Raktapitta Chikitsa

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

==(Chikitsa Sthana Chapter 4. Raktapitta Chikitsa (Management of bleeding disorders)

Abstract: Raktapitta is a disease not yet known to modern medical science. It 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). Unlike most other bleeding disorders which are hereditary, raktapitta is acquired and occurs because of excessive aggravation of pitta and its afflication 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. Keywords: Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation.

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 and based on dosha specific features of raktapitta may appear pale, unctuous and slimy in kapha, frothy, blackish red in vata and cane sugar like 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 uppper 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. The details regimen, priniciples of management are elaborately described in the chapter अथातो रक्तपित्तचिकित्सितं व्याख्यास्यामः ||१|| इति ह स्माह भगवानात्रेयः||२|| athātō raktapittacikitsitaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAto raktapittacikitsitaM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2|| Now we shall expound the chapter on raktapitta (haemorrhagic disorders). (1) As propounded by 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|| viharantaṁ jitātmānaṁ pañcagaṅgē punarvasum| praṇamyōvāca nirmōhamagnivēśō'gnivarcasam||3|| bhagavan raktapittasya hēturuktaḥ salakṣaṇaḥ| vaktavyaṁ yat paraṁ tasya vaktumarhasi tadgurō||4|| viharantaM jitAtmAnaM pa~jcaga~gge punarvasum| praNamyovAca nirmohamagnivesho~agnivarcasam||3|| bhagavan raktapittasya heturuktaH salakShaNaH| vaktavyaM yat paraM tasya vaktumarhasi tadguro||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: गुरुरुवाच- महागदं महावेगमग्निवच्छीघ्रकारि च| हेतुलक्षणविच्छीघ्रं रक्तपित्तमुपाचरेत्||५|| तस्योष्णं तीक्ष्णमम्लं च कटूनि लवणानि च| घर्मश्चान्नविदाहश्च हेतुः पूर्वं निदर्शितः||६|| gururuvāca- mahāgadaṁ mahāvēgamagnivacchīghrakāri ca| hētulakṣaṇavicchīghraṁ raktapittamupācarēt||5|| tasyōṣṇaṁ tīkṣṇamamlaṁ ca kaṭūni lavaṇāni ca| gharmaścānnavidāhaśca hētuḥ pūrvaṁ nidarśitaḥ||6|| gururuvAca- mahAgadaM mahAvegamagnivacchIghrakAri ca| hetulakShaNavicchIghraM raktapittamupAcaret||5|| tasyoShNaM tIkShNamamlaM ca kaTUni lavaNAni ca| gharmashcAnnavidAhashca hetuH pUrvaM nidarshitaH||6|| 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|| tairhētubhiḥ samutkliṣṭaṁ pittaṁ raktaṁ prapadyatē| tadyōnitvāt prapannaṁ ca vardhatē tat pradūṣayat||7|| tasyōṣmaṇādravō dhāturdhātōrdhātōḥ rasicyatē| svidyatastēnasaṁvr̥ddhiṁ hūyastadadhigacchati||8|| tairhetubhiH samutkliShTaM pittaM raktaM prapadyate| tadyonitvAt prapannaM ca vardhate tat pradUShayat||7|| tasyoShmaNA dravo dhAturdhAtordhAtoH prasicyate| svidyatastena saMvRuddhiM bhUyastadadhigacchati||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: संयोगाद्दूषणात्तत्तु सामान्याद्गन्धवर्णयोः| रक्तस्य पित्तमाख्यातं रक्तपित्तं मनीषिभिः||९|| saṁyōgāddūṣaṇāttattu sāmānyādgandhavarṇayōḥ| raktasya pittamākhyātaṁ raktapittaṁ manīṣibhiḥ||9|| saMyogAddUShaNAttattu sAmAnyAdgandhavarNayoH| raktasya pittamAkhyAtaM raktapittaM manIShibhiH||9|| Because of conjunction with, similarity in causes of vitiation, odour, colour and origin, the disease is called rakta-pitta. (9) Origin of disease: प्लीहानं च यकृच्चैव तदधिष्ठाय वर्तते| स्रोतांसि रक्तवाहीनि तन्मूलानि हि देहिनाम्||१०|| plīhānaṁ ca yakr̥ccaiva tadadhiṣṭhāya vartatē| srōtāṁsi raktavāhīni tanmūlāni hi dēhinām||10|| plIhAnaM ca yakRuccaiva tadadhiShThAya vartate| srotAMsi raktavAhIni tanmUlAni hi dehinAm||10|| 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| sāndraṁ sapāṇḍu sasnēhaṁ picchilaṁ ca kaphānvitam| śyāvāruṇaṁ saphēnaṁ ca tanu rūkṣaṁ ca vātikam||11|| raktapittaṁ kaṣāyābhaṁ kr̥ṣṇaṁ gōmūtrasannibham| mēcakāgāradhūmābhamañjanābhaṁ capaittikam||12|| saṁsr̥ṣṭaliṅgaṁ saṁsargāttriliṅgaṁ ānnipātikam|13| sAndraM sapANDu sasnehaM picchilaM ca kaphAnvitam| shyAvAruNaM saphenaM ca tanu rUkShaM ca vAtikam||11|| raktapittaM kaShAyAbhaM kRuShNaM gomUtrasannibham| mecakAgAradhUmAbhama~jjanAbhaM ca paittikam||12|| saMsRuShTali~ggaM saMsargAttrili~ggaM sAnnipAtikam|13| 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 collyrium-like colour 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|| ēkadōṣānugaṁ sādhyaṁ dvidōṣaṁ yāpyamucyatē||13|| yattridōṣamasādhyaṁtanmandāgnērativēgavat|vyādhibhiḥ

kṣīṇadēhasya vr̥ddhasyānaśnataśca yat||14||

ekadoShAnugaM sAdhyaM dvidoShaM yApyamucyate||13|| yattridoShamasAdhyaM tanmandAgnerativegavat| vyAdhibhiH kShINadehasya vRuddhasyAnashnatashca yat||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: 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|| gatirūrdhvamadhaścaiva raktapittasya | darśitā ūrdhvā saptavidhadvārā dvidvārā tvadharā gatiḥ||15||

sapta cchidrāṇi śirasi dvē cādhaḥ, sādhyamūrdhvagam| 

yāpyaṁtvadhōgaṁ, mārgau tu dvāvasādhyaṁprapadyatē||16||

yadā tu sarvacchidrēbhyō rōmakūpēbhya  ēva  ca|

vartatē tāmasaṅkhyēyāṁ gatiṁ tasyāhurāntikīm||17||

yaccōbhayābhyāṁ mārgābhyāmatimātraṁ pravartatē| 

tulyaṁ kuṇapagandhēna raktaṁ kr̥ṣṇamatīva ca||18||

saṁsr̥ṣṭaṁ kaphavātābhyāṁ kaṇṭhēsajjati cāpi yat| 

yaccāpyupadravaiḥ sarvairyathōktaiḥ samabhidrutam||19||

hāridranīlaharitatāmrairvarṇairupadrutam|

kṣīṇasya kāsamānasya yacca tacca nasidhyati||20||

yadvidōṣānugaṁ yadvā śāntaṁ śāntaṁ prakupyati|

mārgānmārgaṁ rēdyadvā yāpyaṁ ittamasr̥k ca tat||21||

gatirUrdhvamadhashcaiva raktapittasya darshitA| UrdhvA saptavidhadvArA dvidvArA tvadharA gatiH||15|| sapta cchidrANi shirasi dve cAdhaH, sAdhyamUrdhvagam| yApyaM tvadhogaM, mArgau tu dvAvasAdhyaM prapadyate||16|| yadA tu sarvacchidrebhyo romakUpebhya eva ca| vartate tAmasa~gkhyeyAM gatiM tasyAhurAntikIm||17|| yaccobhayAbhyAM mArgAbhyAmatimAtraM pravartate| tulyaM kuNapagandhena raktaM kRuShNamatIva ca||18|| saMsRuShTaM kaphavAtAbhyAM kaNThe [4] sajjati cApi yat| yaccApyupadravaiH sarvairyathoktaiH samabhidrutam||19|| hAridranIlaharitatAmrairvarNairupadrutam| kShINasya kAsamAnasya yacca tacca na sidhyati||20|| yadvidoShAnugaM yadvA shAntaM shAntaM [5] prakupyati| mArgAnmArgaM caredyadvA yApyaM pittamasRuk ca tat||21|| 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, posessing 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 rakta-pitta: एकमार्गं बलवतो नातिवेगं नवोत्थितम्| रक्तपित्तं काले साध्यं स्यान्निरुपद्रवम्||२२|| ēkamārgaṁ balavatō nātivēgaṁ avōtthitam| raktapittaṁ sukhē kālē sādhyaṁ syānnirupadravam||22|| ekamArgaM balavato nAtivegaM navotthitam| raktapittaM sukhe kAle sAdhyaM syAnnirupadravam||22|| Raktapitta which has only one passage, is in the strong person, not very forceful, with recent onset, in favourable 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|| snigdhōṣṇamuṣṇarūkṣaṁ ca raktapittasya kāraṇam| hōgasyōttaraṁ rāyaḥ, pūrvaṁ syādūrdhvagasyatu||23|| ūrdhvagaṁ kaphasaṁsr̥ṣṭamadhōgaṁ mārutānugam| dvimārgaṁkaphavātābhyāmubhābhyāmanubadhyatē||24|| snigdhoShNamuShNarUkShaM ca raktapittasya kAraNam| adhogasyottaraM prAyaH, pUrvaM syAdUrdhvagasya tu||23|| UrdhvagaM kaphasaMsRuShTamadhogaM mArutAnugam| dvimArgaM kaphavAtAbhyAmubhAbhyAmanubadhyate||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: 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|| akṣīṇabalamāṁsasya raktapittaṁ yadaśnataḥ| taddōṣaduṣṭamutkliṣṭaṁ nādau stambhanamarhati||25||

galagrahaṁ pūtinasyaṁ mūrcchāyamaruciṁ  jvaram|

gulmaṁ plīhānamānāhaṁ kilāsaṁ r̥cchramūtratām||26||

kuṣṭhānyarśāṁsi vīsarpaṁ varṇanāśaṁ bhagandaram| 

buddhīndriyōparōdhaṁ ca kuryāt stambhitamāditaḥ||27||

		tasmādupēkṣyaṁbalinō  baladōṣavicāriṇ raktapittaṁ 
prathamataḥ ravr̥ddhaṁsiddhimicchatā||28||

akShINabalamAMsasya raktapittaM yadashnataH| taddoShaduShTamutkliShTaM nAdau stambhanamarhati||25|| galagrahaM pUtinasyaM mUrcchAyamaruciM jvaram| gulmaM plIhAnamAnAhaM kilAsaM kRucchramUtratAm||26|| kuShThAnyarshAMsi vIsarpaM varNanAshaM bhagandaram| buddhIndriyoparodhaM ca kuryAt stambhitamAditaH||27|| tasmAdupekShyaM balino baladoShavicAriNA [6] | raktapittaM prathamataH pravRuddhaM [7] siddhimicchatA||28||

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, foetid 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 haemorrhagic disorder after assessing the strength and condition or morbity in a strong patient. (25-28) प्रायेण हि समुत्क्लिष्टमामदोषाच्छरीरिणाम्| वृद्धिं प्रयातिपित्तासृक्तस्मात्तल्लङ्घ्यमादितः||२९|| मार्गौ दोषानुबन्धं च निदानं प्रसमीक्ष्य च| लङ्घनं रक्तपित्तादौ तर्पणं वा प्रयोजयेत्||३०|| prāyēṇa hi mutkliṣṭamāmadōṣāccharīriṇām| vr̥ddhiṁ prayāti pittāsr̥ktasmāttallaṅghyamāditaḥ||29|| mārgau dōṣānubandhaṁ ca nidānaṁ prasamīkṣya ca| laṅghanaṁ raktapittādau tarpaṇaṁ vā prayōjayēt||30|| prAyeNa hi samutkliShTamAmadoShAccharIriNAm| vRuddhiM prayAti pittAsRuktasmAttalla~gghyamAditaH||29|| mArgau doShAnubandhaM ca nidAnaM prasamIkShya ca| la~gghanaM raktapittAdau tarpaNaM vA prayojayet||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: 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|| hrībēracandanōśīramustaparpaṭakaiḥ śr̥tam|kēvalaṁ śr̥taśītaṁ vā dadyāttōyaṁ pipāsavē||31|| ūrdhvagē tarpaṇaṁ pūrvaṁ pēyāṁ pūrvamadhōgatē| kālasātmyānubandhajñō dadyāt prakr̥tikalpavit||32|| jalaṁ kharjūramr̥dvīkāmadhūkaiḥ saparūṣakaiḥ| śr̥taśītaṁ prayōktavyaṁ tarpaṇārthē saśarkaram||33|| tarpaṇaṁ saghr̥takṣaudraṁ lājacūrṇaiḥ pradāpayēt| ūrdhvagaṁ raktapittaṁ tat pītaṁ kālē vyapōhati||34|| mandāgnēramlasātmyāya tat sāmlamapi kalpayēt|

dāḍimāmalakairvidvānamlārthaṁ cānudāpayēt||35||

hrIberacandanoshIramustaparpaTakaiH shRutam| kevalaM shRutashItaM vA dadyAttoyaM pipAsave||31|| Urdhvage tarpaNaM pUrvaM peyAM pUrvamadhogate| kAlasAtmyAnubandhaj~jo dadyAt prakRutikalpavit||32|| jalaM kharjUramRudvIkAmadhUkaiH saparUShakaiH| shRutashItaM prayoktavyaM tarpaNArthe sasharkaram||33|| tarpaNaM saghRutakShaudraM lAjacUrNaiH pradApayet| UrdhvagaM raktapittaM tat pItaM kAle vyapohati||34|| mandAgneramlasAtmyAya tat sAmlamapi kalpayet| dADimAmalakairvidvAnamlArthaM [8] cAnudApayet||35|| 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 rakta-pitta: 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|| śāliṣaṣṭikanīvārakōradūṣapraśāntikāḥ| śyāmākaśca priyaṅguśca bhōjanaṁ raktapittinām||36|| mudgā masūrāścaṇakāḥ samakuṣṭhāḍhakīphalāḥ| praśastāḥ sūpayūṣārthē kalā raktapittinām||37|| paṭōlanimbavētrāgraplakṣavētasapallavāḥ| kirātatiktakaṁ śākaṁ gaṇḍīraḥ sakaṭhillakaḥ||38|| kōvidārasya puṣpāṇi kāśmaryasyātha śālmalēḥ| annapānavidhau śākaṁ yaccānyadraktapittanut||39|| śākārthaṁ śākasātmyānāṁ tacchastaṁ raktapittinām| svinnaṁ vā sarpiṣā bhr̥ṣṭaṁ yūṣavadvā vipācitam||40|| pārāvatān kapōtāṁśca lāvān raktākṣavartakān| śaśān kapiñjalānēṇān hariṇānkālapucchakān||41|| raktapittē hitān vidyādrasāṁstēṣāṁ prayōjayēt| īṣadamlānanamlān vā ghr̥tabhr̥ṣṭān saśarkarān||42|| kaphānugē yūṣaśākaṁ dadyādvātānugē rasam| raktapittē yavāgūnāmataḥ kalpaḥpravakṣyatē||43|| shAliShaShTikanIvArakoradUShaprashAntikAH| shyAmAkashca priya~ggushca bhojanaM raktapittinAm||36|| mudgA masUrAshcaNakAH samakuShThADhakIphalAH| prashastAH sUpayUShArthe kalpitA raktapittinAm||37|| paTolanimbavetrAgraplakShavetasapallavAH| kirAtatiktakaM shAkaM gaNDIraH [9] sakaThillakaH||38|| kovidArasya puShpANi kAshmaryasyAtha shAlmaleH| annapAnavidhau shAkaM yaccAnyadraktapittanut||39|| shAkArthaM shAkasAtmyAnAM tacchastaM raktapittinAm| svinnaM vA sarpiShA bhRuShTaM yUShavadvA vipAcitam||40|| pArAvatAn kapotAMshca lAvAn raktAkShavartakAn| shashAn kapi~jjalAneNAn hariNAnkAlapucchakAn||41|| raktapitte hitAn vidyAdrasAMsteShAM prayojayet| IShadamlAnanamlAn vA ghRutabhRuShTAn sasharkarAn||42|| kaphAnuge yUShashAkaM dadyAdvAtAnuge rasam| raktapitte yavAgUnAmataH kalpaH pravakShyate||43||

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 (types of deer) are wholesome in raktapitta. Their soup is used soured or unsoured, 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 rakta-pitta: 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|| padmōtpalānāṁ kiñjalkaḥ pr̥śniparṇī priyaṅgukāḥ| jalē sādhyā rasē tasmin pēyā syādraktapittinām||44|| candanōśīralōdhrāṇāṁ rasē tadvat sanāgarē| kirātatiktakōśīramustānāṁ tadvadēva ca||45|| dhātakīdhanvayāsāmbubilvānāṁ vā rasē śr̥tā| masūrapr̥śniparṇyōrvāsthirāmudgarasē'tha vā||46|| rasē harēṇukānāṁ vā saghr̥tē sabalārasē| siddhāḥ pārāvatādīnāṁ rasē vā syuḥ pr̥thakpr̥thak||47|| ityuktā raktapittaghnyaḥ śītāḥ samadhuśarkarāḥ| yavāgvaḥ kalpanā caiṣā kāryā māṁsarasēṣvapi||48|| padmotpalAnAM ki~jjalkaH pRushniparNI priya~ggukAH| jale sAdhyA rase tasmin peyA syAdraktapittinAm||44|| candanoshIralodhrANAM rase tadvat sanAgare| kirAtatiktakoshIramustAnAM tadvadeva ca||45|| dhAtakIdhanvayAsAmbubilvAnAM vA rase shRutA| masUrapRushniparNyorvA sthirAmudgarase~atha vA||46|| rase hareNukAnAM vA saghRute sabalArase| siddhAH pArAvatAdInAM rase vA syuH pRuthakpRuthak||47|| ityuktA raktapittaghnyaH shItAH samadhusharkarAH| yavAgvaH kalpanA caiShA kAryA mAMsaraseShvapi||48|| 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|| śaśaḥ savāstukaḥ śastō vibandhē raktapittinām| ātōlbaṇē tittiriḥ syādudumbararasē śr̥taḥ||49|| mayūraḥ plakṣaniryūhē nyagrōdhasya ca kukkuṭaḥ| rasē bilvōtpalādīnāṁ vartakakrakarau hitau||50|| tr̥ṣyatē tiktakaiḥ siddhaṁtr̥ṣṇāghnaṁ vā phalōdakam| siddhaṁ vidārigandhādyairathavā śr̥taśītalam||51|| shashaH savAstukaH shasto vibandhe raktapittinAm| vAtolbaNe tittiriH syAdudumbararase shRutaH||49|| mayUraH plakShaniryUhe nyagrodhasya ca kukkuTaH| rase bilvotpalAdInAM [10] vartakakrakarau hitau||50|| tRuShyate tiktakaiH siddhaM tRuShNAghnaM vA phalodakam| siddhaM vidArigandhAdyairathavA [11] shRutashItalam||51|| 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) peocock 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|| jñātvā dōṣāvanubalau balamāhāramēva ca| jalaṁ pipāsavē dadyādvisargādalpaśō'pi vā||52|| j~jAtvA doShAvanubalau balamAhArameva ca| jalaM pipAsave dadyAdvisargAdalpasho~api [12] vA||52||

Water should be given to the thirsty patient upto complete satisfaction of thrist 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| nidānaṁ raktapittasya yatkiñcit samprakāśitam| jīvitārōgyakāmaistanna sēvyaṁ raktapittibhiḥ||53|| ityannapānaṁ nirdiṣṭaṁ kramaśō raktapittanut|54| nidAnaM raktapittasya yatki~jcit samprakAshitam| jIvitArogyakAmaistanna sevyaM raktapittibhiH||53|| ityannapAnaM nirdiShTaM kramasho raktapittanut|54| 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 rakta-pitta 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|| vakṣyatē bahudōṣāṇāṁ kāryaṁ balavatāṁ ca yat||54|| akṣīṇabalamāṁsasya yasya santarpaṇōtthitam| bahudōṣaṁ balavatō raktapittaṁ śarīriṇaḥ||55|| kālē saṁśōdhanārhasya taddharēnnirupadravam| virēcanēnōrdhvabhāgamadhōgaṁ vamanēna ca||56|| trivr̥tāmabhayāṁ prājñaḥ phalānyāragvadhasya vā| trāyamāṇāṁ gavākṣyā vā mūlamāmalakāni vā||57|| virēcanaṁ prayuñjīta prabhūtamadhuśarkaram| rasaḥ praśasyatē tēṣāṁ raktapittē viśēṣataḥ||58|| vamanaṁ madanōnmiśrō manthaḥ sakṣaudraśarkaraḥ| saśarkaraṁ vā salilamikṣūṇāṁ rasa ēva vā||59|| vatsakasya phalaṁ mustaṁ madanaṁ madhukaṁ madhu| adhōvahē raktapittē vamanaṁ paramucyatē||60|| ūrdhvagē śuddhakōṣṭhasya tarpaṇādiḥ kramō hitaḥ| adhōgatē yavāgvādirna cētsyānmārutō balī||61|| vakShyate bahudoShANAM kAryaM balavatAM ca yat||54|| akShINabalamAMsasya yasya santarpaNotthitam| bahudoShaM balavato raktapittaM sharIriNaH||55|| kAle saMshodhanArhasya taddharennirupadravam| virecanenordhvabhAgamadhogaM vamanena ca||56|| trivRutAmabhayAM prAj~jaH phalAnyAragvadhasya vA| trAyamANAM gavAkShyA vA mUlamAmalakAni vA||57|| virecanaM prayu~jjIta prabhUtamadhusharkaram| rasaH prashasyate teShAM raktapitte visheShataH||58|| vamanaM madanonmishro manthaH sakShaudrasharkaraH| sasharkaraM vA salilamikShUNAM rasa eva vA||59|| vatsakasya phalaM mustaM madanaM madhukaM madhu| adhovahe raktapitte [13] vamanaM paramucyate||60|| Urdhvage shuddhakoShThasya tarpaNAdiH kramo hitaH| adhogate yavAgvAdirna cetsyAnmAruto balI||61||

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 don’t haveemaciation, 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 dietitic 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|| balamāṁsaparikṣīṇaṁ śōkabhārādhvakarśitam jvalanādityasantaptamanyairvā kṣīṇamāmayaiḥ||62|| garbhiṇīṁ sthaviraṁ bālaṁ rūkṣālpapramitāśinam| avamyamavirēcyaṁ vā yaṁ paśyēdraktapittinam||63|| śōṣēṇa sānubandhaṁ vā tasya saṁśamanī kriyā| śasyatē raktapittasya paraṁ sā'tha pravakṣyatē||64|| aṭarūṣakamr̥dvīkāpathyākvāthaḥ saśarkaraḥ| madhumiśraḥ śvāsakāsaraktapittanibarhaṇaḥ||65|| aṭarūṣakaniryūhē priyaṅguṁ mr̥ttikāñjanē| vinīya lōdhraṁ kṣaudraṁ ca raktapittaharaṁ pibēt||66|| padmakaṁ padmakiñjalkaṁ dūrvāṁ vāstūkamutpalam| nāgapuṣpaṁ ca lōdhraṁ ca tēnaiva vidhinā pibēt||67|| prapauṇḍarīkaṁ madhukaṁ madhu cāśvaśakr̥drasē| yavāsabhr̥ṅgarajasōrmūlaṁ vā gōśakr̥drasē||68|| vinīya raktapittaghnaṁ pēyaṁ syāttaṇḍulāmbunā| yuktaṁ vā maghusarpirbhyāṁ lihyādgōśvaśakr̥drasam||69|| khadirasya priyaṅgūṇāṁ kōvidārasya śālmalēḥ| puṣpacūrṇāni madhunā lihyānnā raktapittikaḥ||70|| śr̥ṅgāṭakānāṁ lājānāṁ mustakharjūrayōrapi| lihyāccūrṇāni madhunā padmānāṁ kēśarasya ca||71|| dhanvajānāmasr̥glihyānmadhunā mr̥gapakṣiṇām| sakṣaudraṁ grathitē raktē lihyāt pārāvataṁ śakr̥t||72|| balamAMsaparikShINaM shokabhArAdhvakarshitam| jvalanAdityasantaptamanyairvA kShINamAmayaiH||62|| garbhiNIM sthaviraM bAlaM rUkShAlpapramitAshinam| avamyamavirecyaM vA yaM pashyedraktapittinam||63|| shoSheNa sAnubandhaM vA tasya saMshamanI kriyA| shasyate raktapittasya paraM sA~atha pravakShyate||64|| aTarUShakamRudvIkApathyAkvAthaH sasharkaraH| madhumishraH shvAsakAsaraktapittanibarhaNaH||65|| aTarUShakaniryUhe priya~gguM mRuttikA~jjane| vinIya lodhraM kShaudraM ca raktapittaharaM pibet||66|| padmakaM padmaki~jjalkaM dUrvAM vAstUkamutpalam| nAgapuShpaM ca lodhraM ca tenaiva vidhinA pibet||67|| prapauNDarIkaM madhukaM madhu cAshvashakRudrase| yavAsabhRu~ggarajasormUlaM vA goshakRudrase||68|| vinIya raktapittaghnaM peyaM syAttaNDulAmbunA| yuktaM vA maghusarpirbhyAM lihyAdgoshvashakRudrasam||69|| khadirasya priya~ggUNAM kovidArasya shAlmaleH| puShpacUrNAni madhunA lihyAnnA raktapittikaH||70|| shRu~ggATakAnAM lAjAnAM mustakharjUrayorapi| lihyAccUrNAni madhunA padmAnAM kesharasya ca||71|| dhanvajAnAmasRuglihyAnmadhunA mRugapakShiNAm| sakShaudraM grathite rakte lihyAt pArAvataM shakRut||72|| 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 dyspnoea, cough and haemorrhagic 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 liquified horse's faeces or the roots of yavasa or bhringaraja dissolved in liquified cowdung should be taken with rice water. This alleviates haemorrhagic disorder. Or the solution of cow-dung and horse-dung mixed with honey and ghee be taken. The patient suffering from haemorrhagic 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|| uśīrakālīyakalōdhrapadmakapriyaṅgukākaṭphalaśaṅkhagairikāḥ| pr̥thak pr̥thak candanatulyabhāgikāḥ saśarkarāstaṇḍuladhāvanāplutāḥ||73|| raktaṁ sapittaṁ tamakaṁ pipāsāṁ dāhaṁ ca pītāḥ śamayanti sadyaḥ| kirātatiktaṁ kramukaṁ samustaṁ rapauṇḍarīkaṁ kamalōtpalē ca||74|| hrībēramūlāni paṭōlapatraṁ durālabhā parpaṭakō mr̥ṇālam| dhanañjayōdumbaravētasatvaṅnyagrōdhaśālēyayavāsakatvak||75||

tugālatāvētasataṇḍulīyaṁ sasārivaṁ mōcarasaḥ samaṅgā| 

pr̥thak pr̥thak candanayōjitāni tēnaiva kalpēna hitāni tatra||76|| niśi sthitā vā svarasīkr̥tā vā kalkīkr̥tā vā mr̥ditāḥ śr̥tā vā| ētē samastā gaṇaśaḥ pr̥thagvā raktaṁ sapittaṁ śamayanti yōgāḥ||77|| ushIrakAlIyakalodhrapadmakapriya~ggukAkaTphalasha~gkhagairikAH| pRuthak pRuthak candanatulyabhAgikAH sasharkarAstaNDuladhAvanAplutAH||73|| raktaM sapittaM tamakaM pipAsAM dAhaM ca pItAH shamayanti sadyaH| kirAtatiktaM kramukaM samustaM prapauNDarIkaM kamalotpale ca||74|| hrIberamUlAni paTolapatraM durAlabhA parpaTako mRuNAlam| dhana~jjayodumbaravetasatva~gnyagrodhashAleyayavAsakatvak||75|| tugAlatAvetasataNDulIyaM [15] sasArivaM mocarasaH sama~ggA| pRuthak pRuthak candanayojitAni tenaiva kalpena hitAni tatra||76|| nishi sthitA vA svarasIkRutA vA kalkIkRutA [16] vA mRuditAH shRutA vA| ete samastA gaNashaH pRuthagvA raktaM sapittaM shamayanti [17] yogAH||77||

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 haemorrhagic disorder. (72-77)

मुद्गाः सलाजाःसयवाः कृष्णाः सोशीरमुस्ताःसह चन्दनेन| बलाजले पर्युषिताः कषाया रक्तं सपित्तं शमयन्त्युदीर्णम्||७८|| mudgāḥ salājāḥ sayavāḥ sakr̥ṣṇāḥ sōśīramustāḥ saha candanēna|balājalē paryuṣitāḥ kaṣāyā raktaṁ sapittaṁ śamayantyudīrṇam||78|| mudgAH salAjAH sayavAH sakRuShNAH soshIramustAH saha candanena| balAjale paryuShitAH kaShAyA raktaM sapittaM shamayantyudIrNam||78||

Green gram, parched paddy, pippali, ushira, musta and chandana are kept for the whole night in water boiled with bala. This pacifies even the agravated rakta pitta. (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|| vaidūryamuktāmaṇigairikāṇāṁ mr̥cchaṅkhahēmāmalakōdakānām| madhūdakasyēkṣurasasya caiva pānācchamaṁ gacchati raktapittam||79|| uśīrapadmōtpalacandanānāṁ pakvasya lōṣṭasya ca yaḥ prasādaḥ| saśarkaraḥ kṣaudrayutaḥ suśītō raktātiyōgapraśamāya dēyaḥ||80||

priyaṅgukācandanalōdhrasārivāmadhūkamustābhayadhātakījalam| 

samr̥tprasādaṁ saha yaṣṭikāmbunā saśarkaraṁ raktanibarhaṇaṁ param||81|| vaidUryamuktAmaNigairikANAM mRuccha~gkhahemAmalakodakAnAm| madhUdakasyekShurasasya caiva pAnAcchamaM gacchati raktapittam||79|| ushIrapadmotpalacandanAnAM pakvasya loShTasya ca yaH prasAdaH| sasharkaraH kShaudrayutaH sushIto raktAtiyogaprashamAya deyaH||80|| priya~ggukAcandanalodhrasArivAmadhUkamustAbhayadhAtakIjalam| samRutprasAdaM saha yaShTikAmbunA [20] sasharkaraM raktanibarhaNaM param||81||

Haemorrhagic 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|| kaṣāyayōgairvividhairyathōktairdīptē'nalē ślēṣmaṇi nirjitē ca| yadraktapittaṁ praśamaṁ na yāti tatrānilaḥ syādanu tatra kāryam||82|| chāgaṁ payaḥ syāt paramaṁ prayōgē gavyaṁ śr̥taṁ pañcaguṇē jalē vā| saśarkaraṁ mākṣikasamprayuktaṁ vidārigandhādigaṇaiḥ śr̥taṁ vā||83|| drākṣāśr̥taṁ nāgarakaiḥ śr̥taṁ vā balāśr̥taṁ gōkṣurakaiḥ śr̥taṁ vā| sajīvakaṁ sarṣabhakaṁ sasarpiḥ payaḥ prayōjyaṁ sitayā śr̥taṁ vā||84|| kaShAyayogairvividhairyathoktairdIpte~anale shleShmaNi nirjite ca| yadraktapittaM prashamaM na yAti tatrAnilaH syAdanu tatra kAryam||82|| chAgaM payaH syAt paramaM prayoge gavyaM shRutaM pa~jcaguNe jale vA| sasharkaraM mAkShikasamprayuktaM vidArigandhAdigaNaiH shRutaM vA||83|| drAkShAshRutaM nAgarakaiH shRutaM vA balAshRutaM gokShurakaiH shRutaM vA| sajIvakaM sarShabhakaM sasarpiH payaH prayojyaM sitayA shRutaM vA||84|| The haemorrhagic 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|| śatāvarīgōkṣurakaiḥ śr̥taṁ vā śr̥taṁ payō vā'pyatha parṇinībhiḥ| raktaṁ nihantyāśu viśēṣatastu yanmūtramārgāt sarujaṁ prayāti||85|| shatAvarIgokShurakaiH shRutaM vA shRutaM payo vA~apyatha parNinIbhiH| raktaM nihantyAshu visheShatastu yanmUtramArgAt sarujaM prayAti||85|| Milk boiled with shatavari and gokshura, or the four leaved herbs (mudgaparni, mashaparni, shalaparni and prashniparni), check the haemorrhage 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|| viśēṣatō viṭpathasampravr̥ttē payō mataṁ mōcarasēnasiddham| vaṭāvarōhairvaṭaśuṅgakairvā hrībēranīlōtpalanāgarairvā||86|| kaṣāyayōgān payasā purā vā pītvā'nu cādyāt payasaiva śālīn| kaṣāyayōgairathavā vipakvamētaiḥ pibēt sarpiratisravē ca||87|| visheShato viTpathasampravRutte payo mataM mocarasena siddham| vaTAvarohairvaTashu~ggakairvA hrIberanIlotpalanAgarairvA||86|| kaShAyayogAn payasA purA vA pItvA~anu cAdyAt payasaiva shAlIn| kaShAyayogairathavA vipakvametaiH pibet sarpiratisrave ca||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: वासां सशाखां सपलाशमूलां कृत्वा कषायं कुसुमानि चास्याः| प्रदाय कल्कं विपचेद्घृतं तत् सक्षौद्रमाश्वेवनिहन्ति रक्तम्||८८|| इति वासाघृतम्| vāsāṁ saśākhāṁ sapalāśamūlāṁ kr̥tvā kaṣāyaṁ kusumāni cāsyāḥ| pradāya kalkaṁ vipacēdghr̥taṁ tat sakṣaudramāśvēva nihanti raktam||88|| iti vāsāghr̥tam| vAsAM sashAkhAM sapalAshamUlAM kRutvA kaShAyaM kusumAni cAsyAH| pradAya kalkaM vipacedghRutaM tat sakShaudramAshveva nihanti raktam||88|| iti vAsAghRutam 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 haemorrhage quickly. (88) (Thus vasa ghrita) पलाशवृन्तस्वरसेन सिद्धं तस्यैव कल्केन मधुद्रवेण| लिह्याद्घृतं वत्सककल्कसिद्धं तद्वत् समङ्गोत्पललोध्रसिद्धम्||८९|| स्यात्त्रायमाणाविधिरेष एव सोदुम्बरे चैव पटोलपत्रे | सर्पींषि पित्तज्वरनाशनानि सर्वाणि शस्तानि च रक्तपित्ते||९०|| palāśavr̥ntasvarasēna siddhaṁ tasyaiva kalkēna madhudravēṇa| lihyādghr̥taṁ vatsakakalkasiddhaṁ tadvat samaṅgōtpalalōdhrasiddham||89|| syāttrāyamāṇāvidhirēṣa ēva sōdumbarē caiva paṭōlapatrē| sarpīṁṣi pittajvaranāśanāni sarvāṇi śastāni ca raktapittē||90|| palAshavRuntasvarasena siddhaM tasyaiva kalkena madhudraveNa| lihyAdghRutaM vatsakakalkasiddhaM tadvat sama~ggotpalalodhrasiddham||89|| syAttrAyamANAvidhireSha eva sodumbare caiva paTolapatre| sarpIMShi pittajvaranAshanAni sarvANi shastAni ca raktapitte||90||

Ghrita cooked with (1) the juice of the stamens of the palasha (flowers) alongwith 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 haemorrhagic 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|| abhyaṅgayōgāḥ pariṣēcanāni sēkāvagāhāḥ śayanāni vēśma| śītōvidhirbastividhānamagryaṁ pittajvarē yat praśamāyadiṣṭam||91|| tadraktapittē nikhilēna kāryaṁ kālaṁ ca mātrāṁ ca purā samīkṣya| sarpirguḍā yē ca hitāḥ kṣatēbhyastē raktapittaṁ śamayanti sadyaḥ||92|| abhya~ggayogAH pariShecanAni sekAvagAhAH shayanAni veshma| shIto vidhirbastividhAnamagryaM pittajvare yat prashamAya diShTam||91|| tadraktapitte nikhilena kAryaM kAlaM ca mAtrAM ca purA samIkShya| sarpirguDA ye ca hitAH kShatebhyaste raktapittaM shamayanti sadyaH||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 appiled in haemorrhagic disorder considering the season and dose. Sarpirguda (the formulation of jaggery and ghee) prescribed for the patients of kshata (chest injury) control the haemorrhagic 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|| kaphānubandhē rudhirē sapittē kaṇṭhāgatē syādgrathitē prayōgaḥ| yuktasya yuktyā madhusarpiṣōśca kṣārasya caivōtpalanālajasya||93|| mr̥ṇālapadmōtpalakēśarāṇāṁ tathā palāśasya tathā priyaṅgōḥ| tathā madhūkasya tathā'sanasya kṣārāḥ prayōjyā vidhinaiva tēna||94|| kaphAnubandhe rudhire sapitte kaNThAgate syAdgrathite prayogaH| yuktasya yuktyA madhusarpiShoshca kShArasya caivotpalanAlajasya||93|| mRuNAlapadmotpalakesharANAM tathA palAshasya tathA priya~ggoH| tathA madhUkasya tathA~asanasya kShArAH prayojyA vidhinaiva tena||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: 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| śatāvarīdāḍimatintiḍīkaṁ kākōlimēdē madhukaṁvidārīm| piṣṭvā ca mūlaṁ phalapūrakasya ghr̥taṁ pacēt kṣīracaturguṇaṁ jñaḥ||95|| kāsajvarānāhavibandhaśūlaṁ tadraktapittaṁ ca ghr̥taṁ nihanyāt| yat pañcamūlairatha pañcabhirvā siddhaṁ ghr̥taṁ tacca tadarthakāri||96|| iti śatāvaryādighr̥tam| shatAvarIdADimatintiDIkaM kAkolimede madhukaM vidArIm| piShTvA ca mUlaM phalapUrakasya ghRutaM pacet kShIracaturguNaM j~jaH||95|| kAsajvarAnAhavibandhashUlaM tadraktapittaM ca ghRutaM nihanyAt| yat pa~jcamUlairatha pa~jcabhirvA siddhaM ghRutaM tacca tadarthakAri||96|| iti shatAvaryAdighRutam

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 haemorrhagic 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|| kaṣāyayōgā ya ihōpadiṣṭāstē cāvapīḍē bhiṣajā prayōjyāḥ| ghrāṇāt pravr̥ttaṁ rudhiraṁ sapittaṁ yadā bhavēnniḥsr̥taduṣṭadōṣam||97|| raktē praduṣṭē hyavapīḍabandhē duṣṭapratiśyāyaśirōvikārāḥ| raktaṁ sapūyaṁ kuṇapaśca gandhaḥ syād ghrāṇanāśaḥ kr̥mayaśca duṣṭāḥ||98|| nīlōtpalaṁ gairikaśaṅkhayuktaṁ sacandanaṁ syāttu sitājalēna| nasyaṁ tathāmrāsthirasaḥ samaṅgā sadhātakīmōcarasaḥ salōdhraḥ||99|| drākṣārasasyēkṣurasasya nasyaṁ kṣīrasya dūrvāsvarasasya caiva| yavāsamūlāni palāṇḍumūlaṁ nasyaṁ tathā dāḍimapuṣpatōyam||100|| priyālatailaṁ madhukaṁ payaśca siddhaṁghr̥taṁ māhiṣamājikaṁ vā| āmrāsthipūrvaiḥ payasā ca nasyaṁ sasārivaiḥ syāt kamalōtpalaiśca||101|| kaShAyayogA ya ihopadiShTAste cAvapIDe bhiShajA prayojyAH| ghrANAt pravRuttaM rudhiraM sapittaM yadA bhavenniHsRutaduShTadoSham||97|| rakte praduShTe hyavapIDabandhe duShTapratishyAyashirovikArAH| raktaM sapUyaM kuNapashca [21] gandhaH syAd ghrANanAshaH kRumayashca duShTAH||98|| nIlotpalaM gairikasha~gkhayuktaM sacandanaM syAttu sitAjalena| nasyaM tathA~a~amrAsthirasaH sama~ggA sadhAtakImocarasaH salodhraH||99|| drAkShArasasyekShurasasya nasyaM kShIrasya dUrvAsvarasasya caiva| yavAsamUlAni palANDumUlaM nasyaM tathA dADimapuShpatoyam||100|| priyAlatailaM madhukaM payashca siddhaM ghRutaM mAhiShamAjikaM vA| AmrAsthipUrvaiH payasA ca nasyaM sasArivaiH syAt kamalotpalaishca||101||

The haemorrhagic 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||

bhadraśriyaṁ lōhitacandanaṁ ca prapauṇḍarīkaṁ kamalōtpalē ca| uśīravānīrajalaṁ mr̥ṇālaṁ sahasravīryā madhukaṁ payasyā||102|| śālīkṣumūlāni yavāsagundrāmūlaṁ nalānāṁ kuśakāśayōśca| kucandanaṁ śaivalamapyanantā kālānusāryātr̥ṇamūlamr̥ddhiḥ||103|| mūlāni puṣpāṇi ca vārijānāṁ pralēpanaṁpuṣkariṇīmr̥daśca|

udumbarāśvatthamadhūkalōdhrāḥ kaṣāyavr̥kṣāḥ śiśirāśca sarvē||104|| pradēhakalpē pariṣēcanē ca tathā'vagāhē ghr̥tatailasiddhau| raktasya pittasya ca śāntimicchan bhadraśriyādīni bhiṣak prayuñjyāt||105|| dhārāgr̥haṁ bhūmigr̥haṁ suśītaṁ vanaṁ ca ramyaṁ jalavātaśītam| vaidūryamuktāmaṇibhājanānāṁ sparśāśca dāhēśiśirāmbuśītāḥ||106|| patrāṇi puṣpāṇi ca vārijānāṁ kṣaumaṁ caśītaṁ kadalīdalāni| pracchādanārthaṁ śayanāsanānāṁ padmōtpalānāṁ ca dalāḥ praśastāḥ||107|| priyaṅgukācandanarūṣitānāṁ sparśāḥ priyāṇāṁ ca varāṅganānām| dāhē praśastāḥ sajalāḥ suśītāḥ padmōtpalānāṁ ca kalāpavātāḥ||108|| sariddhradānāṁ himavaddarīṇāṁ candrōdayānāṁ kamalākarāṇām| manō'nukūlāḥ śiśirāśca sarvāḥ kathāḥ saraktaṁ śamayanti pittam||109|| bhadrashriyaM lohitacandanaM ca prapauNDarIkaM kamalotpale ca| ushIravAnIrajalaM mRuNAlaM sahasravIryA madhukaM payasyA||102|| shAlIkShumUlAni yavAsagundrAmUlaM nalAnAM kushakAshayoshca| kucandanaM shaivalamapyanantA kAlAnusAryA tRuNamUlamRuddhiH||103|| mUlAni puShpANi ca vArijAnAM pralepanaM puShkariNImRudashca| udumbarAshvatthamadhUkalodhrAH kaShAyavRukShAH shishirAshca sarve||104|| pradehakalpe pariShecane ca tathA~avagAhe ghRutatailasiddhau| raktasya pittasya ca shAntimicchan bhadrashriyAdIni bhiShak prayu~jjyAt||105|| dhArAgRuhaM bhUmigRuhaM sushItaM vanaM ca ramyaM jalavAtashItam| vaidUryamuktAmaNibhAjanAnAM sparshAshca dAhe shishirAmbushItAH||106|| patrANi puShpANi ca vArijAnAM kShaumaM ca shItaM kadalIdalAni| pracchAdanArthaM shayanAsanAnAM padmotpalAnAM ca dalAH prashastAH||107|| priya~ggukAcandanarUShitAnAM sparshAH priyANAM ca varA~gganAnAm| dAhe prashastAH sajalAH sushItAH padmotpalAnAM ca kalApavAtAH||108|| sariddhradAnAM himavaddarINAM candrodayAnAM kamalAkarANAm| mano~anukUlAH shishirAshca sarvAH kathAH saraktaM shamayanti pittam||109|| 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, favourite 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|| tatra ślōkau- hētuṁ vr̥ddhiṁ sañjñāṁ sthānaṁ liṅgaṁ pr̥thakpraduṣṭasya| mārgau sādhyamasādhyaṁ yāpyaṁ kāryakramaṁ caiva||110||

pānānnamiṣṭamēva ca varjyaṁ saṁśōdhanaṁ ca śamanaṁ ca| 

gururuktavānyathāvaccikitsitē raktapittasya||111|| tatra shlokau- hetuM vRuddhiM sa~jj~jAM sthAnaM li~ggaM pRuthak praduShTasya| mArgau sAdhyamasAdhyaM yApyaM kAryakramaM caiva||110|| pAnAnnamiShTameva ca varjyaM saMshodhanaM ca shamanaM ca| gururuktavAnyathAvaccikitsite raktapittasya||111||

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 rakta-pitta (haemorrhagic disorder). (110-110)

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेचिकित्सितस्थाने रक्तपित्तचिकित्सितं नाम चतुर्थोऽध्यायः||४||

ityagnivēśakr̥tētantrē carakapratisaṁskr̥tē cikitsitasthānēraktapittacikitsitaṁ nāma caturthō'dhyāyaḥ||4|| ityagniveshakRute tantre carakapratisaMskRute cikitsitasthAne raktapittacikitsitaM nAma caturtho~adhyAyaH||4||

Thus ends the fourth chapter on the treatment of haemorrhagic disorder in Chikitsasthana in the treatise composed by Agnivesha and redacted by Charaka. (4)

Tattva Vimarsha • The causes of rakta pitta 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, odour, colour 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 colour 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 rakta-pitta 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, overnourished 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 dietitic 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 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 1.Urdhvaga Nasa Epitaxis Mukha Hematemesis Karna Otorrhagia

2.Adhoga Guda Bacillary dysentery, melina, bloody

                                                                            diarrhoea

Mutra

                                     	Heamaturia

Yoni Menorrhagia or metrorrhagia

3.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 nidana panchaka as a diagnostic tool can enhance the treatment modalities of ayurvedic management of diseases in coming years. Commonly used medicines in rakta-pitta: Important medicines: 1. Vasa 2. Aamalaki 3. Praval bhasma Treatment of urdhvaga rakta pitta: 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 rakta-pitta: 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 aamalaki 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

Glossary Iyhg PlÍhÁ Spleen

Ñr Yakéta Liver

Òksrl Srotasa Channels lkUæ SÁndra Concentrated ik.Mq PÁÆdu Anemia fifPNy Picchila unctous xksew= GomÚtra Cow urine Jksedwi RomakÚpa Hair roots Xyxzg Galagraha Choking of throat iwfruL; PÚtinasya Foetid smell from the nose Fdykl KilÁsa Leucoderma ÑPNªew=rk KécchamÚtratÁ Dysuria ohliZ VÍsarpa Erysipelas riZ.k TarpaÆa Saturating measure pUnu Candana Santalum album Linn. eqLr Musta Cyperus rotundus Linn. Ük`rlhr SétaÐÍta Cooled boiled water e}hdk MédvÍkÁ Vitis venifera e/kwd MadhÚka Madhuca indica J.F.Gmel. i:"kd ParÚÒaka Grewia asiatica Linn. ?k`r GhétÁ Clarified butter nkfMe DÁÕima Punica granatum Linn. Vkeyd Àmalaka Emblica officinalis Gaertn. fuEc Nimba Azadirachta indica(L.)A.Juss. Iy{k PlakÒa Ficus lacor Buch-Ham. iYyo Pallava Tender new leaves Dksfonkj KovidÁra Bauhinia purpurea Linn. 'kkYeyh ÏÁlmalÍ Salmalia malabarica 9DC)Schott and Endl. i`f’ui.khZ PéÐniparÆÍ Uraria picta Desv. m’khj UÐÍra Vetiveria zizanioides(Linn) Nash. eqLrd Mustaka Cyperus rotundus Linn. /kkrdh DhÁtakÍ Woodfordia fruticosa Kurz. fcYo Bilva Aegle marmelos Corr. Cyk BalÁ Sida cordifolia Linn. mnqEcj Udumbara Ficus glomerata Labill. Iy{k PlakÒa Ficus lacor Buch-Hum. U;xzks/k Nyagrodha Ficus bengalensis linn. dqDdqV KuktuÔa Cock fonkfjxU/kk VidÁrigandha Desmodium gangeticum DC. f=o`r Trivéta Operculina turpethum(Linn.)Briquet. vHk;k Abhaya Terminalia chebula Retz. vkjXo/k Àragvadha Cassia fistula Linn. enuQy Madanaphala Randia spinosa Poir. oRld Vatsaka Holarrhena antidysenterica (Linn.) Wall. vV:"k AtarÚÒa Adhatoda vasica Nees. nwokZ DÚrvÁ Cynodon dactylon(Linn)Pers. ukxiq"i NÁgapuÒpa Mesua ferrea. [kfnj Khadira Acacia catechu Willd. Ekspjl Mocarasa Exudate of Salmalia malabarica (DC.) Schott and Endl. xksa{kqj GokÒura Tribulus errestris Linn. 'krkojh ÏatÁvarÍ Asparagus racemosus Willd. if.kZuh ParÆinÍ Four leaved herbs (MudgaparÆÍ, mÁÒaparÆÍ, ÐÁlaparÆÍ and péÒniparÆÍ) iyk’k PalÁÐa Butea monosperma (Lam.) Kuntze. vkezkfLFk ÀmrÁsthi Mangifera indica Linn. iyk.Mq PalÁÆdu Allium cepa Linn. Lkfjok SÁrivÁ Hemidesmus indicus R. Br. Uy Nala Arundo donax Linn. dq’k KuÒa Desmostachya bipinnata Stapf. dk’k KÁÐa Saccharum spontaneum Linn.