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  RAKTAPITTA - BLEEDING  
  Raktapitta Chikitsaa

 

References:

C. Chi. 4, S. U. 45, .H. Ni. 3, Chi. 2, N.R. Raktapitta

 

Introduction:

This is an acute disease (Aas`hukaaree). It spreads like forest fire. It should be treated immediately and carefully. When this disease changes the course (direction) it is indicative of incurability (Asaadhyatva). It is a serious disease (Mahaagada), having grave consequences. It afflicts the patient very fast. Mahaavega - greatly agitated). It is like fire and affects instantaneously (Agnivat S`heeghrakaaree)

 

Pitta is associated with Rakta; hence it has a natural tendency to vitiate. This vitiated Pitta combines with Rakta and contaminates it. Pitta and Rakta have comparable smell and colour. Owing to this relationship in this Vyaadhi Pitta is addressed as Rakta.

 

 

Saamanya Chikitsaa

 

Raktapitta is of three types

o       Oordhvaga which is Kaphaanubandhee and is Saadhya

o       Adhoga which is Vaataanubandhee and Yaapya

o       Tiryak which is Asaadhya.

 

Note: - Pratimaarga (Viruddha) Maarga Haran`a (S`hodhana): Eliminating the causative, vitiated Dosha from the opposite direction of its manifestation is the key to management of Rakta Pitta.

(For Oordhvaga Raktapitta Kashaaya and Tikta Rasa are criteria for S`hamana Dravya and Madhura Rasa is for Adhoga Raktapitta.)

 

Oordhvaga Raktapitta: -

 

The causative attributes are Snigdha and Ushn`a which vitiate the combination of Kapha and Pitta resulting in Oordhvaga Rakta Pitta. To eliminate from the opposite Maarga, Virechana is the modality of choice; which is the best S`hodhana for Pitta and for Kapha too. Hence Oordhvaga Rakta Pitta is Saadhya / Curable. Out of the three Rasa_s owing to Kapha involvement Madhura is contraindicated; which leaves Kashaaya and Tikta for S`hodhana which are abundantly available, thus the choice is wide, hence it is Saadhya.

 

Adhoga Raktapitta: -

 

Vamana is the modality of choice as per Pratimaarga Haran`atenet. The attributes are Rooks`ha and Ushn`a; which cause vitiation of Vaata and Pitta. The available taste for S`hodhana is only Madhura. The availability for Madhura Vamana dravya is limited as well as S`hamana with Madhura Rasa too is limited. Vamana is not a treatment of choice for Pitta as well as Vaata. This makes Adhoga Rakta Pitta Yaapya / incurable but controllable with diet and regimen.

 

Tiryak Raktapitta: -

 

When all three Dosha_s are simultaneously vitiated and are circulating in the blood stream, the manifestation is subcutaneous, which does not respond to either Vamana or Virechana as the Dosha_s are in the S`haakha Maarga, owing to the amount of the Dosha_s it becomes impossible to bring them in the Kosht`ha for elimination. There is limited number of drugs available to manage this condition. The patient may be Durbala due vitiation of all the three Dosha_s and Rakta, all of them being Pran`aayatana_s. All these factors taken together render the condition incurable.

 

Aavasthika Chikitsaa

 

Flow of treatment

State of Upeks`haa (Na Aadau Stambhanam Arhati) initially ignore if the bleeding is not too much as arresting the bleed may lead to complications

        S`hamanaarha (Garbhin`ee, Baala etc.)

o       Langhana

o       Oordhvaga Peyaa, Yavaagoo

o       Adhoga Tarpan`a

        S`hodhanaarha (Bahu Dosha, Balavaan Rugn`a etc.)

o       Oordhvaga Virechana, Peyaa, Yavaagoo

o       Adhoga Vamana, Tarpan`a

 

Oordhvaga Raktapitta:

        Kan`t`hagata

o       Pichchha + Grathita

o       Kalpa

        Naasaagata

o       Astambhanaarha Upeks`haa

o       Ati Raktasraava S`hamanaarha

o       Stambhana Avapeed`a Nasya (S`heeta Dravya)

 

Adhoga Raktapitta:

        Yonigata Pradaravat Chikitsaa

        Mootra Maarga Gata + Rujaa Ksheerapaaka + Uttara Basti

        Gudagata Kalpa + Basti Raktaatisaara Chikitsaa Raktaja Ars`ha Chikitsaa

        Vaata Ulban`a Avasthaa Vibandha Maamsa Rasa Sevana

 

 

Description:

State of Upeks`haa

Since Raktapitta is a bleeding disorder initially in person who is not weak and if only vitiated Dosha_s are flowing out, then no attempt should be made to arrest the bleeding as untimely arrest invariably leads to complications like Paan`d`u (anemia), Grahan`ee (Intestinal motility disorder), Kusht`ha (Resistant skin diseases), Prameha (Urinary tract and system disorders), Gulma (Solitary lump in abdomen) and Jvara (Pyrexia / fever) etc.

S`hamanaarha Avasthaa

If a person afflicted with bleeding disorder is exhibiting one or more of the following he should be subjected to palliative mode of treatment immediately without delay

    * weakness (Ksheen`a Bala),
    * wasting / reduced power of muscle tissue (Ksheen`a Maamsa),
    * emaciated by grief (S`hoka Kars`hita),
    * carrying heavy load (Bhaara Kars`hita), or
    * walking for long time and distance (Adhva Kars`hita),
    * Affected by exposure to heat of fire or Sun (Jvalana Santapta, Aatapa Santapta),
    * emaciated by other debilitating or wasting diseases (Kshee`nam Aamayaih),
    * Pregnant/ expectant woman (Garbhin`ee),
    * Child under sixteen years (Baala),
    * having habit of consuming dry food (Rooks`haanabhuk) or
    * consume food in less quantity (Alpaas`hana) or
    * taking food at less times (Pramitaas`hana),
    * who is not suitable for Vamana or Virechana (S`hodhana Anarha )and
    * who is suffering from S`hosha ( Tuberculosis or wasting disease leading to progressive weight loss)

Should be treated by S`hamana Therapy.

    * S`hamana

o       By examining Langhanaarha and Brimhan`aarha, Tikta and Kashaaya Rasa substances should be used for S`hamana Therapy in Oordhvaga Raktapitta.

 

o       Langhanaaraha persons should be administered Tikta (Bitter) and Kashaaya (Astringent) substance while Brimhan`eeya persons should be administered Madhura (Sweet) substances, in case sweet tasting substances is not available a substances having sweet post digestive taste (Madhura Vipaaka) should employed.

 

o       Madhura Rasa substances should be used for Adhoga Raktapitta.

o       Vaasaa is the S`hamana drug of choice in Rakta Pitta.

 

 

    * State of Langhana in S`hamana

 

o       The state of Upekshaa is assisted by Langhana (Fasting which could be complete fasting to restricted food intake in the form of Tarpan`a). By examining the Dosha_s (Dominant Dosha), Avasthaa (Oordhvaga or Adhoga or Tiryak), Saatmya (homologation) and Anubandha (associated Dosha) fasting should be done by consuming Tarpan`a.

 

o       If Raktapitta is Oordhvaga, fasting is assisted by consuming Tarpan`a and if it is Adhoga fasting is done with consuming Peyaa, Yavaagoo etc. to control Vaata.

 

o       After adequate fasting Sus`hruta advises the person to consume Peyaa with a little rice.

 

o       The Rasa and Yoosha prepared by using Aromatic drugs and Sneha (oil or Ghee) are also suggested.

 

o       Tarpan`a, Paachana, Avaleha and medicated ghee are also advised as per the condition and indication.

 

o       The monitoring and protection of the persons physical power and mental strength is emphasized by Vagbhat`a throughout the management.

 

    * S`hodhanaarha Avasthaa

A person suffering from Raktapitta exhibits aggravated Dosha_s, good strength and power, without muscular wasting and whose condition has arisen out of Santarpan`a, who can withstand S`hodhana and is devoid of complications should always be treated by S`hodhana.

 

    * S`hodhana Pas`hchaat Samsarjana Krama

In a strong person suffering from Oordhvaga Raktapitta after Purification the sequence of food should consuming Tarpan`a and in case of Adhoga Raktapitta it should consist of Peyaa, Yavagoo etc. to establish control over Vaata activity.

 

 

    * Mandaagni + Amla Rasa Saatmya

If the person suffers from Mandaagni and likes sour things to eat he should be given Tarpan`a prepared with sour substance which is not only harmless but also beneficial to him.

 

    * Trishn`aa

The S`hritas`heeta Jala medicated with Tikta (bitter) drugs as well as fruit juices are suggested for Trishn`aa. By examining Dosha_s, Bala (Physical capacity) and Aahaara (food consumption) water can be given in small quantity and at small time intervals in Trishn`aa.

 

    * Grathita Rakta Avasthaa: -

In this condition clotting of blood occurs. Due to intermittent bleeding clots are seen in excreted blood. Excreta of pigeon (Paaraavata S`hakrit) mixed with appropriate Anupaana is used as medicine.

 

o       Ati Nihsrita Rakta / Ati Raktasraava: -

This condition can happen in any type of Raktapitta due to extremely aggravated intensity and heat of both Rakta and Pitta. In this condition medicine in the form of medicated Ghee as well as fresh blood with honey is advised to be taken internally.

 

o       Udeern`a Raktapitta: -

This is an acute disease and affects instantaneously like fire in terms of spread, causing damage and acuteness. The decoction of Rakta Stambhaka drugs should be used to treat Udeern`a Raktapitta.

 

Note: - The above given conditions can occur irrespective of the type and Dosha Praadhaanya. The following are the conditions which occur in any of the type of Raktapitta.

 

Oordhvaga Raktapitta:

Oordhvaga Raktapitta is Saadhya type of Raktapitta. It is Kaphaanubandhi.

 

Oordhvaga Raktapitta:

    * Kan`t`hagata

         Kaphaanubandha + Sapichchha + Grathita Rakta: -

In this condition bleeding occurs from throat. The expectorated blood is found to be sticky due to mucous strands (Sa Pichchha), and along with clots (Grathita Rakta). Ks`haara is used in this condition though they are normally contraindicated. Ks`haara of Kamalanaala is used in this condition.

 

    * Naasaagata

Avapeed`a Nasya of Raktapitta Naas`haka drugs is the procedure of choice. This is given only when vitiated Dosha_s are excreted.

To combat the effects of excessive bleeding use of fresh blood internally is advised as well as fresh goats liver is also advised to be consumed. Cold and Sweet substances should be used to treat Naasaagata Raktapitta.

 

        Threat in treating Naasaagata Raktapitta

If bleeding is arrested when blood is still vitiated it produces Dusht`a Pratis`hyaaya, S`hiroroga, the smell of blood coming out from the nose resembles Pus or foul smell, power of smelling gets diminished / perception of smell is affected and Dusht`a Krimi appears in nose / the nose may exhibit presence of worm infestation in the later stages.

 

Guidelines for Oordhvaga Raktapitta (which doesnt get pacified):

Even after improved Agni, annihilation of Kapha, if bleeding persists then it is considered to be due to Vaata. Hence the management should aim at establishing normal flow of Vaata along its channels (Vaataanulomana).Vaataghna treatment should be done and Ksheerapaaka is the drug of choice for such condition.

 

Adhoga Raktapitta: -

This is Yaapya (remains controlled as long as the treatment is going on palliative) type of Raktapitta. In this Vaata is Anubandhi / associated Dosha. In this type bleeding occurs from Mootra Maarga (Urethra), Guda (per rectum), and Yoni (per vaginum) in females.

This should be differentiated from Raktaatisaara, Raktaja Ars`ha, Rakta Pradara like disorders resembling Adhoga Raktapitta.

 

    * Vaatolban`a Raktapitta
          o Vibandha Avasthaa

Vibandha is a condition found in Vaata Pradhaana Raktapitta in which MaamsaRasa is the medicine of choice.

 

    * Mootra Maargagata
          o Rujaa

Ks`heerapaaka is the drug of choice according to Charaka and Vaagbhat`a. Sus`hruta suggests Uttarabasti for managing this condition.

 

    * Gudagata

Since the sign and symptoms are similar to Raktaatisaara and Raktaja Ars`ha, their treatment also shows similarity. According to Sus`hruta it should be treated by the medicines used in Raktaatisaara. In Raktasraavee Ars`ha treatment of Raktapitta can be used and vise versa.

Vaagbhat`a adds Basti as the procedure of choice for this condition

 

Similar Chikitsaa: -

 

    * In Raktapitta, treatment of Pittaja Jvara is advised. Along with this Sarpigud`a from Ks`hataks`heen`a Chikitsaa are also suggested.

 

    * Similarly in Adhoga Raktapitta, treatment of Raktaatisaara, Raktasraavee Ars`ha and Rakta Pradara is advised.

 

Wholesome things for the person suffering from Raktapitta: -

All Kashaaya and substances which are cold to touch and in potency are useful for treating Raktapitta in both ways i.e., internal as well as external.

 

Aahaara for Raktapitta (Pathya): -

 

    * In Kaphaanuga Raktapitta Yoosha, S`haaka can be given as wholesome food.
    * In Vaataanuga Raktapitta Maamsarasa, Yavaagoo can be given as wholesome food.

 

Vihaara (Life style): -

 

    * All the cold and things favorable / conformable to the mind (Mana Anukoola) are advised in Raktapitta.
    * For Basti Ksheera and Ghrita (plain as well as medicated) is indicated for Aasthaapana Basti.

 

 

Counter references: -

Ch. Chi.11/50 -77 Kshataksheen`a Chikitsaa Sarpigud`a.

Ch. Chi. 19/93 -94 Raktaatisaara Chikitsaa.

A.H.8/98 -101,107,123 Rakta Sraavee Ars`ha Chikitsaa.

 
Pathya -

        Rasa -Kashaaya

        Dhaanya - Jeern`a Shasht`ika S`haalee, Priyangu, Neevaara, Yava, Godhuma

        S`himbee - Mudga, Masoora, Chan`aka, Aad`hakee, Makusht`a, Koradoosha, S`hyaamaaka

        Maamsa - Ajaa, Matsya, Pakshee Maamsa Rasa, Hareen`a, Kukkut`a

        Dugdha - Godugdha, Ghrita, Maahisha Ghrita, Ajaa Dugdha, Santaanikaa

        Drava - S`heeta Jala, Naarikela Jala, Vaarun`ee, Audbhid Jala, Shritas`heeta Jala, Madhu + Jala, Shad`angodaka, Laghu Panchamoola Siddha Jala,

        Phala - Panasa, Kadalee, Taalaphala, Daad`ima, Kharjoora, Aamalakee, Naarikela, Kapittha, Draaksha, Ikshu, Pakva Aamra Phala

        Kritaanna - Utpalaadi Siddha Ksheera, Tarpan`a, Peyaa, Yoosha, Yavaagoo, Maamsa Rasa
        Other - Mis`hreyaa, Laajaa, Saktu, Madhu, S`hrakaraa, Priyangu, Gajapippalee

 

Apathya -

        Rasa - Kat`u, Amla, Lavan`a

        Gun`a - Vidaahee

        S`haaka - Rasona, Vaarataaka

        S`himbee - Tila, Maasha, Sarshapa, Kulattha

        Dugdha - Dadhi

        Drava - Kaupa Jala, Madya
        Other - Gud`a, Taambula, Viruddhaanna, Lavan`a, Vyaayaama, Pravaasa, Aatapa Sevana, Teekshn`a S`hodhana, Kshobha, Mala Mootraadi Vegadhaaran`a, Svedana, Raktamokshan`a, Dhoomapaana, Maithuna, Krodha, Kshaara

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    * Effect on Dosha Pittaghna
    * Effect on Dhaatu Rakta Dusht`i, Rakta Prasaadana, Rakta Stambhana, S`hon`itasthaapana.
    * Indicated in Vyaadhi Raktapitta, Raktaatisaara, Rakta Pradara, Pittaja Jvara and Kshataksheen`a.
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