Changes

=== Abstract ===

=== Abstract ===

 

This chapter focuses on ''rakta dhatu'' (blood tissues), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. ''Shuddha rakta'' (pure blood) is formed by following proper dietary habits as described in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, ''dosha'' specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as ''mada'' (intoxication/confusion), ''murchha'' (syncope), and ''sanyasa'' (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided.  

This chapter focuses on ''rakta dhatu'' (blood tissues), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. ''Shuddha rakta'' (pure blood) is formed by following proper dietary habits as described in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, ''dosha'' specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as ''mada'' (intoxication/confusion), ''murchha'' (syncope), and ''sanyasa'' (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided.  

'''Keywords''': ''Rakta, rakta visravana, sanyasa sangyavahi srotas,'' vegetative state, ''sadyahphalaakriyaah, sangyaprabodhanam,'' pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction.

'''Keywords''': ''Rakta, rakta visravana, sanyasa sangyavahi srotas,'' vegetative state, ''sadyahphalaakriyaah, sangyaprabodhanam,'' pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction.

 

=== Introduction ===

=== Introduction ===

 

In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three ''doshas'' were described. In continuation, the present chapter describes the management principles of disorders due to ''shonita'' (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of ''rakta'' have been explained in this treatise. Vitiated ''rakta'' causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) ''dravyas'' are used for treatment without response, ''raktaja vikara'' (blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence -  have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three ''doshas'' were described. In continuation, the present chapter describes the management principles of disorders due to ''shonita'' (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of ''rakta'' have been explained in this treatise. Vitiated ''rakta'' causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) ''dravyas'' are used for treatment without response, ''raktaja vikara'' (blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence -  have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

 

===Sanskrit text, Transliteration and English Translation===

===Sanskrit text, Transliteration and English Translation===

shramAbhighAtasantApairajIrNAdhyashanaistathA|  

shramAbhighAtasantApairajIrNAdhyashanaistathA|  

sharatkAlasvabhAvAcca shoNitaM sampraduShyati||10||  

sharatkAlasvabhAvAcca shoNitaM sampraduShyati||10||  

 

By habitual intake of spoiled food and/or liquids, overeating, imbibing hard liquor and other similar drinks, too much salt, alkaline substances, sour and pungent food, ''kulatha'' (Dolichos biflorus Linn.),  ''masha'' (Phaseolus mungo Linn.), ''nishpava'' (Dolichos lablab Linn.), ''tila taila'' (Sesamum indicum Linn. oils), ''pindalu'' (Randia uliginosa DC.), radish and all green (leafy) vegetables, meat of aquatic and marshy animals, burrowing animals and those that snatch birds, excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids, consuming decomposed, putrid food with opposite properties  excessive sleeping during the day especially after taking liquids, unctuous and heavy food, excessive anger, excessive exposure to the sun and the wind, suppression of the natural urges like vomiting, avoidance of blood-letting in prescribed time (autumn), too much exertion, injury, heat, indigestion, taking meal during indigestion and in the autumn season naturally vitiates ''rakta'' (blood).[5-10]

By habitual intake of spoiled food and/or liquids, overeating, imbibing hard liquor and other similar drinks, too much salt, alkaline substances, sour and pungent food, ''kulatha'' (Dolichos biflorus Linn.),  ''masha'' (Phaseolus mungo Linn.), ''nishpava'' (Dolichos lablab Linn.), ''tila taila'' (Sesamum indicum Linn. oils), ''pindalu'' (Randia uliginosa DC.), radish and all green (leafy) vegetables, meat of aquatic and marshy animals, burrowing animals and those that snatch birds, excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids, consuming decomposed, putrid food with opposite properties  excessive sleeping during the day especially after taking liquids, unctuous and heavy food, excessive anger, excessive exposure to the sun and the wind, suppression of the natural urges like vomiting, avoidance of blood-letting in prescribed time (autumn), too much exertion, injury, heat, indigestion, taking meal during indigestion and in the autumn season naturally vitiates ''rakta'' (blood).[5-10]

 

==== Diseases due to vitiation of blood ====

==== Diseases due to vitiation of blood ====

shItoShNasnigdharUkShAdyairupakrAntAshca ye gadAH|  

shItoShNasnigdharUkShAdyairupakrAntAshca ye gadAH|  

samyak sAdhyA na sidhyanti raktajAMstAn vibhAvayet||17||  

samyak sAdhyA na sidhyanti raktajAMstAn vibhAvayet||17||  

 

The above mentioned dietary habits or lifestyle choices cause various diseases that should be considered blood disorders, such as stomatitis, redness in eyes, foul smell in nose and mouth, ''gulma'' (lump abdomen), ''upakusha'' (inflammation of gum leads to falling of teeth), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, ''vatarakta'', discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical and mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc. The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by (impure) blood. [11-17]

The above mentioned dietary habits or lifestyle choices cause various diseases that should be considered blood disorders, such as stomatitis, redness in eyes, foul smell in nose and mouth, ''gulma'' (lump abdomen), ''upakusha'' (inflammation of gum leads to falling of teeth), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, ''vatarakta'', discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical and mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc. The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by (impure) blood. [11-17]

 

==== Management of blood vitiation disorders ====

==== Management of blood vitiation disorders ====

IShatpANDu kaphAdduShTaM picchilaM tantumadghanam|  

IShatpANDu kaphAdduShTaM picchilaM tantumadghanam|  

saMsRuShTali~ggaM  saMsargAttrili~ggaM sAnnipAtikam||21||  

saMsRuShTali~ggaM  saMsargAttrili~ggaM sAnnipAtikam||21||  

 

Due to vitiated ''vata,'' blood becomes arunabham (reddish), non-slimy, frothy and thin. Due to vitiated ''pitta'', it becomes yellow or blackish, with delayed coagulation because of heat. Due to vitiated ''kapha'' it is slightly pale, slimy, fibrous and more viscous. In the case of combination of vitiated ''doshas'', it acquires mixed characters and in ''sannipata'', has symptoms of all the three ''doshas''.[20-21]

Due to vitiated ''vata,'' blood becomes arunabham (reddish), non-slimy, frothy and thin. Due to vitiated ''pitta'', it becomes yellow or blackish, with delayed coagulation because of heat. Due to vitiated ''kapha'' it is slightly pale, slimy, fibrous and more viscous. In the case of combination of vitiated ''doshas'', it acquires mixed characters and in ''sannipata'', has symptoms of all the three ''doshas''.[20-21]

 

==== Characteristics of pure blood ====

==== Characteristics of pure blood ====

nAtyuShNashItaM laghu dIpanIyaM rakte~apanIte hitamannapAnam|  

nAtyuShNashItaM laghu dIpanIyaM rakte~apanIte hitamannapAnam|  

tadA sharIraM hyanavasthitAsRugagnirvisheSheNa ca rakShitavyaH||23||  

tadA sharIraM hyanavasthitAsRugagnirvisheSheNa ca rakShitavyaH||23||  

 

After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the ''agni'' (digestive power) should be protected with care. [23]

After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the ''agni'' (digestive power) should be protected with care. [23]

 

==== Characteristics of a person with pure blood ====

==== Characteristics of a person with pure blood ====

pittamevaM kaphashcaivaM mano vikShobhayannRuNAm|  

pittamevaM kaphashcaivaM mano vikShobhayannRuNAm|  

sa~jj~jAM nayatyAkulatAM visheShashcAtra vakShyate||29||

sa~jj~jAM nayatyAkulatAM visheShashcAtra vakShyate||29||

 

When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated ''doshas'', singly or in combination, reside and obstruct the channels that carry ''rakta, rasa'' (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated ''doshas'' distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated ''doshas'', singly or in combination, reside and obstruct the channels that carry ''rakta, rasa'' (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated ''doshas'' distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

 

==== ''Dosha'' specific features of ''mada'' ====

==== ''Dosha'' specific features of ''mada'' ====

sarvANyetAni rUpANi sannipAtakRute made|33|  

sarvANyetAni rUpANi sannipAtakRute made|33|  

 

The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with ''kaphaja mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with ''kaphaja mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

 

जायते शाम्यति क्षिप्रं मदो मद्यमदाकृतिः||३३||  

जायते शाम्यति क्षिप्रं मदो मद्यमदाकृतिः||३३||  

sarvAkRutiH sannipAtAdapasmAra ivAgataH|  

sarvAkRutiH sannipAtAdapasmAra ivAgataH|  

sa jantuM pAtayatyAshu vinA bIbhatsaceShTitaiH||41||  

sa jantuM pAtayatyAshu vinA bIbhatsaceShTitaiH||41||  

 

In ''vatika murchcha'', the patient becomes unconscious after seeing the sky as blue, black or reddish and regains consciousness quickly. Other symptoms include trembling, bodyache, excessive pain in the cardiac region, emaciation, and blackish and reddish luster.  

In ''vatika murchcha'', the patient becomes unconscious after seeing the sky as blue, black or reddish and regains consciousness quickly. Other symptoms include trembling, bodyache, excessive pain in the cardiac region, emaciation, and blackish and reddish luster.  

In ''paittika murchcha'', unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor.

In ''paittika murchcha'', unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor.

''Sannipataja murchcha'' has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this ''murchcha'' the patient falls unconscious without violent or revolting movements.[35-41]

''Sannipataja murchcha'' has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this ''murchcha'' the patient falls unconscious without violent or revolting movements.[35-41]

 

==== Sanyasa (coma) ====

==== Sanyasa (coma) ====

prabuddhasa~jj~jaM matimAnanubandhamupakramet|  

prabuddhasa~jj~jaM matimAnanubandhamupakramet|  

tasya  saMrakShitavyaM hi manaH pralayahetutaH||53||

tasya  saMrakShitavyaM hi manaH pralayahetutaH||53||

 

''Mada'' and ''murchcha'' subside on their own when the vitiated ''doshas'' subside. However, ''sanyasa'' (coma) does not subside without medical treatment. In weak patients, when vitiated ''doshas'' move into a vital organ (i.e. brain and heart) and start affecting speech, physical movement, and the mind, coma ensues. A person affected with coma appears to be in a vegetative state or seems dead. Death can occur if prompt and effective treatment is not given. The physician should manage a comatose patient just as a wise person recovers a utensil sinking in deep water quickly before it settles down in the bottom.

''Mada'' and ''murchcha'' subside on their own when the vitiated ''doshas'' subside. However, ''sanyasa'' (coma) does not subside without medical treatment. In weak patients, when vitiated ''doshas'' move into a vital organ (i.e. brain and heart) and start affecting speech, physical movement, and the mind, coma ensues. A person affected with coma appears to be in a vegetative state or seems dead. Death can occur if prompt and effective treatment is not given. The physician should manage a comatose patient just as a wise person recovers a utensil sinking in deep water quickly before it settles down in the bottom.

When the patient regains consciousness, he should be given a light diet and should be entertained with interesting stories or anecdotes, memoirs, pleasing talks, enchanting songs, and live music, and colorful scenery. Moreover, he should be treated with purgation, emesis, smoking, collyriums, gargles, bloodletting, exercise and rubbing over the body. His mind should be protected well from the causes of distress or confusion. [42-53]

When the patient regains consciousness, he should be given a light diet and should be entertained with interesting stories or anecdotes, memoirs, pleasing talks, enchanting songs, and live music, and colorful scenery. Moreover, he should be treated with purgation, emesis, smoking, collyriums, gargles, bloodletting, exercise and rubbing over the body. His mind should be protected well from the causes of distress or confusion. [42-53]

 

==== Various treatments of ''mada'' amd ''murchcha'' ====

==== Various treatments of ''mada'' amd ''murchcha'' ====

raktAvasekAcchAstrANAM satAM sattvavatAmapi|  

raktAvasekAcchAstrANAM satAM sattvavatAmapi|  

sevanAnmadamUrcchAyAH prashAmyanti sharIriNAm||58||  

sevanAnmadamUrcchAyAH prashAmyanti sharIriNAm||58||  

 

In the cases of ''mada'' and ''murchcha'', patients should be subjected to five (evacuative) measures, after proper oleation and fomentation, according to the ''dosha'' and strength of the person and the disease. Likewise, the administration of ''paniya-kalyana ghrita'', ''tiktashatpala ghrita'' or ''mahatikta ghrita'' is recommended. The use of ''triphala'' with ''ghrita'', honey and sugar, ''shilajatu,'' milk, ''pippali'' (Piper longum) or ''chitraka'' (Plumbago zeylanica Linn.) with milk, ''rasayana,'' and ''kaumbha'' (ten year old) ''ghrita'' are also beneficial.

In the cases of ''mada'' and ''murchcha'', patients should be subjected to five (evacuative) measures, after proper oleation and fomentation, according to the ''dosha'' and strength of the person and the disease. Likewise, the administration of ''paniya-kalyana ghrita'', ''tiktashatpala ghrita'' or ''mahatikta ghrita'' is recommended. The use of ''triphala'' with ''ghrita'', honey and sugar, ''shilajatu,'' milk, ''pippali'' (Piper longum) or ''chitraka'' (Plumbago zeylanica Linn.) with milk, ''rasayana,'' and ''kaumbha'' (ten year old) ''ghrita'' are also beneficial.

''Mada'' and ''murchcha'' are alleviated by bloodletting and constantly keeping the patient regaled with anecdotes from the scriptures, and in the company of noble and intelligent persons. [54-58]

''Mada'' and ''murchcha'' are alleviated by bloodletting and constantly keeping the patient regaled with anecdotes from the scriptures, and in the company of noble and intelligent persons. [54-58]

 

==== Summary ====

==== Summary ====

Now the (summing up) verses-

Now the (summing up) verses-

 

Characteristics of pure and impure blood, its causes, disorders of blood and their treatment, causes, symptoms and treatment of ''mada,'' ''murchcha'' and ''sanyasa'' – all this has been described in the chapter on properly formed blood etc.  

Characteristics of pure and impure blood, its causes, disorders of blood and their treatment, causes, symptoms and treatment of ''mada,'' ''murchcha'' and ''sanyasa'' – all this has been described in the chapter on properly formed blood etc.  

Diseases with variable state of consciousness, from confusion to coma have been described in this chapter. [59-60]  

Diseases with variable state of consciousness, from confusion to coma have been described in this chapter. [59-60]  

#Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 9 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913.

#Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 9 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913.

#Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Indriya sthana, Chap 7, shlok no. 13 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 995.

#Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charaka Samhita, Ist part, Indriya sthana, Chap 7, shlok no. 13 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 995.

 

=== Glossary ===

=== Glossary ===