 patients each. Group A received Haritaki, Group B received Haritaki with Guda (jaggery) while Group C was given placebo for one month. The changes in the objective and subjective parameters were noticed after one month. The overall improvement in subjective parameter in Group A was 76.08% while in Group B was 68.01% and in Group C was 7.70%. Group A showed 17.96% increase in Hemoglobin percentage while Group B showed 14.71% increase in Hemoglobin and Group C perceived 1.22% increase in Hemoglobin percentage. The results were highly significant in Group A and Group B while insignificant in Group C. Haritaki and Guda Haritaki both were found potent in alleviating pandu roga. Haritaki churna gave better result than Guda Haritaki.
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J. Res. Educ. Indian Med., Vol. XVI (1-2) : 27-32 (2010) ISSN 0970-7700
ROLE OF HARITAKI (TERMINALIA CHEBULA) IN THE
MANAGEMENT OF PANDU ROGA (ANAEMIA)
VIDHI KUMATH (BAPNA)1 AND MAHESH DADHICH2
Department of Dravyaguna,1 Parul Institute of Ayurveda, Limda, Vadodara, Gujarat (India)
Department of Dravyaguna,2 Government Dhanvantari Ayurveda College, Ujjain, M.P. (India)
Abstract: Anaemia is the world’s second leading cause of disability and thus one of the most
serious global public health problems. The persons suffering from anaemia are unable to function
at their full potential either mentally or physically. Nine out of ten anaemia sufferers live in
developing countries. The present study was undertaken to evaluate the role of single drug Haritaki
(Terminalia chebula) in the patients of anaemia. The clinical trial was conducted on 45 patients
who were divided in three groups of 15 patients each. Group A received Haritaki, Group B
received Haritaki with Guda (jaggery) while Group C was given placebo for one month. The
changes in the objective and subjective parameters were noticed after one month. The overall
improvement in subjective parameter in Group A was 76.08% while in Group B was 68.01% and
in Group C was 7.70%. Group A showed 17.96% increase in Hemoglobin percentage while Group
B showed 14.71% increase in Hemoglobin and Group C perceived 1.22% increase in Hemoglobin
percentage. The results were highly significant in Group A and Group B while insignificant in
Group C. Haritaki and Guda Haritaki both were found potent in alleviating pandu roga. Haritaki
churna gave better result than Guda Haritaki.
Keywords: Haritaki, Terminalia chebula, Pandu roga, Anaemia.
Introduction
In Ayurveda the word Haritaki (Terminalia
chebula) literally means one which carries away
all the diseases.1 Critical review of Ayurvedic
classics supports the fact. Pandu roga is a dusta
dhatujanya vikara characterized by panduta2 i.e.
pallor of the skin and other parts of body
accompanied with other constitutional features.
Among the modern counterpart of Pandu
roga there is Anaemia, which satisfies all the
conditions required for real correlation. Anaemia
refers to a state in which the level of Hemoglobin
in the blood is below the normal range
appropriate for age and sex. The normal
Hemoglobin value has been considered to be
11.5-16.5 gm/ dL in females and 13.5-18gm/dL
in males.3
Although many drugs are available in the
modern medicine system for combating anaemia
but they are costly and therefore out of reach of
poor people who are the major sufferers of the
ailment moreover, the Allopathic drugs produce
side effects like constipation, nausea etc. Thus it
is the need of time to use single herbal drugs,
which are easily available, effective and low in
cost. Haritaki is an ideal drug to be used.
Haritaki is indicated for the treatment of
Pandu roga in almost all the classics of Ayurveda.
Pandu roga is considered to be a rasaja vyadhi.
Haritaki being a rasayana drug regulates the
dhatudusti and promotes the anabolism of healthy
dhatu. To evaluate the efficacy of Haritaki on
pandu roga the clinical study was carried out.
For this study 45 patients were randomly selected.
The various karmas of Haritaki documented
in Ayurveda are dosanulomana, dipana, ayusya,
poustika, vyahsthapana, sarvarogaprasamana and
buddhinadriyabalaprada.4
Pharmacological actions of Terminalia chebula
The faculties of Pharmacology, Botany,
Ayurveda, Chemistry, Phytochemistry and
Modern medicine have established the
pharmacological actions of Terminalia chebula
1. Lecturer 2. Reader
Kumath and Dadhich28
through experiments. Those pharmacological
actions confirmed include laxative, stomachic,
antifungal, antiviral, anticancer, cardio tonic,
hypotensive, myocardial depressant and
antioxidant actions.5
Aims and Objectives
1. To collect, compile and analyze the literally
material regarding Haritaki.
2. To evaluate the clinical efficacy of Haritaki
on pandu roga.
3. To assess the effect of Haritaki in rakta
dhatu by hematological study.
Materials and Methods
1. Pharmaceutical preparation
The well matured and ripe fruits of Haritaki
of good quality were bought from the local market.
The fruits were golden yellowish, shining, solid,
having average size of about 2.5" - 3" and weighed
about 15-20 gm.
Selection of Prashasta Haritaki
In Ayuverdic classics, the characteristics of
the best quality Haritaki are laid down and the
methods of its examination are also described. It
has been claimed that the fruits of Haritaki, which
dip in water, are the best for therapeutic use.6 So,
for the selection of the best quality Haritaki for
making churna, all the Haritaki fruits were put in
a vessel, full of water. The fruits that sink were
chosen and those that floated upon the surface
were discarded.
Process of manufacturing of Haritaki churna
The above chosen Haritaki fruits were
dried in sun for some days. Then the fruits of
Haritaki were broken using a mortar and pestle
and seeds were separated out. From one kg of
Haritaki fruits, about 650 gm fruit pulp obtained.
Pulp was kept in sunlight for some days. Dried
pulp was then grinded in a pulverizer. The powder
obtained was then sieved with a fine sieve. A
fine powder of greenish yellow colour with
astringent taste was obtained. About 600 gms
powder obtained from 1kg of Haritaki fruits. The
advantage of churna kalpana is that smaller
particle size of powder facilitate rapid absorption
of drug that leads to higher concentration of drug
in the blood in a shorter time thereby the action
is produced in a lesser time.
Packaging in capsules
Because of the astringent taste of churna,
its direct oral administration in the clinical subject
was difficult therefore, it was packed in capsules
(750 mg/cap). The advantages of capsule packing
are, that it looks elegant and it masks the
astringent taste of churna, it is easily swallowed
due to its smooth and slippery surface, portable,
protects medicament form atmospheric effects and
its fixation of dose is easy.
Preservation
The capsules were packed in plastic bags
(60 caps/ plastic bag; weekly dose) for dispensing
and these were kept in air tight glass vessels.
2. Selection of patient
The patients reporting in the O.P.D. and
I.P.D. of Govt. Autonomous Dhanvantari
Ayurveda Hospital, Ujjain (India) fulfilling the
diagnostic criterion of pandu roga were randomly
chosen for clinical trail irrespective of the age,
sex, religion etc.
Table 1. Proforma for grading of main features of Pandu roga.
Grading
Absent
Occasional
Frequent
Persistent
Sl.
No.
Clinical Feature
0 1 2 3
1. Vaivarnya
(Discolouration/ paleness)
2. Karnakshveda (
Tinnitus
)
3. Mandagni (
Indigestion
)
4. Durbalata (
Weakness
)
5. Shrama (
Fatigue
)
6. Bhrama (
Vertigo
)
7. Gatrashula (
Bodyache
)
8. Jvara (
Pyrexia
)
9. Shirnaroma (
Hairfall
)
10. Gaurava (
Feeling of heaviness
)
11. Shvasa (
Dyspnoea
)
12. Aruchi (
Anorexia
)
13. Aksikutasotha
(Swelling around eyeball)
14. Sadana (
Malaise
)
15. Shisiradvesa (
Aversion to cold
)
16. Nidra (
Excessive sleep
)
17. Aarohanayasa
(Difficulty in climbing)
18. Pindikodvestana
(Pain in calf muscle)
Role of Terminalia chebula in Anaemia 29
Inclusion criteria
Classical signs and symptoms of pandu
roga are described in Ayurvedic classics.
About 18 laksanas (features) common to all
texts were considered as subjective parameter
(Table 1).
The objective parameter (Laboratory
investigations) were the tests for Hb%, R.B.C.
count, Total and differential count, ESR, PCV,
MCV, MCHC which were carried out before and
after the treatment. These were considered as
inclusion criteria for the selection of the patient
(Table 5).
Exclusion criteria
The authorities of Ayurveda have asserted
certain conditions in which use of Haritaki is
contraindicated.7 The patients falling under any
of those conditions and having asadhya laksanas
of pandu roga were excluded.
Plan of study
Total 73 patients were selected, out of
which 45 completed the course. They were
randomly distributed in following groups: -
Group - A: 15 patients of this group were
administered Haritaki powder 3
gm. in capsule form (4 capsules)
BD for 30 days.
Group - B: 15 patients of this group were
managed with Haritaki powder 3
gm. in capsule form (4 capsules)
BD with equal quantity of guda
(jaggery) for 30 days.
Group - C: 15 patients of this group were given
placebo capsule 1 BD for 30 days.
Observation
A specific research proforma was prepared
incorporating both the Ayurvedic and modern
parameters. For the assessment of signs and
symptom 0-3 grading pattern was followed. The
Table 2. Showing distribution of 45 patients of Pandu roga according to the laksana present.
Group A Group B Group C Total Sl.
No.
Laksana
No. percent No. percent No. percent No. percent
1 Vaivarnya
15 100.00 15 100.00 15 100.00 45 100.00
2 Karnakshveda
7 46.67 8 53.33 6 40.00 21 46.67
3 Mandagni
12 80.00 10 66.67 9 60.00 31 68.89
4 Durbalata
15 100.00 15 100.00 15 100.00 45 100.00
5 Shrama
14 93.33 15 100.00 13 77.78 42 93.33
6 Bhrama
10 66.67 12 80.00 8 53.33 30 66.67
7 Gatrashula
13 77.78 14 93.33 11 73.33 38 84.40
8 Jvara
6 40.00 7 46.67 3 20.00 16 35.56
9 Shirnaroma
9 60.00 11 73.33 12 80.00 32 71.11
10 Gaurava
11 73.33 9 60.00 7 46.67 27 60.00
11 Shvasa
8 53.33 8 53.33 8 53.33 24 53.33
12 Aruchi
11 73.33 10 66.67 7 46.67 28 62.22
13 Aksikutasotha
3 20.00 8 53.33 6 40.00 17 37.78
14 Sadana
7 46.67 9 60.00 6 40.00 22 48.89
15 Shisiradvesa
4 26.67 4 26.67 1 6.67 9 20.00
16 Nidra
6 40.00 4 26.67 2 13.33 12 26.67
17 Aarohanayasa
7 46.67 13 77.78 8 53.33 28 62.22
18 Pindikodvestana
15 100.00 14 93.33 12 80.00 41 91.11
Kumath and Dadhich30
Table 3. Showing the pattern of clinical relief in all subjective parameters.
Mean Score Sl.
No. Feature B.T A.T D
Percent
of Relief S.D S.E t P Result
Group A
1 Vairvarnyata 1.6 0.27 1.33 83.13 0.49 0.13 10.23 <.001 H.S
2 Karnakshveda 0.53 0.06 0.47 88.68 0.64 0.17 2.86 <.02 S
3 Mandagni 1.4 0.27 1.13 80.71 0.83 0.21 5.38 <.001 H.S
4 Durbalata 2.46 0.53 1.93 78.46 0.46 0.12 16.08 <.001 H.S
5 Shrama 1.87 0.4 1.47 78.61 0.83 0.21 7 <.001 H.S
6 Bhrama 0.87 0.2 0.67 77.01 0.49 0.13 5.15 <.001 H.S
7 Gatrashula 1.8 0.4 1.4 77.78 0.83 0.21 6.67 <.001 H.S
8 Jvara 0.4 0.07 0.33 82.50 0.49 0.13 2.54 <.05 S
9 Shirnaroma 0.73 0.46 0.27 36.99 0.46 0.12 2.25 <.0.5 S
10 Gaurava 1.2 0.53 0.67 55.83 0.49 0.13 5.15 <.001 H.S
11 Shvasa 0.6 0.13 0.47 78.33 0.52 0.13 3.62 <.01 S
12 Aruchi 1.4 0.2 1.2 85.71 0.94 0.24 5 <.001 H.S
13 Aksikutasotha 0.33 0.06 0.27 81.82 0.46 0.12 2.25 <.05 S
14 Sadana 0.53 0.13 0.4 75.47 0.51 0.13 3.08 <.01 S
15 Shisiradvesa 0.27 0.07 0.2 74.07 0.41 0.11 1.82 >.05 I.S
16 Nidra 0.47 0.14 0.33 70.21 0.49 0.13 2.54 <.05 S
17 Aarohanayasa 0.67 0.14 0.53 79.10 0.64 0.17 3.12 <.01 S
18 Pindikodvestana 1.8 0.27 1.53 85.00 0.74 0.19 8.05 <.001 H.S
Group B
1 Vairvarnyata 2.2 0.93 1.27 57.73 0.46 0.12 10.58 <.001 H.S
2 Karnakshveda 0.73 0.13 0.6 82.19 0.64 0.17 3.52 <.01 S
3 Mandagni 1.53 0.33 1.2 78.43 0.94 0.24 5 <.001 H.S
4 Durbalata 2.6 0.93 1.67 64.23 0.62 0.16 10.43 <.001 H.S
5 Shrama 2.13 0.66 1.47 69.01 0.64 0.17 8.65 <.001 H.S
6 Bhrama 1.47 0.34 1.13 76.87 0.99 0.26 4.35 <.001 H.S
7 Gatrashula 1.73 0.4 1.33 76.88 0.62 0.16 8.31 <.001 H.S
8 Jvara 0.47 0.07 0.4 85.11 0.51 0.13 3.08 <.01 S
9 Shirnaroma 1.13 0.8 0.33 29.20 0.49 0.13 2.54 <.05 S
10 Gaurava 0.87 0.33 0.54 62.07 0.52 0.13 4.15 <.001 H.S
11 Shvasa 0.93 0.33 0.6 64.52 0.63 0.16 3.75 <.01 S
12 Aruchi 1.47 0.4 1.07 72.79 1.03 0.27 3.96 <.01 S
13 Aksikutasotha 0.6 0.2 0.4 66.67 0.51 0.13 3.08 <.01 S
14 Sadana 0.8 0.2 0.6 75.00 0.63 0.16 3.75 <.01 S
15 Shisiradvesa 0.33 0.13 0.2 60.61 0.41 0.11 1.82 >.05 I.S
16 Nidra 0.27 0.07 0.2 74.07 0.41 0.11 1.82 >.05 I.S
17 Aarohanayasa 1.53 0.66 0.87 56.87 0.52 0.13 6.69 <.001 H.S
18 Pindikodvestana 1.67 0.47 1.2 71.86 0.78 0.20 6 <.001 H.S
Group C
1 Vairvarnyata 1.13 1.06 0.07 6.20 0.46 0.12 0.58 >.1 I.S
2 Karnakshveda 0.73 0.66 0.07 9.59 0.26 0.07 1 >.1 I.S
3 Mandagni 1.13 1 0.13 11.5 0.35 0.09 1.44 >.1 I.S
4 Durbalata 1.93 1.8 0.13 6.74 0.35 0.09 1.44 >.1 I.S
5 Shrama 1.27 1.14 0.13 10.24 0.35 0.09 1.44 <.1 I.S
6 Bhrama 0.6 0.53 0.07 11.67 0.26 0.07 1 >.1 I.S
7 Gatrashula 1.2 1.07 0.13 10.83 0.35 0.09 1.44 >.1 I.S
8 Jvara 0.2 0.2 0.00 0.00 0.00 0.00 0 >.1 I.S
9 Shirnaroma 1.2 1.2 0.00 0.00 0.53 0.14 0 >.1 I.S
10 Gaurava 0.6 0.53 0.07 11.67 0.46 0.12 0.58 >.1 I.S
11 Shvasa 0.73 0.66 0.07 9.59 0.46 0.12 0.58 >.1 I.S
12 Aruchi 0.87 0.8 0.07 8.05 0.26 0.07 1 >.1 I.S
13 Aksikutasotha 0.53 0.46 0.07 13.21 0.26 0.07 1 >.1 I.S
14 Sadana 0.67 0.6 0.07 10.45 0.26 0.07 1 >.1 I.S
15 Shisiradvesa 0.07 0.07 0.00 0.00 0.00 0.00 0.00 >.1 I.S
16 Nidra 0.13 0.13 0.00 0.00 0.00 0.00 0.00 >.1 I.S
17 Aarohanayasa 0.73 0.66 0.07 9.59 0.26 0.07 1 >.1 I.S
18 Pindikodvestana 1.4 1.27 0.13 9.29 0.35 0.09 1.44 >.1 I.S
H.S.=Highly Significant, S = Significant, IS = Insignificant
patients of the present study were interrogated
for the history and were examined properly and all the findings were recorded before and after
treatment.
Role of Terminalia chebula in Anaemia 31
ResultThe data observed on the basis of objective
and subjective parameters before and after
treatment was collected (All the values were
corrected up to two places of decimal) subjected
to students ‘t’ test (paired). The results so
generated are presented in Table 2 and Table 3.
Table 5. Showing the pattern of change in objective parameters.
Mean Score Sl.
No. Objective Parameters B.T A.T D
% of
Change S.D S.E t P Result
Group A
1. Hb% 9.47 11.17 -1.7 17.96% n 0.93 0.24 7.14 <.001 H.S.
2. R.B.C Count 3.24 3.68 -0.44
13.58% n 0.29 0.07 6.29 <.001 H.S
3. PCV 29.71 33.57 -3.86 12.99% n 2.80 0.72 5.72 <.001 H.S
4. MCV 94.83 91.19 -3.64 3.83% p 12.80 3.31 1.1 >.1 I.S
5. MCH 30.4 29.52 0.88 2.89% p 3.42 .88 .99 >.1 I.S
6. MCHC 32.67 33.06 -0.39 1.19% n 0.94 0.24 1.63 >.1 I.S
7. ESR 25.46 20.33 5.13 20.15% p 7.91 2.04 2.51 <.05 S
8. T.W.B.C 6.42 6.73 0.31 4.83% n 1.07 0.28 1.11 >.1 I.S
9. Neutrophills 54.6 56 -1.4 2.56% p 4.26 1.1 1.27 >.1 I.S
10. Eosinophill 0.2 0.2 0 0 0.65 0.17 0 >.1 I.S
11. Basophills 0 0 0 0 0 0 0 >.1 I.S
12. Monocytes 1.67 1.67 0 0 1 0.26 0 >.1 I.S
13. Lymphocytes 43.73 42.47 1.26 2.88% p 5.69 1.47 0.86 >.1 I.S
Group B
1. Hb% 8.63 9.90 -1.27
14.71%n 0.93 0.24 5.29 <.001 H.S
2. R.B.C Count 2.9 3.35 -0.45
15.51% n 0.32 0.08 5.63 <.001 H.S
3. PCV 26.07 30.2 -4.13 15.84% n 2.47 0.64 6.47 <.001 H.S
4. MCV 90.45 90.00 -0.45 0.5% p 10.37 2.68 0.17 >.1 I.S
5. MCH 29.95 29.66 0.29 0.97%p 4.02 1.04 .28 >.1 I.S
6. MCHC 33.05 33.09 0.04 0.12%n 0.67 .17 .23 >.1 I.S
7. ESR 29.07 22.73 6.34 21.80% p 7.05 1.82 3.48 <.01 S
8. T.W.B.C 6.23 6.27 0.04 0.64% n 0.50 0.13 0.31 >.1 I.S
9. Neutrophills 53.47 54.73 -1.26 2.36 % n 2.49 0.64 1.97 >.05 I.S
10. Eosinophill 0.2 0.2 0 0 0.65 0.17 0 >.1 I.S
11. Basophills 0 0 0 0 0 0 0 >.1 I.S
12. Monocytes 1.13 0.93 0.2 17.70%p 1.47 0.38 0.53 >.1 I.S
13. Lymphocytes 44.93 44.13 0.8 1.78% p 2.57 0.66 1.21 >.1 I.S
Group C
1. Hb% 10.63 10.76 -0.13 1.22%n 0.35 0.09 1.44 >.1 I.S
2. R.B.C Count 3.87 3.92 -0.05
1.29% n 0.28 0.07 0.71 >.1 I.S
3. PCV 31.93 32.6 -0.67 2.1% n 1.39 0.36 1.84 >.05 I.S
4. MCV 84.03 85.13 -1.1 1.31% n 4.30 1.11 0.99 >.1 I.S
5. MCH 27.76 27.97 -0.21 0.76%n 1.93 .50 .42 >.1 I.S
6. MCHC 33.29 33.20 0.09 0.27%p 1.93 .50 .18 >.1 I.S
7. ESR 14.93 13.4 1.53 10.25% p 7.09 1.83 0.83 >.1 I.S
8. T.W.B.C 6.8 6.61 0.19
2.79% p 0.33 0.09 2
9. Neutrophills 55.47 55.07 0.4 0.72% p 2.9 0.75 0.53 >.1 I.S
10. Eosinophill 0.13 0.13 0 0 0.38 0.10 0 >.1 I.S
11. Basophills 0 0 0 0 0 0 0 >.1 I.S
12. Monocytes 1.67 1.33 0.34 20.36%p 1.44 0.37 0.92 >.1 I.S
13. Lymphocytes 42.6 43.8 1.2 2.82% n 2.93 0.76 1.58 >.1 I.S
H.S.=Highly Significant, S = Significant , IS = Insignificant
Table 4. Showing relief in subjective parameters.
Sl.
No.
Group Percentage
of Relief
1 Group A 76.08%
2 Group B 68.01%
3 Group C 7.70%
Kumath and Dadhich32
Address for correspondence: Dr. Vidhi Bapna, Parul Institute of Ayurveda, Parul Institute Campus, PO.Limda,
Taluka Waghodia - 391760 District Vadodara, Gujarat (India). E-mail: drkumathvidhi29@yahoo.com
Overall results on subjective parameters are
depicted in Table 4.
Conclusion
The results were highly significant in group
A and group B while insignificant in group C.
Haritaki and Guda Haritaki both were potent in
alleviating pandu roga. Haritaki churna surmised
better results in both objective and subjective
parameters than Guda Haritaki. Placebo showed
insignificant effect. Haritaki is a safe and
effective drug devoid of any toxic effect. Single
herbal drugs are easily available and economical.
These drugs can be used for a longer period
without any complications. Herbal drug can be
an appropriate answer to the world facing
complications of synthetic drugs.
The present study has yielded encouraging
result and it is hoped that out come of this study
will form the guideline for the enthusiastic
research workers for further enhancement in the
avenue and the knowledge obtained will be useful
in day to day practice.
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30 (1994).
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Haritakyadivarga/35 (2002).
... Significant changes were noticed in RBC volume (mean difference: −0.2250, P < 0.035), PCV (mean difference: 0.31500, P < 0.005), and MCHC (mean difference: 0.17000, P < 0.018), indicating better potential of Saptamritaloha in increasing blood parameters. This could further be because of the additional effects of ingredients such as Hareetaki [20] Madhu and Ghrita in the study drug that aid better tissue absorption and improve blood parameters. Amalaki, Yashtimadhu, and Guduchi stimulate better tissue absorption, RBC production and improve immunity by virtue of their Rasayana (rejuvenating), Vayasthapana (longevity promoting), and Raktaprasadana (blood purifying) properties. ...
... Many drugs are available in the modern science for combating anemia but they are costly and therefore out of reach of poor people who are the major sufferers [6] of the ailment, moreover the allopathic drugs used to treat anemia produce gastric irritation and have side effects like nausea, constipation, diarrhea etc. which [7] further deteriorates the health of the patient. Thus, it is the need of time to use herbal drugs which are easily available, safe, effective and low in cost . ...
Incorporating commentaries of Jejjata, Cakrapanni, Gangadhara and Yogindranatha
  • Charaka Samhita
Charaka Samhita: Incorporating commentaries of Jejjata, Cakrapanni, Gangadhara and Yogindranatha. Prof. P.V. Sharma. Chaukhambha Orientalia, Varanasi. 6 th edition (2001).
English translation and critical notes by P.V. Sharma. Chaukhambha Orientalia, Varanasi. Charak Samhita Chikitsasthan 1/29
  • Charaka Samhita
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