AIAPGET Points
– KRODHA, SHOKA & BHAYA are the mental causes mentioned amongst the Nidanas of RAKTAPITTA. (Su.Ut.45/3)
– Important Purvarupas of Raktapitta are – Sadanam, SHITA KAMITVAM, KANTA DHUMAYANAM, Vami, LOHAGANDHI NISHVASA.
– Vamana – indicated in Adhah Raktapitta. Virechana – indicated in Urdhwa Raktapitta. Shamana – indicated in Ubhayatah Raktapitta.
– APATARPANA is the first line of treatment for RAKTAPITTA. It should be administered when there is Ati Pravrddha Doshas, Akshina Bala, Mamsa and Agni. (Su.Ut.45/13)
– PALASHA GHRTA – is an important Ghee preparation prescribed in Raktapitta. This should be consumed cold with honey.
– The roots and flowers of MATULUNGA should be macerated. It should be consumed along with rice-wash. (Su.Ut.45/36, Nasagata Raktapitta Chikitsa).
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The 45th chapter of Uttaratantra of Sushruta Samhita is named as Raktapitta Pratiṣedha Adhyaya. This chapter deals with the Treatment of Bleeding Disease.
अथातो रक्तपित्तप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Raktapitta pratiṣedha – treatment of bleeding disease; as revealed by the venerable Dhanvantari.
Nidāna samprapti- causes and pathogenesis
क्रोधशोकभयायासविरुद्धान्नातपानलान् |
कट्वम्ललवणक्षारतीक्ष्णोष्णातिविदाहिनः ||३||
नित्यमभ्यसतो दुष्टो रसः पित्तं प्रकोपयेत् |
विदग्धं स्वगुणैः पित्तं विदहत्याशु शोणितम् ||४||
ततः प्रवर्तते रक्तमूर्ध्वं चाधो द्विधाऽपि वा |५|
Causative Factors of Raktapitta –
Excessive indulgence in the below mentioned factors –
– anger, sorrow, fear or exertion,
– incompatible foods,
– excessive exposure to sunlight and fire,
– intake of foods which are predominantly pungent, sour, salty or alkaline in taste,
– foods which are penetrating, hot in touch and potency and those which cause more burning sensation during digestion
Pathogenesis – Due to the above said causes, rasa – the essence of food produced after digestion (chyme) causes pitta aggravation. The pitta becomes abnormal in its own qualities and in turn vitiates rakta – blood.
Then, the blood flows out of the body through upper or lower orifices or in both directions.
आमाशयाद्व्रजेदूर्ध्वमधः पक्वाशयाद्व्रजेत् ||५||
विदग्धयोर्द्वयोश्चापि द्विधाभागं प्रवर्तते |
केचित् सयकृतः प्लीह्नः प्रवदन्त्यसृजो गतिम् ||६||
Blood present in the amasaya – stomach comes out through the upper orifices i.e. through mouth, nose, eyes and ears.
Blood present in Pakvasaya i.e. large intestine / colon – comes out through the lower passages / orifices i.e. rectum (anus), urethra and vagina.
Blood comes out from both orifices (upper and lower orifices) when both the asayas i.e. amasaya and pakvasaya are abnormal. According to the opinion of some scholars, blood comes from yakrit – liver and pliha – spleen.
ऊर्ध्वं साध्यमधोयाप्यमसाध्यं युगपद्गतम् |७|
The prognosis of Raktapitta is as mentioned below –
– blood coming from upper orifices – is curable,
– blood coming from lower orifices – is controllable and persists for long time and
– blood coming from both orifices – is incurable
Purvarüpa- premonitory symptoms
Rupa and vidha-
सदनं शीतकामित्वं कण्ठधूमायनं वमिः ||७||
लोहगन्धिश्च निःश्वासो भवत्यस्मिन् भविष्यति |८|
Below mentioned are the premonitory symptoms of raktapitta (symptoms of the disease which is yet to be manifested) –
– debility,
– desire for cold things,
– feeling of hot fumes coming out of the throat,
– vomiting and
– smell of iron in expiration
बाह्यासृग्लक्षणैस्तस्य सङ्ख्यादोषोच्छ्रितीर्विदुः ||८||
The symptoms of the disease (raktapitta) are the same as those of blood vitiated by the doshas (as explained in sutra sthana section, chapter 14). Types of the disease are also the same as the aggravated doshas.
Upadravās – complications / secondary diseases
दौर्बल्यश्वासकासज्वरवमथुमदास्तन्द्रितादाहमूर्च्छा
भुक्ते चान्ने विदाहस्त्वधृतिरपि सदा हृद्यतुल्या च पीडा |
तृष्णा कण्ठस्य भेदः शिरसि च दवनं पूतिनिष्ठीवनं च
द्वेषो भक्तेऽविपाको विरतिरपि रते रक्तपित्तोपसर्गाः ||९||
Below mentioned are the complications of Raktapitta –
– Debility,
– Dyspnoea,
– Cough,
– Fever,
– Vomiting,
– Toxaemia,
– Stupor,
– Feeling of burning sensation,
– Fainting,
– Burning sensation inside the body when the food is consumed,
– Feeling of Anxiety,
– Constant pain in the region of heart / heart,
– Thirst,
– Chance of voice,
– Intense pain in the head,
– Bad smell in the sputum,
– Improper digestion and
– Lack of sexual desire
मांसप्रक्षालनाभं क्वथितमिव च यत् कर्दमाम्भोनिभं वा
मेदःपूयास्रकल्पं यकृदिव यदि वा पक्वजम्बूफलाभम् |
यत् कृष्णं यच्च नीलं भृशमतिकुणपं यत्र चोक्ता विकारास्तद्वर्ज्यं रक्तपित्तं सुरपतिधनुषा यच्च तुल्यं विभाति ||१०||
Patients of Raktapitta should be rejected (should not be treated) if the blood coming out of the orifices of the body has below mentioned characteristics –
– resembles mutton wash,
– resembles decoction or muddy water,
– is mixed with fat or pus or blood,
– resembles liver or ripe fruit of Jambu in colour,
– is black or blue,
– greatly emits cadaveric smell,
– shines like a rainbow, with many colours and
– accompanied with complications mentioned earlier
Cikitsa – treatment
नादौ सङ्ग्राह्यमुद्रिक्तं यदसृग्बलिनोऽश्नतः |
तत् पाण्डुग्रहणीकुष्ठप्लीहगुल्मज्वरावहम् ||११||
In persons who are strong and are consuming food, bleeding, in spite of being severe, should not be stopped in Raktapitta.
if bleeding is stopped it will give rise to the below mentioned complications –
– anaemia,
– duodenal disease,
– skin diseases,
– spleen diseases,
– abdominal tumours and
– fever
अधःप्रवृत्तं वमनैरूर्ध्वगं च विरेचनैः |
जयेदन्यतरद्वाऽपि क्षीणस्य शमनैरसृक् ||१२||
Emesis – should be administered to control bleeding from the lower routes / orifices.
Purgation – should be administered to control bleeding from upper routes / orifices.
Palliatives – should be administered to control bleeding occurring from both routes i.e. upward and downward orifices.
अतिप्रवृद्धदोषस्य पूर्वं लोहितपित्तिनः |
अक्षीणबलमांसाग्नेः कर्तव्यमपतर्पणम् ||१३||
लङ्घितस्य ततः पेयां विदध्यात् स्वल्पतण्डुलाम् |
रसयूषौ प्रदातव्यौ सुराभिस्नेहसंस्कृतौ |
तर्पणं पाचनं लेहान् सर्पींषि विविधानि च ||१४||
The person should be advised to do fasting in the below mentioned conditions –
– when there is great aggravation of doshas and
– patient does not have decrease of strength, muscles and digestive fire
The patient should be given peya – thin gruel having less grains of rice in it for drinking, after he has fasted.
Following this, meat soup or soup of pulses processed with herbs smelling sweet and fats should be administered.
After this, nourishing and digestive confections should be given and so also different kinds of medicated ghee.
द्रक्षामधुककाश्मर्यसितायुक्तं विरेचनम् |
यष्टीमधुकयुक्तं च सक्षौद्रं वमनं हितम् ||१५||
Powder of the below mentioned ingredients should be given added with sugar to induce purgation –
– Draksa,
– Madhuka,
– Kasmarya
Decoction of Yastimadhuka added with honey should be used to induce vomiting.
पयांसि शीतानि रसाश्च जाङ्गलाः सतीनयूषाश्च सशालिषष्टिकाः |
पटोलशेलूसुनिषण्णयूथिकावटातिमुक्ताङ्कुरसिन्दुवारजम् ||१६||
हितं च शाकं घृतसंस्कृतं सदा तथैव धात्रीफलदाडिमान्वितम् |
रसाश्च पारावतशङ्खकूर्मजास्तथा यवाग्वो विहिता घृतोत्तराः ||१७||
सन्तानिकाश्चोत्पलवर्गसाधिते क्षीरे प्रशस्ता मधुशर्करोत्तराः |
हिमाः प्रदेहा मधुरा गणाश्च ये घृतानि पथ्यानि रक्तपित्तिनाम् ||१८||
The patient should consume the below mentioned foods –
– milk and soup of meat of animals living in arid lands, made cold,
– soup of satina,
– food prepared with sali and swastika,
– patola, selu, sunisanna, yuthika, tender leaves of vata, atimukta and sinduvara processed with ghee and
– dhatriphala and dadima fruits
Below mentioned foods are also beneficial –
– soup of meat of pigeon, worm of conch and of tortoise or
– yavagu – thick gruel with more quantity of ghee,
– cream of milk,
– milk boiled with herbs belonging to Utpaladi Gana group, added with more quantity of honey and sugar
For the patients of bleeding diseases, cold poultice and ghee prepared with herbs of sweet taste (Kakolyadi Gana group) are ideal.
मधूकशोभाञ्जनकोविदारजैः प्रियङ्गुकायाः कुसुमैश्च चूर्णितैः |
भिषग्विदध्याच्चतुरः समाक्षिकान् हिताय लेहानसृजः प्रशान्तये ||१९||
लिह्याच्च दूर्वावटजांश्च पल्लवान् मधुद्वितीयान् सितकर्णिकस्य च |
हितं च खर्जूरफलं समाक्षिकं फलानि चान्यान्यपि तद्गुणान्यथ ||२०||
Powder of Madhuka, Sobhanjana, Kovidara and Priyangu kusuma should be administered with honey by the intelligent physician for mitigating bleeding.
Below mentioned should be mixed together and given for licking –
– one part of – tender leaves of durva, vata and sveta karnikara together and
– two parts of honey
Kharjura phala or other fruits having similar properties as those of Kharjura phala should be given for consumption, mixed with honey.
रक्तातिसारप्रोक्तांश्च योगानत्रापि योजयेत् |२१|
Medicines and formulations prescribed for treating bleeding diarrhoea (rakta atisara) may also be administered in this disease.
शुद्धेक्षुकाण्डमापोथ्य नवे कुम्भे हिमाम्भसा ||२१||
योजायित्वा क्षिपेद्रात्रावाकाशे सोत्पलं तु तत् |
प्रातः स्रुतं क्षौद्रयुतं पिबेच्छोणितपित्तवान् ||२२||
पिबेच्छीतकषायं वा जम्ब्वाम्रार्जुनसम्भवम् |
उदुम्बरफलं पिष्ट्वा पिबेत्तद्रसमेव वा ||२३||
Sugarcane pieces should be taken. At night, they should be put into a new pot containing cold water. This pot should be kept in open space. The water should be filtered the next morning. Powder of Utpala and honey are added to it. This recipe will be beneficial if it is consumed by the patient suffering from bleeding diseases. Alternatively, the patient needs to drink cold infusions prepared from Jambu, Amra, Arjuna or juice of Udumbara fruits.
त्रपुषीमूलकल्कं वा सक्षौद्रं तण्डुलाम्बुना |
पिबेदक्षसमं कल्कं यष्टीमधुकमेव वा ||२४||
चन्दनं मधुकं रोध्रमेवमेव समं पिबेत् |
करञ्जबीजमेवं वा सिताक्षौद्रयुतं पिबेत् ||२५||
मज्जानमिङ्गुदयस्यैवं पिबेन्मधुकसंयुतम् |
सुखोष्णं लवणं बीजं कारञ्जं दधिमस्तुना ||२६||
पिबेद्वाऽपि त्र्यहं मर्त्यो रक्तपित्ताभिपीडितः |
रक्तपित्तहराः शस्ताः षडेते योगसत्तमाः ||२७||
पथ्याश्चैवावपीडेषु घ्राणतः प्रस्रुतेऽसृजि |२८|
Roots of Trapusa are taken and made into paste. It is added with honey and consumed. Following this, the patient should drink rice-wash.
Alternatively, paste of Yastimadhu should be taken in one aksa (10gm) quantity.
Similarly, the below mentioned recipes may be consumed –
– pastes of candana, madhuka and rodhra,
– paste of karanja added with sugar and honey or
– marrow of ingudi fruit mixed with honey or
– paste of karanja seeds mixed with water, curd and salt
All these should be consumed warm.
Thus, six formulae have been described here. These recipes should be consumed for three days. They are said to be the best ones for the patient suffering from bleeding disorders. The same formulations are also beneficial for treating nose bleeding.
अतिनिस्रुतरक्तो वा क्षौद्रयुक्तं पिबेदसृक् |
यकृद्वा भक्षयेदाजमामं पित्तसमायुतम् ||२८||
The patient may be given blood of animals mixed with honey for drinking if there is profuse bleeding. Alternatively he may be asked to consume uncooked liver of a goat along with its bile.
पलाशवृक्षस्वरसे विपक्वं सर्पिः पिबेत् क्षौद्रयुतं सुशीतम् |
वनस्पतीनां स्वरसैः कृतं वा सशर्करं क्षीरघृतं पिबेद्वा ||२९||
Ghee should be cooked and prepared with fresh juice from the Palasa. This ghee should be added with honey and consumed cold.
Alternatively, ghee should be cooked with juice of other vanaspatis (pancavalkala trees etc.). It should be consumed with sugar.
द्राक्षामुशीराण्यथ पद्मकं सिता पृथक्पलांशान्युदके समावपेत् |
स्थितं निशां तद्रुधिरामयं जयेत् पीतं पयो वाऽम्बुसमं हिताशिनः ||३०||
One pala (40 gm) each of Draksa, Usira, Padmaka and Sita (sugar) are put into water. The ingredients are allowed to stay for one night in the water. This should be consumed by the patient who is taking suitable foods, in the morning, added with milk. This recipe cures bleeding diseases.
तुरङ्गवर्चःस्वरसं समाक्षिकं पिबेत् सिताक्षौद्रयुतं वृषस्य वा |
लिहेत्तथा वास्तुकबीजचूर्णं क्षौद्रान्वितं तण्डुलसाह्वयं वा ||३१||
लिह्याच्च लाजाञ्जनचूर्णमेकमेवं सिताक्षौद्रयुतां तुगाख्याम् |
द्राक्षां सितां तिक्तकरोहिणीं च हिमाम्बुना वा मधुकेन युक्ताम् ||३२||
पथ्यामहिंस्रां रजनीं घृतं च लिह्यात्तथा शोणितपित्तरोगी |३३|
Juice of fresh dung of horse or bull should be taken. To this, sugar and honey should be added and consumed.
Alternatively, the powder of seeds of Vastuka should be taken with honey or rice wash.
Below mentioned recipes can also be used by patient of bleeding diseases –
– Powder of Anjana (Srotonjana)
– Powder of Tugaksiri added with sugar and honey
– Paste of Draksa, Sita and Tiktarohini added with honey and
– Powder of Madhuka with cold water or
– Paste of Pathya,
– Ahimsa and Rajani added with ghee
वासाकषायोत्पलमृत्प्रियङ्गुरोध्राञ्जनाम्भोरुहकेशराणि ||३३||
पीत्वा सिताक्षौद्रयुतानि जह्यात् पित्तासृजो वेगमुदीर्णमाशु |३४|
Decoction of Vasa should be prepared. It should be added with the below mentioned ingredients and consumed –
– utpala,
– mrt (black mud),
– priyangu,
– rodhra,
– anjana,
– filaments of ambhoruha,
– sugar and
– honey
This recipe quickly stops bouts of bleeding when consumed.
गायत्रिजम्ब्वर्जुनकोविदारशिरीषरोध्राशनशाल्मलीनाम् ||३४||
पुष्पाणि शिग्रोश्च विचूर्ण्य लेहो मध्वन्वितः शोणितपित्तरोगे |३५|
Flowers of the below mentioned are collected –
– Gayatri,
– Jambu,
– Arjuna,
– Kovidara,
– Sirisa,
– Rodhra,
– Asana (Bijaka),
– Salmali and
– Sigru
The powder of these flowers is prepared. The powder should be mixed in honey and licked. It cures bleeding disorders.
सक्षौद्रमिन्दीवरभस्मवारि करञ्जबीजं मधुसर्पिषी च ||३५||
जम्ब्वर्जुनाम्रक्वथितं च तोयं घ्नन्ति त्रयः पित्तमसृक् च योगाः |३६|
Below mentioned three formulations cure bleeding diseases –
– solution of ash of indivara mixed with honey and ghee or
– paste of seeds of karanja mixed with honey and ghee and
– decoction of jambu, arjuna and amra
Nāsāraktapitta – treatment of epistaxis
मूलानि पुष्पाणि च मातुलुङ्ग्याः पिष्ट्वा पिबेत्तण्डुलधावनेन ||३६||
घ्राणप्रवृत्ते जलमाशु देयं सशर्करं नासिकया पयो वा |
द्राक्षारसं क्षीरघृतं पिबेद्वा सशर्करं चेक्षुरसं हिमं वा ||३७||
The roots and flowers of Matulunga should be macerated. It should be consumed along with rice-wash. Drops of sugar water should be instilled into the nose. This would stop bleeding from the nose.
Alternatively the below mentioned recipes also can be used in cold state to stop bleeding from the nose –
– juice of draksa for drinking
– ghee prepared (extracted) from milk or mixed with milk for drinking,
– sugarcane juice mixed with sugar shall be put into the nose in cold state
शीतोपचारं मधुरं च कुर्याद्विशेषतः शोणितपित्तरोगे |३८|
In bleeding diseases, below mentioned should always be administered –
– all kinds of cold treatments and
– medicines and foods predominantly of sweet taste
Gudaraktasrāva – rectal haemorrhage
द्राक्षाघृतक्षौद्रसितायुतेन विदारिगन्धादिविपाचितेन ||३८||
क्षीरेण चास्थापनमग्र्यमुक्तं हितं घृतं चाप्यनुवासनार्थम् |३९|
Decoction should be prepared from the herbs belonging to Vidarigandhadi Gana group. This decoction should be administered as decoction enema after adding paste of draksa, ghee and honey.
Milk should be boiled and processed with the same herbs adding ghee to it. This ghee is beneficial to be used as Anuvasana Basti – unctuous enema.
प्रियङ्गुरोध्राञ्जनगैरिकोत्पलैः सुवर्णकालीयकरक्तचन्दनैः ||३९||
सिताश्वगन्धाम्बुदयष्टिकाह्वयैर्मृणालसौगन्धिकतुल्यपेषितैः |
निरूह्य चैनं पयसा समाक्षिकैर्घृतप्लुतैः शीतजलावसेचितम् ||४०||
क्षीरौदनं भुक्तमथानुवासयेद्घृतेन यष्टीमधुसाधितेन च |
अधोवहं शोणितमेष नाशयेत्तथाऽतिसारं रुधिरस्य दुस्तरम् ||४१||
विरेकयोगे त्वति चैव शस्यते… |४२|
Paste of equal parts of the below mentioned is prepared –
– Priyangu,
– Rodhra,
– Anjana,
– Gairika,
– Utpala,
– Suvarna Gairika,
– Kalingaka,
– Rakta Candana,
– Sita,
– Asvagandha,
– Ambuda,
– Yastikahvaya,
– Mrnala,
– Saugandhika (a variety of Kumuda)
This paste is mixed with ghee and cold water and is administered as decoction enema.
The patient is given food with milk.
Lubricating enema is administered after meals. For this, ghee boiled and processed with Yastimadhu should be used.
This would cure cases of bleeding through lower orifices. It is also beneficial in treating even severe cases of bleeding diarrhoea.
The same recipe can be used in excess bouts of purgation therapy.
… वाम्यश्च रक्ते विजिते बलान्वितः ||४२||
The patient should be administered emesis therapy after the bleeding stops and the patient has gained strength.
एवंविधा उत्तरबस्तयश्च मूत्राशयस्थे रुधिरे विधेयाः |
प्रवृत्तरक्तेषु च पायुजेषु कुर्याद्विधानं खलु रक्तपैत्तम् ||४३||
Uttara Basti – urethral enema (doouche) should be administered in the same manner when the bleeding occurs through the urinary bladder (urinary passages).
Treatments prescribed for bleeding diseases may also be adopted when the bleeding occurs from piles.
विधिश्चासृग्दरेऽप्येष स्त्रीणां कार्यो विजानता |
शस्त्रकर्मणि रक्तं च यस्यातीव प्रवर्तते ||४४||
The same treatments as done in bleeding diseases should be adopted in Asrgdhara – menorrhagia occurring in women.
The same treatments (of bleeding diseases) can also be administered when profuse bleeding takes place during surgical operations (procedures).
त्रयाणामपि दोषाणां शोणितेऽपि च सर्वशः |
लिङ्गान्यालोक्य कर्तव्यं चिकित्सितमनन्तरम् ||४५||
Treatments should be decided after noting the symptoms produced by the three doshas and blood in case of treatment of Raktapitta and also in other conditions involving bleeding.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे रक्तपित्तप्रतिषेधो नाम (सप्तमोऽध्यायः, आदितः) पञ्चचत्वारिंशत्तमोऽध्यायः ||४५||
Thus ends the forty-fifth chapter by name Raktapitta Pratiședha in Uttara Sthana of Suśruta Samhita.
