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

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

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

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

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

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

== Introduction ==

== Introduction ==

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''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.

''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''.

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

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

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

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

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

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

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.

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.

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== Sanskrit text, Transliteration and English Translation ==

== Sanskrit text, Transliteration and English Translation ==

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

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

=== Derivation ===

=== Derivation ===

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

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

=== Characteristics of ''dosha'' vitiation ===

=== Characteristics of ''[[dosha]]'' vitiation ===

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

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

=== Prognosis ===

=== Prognosis ===

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

''Raktapitta'' associated with one ''[[dosha]]'' is curable; that with two ''[[dosha]]s'' is palliable while that caused by three ''[[dosha]]s'' 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 ===

=== ''Gati'' (direction of flow) and prognosis ===

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.

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

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

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

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

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

=== Characteristics of curable ''raktapitta'' ===

=== Characteristics of curable ''raktapitta'' ===

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

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

=== Consequneces of styptic therapy in ''rakta-pitta'' ===

=== Consequneces of styptic therapy in ''rakta-pitta'' ===

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

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

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

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

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

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

=== Nourishment regimen ===

=== Nourishment regimen ===

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

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

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

=== Medicated gruels in ''raktapitta'' ===

=== Medicated gruels in ''raktapitta'' ===

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

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

#rabbit cooked with ''vastuka'',  

#rabbit cooked with ''vastuka'',  

#partridge cooked in decoction of ''udumbara'',  

#partridge cooked in decoction of ''udumbara'',  

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

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

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

Now the management of strong patients having plenty of ''[[dosha]]s'' will be explained further:

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

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

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

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''.  

#sugarcane juice, or ''indrayava, musta, madana, madhuka'' and honey – all mixed together make an excellent emetic.

#sugarcane juice, or ''indrayava, musta, madana, madhuka'' and honey – all mixed together make an excellent emetic.

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

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

=== Pacification therapy ===

=== Pacification therapy ===