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

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

<div style="text-align:justify;">This chapter deals with diagnosis of bleeding disorders ([[raktapitta]]) caused by an excess of [[pitta dosha]] vitiating blood tissue ([[rakta dhatu]]) in the body. This leads to capillary break-down causing hemorrhage from external openings like mouth, per rectum, nose, eyes, ears, urethra. Contributing factors that increase the probability of [[raktapitta]] include consumption of incompatible food substances, consuming certain meats with alcohol, butter milk with meat of animals etc. The regular exposure to dietary and lifestyle factors with hot (ushna) properties vitiates [[pitta dosha]]. This [[pitta dosha]] has the same color and smell as [[rakta dhatu]], and blends seamlessly with it. Vitiated [[pitta dosha]] and increased [[rakta dhatu]] circulate in the channels and the resultant increased volume of the blood overflows from the bodily orifices. The pathogenesis, if associated with vitiated [[kapha dosha]], leads to bleeding from upper orifices; whereas if it is associated with vitiated [[vata dosha]], leads to bleeding from the lower orifices. The first condition is curable, and later is difficult to cure. If both [[kapha]] and [[Vata dosha|vata]] are involved in the pathogenesis, then the complications arise and such conditions are incurable. Avoiding etiological factors enlisted in this chapter can delay the progression of hemorrhagic disorders. Therapeutic measures of [[emesis]] and [[purgation]], along with useful medicinal formulations and attention can improve the condition of patients of hemorrhagic disorders in varying degrees. Prodromal symptoms and complications have been described in this chapter. </div>

<div style="text-align:justify;">This chapter deals with diagnosis of bleeding disorders ([[raktapitta]]) caused by an excess of [[pitta dosha]] vitiating blood tissue ([[rakta dhatu]]) in the body. This leads to capillary break-down causing hemorrhage from external openings like mouth, per rectum, nose, eyes, ears, urethra. Contributing factors that increase the probability of [[raktapitta]] include consumption of incompatible food substances, consuming certain meats with alcohol, butter milk with meat of animals etc. The regular exposure to dietary and lifestyle factors with hot (ushna) properties vitiates [[pitta dosha]]. This [[pitta dosha]] has the same color and smell as [[rakta dhatu]], and blends seamlessly with it. Vitiated [[pitta dosha]] and increased [[rakta dhatu]] circulate in the channels and the resultant increased volume of the blood overflows from the bodily orifices. The pathogenesis, if associated with vitiated [[kapha dosha]], leads to bleeding from upper orifices; whereas if it is associated with vitiated [[vata dosha]], leads to bleeding from the lower orifices. The first condition is curable, and later is difficult to cure. If both [[kapha]] and [[Vata dosha|vata]] are involved in the pathogenesis, then the complications arise and such conditions are incurable. Avoiding etiological factors enlisted in this chapter can delay the progression of hemorrhagic disorders. Therapeutic measures of [[emesis]] and [[purgation]], conservative therapy with medicinal formulations and proper attention can improve the condition of patients of hemorrhagic disorders in varying degrees. Prodromal symptoms and complications are described in this chapter. </div>

'''Keywords''': Etiopathogenesis of [[raktapitta]], bleeding disorders, epistaxis, hemorrhage, hematemesis, rectal bleeding.

'''Keywords''': Etiopathogenesis of [[raktapitta]], bleeding disorders, epistaxis, hemorrhage, hematemesis, rectal bleeding.

== Introduction ==

== Introduction ==

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The second chapter of the [[Nidana Sthana]] focuses on [[Rakta dhatu|rakta]] , the second [[dhatu]], just as the first chapter on [[jwara]] focused on the first [[dhatu]], [[Rasa dhatu|rasa]]. [[Pitta dosha|Pitta]] is the primary cause of [[jwara]] which causes elevated temperature, leading to [[raktapitta]]. Thus it can be said that [[jwara]] is a cause of [[raktapitta]], and an aggravated [[Pitta dosha|pitta]] is the cause of both [[jwara]] and [[raktapitta]].  

The second chapter of the [[Nidana Sthana]] deals with disorders of  [[Rakta dhatu|rakta]] [[dhatu]], just as the previous chapter on [[jwara]] focused on the [[Rasa dhatu|rasa]] [[dhatu]]. [[Pitta dosha|Pitta]] is the primary cause of [[jwara]] resulting in elevated temperature. This can further lead to [[raktapitta]]. Thus it can be said that [[jwara]] is a cause of [[raktapitta]], and an aggravated [[Pitta dosha|pitta]] is the cause of both [[jwara]] and [[raktapitta]].  

Bleeding disorders also include conditions where bleeding is not apparent. Hemorrhagic strokes, vessel diseases, and heart attacks cause internal bleeding and do not erupt through the skin or orifices. These are typically due to vascular and other events and not caused due to [[raktapitta]]. These disorders should be classified under [[avarana]] and disorders of [[vata dosha]] affecting vessles (siragata vata).

Bleeding disorders also include conditions where bleeding is not apparent. Hemorrhagic strokes, vessel diseases, and heart attacks cause internal bleeding and do not erupt through the skin or orifices. These are typically due to vascular and other events and not caused due to [[raktapitta]]. These disorders should be classified under [[avarana]] and disorders of [[vata dosha]] affecting vessels (siragata vata).

[[Raktapitta]] manifests through two broadly divided routes that correlate with the flow of [[dosha]] energies in the body: the upper tract and the lower tract. The upper tract includes the orifices of eyes, ear, nose, and mouth/throat. It is the route taken by the flow of blood when the person has an abundance of [[Kapha dosha|kapha]] besides [[Rakta dhatu|rakta]] and [[Pitta dosha|pitta]]. When there is an abundance of body [[Vata dosha|vata]] with an interplay of [[Rakta dhatu|rakta]] and [[Pitta dosha|pitta]], [[raktapitta]] manifests through the lower tract as in hematuria and per rectal bleeding.  When bleeding manifests through both the routes, it indicates the involvement of both the [[dosha]], [[Vata dosha|vata]] and [[Kapha dosha|kapha]].  

[[Raktapitta]] manifests through two broadly divided routes that correlate with the flow of [[dosha]] energies in the body: the upper tract and the lower tract. The upper tract includes the orifices of eyes, ear, nose, and mouth/throat. It is the route taken by the flow of blood when the person has an abundance of [[Kapha dosha|kapha]] besides [[Rakta dhatu|rakta]] and [[Pitta dosha|pitta]]. When there is an abundance of body [[Vata dosha|vata]] with an interplay of [[Rakta dhatu|rakta]] and [[Pitta dosha|pitta]], [[raktapitta]] manifests through the lower tract as in hematuria and per rectal bleeding.  When bleeding manifests through both the routes, it indicates the involvement of both the [[dosha]], [[Vata dosha|vata]] and [[Kapha dosha|kapha]].  

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We shall also expoutd how [[Pitta dosha]] gets the term 'Lohitapitta'.  [3]  

We shall also expound how [[Pitta dosha]] gets the term 'Lohitapitta'.  [3]  

=== Etiopathogenesis ===

=== Etiopathogenesis ===

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When a person consumes a diet or food consisting mostly of:

When a person consumes a diet or food mainly of:

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*Grains such as barley (yavaka), Kodo millet or [https://en.wikipedia.org/wiki/Paspalum_scrobiculatum Paspalum scrobiculatum (uddalaka)], and [http://www.agrisources.com/herbs/paspalumscrobiculatum.html Ditch Millet (koradusha)], in excess quantities, with other food items that are hot (ushna) and sharply acting (tikshna) such as  legumes of  Dolichos lablab Linn. (nishpaava), black gram (masha), horse gram (kulaththa) and alkali (kshara) , or with curd, whey, buttermilk, sour buttermilk or sour gruel

*Grains such as barley (yavaka), Kodo millet or [https://en.wikipedia.org/wiki/Paspalum_scrobiculatum Paspalum scrobiculatum (uddalaka)], and [http://www.agrisources.com/herbs/paspalumscrobiculatum.html Ditch Millet (koradusha)], in excess quantities, with other food items that are hot (ushna) and sharply acting (tikshna) such as  legumes of  Dolichos lablab Linn. (nishpaava), black gram (masha), horse gram (kulaththa) and alkali (kshara) , or with curd, whey, buttermilk, sour buttermilk or sour gruel

*Meat of pig, buffalo, sheep, fish and cow,

*Meat of pig, buffalo, sheep, fish and cow

*Vegetables of oil cake, pindalu (a tuber) and dried potherbs

*Vegetables of oil cake (pinyaka), pindalu (a tuber) and dried potherbs

*Upadamsha (chutney or salad) of radish (mulaka), mustard (sarshapa), garlic (lashuna), fruits of indian beech tree (Pongamia Glabra) (karanja), drumsticks (Moringa oleifera)  (shigru), its sweet variety (madhu shigru) , muskmelon (kharabusa), lemongrass(bhustruna), sumukha, surasa, kutheraka, gandira, kalamala, parnasa, kshavaka and phanijzaka

*Upadamsha (chutney or salad) of radish (mulaka), mustard (sarshapa), garlic (lashuna), fruits of Indian beech tree (Pongamia Glabra) (karanja), drumsticks (Moringa oleifera)  (shigru), its sweet variety (madhu shigru) , muskmelon (kharabusa), lemongrass (bhustruna), sumukha (Ocimum gratissimum L.), surasa (Ocimum sanctum L.), kutheraka (Ocimum basilicum L.), gandeera (Coleus barbatus (Andr.) Benth.) , kalamalaka (?), parnasa (Ocimum basilicum L.), kshavaka (Brassica nigra (L.) Koch.) and phanijzaka (Origanum majorana L.)

*Drink of sura (wine), sauvira, tushodaka (types of vinegar), maireya, medaka, madhulaka (fermented beverages), shukta (sour beverage), sour preparations of kuvala and badara (types of jujube)

*Consumption of fermented beverages like sura (wine), sauvira (sour gruel), tushodaka (types of vinegar or fermented water of chaff of grain or corn or rice), maireya (a type of intoxicating drink), medaka (spirituous liquor used for distillation), madhulaka (arak distilled from the blossoms of the honey tree or any intoxicating drink [Madhuca longifolia -Bot.]), shukta (any sour liquor or gruel), sour preparations of kuvala (Zizyphus mauritiana Lam.) and badara (Zizyphus mauritiana Lam.) (both are types of jujube)

*Preparations of (rice) flour in excess after meals

*Preparations of (rice) flour in excess after meals

*Excessive quantities of pishtanna (triturated grains)

*Excessive quantities of pishtanna (triturated grains)