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→Vidhi Vimarsha (Applied Inferences)
===Causes of vitiation of blood===
===Causes of vitiation of blood===
'''Dietary causes:'''
*Habitual intake of spoiled or unsuitable food and/or liquids
*Habitual intake of spoiled or unsuitable food and/or liquids
*Overeating
*Overeating
*Taking meal during indigestion
*Taking meal during indigestion
'''Lifestyle causes:'''
*Excessive sleeping during daytime especially after taking liquids, unctuous and heavy food
*Excessive sleeping during daytime especially after taking liquids, unctuous and heavy food
*Excessive exposure to the sun and wind
*Excessive exposure to the sun and wind
*Excess exertion, injury, heat
*Excess exertion, injury, heat
'''Mental factors:'''
*Excessive anger
*Excessive anger
'''Environmental conditions:'''
*Autumn season [Cha.Sa.[[Sutra Sthana]] 24/5-10]
*Autumn season [Cha.Sa.[[Sutra Sthana]] 24/5-10]
===Intoxication (mada), Syncope (murchha) and Coma (sanyasa)===
===Intoxication (mada), Syncope (murchha) and Coma (sanyasa)===
Excess vitiation of blood can lead to state of intoxication (mada), syncope and coma. These three are progressive stages of diseases due to vitiation of blood. Intoxication (mada) state may arise due to consumption of alcohol, poisoning or due to vitiation of blood. The person may be semiconscious or in an altered state of consciousness. [Su.Sa.Sutra Sthana.11/19] In murchcha, the person may be unconscious but involuntary physical movements might be present.[Su.Sa.Nidhana Sthana.1/23] Sanyasa is a condition in which the person will remain unconscious and also there won’t be any physical movements.[Cha.Sa.[[Sharira Sthana]] 1/154]
Excess vitiation of blood can lead to state of intoxication (mada), syncope and coma. These three are progressive stages of diseases due to vitiation of blood. Intoxication (mada) state may arise due to consumption of alcohol, poisoning or due to vitiation of blood. The person may be semiconscious or in an altered state of consciousness. [Su.Sa.Sutra Sthana.11/19]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> In murchcha, the person may be unconscious but involuntary physical movements might be present.[Su.Sa.Nidhana Sthana.1/23]<ref name=Susruta/> Sanyasa is a condition in which the person will remain unconscious and also there won’t be any physical movements.[Cha.Sa.[[Sharira Sthana]] 1/154]
====Intoxication (mada)====
====Intoxication (mada)====
'''Stages of intoxication (mada)'''
'''Stages of intoxication (mada)'''
Three stages of intoxication (mada) are mentioned. In initial stage the person will be over enthusiastic. [Su.Sa.Uttara Sthana. 47/11] In the second stage person may talk irrelevantly and will be in delusion stage. In the final stage the person lies unconscious. He may loose his ability to perform any physical action. [Su.Sa.Uttara Sthana. 47/12]
Three stages of intoxication (mada) are mentioned. In initial stage the person will be over enthusiastic. [Su.Sa.Uttara Sthana. 47/11]<ref name=Susruta/> In the second stage person may talk irrelevantly and will be in delusion stage. In the final stage the person lies unconscious. He may loose his ability to perform any physical action. [Su.Sa.Uttara Sthana. 47/12]<ref name=Susruta/>
'''Types and [[dosha]] specific features of intoxication (mada)'''
'''Types and [[dosha]] specific features of intoxication (mada)'''
| |[[Sannipata]] || Mixed symptoms
| |[[Sannipata]] || Mixed symptoms
|-
|-
| | Blood ([[rakta]])|| Stiffness of body parts, fixed gaze [A.Hr. Nidhana Sthana. 6/28]
| | Blood ([[rakta]])|| Stiffness of body parts, fixed gaze [A.Hr. Nidhana Sthana. 6/28]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>
|-
|-
| | Alcohol (madya)|| Features similar to [[pitta]] dominant type, abnormal movements of body parts, abnormal speech, abnormal voice [A.Hr. Nidhana Sthana. 6/29]
| | Alcohol (madya)|| Features similar to [[pitta]] dominant type, abnormal movements of body parts, abnormal speech, abnormal voice [A.Hr. Nidhana Sthana. 6/29]<ref name=Hridaya/>
|-
|-
| |Poison (visha) || Tremors and excessive sleep [A.Hr. Nidhana Sthana 6/29]
| |Poison (visha) || Tremors and excessive sleep [A.Hr. Nidhana Sthana 6/29]<ref name=Hridaya/>
|-
|-
|}
|}
'''Prognosis:'''
'''Prognosis:'''
Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29]
Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29]<ref name=Hridaya/>
====Syncope (murchha)====
====Syncope (murchha)====
The obstruction of channel of consciousness by aggravated [[dosha]] lead to sudden aggravation of [[tamas]]. This results in cessation of feeling of happiness. The person falls down just like a log of wood. [Su.Sa.Uttara Sthana. 46/6] This is a transient state of unconsciousness. The person awakes after the episode of aggravation of [[dosha]] is over.
The obstruction of channel of consciousness by aggravated [[dosha]] lead to sudden aggravation of [[tamas]]. This results in cessation of feeling of happiness. The person falls down just like a log of wood. [Su.Sa.Uttara Sthana. 46/6]<ref name=Susruta/> This is a transient state of unconsciousness. The person awakes after the episode of aggravation of [[dosha]] is over.
'''Pathogenesis'''
'''Pathogenesis'''
Weak or emaciated person with excessive vitiation of [[dosha]] are susceptible. If these persons indulge in incompatible food, suppression of natural urges, or if afflicted by injuries; then the excessively aggravated [[dosha]] affect sensory organs and mind. This results in sudden loss of consciousness. [Su.Sa.Uttara Sthana.46/4] The predominant [[dosha]] in the pathogenesis of murchha is [[pitta]]. [Su.Sa.Uttara Sthana.46/8]
Weak or emaciated person with excessive vitiation of [[dosha]] are susceptible. If these persons indulge in incompatible food, suppression of natural urges, or if afflicted by injuries; then the excessively aggravated [[dosha]] affect sensory organs and mind. This results in sudden loss of consciousness. [Su.Sa.Uttara Sthana.46/4]<ref name=Susruta/> The predominant [[dosha]] in the pathogenesis of murchha is [[pitta]]. [Su.Sa.Uttara Sthana.46/8]<ref name=Susruta/>
'''Premonitory symptoms'''
'''Premonitory symptoms'''
Pain in chest, excessive yawning, exhaustion, loss of strength and consciousness. [Su.Sa.Uttara Sthana.46/5]
Pain in chest, excessive yawning, exhaustion, loss of strength and consciousness. [Su.Sa.Uttara Sthana.46/5]<ref name=Susruta/>
'''Types and Features of Syncope (murchha)'''
'''Types and Features of Syncope (murchha)'''
! Types !! Features
! Types !! Features
|-
|-
| | Vata dosha || Irregular and unpredictable pattern of unconsciousness. While losing consciousness, he may feel bluish, blackish or reddish discoloration of surroundings. [Cha.Su.24/35-36] Tremors, pain in chest and body ache may also present.
| | [[Vata dosha]] || Irregular and unpredictable pattern of unconsciousness. While losing consciousness, he may feel bluish, blackish or reddish discoloration of surroundings. [Cha.Sa.[[Sutra Sthana]] 24/35-36] Tremors, pain in chest and body ache may also present.
|-
|-
| | Pitta dosha || Regains consciousness associated with sweating, feeling of warmth, thirst, reddish yellow discoloration of eyes and may pass loose stools. [Cha.Su.24/37-38][AH Ni 6/32]
| | [[Pitta dosha]] || Regains consciousness associated with sweating, feeling of warmth, thirst, reddish yellow discoloration of eyes and may pass loose stools. [Cha.Sa.[[Sutra Sthana]] 24/37-38][A.Hr. Nidhana Sthana 6/32]<ref name=Hridaya/>
|-
|-
| | Kapha dosha || Regains consciousness slowly, feels as if body is covered with thick blanket, salivation and nausea. [Cha.Su.24/39-40] [AH Ni 6/35]
| | [[Kapha dosha]] || Regains consciousness slowly, feels as if body is covered with thick blanket, salivation and nausea. [Cha.Sa.[[Sutra Sthana]] 24/39-40] [A.Hr. Nidhana Sthana 6/35]<ref name=Hridaya/>
|-
|-
| | Sannipata || Symptoms resembles epilepsy (apasmara) but devoid of irregular body movements. [Cha.Su.24/41][AH Ni 6/35]
| | Sannipata || Symptoms resembles epilepsy (apasmara) but devoid of irregular body movements. [Cha.Sa.[[Sutra Sthana]] 24/41][A.Hr. Nidhana Sthana 6/35]<ref name=Hridaya/>
|-
|-
| | Blood (rakta) || Stiffness of body parts, fixed gaze and feeble respiration [Su.Ut 46/11]
| | Blood ([[rakta]]) || Stiffness of body parts, fixed gaze and feeble respiration. [Su.Sa.Uttara Sthana 46/11]<ref name=Susruta/>
|-
|-
| | Alcohol (Madya) || Irrelevant speech, altered state of mind, irregular movements of body parts[Su.Ut 46/12]
| | Alcohol (Madya) || Irrelevant speech, altered state of mind, irregular movements of body parts. [Su.Sa.Uttara Sthana 46/12]<ref name=Susruta/>
|-
|-
| | Visha || Tremors, sleep, thirst and body stiffness [Su.Ut 46/13]
| | Visha || Tremors, sleep, thirst and body stiffness. [Su.Sa.Uttara Sthana 46/13]<ref name=Susruta/>
|-
|-
|}
|}
====Coma (sanyasa)====
The excessively aggravated [[dosha]] affect speech, body and mind. They are lodged in heart (hridaya) and result in cessation of all body activities with absolute loss of consciousness. This condition is coma (sanyasa). [Cha.Sa.[[Sutra Sthana]] 24/42] This is a prolonged episode of unconsciousness.
'''Prognosis'''
The episodes Intoxication (mada) and syncope (murchha) subside without any medical treatment. But immediate medical intervention is needed for coma (sanyasa). [A.Hr. Nidhana Sthana 6/36] Medical treatment is required to prevent recurrent episodes of disease and correct vitiation of blood tissues.
'''Management'''
The first aim of treatments mentioned are under emergency medical care is regaining consciousness. It includes stimulating and irritant therapies. Sensory stimuli by pricking with needle, applying potent collyrium etc. are used to check the level of consciousness. The drugs used are strong and penetrating in nature.
After regaining the consciousness, the treatment should be continued to prevent the remission. This includes purificatory procedures like emesis ([[vamana]]), purgation ([[virechana]]), bloodletting ([[raktamoksha]]) etc. After that rejuvenating therapy ([[rasayana]]) is also advised. Medicated ghee processed with herbs is used for this purpose. The lipoidal nature of ghee (cow’s ghee) makes it an effective vehicle for carrying the active principles of processed drugs and it can easily cross the blood brain barrier.<ref>Karandikar YS, Bansude AS, Angadi EA. Comparison between the Effect of Cow Ghee and Butter on Memory and Lipid Profile of Wistar Rats. J Clin Diagn Res. 2016;10(9):FF11-FF15. doi:10.7860/JCDR/2016/19457.8512</ref>
==Case reports==
A sixty one year old female patient in state of coma was treated successively through [[Ayurveda]] treatment. Initially the GCS score of patient was 3. Nasal medication ([[nasya]]) with trikatu powder was administered for seven days followed by seven days of inhalation of medicated smoke (dhumapana). The GCS score was improved to 11 after the treatment. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness.<ref>Rajkala SR, PD Patil, AB Thakar. Efficacy of Nasya (nasal medication) in coma: A case study. Ans Sci Life. 2016 Apr-Jun;35(4):232-5. Doi: 10.4103/0257-7941. 188188. </ref>
==Contemporary views==
Advanced medical technology has enhanced the understanding of microscopic nature of blood tissue, its components and all physical characteristics. The features described in [[Ayurveda]] text describe macroscopic changes related to affecting [[dosha]]. However, there is much scope of research in bridging the gaps between concepts of these two biomedical sciences.
Some researchers state that the clinical features are similar to the state of disorders due to change in blood pressure leading to hypertension. Some researchers opine that the pathogenesis and features of mada, murchcha and sanyasa show many similarities with shock due to severe hypotension.<ref>Soumya P. Viswan, Rashmi R. A critical review on hypotension and its management from Ayurvedic perspective. Int. J. Res. Ayurveda Pharm. 2020;11(5):114-120 http://dx.doi.org/10.7897/2277-4343.1105152</ref>
==Future research areas==
*Role of causative factors described in this chapter in hematological disorders and disorders of cardio vascular system
*Understanding exact pathological and microscopic nature of vitiation of blood and relation with [[dosha]] specific changes
*Influence of seasonal changes on blood physiology
*Epigenetic changes in blood tissue and its patho-physiological understanding
==Related chapters==
[[Rakta dhatu]], [[Raktamokshana]], [[Syncope]], [[Blood tissue]], [[Hematological disorders]]
==References==
== Related Chapters ==
== Related Chapters ==