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{{#seo:

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|title=Vidhishonitiya Adhyaya

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|titlemode=append

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|keywords=Rakta, rakta visravana, sanyasa sangyavahi srotas, vegetative state, shonita, sadyaphala kriya, sangyaprabodhanam, pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction, blood, Ayurveda, Indian system of medicine, charak samhita.

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|description=Sutra Sthana Chapter 24. Characteristics of Shonita (Blood), its vitiation and 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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}}

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<big>'''Sutra Sthana Chapter 24. Characteristics of Shonita (Blood), its vitiation and disorders '''</big>

{{Infobox

|title = Vidhishonitiya Adhyaya

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|label5 = Other Sections

|data5 = [[Nidana 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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|data6 = Bharadwaj P.K., Sharma A.K.

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|label7 = Reviewer

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|data7 = Byadgi P.S.

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|label8 = Editors

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|data8 = Dwivedi R.B., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|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.s01.026 10.47468/CSNE.2020.e01.s01.026]

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}}

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}}

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

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==[[~~Sutra Sthana~~]] ~~Chapter 24~~, ~~Chapter on~~ the ~~Characteristics~~ of ~~Blood~~ and ~~its Disorders ==~~

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<p style="text-align:justify;">Blood is important for maintaining vitality of individuals. It is also the most important factor in patho-physiology of any disease as it carries vitiated [[dosha] leading to disease. This chapter focuses on [[rakta dhatu]] (blood tissue), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. Pure blood (Shuddha rakta) is formed by following proper dietary habits. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, [[dosha]] specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as mada (intoxication/confusion), murchha (syncope), and sanyasa (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided. </br>

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'''Keywords''': [[Rakta]], rakta visravana, sanyasa sangyavahi srotas, vegetative state, shonita, sadyaphala kriya, sangyaprabodhanam, pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction.

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</p>

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~~=== Abstract ===~~

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~~<div style="text-align:justify;">~~

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This chapter focuses on ''rakta dhatu'' (blood tissues), delineating the characteristic features of pure blood as well as the factors influencing the formation of blood. ''Shuddha rakta'' (pure blood) is formed by following proper dietary habits as described in Ayurveda. Therefore, characteristics of pure blood, the causative factors for vitiation of blood, ''dosha'' specific features of vitiated blood, their treatment and procedure of bloodletting are described in this chapter. Since blood plays an important role in the treatment of cerebrovascular diseases, a description of ailments such as ''mada'' (intoxication/confusion), ''murchha'' (syncope), and ''sanyasa'' (coma), their pathology and courses of treatment, and mind’s role in the pathogenesis of some of these diseases have also been provided.

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'''Keywords''': ''Rakta, rakta visravana, sanyasa sangyavahi srotas,'' vegetative state, ''shonita'', ''sadyahphalaakriyaah, sangyaprabodhanam,'' pure blood, blood vitiating factors, coma, syncope, intoxication, drug addiction.

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== Introduction ==

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~~</div>~~

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=== Introduction ===

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In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three ~~''doshas''~~ were described. In continuation, the present chapter describes the management principles of disorders due to ''shonita'' (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of ''rakta'' have been explained in this ~~treatise~~. Vitiated ''rakta'' causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) ''dravyas'' are used for treatment without response, ''raktaja vikara'' (blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence - have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

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In the previous chapters of ''Yojana Chatushka'' (tetrad on management protocol), procedures for the management of disorders caused due to vitiation of three [[dosha]] were described. In continuation, the present chapter describes the management principles of disorders due to shonita (blood) vitiation. Formation of pure blood is very important for survival because blood is vital for sustaining life [1,2]. Origin, development, and survival of the body depend on blood [3]. Various etiological factors for vitiation of [[rakta]] have been explained in this chapter. Vitiated [[rakta]] causes various diseases e.g. stomatitis, redness in the eye, etc. If cold (or hot) and rough (or unctuous) dravyas are used for treatment without response, raktaja vikara(blood disorder) should be the reason. The line of treatment for ''raktaja vikara'' constitutes courses of treatment for ''raktapitta'' (i.e., prescribed for cases of vitiated ''pitta'' such as purgation and fasting, along with bloodletting). The physical appearance of pure blood has been described to be of golden colors, like red lotus, firefly, ''lakh'' (''laksha''), the fruit of ''gunja'' (Abrus precatorius Linn.). Any deviation from these could be explained to be due to ''vikaras'' or disorders. Some of the prominent blood-related disorders such as ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa'' (coma) have therefore been described in this chapter. Their etiopathogenesis, types, symptoms and grades of severity - in this sequence - have been explained, along with some suggested courses of treatment. In the case of ''mada'' and ''murchcha'', purificatory measures ([[Panchakarma]]) have been suggested, while for ''sanyasa'', an emergency treatment (''attyaika chikitsa'') should be followed.

</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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अथातो विधिशोणितीयमध्यायं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः||२||

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athātō vidhiśōṇitīyamadhyāyaṁ vyākhyāsyāmaḥ ||1||

Line 40: Line 63:

iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

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~~“Now I~~ shall expound the chapter ~~on properly formed blood”~~, said Lord Atreya. [1-2]

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Now we shall expound the chapter "Vidhishonitiya" (Characteristics of Shonita (Blood), its vitiation and disorders). Thus said Lord Atreya. [1-2]

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==== Formation of pure blood ====

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=== Formation of pure blood ===

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विधिना शोणितं जातं शुद्धं भवति देहिनाम्|

देशकालौकसात्म्यानां विधिर्यः सम्प्रकाशितः||३||

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vidhinā śōṇitaṁ jātaṁ śuddhaṁ bhavati dēhinām|

Line 56: Line 82:

deshakAlaukasAtmyAnAM vidhiryaH samprakAshitaH||3||

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</div></div>

Pure blood is formed in harmony with place, time, and adaptation, as said earlier. (C.Su.6) [3]

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==== Effects of pure blood on body ====

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=== Effects of pure blood on body ===

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तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा|

युनक्ति प्राणिनं प्राणः शोणितं ह्यनुवर्तते||४||

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tadviśuddhaṁ hi rudhiraṁ balavarṇasukhāyuṣā|

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yunakti prANinaM prANaH shoNitaM hyanuvartate||4||

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</div></div>

That pure blood provides the individual with strength, complexion, happiness, and life. Because vitality of life depends on blood. [4]

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==== Causes of blood vitiation ====

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=== Causes of blood vitiation ===

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प्रदुष्टबहुतीक्ष्णोष्णैर्मद्यैरन्यैश्च तद्विधैः|

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शरत्कालस्वभावाच्च शोणितं सम्प्रदुष्यति||१०||

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praduṣṭabahutīkṣṇōṣṇairmadyairanyaiśca tadvidhaiḥ|

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sharatkAlasvabhAvAcca shoNitaM sampraduShyati||10||

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</div></div>

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By habitual intake of spoiled food and/or liquids, overeating, ~~imbibing hard~~ liquor and other similar drinks, too much ~~salt~~, alkaline substances, sour and pungent food, ''kulatha'' (Dolichos biflorus Linn.), ''masha'' (Phaseolus mungo Linn.), ''nishpava'' (Dolichos lablab Linn.), ''tila taila'' (Sesamum indicum Linn. oils), ''pindalu'' (Randia uliginosa DC.), radish and all green (leafy) vegetables, meat of aquatic and marshy animals, burrowing animals and those that snatch birds, excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids, consuming decomposed, putrid food with opposite properties excessive sleeping during the day especially after taking liquids, unctuous and heavy food, excessive anger, excessive exposure to the sun and the wind, suppression of the natural urges like vomiting, avoidance of blood-letting in prescribed time (autumn), too much exertion, injury, heat, indigestion, taking meal during indigestion and in ~~the~~ autumn season ~~naturally vitiates ''rakta'' (blood)~~.[5-10]

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The blood is vitiated due to the following causes:

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By 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, ''kulatha'' (Dolichos biflorus Linn.), ''masha'' (Phaseolus mungo Linn.), ''nishpava'' (Dolichos lablab Linn.), ''tila taila'' (Sesamum indicum Linn. oils), ''pindalu'' (Randia uliginosa DC.), radish and all green (leafy) vegetables, meat of aquatic and marshy animals, burrowing animals and those that snatch birds, excessive intake of curd, sour whey (curd-water), vinegars and other sour fermented liquids, consuming decomposed, putrid food with opposite properties excessive sleeping during the day especially after taking liquids, unctuous and heavy food, excessive anger, excessive exposure to the sun and the wind, suppression of the natural urges like vomiting, avoidance of blood-letting in prescribed time (autumn), too much exertion, injury, heat, indigestion, taking meal during indigestion and due to natural pattern in autumn season.[5-10]

</div>

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==== Diseases due to vitiation of blood ====

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=== Diseases due to vitiation of blood ===

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ततः शोणितजा रोगाः प्रजायन्ते पृथग्विधाः|

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सम्यक् साध्या न सिध्यन्ति रक्तजांस्तान् विभावयेत्||१७||

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tataḥ śōṇitajā rōgāḥ prajāyantē pr̥thagvidhāḥ|

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samyak sAdhyA na sidhyanti raktajAMstAn vibhAvayet||17||

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</div></div>

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The above mentioned dietary habits or lifestyle choices cause various diseases that should be considered blood disorders, such as stomatitis, redness in eyes, foul smell in nose and mouth, ''gulma'' (lump abdomen), ''upakusha'' (inflammation of gum leads to falling of teeth), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, ''vatarakta'', discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, 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, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc. The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by (impure) blood. [11-17]

</div>

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==== Management of blood vitiation disorders ====

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=== Management of blood vitiation disorders ===

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कुर्याच्छोणितरोगेषु रक्तपित्तहरीं क्रियाम्|

विरेकमुपवासं च स्रावणं शोणितस्य च||१८||

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kuryācchōṇitarōgēṣu raktapittaharīṁ kriyām|

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virekamupavAsaM ca srAvaNaM shoNitasya ca||18||

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</div></div>

Treatment for blood disorder is as per ''raktapitta'' with therapeutic purgation, fasting and bloodletting. [18]

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==== Extent of bloodletting ====

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=== Extent of bloodletting ===

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बलदोषप्रमाणाद्वा विशुद्ध्या रुधिरस्य वा|

रुधिरं स्रावयेज्जन्तोराशयं प्रसमीक्ष्य वा||१९||

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baladōṣapramāṇādvā viśuddhyā rudhirasya vā|

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rudhiraM srAvayejjantorAshayaM prasamIkShya vA||19||

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</div></div>

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Bloodletting should be done considering the strength of the person, ''dosha'',location of the disease, and until pure blood starts to flow out.[19]

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Bloodletting should be done considering the strength of the person, [[dosha]], location of the disease, and until pure blood starts to flow out.[19]

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===~~= ''~~Dosha''-specific features of vitiated blood ====

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=== [[Dosha]]-specific features of vitiated blood ===

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अरुणाभं भवेद्वाताद्विशदं फेनिलं तनु|

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संसृष्टलिङ्गं संसर्गात्त्रिलिङ्गं ||२१||

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aruṇābhaṁ bhavēdvātādviśadaṁ phēnilaṁ tanu|

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saMsRuShTali~ggaM saMsargAttrili~ggaM sAnnipAtikam||21||

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</div></div>

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Due to vitiated ''vata,'' blood becomes arunabham (reddish), non-slimy, frothy and thin. Due to vitiated ''pitta'', it becomes yellow or blackish, with delayed coagulation because of heat. Due to vitiated ''kapha'' it is slightly pale, slimy, fibrous and more viscous. In the case of combination of vitiated ''doshas'', it acquires mixed characters and in ''sannipata'', has symptoms of all the three ''doshas''.[20-21]

</div>

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==== Characteristics of pure blood ====

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=== Characteristics of pure blood ===

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तपनीयेन्द्रगोपाभं पद्मालक्तकसन्निभम्|

गुञ्जाफलसवर्णं च विशुद्धं विद्धि शोणितम्||२२||

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tapanīyēndragōpābhaṁ padmālaktakasannibham|

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gu~jjAphalasavarNaM ca vishuddhaM viddhi shoNitam||22||

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</div></div>

Blood should be regarded as pure when its color resembles red-gold, firefly, red lotus, ''laksha'' (lac-resinous material) and ''gunja'' fruit (Abrus precatorius Linn.).[22]

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==== Diet after bloodletting ====

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=== Diet after bloodletting ===

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नात्युष्णशीतं लघु दीपनीयं रक्तेऽपनीते हितमन्नपानम्|

तदा शरीरं ह्यनवस्थितासृगग्निर्विशेषेण च रक्षितव्यः||२३||

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nātyuṣṇaśītaṁ laghu dīpanīyaṁ raktē'panītē hitamannapānam|

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tadA sharIraM hyanavasthitAsRugagnirvisheSheNa ca rakShitavyaH||23||

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</div></div>

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After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the ''agni'' (digestive power) should be protected with care. [23]

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After bloodletting, it is beneficial to take diet that is neither too hot nor cold, is light (to digest), and is appetizing. During this period, the body is vulnerable to relapse of various other forms of blood-related diseases, so the [[agni]](digestive power) should be protected with care. [23]

</div>

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==== Characteristics of a person with pure blood ====

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=== Characteristics of a person with pure blood ===

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प्रसन्नवर्णेन्द्रियमिन्द्रियार्थानिच्छन्तमव्याहतपक्तृवेगम्|

सुखान्वितं तु(पु)ष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति||२४||

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prasannavarṇēndriyamindriyārthānicchantamavyāhatapaktr̥vēgam|

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sukhAnvitaM tu(pu)ShTibalopapannaM vishuddharaktaM puruShaM vadanti||24||

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</div></div>

A person should be considered as having pure blood if he has glowing complexion, well-functioning sense organs, and is cheerful. A person with unvitiated blood has normal digestion and unobstructed natural urges, is happy and is endowed with saturation and strength. [24]

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==== Causative factors and pathogenesis of ''mada'' (intoxication), ''murchcha'' (syncope) and ''sanyasa''(coma) ====

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=== Causative factors and pathogenesis of mada (intoxication), murchcha (syncope) and sanyasa(coma) ===

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यदा तु रक्तवाहीनि रससञ्ज्ञावहानि च|

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सञ्ज्ञां नयत्याकुलतां विशेषश्चात्र वक्ष्यते||२९||

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yadā tu raktavāhīni rasasañjñāvahāni ca|

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sa~jj~jAM nayatyAkulatAM visheShashcAtra vakShyate||29||

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</div></div>

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When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated ~~''doshas''~~, singly or in combination, reside and obstruct the channels that carry ''rakta, rasa'' (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated ~~''doshas''~~ distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

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When a person indulges in spoiled food and unhealthy habits, he develops a clouded sensorium with ''rajas'' and ''tamas'' qualities. The vitiated [[dosha]], singly or in combination, reside and obstruct the channels that carry [[rakta]], [[rasa]] (plasma), and consciousness. This leads to various diseases such as ''mada'' (intoxication), ''murchcha'' (syncope), and ''sanyasa'' (coma) which are etiologically, symptomatically and therapeutically progressive. Vitiated [[dosha]] distress the mind and alter the sensorium leading to further impairment of consciousness. [25-29]

</div>

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===~~= ''~~Dosha'' specific features of ''mada'' (intoxication) ====

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=== [[Dosha]] specific features of ''mada'' (intoxication) ===

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सक्तानल्पद्रुताभाषं चलस्खलितचेष्टितम्|

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सर्वाण्येतानि रूपाणि सन्निपातकृते मदे|३३|

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saktānalpadrutābhāṣaṁ calaskhalitacēṣṭitam |

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sarvANyetAni rUpANi sannipAtakRute made|33|

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</div></div>

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The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with ~~''kaphaja~~ mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

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The person should be diagnosed as suffering from ''vatika mada'', if his speech is excessive and fast, movement is unstable, and face is rough, reddish or blackish. A person with angry and harsh tongue, quarrelsome, tends to be physical with a red, yellow and black face should be known to be suffering from ''paittika mada''. The one affected with [[kapha]]ja mada'' speaks less with incoherence, seems drowsy and lethargic, is pale and is continuously in a state of anxiety. In ''sannipataja mada'', all these features are found in combination. [30-33]

</div>

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जायते शाम्यति क्षिप्रं मदो मद्यमदाकृतिः||३३||

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jāyatē śāmyati kṣipraṁ madō madyamadākr̥tiḥ||33||

jAyate shAmyati kShipraM mado madyamadAkRutiH||33||

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''

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</div></div>

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Sannipataja mada'' (a type of narcosis) arises and subsides quickly like alcoholic narcosis. [33]

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''Sannipataja mada'' (a type of narcosis) arises and subsides quickly like alcoholic narcosis. [33]

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यश्च मद्यकृतः प्रोक्तो विषजो रौधिरश्च यः|

सर्व एते मदा नर्ते वातपित्तकफत्रयात्||३४||

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yaśca madyakr̥taḥ prōktō viṣajō raudhiraśca yaḥ|

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sarva ete madA narte vAtapittakaphatrayAt||34||

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</div></div>

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All types of narcosis are caused by alcoholic drinks, poisons or by vitiation of blood. It can be concluded that all types of narcosis are caused by nothing but the vitiation of the three ~~''doshas''~~ viz. ''vata, pitta'' and ''kapha''. [34]

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All types of narcosis are caused by alcoholic drinks, poisons or by vitiation of blood. It can be concluded that all types of narcosis are caused by nothing but the vitiation of the three [[dosha]] viz. [[vata]], [[pitta]] and [[kapha]]. [34]

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==== Specific features of ''dosha'' dominant ''murchcha'' (syncope) ====

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=== Specific features of [[dosha]] dominant ''murchcha'' (syncope) ===

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नीलं वा यदि वा कृष्णमाकाशमथवाऽरुणम्|

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स जन्तुं पातयत्याशु विना बीभत्सचेष्टितैः||४१||

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nīlaṁ vā yadi vā kr̥ṣṇamākāśamathavā'ruṇam|

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sa jantuM pAtayatyAshu vinA bIbhatsaceShTitaiH||41||

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</div></div>

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In ''vatika murchcha'', the patient becomes unconscious after seeing the sky as blue, black or reddish and regains consciousness quickly. Other symptoms include trembling, body-ache, excessive pain in the cardiac region, emaciation, and blackish and reddish luster.

In ''paittika murchcha'', unconciousness comes after seeing the sky as red, green or yellow, and recovery is accompanied by sweating. There are also symptoms like thirst, pyrexia, red or yellow distressed eyes, loose motion, and yellowish pallor.

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The patient of ~~''kaphaja~~ murchcha'' gets unconscious after seeing the sky covered in clouds or covered with deep darkness and recovers after a long time. He generally finds his body parts feel heavy and wrapped in wet hide. He also suffers from excessive salivation and nausea.

+

The patient of [[kapha]]ja murchcha gets unconscious after seeing the sky covered in clouds or covered with deep darkness and recovers after a long time. He generally finds his body parts feel heavy and wrapped in wet hide. He also suffers from excessive salivation and nausea.

''Sannipataja murchcha'' has characters of all the above types and the patient suffers from (epilepsy-like) bouts of paroxysm, with the difference that in this ''murchcha'' the patient falls unconscious without violent or revolting movements.[35-41]

</div>

−

==== Sanyasa (coma) ====

+

=== Sanyasa (coma) ===

+

दोषेषु मदमूर्च्छायाः कृतवेगेषु देहिनाम्|

Line 627: Line 708:

तस्य संरक्षितव्यं हि मनः प्रलयहेतुतः||५३||

+

dōṣēṣu madamūrcchāyāḥ kr̥tavēgēṣu dēhinām|

Line 723: Line 805:

tasya saMrakShitavyaM hi manaH pralayahetutaH||53||

+

</div></div>

+

''Mada'' and ''murchcha'' subside on their own when the vitiated ''doshas'' subside. However, ''sanyasa'' (coma) does not subside without medical treatment. In weak patients, when vitiated ''doshas'' move into a vital organ (i.e. brain and heart) and start affecting speech, physical movement, and the mind, coma ensues. A person affected with coma appears to be in a vegetative state or seems dead. Death can occur if prompt and effective treatment is not given. The physician should manage a comatose patient just as a wise person recovers a utensil sinking in deep water quickly before it settles down in the bottom.

Line 731: Line 815:

</div>

−

==== Various treatments of ''mada'' and ''murchcha'' ====

+

=== Various treatments of ''mada'' and ''murchcha'' ===

+

स्नेहस्वेदोपपन्नानां यथादोषं यथाबलम्|

Line 752: Line 837:

सेवनान्मदमूर्च्छायाः प्रशाम्यन्ति शरीरिणाम्||५८||

+

snēhasvēdōpapannānāṁ yathādōṣaṁ yathābalam|

Line 792: Line 878:

sevanAnmadamUrcchAyAH prashAmyanti sharIriNAm||58||

+

</div></div>

+

In the cases of ''mada'' and ''murchcha'', patients should be subjected to five (evacuative) measures, after proper oleation and fomentation, according to the ''dosha'' and strength of the person and the disease. Likewise, the administration of ''paniya-kalyana ghrita'', ''tiktashatpala ghrita'' or ''mahatikta ghrita'' is recommended. The use of ''triphala'' with ''ghrita'', honey and sugar, ''shilajatu,'' milk, ''pippali'' (Piper longum) or ''chitraka'' (Plumbago zeylanica Linn.) with milk, ''rasayana,'' and ''kaumbha'' (ten year old) ''ghrita'' are also beneficial.

Line 798: Line 886:

</div>

−

==== Summary ====

+

=== Summary ===

+

तत्र श्लोकौ-

Line 809: Line 898:

विधिशोणितकेऽध्याये सर्वमेतत् प्रकाशितम्||६०||

+

tatra ślōkau-

Line 829: Line 919:

vidhishoNitake~adhyAye sarvametat prakAshitam||60||

+

</div></div>

Now the (summing up) verses-

Line 835: Line 926:

Diseases with variable state of consciousness, from confusion to coma have been described in this chapter. [59-60]

−

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

+

== Tattva Vimarsha (Fundamental Principles) ==

*Formation of pure blood depends upon the place, time, diet, and lifestyle. [3]

*Pureblood is one of ten vital components of the body. [4]

−

*''Katu'',(pungent) ''amla'' (sour), ''lavana'' (salty), ''ushna'' (hot) foods, excessive anger, excessive food, exposure to sun & fire, trauma and autumn season are main causes of ~~''raktaja~~ vikara''. All diet and lifestyle factors responsible for ''pitta'' vitiation can cause vitiation of blood. [5-10]

+

*''Katu'',(pungent) ''amla'' (sour), ''lavana'' (salty), ''ushna'' (hot) foods, excessive anger, excessive food, exposure to sun & fire, trauma and autumn season are main causes of [[rakta]]ja vikara. All diet and lifestyle factors responsible for [[pitta]] vitiation can cause vitiation of blood. [5-10]

*Treatment of blood vitiation disorders is like ''raktapitta'' with purgation, fasting, and bloodletting. [18]

*The extent of bloodletting is decided according to the severity of the disease, location of the disease, and strength of the patient.[19]

−

*''Vata'' and ''pitta'' increase bleeding and delay blood-clotting while ''kapha'' does the opposite.[20-21]

+

*[[Vata]] and [[pitta]] increase bleeding and delay blood-clotting while [[kapha]] does the opposite.[20-21]

*A person should take digestion-enhancing diet consisting of ''shali'' (red rice), ''moong'' (green gram), etc. to strengthen digestive power after bloodletting. [23]

−

*''Mada, murchcha'', and ''sanyasa'' are caused due to vitiated doshas as well as ''rajas'' and ''tamas,'' which impair and obstruct ~~''rasavaha~~, ~~raktavaha''~~, and ''sangyavahi srotas'' ~~and~~ are responsible for various states of consciousness. Altered sensorium and consciousness are caused by consumption of contaminated diet and conduct. Mind and body are equally involved in the pathology of intoxication, syncope, and coma. [25-29]

+

*''Mada, murchcha'', and ''sanyasa'' are caused due to vitiated doshas as well as ''rajas'' and ''tamas,'' which impair and obstruct [[rasa]]vaha, [[rakta]]vaha, and ''sangyavahi srotas''. They are responsible for various states of consciousness. Altered sensorium and consciousness are caused by consumption of contaminated diet and conduct. Mind and body are equally involved in the pathology of intoxication, syncope, and coma. [25-29]

*''Mada'' and ''madatyaya'' are clinically interchangeable. All types of narcosis and intoxication are caused by the vitiation of the three ''doshas''.[34]

−

*''Murchcha'' is a transient loss of consciousness with prodromal visual hallucinations specific to ''vata, pitta,'' and ''kapha''. [35-41]

+

*''Murchcha'' is a transient loss of consciousness with prodromal visual hallucinations specific to [[vata]], [[pitta]],and [[kapha]]. [35-41]

−

*''Mada'' and ''murchcha'' are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. ''Sanyasa'' requires intensive ~~care~~ management. [42-53]

+

*''Mada'' and ''murchcha'' are mostly self-limiting conditions in which spontaneous recovery occurs most of the time. ''Sanyasa'' requires intensive management. [42-53]

*Purification of channels through [[Panchakarma]] is indicated before administration of drugs.[54-58]

−

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

+

== 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===

+

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.

−

~~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]] <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no~~.~~28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457.~~ </ref>~~) - food having six ''rasaja''~~, ~~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 ''majjagata'' substances (~~bone marrow~~). ~~The importance~~ of ~~pure blood is described in ''Sushruta Sutra'' <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Vimana sthana, Chap 1, shlok no~~.~~21 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi~~, ~~pp 680~~.</ref>15/7 and ''Charak Chikitsa'' <ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 15, shlok no.7 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 75. </ref>15/28.[3]

+

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>

−

~~Pure-blood is the basis~~ of ~~life as it nourishes ''dasha pranayatna'' (ten important “life areas” of the body: two temples, heart, head, bladder, throat,~~ blood, semen, ''ojas'' and rectum <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, 2nd part, Chikitsa sthana, Chap 15, shlok no.28 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 457. </ref>, (Ch. Sha. 7/9) <ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sutrasthana, Chap 29, shlok no.3 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 576. </ref>. ''Rakta'' increases the physical strength, complexion, immunity, and vitality of life (Su.Su. 15/7)<ref>Pandit Kashi Nath Shastri, Dr. Gorakhanath Chaturvedi, Charak Samhita, Ist part, Sharira sthana, Chap 7, shlok no. 9 ,Reprint 2005, Chaukhambha Bharati Academy, Varanasi, pp 913. </ref>. [4]

+

===[[Dosha]] specific features of blood===

−

~~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]~~

+

When the blood tissue is vitiated by [[dosha]], it shows following features.

−

~~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]

+

{| 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]

−

~~Any line of treatment should~~ be ~~planned keeping in mind~~ the ~~basic principles~~ of ~~blood coagulation as described in Ayurvedic texts~~. [~~20-21~~]

+

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/>

−

~~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]~~

+

===Causes of vitiation of blood===

+

'''Dietary causes:'''

−

~~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]~~

+

*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)

+

*Randia uliginosa 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

−

~~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]~~

+

'''Lifestyle causes:'''

−

~~In any drug addiction or narcosis~~, the ~~dominant ''dosha'' should be diagnosed~~ and ~~managed accordingly.~~ [34]

+

*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 at appropriate indicated time or in the autumn season when the blood is affected due to natural aggravation of [[pitta dosha]]

+

*Excess exertion

+

*Injury

+

*Exposure to heat

−

~~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]~~

+

'''Mental factors:'''

−

~~The goal of any course of treatment of ''sanyasa'' is selecting the right formulation to help the patient regain consciousness. [42-53]~~

+

*Excessive anger

−

~~Various medicated~~ ''~~ghrita~~'' ~~are indicated for~~ ''~~sanyasa'' since lipid matrix helps to cross the blood-brain barrier and act on the brain. [54-58]~~

+

'''Environmental conditions:'''

−

~~Metabolic acidosis and alkalosis should be considered~~ to ~~gain an understanding~~ of ~~''raktaja vikara''~~. ~~Electrolyte imbalances should be evaluated for the keen diagnosis of ''mada, murchcha,'' and ''sanyasa''~~. [59-60]

+

*Autumn season due to natural aggravation of [[pitta dosha]] [Cha.Sa.[[Sutra Sthana]] 24/5-10]

−

=== ~~References~~ ===

+

===Clinical features of abnormal blood===

−

<~~references~~/>

+

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)===

+

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)====

+

=====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]<ref name=Susruta/> 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]<ref name=Susruta/>

+

=====Types and [[dosha]] specific features of intoxication (mada)=====

+

{| class="wikitable"

+

|+ Table 2: 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]<ref name= Hridaya > Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref>

+

|-

+

| | Alcohol (madya)|| Features similar to [[pitta]] dominant type, abnormal movements of body parts, abnormal speech, abnormal voice [A.Hr. Nidhana Sthana. 6/29]<ref name=Hridaya/>

+

|-

+

| |Poison (visha) || Tremors and excessive sleep [A.Hr. Nidhana Sthana 6/29]<ref name=Hridaya/>

+

|-

+

|}

+

[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]<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)====

+

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]<ref name=Susruta/> 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]<ref name=Susruta/> The predominant [[dosha]] in the pathogenesis of murchha is [[pitta]]. [Su.Sa.Uttara Sthana.46/8]<ref name=Susruta/>

+

=====Premonitory symptoms=====

+

Pain in chest, excessive yawning, exhaustion, loss of strength and consciousness. [Su.Sa.Uttara Sthana.46/5]<ref name=Susruta/>

+

=====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.Sa.[[Sutra Sthana]] 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.Sa.[[Sutra Sthana]] 24/37-38][A.Hr. Nidhana Sthana 6/32]<ref name=Hridaya/>

+

|-

+

| | [[Kapha dosha]] || Regains consciousness slowly, feels as if body is covered with thick blanket, salivation and nausea. [Cha.Sa.[[Sutra Sthana]] 24/39-40] [A.Hr. Nidhana Sthana 6/35]<ref name=Hridaya/>

+

|-

+

| | [[Sannipata]] || Symptoms resembles epilepsy (apasmara) but devoid of irregular body movements. [Cha.Sa.[[Sutra Sthana]] 24/41][A.Hr. Nidhana Sthana 6/35]<ref name=Hridaya/>

+

|-

+

| | Blood ([[rakta]]) || Stiffness of body parts, fixed gaze and feeble respiration. [Su.Sa.Uttara Sthana 46/11]<ref name=Susruta/>

+

|-

+

| | Alcohol (Madya) || Irrelevant speech, altered state of mind, irregular movements of body parts. [Su.Sa.Uttara Sthana 46/12]<ref name=Susruta/>

+

|-

+

| | Visha || Tremors, sleep, thirst and body stiffness. [Su.Sa.Uttara Sthana 46/13]<ref name=Susruta/>

+

|-

+

|}

+

====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.

+

=====Diagnostic tests=====

+

A variety of blood tests like complete blood count, blood smear, blood type, Coomb's 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=====

+

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]

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=====Management=====

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The first aim of treatments mentioned are under emergency medical care is regaining consciousness. It includes stimulating and irritant therapies. Sensory stimuli by pricking with needle, applying potent collyrium etc. are used to check the level of consciousness. The drugs used are strong and penetrating in nature.

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After regaining the consciousness, the treatment should be continued to prevent the remission. This includes purification procedures like emesis ([[vamana]]), purgation ([[virechana]]), bloodletting ([[raktamoksha]]) etc. After that rejuvenating therapy ([[rasayana]]) is also advised. Medicated ghee processed with herbs is used for this purpose. The lipoidal nature of ghee (cow’s ghee) makes it an effective vehicle for carrying the active principles of processed drugs and it can easily cross the blood brain barrier.<ref>Karandikar YS, Bansude AS, Angadi EA. Comparison between the Effect of Cow Ghee and Butter on Memory and Lipid Profile of Wistar Rats. J Clin Diagn Res. 2016;10(9):FF11-FF15. doi:10.7860/JCDR/2016/19457.8512</ref>

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===Case reports===

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'''Case 1:'''

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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>

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'''Case 2:'''

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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>

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'''Case 3, 4 and 5:'''

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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>

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'''Case 6:'''

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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>

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'''Case 7:'''

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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/>

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'''Case 8:'''

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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/>

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===Effect of seasonal variations in blood physiology===

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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.

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===Contemporary views===

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Advanced medical technology has enhanced the understanding of microscopic nature of blood tissue, its components and all physical characteristics. The features described in [[Ayurveda]] text describe macroscopic changes related to affecting [[dosha]]. However, there is much scope of research in bridging the gaps between concepts of these two biomedical sciences.

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Some researchers state that the clinical features are similar to the state of disorders due to change in blood pressure leading to hypertension. Some researchers opine that the pathogenesis and features of mada, murchcha and sanyasa show many similarities with shock due to severe hypotension.<ref>Soumya P. Viswan, Rashmi R. A critical review on hypotension and its management from Ayurvedic perspective. Int. J. Res. Ayurveda Pharm. 2020;11(5):114-120 http://dx.doi.org/10.7897/2277-4343.1105152</ref>

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=== ~~Glossary~~ ===

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===Future research areas===

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*Role of causative factors described in this chapter in hematological disorders and disorders of cardio vascular system

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*Understanding exact pathological and microscopic nature of vitiation of blood and relation with [[dosha]] specific changes

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*Influence of seasonal changes on blood physiology

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*Epigenetic changes in blood tissue and its patho-physiological understanding

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~~#aukasātmyā (aukasAtmyA; अकसात्म्य)– Acquired homologation/adaptation~~

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==Related chapters==

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~~#ādhyaśana (Adhyashana; अध्यशनै ) - Eating before the complete digestion of the previous food.~~

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~~#ajīrṇā (ajIrNA ; अजीर्णा) – Indigestion.~~

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~~#virēka (virekam; विरेक ) - Purgative action.~~

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~~#tantu (tantu; तन्तु ) – Thread-like.~~

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~~#dīpanīya (dIpanIya; दीपनीयं) – To increase appetite or digestive power.~~

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~~#viśadaṁ (vishadaM ; द्विशदं ) – Nonslimy.~~

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~~#agnisāda (agnisAda; अग्निसाद) – loss of appetite or decreased digestive power.~~

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~~#gurugātratā (gurugAtratA; गुरुगात्रता) – Heaviness of body.~~

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~~#santāpa (santApa; सन्ताप) – Pyrexia.~~

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~~#klamaḥ (klamaḥ; क्लमः) – Feeling of exhaustion.~~

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~~#buddhēḥ sammōhō (buddheH sammoho ; बुद्धेः सम्मोहो ) – Confusion of mind.~~

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~~#svarakṣayaḥ (svarakShayaH; स्वरक्षयः) – Weakness of voice.~~

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~~#tandrā (tandrA; तन्द्रा) – Excessive drowsiness.~~

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~~#kōṭha (koTha; कोठ) –Patches on skin.~~

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~~#Prasahanam (प्रसहानां)- Animals and birds that take in their food by snatching.~~

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~~#Prameelakah (प्रमीलकाः)- It is a state of almost falling asleep.~~

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~~#Pradhyantatparam (प्रध्यानतत्परम्)- A person who is continuous in a state of anxiety.~~

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~~=== Related Chapters ===~~

* [[ Raktapitta Nidana ]]

* [[ Raktapitta Chikitsa ]]

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* [[Rakta dhatu]]

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* [[Raktamokshana]]

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== References ==

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