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Raktapitta Nidana (view source)

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{{#seo:

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|title=Raktapitta Nidana

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|titlemode=append

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|keywords=Etio-pathogenesis of raktapitta, bleeding disorders, epistaxis, hemorrhage, hematemesis, rectal bleeding, Ayurveda, Indian system of medicine, charak samhita.

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|description=Nidana Sthana Chapter 2. Diagnosis and etiopathogenesis of Bleeding Disorders

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=carak samhita

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|type=article

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<big>''' Nidana Sthana Chapter 2. Diagnosis and etiopathogenesis of Bleeding Disorders '''</big>

{{Infobox

|title = Raktapitta Nidana

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|label4 = Other Sections

|data4 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|~~header3~~ =

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|data6 = Joshi V.K., Ghildiyal S.

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|label7 = Reviewer

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|data7 = Kar A.C., Nimbalkar R.

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|label8 = Editors

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|data8 = Khandel S.K., Godatwar P., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s02.003 10.47468/CSNE.2020.e01.s02.003]

}}

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~~==([[Nidana Sthana]] Chapter 2, Chapter on the Etio-Pathogenesis of Bleeding Disorders)==~~

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

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=~~== Abstract ===~~

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<div style="text-align:justify;">This chapter deals with diagnosis of bleeding disorders (raktapitta) caused by an excess of pitta dosha vitiating blood (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. This pitta has the same color and smell as rakta, and blends seamlessly with it. Vitiated pitta and increased rakta circulate in the channels and the resultant increased volume of the blood overflows from the bodily orifices. The pathogenesis, if associated with vitiated kapha, leads to bleeding from upper orifices, whereas if it is associated with vitiated vata, leads to bleeding from the lower orifices. The first condition is curable, and later is difficult to cure. If both kapha and 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>

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This second chapter of [[Nidana Sthana]] is about bleeding disorders (''raktapitta'') caused by an excess of ''pitta dosha'' in the body vitiating the ''rakta dhatu''. This vitiated ''rakta dhatu'' leads to tissue break-down, causing hemorrhages in the upper and lower parts of the gastrointestinal tract. Contributing factors that increase the probability of ''raktapitta'' include consumption of specific food and drug substances including consumption of incompatible food substances, consuming certain meats with alcohol, butter milk with meat of animals etc. These etiological factors are basically ''ushna'' (hot) –either in properties or in potency - which when regularly consumed by a person, vitiate ''pitta''. Vitiated ''pitta'' has the same color and smell as ''rakta'', and blends seamlessly with it to form ''raktapitta.'' Vitiated ''pitta'' and increased ''rakta'' circulate in the channels and the resultant increased volume of the blood overflows from the bodily orifices. During the pathogenesis of ''raktapitta'', if an excessive and vitiated ''kapha'' joins in the action, bleeding from upper orifices occurs while an excessive and vitiated ''vata'' leads to bleeding from the lower orifices. While the ''kapha'' condition is curable, the ''vata''-affliction is difficult to cure. Complications arise when both ''kapha'' and ''vata'' vitiations occur alongside ''raktapitta''. Such conditions are incurable. Therapeutic measures of emesis and purgation, along with useful medicinal formulations and attention may improve the condition of patients of hemorrhagic disorders in varying degrees. Prodromal symptoms and complications have been described in this chapter.

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'''Keywords''': Etio-pathogenesis of ''raktapitta'', bleeding disorders, epistaxis, hemorrhage, hematemesis, rectal bleeding.

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</div>

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~~=== Introduction ===~~

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== Introduction ==

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The second chapter of the [[Nidana Sthana]] focuses on ''rakta'', the second ''dhatu'', just as the first chapter on ''jwara'' focused on the first ''dhatu, rasa''. ''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'' is the cause of both ''jwara'' and ''raktapitta''.

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''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 and is the route taken by the flow of blood when the person has an abundance of body ''kapha'' besides ''rakta'' and ''pitta''. When there is an abundance of body ''vata'' with an interplay of ''rakta'' and ''pitta'', ''raktapitta'' manifests through the lower tract using urine via hematuria and feces via occult blood. When bleeding manifests through both the routes, it indicates the involvement of both the ''doshas, vata'' and ''kapha''.

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''Raktapitta'' from the upper orifices is curable, while that from the lower orifices is considered palliable. Manifestation of bleeding from both the tracts is said to be incurable. ~~Charaka~~ advocates that in order to avoid progression to this stage, prompt preventive action should be taken.

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''Raktapitta'' from the upper orifices is curable, while that from the lower orifices is considered palliable. Manifestation of bleeding from both the tracts is said to be incurable. Charak advocates that in order to avoid progression to this stage, prompt preventive action should be taken.

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</div>

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===Sanskrit Text, Transliteration and English Translation===

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==Sanskrit Text, Transliteration and English Translation==

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अथातोरक्तपित्तनिदानंव्याख्यास्यामः||१||

इतिहस्माहभगवानात्रेयः||२||

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athātō raktapittanidānaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

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Now, the ~~etio-pathogenesis~~ of ~~''raktapitta'' would be explained~~. Thus, said Lord Atreya. [1-2]

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Now we shall expound the chapter "Raktapitta Nidana" (Diagnosis and etiopathogenesis of Bleeding Disorders). Thus said Lord Atreya.[1-2]

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==== Synonym of ''raktapitta'' ====

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=== Synonym of ''raktapitta'' ===

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पित्तं यथाभूतं लोहितपित्तमिति सञ्ज्ञां लभते, तद्व्याख्यास्यामः||३||

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pittaṁ yathābhūtaṁ lōhitapittamiti sañjñāṁ labhatē, tad [1] vyākhyāsyāmaḥ||3||

pittaM yathAbhUtaM lohitapittamiti sa~jj~jAM labhate, tad [1] vyAkhyAsyAmaH||3||

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</div></div>

Also explained would be the origin of ''lohitapitta'' as an alternate name for ''pitta''. [3]

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==== Etiopathogenesis ====

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=== Etiopathogenesis ===

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यदा जन्तुर्यवकोद्दालककोरदूषप्रायाण्यन्नानि भुङ्क्ते, भृशोष्णतीक्ष्णमपि चान्यदन्नजातं निष्पावमाषकुलत्थसूपक्षारोपसंहितं, दधिदधिमण्डोदश्वित्कट्वराम्लकाञ्जिकोपसेकं वा, वाराहमाहिषाविकमात्स्यगव्यपिशितं, पिण्याकपिण्डालुशुष्कशाकोपहितं, मूलकसर्षपलशुन-करञ्ज-शिग्रुमधुशिग्रु(खडयूष) भूस्तृणसुमुखसुरसकुठेरकगण्डीरकालमालकपर्णासक्षवकफ-णिज्झ-कोपदंशं, सुरासौवीरतुषोदकमैरेयमेदकमधूलकशुक्तकुवलबदराम्लप्रायानुपानं वा, पिष्टान्नोत्तरभूयिष्ठम्; उष्णाभितप्तो वाऽतिमात्रमतिवेलं वाऽऽमं पयः पिबति, पयसा समश्नाति रौहिणीकं काणकपोतं वा सर्षपतैलक्षारसिद्धं, कुलत्थपिण्याकजाम्बवलकुचपक्वैः शौक्तिकैर्वा सह क्षीरं बत्युष्णाभितप्तः तस्यैवमाचरतः पित्तं प्रकोपमापद्यते, लोहितं च स्वप्रमाणमतिवर्तते तस्मिन् प्रमाणातिवृत्ते पित्तं प्रकुपितं शरीरमनुसर्पद्यदेव यकृत्प्लीहप्रभवाणां लोहितवहानां च स्रोतसां लोहिताभिष्यन्दगुरूणि मुखान्यासाद्य प्रतिरुन्ध्यात् तदेव लोहितं दूषयति||४||

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yadā janturyavakōddālakakōradūṣaprāyāṇyannāni bhuṅktē, bhr̥śōṣṇatīkṣṇamapi cānyadannajātaṁ niṣpāvamāṣakulatthasūpakṣārōpasaṁhitaṁ,dadhidadhimaṇḍōdaśvitkaṭvarāmlakāñjikōpasēkaṁ [2] vā, vārāhamāhiṣāvikamātsyagavyapiśitaṁ, piṇyākapiṇḍāluśuṣkaśākōpahitaṁ,mūlakasarṣapalaśunakarañjaśigrumadhuśigru(khaḍayūṣa [3] ) bhūstr̥ṇasumukhasurasakuṭhērakagaṇḍīrakālamālakaparṇāsakṣavakaphaṇijjhakōpadaṁśaṁ,~~surāsauvīratuṣōdakamairēyamēdakamadhūlakaśuktakuvalabadarāmlaprāyānupānaṁ~~ vā, piṣṭānnōttarabhūyiṣṭham; uṣṇābhitaptō vā'timātramativēlaṁ vā''maṁpayaḥ pibati, payasā samaśnāti rauhiṇīkaṁ [4] , kāṇakapōtaṁ vā sarṣapatailakṣārasiddhaṁ, kulatthapiṇyākajāmbavalakucapakvaiḥ śauktikairvā saha kṣīraṁpibatyuṣṇābhitaptaḥ [5] ; tasyaivamācarataḥ pittaṁ prakōpamāpadyatē, lōhitaṁ ca [6] svapramāṇamativartatē|

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yadā janturyavakōddālakakōradūṣaprāyāṇyannāni bhuṅktē, bhr̥śōṣṇatīkṣṇamapi cānyadannajātaṁ niṣpāvamāṣakulatthasūpakṣārōpasaṁhitaṁ,dadhidadhimaṇḍōdaśvitkaṭvarāmlakāñjikōpasēkaṁ [2] vā, vārāhamāhiṣāvikamātsyagavyapiśitaṁ, piṇyākapiṇḍāluśuṣkaśākōpahitaṁ,mūlakasarṣapalaśunakarañjaśigrumadhuśigru(khaḍayūṣa [3] ) bhūstr̥ṇasumukhasurasakuṭhērakagaṇḍīrakālamālakaparṇāsakṣavakaphaṇijjhakōpadaṁśaṁ,surāsauvīratuṣōdakamairēyamēdakamadhūlakaśuktakuvalab<br>adarāmlaprāyānu<br>pānaṁ vā, piṣṭānnōttarabhūyiṣṭham; uṣṇābhitaptō vā'timātramativēlaṁ vā''maṁpayaḥ pibati, payasā samaśnāti rauhiṇīkaṁ [4] , kāṇakapōtaṁ vā sarṣapatailakṣārasiddhaṁ, kulatthapiṇyākajāmbavalakucapakvaiḥ śauktikairvā saha kṣīraṁpibatyuṣṇābhitaptaḥ [5] ; tasyaivamācarataḥ pittaṁ prakōpamāpadyatē, lōhitaṁ ca [6] svapramāṇamativartatē|

tasmin pramāṇātivr̥ttē pittaṁ prakupitaṁ śarīramanusarpadyadēva [7] yakr̥tplīhaprabhavāṇāṁ lōhitavahānāṁ ca srōtasāṁ lōhitābhiṣyandagurūṇi mukhānyāsādyapratirundhyāt [8] tadēva [9] lōhitaṁ dūṣayati||4||

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yadA janturyavakoddAlakakoradUShaprAyANyannAni bhu~gkte, bhRushoShNatIkShNamapi cAnyadannajAtaM niShpAvamAShakulatthasUpakShAropasaMhitaM,dadhidadhimaNDodashvitkaTvarAmlakA~jjikopasekaM [2] vA, vArAhamAhiShAvikamAtsyagavyapishitaM, piNyAkapiNDAlushuShkashAkopahitaM,mUlakasarShapalashunakara~jjashigrumadhushigru(khaDayUSha [3])bhUstRuNasumukhasurasakuTherakagaNDIrakAlamAlakaparNAsakShavakaphaNijjhakopadaMshaM,~~surAsauvIratuShodakamaireyamedakamadhUlakashuktakuvalabadarAmlaprAyAnupAnaM~~ vA, piShTAnnottarabhUyiShTham; uShNAbhitapto vA~atimAtramativelaMvA~a~amaM payaH pibati, payasA samashnAti rauhiNIkaM [4], kANakapotaM vA sarShapatailakShArasiddhaM, kulatthapiNyAkajAmbavalakucapakvaiH shauktikairvAsaha kShIraM pibatyuShNAbhitaptaH [5] ; tasyaivamAcarataH pittaM prakopamApadyate, lohitaM ca [6] svapramANamativartate|

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yadA janturyavakoddAlakakoradUShaprAyANyannAni bhu~gkte, bhRushoShNatIkShNamapi cAnyadannajAtaM niShpAvamAShakulatthasUpakShAropasaMhitaM,dadhidadhimaNDodashvitkaTvarAmlakA~jjikopasekaM [2] vA, vArAhamAhiShAvikamAtsyagavyapishitaM, piNyAkapiNDAlushuShkashAkopahitaM,mUlakasarShapalashunakara~jjashigrumadhushigru(khaDayUSha [3])bhUstRuNasumukhasurasakuTherakagaNDIrakAlamAlakaparNAsakShavakaphaNijjhakopadaMshaM,surAsauvIratuShodakamaireyamedakamadhUlakas<br>huktakuvalabadarAmlaprAyAnupAnaM vA, piShTAnnottarabhUyiShTham; uShNAbhitapto vA~atimAtramativelaMvA~a~amaM payaH pibati, payasA samashnAti rauhiNIkaM [4], kANakapotaM vA sarShapatailakShArasiddhaM, kulatthapiNyAkajAmbavalakucapakvaiH shauktikairvAsaha kShIraM pibatyuShNAbhitaptaH [5] ; tasyaivamAcarataH pittaM prakopamApadyate, lohitaM ca [6] svapramANamativartate|

tasmin pramANAtivRutte pittaM prakupitaM sharIramanusarpadyadeva [7] yakRutplIhaprabhavANAM lohitavahAnAM ca srotasAM lohitAbhiShyandagurUNimukhAnyAsAdya pratirundhyAt [8] tadeva [9] lohitaM dUShayati||4||

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</div></div>

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

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*Grains such as ''yavaka, uddalaka,'' and ''koradusha'', in excess quantities, along with other food items that are ''ushna'' (hot in potency) and ''tikshna'' ( sharply acting) such as legumes of ''nishpaava'', black gram, horse gram and alkali, or with curd, whey, buttermilk, sour buttermilk or sour gruel

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

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With such food articles, a person’s ''pitta'' gets vitiated and the quantity of blood in his body exceeds its normal quantity. Along with the increased quantity of vitiated blood in the system, vitiated ''pitta'' gets into the circulation and reaches ''raktavaha srotas'' and its organs like liver and spleen. Due to ''abhishyandi'' and guru qualities of ''rakta'', obstructions in the channels occur leading to morbidity in ''rakta''. [4]

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</div>

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संसर्गाल्लोहितप्रदूषणाल्लोहितगन्धवर्णानुविधानाच्च पित्तं लोहितपित्तमित्याचक्षते||५||

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saṁsargāllōhitapradūṣaṇāllōhitagandhavarṇānuvidhānācca [12] pittaṁ lōhitapittamityācakṣatē||5||

saMsargAllohitapradUShaNAllohitagandhavarNAnuvidhAnAcca [12] pittaM lohitapittamityAcakShate||5||

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</div></div>

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''Pitta'' gets the name ''lohitapitta'' because after mixing with blood it acquires the color and smell of blood. (5)

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''Pitta'' gets the name ''lohitapitta'' because after mixing with blood it acquires the color and smell of blood. [5]

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==== Prodromal symptoms ====

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=== Prodromal symptoms ===

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तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- अनन्नाभिलाषः, भुक्तस्य विदाहः, शुक्ताम्लगन्धरस उद्गारः, छर्देरभीक्ष्णमागमनं, छर्दितस्य बीभत्सता, स्वरभेदो, गात्राणां सदनं, परिदाहः, मुखाद्धूमागम इव, लोहलोहितमत्स्यामगन्धित्वमिव चास्यस्य, रक्तहरितहारिद्रत्वमङ्गावयवशकृन्मूत्रस्वेदलालासिङ्घाणकास्यकर्णमलपिडकोलिकापिडकानाम्, अङ्गवेदना, लोहितनीलपीतश्यावानामर्चिष्मतां च रूपाणां स्वप्ने दर्शनमभीक्ष्णमिति (लोहितपित्तपूर्वरूपाणि भवन्ति)||६||

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tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilāṣaḥ, bhuktasya vidāhaḥ, śuktāmlagandharasa udgāraḥ, chardērabhīkṣṇamāgamanaṁ, charditasyabībhatsatā, svarabhēdō, gātrāṇāṁ sadanaṁ, paridāhaḥ, mukhāddhūmāgama iva, lōhalōhitamatsyāmagandhitvamiva cāsyasya,raktaharitahāridratvamaṅgāvayavaśakr̥nmūtrasvēdalālāsiṅghāṇakāsyakarṇamalapiḍakōlikāpiḍakānām [14] , aṅgavēdanā, lōhitanīlapītaśyāvānāmarciṣmatāṁ carūpāṇāṁ svapnē darśanamabhīkṣṇamiti (lōhitapittapūrvarūpāṇi [15] bhavanti)||6||

tasyemAni pUrvarUpANi bhavanti; tadyathA- anannAbhilAShaH, bhuktasya vidAhaH, shuktAmlagandharasa udgAraH, charderabhIkShNamAgamanaM, charditasyabIbhatsatA, svarabhedo, gAtrANAM sadanaM, paridAhaH, mukhAddhUmAgama iva, lohalohitamatsyAmagandhitvamiva cAsyasya,raktaharitahAridratvama~ggAvayavashakRunmUtrasvedalAlAsi~gghANakAsyakarNamalapiDakolikApiDakAnAm [14] , a~ggavedanA,lohitanIlapItashyAvAnAmarciShmatAM ca rUpANAM svapne darshanamabhIkShNamiti (lohitapittapUrvarUpANi [15] bhavanti)||6||

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</div></div>

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The prodromal symptoms of ''raktapitta'' include aversion to food, hot eructation just after meal, belches with smell and aftertaste of sour gruel, frequent vomiting, ugliness of vomitus, hoarseness of voice, malaise, radiating burning sensation, emittance of smoke from the mouth, smell of metal, blood, or fish , mucus in the mouth, appearance of red, green or yellow spots in body parts, feces, urine, sweat, saliva, nose-secretion, excreta from mouth and ear and boils, bodyache, and frequent vision of red, blue, yellow, blackish and brilliant objects in dreams. [6]

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</div>

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==== Complications ====

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=== Complications ===

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उपद्रवास्तु खलु दौर्बल्यारोचकाविपाकश्वासकासज्वरातीसारशोफशोषपाण्डुरोगाः स्वरभेदश्च||७||

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upadravāstu khalu daurbalyārōcakāvipākaśvāsakāsajvarātīsāraśōphaśōṣapāṇḍurōgāḥ svarabhēdaśca||7||

upadravAstu khalu daurbalyArocakAvipAkashvAsakAsajvarAtIsArashophashoShapANDurogAH svarabhedashca||7||

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</div></div>

Complications (of ''raktapitta'') include debility, anorexia, indigestion, dyspnea, cough, fever, diarrhea, edema, emaciation, anemia and hoarseness of voice. [7]

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==== Disease pathways ====

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=== Disease pathways ===

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मार्गौ पुनरस्य द्वौ ऊर्ध्वं, चाधश्च तद्बहुश्लेष्मणि शरीरे श्लेष्मसंसर्गादूर्ध्वं प्रतिपद्यमानं कर्णनासिकानेत्रास्येभ्यः प्रच्यवते, बहुवाते तु शरीरे वातसंसर्गादधः प्रतिपद्यमानं मूत्रपुरीषमार्गाभ्यां प्रच्यवते, बहुश्लेष्मवाते तु शरीरे श्लेष्मवातसंसर्गाद्द्वावपि मार्गौ प्रतिपद्यते, तौ मार्गौ प्रतिपद्यमानं सर्वेभ्य एव यथोक्तेभ्यः खेभ्यः प्रच्यवते शरीरस्य||८||

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mārgau punarasya dvau ūrdhvaṁ, cādhaśca|

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mArgau punarasya dvau UrdhvaM, cAdhashca|

tadbahushleShmaNi sharIre shleShmasaMsargAdUrdhvaM pratipadyamAnaM karNanAsikAnetrAsyebhyaH pracyavate, bahuvAte tu sharIre vAtasaMsargAdadhaHpratipadyamAnaM mUtrapurIShamArgAbhyAM pracyavate, bahushleShmavAte tu sharIre shleShmavAtasaMsargAddvAvapi mArgau pratipadyate, tau mArgaupratipadyamAnaM sarvebhya eva yathoktebhyaH khebhyaH pracyavate sharIrasya||8||

+

</div></div>

+

There are two routes of the manifestation of ''raktapitta'' - upwards and downwards. In persons having an abundance of ''kapha'', vitiated ''rakta'' goes up and bleeding occurs from ear, nose, eyes and mouth. In those having an excess of ''vata, rakta'' flows downwards along with ''vata'' and patients bleed through the urinary tract and rectum. Finally, in those having abundance of both ''kapha'' and ''vata'', ''rakta'' comes out from the body with both the routes and thus bleeds through all the aforesaid orifices. [8]

−

+

</div>

−

==== Prognosis ====

+

=== Prognosis ===

+

तत्र यदूर्ध्वभागं तत् साध्यं, विरेचनोपक्रमणीयत्वाद्बह्वौषधत्वाच्च; यदधोभागं तद्याप्यं, वमनोपक्रमणीयत्वादल्पौषधत्वाच्च; यदुभयभागं तदसाध्यं, वमनविरेचनायोगित्वादनौषधत्वाच्चेति||९||

+

tatra yadūrdhvabhāgaṁ tat sādhyaṁ, virēcanōpakramaṇīyatvādbahvauṣadhatvācca; yadadhōbhāgaṁ tadyāpyaṁ, vamanōpakramaṇīyatvādalpauṣadhatvācca;yadubhayabhāgaṁ tadasādhyaṁ, vamanavirēcanāyōgitvādanauṣadhatvāccēti||9||

+

tatra yadUrdhvabhAgaM tat sAdhyaM, virecanopakramaNIyatvAdbahvauShadhatvAcca; yadadhobhAgaM tadyApyaM, vamanopakramaNIyatvAdalpauShadhatvAcca;yadubhayabhAgaM tadasAdhyaM, vamanavirecanAyogitvAdanauShadhatvAcceti||9||

+

</div></div>

+

Amongst these, that which comes out of the upper orifices is curable and is treatable by purgation due to availability of plenty of drugs for the purpose. That coming out from the lower orifices is palliable because of being amenable to emesis and availability of lesser number of drugs for the purpose. That coming out from both the routes is incurable because of non-applicability of both emesis and purgation and in want of suitable drugs. (9)

+

</div>

+

=== Origin of ''raktapitta'' ===

+

−

=~~=== Origin of ''raktapitta'' ====~~

+

रक्तपित्तप्रकोपस्तु खलु पुरा दक्षयज्ञोद्ध्वंसे रुद्रकोपामर्षाग्निना प्राणिनां परिगतशरीरप्राणानामभवज्ज्वरमनु||१०||

+

−

रक्तपित्तप्रकोपस्तु खलु पुरा दक्षयज्ञोद्ध्वंसे रुद्रकोपामर्षाग्निना प्राणिनां परिगतशरीरप्राणानामभवज्ज्वरमनु||१०||

raktapittaprakōpastu khalu purā dakṣayajñōddhvaṁsē rudrakōpāmarṣāgninā [16] prāṇināṁ parigataśarīraprāṇānāmabhavajjvaramanu||10||

+

raktapittaprakopastu khalu purA dakShayaj~joddhvaMse rudrakopAmarShAgninA [16] prANinAM parigatasharIraprANAnAmabhavajjvaramanu||10||

+

</div></div>

−

Hystorically, ''raktapitta'' occured after ''jwara'' because of Rudra’s anger pervaded the human being at the time of destruction of Daksha's sacrifice. (10)

+

Hystorically, ''raktapitta'' occured after ''jwara'' because of Rudra’s anger pervaded the human being at the time of destruction of Daksha's sacrifice. [10]

−

==== General principles of management ====

+

=== General principles of management ===

+

तस्याशुकारिणो दावाग्नेरिवापतितस्यात्ययिकस्याशु प्रशान्त्यै प्रयतितव्यं मात्रां देशं कालं चाभिसमीक्ष्य सन्तर्पणेनापतर्पणेन वा मृदुमधुरशिशिरतिक्तकषायैरभ्यवहार्यैः प्रदेहपरिषेकावगाहसंस्पर्शनैर्वमनाद्यैर्वा तत्रावहितेनेति||११||

+

tasyāśukāriṇō dāvāgnērivāpatitasyātyayikasyāśu praśāntyai prayatitavyaṁ mātrāṁ dēśaṁ kālaṁ cābhisamīkṣya santarpaṇēnāpatarpaṇēna vāmr̥dumadhuraśiśiratiktakaṣāyairabhyavahāryaiḥ pradēhapariṣēkāvagāhasaṁsparśanairvamanādyairvā tatrāvahitēnēti||11||

tasyAshukAriNo dAvAgnerivApatitasyAtyayikasyAshu prashAntyai prayatitavyaM mAtrAM deshaM kAlaM cAbhisamIkShya santarpaNenApatarpaNena vAmRudumadhurashishiratiktakaShAyairabhyavahAryaiH pradehapariShekAvagAhasaMsparshanairvamanAdyairvA tatrAvahiteneti||11||

+

</div></div>

+

The disease is acute in nature and becomes critical very quickly, spreading like bush fire. Hence its treatment should be done immediately with saturating or de-saturating soft, sweet, cold, bitter and astringent diet and pastes, baths, emesis etc. after due consideration of dose, place and time. [11]

+

</div>

+

भवन्ति चात्र- साध्यं लोहितपित्तं तद्यदूर्ध्वं प्रतिपद्यते|

+

विरेचनस्य योगित्वाद्बहुत्वाद्भेषजस्य च||१२||

विरेचनं तु पित्तस्य जयार्थे परमौषधम्|

+

यश्च तत्रान्वयः श्लेष्मा तस्य चानधमं स्मृतम्||१३||

भवेद्योगावहं तत्र मधुरं चैव भेषजम्|

+

तस्मात् साध्यं मतं रक्तं यदूर्ध्वं प्रतिपद्यते||१४||

+

bhavanti cātra- sādhyaṁ lōhitapittaṁ tadyadūrdhvaṁ pratipadyatē|

+

virēcanasya yōgitvādbahutvādbhēṣajasya ca||12||

virēcanaṁ tu pittasya jayārthē paramauṣadham|

+

yaśca tatrānvayaḥ [17] ślēṣmā tasya cānadhamaṁ smr̥tam||13||

bhavēdyōgāvahaṁ tatra madhuraṁ [18] caiva bhēṣajam|

+

tasmāt sādhyaṁ mataṁ raktaṁ yadūrdhvaṁ pratipadyatē||14||

bhavanti cAtra- sAdhyaM lohitapittaM tadyadUrdhvaM pratipadyate|

+

virecanasya yogitvAdbahutvAdbheShajasya ca||12||

virecanaM tu pittasya jayArthe paramauShadham|

+

yashca tatrAnvayaH [17] shleShmA tasya cAnadhamaM smRutam||13||

bhavedyogAvahaM tatra madhuraM [18] caiva bheShajam|

+

tasmAt sAdhyaM mataM raktaM yadUrdhvaM pratipadyate||14||

+

</div></div>

+

The “upward” variety of ''raktapitta'' is curable because of applicability of purgation and abundance of useful drugs. Purgation is the best remedy for alleviation of ''pitta'' and ambivalence to ''kapha''. Sweet drugs are also applicable in this case. Hence, bleeding from the upper part is curable. [12-14]

+

</div>

+

रक्तं तु यदधोभागं तद्याप्यमिति निश्चितम्|

+

वमनस्याल्पयोगित्वादल्पत्वाद्भेषजस्य च||१५||

वमनं हि न पित्तस्य हरणे श्रेष्ठमुच्यते|

+

यश्च तत्रान्वयो वायुस्तच्छान्तौ चावरं स्मृतम्||१६||

तच्चायोगावहं तत्र कषायं तिक्तकानि च|

+

तस्माद्याप्यं समाख्यातं यदुक्तमनुलोमगम्||१७||

+

raktaṁ tu yadadhōbhāgaṁ tadyāpyamiti niścitam|

+

vamanasyālpayōgitvādalpatvādbhēṣajasya ca||15||

vamanaṁ hi na pittasya haraṇē [20] śrēṣṭhamucyatē|

+

yaśca tatrānvayō [21] vāyustacchāntau cāvaraṁ smr̥tam||16||

taccāyōgāvahaṁ [22] tatra kaṣāyaṁ tiktakāni ca|

+

tasmādyāpyaṁ samākhyātaṁ yaduktamanulōmagam [23] ||17||

raktaM tu yadadhobhAgaM tadyApyamiti nishcitam|

+

vamanasyAlpayogitvAdalpatvAdbheShajasya ca||15||

vamanaM hi na pittasya haraNe [20] shreShThamucyate|

+

yashca tatrAnvayo [21] vAyustacchAntau cAvaraM smRutam||16||

taccAyogAvahaM [22] tatra kaShAyaM tiktakAni ca|

+

tasmAdyApyaM samAkhyAtaM yaduktamanulomagam [23] ||17||

+

</div></div>

−

Hemorrhage from the lower parts is decidedly palliable because emesis has limited efficacy here and effective drugs are also a few. Emesis is not so efficacious for elimination of pitta and it is also ineffective in alleviation of ''vata'' responsible for the downward flow. Moreover, astringents and bitter drugs are not applicable there. Hence hemorrhage from the lower parts is considered palliable. (15-17)

+

+

Hemorrhage from the lower parts is decidedly palliable because emesis has limited efficacy here and effective drugs are also a few. Emesis is not so efficacious for elimination of ''pitta'' and it is also ineffective in alleviation of ''vata'' responsible for the downward flow. Moreover, astringents and bitter drugs are not applicable there. Hence hemorrhage from the lower parts is considered palliable. [15-17]

+

</div>

+

रक्तपित्तं तु यन्मार्गौ द्वावपि प्रतिपद्यते|

+

असाध्यमिति तज्ज्ञेयं पूर्वोक्तादेव कारणात्||१८||

नहि संशोधनं किञ्चिदस्त्यस्य प्रतिमार्गगम्|

+

प्रतिमार्गं च हरणं रक्तपित्ते विधीयते||१९||

एवमेवोपशमनं सर्वशो नास्य विद्यते|

+

संसृष्टेषु च दोषेषु सर्वजिच्छमनं मतम् ||२०||

इत्युक्तं त्रिविधोदर्कं रक्तं मार्गविशेषतः||२१||

+

raktapittaṁ tu yanmārgau dvāvapi pratipadyatē|

+

asādhyamiti tajjñēyaṁ pūrvōktādēva kāraṇāt||18||

nahi saṁśōdhanaṁ kiñcidastyasya pratimārgagam|

+

pratimārgaṁ ca haraṇaṁ raktapittē vidhīyatē||19||

ēvamēvōpaśamanaṁ sarvaśō nāsya vidyatē|

+

saṁsr̥ṣṭēṣu ca dōṣēṣu sarvajicchamanaṁ matam [25] ||20||

Line 234: Line 329:

raktapittaM tu yanmArgau dvAvapi pratipadyate|

+

asAdhyamiti tajj~jeyaM pUrvoktAdeva kAraNAt||18||

nahi saMshodhanaM ki~jcidastyasya pratimArgagam|

+

pratimArgaM ca haraNaM raktapitte vidhIyate||19||

evamevopashamanaM sarvasho nAsya vidyate|

+

saMsRuShTeShu ca doSheShu sarvajicchamanaM matam [25] ||20||

+

ityuktaM trividhodarkaM raktaM mArgavisheShataH|21|

+

</div></div>

+

In cases where blood comes out from both the routes, ''raktapitta'' is incurable because no effective evacuative measure is applicable. In ''raktapitta'', elimination of ''dosha'' from the opposite route is recommended. Thus, the three types (on the basis of the routes taken by ''rakta'') of ''raktapitta'' progression (''udarka'') have been described. [18-20]

+

</div>

+

एभ्यस्तु खलु हेतुभ्यः किञ्चित्साध्यं न सिध्यति||२१||

प्रेष्योपकरणाभावाद्दौरात्म्याद्वैद्यदोषतः|

+

अकर्मतश्च साध्यत्वं कश्चिद्रोगोऽतिवर्तते||२२||

+

तत्रासाध्यत्वमेकं स्यात् साध्ययाप्यपरिक्रमात्|२३|

+

+

ēbhyastu khalu hētubhyaḥ kiñcitsādhyaṁ na sidhyati||21||

+

prēṣyōpakaraṇābhāvāddaurātmyādvaidyadōṣataḥ|

+

akarmataśca sādhyatvaṁ kaścidrōgō'tivartatē||22||

+

tatrāsādhyatvamēkaṁ syāt sādhyayāpyaparikramāt|23|

+

ebhyastu khalu hetubhyaH ki~jcitsAdhyaM na sidhyati||21||

+

preShyopakaraNAbhAvAddaurAtmyAdvaidyadoShataH|

+

akarmatashca sAdhyatvaM kashcidrogo~ativartate||22||

+

tatrAsAdhyatvamekaM syAt sAdhyayApyaparikramAt|23|

+

</div></div>

−

Some curable diseases do not get treated successfully because of the lack of attendants and equipments, uncontrolled self and fault of the physician. If the disease is not treated, then it proceeds to incurability. If treated well, sometimes the incurable disease may become curable or palliable. (21-23)

+

Some curable diseases do not get treated successfully because of the lack of attendants and equipments, uncontrolled self and fault of the physician. If the disease is not treated, then it proceeds to incurability. If treated well, sometimes the incurable disease may become curable or palliable. [21-23]

−

==== Signs of incurable ''raktapitta'' ====

+

=== Signs of incurable ''raktapitta'' ===

+

रक्तपित्तस्य विज्ञानमिदं तस्योपदिश्यते||२३||

यत् कृष्णमथवा नीलं यद्वा शक्रधनुष्प्रभम्|

+

रक्तपित्तमसाध्यं तद्वाससो रञ्जनं च यत्||२४||

भृशं पूत्यतिमात्रं च सर्वोपद्रववच्च यत्|

+

बलमांसक्षये यच्च तच्च रक्तमसिद्धिमत्||२५||

येन चोपहतो रक्तं रक्तपित्तेन मानवः|

+

पश्येद्दृश्यं वियच्चापि तच्चासाध्यं न संशयः||२६||

+

raktapittasya vijñānamidaṁ tasyōpadiśyatē||23||

yat kr̥ṣṇamathavā nīlaṁ yadvā śakradhanuṣprabham|

+

raktapittamasādhyaṁ tadvāsasō rañjanaṁ ca yat||24||

bhr̥śaṁ pūtyatimātraṁ ca sarvōpadravavacca yat|

+

balamāṁsakṣayē yacca tacca raktamasiddhimat||25||

yēna cōpahatō raktaṁ raktapittēna mānavaḥ|

+

paśyēddr̥śyaṁ viyaccāpi taccāsādhyaṁ na saṁśayaḥ||26||

Line 288: Line 411:

yat kRuShNamathavA nIlaM yadvA shakradhanuShprabham|

+

raktapittamasAdhyaM tadvAsaso ra~jjanaM ca yat||24||

bhRushaM pUtyatimAtraM ca sarvopadravavacca yat|

+

balamAMsakShaye yacca tacca raktamasiddhimat||25||

yena copahato raktaM raktapittena mAnavaH|

+

pashyeddRushyaM viyaccApi taccAsAdhyaM na saMshayaH||26||

+

</div></div>

+

Now described are types of ''raktapitta'', identified (by their physical appearance). ''Raktapitta'' which is black, blue or of rainbow color and stains clothes is incurable. Bleeding which is of excessively fetid smell, in large quantities, and which is associated with all the complications particularly in weak and emaciated patients is incurable. A patient, if sees things around him and the sky red, is certainly suffering from an incurable variant of the disease. [23-26]

+

</div>

+

तत्रासाध्यं परित्याज्यं, याप्यं यत्नेन यापयेत्|

+

साध्यं चावहितः सिद्धैर्भेषजैः साधयेद्भिषक्||२७|

+

tatrāsādhyaṁ parityājyaṁ, yāpyaṁ yatnēna yāpayēt|

+

sādhyaṁ cāvahitaḥ siddhairbhēṣajaiḥ sādhayēdbhiṣak||27||

tatrAsAdhyaM parityAjyaM, yApyaM yatnena yApayet|

+

sAdhyaM cAvahitaH siddhairbheShajaiH sAdhayedbhiShak||27||

+

</div></div>

−

A patient suffering from the incurable variant should be avoided, while the one with the palliable variant should be managed with efforts and the curable one should be treated successfully with tried remedies. [27]

+

A patient suffering from the incurable variant should be avoided, while the one with the palliable variant should be managed with efforts and the curable one should be treated successfully with tried remedies. [27]

−

==== Summary ====

+

=== Summary ===

+

तत्र श्लोकौ-

+

कारणं नामनिर्वृत्तिं पूर्वरूपाण्युपद्रवान्|

+

मार्गौ दोषानुबन्धं च साध्यत्वं न च हेतुमत्||२८||

निदाने रक्तपित्तस्य व्याजहार पुनर्वसुः|

+

वीतमोहरजोदोषलोभमानमदस्पृहः||२९||

+

tatra ślōkau- kāraṇaṁ nāmanirvr̥ttiṁ pūrvarūpāṇyupadravān|

+

mārgau dōṣānubandhaṁ ca sādhyatvaṁ na ca hētumat||28||

nidānē raktapittasya vyājahāra punarvasuḥ|

+

vītamōharajōdōṣalōbhamānamadaspr̥haḥ||29||

tatra shlokau- kAraNaM nAmanirvRuttiM pUrvarUpANyupadravAn|

+

mArgau doShAnubandhaM ca sAdhyatvaM na ca hetumat||28||

nidAne raktapittasya vyAjahAra punarvasuH|

+

vItamoharajodoShalobhamAnamadaspRuhaH||29||

+

</div></div>

Now summarizing the chapter–

+

Etiology, etymology of the disease, prodroma, complications, routes, association of ''doshas'', curability (or otherwise), with reasoning – all this has been addressed in the chapter on diagnosis of ''raktapitta'' by Punarvasu who has shed off ''tamas'' and ''rajas, doshas,'' greed, conceit and pride. [28-29]

+

</div>

+

−

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते~~| निदानस्थाने रक्तपित्तनिदानं नाम द्वितीयोऽध्यायः||२|~~|

+

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते|

−

~~ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē raktapittanidānaṁ nāma dvitīyō'dhyāyaḥ~~||2||

+

निदानस्थाने रक्तपित्तनिदानं नाम द्वितीयोऽध्यायः||२||

+

−

~~ityagniveshakRute tantre carakapratisaMskRute nidAnasthAne raktapittanidAnaM nAma dvitIyo~adhyAyaH||2||~~

+

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē

−

~~Thus ends the second chapter on diagnosis of~~ '~~'raktapitta'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charaka. [~~2]

+

nidānasthānē raktapittanidānaṁ nāma dvitīyō'dhyāyaḥ||2||

−

~~=== ''Tattva Vimarsha'' ===~~

+

ityagniveshakRute tantre carakapratisaMskRute

+

nidAnasthAne raktapittanidAnaM nAma dvitIyo~adhyAyaH||2||

+

</div></div>

+

Thus ends the second chapter on diagnosis of ''raktapitta'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [2]

+

== Tattva Vimarsha (Fundamental principles) ==

+

*''Rakta'' and ''pitta'' have a cause-and-effect relationship because of their common origin, and this fact is important in the pathogenesis and manifestation of ''raktapitta''.

*The ''amla'' (sour), ''lavana'' (salty), ''katu'' (pungent) food articles with ''ushna'' (hot potency), ''tikshna'' (sharply acting) lead to vitiation of ''pitta dosha'' and blood. This causes ''abhishyanda'' (excess discharge leading to increase in volume of fluid) and ''guru'' (heaviness) in blood. This results in obstruction of ''raktavaha srotasa'' rooted in ''yakrita''(liver)-''pleeha'' (spleen) and ''raktapitta'' (hemorrhage).

Line 350: Line 506:

*Prognosis is based on ''dosha'', route, purification treatment, and availability of effective medicines.

−

==~~= ''~~Vidhi Vimarsha~~'' =~~==

+

== Vidhi Vimarsha (Applied Inferences) ==

What is ''rakta''’s relationship with blood? ''Rakta'' is a ''dhatu'', or a flowing tissue that is responsible for the sustenance of life. Unlike what has been written in various commentaries or texts on ''rakta'', blood is not the same as ''raktadhatu''. Blood contains formed elements (RBC, WBC, platelets) which are products of ''sarakta meda'', the integral component of ''majjadhatu''. It has ''plasma'' containing minerals, vitamins, procoagulant and anticoagulant factors, enzymes, hormones, neurotransmitters, nutrients, etc., which are mostly assigned to ''rasadhatu''. Blood also contains fats, cholesterol, free fatty acids etc., which are products of ''medadhatu''. It contains blood proteins such as actin, myosin, myoglobin, etc. which are integral components of ''mamsadhatu''. It also contains metabolic wastes such as urea and lactic acid etc., which are ''mala''. Therefore, ''raktadhatu'' is a component of blood, using it as part of its material structure for its functions.

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Nutritional research claims on substances linked to hypo-coagulation and/or bleeding disorders

−

==== Vitamin K ====

+

=== Vitamin K ===

Much of the research on dietary interactions with bleeding disorders comes from the interaction of foods with warfarin. Since 1951, warfarin has been used as an anticoagulant, effectively preventing the formation of blood clots in the blood vessels and their migration elsewhere in the body respectively. warfarin reduces the availability of the reduced form of Vitamin K1, a critical molecule in the coagulation cascade, affecting blood coagulation proteins prothrombin and factor VII. Warfarin inhibits the enzyme vitamin K epoxide reductase, which recycles Vitamin K1 from its oxidized form to a ready reduced form. The net effect is that coagulation is lessened. Foods with high vitamin K1 directly supply the vitamin to the body, bypassing the inhibition of warfarin; thus they reinitiate the coagulation pathway.

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Spices and herbs with high salicylate content block vitamin K and act as natural blood thinners. The food substances mentioned in the etiology are rich in salicylates.

−

Garlic (''Rasona'') is clearly-mentioned among the etiological factors of ''raktapitta'' (C.Ni. 2/4). Garlic contains nine different naturally-occurring anti-platelet compounds. It also acts as natural antibiotic that can kill intestinal bacteria, which manufacture vitamin K.

+

Garlic (''Rasona'') is clearly-mentioned among the etiological factors of ''raktapitta''. [Cha.Sa.[[Nidana Sthana]] 2/4] Garlic contains nine different naturally-occurring anti-platelet compounds. It also acts as natural antibiotic that can kill intestinal bacteria, which manufacture vitamin K.

−

==== Omega-3 Fatty Acids ====

+

=== Omega-3 Fatty Acids ===

−

Fish oil is a rich source of omega–3 fatty acids. Omega-3-fatty acids help to thin the blood. Fish may therefore be a great food for people who are at risk of blood clots but too much consumption of omega-3 can be at risk of bleeding disorders. This fact was long back observed and reported in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] in [[~~Charaka Samhita~~]] ~~(Ni.~~2.4).

+

Fish oil is a rich source of omega–3 fatty acids. Omega-3-fatty acids help to thin the blood. Fish may therefore be a great food for people who are at risk of blood clots but too much consumption of omega-3 can be at risk of bleeding disorders. This fact was long back observed and reported in [https://en.wikipedia.org/wiki/[[Ayurveda]] [[Ayurveda]]] in [Cha.Sa.[[Nidana Sthana]] 2/4]

−

===~~= Alcohols =~~===

+

=== Alcohol ===

−

~~Charaka~~ describes a group of preparations containing alcohol under ''nidana'' ~~(Ni~~.2.4) (etiological factors): ''sura, sauvira,'' ''shukta, badaramala''. Ayurvedic classics warn against excessive use of alcohols in ''pitta''-vitiated patients, due to their heating and drying. In addition, biomedical research in 1986, suggests that subclinical vitamin K deficiency occurs in alcoholics, contributing to hypo-coagulability.

+

Charak describes a group of preparations containing alcohol under ''nidana'' [Cha.Sa.[[Nidana Sthana]] 2/4] (etiological factors): ''sura, sauvira,'' ''shukta, badaramala''. Ayurvedic classics warn against excessive use of alcohols in ''pitta''-vitiated patients, due to their heating and drying. In addition, biomedical research in 1986, suggests that subclinical vitamin K deficiency occurs in alcoholics, contributing to hypo-coagulability.

In summary, it appears that all the foods listed, either due to inherent ''veerya'' (heat ''dosha'' transfer potential) or combinations that create difficulty to digest using the body’s own heat, will raise a level of heat in the body that aggravates ''pitta dosha'' and initiates the cascade of ''pittakopa'' that leads eventually, if un-intervened, to ''raktapitta''.

−

==== Excess heat ====

+

=== Excess heat ===

Among the lifestyle factors that lead down to aggravated ''pitta'' (''viharaja nidanas'') and ''raktapitta'' are excessive exercise(''vyayama''), and exposure to sunlight. Scientific evidence has now established that vigorous exercise appears to lower vitamin K levels and thus thin the blood. Sunlight increases the conversion of Vitamin D to Vitamin D3 in the skin; a recent clinical trial of a biologically active metabolite of Vitamin D3 demonstrated an unanticipated reduction of thrombosis in cancer patients. Therefore, it appears that Vitamin D3 reduces blood clotting.

−

==== Hereditary issues ====

+

=== Hereditary issues ===

−

Some bleeding disorders are known as hereditary or acquired through genetic transmission. [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] seems to point to specific foods and habits that promote the manifestation of acquired bleeding disorders; one could propose an epigenetic mechanism to explain these disorders that have eventual onset. Bleeding disorders such as hemophilia that occur from birth, indeed all hereditary imperfections, are explained in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] with the concept of ''beeja dosha'', or inheritance of ''paapam'' through cycles of ''karma''.

+

Some bleeding disorders are known as hereditary or acquired through genetic transmission. [https://en.wikipedia.org/wiki/[[Ayurveda]] [[Ayurveda]]] seems to point to specific foods and habits that promote the manifestation of acquired bleeding disorders; one could propose an epigenetic mechanism to explain these disorders that have eventual onset. Bleeding disorders such as hemophilia that occur from birth, indeed all hereditary imperfections, are explained in [https://en.wikipedia.org/wiki/[[Ayurveda]] [[Ayurveda]]] with the concept of ''beeja dosha'', or inheritance of ''paapam'' through cycles of ''karma''.

Some pharmaceutical medications promote bleeding disorders. These situations can be treated by avoiding the etiological factors listed in this chapter. Once bleeding begins, the disease can be treated by removing the medicine, giving the patient sources of strong healthy ''pitta dosha'', and fortifying the ''rakta'' so that organs fed by ''rakta'' can remain as healthy as possible.

−

==== Pathophysiology of Bleeding/Hemorrhagic Disorders in modern medicine ====

+

=== Pathophysiology of Bleeding/Hemorrhagic Disorders in modern medicine ===

Per biomedicine, bleeding disorders are a group of heterogenous conditions that occur when the blood cannot clot properly. In normal clotting, platelets stick together when prompted by a stimulus that invokes the clotting pathway to ultimately form a plug at the site of an injured blood vessel. Proteins in the blood (clotting factors) are activated when either a pathogen or an exposed cell wall signal rupture of the blood vessel. An interactive cascade then leads to the formation of a fibrin clot, which holds the platelets in place and allows repair to occur at the site of the injury while preventing blood from escaping the blood vessel. While too much clotting can create either a thrombus or embolus that may lead to a heart attack and stroke, the inability to form clots can be very dangerous as well, as excess bleeding will also interrupt the integrity of the vascular system.

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#Clot inhibition/lysis

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===== I. Hemorrhagic Disorder Classifications =====

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==== I. Hemorrhagic Disorder Classifications ====

Hemorrhagic disorders can also occur from functional abnormalities of the vascular wall and are classified as:

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#'''Other purpuras''': purpura simplex, senile purpura, mechanic purpura, paraproteinemia

−

===== II. Platelet abnormalities =====

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==== II. Platelet abnormalities ====

−

#Thrombocytopenia: ① Diminished or defective platelet production: aplastic anemia, marrow infiltration (carcinoma, leukemia, myelofibrosis, tuberculosis, etc), infections, drugs that act on platelet production (alcohol, thiazide diuretics).② Enhanced platelet destruction: idiopathic thrombocytopenic purpura, drug-induced, thrombotic thrombocytopenic purpura. ~~③Sequestration~~ of platelets: hypersplenism

+

#Thrombocytopenia:

−

#Thrombocytosis: ① Primary: essential thrombocythemia.② Secondary: infections, injury, post-splenectomy chronic myelocytic leukemia, other myeloproliferative disorders (such as polycythemia vera)

+

##Diminished or defective platelet production: aplastic anemia, marrow infiltration (carcinoma, leukemia, myelofibrosis, tuberculosis, etc), infections, drugs that act on platelet production (alcohol, thiazide diuretics).

−

#Functional abnormalities of platelets: ① Congenital: thrombasthenia, giant platelet syndrome (Bernard-Soulier syndrome). ② Acquired: due to drugs, uremia, liver diseases, dysproteinemias

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##Enhanced platelet destruction: idiopathic thrombocytopenic purpura, drug-induced, thrombotic thrombocytopenic purpura. ##Sequestration of platelets: hypersplenism

+

#Thrombocytosis:

+

##Primary: essential thrombocythemia.

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##Secondary: infections, injury, post-splenectomy chronic myelocytic leukemia, other myeloproliferative disorders (such as polycythemia vera)

+

#Functional abnormalities of platelets:

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##Congenital: thrombasthenia, giant platelet syndrome (Bernard-Soulier syndrome).

+

##Acquired: due to drugs, uremia, liver diseases, dysproteinemias

−

===== III. Coagulation disorders due to coagulation factor deficiencies =====

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==== III. Coagulation disorders due to coagulation factor deficiencies ====

#Congenital: hemophilia A (F VIII deficiency), hemophilia B (F IX deficiency),factor XI deficiency (formerly hemophilia C), hypothrombinogenemia, hypofibrinogenemia, von Willebrand’s disease, other coagulation factors deficiency, including deficiency of activatedprotein C inhibitor structural abnormalities

#Acquired: Vitamin K deficiency, severe liver diseases, drugs (dicumarol), disseminated intravascular coagulation (DIC) etc

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===== IV. Hyperfibrinolysis =====

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==== IV. Hyperfibrinolysis ====

#Primary: Congenital deficiency of α2 antiplasmin, clinical use of urokinase, liver diseases, liberation of tissue plasminogen activator into the circulation

#Secondary: DIC

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==== Causes of Bleeding ====

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=== Causes of Bleeding ===

When normal hemostatic mechanisms fail, major hemorrhage may follow minor trauma or may appear to arise spontaneously. Biomedicine observes spontaneous bleeding primarily from either the rectum or from the naso-pharyngeal cavity.

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===== A.Causes of bleeding from the mouth =====

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==== A.Causes of bleeding from the mouth ====

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~~i) Common causes of bleeding from the mouth include:~~

−

~~- Dental caries, due to decay from chronic bacteria~~

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~~- Trauma, due to mechanical injury~~

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~~- Periodontal diseases, due to tissue decay from infectious origin, metabolic diseases or nutritional deficiencies~~

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~~ii) Rare causes of bleeding from the mouth include:~~

−

~~- Hemophilia~~

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~~- Leukemia~~

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~~- Viral hemorrhagic fevers~~

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~~iii) Iatrogenic procedures such as crown placement, dental cleaning, placement and use of dentures, plaque removal, root canal, post tonsillectomy bleeding, and tooth extraction~~

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~~iv)~~ Other causes of bleeding from the mouth include:

+

#Common causes of bleeding from the mouth include:

−

~~- bleeding~~ diathesis

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##Dental caries, due to decay from chronic bacteria

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- Carcinoma, squamous cell of head and neck

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##Trauma, due to mechanical injury

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~~- hantavirosis~~

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##Periodontal diseases, due to tissue decay from infectious origin, metabolic diseases or nutritional deficiencies

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- Idiopathic thrombocytopenic purpura

+

#Rare causes of bleeding from the mouth include:

−

- Pancytopenia

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##Hemophilia

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- Stomatitis

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##Leukemia

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- Thrombocytopenia

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##Viral hemorrhagic fevers

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- Tonsillar abscess

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#Iatrogenic procedures such as crown placement, dental cleaning, placement and use of dentures, plaque removal, root canal, post tonsillectomy bleeding, and tooth extraction

+

#Other causes of bleeding from the mouth include:

+

##Bleeding diathesis

+

##Carcinoma, squamous cell of head and neck

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##Hantavirosis

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##Idiopathic thrombocytopenic purpura

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##Pancytopenia

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##Stomatitis

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##Thrombocytopenia

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##Tonsillar abscess

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B. Causes of Rectal Bleeding

+

==== B.Causes of Rectal Bleeding ====

Rectal bleeding, known medically as hematochezia, refers to the passage of red blood through the anus, often mixed with stool and/or blood clots. Rectal bleeding occurs from the tissues adjoining the anus. Blood in the stool does not always originate from the rectum but can come from any part of the gastro-intestinal tract. In fact, the color of the blood in the stool signifies its origin and could be red, maroon, brown, or black. The blood may also be invisible to the naked eye and only appear in the stool under microscopic investigation (thus it is called occult blood). When the blood passes through the zone of digestion in the duodenum, enzymes denature the hemoglobin changing its color from red to brown. When the blood passes through both the stomach’s intense acidic environment into the duodenum’s alkaline enzymes, the denaturing process renders it black by the time it exits from the rectum. Some of the common causes of rectal bleeding include anal fissure, hemorrhoids, diverticulosis, colon cancer and polyps, post-polypectomy, angiodysplasias, colitis, proctitis, and Meckel's diverticula. Rectal bleeding originating in the colon generally appears red in color. The origin of rectal bleeding is determined by history and physical examination, including tests such as anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, visceral angiograms, and blood tests. The severity of rectal bleeding, determined by the quantity of blood passed, varies widely. Most blood in the stool or rectal bleeding is mild and self-limited. Many patients report only passing a few drops of fresh blood that turns the toilet water pink or observing spots of blood on toilet paper. Others may report brief passage of a spoonful or two of blood.

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Bleeding may be moderate or severe. Patients with moderate bleeding will repeatedly pass larger quantities of bright or dark red (maroon-colored) blood often mixed with stools and/or blood clots. Patients with severe bleeding may either suffer from multiple bowel movements in a day or a single bowel movement containing a large amount of blood. Moderate or severe rectal bleeding can exhibit typical symptoms of anemia - weakness, dizziness, near-fainting or fainting, signs of low blood pressure or orthostatic hypotension, or a significant drop in blood pressure when going from a sitting or lying position to a standing position. In rare cases, the bleeding may be so severe that the body exhibits symptoms of shock due to excessive loss of blood. Moderate or severe rectal bleeding must be evaluated and treated in the hospital and may require the patient to undergo emergency hospitalization and transfusion of blood. Rectal bleeding is treated by correcting the resulting low blood volume and anemia, by determining the site and cause of blood loss, by stopping the bleeding, and by preventing relapse in bleeding.

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Correlation between Ayurvedic knowledge and ~~Biomedicine~~

+

=== Correlation between Ayurvedic knowledge and Western medicine ===

−

Biomedical textbooks rarely discuss the pathophysiology of bleeding disorders in terms of diet or nutrition, unlike Ayurveda. There is, therefore, a need to research the correlation between food articles and bleeding disorders. The following food substances are etiological factors of raktapitta, since these seem to act as blood thinners and can cause bleeding disorders in predisposed patients: (C.Ni. 2/4)

+

Biomedical textbooks rarely discuss the pathophysiology of bleeding disorders in terms of diet or nutrition, unlike [[Ayurveda]]. There is, therefore, a need to research the correlation between food articles and bleeding disorders. The following food substances are etiological factors of ''raktapitta'', since these seem to act as blood thinners and can cause bleeding disorders in predisposed patients: (C.Ni. 2/4)

−

Mulaka (Raphanus sativus Linn.), radish, Brassicaceae family

+

#''Mulaka'' (Raphanus sativus Linn.), radish, Brassicaceae family

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Sarshapa (Brassica compestris Var.), Brassica rapa - turnip, napa cabbage, canola,

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#''Sarshapa'' (Brassica compestris Var.), Brassica rapa - turnip, napa cabbage, canola,

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Lashuna (Allium sativum Linn.), garlic

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#''Lashuna'' (Allium sativum Linn.), garlic

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Sumukha (Ocimum sp),

+

#''Sumukha'' (Ocimum sp),

−

Kutheraka (Ocimum sp.)

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#''Kutheraka'' (Ocimum sp.)

−

Also, the pathogenesis of blood disorders do not mention why a body would be predisposed to vessel wall problems, platelet dysfunctions, or clot inhibitions. Bleeding from different orifices of the body is not correlated with pathophysiology in biomedicine. Ayurveda however discusses raktapitta as an endpoint to a series of imbalancing events, and separates the discussion of diagnosis in ~~Nidanasthana~~ from the discussion of treatment in ~~Chikitsasthana~~.

+

Also, the pathogenesis of blood disorders do not mention why a body would be predisposed to vessel wall problems, platelet dysfunctions, or clot inhibitions. Bleeding from different orifices of the body is not correlated with pathophysiology in biomedicine. [[Ayurveda]] however discusses ''raktapitta'' as an endpoint to a series of imbalancing events, and separates the discussion of diagnosis in [[Nidana Sthana]] from the discussion of treatment in [[Chikitsa Sthana]].

−

Summary:

+

=== Summary ===

−

Internal hemorrhage/hemorrhagic disorders of conventional medicine are well described in Ayurvedic texts in the form of raktapitta disorders, and the pathogenesis of raktapitta diseases forms the basis of this chapter. Raktapitta bleeding occurs through bodily orifices (mouth, rectum, urethra, nose, eye, ear, vagina, as well as hair-roots), per Ayurveda. The parallels between the description of bleeding disorders in conventional medicine and Ayurveda are quite apparent in this regard. An important aspect of the discussion on raktapitta disorders is the fact that some disorders are curable, some palliable and some are incurable – and that all these variants are dependent on doshic imbalances beyond just the pitta vitiation. It is important to note here that if proper attention is not paid, even curable disorders can soon aggravate to incurable variants. Avoidance of known causative factors is certainly one of the best measures to overcome this disease. Attempts need to be made to collect data on the effect of these factors (known to Ayurveda) and establish an empirical, evidence-based relationship between food articles (some of the primary etiological factors) and bleeding disorders.

+

Internal hemorrhage/hemorrhagic disorders of conventional medicine are well described in Ayurvedic texts in the form of ''raktapitta'' disorders, and the pathogenesis of ''raktapitta'' diseases forms the basis of this chapter. ''Raktapitta'' bleeding occurs through bodily orifices (mouth, rectum, urethra, nose, eye, ear, vagina, as well as hair-roots), per [[Ayurveda]]. The parallels between the description of bleeding disorders in conventional medicine and [[Ayurveda]] are quite apparent in this regard. An important aspect of the discussion on ''raktapitta'' disorders is the fact that some disorders are curable, some palliable and some are incurable – and that all these variants are dependent on ''doshic'' imbalances beyond just the ''pitta'' vitiation. It is important to note here that if proper attention is not paid, even curable disorders can soon aggravate to incurable variants. Avoidance of known causative factors is certainly one of the best measures to overcome this disease. Attempts need to be made to collect data on the effect of these factors (known to [[Ayurveda]]) and establish an empirical, evidence-based relationship between food articles (some of the primary etiological factors) and bleeding disorders.

+

</div>

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~~Glossary of Technical terms:~~

+

=== Related Chapters ===

+

*[[Vidhishonitiya Adhyaya]]

+

*[[Raktapitta Chikitsa]]

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~~Àavika vkfod Relating to Sheep~~

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== References ==

−

~~AÉgavedanÁ vaxosnuk Pain in body / body ache~~

+

<div id="BackToTop" class="noprint" style="background-color:#DDEFDD; position:fixed;

−

~~AmarÒa ve~~"~~kZ Non endurance / Intolerance~~

+

bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;

−

~~Anulomana vuqykseu Pushing the impurities and vata to its natural course~~

+

font-size:8pt; font-face:verdana,sans-serif; border:0.2em outset #ceebf7;

−

~~AnupÁna vuqiku A vehicle of the medicine. A drink taken with or after medication~~

+

padding:0.1em; font-weight:bolder; -moz-border-radius:8px; ">

−

~~ApatarpaÆa viriZ.k Desaturation~~

+

[[#top| Back to the Top ]]</span></div>

−

~~Arocaka vjkspd Anorexia~~

−

~~Àsu vk'kq Quick / Immediately~~

−

~~AtisÁra vfrlkj Diarrhoea~~

−

~~Ativelama vfrosye~ Repeatedly~~

−

~~AuÒadha vkS~~"~~k/k a kind of medicine / drug in Aurveda of natural origin~~

−

~~AvagÁha voxkg Deep seated, Immersed bath~~

−

~~AvipÁka vfoikd Non digestion of food substance to its final stage~~

−

~~BadrÁmla cnjkEy A sour preparation from the fruit of Zizyphus jujuba~~

−

~~BÚsténa HkwLr`.k Cymbopogon citratus (DC) Stapf.~~

−

~~Chardi NfnZ Vomiting~~

−

~~DadhimaÆda nf/ke.M% Watery part of Yoghurt or curd~~

−

~~GaÆdÍra x.Mhj Limnophila indica (Lam.) Kuntze~~

−

~~Guru xq# Heavy, one of the attributes of a substance, one of the potencies in drug substance.~~

−

~~JÁmbava tkEco Syzygium caryophyllatum (Linn.) Alston~~

−

~~Jvara Toj Fever/ pyrexia~~

−

~~KÁÆakapota dk.kdiksra Wild pigeon~~

−

~~KÁlamalaka dkyekyd Ocimum basilicum Linn.~~

−

~~KÁñjika dkf´~td Sour gruel~~

−

~~KaÒÁya d"kk~~; ~~Astringent – one of the tastes perceived by tongue~~

−

~~KaÔvara dV~oj~~% ~~Butter milk mixed with water~~

−

~~Karañja dj´~t Pongamia glabra Vent.~~

−

~~KatvarÁmla dV~ojkEy Pungent with sour~~

−

~~Kharabusa [kjcql Origanum majorana~~

−

~~KÒÁra {kkj medicinal alkali~~

−

~~KÒavaka {kod Centipeda minima (Linn.) A.Br. Aschers.~~

−

~~Kulattha dqyRFk Dolichos biflorus Linn.~~

−

~~KuÔheraka dqBsjd Ocimum s.p~~

−

~~Kuvala dqoy Zizyphus sp.~~

−

~~LaÐuna y'kqu Allium sativum Linn.~~

−

~~Lukuca ydqp Artocarpus lakoocha Roxb.~~

−

~~Mada en Intoxicated~~

−

~~MadhuÐigru e/kqf'kxzq Moringa concanersis Nimm.~~

−

~~MadhÚlaka e/kwyd A kind of wheat (Triticum sativum Lam.)~~

−

~~Madhura e/kqj Sweet, one of the tastes perceived by tongue~~

−

~~MÁÒa ek~~"~~k Phaseolus mungo Linn.~~

−

~~Medaka esnd One of the dietary~~

−

~~preparation prescribed in Àyurveda~~

−

~~Médu e`nq Soft, one of the attributes in a food substance, one of the potencies in drug substance~~

−

~~MÚlaka ewyd Raphanus sativus Linn.~~

−

~~NiÒpÁva fu~~"~~iko Dolichus lablab Linn.~~

−

~~PaÆÕu ik.Mq Anemia / Jaundice~~

−

~~ParÆÁsa i.kkZl Ocimum sp.~~

−

~~ParidÁha ifjnkg Burning around~~

−

~~Parigata ifjxr All around~~

−

~~PariÒeka ifj"ksd Pouring over / Sprinkling~~

−

~~PhaÆijjaka Qf.k´~>d Ocimum majurana~~

−

~~PiÆÕalÚ fi.Mkyq Colocasia oleracea.~~

−

~~PiÆyÁka fi.~~;~~kd Liquidamber orientalis Miller.~~

−

~~Pradeha iznsg External application of drugs in Kalka form~~

−

~~Pratimarga izfrekxZ Opposite route~~

−

~~Pratirundhya izfr~~:U/; ~~Obstructed / Hindered~~

−

~~Raja jt Menstrual blood~~

−

~~RauhiÆÍka jkSfg~~.~~khd A kind of vegetable~~

−

~~ÏiÐira f'kf'kj Winter season~~

−

~~Ïigru f'kxzq Moringa pterygosperma Gaertn~~.

−

~~ÏoÒa 'kks"k Emaciation~~

−

~~Ïopha 'kksQ Inflammation, swelling~~

−

~~Ïukta 'kqDr% A kind of sour article~~

−

~~ÏuÒkaÐÁka 'kq"d'kkd Dry vegetables~~

−

~~SÁdhya lk/~~; ~~Curable~~

−

~~SaÉsargÁta lalxZ Union / Combining~~

−

~~SaÉtarpaÆa lariZ.k Saturating~~

−

~~Saïsodhana la'kks/ku Purification~~

−

~~SarÒapa l~~"~~kZi Brassica compestris var. Sarson Prain~~

−

~~SauvÍra lkSohj A kind of Sour article~~

−

~~Srotasa lzksrl Channels~~

−

~~Sumukha lqeq~~[~~k Ocimum sp~~

−

~~SÚpa lwi A kind of~~ the ~~semi liquid dietary preparation~~

−

~~SurÁ lqjk A kind of Alcoholic drink~~

−

~~Surasa lqjl Ocimum sanctum Linn.~~

−

~~Svarabheda LojHksn Hoarseness of the voice~~

−

~~Tikta frDr Bitter, one of the tastes perceived by tongue~~

−

~~TuÒodaka rq"kksnd A Preparation of Kanji (sour drink) involving yava along with raw husk.~~

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~~UdaÐvit mnfJr~ Whey, Diluted butter milk~~

−

~~UdagÁra mn~xkj Belching~~

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~~UddÁlaka míky% Pasapalum scorbiclilatum Linn.~~

−

~~UpadaïÐa mina'k Anything which excites thirst or appetite~~ / ~~condiment~~

−

~~Upadrava miæo Complications~~

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~~Vamana oeu Emesis~~ / ~~Vomiting~~

−

~~VÍbhatsatÁ ohHkRlrk Horrible~~

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~~VidÁha fonkg Burning sensation~~

−

~~Virecana fojspu Purgation / laxative~~

−

~~Yakéta ;Ñr Liver~~

−

~~YÁpya ;kI; The controllable diseases are those that persist till the remainder of life, but can be controlled with continuous good regimen.~~

−

~~Yavaka ;od% A type of grain Ieum vulgare Linn.~~

−

~~References:~~

Agnivesha

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