CLASSIFICATION OF RAKTAPITTA

Based on the direction of bleeding:

• UrdhwagaRaktapitta

• AdhogaRaktapitta

Based on the dosha predominance:

• Kaphaja

• Vataja

• Pittaja

• Vata-Pittaja

• Vata-Kaphaja

• Kapha-Pittaja

• TridoshajaRaktapitta

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INTRODUCTION

Raktapitta is a bleeding disorder in which the blood contaminated by vitiated Pitta bleeds through the orifices of the body, both in upward and downward directions, including the skin orifices.

Raktapitta is a clinical emergency

Raktapitta is a clinical emergency and should be treated as quickly as possible, without any delay. Otherwise it is going to cause serious threat to life. 

Raktapitta is a bleeding disorder wherein the blood (rakta) vitiated by pitta flows out of the orifices (openings) of the body. Bleeding occurs due to some internal cause or as an effect of some chronic and stubborn diseases and importantly in the absence of injury.

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NIDANA

• Gharma / Aatapa – Excessive exposure to heat of Sun

• Vyaayaama – Excessive physical exercise

• Shoka – Excessive grief

• Adhwa – Excessive walking

• Vyavaaya – Excessive indulgence in sexual activities

• Teekshna – Excessive consumption of intense, strong and damaging foods

• Ushna – Excessive consumption of hot foods (hot to touch)

• Kshaara – Excessive consumption of alkalis or alkaline foods

• Lavana – Excessive consumption of salts or salty foods (or tastes)

• Amla – Excessive consumption of sour foods (or tastes)

• Katu – Excessive consumption of pungent and spicy foods (or tastes)

• Vidahi Anna – Corrosive food 

GROSS CAUSATIVE FACTORS –

According to Charaka,

• UrdhwagaRaktapitta (raktapitta in which the bleeding of contaminated blood takes place in the upward directions and from upward passages or orifices) is caused by Snigdha-Ushnasevana (consumption of unctuous and hot foods together)

• AdhogaRaktapitta (raktapitta in which the bleeding of contaminated blood takes place in the downward directions and from downward passages or orifices) is caused by Ruksha-Ushnasevana (consumption of dry and hot foods together) 

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SAPEKSHA NIDANA- 

Raktapitta-

1. anna mile rakt ko kutta –kouva nhi khate.

2. Raktranjit vastra sukhane per jal se dhone se daag nhi jate

3. Rakta pitta k purvarupa hote h

4. Purva vyadhi itihas absent

5. Pitta dushita rakta srava

Anya raktasravi roga-

1. Anna mile rakt ko kutta-kauva khate h.

2. Rakt daag chut jata h

3. Purva rupa absent

4. Purva vyadhi itihas prasent

5. Suddha rakta srava 

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SAMPRAPTI

Pitta prakopa-> prakupita pitta duara rakt ki dusti-> pitta & rakta ka milna-> mamsadi dhatu ka pitta ki ushma se pighalkar drava dhatu ka shravan -> raktvahiniyo me rakt ki vriddhi-> rakta-pitta

The disease Raktapitta develops and manifests as the pathogenesis runs through the below mentioned steps in that order –

• Pitta aggravated by the above said causes leaves its sites and reaches rakta (blood).

• Being a mala (waste product) of rakta, the pitta on getting mixed with rakta attains quantitative increase.

• The pitta in turn vitiates the rakta. Due to the heat of Pitta, the dravadhatu or the liquid portion (fluid) of other tissues like mamsa (muscles), meda (fat) etc oozes out of their respective tissues and gets admixed with rakta.

• This further enhances the quantity of rakta, beyond the limits of normal quantity.

• This also enhances the quantity of blood flowing in the blood vessels creating immense pressure in the blood vessels.

• Due to the pressure of the blood and heat of pitta, the walls of the blood vessels get damaged and the blood starts flowing through various openings of the body.

• Bleeding occurs through mouth, nose, ears, eyes, skin, anus, penis and vagina.

• This bleeding of blood vitiated by pitta through various orifices of the body is called Raktapitta.

Acharya Sushruta explains the Samprapti (pathogenesis) of Raktapitta in a simple way and tells –

The pitta which becomes vidagdha (burnt or corroded) by the above mentioned etiological factors quickly reaches the rakta (blood) and causes its vidaha (burns the blood). This rakta contaminated by vikrita (vitiated) and vidagdha pitta flows out of the orifices in the upward or downward or in both directions. While flowing upwards, the bleeding in raktapitta occurs through nasa (nasal openings), akshi (eyes), karna (ears) and aasya (mouth). The raktapitta flowing downwards bleeds through medhra (urinary passages in men and women), yoni (vagina in women) and guda (anal opening). Severely aggravated raktapitta moves side-ways and bleeds through the orifices in the skin (romakupas)

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SAMPRAPTI GHATAKA

DOSHA- pitta

DUSHYA-rakta

ADHISTHANA- yakruit, pleeha

SHROTAS- ratvaha

SVABHAVA- ashukari

SADHYAASADHYATA-

*Sadhya-ek doshaja,balvan,navin,alpa vega, udharvgata, upadrava rahit,hemant & sishir ritu me utpanna,upadrava rahit.

*Yapya- adhogata, dvi doshaja

*Asadhya- ubhayadharmi, tridoshaja, mandagni ,ksheen,durgandhit rakta. 

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POORVARUPA (PREMONITORY SYMPTOMS) OF RAKTAPITTA 

• Anannaabhilasha – loss of interest in food

• Bhuktasyavidaha – burning (very quick digestion?) of consumed food

• Shuktaamlagandha – smell of sour fermented liquid (from the mouth)

• Shuktaamla rasa – taste of sour fermented liquid (sour and fermented liquid) from the mouth

• Shuktaamlaudgaara – sour belching or belching having taste of fermented liquid

• Abheekshnachardi – severe, uncontrolled and projectile vomiting

• Charditasyabheebatsataa – scary look and gesture of the person who has vomited

• Swarabheda – hoarseness of voice

• Gaatrasadana – feeling of tiredness in the whole body

• Paridaaha – feeling of burning sensation in the body

• Mukhaaddhumaaagamanaiva – feeling as if the fumes are coming out of the mouth

• Lohagandha – smell of iron from the mouth

• Lohitagandha – smell of blood from the mouth

• Matsyagandha – smell of fish (fishy odor) from the mouth

• Raktaharitahaaridratwamangaavayavashakrutmootraswedalaalaasinghaanakaaasyakarna mala – Reddish, greenish and turmeric colored discoloration of body, body parts, feces, urine, sweat, saliva, nasal dirt or discharges, oral dirt or discharges and ear discharges

• Angavedana – body pains

• Lohitneelapeetashyaavaanaamarchishyataam cha roopaanaamswapnedarshanamabheekshnamiti – ferocious and scary figures having red, blue, yellow or bluish black color are seen in dreams

• Shirogurutwam – heaviness of head (Vagbhata)

• Aruchi – tastelessness (Vagbhata)

• Kasa – cough (Vaghata)

• Shwasa – dyspnoea, shortness of breath (Vagbhata)

• Bhrama – giddiness (Vagbhata)

• Klama – fatigue (Vagbhata)

• Sheetakaamitwam (Sushruta) 

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LAKSHANAS (SYMPTOMS) OF DOSHAJA RAKTAPITTA 

KAPHAJA RAKTAPITTA

In the raktapitta associated with kapha, the blood is thick (Sandra), pale (panduvarna) and unctuous (snigdha).

VATAJA RAKTAPITTA

In the raktapitta associated with Vata, the blood will be blackish blue or blackish brown (shyava) or reddish yellow or golden yellow (aruna) in color, thin / dilute (tanu), dry (ruksha) and associated with froth (saphenam)

PITTAJA RAKTAPITTA

In the Raktapitta associated with Pitta, the blood will have black (Krishna) or decoction like (kashayabham) color. The blood resembles the urine of cow (gomutrasannibham), with mixture of many colors (mechaka). It will also have resemblance with agaradhuma (soot of chimney) and collyrium (anjanabham).

DWANDWAJA RAKTAPITTA

(Raktapitta having association of 2 doshas) – In Vatapittaja, Vatakaphaja and KaphapittajaRaktapittas, symptoms of 2 doshas will be present in mixed proportions

SANNIPATAJA RAKTAPITTA

Sannipataja or TridoshajaRaktapitta – In Raktapitta caused by association of all the 3 doshas, the symptoms of all the 3 doshas will be present in mixed proportions

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ROUTES AND DOSHA ASSOCIATION

RaktapittaMarga and Doshasamsarga (Routes of Raktapitta and dosha association)

Based on the direction of flow of vitiated blood (blood vitiated by pitta), Raktapitta is said to be of 2 types i.e.

UrdhwaRaktapitta – Raktapitta in which bleeding occurs in upward direction, from orifices in the upper parts of the body. Caused by SnigdhaUshnaSevana – associated with KaphaDosha. Leads to movement of Rakta in upward direction and bleeding through nostrils, eyes, ears, nose.

AdhogaRaktapitta – Raktapitta in which bleeding occurs in downward direction, from orifices in the lower parts of the body. Caused by RukshaUshnasevana, associated with VataDosha. Leads to downward movement of Rakta and bleeding through urinary passages, vagina, anal orifice.

UbhayamargagaRaktapitta – Caused by combination of the above two, with influence of Vata and kaphaDosha. Leads to movement of Rakta in both upper and lower direction and leads bleeding through all orifices. mentioned passages. 

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UPADRAVA

- Daurbalya-anemea-mada(mental confusion)

- Svasa-kasa-fever

- Paha- vamana- murcha

- Severe burninig after meals

- Pain in chest- trishna- atisara- headach- anorexia

- Indigetion-defect in discharged blood 

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PRINCIPLES OF TREATMENT OF RAKTAPITTA 

NIDANAPARIVARJANAM – AVOIDING THE CAUSATIVE FACTORS IS THE KEY

In any disease, avoiding the causative factors is considered as the prime approach towards healing. Even in Raktapitta this rule holds good. The patients of Raktapitta desirous of good health and life should keep away all the causative factors which are mentioned in RaktapittaNidana i.e. causes of Raktapitta. These include foods and lifestyle practices which cause vitiation of pitta and rakta (blood).

STAMBHANA – BLEEDING SHOULD NOT BE STOPPED INITIALLY

In the initial stages of Raktapitta, stambhana treatment – measures targeting stoppage of bleeding should not be given. Since in Raktapitta it is not the pure blood but in fact is the blood contaminated with pitta that is flowing through bleeding, stambhana should not be given. The blood should be allowed to flow if the strength, muscle bulk and appetite of the patient has been preserved and are in good condition. In weak people stambhana should be immediately given.

LANGHANA, TARPANA&PEYA – LIGHTENING AND NUTRITIVE THERAPIES, DIGESTIVE LIQUID DIETS (GRUELS)

After allowing the bleeding to occur in the initial phases of Raktapitta, the below mentioned strategies should be planned.

LANGHANA

Lightening treatment to digest ama (unprocessed digestive juices in circulation, caused due to sluggish digestion) are administered initially

TARPANA

After Langhana, Tarpana – nutritious herbal drinks and diet including vegetables and meat (and meat soup) should be administered in UrdhwagaRaktapitta (Raktapitta having upward course)

Tarpana is given in different forms. They are –

• Tarpana in the form of medicated drinks

• Tarpana in the form of Yavagu (medicated gruels)

• Tarpana in the form of Ahara (diet, including leafy vegetables, dhanya i.e. grain, food, mamsarasa i.e. meat soup etc)

PEYA

Digestive liquid diet especially in the form of gruels should be given after Langhana in AdhogaRaktapitta (Raktapitta having downward course)

DIET IN RAKTAPITTA

Nutrition is essential in Raktapitta to combat complications of bleeding, to regularize metabolism and to provide strength to the patient.

Bhojana is provided in different forms, mainly in the form of Tarpana as mentioned above. Ayurveda has given a gist of essential and beneficial dietetic inclusions in Raktapitta. They are –

• Yavagu – medicated gruels

• Anna – cooked rice

• Shaka – Leafy vegetables and food stuff prepared from them

• YushaSupa – Drinks and soups

• Dhanya – Grains and millets and food stuff prepared from them

• Mamsarasa – meat soup

PREFERENCE OF YUSHA, SHAKA AND MAMSARASA IN RAKTAPITTA

• In Raktapitta having KaphaAnubandha (association of kapha) i.e. UrdhwagaRaktapitta (Raktapitta having upward course, bleeding through nose, ears, eyes, mouth) – Yusha (soups and drinks) and Shaka (leafy vegetables and dishes prepared from the same) shall be used

• In VataAnubandhaRaktapitta (Raktapitta associated with Vata) i.e. AdhogaRaktapitta (Raktapitta having downward course, bleeding through anus, urinary tract and vagina) – Mamsa rasa (meat soup) should be preferably administered

PRINCIPLES OF MANAGEMENT OF THIRST IN RAKTAPITTA

Thirst is a common complaint in Raktapitta. This occurs due to severe blood loss and fluid loss. Thirst should be managed with top priority.

After having analyzed the strength of dosha, associated doshas (Kapha, Vata), aturabala (strength of the patient) and aharashakti of the patient (capacity to take food), water shall be given as and when desired until the thirst comes down and the patient starts feeling better. Alternatively, small quantities of water shall be fed to the patient at regular intervals.

In presence of thirst in Raktapitta below mentioned forms of water should be given –

• Water processed with bitter tasting herbs

• Juices of fruits which alleviate thirst

• VidarigandhadiGanasiddajala – Water processed with Vidarigandha group of herbs

• Shrutasheetajala – Boiled and cold water

• HreeberadiPaniya – Water processed with Hrivera (Coleus vettiveroides / Pavoniaodorata), Raktachandana (Red Sandalwood), Usheera (Vetiveriazizanioides), Musta (Cyperusrotundus) and Parpataka (Fumariaparviflora) 

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SHODHAN CHIKITSA

SHODHANA IN RAKTAPITTA (PANCHAKARMA IN RAKTAPITTA)

Shodhana, especially Vamana (therapeutic emesis) and Virechana (therapeutic purgation) should be given in Raktapitta in patients whose bala (strength) and mamsa (muscle mass) are not reduced, if the Raktapitta is caused due to santarpana (excessive saturation), if there is bahudosha (excessive morbidity) in the body of the patient, if there are no associated upadravas (complications) and if the patient is an eligible candidate to undergo Shodhana.

PRATIMARGAHARANA CHIKITSA

In the treatment of Raktapitta, the doshas should be expelled from the opposite route of their course (opposite to the direction of bleeding). Following this pattern, Virechana should be administered in UrdhwagaRaktapitta (bleeding in upper passages, in upward direction) and Vamana should be administered in AdhogaRaktapitta (bleeding in lower passages, in downward direction).

After Vamana, Tarpana i.e. nourishing drinks and food should be administered in UrdhwagaRaktapitta and Yavagu, i.e. gruels (when Vayu is in control) or mamsarasa i.e. meat-soup (in vitiation of vata) should be administered in AdhogaRaktapitta.

SAMSHAMANI KRIYA

Medicines and formulations to pacify vitiated Pitta should be administered as a part of SamshamaniKriya. In this, many formulations including herbal teas, powders etc are administered. Samshamani also includes disease modifying medicines. 

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SPECIFIC RAKTPITTA CHIKITSA

MANAGEMENT OF MUTRAMARGAGATARAKTAPITTA (BLEEDING FROM URINARY TRACT)

ShatavariGokshura siddha ksheera – Milk processed with decoction of Shatavari (Asparagus racemosus) and Gokshura (Tribulusterrestris)

Chaturparni siddha ksheera – Milk processed with Shalaparni (Desmodiumgangeticum), Prishniparni (Urariapicta), Mudgaparni (Phaseolustrilobus) and Mashaparni (Teramnuslabialis)

MANAGEMENT OF GUDAMARGAGATARAKTAPITTA (BLEEDING FROM RECTUM)

Mocharasa siddha ksheera – Milk processed with paste of Mocharasa (Gum of silk cotton tree)

Vata siddha ksheera – Milk processed with paste of shoots of Vata (Banyan tree)

Hreeveradikalka siddha ksheera – Milk processed with paste of Hrivera (Coleus vettiveroides, Pavoniaodorata), Neelautpala (blue variety of lotus) and Nagara (ginger)

MANAGEMENT OF NASAGATARAKTAPITTA (BLEEDING FROM NOSE)

Bleeding of blood contaminated with pitta from the nose is called NasagataRaktapitta. This condition is categorized as subtype of UrdhwagaRaktapitta and should be addressed immediately.

USE OF HERBAL GHEE IN IN RAKTAPITTA

Medicated ghee should be used in Raktapitta to combat severe and stubborn bleeding. Some of the Ghritas which are highly beneficial in Raktapitta are –

• Vasa Ghrita

• PalashaGhrita

• VatsakaGhrita

• TrayamanaGhrita

• AudumbaraGhritaetc

USE OF KSHARA (ALKALIS) IN RAKTAPITTA

Kshara – alkalis should be used in KaphanubandhaRaktapitta (Raktapitta associated with kapha). When Kapha gets associated with Raktapitta, the blood gets clogged (clot) and blocked in the throat. Kshara should be used in this condition. The Ksharas of the below mentioned should be used in grathitaraktapitta –

• Utpalanalakshara – alkali prepared from petioles of water lily

• PadhmakakesaraKshara – alkali prepared from stamens of lotus

• MrunalaNalaKshara – alkali prepared from petioles of Mrunala, variety of lotus

• Utpalakesarakshara – alkali prepared from stamens of water lily or blue variety of lotus

• Palashakshara – alkali prepared from Butea monosperma

• Priyangukshara – alkali prepared from Callicarpamacrophylla

• MadhookaKshara – alkali prepared from Madhookalongifolia

• Asana kshara – alkali prepared from Pterocarpus marsupium

BAHYACHIKITSA (EXTERNAL TREATMENTS) IN RAKTAPITTA

Though Raktapitta is a bleeding disorder in which the bleeding should be controlled from within, external treatments are equally necessary to combat pitta and rakta. The external maneuvers include abhyanga, parishechana (sprinkling of medicated fluids over the body), pradeha (anointment of medicated pastes), sheetaupachara (cold comforts) etc. 

Pathya(DO):

Purana shali rice,wheat, dhana lava, sabhdana, munga, masura, louki, parval, muli, bhindi, ajadugdha, jangam mamsa,godugdha, ghrita, amla,kela, singhada, angoora,munakka, kaccha nariyal, petha, ikshu rasa, cheeni, mishri

Sheetal jala snana, seeta vayu sevana, chandana lepa, vaman,virechana,nasya

Apathya(DON’T):

Tila,udad, kulthi,guda, sarso, rai, dadhi, kshar, lavana, katu,vidahi, garm masala, fish, atap sevana, maithuna, svedana, vega dharana

Vyayama, bhaya, krodha, chinta  

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Raktpitta kulkandan rasa-(parad,gandhak,praval,svarna,naga,vanga)

- Raktpittantak rasa-(abhrak,tikshna loha,parad,hartal,gandhak)

- Pittantak rasa-(abhrak,loh,javitri,jayphala,jatamansi,kuth,talisa)

- Karpadako rasa-(rasa sindur,karpas pushpa,karpada)

- Bol parpati-(bol,parad,gandhak)

- Bol babadda rasa-(bol,parad,gandhak,nagkesar)

- Gairik bhasma

- Shankh bhasma

- Chandrakala rasa-(kajjali,abhrak,tamra)

- Praval bhasma

- Praval pisti

- Praval panchamrit-(praval,mukta,shankh,sukti,varatika)

VATI-(250-500MG WITH USHNA JALA)

- Eladi vati-(ela,vanga,maricha,pippali)

- Tikshnadi vati-(suddha kharpara,abhrak,rasasindura,tikshna loha, laksha)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Lakshadi curna-(laksha)

- Ushiradi curna-(usheera)

- Priyangvadi curna-(adusha,fitkari,priyangu,rasout)

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Atrusadi kvatha-(adusha,draksha,harad)

- Vasakadi kvatha-(vasa)

- Padmakadi kvatha-(padma kasta,kamalkesar,lodhra,neelkamal,nagakesar)

- Draksharista-(draksha,mahua,dhatki,triphala,amlaki)

- Lodhrasava-(lodhra,ela,kuth,manjith,haridra,priyangu)

- Usheerasava-(usheer,chandan,nagkesar,priyangu,khas,lodhra)

GHRITA-(10-30ML WITH USNODAKA/DUGDHA)

- Vasa ghrita-(adusha,vasa,goghrita,godugdha)

- Durvadha ghrita-(durva,kamalkesar,manjith,khand ghrita)

- Shatavari ghrita-(satavari,jeebhak,rishbhag,parnidvya)

- Kamdev ghrita-(asagnadha,shatavari,vidarikanda,salparni,pippal)

AVLEHA/PAKA/KHANDA-(15-20GM WITH DUGDHA)

- Khanda kusmanda avleha-(kushmanda,amla)

- Vasakhanda-(adusa,khanda,trikatu,,trijata)