Pathological viewpoints and considerations – Ayurveda Perspective

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Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Yakrit, the organ compared to Liver, is an important organ according to Ayurveda. The definition and word derivation itself explains Yakrit as Ya – that which maintains + Krit – that which does (many functions) i.e. an organ which maintains and does many important functions in the body.

Yakrit along with its partner organ Pleeha (spleen) is the abode of blood tissue (raktashaya), have embedded in them the layers and membranes which manufacture blood (raktadhara kala) and are roots of blood conveying channels (raktavaha srotas). Along with Pleeha, Yakrit is also the seat of Ranjaka Pitta, a subtype of pitta which is responsible to transform and color rasa tissue passing through them into rakta – the blood tissue. They are also the seat of Ranjaka Agni – the fiery component located in the Ranjaka Pitta, which is responsible for transforming rasa into rakta.

The pathological manifestations related to the Yakrit may occur at one or more of the below mentioned levels –

1. At Embryological Level

The liver is a matruja avayava i.e., derived from mother. Therefore, any defects of ovum, disease of the mother before and during conception or disturbances in fetal circulation might cause liver disorders in the fetus.

Yakrit is Shonitaja Avayava – an organ formed from blood tissue. So, it is obviously rich in blood. The blood which forms the liver and blood rich organs will obviously be derived and tapped from the mother’s blood reaching the fetus through the fetal circulation. Defects or obstruction of blood supply to the fetus from the mother can cause anatomical and physiological defects and deficits in the liver and spleen.

2. At Anatomical & Physiological Level

Defects in the Raktadhara Kala part of Liver

Raktadhara Kala comprises the membranes, including the cells of the liver and spleen which take part in forming, shielding and holding the blood in them. The entire haemopoietic system can also be considered as part and parcel of this kala. When there is defect or damage to these kalas, the blood is not formed properly. This may lead to many diseases including various kinds of anemia. Immature blood cells may also be formed due to this pathology.

Defects in the Raktashaya part of Liver

The liver being an organ predominantly formed by blood, also controls the blood formation and circulation throughout the life. Liver is a temporary depot or storehouse of blood tissue until it is distributed to all parts of the body through raktavaha srotas. There is an enriched blood circuit system inside the liver. The portal circulation system can be considered as part and parcel of Raktashaya and also Raktavaha Srotas. The same kinds of problems can arise as happens in defects of Raktadhara Kala, when there is defect or damage to these depots. There can also be internal bleeding inside the liver.

Defects in the Raktavaha Srotas part of the Liver

रक्त वहे द्वे तयोः मूलं यकृत् प्लीहानौ रक्त वाहिन्यः च धमन्यः।
तत्र विद्धस्य श्याव अङ्गता ज्वरो दाहः पाण्डुता शोणित आगमनं रक्त नेत्रता च (सु.शा.9/12)
शोणित वहानां स्रोतसां यकृत् मूलं प्लीहा च।(च.वि.५/७)

Raktavaha Srotas – According to Master Sushruta, liver and spleen (as one unit) and the dhamanis – blood vessels, arteries (as another unit) that carry blood are the two roots of channels carrying or transporting blood tissue. (Master Charaka also mentions liver and spleen, but not the rakta vahini dhamanis).

When these roots are injured / vitiated, the below mentioned symptoms or conditions are manifested –

–         blackish brown or greyish discoloration of body parts
–         fever
–         burning sensation
–         anemia or pallor
–         bleeding from different orifices of body
–         reddish discoloration of eyes

Rakta Pradoshaja Vikara

Master Charaka has listed the diseases caused due to contamination of blood which are the same as the symptoms of vitiation of raktavaha srotas.

…वक्ष्यन्ते रक्त दोषजाः।
कुष्ठ वीसर्प पिडका रक्तपित्तं असृग्धरः॥
गुद मेढ्र आस्य पाकः च प्लीहा गुल्मो अथ विद्रधिः।
नीलिका कामला व्यङ्गः पिप्लवः तिलकालकः॥
ददृः चर्मदलं श्वित्रं पामा कोठ अस्र मण्डलम्।
रक्त प्रदोषात् जायन्ते…(च.सू.२८/११,१२)

–         inflammation and suppuration of anal canal and anal orifice
–         inflammation and suppuration of penis
–         ulceration of mouth and tongue, stomatitis,
–         enlargement of spleen
–         abdominal tumors
–         abscess
–         bluish eruptions
–         jaundice
–         includes pigmentation and melanin related problems like freckles, mole, melano-derma, chloasma etc.
–         ringworm or tines
–         excoriation
–         leukoderma
–         scabies
–         skin eruptions
–         reddish circular skin eruptions or patches

Among the rakta doshaja vikara i.e. symptoms / diseases manifested due to the contamination of Raktavaha Srotas, Pleeha i.e. splenomegaly is mentioned by Master Charaka. As per the above discussion, hepatomegaly too has to be considered. Other diseases having their origin from liver / hemopoetic system like Kamala – jaundice has been mentioned. Pandutaa – anemia or pallor too has been mentioned in the list of disorders.

The diseases / symptoms explained by Sushruta are those of damage to the roots of raktavaha srotas i.e. injury to liver, spleen or blood vessels or all of them. So, the symptoms are the results / effects of injury.

The diseases / symptoms explained by Charaka are those of contamination of blood. These will in turn contaminate / vitiate the raktavaha srotas and its roots, including liver and spleen. Here, the contamination of liver and spleen is due to contamination of blood. Hence enlargement of spleen (and liver) and jaundice have been mentioned amongst the symptoms. Here also the liver and spleen are affected, but due to and as an effect of vitiation of rakta – blood.

When most of the viddha lakshanas (Sushruta) or prodashaja vikaras (Charaka) are present it indicates that yakrit and pliha are invariably involved. While the other symptoms are caused, the liver and spleen as organs also suffer from collateral damage.

Disturbance of functions of hemopoiesis, of liver and spleen, enlargement of these organs, anemia and jaundice when present with other symptoms mentioned above indicate a gross disturbance of structures of blood formation, storage and conveyance.

In the process, the liver and spleen are either victims or culprits. Blood is either contaminated or not formed properly when there is disease of liver or spleen or both. On the other hand, contamination or vitiation of blood will hit hard on the liver and spleen, they being the root sources of the blood, leading to disorders and dysfunctions of liver and spleen. The other symptoms indicate the impact of this damage or vitiation of blood or organs connected to blood on the other parts of the body. This is because blood moves to each and every part of the body.

These symptoms are also the indicators of pathological manifestations of liver and spleen disorders.

Causes of vitiation of Raktavaha srotas

विदाहीनि अन्न पानानि स्निग्ध उष्णानि द्रवाणि च।
रक्त वाहीनि दुष्यन्ति भजतां च आतप अनलौ॥(च.वि.५/१४)

The causes of vitiation of Raktavaha Srotas are the same as the causes of contamination / vitiation of liver and spleen. They are –

–         foods and drinks which cause burning sensation after consuming them in excess (corrosive foods and drinks)
–         excessive consumption of oily foods
–         excessive consumption of hot foods
–         excessive consumption of liquid foods
–         excessive exposure to sunlight
–         excessive exposure to fire

3. Other pathological conditions

Yakrutodara or Yakrutdalyudara – It is one among the eight types of udara roga – enlargement of abdomen. After explaining plihodara – enlargement of spleen, the masters have said that Yakrutodara is a similar condition but occurs on the right side of the abdomen, the seat of the liver. Yakrutodara thus explains ‘enlargement of the liver’ or hepatomegaly. Its causes, symptoms and treatments are similar to those of Plihodara.

Symptoms of Yakrutodara include – feeling as if entering into a zone of darkness, excessive thirst, malaise, vomiting, fainting, prostration, cough, dyspnea, mild fever, flatulence / constipation, loss of digestion capacity, emaciation, distaste in the mouth, pain in small joints of the hands, distension of abdomen and colic pain, redness or discoloration of abdomen, and appearance of network of veins having blue, green or yellow color on the abdomen.

Related Reading – Hepatomegaly

Rakta Vriddhi – Pathological increase of blood tissue will cause many diseases among which Pliha or Plihodara is one. Since along with Pliha, Yakrit is also a root of Raktavaha Srotas, though unsaid, Yakrutodara can also be considered amongst the symptoms of rakta vriddhi.

Medo Kshaya – Pliha Vriddhi i.e. enlargement of spleen is one of the symptoms of pathological depletion / decrease of fat tissue.

 4. Pathological Mentions of Yakrit – liver

Apart from the liver being a culprit or victim in disease processes, we have the organ mentioned in some other contexts, as an example or simily or complication.

Example –

a.     Yakrit pliha antrani mukhad iva akshipan – In the pathogenesis of Hikka – hiccup – it is said that when the person has intense episodes of hiccup he would feel as if his liver, spleen and intestines are moving up and coming out of the mouth.

b.    Yakrit Khanda Nibham – In the explanation of prognosis of atisara – diarrhea, the disease is said to be incurable if it resembles certain things. One among them is the ‘loose stools resembling pieces of liver’ in color or having something in the excreta which resembles pieces of liver. (Ma.Ni.3/14-16, Su.Ut.40)

c.     Pliha – enlargement of spleen has been mentioned among the complications of Vataja Arshas – piles caused due to predominant aggravation of vata. Liver enlargement too shall be considered here.

d.    Pliha Shanki – Among the symptoms of vataja grahani – intestinal / duodenal disorder caused due to predominant aggravation of vata, pliha shanki has been mentioned. This means to tell that the person / patient is apprehensive or doubts that he is suffering from either of vata gulma – abdominal tumors caused due to predominant aggravation of vata, hrdroga – cardiac disorders and pliha – spleen enlargement / splenomegaly (hepatomegaly – liver enlargement too shall be considered).


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