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Line 3: − + − + Line 44:
Line 44: − === Sanskrit text, Transliteration and English Translation ===+ Line 61:
Line 61: − + − As propounded by Lord Atreya. [1-2]+ − − ==== Agnivesha’s query ==== Line 90:
Line 88: − ==== Atreya Punarvasu’s reply ====+ Line 123:
Line 121: − ==== Pathogenesis ====+ Line 148:
Line 146: − ==== Derivation ====+ Line 164:
Line 162: − ==== Origin of disease ====+ Line 180:
Line 178: − ==== Characteristics of ''dosha'' vitiation ====+ Line 211:
Line 209: − ==== Prognosis ====+ Line 233:
Line 231: − ==== ''Gati'' (direction of flow) and prognosis ====+ Line 307:
Line 305: − ==== Characteristics of curable ''raktapitta'' ====+ Line 346:
Line 344: − ==== Consequneces of styptic therapy in ''rakta-pitta'' ====+ Line 414:
Line 412: − ==== Nourishment regimen ====+ Line 468:
Line 466: − ==== Diet advised in ''raktapitta'' ====+ Line 549:
Line 547: − ==== Medicated gruels in ''raktapitta'' ====+ Line 681:
Line 679: − ==== Indication of purification therapy ====+ Line 768:
Line 766: − ==== Pacification therapy ====+ Line 1,031:
Line 1,029: − ==== Treatment of hematuria and per rectal bleeding ====+ Line 1,047:
Line 1,045: − ==== Treatment of per rectal bleeding ====+ Line 1,072:
Line 1,070: − ==== ''Vasa'' ghee ====+ Line 1,126:
Line 1,124: − ==== External applications ====+ Line 1,151:
Line 1,149: − ==== Treatment of ''raktapitta'' with associated ''kapha'' ====+ Line 1,176:
Line 1,174: − ==== ''Shatavaryadi'' ghee ====+ Line 1,209:
Line 1,207: − ==== Treatment of nasal bleeding ====+ Line 1,356:
Line 1,354: − ==== Summary ====+ Line 1,426:
Line 1,424: − ==== Types of Bleeding Disorders ====+ Line 1,436:
Line 1,434: − ==== Identification of Bleeding Disorders/Symptoms ====+ Line 1,480:
Line 1,478: − ==== Commonly used medicines in ''raktapitta'' ====+ − ===== Important medicines =====+ Line 1,488:
Line 1,486: − ===== Treatment of ''urdhvaga raktapitta'' =====+ − ===== Treatment of ''adhoga raktapitta'' =====+ Line 1,500:
Line 1,498: − ===== Treatment of chronic stage =====+ − === Related Chapters ===+
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|titlemode=append
|titlemode=append
|keywords=Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation
|keywords=Raktapitta, Chikitsa, Mahagada, bleeding disorders, pitta aggravation, rakta vitiation
|description=Chikitsa Sthana Chapter 4. Management of Raktapitta (Bleeding Disorders)
|description=Chikitsa Sthana Chapter 4. Management of Bleeding Disorders
}}
}}
<big>'''[[Chikitsa Sthana]] Chapter 4. Management of Raktapitta (Bleeding Disorders)'''</big>
<big>'''[[Chikitsa Sthana]] Chapter 4. Management of Bleeding Disorders'''</big>
<big>'''Abstract '''</big>
<big>'''Abstract '''</big>
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.
== Sanskrit text, Transliteration and English Translation ==
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Now we shall expound the chapter on ''raktapitta'' (haemorrhagic disorders). (1)
Now we shall expound the chapter "Raktapitta Chikitsa'' (Management of bleeding disorders). Thus said Lord Atreya. [1-2]
=== Agnivesha’s query ===
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Agnivesha bowed to Punarvasu Atreya who is devoid of confusion, having fire-like brilliance(sharp intellect) and self-control while he was making stroll in the ''panchaganga'' region, and said, “O Lord! the etiology along with symptoms of haemorrhagic disorders has already been said, now you may tell me the further points, O my teacher! [3-4]
Agnivesha bowed to Punarvasu Atreya who is devoid of confusion, having fire-like brilliance(sharp intellect) and self-control while he was making stroll in the ''panchaganga'' region, and said, “O Lord! the etiology along with symptoms of haemorrhagic disorders has already been said, now you may tell me the further points, O my teacher! [3-4]
=== Atreya Punarvasu’s reply ===
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The physician knowing causes and symptoms should quickly manage the case of haemorrhagic disorders which is an acute dreadful disease, having more severity and quick-acting like fire. The etiology of the same has already been said earlier such as intake of hot, sharp, sour, pungent and salty substances in excess, exposure to the sun and foods that cause burning sensations. [5-6]
The physician knowing causes and symptoms should quickly manage the case of haemorrhagic disorders which is an acute dreadful disease, having more severity and quick-acting like fire. The etiology of the same has already been said earlier such as intake of hot, sharp, sour, pungent and salty substances in excess, exposure to the sun and foods that cause burning sensations. [5-6]
=== Pathogenesis ===
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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 ''dhatus'' oozes out, which additionally leads to aggravation of ''rakta'' and ''pitta''. [7-8]
=== Derivation ===
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Because of conjunction with, similarity in causes of vitiation, odor, color and origin, the disease is called ''rakta-pitta''. [9]
Because of conjunction with, similarity in causes of vitiation, odor, color and origin, the disease is called ''rakta-pitta''. [9]
=== Origin of disease ===
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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 ===
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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 ''doshas'' the symptoms of the concerned ones are combined. ''Raktapitta'' caused by ''sannipata'' has symptoms of all the three ''doshas''. [11-12]
=== 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 ''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]
=== ''Gati'' (direction of flow) and prognosis ===
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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 ''doshas'', which aggravates again and again after subsiding and shifts from one passage to another. [15-21]
=== 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'' ===
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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 ===
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Powder of parched paddy mixed with ghee and honey makes a good saturating preparation which, if taken timely, alleviates the upward movement of ''raktapitta''. The saturating preparation may be soured with pomegranates and ''amalaka'' fruits in persons having poor digestion and suited to sour things.[31-35]
Powder of parched paddy mixed with ghee and honey makes a good saturating preparation which, if taken timely, alleviates the upward movement of ''raktapitta''. The saturating preparation may be soured with pomegranates and ''amalaka'' fruits in persons having poor digestion and suited to sour things.[31-35]
=== Diet advised in ''raktapitta'' ===
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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'' ===
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Whatever etiological factors of ''raktapitta'' are mentioned should be avoided by those patients, if they want to survive and to be free from the disease. Thus, the diet allevating ''raktapitta'' has been described in order. [53]
Whatever etiological factors of ''raktapitta'' are mentioned should be avoided by those patients, if they want to survive and to be free from the disease. Thus, the diet allevating ''raktapitta'' has been described in order. [53]
=== Indication of purification therapy ===
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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 ===
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#''jivaka'' and ''rishabhaka'' added with ghee and sugar. [82-84]
#''jivaka'' and ''rishabhaka'' added with ghee and sugar. [82-84]
=== Treatment of hematuria and per rectal bleeding ===
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Milk boiled with ''shatavari'' and ''gokshura'', or the four leaved herbs (''mudgaparni, mashaparni, shalaparni'' and ''prashniparni''), check the hemorrhage quickly particularly that from urinary passage and with pain.[85]
Milk boiled with ''shatavari'' and ''gokshura'', or the four leaved herbs (''mudgaparni, mashaparni, shalaparni'' and ''prashniparni''), check the hemorrhage quickly particularly that from urinary passage and with pain.[85]
=== Treatment of per rectal bleeding ===
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Particularly in haemorrhage from rectum milk boiled with ''mocharasa'', or hanging roots or leaf-buds of ''vata'' or ''hribera, nilotpala'' and ''nagara'' (''musta'') should be taken. After taking the medicinal extracts with milk the patient should take ghee cooked with these extracts. [85-87]
Particularly in haemorrhage from rectum milk boiled with ''mocharasa'', or hanging roots or leaf-buds of ''vata'' or ''hribera, nilotpala'' and ''nagara'' (''musta'') should be taken. After taking the medicinal extracts with milk the patient should take ghee cooked with these extracts. [85-87]
=== ''Vasa'' ghee ===
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#''patola'' leaves are efficacious in ''paittika'' fever and all are commended for use in hemorrhagic disorder. [89-90]
#''patola'' leaves are efficacious in ''paittika'' fever and all are commended for use in hemorrhagic disorder. [89-90]
=== External applications ===
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All measures which are prescribed for the treatment of ''pattika'' fever such as massage, sprinkling, baths, beds, room/coverings, cooling methods or enema should be applied in hemorrhagic disorder considering the season and dose. ''Sarpirguda'' (the formulation of jaggery and ghee) prescribed for the patients of ''kshata'' (chest injury) control the hemorrhagic disorder quickly. [91-92]
All measures which are prescribed for the treatment of ''pattika'' fever such as massage, sprinkling, baths, beds, room/coverings, cooling methods or enema should be applied in hemorrhagic disorder considering the season and dose. ''Sarpirguda'' (the formulation of jaggery and ghee) prescribed for the patients of ''kshata'' (chest injury) control the hemorrhagic disorder quickly. [91-92]
=== Treatment of ''raktapitta'' with associated ''kapha'' ===
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In case of ''raktapitta'' if there is association of ''kapha'' and blood reaching the throat is adherent, alkali of the stalk of water lily mixed with honey and ghee should be used. In the same way, alkali of lotus stalk, lotus, water lily, ''nagakeshara, palasha, priyangu, madhuka'' and asana should be used. [93-94]
In case of ''raktapitta'' if there is association of ''kapha'' and blood reaching the throat is adherent, alkali of the stalk of water lily mixed with honey and ghee should be used. In the same way, alkali of lotus stalk, lotus, water lily, ''nagakeshara, palasha, priyangu, madhuka'' and asana should be used. [93-94]
=== ''Shatavaryadi'' ghee ===
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Ghee cooked with drugs of five groups of five roots each( described in [[Rasayana]] chapter) has the same effect. (This is ''shatavaryadi ghrita''). [95-96]
Ghee cooked with drugs of five groups of five roots each( described in [[Rasayana]] chapter) has the same effect. (This is ''shatavaryadi ghrita''). [95-96]
=== Treatment of nasal bleeding ===
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Visit of rivers and lakes, glaciers, ponds having water lily and lotus flowers, ''shishira'' (winter) season, favorite and soothing narratives pacify ''raktapitta''. [101-109]
Visit of rivers and lakes, glaciers, ponds having water lily and lotus flowers, ''shishira'' (winter) season, favorite and soothing narratives pacify ''raktapitta''. [101-109]
=== Summary ===
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*medication side-effects
*medication side-effects
=== Types of Bleeding Disorders ===
There are several bleeding disorders that can be inherited (passed down through genetics) or acquired. Some cause bleeding spontaneously, whereas others cause bleeding following an accident.
There are several bleeding disorders that can be inherited (passed down through genetics) or acquired. Some cause bleeding spontaneously, whereas others cause bleeding following an accident.
Certain diseases or medical conditions can also cause a deficiency of one or more blood clotting factors. The most common causes of acquired bleeding disorders are end-stage liver disease or vitamin K deficiency. According to the American Association of Clinical Chemistry (AACC), this is because most blood clotting factors are produced in the liver, and certain clotting factors are vitamin k dependent (AACC, 2011).
Certain diseases or medical conditions can also cause a deficiency of one or more blood clotting factors. The most common causes of acquired bleeding disorders are end-stage liver disease or vitamin K deficiency. According to the American Association of Clinical Chemistry (AACC), this is because most blood clotting factors are produced in the liver, and certain clotting factors are vitamin k dependent (AACC, 2011).
=== Identification of Bleeding Disorders/Symptoms ===
The main sign of a bleeding disorder is prolonged or excessive bleeding. The bleeding is normally heavier than normal and unprovoked.
The main sign of a bleeding disorder is prolonged or excessive bleeding. The bleeding is normally heavier than normal and unprovoked.
There are various bleeding disorders, some of which can be correlated with ''raktapitta''. Bleeding disorders can occur either due to decrease in coagulation factor in blood or due to increase in bleeding factor. When patient has bleeding from anus (''guda'') or vagina(''yoni''), then it is difficult to differentiate whether the disease is ''adhoga raktapitta'' or ''raktarsha'' or ''raktatisara'' or ''pradara''. There are major similarities in causes, signs, ''doshas'' involved but also minor differences. And that minor differences need to be studied to capture the right link of disease, which can be done only when one has, the deep knowledge of Ayurvedic diagnostic tool i.e. ''nidanpanchaka''. The profound cognizance of ''nidanapanchaka'' as a diagnostic tool can enhance the treatment modalities of Ayurvedic management of diseases in coming years.
There are various bleeding disorders, some of which can be correlated with ''raktapitta''. Bleeding disorders can occur either due to decrease in coagulation factor in blood or due to increase in bleeding factor. When patient has bleeding from anus (''guda'') or vagina(''yoni''), then it is difficult to differentiate whether the disease is ''adhoga raktapitta'' or ''raktarsha'' or ''raktatisara'' or ''pradara''. There are major similarities in causes, signs, ''doshas'' involved but also minor differences. And that minor differences need to be studied to capture the right link of disease, which can be done only when one has, the deep knowledge of Ayurvedic diagnostic tool i.e. ''nidanpanchaka''. The profound cognizance of ''nidanapanchaka'' as a diagnostic tool can enhance the treatment modalities of Ayurvedic management of diseases in coming years.
=== Commonly used medicines in ''raktapitta'' ===
==== Important medicines ====
#''Vasa''
#''Vasa''
#''Praval bhasma''
#''Praval bhasma''
==== Treatment of ''urdhvaga raktapitta'' ====
#''Lakshadi'' mixture 3-5 grams frequently with ''vasavaleha''
#''Lakshadi'' mixture 3-5 grams frequently with ''vasavaleha''
#''Padmakadi tailam'' 10-20 drops empty stomach three times in a day with milk
#''Padmakadi tailam'' 10-20 drops empty stomach three times in a day with milk
==== Treatment of ''adhoga raktapitta'' ====
#''Shatavaryadi kwatha'' 25 to 40 ml empty stomach three times with sugar
#''Shatavaryadi kwatha'' 25 to 40 ml empty stomach three times with sugar
#''Bol-parpati'' mixture 250 to 500 mg after meals with ''vasavaleha''
#''Bol-parpati'' mixture 250 to 500 mg after meals with ''vasavaleha''
==== Treatment of chronic stage ====
#''Vasa'' ghee 10 to 40 ml after meals with milk
#''Vasa'' ghee 10 to 40 ml after meals with milk
== Related Chapters ==
*[[Vidhishonitiya Adhyaya]]
*[[Vidhishonitiya Adhyaya]]
*[[Raktapitta Nidana]]
*[[Raktapitta Nidana]]