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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||

यदा  जन्तुर्यवकोद्दालककोरदूषप्रायाण्यन्नानि भुङ्क्ते, भृशोष्णतीक्ष्णमपि चान्यदन्नजातं  निष्पावमाषकुलत्थसूपक्षारोपसंहितं, दधिदधिमण्डोदश्वित्कट्वराम्लकाञ्जिकोपसेकं  वा, वाराहमाहिषाविकमात्स्यगव्यपिशितं,  पिण्याकपिण्डालुशुष्कशाकोपहितं, मूलकसर्षपलशुनकरञ्जशिग्रुमधुशिग्रु(खडयूष) भूस्तृणसुमुखसुरसकुठेरकगण्डीरकालमालकपर्णासक्षवकफणिज्झकोपदंशं, 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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*Meat of pig, buffalo, sheep, fish and cow

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

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

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

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

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

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

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

*Preparations of (rice) flour in excess after meals

*Preparations of (rice) flour in excess after meals

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संसर्गाल्लोहितप्रदूषणाल्लोहितगन्धवर्णानुविधानाच्च पित्तं  लोहितपित्तमित्याचक्षते||५||

संसर्गाल्लोहितप्रदूषणाल्लोहितगन्धवर्णानुविधानाच्च पित्तं  लोहितपित्तमित्याचक्षते||५||

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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]

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]

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=== Prognosis ===

=== Prognosis ===

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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 of bleeding) of [[raktapitta]] progression ([[udarka]]) have been described. [18-20]

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 of bleeding) of [[raktapitta]] progression ([[udarka]]) have been described. [18-20]

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Some curable diseases do not get treated successfully because of the lack of attendants and equipment, 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 (and lead to incurability) because of following factors:

 

* lack of attendants and equipment

* Mischievousness 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]] ===

== Tattva Vimarsha (Fundamental principles) ==

== Tattva Vimarsha (Fundamental principles) ==

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*''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''.

*''[[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).   

*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).   

*''Raktapitta'' disorders can be classified by the route of bleeding. The vitiated ''pitta'' and ''rakta'' if gets associated with vitiated ''kapha'' causes bleeding from the upper orifices in the body. While if associated with vitiated ''vata'', it leads to bleeding from the lower orifices. Vitiation of all the three ''doshas'', from the standpoint of ''raktapitta'', is considered incurable.

*''Raktapitta'' disorders can be classified by the route of bleeding. The vitiated ''[[pitta]]'' and ''[[rakta]]'' if gets associated with vitiated ''[[kapha]]'' causes bleeding from the upper orifices in the body. While if associated with vitiated ''[[vata]]'', it leads to bleeding from the lower orifices. Vitiation of all the three ''[[dosha]]s'', from the standpoint of ''raktapitta'', is considered incurable.

*Purification therapy from the opposite route is unique for the treatment of ''raktapitta''. If the bleeding is from upper orifices then purgation is done and if it is from the lower route then ''vamana'' is indicated.  

*Purification therapy from the opposite route is unique for the treatment of ''raktapitta''. If the bleeding is from upper orifices then purgation is done and if it is from the lower route then ''[[vamana]]'' is indicated.  

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

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

== Vidhi Vimarsha (Applied Inferences) ==

== 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 ''rakta dhatu''. 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.  

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 ''[[rakta dhatu]]''. Blood contains formed elements (RBC, WBC, platelets) which are products of ''sarakta meda'', the integral component of ''[[majja dhatu]]''. It has ''plasma'' containing minerals, vitamins, procoagulant and anticoagulant factors, enzymes, hormones, neurotransmitters, nutrients, etc., which are mostly assigned to ''[[rasa dhatu]]''. Blood also contains fats, cholesterol, free fatty acids etc., which are products of ''[[meda dhatu]]''. It contains blood proteins such as actin, myosin, myoglobin, etc. which are integral components of ''[[mamsa dhatu]]''. It also contains metabolic wastes such as urea and lactic acid etc., which are ''mala''. Therefore, ''[[rakta dhatu]]'' is a component of blood, using it as part of its material structure for its functions.  

Blood is a balanced fluid that will not cause disease on its own, since its job is to give life. ''Rakta'' is a ''dhatu'' with the functions of ''jeevana'', carriage, transformation, and the role of traveling through the arterial system, providing building blocks for creation and sustenance of the organs in the ''koshtha''. Indeed, it was ''rakta'' that helped create them in the embryonic state. Prolonged consumption of ''pitta'' provoking diet and lifestyle vitiate ''rakta''/blood. When the ''rakta''/blood is vitiated, then it becomes an incompatible substance to the body. The body tries to clear it by expelling it in the form of bleeding.  

Blood is a balanced fluid that will not cause disease on its own, since its job is to give life. ''[[Rakta]]'' is a ''[[dhatu]]'' with the functions of ''jeevana'', carriage, transformation, and the role of traveling through the arterial system, providing building blocks for creation and sustenance of the organs in the ''koshtha''. Indeed, it was ''[[rakta]]'' that helped create them in the embryonic state. Prolonged consumption of ''[[pitta]]'' provoking diet and lifestyle vitiate ''[[rakta]]''/blood. When the ''[[rakta]]''/blood is vitiated, then it becomes an incompatible substance to the body. The body tries to clear it by expelling it in the form of bleeding.  

The ''rakta'', containing this contaminated ''pitta dosha'' provoking it, becomes increased in volume, and continues to circulate through the body, disturbing and dominating over all the functions of the ''rakta'' tissue. This ''rakta-pitta'' then blocks, coats, and vitiates the blood and the organs that ''rakta'' produces and nourishes. In ''raktapitta'', the disease requires recognition early in its course to provide a person a cure, as manifestation of actual symptoms indicates end-stage.   

The ''[[rakta]]'', containing this contaminated ''[[pitta dosha]]'' provoking it, becomes increased in volume, and continues to circulate through the body, disturbing and dominating over all the functions of the ''[[rakta]]'' tissue. This ''[[rakta]]-[[pitta]]'' then blocks, coats, and vitiates the blood and the organs that ''[[rakta]]'' produces and nourishes. In ''[[raktapitta]]'', the disease requires recognition early in its course to provide a person a cure, as manifestation of actual symptoms indicates end-stage.   

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

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

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.  

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''. [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.

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 ===

=== 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.

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. [[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 [[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. [[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 [[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.

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 ===

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

=== 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: [Cha.Sa.[[Nidana Sthana]] 2/4]

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

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

=== 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.   

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*[[Vidhishonitiya Adhyaya]]

*[[Vidhishonitiya Adhyaya]]

*[[Raktapitta Chikitsa]]

*[[Raktapitta Chikitsa]]

== References ==

== References ==