Difference between revisions of "Raktapitta Chikitsa"

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|keywords=Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation
 
|keywords=Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation
|description=Chikitsa Sthana Chapter 4. Management of Raktapitta (Bleeding Disorders)
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|description=Chikitsa Sthana Chapter 4. Management of Bleeding Disorders
 
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<big>'''[[Chikitsa Sthana]] Chapter 4. Management of Raktapitta (Bleeding Disorders)'''</big>
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<big>'''[[Chikitsa Sthana]] Chapter 4. Management of Bleeding Disorders'''</big>
  
 
<big>'''Abstract '''</big>
 
<big>'''Abstract '''</big>
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Their drugs mainly have ''madhura, tikta'' and ''sheeta guna'' which pacify ''pitta'' and ''rakta''. One herb which is very important in ''raktapitta'' is ''vasa'', which alone can check the bleeding quickly.
 
Their drugs mainly have ''madhura, tikta'' and ''sheeta guna'' which pacify ''pitta'' and ''rakta''. One herb which is very important in ''raktapitta'' is ''vasa'', which alone can check the bleeding quickly.
  
=== Sanskrit text, Transliteration and English Translation ===
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== Sanskrit text, Transliteration and English Translation ==
 
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Now we shall expound the chapter on ''raktapitta'' (haemorrhagic disorders). (1)
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Now we shall expound the chapter "Raktapitta Chikitsa'' (Management of bleeding disorders). Thus said Lord Atreya. [1-2]
  
As propounded by Lord Atreya. [1-2]
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=== Agnivesha’s query ===
 
 
==== Agnivesha’s query ====
 
 
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Agnivesha bowed to Punarvasu Atreya who is devoid of confusion, having fire-like brilliance(sharp intellect) and self-control while he was making stroll in the ''panchaganga'' region, and said, “O Lord! the etiology along with symptoms of haemorrhagic disorders has already been said, now you may tell me the further points, O my teacher! [3-4]
 
Agnivesha bowed to Punarvasu Atreya who is devoid of confusion, having fire-like brilliance(sharp intellect) and self-control while he was making stroll in the ''panchaganga'' region, and said, “O Lord! the etiology along with symptoms of haemorrhagic disorders has already been said, now you may tell me the further points, O my teacher! [3-4]
  
==== Atreya Punarvasu’s reply ====
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=== Atreya Punarvasu’s reply ===
 
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The physician knowing causes and symptoms should quickly manage the case of haemorrhagic disorders which is an acute dreadful disease, having more severity and quick-acting like fire. The etiology of the same has already been said earlier such as intake of hot, sharp, sour, pungent and salty substances in excess, exposure to the sun and foods that cause burning sensations. [5-6]
 
The physician knowing causes and symptoms should quickly manage the case of haemorrhagic disorders which is an acute dreadful disease, having more severity and quick-acting like fire. The etiology of the same has already been said earlier such as intake of hot, sharp, sour, pungent and salty substances in excess, exposure to the sun and foods that cause burning sensations. [5-6]
  
==== Pathogenesis ====
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=== Pathogenesis ===
 
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''Pitta'' aggravated by these causes vitiates ''rakta''. Due to similarity in constitution (of ''rakta'' and ''pitta''), the pathogenesis develops furthermore to vitiate ''rakta''. Due to heat of ''pitta'', the fluid portion from all the fomented ''dhatus'' oozes out, which additionally leads to aggravation of ''rakta'' and ''pitta''. [7-8]
 
''Pitta'' aggravated by these causes vitiates ''rakta''. Due to similarity in constitution (of ''rakta'' and ''pitta''), the pathogenesis develops furthermore to vitiate ''rakta''. Due to heat of ''pitta'', the fluid portion from all the fomented ''dhatus'' oozes out, which additionally leads to aggravation of ''rakta'' and ''pitta''. [7-8]
  
==== Derivation ====
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=== Derivation ===
 
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Because of conjunction with, similarity in causes of vitiation, odor, color and origin, the disease is called ''rakta-pitta''. [9]
 
Because of conjunction with, similarity in causes of vitiation, odor, color and origin, the disease is called ''rakta-pitta''. [9]
  
==== Origin of disease ====
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=== Origin of disease ===
 
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The ''pitta'' (''raktapitta'') stays located in spleen and liver, because in persons the blood vessels originate from them. [10]
 
The ''pitta'' (''raktapitta'') stays located in spleen and liver, because in persons the blood vessels originate from them. [10]
  
==== Characteristics of ''dosha'' vitiation ====
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=== Characteristics of ''dosha'' vitiation ===
 
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Viscous, pale, unctuous and slimy (in blood coming out) indicates affliction by ''kapha''. Blackish, reddish, frothy, thin and roughness in blood indicates affliction by ''vata''. That having ochre-like, black, cow-urine-like, shining black, smoky and collerium-like color indicates ''pitta'' affliction. Due to combination of two ''doshas'' the symptoms of the concerned ones are combined. ''Raktapitta'' caused by ''sannipata'' has symptoms of all the three ''doshas''. [11-12]
 
Viscous, pale, unctuous and slimy (in blood coming out) indicates affliction by ''kapha''. Blackish, reddish, frothy, thin and roughness in blood indicates affliction by ''vata''. That having ochre-like, black, cow-urine-like, shining black, smoky and collerium-like color indicates ''pitta'' affliction. Due to combination of two ''doshas'' the symptoms of the concerned ones are combined. ''Raktapitta'' caused by ''sannipata'' has symptoms of all the three ''doshas''. [11-12]
  
==== Prognosis ====
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=== Prognosis ===
 
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''Raktapitta'' associated with one ''dosha'' is curable; that with two ''doshas'' is palliable while that caused by three ''doshas'' is incurable. It is also incurable if it is severely forceful and invading the person who has poor digestion, is emaciated due to diseases, old and under-nourished. [13-14]
 
''Raktapitta'' associated with one ''dosha'' is curable; that with two ''doshas'' is palliable while that caused by three ''doshas'' is incurable. It is also incurable if it is severely forceful and invading the person who has poor digestion, is emaciated due to diseases, old and under-nourished. [13-14]
  
==== ''Gati'' (direction of flow) and prognosis ====
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=== ''Gati'' (direction of flow) and prognosis ===
 
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That ''raktapitta'' is palliable which is associated with two ''doshas'', which aggravates again and again after subsiding and shifts from one passage to another. [15-21]
 
That ''raktapitta'' is palliable which is associated with two ''doshas'', which aggravates again and again after subsiding and shifts from one passage to another. [15-21]
  
==== Characteristics of curable ''raktapitta'' ====
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=== Characteristics of curable ''raktapitta'' ===
 
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''Raktapitta'' is caused by food having predominantly unctuous-hot and rough-hot properties. The former often gives rise to the upward movement and the latter to the downward movement of ''raktapitta''. The upward movement in ''raktapitta'' is associated with ''kapha'', the downward one with ''vata'' and that from both the passages is associated with both ''kapha'' and ''vata''. [23-24]
 
''Raktapitta'' is caused by food having predominantly unctuous-hot and rough-hot properties. The former often gives rise to the upward movement and the latter to the downward movement of ''raktapitta''. The upward movement in ''raktapitta'' is associated with ''kapha'', the downward one with ''vata'' and that from both the passages is associated with both ''kapha'' and ''vata''. [23-24]
  
==== Consequneces of styptic therapy in ''rakta-pitta'' ====
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=== Consequneces of styptic therapy in ''rakta-pitta'' ===
 
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Mostly the ''raktapitta'' is aggravated by ''amadosha'', hence patient should be managed with lightening measures. The physician should apply in the beginning of ''raktapitta'', lightening or nourishing measure according to passage, association of ''dosha'' and etiology. [29-30]
 
Mostly the ''raktapitta'' is aggravated by ''amadosha'', hence patient should be managed with lightening measures. The physician should apply in the beginning of ''raktapitta'', lightening or nourishing measure according to passage, association of ''dosha'' and etiology. [29-30]
  
==== Nourishment regimen ====
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=== Nourishment regimen ===
 
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Powder of parched paddy mixed with ghee and honey makes a good saturating preparation which, if taken timely, alleviates the upward movement of ''raktapitta''. The saturating preparation may be soured with pomegranates and ''amalaka'' fruits in persons having poor digestion and suited to sour things.[31-35]
 
Powder of parched paddy mixed with ghee and honey makes a good saturating preparation which, if taken timely, alleviates the upward movement of ''raktapitta''. The saturating preparation may be soured with pomegranates and ''amalaka'' fruits in persons having poor digestion and suited to sour things.[31-35]
  
==== Diet advised in ''raktapitta'' ====
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=== Diet advised in ''raktapitta'' ===
 
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The flesh of dove, pigeon, common quail, ''raktaksha'' (crane), ''vartaka'' (a quail), grey partridge, ''ena, harina'' and ''kalapucchaka'' (species of deer) are wholesome in ''raktapitta''. Their soup is used in sour or in-soured form, fried with ghee and added sugar. In (''raktapitta'') associated with ''kapha'' vegetable soup and in that with ''vata'' meat-soup is prescribed. Now for ''raktapitta'', preparations of gruel will be described. [36-43]
 
The flesh of dove, pigeon, common quail, ''raktaksha'' (crane), ''vartaka'' (a quail), grey partridge, ''ena, harina'' and ''kalapucchaka'' (species of deer) are wholesome in ''raktapitta''. Their soup is used in sour or in-soured form, fried with ghee and added sugar. In (''raktapitta'') associated with ''kapha'' vegetable soup and in that with ''vata'' meat-soup is prescribed. Now for ''raktapitta'', preparations of gruel will be described. [36-43]
  
==== Medicated gruels in ''raktapitta'' ====
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=== Medicated gruels in ''raktapitta'' ===
 
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Whatever etiological factors of ''raktapitta'' are mentioned should be avoided by those patients, if they want to survive and to be free from the disease. Thus, the diet allevating ''raktapitta'' has been described in order. [53]
 
Whatever etiological factors of ''raktapitta'' are mentioned should be avoided by those patients, if they want to survive and to be free from the disease. Thus, the diet allevating ''raktapitta'' has been described in order. [53]
  
==== Indication of purification therapy ====
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=== Indication of purification therapy ===
 
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After purification, in the case of upward type, the dietetic regimen starts with saturating drink while in that of downward type, it starts with gruel subjected to the condition that ''vata'' is not dominant. [54-61]
 
After purification, in the case of upward type, the dietetic regimen starts with saturating drink while in that of downward type, it starts with gruel subjected to the condition that ''vata'' is not dominant. [54-61]
  
==== Pacification therapy ====
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=== Pacification therapy ===
 
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#''jivaka'' and ''rishabhaka'' added with ghee and sugar. [82-84]
 
#''jivaka'' and ''rishabhaka'' added with ghee and sugar. [82-84]
  
==== Treatment of hematuria and per rectal bleeding ====
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=== Treatment of hematuria and per rectal bleeding ===
 
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Milk boiled with ''shatavari'' and ''gokshura'', or the four leaved herbs (''mudgaparni, mashaparni, shalaparni'' and ''prashniparni''), check the hemorrhage quickly particularly that from urinary passage and with pain.[85]
 
Milk boiled with ''shatavari'' and ''gokshura'', or the four leaved herbs (''mudgaparni, mashaparni, shalaparni'' and ''prashniparni''), check the hemorrhage quickly particularly that from urinary passage and with pain.[85]
  
==== Treatment of per rectal bleeding ====
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=== Treatment of per rectal bleeding ===
 
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Particularly in haemorrhage from rectum milk boiled with ''mocharasa'', or hanging roots or leaf-buds of ''vata'' or ''hribera, nilotpala'' and ''nagara'' (''musta'') should be taken. After taking the medicinal extracts with milk the patient should take ghee cooked with these extracts. [85-87]
 
Particularly in haemorrhage from rectum milk boiled with ''mocharasa'', or hanging roots or leaf-buds of ''vata'' or ''hribera, nilotpala'' and ''nagara'' (''musta'') should be taken. After taking the medicinal extracts with milk the patient should take ghee cooked with these extracts. [85-87]
  
==== ''Vasa'' ghee ====
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=== ''Vasa'' ghee ===
 
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#''patola'' leaves are efficacious in ''paittika'' fever and all are commended for use in hemorrhagic disorder. [89-90]
 
#''patola'' leaves are efficacious in ''paittika'' fever and all are commended for use in hemorrhagic disorder. [89-90]
  
==== External applications ====
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=== External applications ===
 
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All measures which are prescribed for the treatment of ''pattika'' fever such as massage, sprinkling, baths, beds, room/coverings, cooling methods or enema should be applied in hemorrhagic disorder considering the season and dose. ''Sarpirguda'' (the formulation of jaggery and ghee) prescribed for the patients of ''kshata'' (chest injury) control the hemorrhagic disorder quickly. [91-92]
 
All measures which are prescribed for the treatment of ''pattika'' fever such as massage, sprinkling, baths, beds, room/coverings, cooling methods or enema should be applied in hemorrhagic disorder considering the season and dose. ''Sarpirguda'' (the formulation of jaggery and ghee) prescribed for the patients of ''kshata'' (chest injury) control the hemorrhagic disorder quickly. [91-92]
  
==== Treatment of ''raktapitta'' with associated ''kapha'' ====
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=== Treatment of ''raktapitta'' with associated ''kapha'' ===
 
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In case of ''raktapitta'' if there is association of ''kapha'' and blood reaching the throat is adherent, alkali of the stalk of water lily mixed with honey and ghee should be used. In the same way, alkali of lotus stalk, lotus, water lily, ''nagakeshara, palasha, priyangu, madhuka'' and asana should be used. [93-94]
 
In case of ''raktapitta'' if there is association of ''kapha'' and blood reaching the throat is adherent, alkali of the stalk of water lily mixed with honey and ghee should be used. In the same way, alkali of lotus stalk, lotus, water lily, ''nagakeshara, palasha, priyangu, madhuka'' and asana should be used. [93-94]
  
==== ''Shatavaryadi'' ghee ====
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=== ''Shatavaryadi'' ghee ===
 
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Ghee cooked with drugs of five groups of five roots each( described in [[Rasayana]] chapter) has the same effect. (This is ''shatavaryadi ghrita''). [95-96]
 
Ghee cooked with drugs of five groups of five roots each( described in [[Rasayana]] chapter) has the same effect. (This is ''shatavaryadi ghrita''). [95-96]
  
==== Treatment of nasal bleeding ====
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=== Treatment of nasal bleeding ===
 
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Visit of rivers and lakes, glaciers, ponds having water lily and lotus flowers, ''shishira'' (winter) season, favorite and soothing narratives pacify ''raktapitta''. [101-109]
 
Visit of rivers and lakes, glaciers, ponds having water lily and lotus flowers, ''shishira'' (winter) season, favorite and soothing narratives pacify ''raktapitta''. [101-109]
  
==== Summary ====
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=== Summary ===
 
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*medication side-effects
 
*medication side-effects
  
==== Types of Bleeding Disorders ====
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=== Types of Bleeding Disorders ===
 
There are several bleeding disorders that can be inherited (passed down through genetics) or acquired. Some cause bleeding spontaneously, whereas others cause bleeding following an accident.  
 
There are several bleeding disorders that can be inherited (passed down through genetics) or acquired. Some cause bleeding spontaneously, whereas others cause bleeding following an accident.  
  
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Certain diseases or medical conditions can also cause a deficiency of one or more blood clotting factors. The most common causes of acquired bleeding disorders are end-stage liver disease or vitamin K deficiency. According to the American Association of Clinical Chemistry (AACC), this is because most blood clotting factors are produced in the liver, and certain clotting factors are vitamin k dependent (AACC, 2011).
 
Certain diseases or medical conditions can also cause a deficiency of one or more blood clotting factors. The most common causes of acquired bleeding disorders are end-stage liver disease or vitamin K deficiency. According to the American Association of Clinical Chemistry (AACC), this is because most blood clotting factors are produced in the liver, and certain clotting factors are vitamin k dependent (AACC, 2011).
  
==== Identification of Bleeding Disorders/Symptoms ====
+
=== Identification of Bleeding Disorders/Symptoms ===
  
 
The main sign of a bleeding disorder is prolonged or excessive bleeding. The bleeding is normally heavier than normal and unprovoked.  
 
The main sign of a bleeding disorder is prolonged or excessive bleeding. The bleeding is normally heavier than normal and unprovoked.  
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There are various bleeding disorders, some of  which  can be correlated with ''raktapitta''. Bleeding disorders can occur either due to decrease in coagulation factor in blood or due to increase in bleeding factor. When patient has bleeding from anus (''guda'') or vagina(''yoni''), then it is difficult to differentiate whether the disease is ''adhoga raktapitta'' or ''raktarsha'' or ''raktatisara'' or ''pradara''. There are major similarities in causes, signs, ''doshas'' involved but also minor differences. And that minor differences need to be studied to capture the right link of disease, which can be done only when one has, the deep knowledge of Ayurvedic diagnostic tool i.e. ''nidanpanchaka''. The profound cognizance of  ''nidanapanchaka'' as a diagnostic tool can enhance the treatment modalities of Ayurvedic management of diseases in coming years.
 
There are various bleeding disorders, some of  which  can be correlated with ''raktapitta''. Bleeding disorders can occur either due to decrease in coagulation factor in blood or due to increase in bleeding factor. When patient has bleeding from anus (''guda'') or vagina(''yoni''), then it is difficult to differentiate whether the disease is ''adhoga raktapitta'' or ''raktarsha'' or ''raktatisara'' or ''pradara''. There are major similarities in causes, signs, ''doshas'' involved but also minor differences. And that minor differences need to be studied to capture the right link of disease, which can be done only when one has, the deep knowledge of Ayurvedic diagnostic tool i.e. ''nidanpanchaka''. The profound cognizance of  ''nidanapanchaka'' as a diagnostic tool can enhance the treatment modalities of Ayurvedic management of diseases in coming years.
  
==== Commonly used medicines in ''raktapitta'' ====
+
=== Commonly used medicines in ''raktapitta'' ===
  
===== Important medicines =====
+
==== Important medicines ====
  
 
#''Vasa''  
 
#''Vasa''  
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#''Praval bhasma''  
 
#''Praval bhasma''  
  
===== Treatment of ''urdhvaga raktapitta'' =====
+
==== Treatment of ''urdhvaga raktapitta'' ====
  
 
#''Lakshadi'' mixture 3-5 grams frequently with ''vasavaleha''  
 
#''Lakshadi'' mixture 3-5 grams frequently with ''vasavaleha''  
 
#''Padmakadi tailam'' 10-20 drops empty stomach three times in a day with milk  
 
#''Padmakadi tailam'' 10-20 drops empty stomach three times in a day with milk  
  
===== Treatment of ''adhoga raktapitta'' =====
+
==== Treatment of ''adhoga raktapitta'' ====
  
 
#''Shatavaryadi kwatha'' 25 to 40 ml empty stomach three times with sugar  
 
#''Shatavaryadi kwatha'' 25 to 40 ml empty stomach three times with sugar  
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#''Bol-parpati'' mixture 250 to 500 mg after meals with ''vasavaleha''  
 
#''Bol-parpati'' mixture 250 to 500 mg after meals with ''vasavaleha''  
  
===== Treatment of chronic stage =====
+
==== Treatment of chronic stage ====
  
 
#''Vasa'' ghee 10 to 40 ml after meals with milk
 
#''Vasa'' ghee 10 to 40 ml after meals with milk
  
=== Related Chapters ===
+
== Related Chapters ==
 
*[[Vidhishonitiya Adhyaya]]
 
*[[Vidhishonitiya Adhyaya]]
 
*[[Raktapitta Nidana]]
 
*[[Raktapitta Nidana]]

Revision as of 09:30, 4 June 2020


Chikitsa Sthana Chapter 4. Management of Bleeding Disorders

Abstract

Raktapitta is a treatable bleeding disorder, if recognized and managed in early stage. If diagnosis is missed and disease is not managed properly, it becomes life threatening (mahagada).It occurs because of excessive aggravation of pitta and its affliction with rakta. Before initiation of treatment, it is important to assess strength of the patient because the treatment regimen is personified for well nourished and emaciated persons. Etiology, classification, prognosis and treatment of raktapitta have been described in detail. A good number of herbal and animal preparations are given. Further, this chapter enumerates aspects that are favorable or unfavorable to raktapitta. To improve the efficacy of treatment, external beneficial measures, such as pradeha, parisheka, sheetasnana and habitat are described at the end of chapter.This bleeding disorder is not described in modern medicine writings and appears to be unknown to allopathic medicine.

Keywords: Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation.

Raktapitta Chikitsa
Section/Chapter Chikitsa Sthana Chapter 4
Preceding Chapter Jwara Chikitsa
Succeeding Chapter Gulma Chikitsa
Other Sections Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

Introduction

Raktapitta is a serious disease caused due to vitiation of rakta by aggravated pitta. This chapter is placed after jwara, because raktapitta can occur due to the increased heat in the body produced after jwara. Prompt management is necessary for this dreadful disease. This disease develops due to pitta aggravation as a result of consumption of ushna, teekshna, agneya dravya and excessive exposure to sunlight.

Because of similarity in constitution of pitta with rakta, rakta dhatu is also vitiated by the etiological factors and has similarity in its smell and color, and is therefore called raktapitta.

It originates in the spleen and liver which play pivotal roles in the blood physiology, including clotting. Manifestations of raktapitta depend upon vitiation and predominance of a particular dosha. There may be a combination of one, two or all the three dosha. Based on dosha specific features, the blood of the patient of raktapitta may appear pale, unctuous and slimy in kapha, frothy, blackish red in vata and cane sugar like cow urine, shiny black, smoky and coarse-like collerium in pitta. Raktapitta associated with one dosha is curable, with two dosha is difficult to cure and incurable if all three dosha are involved.

Movement of raktapitta may be upward or downward meaning bleeding from upper and/or lower external orifices. This manifestation depends on etiological factors, unctuous hot factors associated with kapha has upward raktapitta however rough hot associated with vata has downward raktapitta.

Upward raktapitta, associated with kapha dosha is treated with tarpana (nourishment therapy) and downwards raktapitta is associated with vata and peya (liquid gruel) should be used.

Their drugs mainly have madhura, tikta and sheeta guna which pacify pitta and rakta. One herb which is very important in raktapitta is vasa, which alone can check the bleeding quickly.

Sanskrit text, Transliteration and English Translation

अथातो रक्तपित्तचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः||२||

Now we shall expound the chapter "Raktapitta Chikitsa (Management of bleeding disorders). Thus said Lord Atreya. [1-2]

Agnivesha’s query

विहरन्तं जितात्मानं पञ्चगङ्गे पुनर्वसुम्|
प्रणम्योवाच निर्मोहमग्निवेशोऽग्निवर्चसम्||३||

भगवन् रक्तपित्तस्य हेतुरुक्तः सलक्षणः|
वक्तव्यं यत् परं तस्य वक्तुमर्हसि तद्गुरो||४||

Agnivesha bowed to Punarvasu Atreya who is devoid of confusion, having fire-like brilliance(sharp intellect) and self-control while he was making stroll in the panchaganga region, and said, “O Lord! the etiology along with symptoms of haemorrhagic disorders has already been said, now you may tell me the further points, O my teacher! [3-4]

Atreya Punarvasu’s reply

गुरुरुवाच-

महागदं महावेगमग्निवच्छीघ्रकारि च|
हेतुलक्षणविच्छीघ्रं रक्तपित्तमुपाचरेत्||५||

तस्योष्णं तीक्ष्णमम्लं च कटूनि लवणानि च|
घर्मश्चान्नविदाहश्च हेतुः पूर्वं निदर्शितः||६||

The teacher said-

The physician knowing causes and symptoms should quickly manage the case of haemorrhagic disorders which is an acute dreadful disease, having more severity and quick-acting like fire. The etiology of the same has already been said earlier such as intake of hot, sharp, sour, pungent and salty substances in excess, exposure to the sun and foods that cause burning sensations. [5-6]

Pathogenesis

तैर्हेतुभिः समुत्क्लिष्टं पित्तं रक्तं प्रपद्यते|
तद्योनित्वात् प्रपन्नं च वर्धतेतत् प्रदूषयत्||७||

तस्योष्मणा द्रवो धातुर्धातोर्धातोः प्रसिच्यते|
स्विद्यतस्तेन संवृद्धिं भूयस्तदधिगच्छति||८||

Pitta aggravated by these causes vitiates rakta. Due to similarity in constitution (of rakta and pitta), the pathogenesis develops furthermore to vitiate rakta. Due to heat of pitta, the fluid portion from all the fomented dhatus oozes out, which additionally leads to aggravation of rakta and pitta. [7-8]

Derivation

संयोगाद्दूषणात्तत्तु सामान्याद्गन्धवर्णयोः|
रक्तस्य पित्तमाख्यातं रक्तपित्तं मनीषिभिः||९||

Because of conjunction with, similarity in causes of vitiation, odor, color and origin, the disease is called rakta-pitta. [9]

Origin of disease

प्लीहानं च यकृच्चैव तदधिष्ठाय वर्तते|
स्रोतांसि रक्तवाहीनि तन्मूलानि हि देहिनाम्||१०||

The pitta (raktapitta) stays located in spleen and liver, because in persons the blood vessels originate from them. [10]

Characteristics of dosha vitiation

सान्द्रं सपाण्डु सस्नेहं पिच्छिलं च कफान्वितम्|
श्यावारुणं सफेनं च तनु रूक्षं च वातिकम्||११||

रक्तपित्तं कषायाभं कृष्णं गोमूत्रसन्निभम्|
मेचकागारधूमाभमञ्जनाभं च पैत्तिकम्||१२||

संसृष्टलिङ्गं संसर्गात्त्रिलिङ्गं सान्निपातिकम्|१३|

Viscous, pale, unctuous and slimy (in blood coming out) indicates affliction by kapha. Blackish, reddish, frothy, thin and roughness in blood indicates affliction by vata. That having ochre-like, black, cow-urine-like, shining black, smoky and collerium-like color indicates pitta affliction. Due to combination of two doshas the symptoms of the concerned ones are combined. Raktapitta caused by sannipata has symptoms of all the three doshas. [11-12]

Prognosis

एकदोषानुगं साध्यं द्विदोषं याप्यमुच्यते||१३||

यत्त्रिदोषमसाध्यं तन्मन्दाग्नेरतिवेगवत्|व्याधिभिः
क्षीणदेहस्य वृद्धस्यानश्नतश्च यत्||१४||

Raktapitta associated with one dosha is curable; that with two doshas is palliable while that caused by three doshas is incurable. It is also incurable if it is severely forceful and invading the person who has poor digestion, is emaciated due to diseases, old and under-nourished. [13-14]

Gati (direction of flow) and prognosis

गतिरूर्ध्वमधश्चैव रक्तपित्तस्य दर्शिता|
ऊर्ध्वा सप्तविधद्वारा द्विद्वारा त्वधरा गतिः||१५||

सप्त च्छिद्राणि शिरसि द्वे चाधः,साध्यमूर्ध्वगम्|
याप्यं त्वधोगं, मार्गौ तु साध्यं प्रपद्यते||१६||

यदा तु सर्वच्छिद्रेभ्यो रोमकूपेभ्य एव
तामसङ्ख्येयां गतिं तस्याहुरान्तिकीम्||१७||

यच्चोभयाभ्यां मार्गाभ्यामतिमात्रं प्रवर्तते|
तुल्यं कुणपगन्धेन रक्तं कृष्णमतीव च||१८||

संसृष्टं कफवाताभ्यां कण्ठे सज्जति चापि यत्|
यच्चाप्युपद्रवैः सर्वैर्यथोक्तैः समभिद्रुतम्||१९||

हारिद्रनीलहरितताम्रैर्वर्णैरुपद्रुतम्|
क्षीणस्य कासमानस्य यच्च न सिध्यति||२०||

यद्विदोषानुगं यद्वा शान्तं शान्तं प्रकुप्यति|
मार्गान्मार्गं चरेद्यद्वा याप्यं पित्तमसृक् चतत्||२१||

Movement of raktapitta is directed upwards and downwards, the former through seven orifices and the latter through two orifices. There are seven orifices in head and two below. That coming from upper passages is curable, the one coming downwards is palliable and that which comes both ways is incurable. When it flows out from all the orifices including the hair follicles it is known as with innumerable movements which is fatal.

Raktapitta passing out excessively through both the passages, having corpselike smell, exceedingly red or black, associated with kapha and vata, adhering in throat, having all the complications mentioned earlier, possessing deep yellow, blue, green or coppery color and is in emaciated and coughing patient is incurable.

That raktapitta is palliable which is associated with two doshas, which aggravates again and again after subsiding and shifts from one passage to another. [15-21]

Characteristics of curable raktapitta

एकमार्गं बलवतो नातिवेगं नवोत्थितम्|
रक्तपित्तं काले साध्यं स्यान्निरुपद्रवम्||२२||

Raktapitta which has only one passage, is in the strong person, not very forceful, with recent onset, in favorable season (early winter and winter) and without complication is curable. [22]

स्निग्धोष्णमुष्णरूक्षं च रक्तपित्तस्य कारणम्|
अधोगस्योत्तरं प्रायः, पूर्वं स्यादूर्ध्वगस्य तु||२३||

ऊर्ध्वगं कफसंसृष्टमधोगं मारुतानुगम्|
द्विमार्गं कफवाताभ्यामुभाभ्यामनुबध्यते||२४||

Raktapitta is caused by food having predominantly unctuous-hot and rough-hot properties. The former often gives rise to the upward movement and the latter to the downward movement of raktapitta. The upward movement in raktapitta is associated with kapha, the downward one with vata and that from both the passages is associated with both kapha and vata. [23-24]

Consequneces of styptic therapy in rakta-pitta

अक्षीणबलमांसस्य रक्तपित्तं यदश्नतः|
तद्दोषदुष्टमुत्क्लिष्टं नादौ स्तम्भनमर्हति||२५||

गलग्रहं पूतिनस्यं मूर्च्छायमरुचिं ज्वरम्|
गुल्मं प्लीहानमानाहं किलासंकृच्छ्रमूत्रताम्||२६||

कुष्ठान्यर्शांसि वीसर्पं वर्णनाशं भगन्दरम्|
बुद्धीन्द्रियोपरोधं च कुर्यात् स्तम्भितमादितः||२७||

तस्मादुपेक्ष्यं बलिनो बलदोषविचारिणा |
रक्तपित्तं प्रथमतप्रवृद्धंसिद्धिमिच्छता||२८||

Stambhana (styptic therapy) should not be given at first in hemorrhagic disorders having excessive impurities, aggravated doshas and in a person who is not emaciated and weak and originated from excess nourishment. If checked at the very start, it produces throat congestion, fetid smell from the nose, fainting, anorexia, fever, gulma, spleen enlargement, hardness of bowels, leucoderma, dysuria, skin disorders, piles, erysipelas, loss of complexion, fistula-in-ano, obstruction to intellect and senses.

Hence for successful management, one should at first ignore (should not give styptic therapy) the hemorrhagic disorder after assessing the strength and condition or morbidity in a strong patient. [25-28]

प्रायेण हि समुत्क्लिष्टमामदोषाच्छरीरिणाम्|
वृद्धिं प्रयातिपित्तासृक्तस्मात्तल्लङ्घ्यमादितः||२९||

मार्गौ दोषानुबन्धं च निदानं प्रसमीक्ष्य च|
लङ्घनं रक्तपित्तादौ तर्पणं वा प्रयोजयेत्||३०||

Mostly the raktapitta is aggravated by amadosha, hence patient should be managed with lightening measures. The physician should apply in the beginning of raktapitta, lightening or nourishing measure according to passage, association of dosha and etiology. [29-30]

Nourishment regimen

ह्रीबेरचन्दनोशीरमुस्तपर्पटकैः शृतम्|
केवलं शृतशीतं वा दद्यात्तोयं पिपासवे||३१||

ऊर्ध्वगे तर्पणं पूर्वं पेयां पूर्वमधोगते|
कालसात्म्यानुबन्धज्ञो दद्यात् प्रकृतिकल्पवित्||३२||

जलं खर्जूरमृद्वीकामधूकैः सपरूषकैः|
शृतशीतं प्रयोक्तव्यं तर्पणार्थे सशर्करम्||३३||

तर्पणं सघृतक्षौद्रं लाजचूर्णैः प्रदापयेत्|
ऊर्ध्वगं रक्तपित्तं तत् पीतं काले व्यपोहति||३४||

मन्दाग्नेरम्लसात्म्याय तत् साम्लमपि कल्पयेत्|
दाडिमामलकैर्विद्वानम्लार्थंचानुदापयेत्||३५||

The patient who feels thirsty should be given water boiled with hribera, chandana, ushira, musta and parpataka or only cooled boiled water. One having knowledge of constitution and preparation should prescribe saturating drink in upward movement of raktapitta and liquid gruel in the downward one considering time, suitability and association of doshas. For saturation, water boiled with kharjura (date), mridvika (fruit), madhuka (dry flowers) and parushaka (fruit) and cooled along with sugar.

Powder of parched paddy mixed with ghee and honey makes a good saturating preparation which, if taken timely, alleviates the upward movement of raktapitta. The saturating preparation may be soured with pomegranates and amalaka fruits in persons having poor digestion and suited to sour things.[31-35]

Diet advised in raktapitta

शालिषष्टिकनीवारकोरदूषप्रशान्तिकाः|
श्यामाकश्च प्रियङ्गुश्च भोजनं रक्तपित्तिनाम्||३६||

मुद्गा मसूराश्चणकाः समकुष्ठाढकीफलाः|
प्रशस्ताः सूपयूषार्थे कल्पिता रक्तपित्तिनाम्||३७||

पटोलनिम्बवेत्राग्रप्लक्षवेतसपल्लवाः|
किराततिक्तकं शाकं गण्डीरः सकठिल्लकः||३८||

कोविदारस्य पुष्पाणि काश्मर्यस्याथ शाल्मलेः|
अन्नपानविधौ शाकंयच्चान्यद्रक्तपित्तनुत्||३९||

शाकार्थं शाकसात्म्यानां तच्छस्तं रक्तपित्तिनाम्|
स्विन्नं वा सर्पिषा भृष्टं यूषवद्वा विपाचितम्||४०||

पारावतान् कपोतांश्च लावान् रक्ताक्षवर्तकान्|
शशान् कपिञ्जलानेणान् हरिणान्कालपुच्छकान्||४१||

रक्तपित्ते हितान् विद्याद्रसांस्तेषां प्रयोजयेत्|
ईषदम्लाननम्लान् वा घृतभृष्टान् सशर्करान्||४२||

कफानुगे यूषशाकं दद्याद्वातानुगे रसम्|
रक्तपित्ते यवागूनामतः कल्पः प्रवक्ष्यते||४३||

The patients of raktapitta should take meal consisting of the cereals of shali, shashtika, nivara, koradusha, prashantika, shyamaka and priyangu. For them gram, lentils, green grams, makustha (kidney beans), and adhaki are recommended for the pulse-soup. The vegetables useful in raktapitta are patola, nimba, tip of vetra, tender leaves of plaksha and vetasa, kiratatikta, gandira and kathillaka. The flowers of kovidara, kashmarya and shalmali are also used and vegetable should be prepared by boiling or frying with ghee or like soup and given to the vegetarian patients.

The flesh of dove, pigeon, common quail, raktaksha (crane), vartaka (a quail), grey partridge, ena, harina and kalapucchaka (species of deer) are wholesome in raktapitta. Their soup is used in sour or in-soured form, fried with ghee and added sugar. In (raktapitta) associated with kapha vegetable soup and in that with vata meat-soup is prescribed. Now for raktapitta, preparations of gruel will be described. [36-43]

Medicated gruels in raktapitta

पद्मोत्पलानां किञ्जल्कः पृश्निपर्णी यङ्गुकाः|
जले साध्या रसे तस्मिन् पेया स्याद्रक्तपित्तिनाम्||४४||

चन्दनोशीरलोध्राणां रसे तद्वत् नागरे|
किराततिक्तकोशीरमुस्तानां तद्वदेव च||४५||

धातकीधन्वयासाम्बुबिल्वानां वा रसे शृता|
मसूरपृश्निपर्ण्योर्वा स्थिरामुद्गरसेऽथ वा||४६||

रसे हरेणुकानां वा सघृते सबलारसे|
सिद्धाः पारावतादीनां रसे वा स्युः पृथक्पृथक्||४७||

इत्युक्ता रक्तपित्तघ्न्यः शीताः समधुशर्कराः|
यवाग्वः कल्पना चैषा कार्या मांसरसेष्वपि||४८||

The stamens of lotus and water lily, prashniparni and priyangu grains should be boiled in water. In the same decoction liquid gruel should be prepared for the patients of raktapitta. Gruel may also be prepared in the decoction of

  1. chandana, ushira, lodhra, and musta,
  2. Kiratatiktaka, ushira and musta,
  3. Dhataki, dhanvayasa, hrivera and bilwa,
  4. Masura and prashniparni or shalaparni and mudga,
  5. Harenuka mixed with ghee,
  6. Bala,
  7. The meat-soup of dove etc.

These are the gruels useful in raktapitta and should be taken cooled and added with honey and sugar. Such preparations may also be made in meat-soups. [44-48]

शशः सवास्तुकः शस्तो विबन्धे रक्तपित्तिनाम्|
वातोल्बणे तित्तिरिः स्यादुदुम्बररसे शृतः||४९||

मयूरः प्लक्षनिर्यूहे न्यग्रोधस्य च कुक्कुटः|
रसे बिल्वोत्पलादीनांवर्तकक्रकरौ हितौ||५०||

तृष्यते तिक्तकैः सिद्धं तृष्णाघ्नं वा फलोदकम्|
सिद्धं विदारिगन्धाद्यैरथवाशृतशीतलम्||५१||

In the patient of raktapitta if there is constipation due to aggravated vata, the following preparations are useful:

  1. rabbit cooked with vastuka,
  2. partridge cooked in decoction of udumbara,
  3. peacock cooked in decoction of plaksha,
  4. fowl cooked in decoction of nygrodha,
  5. vartaka and krakara cooked in decoction of bilwa, utpala etc. In the condition of thirst, water boiled with bitter or thirst-alleviating fruit-juice, or water boiled with the drugs of the vidarigandhadi group or simply water boiled and cooled is prescribed. [49-51]

ज्ञात्वा दोषावनुबलौ बलमाहारमेव च|
जलं पिपासवे दद्याद्विसर्गादल्पशोऽपि वा||५२||

Water should be given to the thirsty patient up to complete satisfaction of thirst or in small quantity considering the associated doshas, strength as well as diet (of the patient). [52]

निदानं रक्तपित्तस्य यत्किञ्चित् सम्प्रकाशितम्|
जीवितारोग्यकामैस्तन्न सेव्यं रक्तपित्तिभिः||५३||

इत्यन्नपानं निर्दिष्टं क्रमशो रक्तपित्तनुत्|५४|

Whatever etiological factors of raktapitta are mentioned should be avoided by those patients, if they want to survive and to be free from the disease. Thus, the diet allevating raktapitta has been described in order. [53]

Indication of purification therapy

वक्ष्यते बहुदोषाणां कार्यं बलवतां च यत्||५४||

अक्षीणबलमांसस्य यस्य सन्तर्पणोत्थितम्|
बहुदोषं बलवतो रक्तपित्तं शरीरिणः||५५||

काले संशोधनार्हस्य तद्धरेन्निरुपद्रवम्|
विरेचनेनोर्ध्वभागमधोगं वमनेन च||५६||

त्रिवृतामभयां प्राज्ञःफलान्यारग्वधस्य वा|
त्रायमाणां गवाक्ष्या वा मूलमामलकानि वा||५७||

विरेचनं प्रयुञ्जीत प्रभूतमधुशर्करम्|
रसः शस्यते तेषां रक्तपित्ते विशेषतः||५८||

वमनं मदनोन्मिश्रो मन्थः सक्षौद्रशर्करः|
सशर्करं वा सलिलमिक्षूणां रस एव वा||५९||

वत्सकस्य फलं मुस्तं मदनं मधुकं मधु|
अधोवहे रक्तपित्ते वमनं परमुच्यते||६०||

ऊर्ध्वगे शुद्धकोष्ठस्य तर्पणादिः क्रमो हितः|
अधोगते यवाग्वादिर्न चेत्स्यान्मारुतोबली||६१||

Now the management of strong patients having plenty of doshas will be explained further:

Raktapitta, due to excess nutrition in a strong patient with aggravated doshas, who do not have emaciation, debility and complications, should be treated with purification therapy by purgation in upward type and emesis in lower movement of raktapitta.

Purgation should be administered with (the decoction) of trivrita, haritaki, fruit of aragavadha, trayamana, indrayana (roots) or amalaka (fruits) mixed with plenty of honey and sugar. Their decoction is efficacious particularly in raktapitta.

In the downward raktapitta madanaphala mixed with

  1. mantha (churned beverage) also having honey and sugar, or
  2. water added with sugar or
  3. sugarcane juice, or indrayava, musta, madana, madhuka and honey – all mixed together make an excellent emetic.

After purification, in the case of upward type, the dietetic regimen starts with saturating drink while in that of downward type, it starts with gruel subjected to the condition that vata is not dominant. [54-61]

Pacification therapy

बलमांसपरिक्षीणं शोकभाराध्वकर्शितम्|
ज्वलनादित्यसन्तप्तमन्यैर्वा क्षीणमामयैः||६२||

गर्भिणीं स्थविरं बालं रूक्षाल्पप्रमिताशिनम्|
अवम्यमविरेच्यं वा यं पश्येद्रक्तपित्तिनम्||६३||

शोषेण सानुबन्धं वा तस्य संशमनी या|
शस्यते रक्तपित्तस्य परं साऽथ प्रवक्ष्यते||६४||

अटरूषकमृद्वीकापथ्याक्वाथः सशर्करः|
मधुमिश्रः श्वासकासरक्तपित्तनिबर्हणः||६५||

अटरूषकनिर्यूहे प्रियङ्गुं मृत्तिकाञ्जने|
विनीयलोध्रं क्षौद्रं च रक्तपित्तहरं पिबेत्||६६||

पद्मकं पद्मकिञ्जल्कं दूर्वां वास्तूकमुत्पलम्|
नागपुष्पं च लोध्रं च तेनैव विधिना पिबेत्||६७||

प्रपौण्डरीकं मधुकं मधु चाश्वशकृद्रसे|
यवासभृङ्गरजसोर्मूलं वा गोशकृद्रसे||६८||

विनीय रक्तपित्तघ्नं पेयं स्यात्तण्डुलाम्बुना|
युक्तं वा मघुसर्पिर्भ्यां लिह्याद्गोश्वशकृद्रसम्||६९||

खदिरस्य प्रियङ्गूणां कोविदारस्य शाल्मलेः|
पुष्पचूर्णानि मधुना लिह्यान्ना रक्तपित्तिकः||७०||

शृङ्गाटकानां लाजानां मुस्तखर्जूरयोरपि|
लिह्याच्चूर्णानि मधुना पद्मानां केशरस्य च||७१||

धन्वजानामसृग्लिह्यान्मधुना मृगपक्षिणाम्|
सक्षौद्रं ग्रथिते रक्ते लिह्यात् पारावतं शकृत्||७२||

The patient of raktapitta who is not fit for emesis or purgation such as one debilitated, emaciated by excess grief, weight lifting or walking, exposed to heat of the fire or the sun, or emaciated by other diseases, pregnant, old, child, taking rough, little and measured diet or associated with phthisis should be treated with pacificatory treatment which is mentioned hereafter.

Decoction of vasa, mridwika and haritaki added with sugar and honey alleviates dyspnea, cough and hemorrhagic disorder.

Decoction of vasa after mixing priyangu, mruttika(mud), collyrium, lodhra and honey in the same should be taken in raktapitta.

In the same way, padmaka, lotus stamens, durva, vastuka, utpala, nagakeshara and lodhra should be taken.

Parpaundarika, madhuka and honey dissolved in the liquefied horse's feces or the roots of yavasa or bhringaraja dissolved in liquefied cow-dung should be taken with rice water. This alleviates hemorrhagic disorder. Or the solution of cow-dung and horse-dung mixed with honey and ghee be taken.

The patient suffering from hemorrhagic disorder should take powder of the flowers of khadira, priyangu, kovidara and shalmali mixed with honey.

Powders or shrangataka parched paddy, musta, kharjura and lotus stamens should be taken with honey.

Blood of the wild animals and birds should be taken with honey. If the blood is clotted, one should take excrement of pigeon with honey. [62-72]

उशीरकालीयकलोध्रपद्मकप्रियङ्गुकाकट्फलशङ्खगैरिकाः|
पृथक् पृथक् चन्दनतुल्यभागिकाःशर्करास्तण्डुलधावनाप्लुताः||७३||

रक्तं सपित्तं तमकं पिपासां दाहं च पीताः शमयन्ति सद्यः|
किराततिक्तं क्रमुकं समुस्तं कमलोत्पले च||७४||

ह्रीबेरमूलानि पटोलपत्रं दुरालभा पर्पटको मृणालम्|
धनञ्जयोदुम्बरवेतसत्वङ्न्यग्रोधशालेययवासकत्वक्||७५||

तुगालतावेतसतण्डुलीयंससारिवंमोचरसः समङ्गा|
पृथक् पृथक् चन्दनयोजितानि तेनैव कल्पेन हितानि तत्र||७६||

निशिस्थिता वा स्वरसीकृता वा कल्कीकृतावा मृदिताः शृता वा|
एते समस्ता गणशः पृथग्वा रक्तं सपित्तं शमयन्ति योगाः||७७||

Ushira, kaliyaka, lodhra, padmaka, priyangu, katphala, conch and ochre-each taken separately with equal part of sandal along with sugar and dissolved in rice water alleviate quickly internal haemorhage, fainting, thirst and burning sensation.

Kiratatikta, kramuka, musta, prapaundarika, kamala, utpala, hribera (root), patola (leaves), duralabha, parpataka, lotus stalk, bark of arjuna, udumbara, vetasa, nyagrodha, shaileya and yavashaka; tuga, lata (durva), vetasa tanduliya, sariva, mocharasa and lajjalu – each separately mixed with sandal may be administered as above. They collectively as group or separately used in the form of cold infusion, juice, paste, hot infusion or decoction check the hemorrhagic disorder. [72-77]

मुद्गाः सलाजाःसयवाः कृष्णाः सोशीरमुस्ताःसह चन्दनेन|
बलाजले पर्युषिताः कषाया रक्तं सपित्तं शमयन्त्युदीर्णम्||७८||

Green gram, parched paddy, pippali, ushira, musta and chandana are kept for the whole night in water boiled with bala. This pacifies even the aggravated raktapitta. [78]

वैदूर्यमुक्तामणिगैरिकाणां मृच्छङ्खहेमामलकोदकानाम्|
मधूदकस्येक्षुरसस्य चैव पानाच्छमं गच्छति रक्तपित्तम्||७९||

उशीरपद्मोत्पलचन्दनानां पक्वस्य लोष्टस्य च यः प्रसादः
सशर्करः क्षौद्रयुतः सुशीतो रक्तातियोगप्रशमाय देयः||८०||

प्रियङ्गुकाचन्दनलोध्रसारिवामधूकमुस्ताभयधातकीजलम्|
समृत्प्रसादं सह यष्टिकाम्बुना सशर्करं रक्तनिबर्हणं परम्||८१||

Hemorrhagic disorder gets alleviated by the use of water in contact with vaidurya (cat's eye), pearls, gems, ochre, earth, conch, nagakeshara and amalaka; honey-water and sugar cane juice.

Clear water kept with ushira, lotus, water lily, sandal and cooked earthen cold (or brick) well-cooled and mixed with sugar and honey should be administered to check excessive bleeding.

Water kept with priyangu, chandana, lodhra, sariva, madhuka, musta, ushira and dhataki, or water kept with brick, or shashtika rice water added with sugar is an excellent haemostatic. [79-81]

कषाययोगैर्विविधैर्यथोक्तैर्दीप्तेऽनले श्लेष्मणि निर्जिते च|
यद्रक्तपित्तं प्रशमं न याति तत्रानिलःस्यादनु तत्र कार्यम्||८२||

छागं पयः स्यात् परमं प्रयोगे गव्यं शृतं पञ्चगुणे जले वा|
सशर्करं माक्षिकसम्प्रयुक्तं विदारिगन्धादिगणैः शृतं वा||८३||

द्राक्षाशृतं नागरकैःशृतं वा बलाशृतं गोक्षुरकैः शृतं वा|
सजीवकं सर्षभकं ससर्पिः पयः प्रयोज्यं सितया शृतं वा||८४||

The hemorrhagic disorder which does not get pacified by the said various extracts after digestive fire being kindled and kapha being overcome, there may be association of vayu which should be treated thereafter.

Goat milk is the excellent remedy for that. Cow milk boiled with:

  1. five times water along with sugar and honey or
  2. the drugs of vidarigandhadi group or
  3. draksha or
  4. nagaraka (musta) or
  5. bala or
  6. gokshuraka or
  7. jivaka and rishabhaka added with ghee and sugar. [82-84]

Treatment of hematuria and per rectal bleeding

शतावरीगोक्षुरकैः शृतं वा शृतं पयो वाऽप्यथ पर्णिनीभिः|
रक्तं निहन्त्याशु विशेषतस्तु यन्मूत्रमार्गात् सरुजं याति||८५||

Milk boiled with shatavari and gokshura, or the four leaved herbs (mudgaparni, mashaparni, shalaparni and prashniparni), check the hemorrhage quickly particularly that from urinary passage and with pain.[85]

Treatment of per rectal bleeding

विशेषतो विट्पथसम्प्रवृत्ते पयो मतं मोचरसेन सिद्धम्|
वटावरोहैर्वटशुङ्गकैर्वा ह्रीबेरनीलोत्पलनागरैर्वा||८६||

कषाययोगान् पयसा पुरा वा पीत्वाऽनु चाद्यात् पयसैव शालीन्|
कषाययोगैरथवा विपक्वमेतैः पिबेत् सर्पिरतिस्रवे च||८७||

Particularly in haemorrhage from rectum milk boiled with mocharasa, or hanging roots or leaf-buds of vata or hribera, nilotpala and nagara (musta) should be taken. After taking the medicinal extracts with milk the patient should take ghee cooked with these extracts. [85-87]

Vasa ghee

वासां सशाखां सपलाशमूलां कृत्वा कषायं कुसुमानि चास्याः|
प्रदाय कल्कं विपचेद्घृतं तत् सक्षौद्रमाश्वेवनिहन्ति रक्तम्||८८||

इति वासाघृतम्|

Vasa along with branches, leaves and root should be boiled and made into decoction. Ghee should be cooked with this decoction putting vasa flowers as paste. This (vasa) ghrita taken with honey checks the hemorrhage quickly (thus the name, vasa ghrita). [88]

पलाशवृन्तस्वरसेन सिद्धं तस्यैव कल्केन मधुद्रवेण|
लिह्याद्घृतं वत्सककल्कसिद्धं तद्वत् समङ्गोत्पललोध्रसिद्धम्||८९||

स्यात्त्रायमाणाविधिरेष एव सोदुम्बरे चैव पटोलपत्रे |
सर्पींषि पित्तज्वरनाशनानि सर्वाणि शस्तानि च रक्तपित्ते||९०||

Ghrita cooked with:

  1. the juice of the stamens of the palasha (flowers) along with the paste of the same liquefied with honey,
  2. the paste of kutaja,
  3. samanga (lajjalu), utpala and lodhra,
  4. trayamana,
  5. udumbara and
  6. patola leaves are efficacious in paittika fever and all are commended for use in hemorrhagic disorder. [89-90]

External applications

अभ्यङ्गयोगाः परिषेचनानि सेकावगाहाः शयनानि वेश्म|
शीतो विधिर्बस्तिविधानमग्र्यं पित्तज्वरे यत् प्रशमाय दिष्टम्||९१||

तद्रक्तपित्ते निखिलेन कार्यं कालं च मात्रां च पुरा समीक्ष्य|
सर्पिर्गुडा ये च हिताः क्षतेभ्यस्ते रक्तपित्तं शमयन्ति सद्यः||९२||

All measures which are prescribed for the treatment of pattika fever such as massage, sprinkling, baths, beds, room/coverings, cooling methods or enema should be applied in hemorrhagic disorder considering the season and dose. Sarpirguda (the formulation of jaggery and ghee) prescribed for the patients of kshata (chest injury) control the hemorrhagic disorder quickly. [91-92]

Treatment of raktapitta with associated kapha

कफानुबन्धे रुधिरे सपित्ते कण्ठागते स्याद्ग्रथिते प्रयोगः|
युक्तस्य युक्त्यामधुसर्पिषोश्च क्षारस्य चैवोत्पलनालजस्य||९३||

मृणालपद्मोत्पलकेशराणां तथा पलाशस्य तथा प्रियङ्गोः|
तथा मधूकस्य तथाऽसनस्य क्षाराः प्रयोज्या विधिनैव तेन||९४||

In case of raktapitta if there is association of kapha and blood reaching the throat is adherent, alkali of the stalk of water lily mixed with honey and ghee should be used. In the same way, alkali of lotus stalk, lotus, water lily, nagakeshara, palasha, priyangu, madhuka and asana should be used. [93-94]

Shatavaryadi ghee

शतावरीदाडिमतिन्तिडीकं काकोलिमेदे मधुकं विदारीम्|
पिष्ट्वा च मूलं फलपूरकस्य घृतं पचेत् क्षीरचतुर्गुणं ज्ञः||९५||

कासज्वरानाहविबन्धशूलं तद्रक्तपित्तं च घृतं निहन्यात्|
यत् पञ्चमूलैरथ पञ्चभिर्वा सिद्धं घृतं तच्च तदर्थकारि||९६||

इति शतावर्यादिघृतम्|

Ghee should be cooked with shatavari, dadima, tintidika, kakoli, meda, madhuka and vidari along with the paste of the root of bijapura adding four times milk. This ghrita alleviates cough, fever, hardness of bowels, constipation, pain and hemorrhagic disorder.

Ghee cooked with drugs of five groups of five roots each( described in Rasayana chapter) has the same effect. (This is shatavaryadi ghrita). [95-96]

Treatment of nasal bleeding

कषाययोगा य इहोपदिष्टास्ते चावपीडे भिषजा प्रयोज्याः|
घ्राणात् प्रवृत्तं रुधिरं सपित्तं यदा भवेन्निःसृतदुष्टदोषम्||९७||

रक्ते प्रदुष्टे ह्यवपीडबन्धे दुष्टप्रतिश्यायशिरोविकाराः|
रक्तं सपूयं कुणपश्चगन्धः स्याद् घ्राणनाशः कृमयश्चदुष्टाः||९८||

नीलोत्पलं गैरिकशङ्खयुक्तं सचन्दनं स्यात्तु सिताजलेन|
नस्यं तथाऽऽम्रास्थिरसः समङ्गा सधातकीमोचरसः सलोध्रः||९९||

द्राक्षारसस्येक्षुरसस्य नस्यं क्षीरस्य दूर्वास्वरसस्य चैव|
यवासमूलानि पलाण्डुमूलं नस्यं तथा दाडिमपुष्पतोयम्||१००||

प्रियालतैलं मधुकं पयश्च सिद्धं घृतं माहिषमाजिकं वा|
आम्रास्थिपूर्वैः पयसा च नस्यं ससारिवैः स्यात् कमलोत्पलैश्च||१०१||

The hemorrhagic disorder coming out of the nose should be treated with the above decoctive drugs in the form of avapida (nasal errhines with juice) when the vitiated doshas are eliminated, otherwise if the affected rakta is checked by juice-snuffing it produces obstinate coryza, head diseases, blood with pus and corpse-like smell, loss of smell sensation and maggots.

In this condition snuffing with:

  1. nilotpala, ochre, conch, sandal along with sugar water,
  2. juice of mango-seed, lajjalu, dhataki, mocharasa and lodhra,
  3. grape juice,
  4. sugarcane juice,
  5. milk,
  6. juice of durva,
  7. yavasa roots,
  8. palandu (bulbs),
  9. juice of pomegranate flowers,
  10. priyala taila or buffalo's or goat's ghee cooked with madhuka and milk,
  11. mango seed, lajjatu, dhataki, mocarasa and lodhra along with milk,
  12. sariva, kamala and utpala with milk. [97-101]

भद्रश्रियं लोहितचन्दनं च प्रपौण्डरीकं कमलोत्पले च|
उशीरवानीरजलं मृणालं सहस्रवीर्या मधुकं पयस्या||१०२||

शालीक्षुमूलानि यवासगुन्द्रामूलं नलानां कुशकाशयोश्च|
कुचन्दनं शैवलमप्यनन्ता कालानुसार्या तृणमूलमृद्धिः||१०३||

मूलापुष्पाणि च वारिजानां प्रलेपनं पुष्करिणीमृदश्च|
उदुम्बराश्वत्थमधूकलोध्राः कषायवृक्षाः शिशिराश्च सर्वे||१०४||

प्रदेहकल्पे परिषेचने च तथाऽवगाहे घृततैलसिद्धौ|
रक्तस्य पित्तस्य च शान्तिमिच्छन् भद्रश्रियादीनि भिषक् प्रयुञ्ज्यात्||१०५||

धारागृहं भूमिगृहं सुशीतं वनं च रम्यं जलवातशीतम्|
वैदूर्यमुक्तामणिभाजनानास्पर्शाश्च दाहे शिशिराम्बुशीताः||१०६||

पत्राणि पुष्पाणि च वारिजानां क्षौमं च शीतं कदलीदलानि|
प्रच्छादनार्थं शयनासनानां पद्मोत्पलानां च दलाः प्रशस्ताः||१०७||

प्रियङ्गुकाचन्दनरूषितानां स्पर्शाः प्रियाणां च वराङ्गनानाम्|
दाहे प्रशस्ताः सजलाः सुशीताः पद्मोत्पलानां च कलापवाताः||१०८||

सरिद्ध्रदानां हिमवद्दरीणां चन्द्रोदयानां कमलाकराणाम्|
मनोऽनुकूलाः शिशिराश्च सर्वाः कथाः सरक्तं शमयन्ति पित्तम्||१०९||

Bhadrashriya, red sandal, prapaundarika, kamala, utpala, ushira, vanira, hribera, mrinala, bigger shatavari, madhuka, payasya, roots of shali, ikshu, yavasa, gundra, nala, kusha, kuchandana, shaivala, ananta, seasonal grass roots (of cold season), riddhi, roots and flowers of aquatic plants, local application of mud from pond, udumbara, ashwattha, madhuka, lodhra and other astringent and cold plants – the physician desiring allevation of raktapitta should use the drugs of the (above) bhadrashriyadi group in anointing, sprinkling, bath and preparation of ghee and oil.

Quiet cool water chamber, underground chamber, beautiful park cooled with watery air, contact of utensils made of vaidurya, pearls, gems cooled with cold water – these are used in case of burning sensation. Moreover, the beds and chairs be covered with leaves and flowers of aquatic plants, cold silk cloth, banana leaves and leaves of lotus and water lily. Touch of the charming women anointed with priyangu and chandana, and moist and cool breezes from lotus and water lily are commended for use in burning sensation. Visit of rivers and lakes, glaciers, ponds having water lily and lotus flowers, shishira (winter) season, favorite and soothing narratives pacify raktapitta. [101-109]

Summary

तत्र श्लोकौ-

हेतुं वृद्धिं सञ्ज्ञां स्थानं लिङ्गंपृथक् प्रदुष्टस्य|
मार्गौ साध्यमसाध्यं याप्यं कार्यक्रमं चैव||११०||

पानान्नमिष्टमेव च वर्ज्यं संशोधनं च शमनं च|
गुरुरुक्तवान्यथावच्चिकित्सिते रक्तपित्तस्य||१११||

Now the summing up verse –

Etiology, aggravation, definition, location, symptoms, passages, curability, incurability and maintainability principle of treatment, diet indicated and contraindicated, purification and pacification measures, all this described by the teacher shall be applied for treatment of raktapitta (hemorrhagic disorder). [110]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेचिकित्सितस्थाने रक्तपित्तचिकित्सितं नाम चतुर्थोऽध्यायः||४||

Thus ends the fourth chapter on the treatment of hemorrhagic disorder in Chikitsa Sthana in the treatise composed by Agnivesha and redacted by Charak. (4)

Tattva Vimarsha (Fundamental Principles)

  • The causes of raktapitta include excess consumption of food with hot potency and ingredients with sharp, sour, pungent and salty taste, exposure to the sun and foods that cause burning sensations.
  • Pitta dosha and rakta have similar properties in terms of vitiation, odor, color and origin. Therefore, anything affecting pitta will affect rakta and vice versa.
  • The pitta and rakta (blood) including blood vessels originate from spleen and liver.
  • Affliction by kapha in rakta can be observed by appearance of viscous, pale, unctuous and slimy blood (in blood coming out).
  • Blackish, reddish, frothy, thin and roughness in blood indicates affliction by vata.
  • Blood having ochre-like, black, cow-urine-like, shining black, smoky and collyrium-like color indicates pitta affliction. Due to combination of two doshas the symptoms of both manifest. Raktapitta caused by sannipata has symptoms of all the three doshas.
  • The prognosis and treatment of raktapitta depend upon movement of vitiated rakta, direction of its flow, origin, severity of disease, strength of patient.
  • Raktapitta is caused by food having predominantly unctuous-hot and rough-hot properties. The former often gives rise to the upward movement and the latter to the downward movement of raktapitta.
  • The upward movement in raktapitta is associated with kapha, the downward one with vata and that from both the passages is associated with both kapha and vata.
  • Stambhana (styptic therapy) should not be given at first in hemorrhagic disorders having excessive impurities, aggravated doshas, over-nourished and in a person who is not emaciated and weak.
  • Mostly the raktapitta is aggravated by amadosha, hence patient should be managed with langhana (lightening measures). In the beginning stage of raktapitta, lightening or nourishing measure according to passage, association of dosha and etiology shall be applied.
  • Raktapitta, due to excess nutrition in a strong patient with aggravated doshas, who don’t have emaciation, debility and complications, should be treated with purification therapy by purgation in upward type and emesis in lower movement of raktapitta.
  • After purification, in the case of upward type, the dietetic regimen starts with saturating drinks. In that of downward type, it starts with gruel subjected to the condition that vata is not dominant.
  • All types of sweet, bitter, astringent medicines with cold potency are indicated in diet and medicinal management. In lifestyle management, the cold measures and avoiding exposure to excess heat are applied in treatment of hemorrhagic disorders.

Vidhi Vimarsha (Applied Inferences )

Bleeding disorders are often caused by a failure of the blood to clot. Several conditions can affect the way the blood clots. Many causes are related to protein defects in the plasma (the liquid component of blood). These proteins are directly responsible for how the blood coagulates (clots). In some diseases, these proteins might be missing completely or they may be low in count. The majority of these defects are hereditary (passed from parent to child through genes). However, some may develop due to other medical conditions. Other conditions that can cause bleeding disorders are:

  • liver disease
  • low red blood cell count
  • vitamin K deficiency
  • medication side-effects

Types of Bleeding Disorders

There are several bleeding disorders that can be inherited (passed down through genetics) or acquired. Some cause bleeding spontaneously, whereas others cause bleeding following an accident.

The most common inherited bleeding disorders are:

  • Hemophilia A and B: caused by a deficiency or lack of certain blood clotting proteins, called factors. This disorder causes heavy or unusual bleeding
  • Factor II, V, VII, X, XII deficiency: relate to blood clotting problems or abnormal bleeding problems
  • von Willebrand’s Disease: the most common inherited bleeding disorder; caused by a deficiency of von Willebrand factor, which helps blood platelets clump together and stick to a blood vessel wall.

Certain diseases or medical conditions can also cause a deficiency of one or more blood clotting factors. The most common causes of acquired bleeding disorders are end-stage liver disease or vitamin K deficiency. According to the American Association of Clinical Chemistry (AACC), this is because most blood clotting factors are produced in the liver, and certain clotting factors are vitamin k dependent (AACC, 2011).

Identification of Bleeding Disorders/Symptoms

The main sign of a bleeding disorder is prolonged or excessive bleeding. The bleeding is normally heavier than normal and unprovoked.

Other signs of a bleeding disorder include:

  • unexplained bruising
  • heavy menstrual bleeding
  • frequent nosebleeds

Types of raktapitta described in Ayurveda can be correlated with following disorders for understanding:

Type Ayurvedic Modern
Urdhvaga Nasa Epitaxis
Mukha Hematemesis
Karna Otorrhagia
Adhoga Guda Bacillary dysentery, melina, bloody diarrhoea
Mutra Hematuria
Yoni Menorrhagia or metrorrhagia
Tiryaka Purpura

There are various bleeding disorders, some of which can be correlated with raktapitta. Bleeding disorders can occur either due to decrease in coagulation factor in blood or due to increase in bleeding factor. When patient has bleeding from anus (guda) or vagina(yoni), then it is difficult to differentiate whether the disease is adhoga raktapitta or raktarsha or raktatisara or pradara. There are major similarities in causes, signs, doshas involved but also minor differences. And that minor differences need to be studied to capture the right link of disease, which can be done only when one has, the deep knowledge of Ayurvedic diagnostic tool i.e. nidanpanchaka. The profound cognizance of nidanapanchaka as a diagnostic tool can enhance the treatment modalities of Ayurvedic management of diseases in coming years.

Commonly used medicines in raktapitta

Important medicines

  1. Vasa
  2. Amalaki
  3. Praval bhasma

Treatment of urdhvaga raktapitta

  1. Lakshadi mixture 3-5 grams frequently with vasavaleha
  2. Padmakadi tailam 10-20 drops empty stomach three times in a day with milk

Treatment of adhoga raktapitta

  1. Shatavaryadi kwatha 25 to 40 ml empty stomach three times with sugar
  2. Mocharasa mixture 125 to 250 mg before meals two times with juice of amalaki or vasavaleha or shatavaryadi kwatha
  3. Chadrakala rasa 250 to 500 mg after meals with vasavaleha
  4. Bol-parpati mixture 250 to 500 mg after meals with vasavaleha

Treatment of chronic stage

  1. Vasa ghee 10 to 40 ml after meals with milk

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