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Vidhishonitiya Adhyaya (view source)
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== Vidhi Vimarsha (Applied Inferences) ==
== Vidhi Vimarsha (Applied Inferences) ==
'''Chapter on formation of blood and its disorders (Vidhishonitiya Adhyaya)'''
Blood tissue ([[rakta dhatu]]) is essential component of life. It is continuously circulated throughout the body and supplies oxygen and nutrients to cells. Formation of blood mainly depends upon the food that is in accordance with the habitat (desha), season and time (kala) and suitability ([[satmya]]) of the individual. The normal formation and circulation of blood maintains equilibrium in the cardio-vascular system and end organs. Any kind of abnormality like impaired growth and development of blood cells, inflammation, trauma, changes in oncotic pressure, internal bleeding leads to disequilibrium and disease. Advanced modern technologies are helpful to identify and diagnose exact nature of abnormalities. However, the causative factors for these abnormalities need more research and analysis. This chapter opens new windows to learn about causes of abnormalities, non-invasive observational methods of assessment, its role in cerebrovascular disorders like syncope and coma.
===Examination of normal blood===
===Examination of normal blood===
The normalcy of blood is assessed on the basis of its observational features.
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.
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===
===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 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.
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.
Contemporary physiology states that the color of blood depends on hemoglobin percentage (Hb%). The clotting time represents coagulation, and packed cell volume etc.can be viewed in terms of thickness of blood.<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>
===[[Dosha]] specific features of blood===
===[[Dosha]] specific features of blood===
*Dolichos lablab Linn. (Nishpava)
*Dolichos lablab Linn. (Nishpava)
*Sesamum indicum Linn. oils (Tila taila)
*Sesamum indicum Linn. oils (Tila taila)
*Randiauliginosa DC. (Pindalu)
*Randia uliginosa DC. (Pindalu)
*Radish and all green (leafy) vegetables
*Radish and all green (leafy) vegetables
*Meat of aquatic and marshy animals, burrowing animals and those animals that snatch birds
*Meat of aquatic and marshy animals, burrowing animals and those animals that snatch birds
*Excessive exposure to the sun and wind
*Excessive exposure to the sun and wind
*Suppression of the natural urges like vomiting
*Suppression of the natural urges like vomiting
*Avoidance of blood-letting in prescribed time (autumn)
*Avoidance of blood-letting at appropriate indicated time or in the autumn season when the blood is affected due to natural aggravation of [[pitta dosha]]
*Excess exertion, injury, heat
*Excess exertion
*Injury
*Exposure to heat
'''Mental factors:'''
'''Mental factors:'''
'''Environmental conditions:'''
'''Environmental conditions:'''
*Autumn season [Cha.Sa.[[Sutra Sthana]] 24/5-10]
*Autumn season due to natural aggravation of [[pitta dosha]] [Cha.Sa.[[Sutra Sthana]] 24/5-10]
===Management===
===Clinical features of abnormal blood===
Abnormalities in the blood can be diagnosed by observing following clinical features in an individual. These features suggest involvement of organs and body systems affected by abnormal blood.
*Stomatitis
*Redness in eyes
*Foul smell in nose and mouth (halitosis)
*Abdominal lump (gulma)
*Gingivitis, periodontitis and tooth loss (upakusha)
*Erysipelas (visarpa)
*Bleeding disorders
*Sleepiness
*Abscess
*Hematuria
*Menorrhagia
*Vatarakta
*Discoloration of skin
*Poor digestive capacity
*Excess thirst
*Heaviness in body
*Increased body temperature and mental irritation
*Extreme debility
*Anorexia
*Headache
*Burning sensation after meals
*Bitter and sour eructation
*Physical and mental exhaustion
*Excessive anger
*State of confusion
*Saline taste in mouth
*Excess sweating
*Fetid body odor
*Narcosis or intoxication
*Tremors
*Feeble voice
*Drowsiness
*Hypersomnia
*Fainting and black outs
*Pruritus
*Pustules
*Boils
*Skin disorders
*Thick skin as in scleroderma and ichthyosis vulgaris
*All diseases that are not relieved by conventional treatment
===Principles of treatment===
The principles of treatment of these conditions include one or all of the following depending upon the clinical condition.
*The principles applied for pacification of [[pitta dosha]] and [[rakta dhatu]]. These are described in management of bleeding disorders (raktapitta) in fourth chapter of section on therapeutics (chikitsa sthana).
*Therapeutic purgation ([[virechana]])
*Fasting (upavasa)
*Blood letting ([[rakta mokshana]])
===Intoxication (mada), Syncope (murchha) and Coma (sanyasa)===
===Intoxication (mada), Syncope (murchha) and Coma (sanyasa)===
If these treatments are not followed at appropriate time, then the abnormal blood can lead to severe disorders like intoxication, 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]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref> In murchcha, the person may be unconscious but involuntary physical movements might be present.[Su.Sa.Nidhana Sthana.1/23]<ref name=Susruta/> 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)====
====Intoxication (mada)====
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[Cha.Sa.[[Sutra Sthana]].24/30-33]
[Cha.Sa.[[Sutra Sthana]] 24/30-33]
'''Prognosis:'''
'''Prognosis:'''
Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29]<ref name=Hridaya/>
Intoxication (mada) caused by poison is most difficult to treat among all types. [A.Hr. Nidhana Sthana 6/29]<ref name=Hridaya/> The transient episodes of other types of intoxication (mada) and syncope (murchha) subside without any medical treatment. However, treatment is required to prevent recurrent episodes and progression in all these disorders.
====Syncope (murchha)====
====Syncope (murchha)====
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====Coma (sanyasa)====
====Coma (sanyasa)====
The excessively aggravated [[dosha]] affect speech, body and mind. They are lodged in heart (hridaya) and result in cessation of all body activities with absolute loss of consciousness. This condition is coma (sanyasa). [Cha.Sa.[[Sutra Sthana]] 24/42] This is a prolonged episode of unconsciousness.
The excessively aggravated [[dosha]] affect speech, body and mind. They are lodged in heart (hridaya) and result in cessation of all body activities with absolute loss of consciousness. This condition is coma (sanyasa). [Cha.Sa.[[Sutra Sthana]] 24/42] This is a prolonged episode of unconsciousness.
'''Diagnostic tests:'''
A variety of blood tests like complete blood count, blood smear, blood type, Coombs test, blood culture, mixing study, bone marrow biopsy are available to diagnose the quality of blood tissue. Angiography, computed tomography scan, magnetic resonance imaging techniques are useful to diagnose abnormalities in blood vessels and blood circulation. Utilization of these diagnostic tools is helpful in knowing precise nature of pathological events in syncope and coma.
'''Prognosis'''
'''Prognosis'''
Immediate medical intervention is needed for coma (sanyasa). [A.Hr. Nidhana Sthana 6/36] Medical treatment is required to prevent recurrent episodes of disease and correct vitiation of blood tissues.
Metabolic acidosis and alkalosis should be considered to gain an understanding of blood disorders (raktaja vikara). Electrolyte imbalances should be evaluated for the keen diagnosis of mada, murchcha, and sanyasa. [59-60]
Metabolic acidosis and alkalosis should be considered to gain an understanding of blood disorders (raktaja vikara). Electrolyte imbalances should be evaluated for the keen diagnosis of mada, murchcha, and sanyasa. [59-60]
==Case reports==
==Case reports==
'''Case 1:'''
A sixty one year old female patient in state of coma was treated successively through [[Ayurveda]] treatment. Initially the GCS score of patient was 3. Nasal medication ([[nasya]]) with trikatu powder was administered for seven days followed by seven days of inhalation of medicated smoke (dhumapana). The GCS score was improved to 11 after the treatment. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness.<ref>Rajkala SR, PD Patil, AB Thakar. Efficacy of Nasya (nasal medication) in coma: A case study. Ans Sci Life. 2016 Apr-Jun;35(4):232-5. Doi: 10.4103/0257-7941. 188188. </ref>
A sixty one year old female patient in state of coma was treated successively through [[Ayurveda]] treatment. Initially the GCS score of patient was 3. Nasal medication ([[nasya]]) with trikatu powder was administered for seven days followed by seven days of inhalation of medicated smoke (dhumapana). The GCS score was improved to 11 after the treatment. Smell sensation projects to higher cortical area and to the limbic system. Drugs administered in powder form may stimulate the limbic system, hypothalamus and thalamus. This in turn may activate the reticular activating system which provokes higher degree of consciousness.<ref>Rajkala SR, PD Patil, AB Thakar. Efficacy of Nasya (nasal medication) in coma: A case study. Ans Sci Life. 2016 Apr-Jun;35(4):232-5. Doi: 10.4103/0257-7941. 188188. </ref>
'''Case 2:'''
An elderly male patient diagnosed with grade-3 hepatic encephalopathy in comatose state was treated with Ayurvedic medicines. The medicines like siddha makaradhwaja, brihad vata chintamani rasa, a proprietary syrup of extract of Phyllanthus niruri, and a proprietary syrup of hepatoprotective and cholegouge herbs were administered through Ryle's tube. Reorientation was started in the patient after 5 hours of initiation of the Ayurvedic therapy. The clinical parameters and pathological biomarkers gradually improved in a period of fifteen days. This case provides scope of ayurvedic interventions in critical care.<ref>Rastogi S, Srivastav PS. Ayurveda in critical care: Illustrating Ayurvedic intervention in a case of hepatic encephalopathy. Ayu. 2011;32(3):345-348. doi:10.4103/0974-8520.93911</ref>
'''Case 3, 4 and 5:'''
A case series on efficacy of functional medicine approach to treat traumatic brain injuries (TBI) was published. It included two cases of teenagers suffered TBI due to motor vehicle accidents in separate events. These patients showed significant improvement and recovered from comatose state after treatment through functional medicine approach. Another case of military veteran was diagnosed with post traumatic stress disorder (PTSD) and post concussion syndrome (PCS) due to blast injury. He completely recovered from PTSD with the help of hyperbaric oxygen therapy (HBOT). The functional medicine approach includes use of acupuncture, [[Ayurveda]], chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t'ai chi, and yoga. Nutritional therapy and HBOT showed improvement in these cases.<ref>Richer AC. Functional Medicine Approach to Traumatic Brain Injury. Med Acupunct. 2017;29(4):206-214. doi:10.1089/acu.2017.1217</ref>
'''Case 6:'''
A 68 year old male patient with a history of hypertension for 10 years, alcoholic liver disease, cirrhosis and adenocarcinoma stomach was treated with ayurvedic treatments. He was in comatose state after suffering from seizures, cerebrovascular stroke due to intracranial hemorrhage and hemiplegia. The patient was treated with medicines like Sutendra rasayana with honey, Arpisa rasayana, a combination of Phyllanthus emblica (dhatri), raktapachaka and Alhagi maurorum Medik.(dhamasa). Tapyadi loha, swarna raja vangeshwara rasa, haridra ghana, kukkuta nakhi, rasa sindura with honey. The patient regained consciousness in three to four days and was relived of major symptoms. He survived for more than one and half years.<ref name=UpendraD>Dixit Upendra. Video lecture on management of emergency conditions through Ayurveda delivered on October 09, 2021 available from https://fb.watch/8KdF2UmL_8/</ref>
'''Case 7:'''
A thirty year old male patient suffered from road traffic accident. He was in coma due to traumatic brain injury. The injury included 10x,2x deep lacerated wound on right side forehead, brain contusion at frontal lobe and intraventricular bleeding on right side. In addition to the conventional treatment, the patient was treated with Ayurvedic medicines like Swarna sindoora (30 mg) mixed with haridra ghana and honey applying on gums of patient. The patient became semiconscious in two days and improved in orientation, too. The patient was further treated with Yogendra rasa (60 mg). He regained consciousness and recovered completely.<ref name=UpendraD/>
'''Case 8:'''
A 43 year old male patient suffered from skull and facial bones fractures due to road traffic accident 10 years ago. He suffered from epilepsy and was taking treatment. The patient reported history of excess mental stress, excess fasting, anorexia and anger. He suffered from convulsions and became unconscious due to intracerebral hemorrhage of 7.9 x 5.6 cm size in right temporo-parietal region. The patient was treated with Ayurvedic medicines like Sindura bhushana mixed with Haridra ghana every four hourly applied on gums. Medicated water processed with gold (Suvarna siddha jala) and green gram soup was given to patient through Ryle’s tube. Jaymangal rasa and Guduchi ghana was added to treat fever. The fever subsided in one day and subsequently the patient started maintaining oxygen levels. The life support system was taken off. The orientation and consciousness improved significantly in a week of treatment. Arpisa rasayana, Jaymangal rasa, vara, and raktapachaka medicines were continued for next two weeks, till complete recovery of the patient. Significant clinical improvement in neurological functions were observed in this patient.<ref name=UpendraD/>
===Effect of seasonal variations in blood physiology===
A research work was conducted to study effect of seasonal variations on clinical features of blood vitiation described in this chapter. The research also included observations on hematological parameters. The study concluded that significant increase in clinical features of blood vitiation was observed in autumn season (sharad ritu) as compared to rainy season (varsha ritu) and early winters (hemant ritu). Mild seasonal variations were observed in hematological parameters like total red blood cells, white blood cell count, erythrocyte sedimentation rate, absolute eosinophil count, serum cholesterol. A large sample study is required to derive a concrete conclusion.
==Contemporary views==
==Contemporary views==