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Line 946: − A person who is following a regimen or conduct suitable to a location (desha-[[satmya]]), time (kala-[[satmya]]), and habit or lifestyle (oka-[[satmya]]), when he takes food according to ahara vidhi visheshayatana (as described in the first chapter of Charak [[Vimana Sthana]]) - food having six [[rasa]]ja, taken at proper time, proper place, in proper quantity, and that which is wholesome in nature, will have pure (or healthy) blood. Pure blood formed after proper digestion of food is full of nutritional values necessary for life. Formation of pure blood takes place due to extrinsic and intrinsic factors. Extrinsic factors are obtained from dietary sources. On the other hand, intrinsic factors are generated inside the body, such as Ranjaka [[pitta]] and [[majja]]gata substances (bone marrow). The importance of pure blood is described in Sushruta Samhita Vidhishonitiya adhyaya.<ref>Sushruta. Sutra Sthana, Cha.14 Vidhishonitiya Adhyaya. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> [3]+ − Pure-blood is the basis of life as it nourishes dasha pranayatana(ten important “life areas” of the body: two temples, heart, head, bladder, throat, blood, semen, [[ojas]] and rectum. [Cha.Sa.[[Sharira Sthana]] 7/9] [[Rakta]] increases the physical strength, complexion, immunity, and vitality of life. [4]+ + + − Severe indigestion, eating leftover foods, and suppression of urge of vomiting can form vasoactive intestinal peptides and in turn lead to allergic diathesis. [5-10]+ + + − + − Any line of treatment should be planned to keep in mind the basic principles of blood coagulation as described in Ayurvedic texts. [20-21]+ − After bloodletting is administered, the patient should be prescribed a nourishing diet and regimen that rejuvenates his blood, and thus, vitalizes his life. The diet shall not interfere with the coagulation process or vitiate his blood but should aid in the bodily processes to replenish blood.[23] + − Without going for blood investigations, a person with pure blood can be recognized by his physical appearance: glowing complexion, well-functioning sense organs, and a cheerful persona. Such a person has normal digestion, and natural urges are unobstructed. [24]+ + + + + + + + + + + + + − Blood supply, neuronal metabolism of the cerebral cortex, especially reticular formation, and limbic system are affected by vitiated [[dosha]] to impair consciousness, from acute confusion to deep coma. [25-29]+ + + − In any drug addiction or narcosis, the dominant [[dosha]] should be diagnosed and managed accordingly. [34]+ + + + + + + + + + + + + + + + + + − The absence of abnormal movements and postures differentiates ''murchcha'' (syncope) from ''apasmara'' (epilepsy). If there are abnormal movements or postures while falling unconscious, syncope and pseudo-syncope should be ruled out. [35-41] + + + + + + − The goal of any course of treatment of ''sanyasa'' is selecting the right formulation to help the patient regain consciousness. [42-53]+ + − Various medicated ''ghrita'' are indicated for ''sanyasa'' since lipid matrix helps to cross the blood-brain barrier and act on the brain. [54-58]+ + − Metabolic acidosis and alkalosis should be considered to gain an understanding of [[rakta]]ja vikara. Electrolyte imbalances should be evaluated for the keen diagnosis of ''mada, murchcha,'' and ''sanyasa''. [59-60]+ − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
→Vidhi Vimarsha (Applied Inferences)
== Vidhi Vimarsha (Applied Inferences) ==
== Vidhi Vimarsha (Applied Inferences) ==
===Examination of normalblood===
The normalcy of blood is assessed on the basis of its observational features.
The normal blood resembles the color of heated red gold, firefly (indragopa), red lotus, lac (laksha) or Abrus precatorius fruit (gunja).[Cha.Sa.[[Sutra Sthana]] 24/22] As blood cells mature their red color may change to different shades from heated gold to gunja color. Different [[dosha]] and body constitution (deha [[prakriti]]) may also be responsible for different shades of red color of blood.<ref>Shaikh Tahamim, Comparative study of Vidhisonitiyam adhyaya of Caraka Samhita and Sonitavarniniyam adhyaya of Susruta samhita with special reference to raktaprasadana and raktasarata. Department of Basic principles. IPGT&RA, GAU Jamnagar. 2014</ref> The color of human blood resembles to that of sheep and rabbit.
===Characteristic features of a person with normal blood tissue===
The person having normal blood, possesses good complexion, clarity of sense organs, cheerful nature, normal digestion, unobstructed natural urges and has good strength. [Cha.Sa.[[Sutra Sthana]] 24/24] It can be inferred that blood plays key role in maintaining these physiological functions.
The recommended therapies for the treatment of vitiated blood disorders – such as bloodletting - are not to be administered or applied in all diseases. Like in the case of any disease, treatment measures are to be selected according to the nature of the disease and condition of the patient. Bloodletting should be administered till the vitiated [[dosha]] are eliminated from blood. [18]
Contemporary physiology states that the color of blood depends on hemoglobin percentage (Hb%). The clotting time represents coagulation, and packed cell volume etc.<ref name=DhamleM>Dhamle Madhumati, The study of yojana chatushka of Charaka and yojana for the management of Raktasrita vyadi (Hypertension). Department of Basic principles. IPGT&RA, GAU Jamnagar. 2001</ref> can be viewed in terms of thickness of blood.
===[[Dosha]] specific features of blood===
When the blood tissue is vitiated by [[dosha]], it shows following features.
{| class="wikitable"
|+ Table 1: [[Dosha]] specific features of blood
|-
! [[Dosha]] !! Features
|-
| |[[Vata]] || Reddish, non-slimy, frothy and thin
|-
| |[[Pitta]] || Yellow/blackish, delayed coagulation
|-
| |[[Kapha]] || Slight pale, slimy, fibrous, viscous
|-
|}
[Cha.Sa.[[Sutra Sthana]] 24/20]
If the blood is vitiated by more than one [[dosha]], it shows mixed features. The features can be inferred on the basis of pathological parameters like packed cell volume, coagulations factors and viscosity. Robust research is required to establish the relation between [[dosha]] specific changes in blood tissue.
When the blood is vitiated, it can cause various diseases ranging from mouth ulcer to coma.<ref name=DhamleM/>
===Causes of vitiation of blood===
#Dietary causes:
*Habitual intake of spoiled or unsuitable food and/or liquids
*Overeating
*Acidic or pungent liquor and other similar drinks
*Too much salty, alkaline substances, sour and pungent food
*Dolichos biflorus Linn. (Kulatha)
*Phaseolus mungo Linn. (Masha)
*Dolichos lablab Linn. (Nishpava)
*Sesamum indicum Linn. oils (Tila taila)
*Randiauliginosa DC. (Pindalu)
*Radish and all green (leafy) vegetables
*Meat of aquatic and marshy animals, burrowing animals and those animals that snatch birds
*Excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids
*Consuming decomposed, putrid food with contradictory properties
*Untreated indigestion
*Taking meal during indigestion
#Lifestyle causes:
*Excessive sleeping during daytime especially after taking liquids, unctuous and heavy food
*Excessive exposure to the sun and wind
*Suppression of the natural urges like vomiting
*Avoidance of blood-letting in prescribed time (autumn)
*Excess exertion, injury, heat
#Mental factors:
*Excessive anger
#Environmental conditions:
*Autumn season [Cha.Sa.[[Sutra Sthana]] 24/5-10]
===Intoxication (mada), Syncope (murchha) and Coma (sanyasa)===
=== Related Chapters ===
Excess vitiation of blood can lead to state of intoxication (mada), syncope and coma. These three are progressive stages of diseases due to vitiation of blood. Intoxication (mada) state may arise due to consumption of alcohol, poisoning or due to vitiation of blood. The person may be semiconscious or in an altered state of consciousness. [Su.Sa.Sutra Sthana.11/19] In murchcha, the person may be unconscious but involuntary physical movements might be present.[Su.Sa.Nidhana Sthana.1/23] Sanyasa is a condition in which the person will remain unconscious and also there won’t be any physical movements.[Cha.Sa.[[Sharira Sthana]] 1/154]
====Intoxication (mada)====
'''Pathogenesis'''
If an individual continuously indulges in stale foods and unhealthy/unhygienic habits, the [[dosha]] are vitiated at physical and mental level. His mind gets afflicted with [[raja]] and [[tama]]. The vitiated [[dosha]] obstructs channels carrying nutrient fluid ([[rasa]]), blood ([[rakta]]) and consciousness (sanjna). This causes altered state of consciousness resulting in intoxication (mada), syncope (murchcha) and coma (sanyasa). [Cha.Sa.[[Sutra Sthana]] 24/24-29] Weak minded persons are more susceptible if exposed to vitiation of tri[[dosha]] ([[vata]]/[[pitta]]/[[kapha]]) separately or in combination. [Cha.Sa.[[Sutra Sthana]] 24/28]
'''Stages of intoxication (mada)'''
Three stages of intoxication (mada) are mentioned. In initial stage the person will be over enthusiastic. [Su.Sa.Uttara Sthana. 47/11] In the second stage person may talk irrelevantly and will be in delusion stage. In the final stage the person lies unconscious. He may loose his ability to perform any physical action. [Su.Sa.Uttara Sthana. 47/12]
'''Types and [[dosha]] specific features of intoxication (mada)'''
{| class="wikitable"
|+ Table 1: Types and [[dosha]] specific features of intoxication (mada)
|-
! [[Dosha]] !! Features of intoxication
|-
| | [[Vata]]|| Excessive and fast speech; unstable movements; rough, reddish or blackish skin discoloration
|-
| | [[Pitta]]|| Angry; uses harsh words; quarrelsome; reddish, yellowish or blackish skin discoloration
|-
| |[[Kapha]] || Incoherent speech; drowsy and lethargic; pale appearance
|-
| |[[Sannipata]] || Mixed symptoms
|-
| | Blood ([[rakta]])|| Stiffness of body parts, fixed gaze [A.Hr. Nidhana Sthana. 6/28]
|-
| | Alcohol (madya)|| Features similar to [[pitta]] dominant type, abnormal movements of body parts, abnormal speech, abnormal voice [A.Hr. Nidhana Sthana. 6/29]
|-
| |Poison (visha) || Tremors and excessive sleep [A.Hr. Nidhana Sthana 6/29]
|-
|}
[Cha.Sa.[[Sutra Sthana]].24/30-33]
'''Prognosis:'''
Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29]
====Syncope (murchha)====
The obstruction of channel of consciousness by aggravated [[dosha]] lead to sudden aggravation of [[tamas]]. This results in cessation of feeling of happiness. The person falls down just like a log of wood. [Su.Sa.Uttara Sthana. 46/6] This is a transient state of unconsciousness. The person awakes after the episode of aggravation of [[dosha]] is over.
'''Pathogenesis'''
Weak or emaciated person with excessive vitiation of [[dosha]] are susceptible. If these persons indulge in incompatible food, suppression of natural urges, or if afflicted by injuries; then the excessively aggravated [[dosha]] affect sensory organs and mind. This results in sudden loss of consciousness. [Su.Sa.Uttara Sthana.46/4] The predominant [[dosha]] in the pathogenesis of murchha is [[pitta]]. [Su.Sa.Uttara Sthana.46/8]
'''Premonitory symptoms'''
Pain in chest, excessive yawning, exhaustion, loss of strength and consciousness. [Su.Sa.Uttara Sthana.46/5]
'''Types and Features of Syncope (murchha)'''
{| class="wikitable"
|+ Table 3: Types and Features of Syncope (murchha)
|-
! Types !! Features
|-
| | Vata dosha || Irregular and unpredictable pattern of unconsciousness. While losing consciousness, he may feel bluish, blackish or reddish discoloration of surroundings. [Cha.Su.24/35-36] Tremors, pain in chest and body ache may also present.
|-
| | Pitta dosha || Regains consciousness associated with sweating, feeling of warmth, thirst, reddish yellow discoloration of eyes and may pass loose stools. [Cha.Su.24/37-38][AH Ni 6/32]
|-
| | Kapha dosha || Regains consciousness slowly, feels as if body is covered with thick blanket, salivation and nausea. [Cha.Su.24/39-40] [AH Ni 6/35]
|-
| | Sannipata || Symptoms resembles epilepsy (apasmara) but devoid of irregular body movements. [Cha.Su.24/41][AH Ni 6/35]
|-
| | Blood (rakta) || Stiffness of body parts, fixed gaze and feeble respiration [Su.Ut 46/11]
|-
| | Alcohol (Madya) || Irrelevant speech, altered state of mind, irregular movements of body parts[Su.Ut 46/12]
|-
| | Visha || Tremors, sleep, thirst and body stiffness [Su.Ut 46/13]
|-
|}
== Related Chapters ==
* [[ Raktapitta Nidana ]]
* [[ Raktapitta Nidana ]]
* [[ Raktapitta Chikitsa ]]
* [[ Raktapitta Chikitsa ]]