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
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.
