Changes

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

<div style="text-align:justify;">Blood is important for maintaining vitality of individual. It is also the most influential factor in patho-physiology of any disease as it carries vitiated dosha leading to disease. This chapter focuses on rakta dhatu (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta)  is formed by following proper dietary habits as described in 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. </div>

<div style="text-align:justify;">Blood is important for maintaining vitality of individuals. It is also the most important factor in patho-physiology of any disease as it carries vitiated dosha leading to disease. This chapter focuses on rakta dhatu (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta)  is formed by following proper dietary habits. 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. </div>

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

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

=== Introduction ===

=== Introduction ===

<div style="text-align:justify;">

<div style="text-align:justify;">

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 chapter. 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.

</div>

</div>

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

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

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]

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' / Fundamental Principles ===

*Formation of pure blood depends upon the place, time, diet, and lifestyle. [3]

*Formation of pure blood depends upon the place, time, diet, and lifestyle. [3]

*''Vata'' and ''pitta'' increase bleeding and delay blood-clotting while ''kapha'' does the opposite.[20-21]

*''Vata'' and ''pitta'' increase bleeding and delay blood-clotting while ''kapha'' does the opposite.[20-21]

*A person should take digestion-enhancing diet consisting of ''shali'' (red rice), ''moong'' (green gram), etc. to strengthen digestive power after bloodletting. [23]

*A person should take digestion-enhancing diet consisting of ''shali'' (red rice), ''moong'' (green gram), etc. to strengthen digestive power after bloodletting. [23]

*''Mada, murchcha'', and ''sanyasa'' are caused due to vitiated doshas as well as ''rajas'' and ''tamas,'' which impair and obstruct ''rasavaha, raktavaha'', and ''sangyavahi srotas'' and are responsible for various states of consciousness. Altered sensorium and consciousness are caused by consumption of contaminated diet and conduct. Mind and body are equally involved in the pathology of intoxication, syncope, and coma. [25-29]

*''Mada, murchcha'', and ''sanyasa'' are caused due to vitiated doshas as well as ''rajas'' and ''tamas,'' which impair and obstruct ''rasavaha, raktavaha'', and ''sangyavahi srotas''. They are responsible for various states of consciousness. Altered sensorium and consciousness are caused by consumption of contaminated diet and conduct. Mind and body are equally involved in the pathology of intoxication, syncope, and coma. [25-29]

*''Mada'' and ''madatyaya'' are clinically interchangeable. All types of narcosis and intoxication are caused by the vitiation of the three ''doshas''.[34]

*''Mada'' and ''madatyaya'' are clinically interchangeable. All types of narcosis and intoxication are caused by the vitiation of the three ''doshas''.[34]

*''Murchcha'' is a transient loss of consciousness with prodromal visual hallucinations specific to ''vata, pitta,'' and ''kapha''. [35-41]

*''Murchcha'' is a transient loss of consciousness with prodromal visual hallucinations specific to ''vata, pitta,'' and ''kapha''. [35-41]

*''Mada'' and ''murchcha'' are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. ''Sanyasa'' requires intensive care management. [42-53]

*''Mada'' and ''murchcha'' are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. ''Sanyasa'' requires intensive management. [42-53]

*Purification of channels through [[Panchakarma]] is indicated before administration of drugs.[54-58]

*Purification of channels through [[Panchakarma]] is indicated before administration of drugs.[54-58]

=== ''Vidhi  Vimarsha'' ===

=== ''Vidhi  Vimarsha'' / Applied Inferences===

A person who is following a regimen or conduct suitable to a location (''desha-satmya''), time (''kala-satmya''), and habit or lifestyle (''oka-satmya''), when he takes food according to ''ahara vidhi visheshayatana'' (as described in the first chapter of Charak [[Vimana Sthana]] <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no.28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457.  </ref>) - food having six ''rasaja'', taken at proper time, proper place, in proper quantity, and that which is wholesome in nature, will have pure (or healthy) blood. Pure blood formed after proper digestion of food is full of nutritional values necessary for life. Formation of pure blood takes place due to extrinsic and intrinsic factors. Extrinsic factors are obtained from dietary sources. On the other hand, intrinsic factors are generated inside the body, such as ''Ranjaka pitta'' and ''majjagata'' substances (bone marrow). The importance of pure blood is described in ''Sushruta Sutra'' <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Vimana sthana, Chap 1, shlok no.21 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 680.</ref>15/7 and ''Charak Chikitsa'' <ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 15, shlok no.7 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 75. </ref>15/28.[3]

A person who is following a regimen or conduct suitable to a location (''desha-satmya''), time (''kala-satmya''), and habit or lifestyle (''oka-satmya''), when he takes food according to ''ahara vidhi visheshayatana'' (as described in the first chapter of Charak [[Vimana Sthana]] <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no.28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457.  </ref>) - food having six ''rasaja'', taken at proper time, proper place, in proper quantity, and that which is wholesome in nature, will have pure (or healthy) blood. Pure blood formed after proper digestion of food is full of nutritional values necessary for life. Formation of pure blood takes place due to extrinsic and intrinsic factors. Extrinsic factors are obtained from dietary sources. On the other hand, intrinsic factors are generated inside the body, such as ''Ranjaka pitta'' and ''majjagata'' substances (bone marrow). The importance of pure blood is described in ''Sushruta Sutra'' <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Vimana sthana, Chap 1, shlok no.21 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 680.</ref>15/7 and ''Charak Chikitsa'' <ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 15, shlok no.7 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 75. </ref>15/28.[3]