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

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

<div style="text-align:justify;">Blood is important for maintaining vitality of individuals. It is also the most important factor in patho-physiology of any disease as it carries vitiated dosha leading to disease. This chapter focuses on rakta dhatu (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta)  is formed by following proper dietary habits. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, dosha specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as mada (intoxication/confusion), murchha (syncope), and sanyasa (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided. </div>

<div style="text-align:justify;">Blood is important for maintaining vitality of individuals. It is also the most important factor in patho-physiology of any disease as it carries vitiated [[dosha] leading to disease. This chapter focuses on [[rakta dhatu]] (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta)  is formed by following proper dietary habits. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, [[dosha]] specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as mada (intoxication/confusion), murchha (syncope), and sanyasa (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided. </div>

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

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

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== Introduction ==

== Introduction ==

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In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three ''doshas'' were described. In continuation, the present chapter describes the management principles of disorders due to ''shonita'' (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of ''rakta'' have been explained in this chapter. Vitiated ''rakta'' causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) ''dravyas'' are used for treatment without response, ''raktaja vikara'' (blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence -  have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three [[dosha]] were described. In continuation, the present chapter describes the management principles of disorders due to shonita (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of [[rakta]] have been explained in this chapter. Vitiated [[rakta]] causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) dravyas are used for treatment without response, raktaja vikara(blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence -  have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

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==Sanskrit text, Transliteration and English Translation==

==Sanskrit text, Transliteration and English Translation==

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Bloodletting should be done considering the strength of the person, ''dosha'',location of the disease, and until pure blood starts to flow out.[19]

Bloodletting should be done considering the strength of the person, [[dosha]], location of the disease, and until pure blood starts to flow out.[19]

=== ''Dosha''-specific features of vitiated blood ===

=== [[Dosha]]-specific features of vitiated blood ===

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After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the ''agni'' (digestive power) should be protected with care. [23]

After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the [[agni]](digestive power) should be protected with care. [23]

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A person should be considered as having pure blood if he has glowing complexion, well-functioning sense organs, and is cheerful. A person with unvitiated blood has normal digestion and unobstructed natural urges, is happy and is endowed with saturation and strength. [24]

A person should be considered as having pure blood if he has glowing complexion, well-functioning sense organs, and is cheerful. A person with unvitiated blood has normal digestion and unobstructed natural urges, is happy and is endowed with saturation and strength. [24]

=== Causative factors and pathogenesis of ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa''(coma) ===

=== Causative factors and pathogenesis of mada (intoxication), murchcha (syncope) and sanyasa(coma) ===

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When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated ''doshas'', singly or in combination, reside and obstruct the channels that carry ''rakta, rasa'' (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated ''doshas'' distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated [[dosha]], singly or in combination, reside and obstruct the channels that carry [[rakta]], [[rasa]] (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated [[dosha]] distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

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The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with ''kaphaja mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with [[kapha]]ja mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

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All types of narcosis are caused by alcoholic drinks, poisons or by vitiation of blood. It can be concluded that all types of narcosis are caused by nothing but the vitiation of the three ''doshas'' viz. ''vata, pitta'' and ''kapha''. [34]

All types of narcosis are caused by alcoholic drinks, poisons or by vitiation of blood. It can be concluded that all types of narcosis are caused by nothing but the vitiation of the three [[dosha]] viz. [[vata]], [[pitta]] and [[kapha]]. [34]

=== Specific features of ''dosha'' dominant ''murchcha'' (syncope) ===

=== Specific features of [[dosha]] dominant ''murchcha'' (syncope) ===

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In ''paittika murchcha'', unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor.

In ''paittika murchcha'', unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor.

The patient of ''kaphaja murchcha'' gets unconscious after seeing the sky covered in clouds or covered with deep darkness and recovers after a long time. He generally finds his body parts feel heavy and wrapped in wet hide. He also suffers from excessive salivation and nausea.  

The patient of [[kapha]]ja murchcha gets unconscious after seeing the sky covered in clouds or covered with deep darkness and recovers after a long time. He generally finds his body parts feel heavy and wrapped in wet hide. He also suffers from excessive salivation and nausea.  

''Sannipataja murchcha'' has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this ''murchcha'' the patient falls unconscious without violent or revolting movements.[35-41]

''Sannipataja murchcha'' has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this ''murchcha'' the patient falls unconscious without violent or revolting movements.[35-41]

*Treatment of blood vitiation disorders is like ''raktapitta'' with purgation, fasting, and bloodletting. [18]

*Treatment of blood vitiation disorders is like ''raktapitta'' with purgation, fasting, and bloodletting. [18]

*The extent of bloodletting is decided according to the severity of the disease, location of the disease, and strength of the patient.[19]

*The extent of bloodletting is decided according to the severity of the disease, location of the disease, and strength of the patient.[19]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Various medicated ''ghrita'' are indicated for ''sanyasa'' since lipid matrix helps to cross the blood-brain barrier and act on the brain. [54-58]

Various medicated ''ghrita'' are indicated for ''sanyasa'' since lipid matrix helps to cross the blood-brain barrier and act on the brain. [54-58]

Metabolic acidosis and alkalosis should be considered to gain an understanding of ''raktaja vikara''. Electrolyte imbalances should be evaluated for the keen diagnosis of ''mada, murchcha,'' and ''sanyasa''. [59-60]

Metabolic acidosis and alkalosis should be considered to gain an understanding of [[rakta]]ja vikara. Electrolyte imbalances should be evaluated for the keen diagnosis of ''mada, murchcha,'' and ''sanyasa''. [59-60]

=== Related Chapters ===

=== Related Chapters ===