A Comprehensive Review on Treatment of Raktapitta according to Acharya Charaka

Vol.01, Issue-03, September 2024

Author: Dr. Manish Singh Tomar, MD, PhD Ayurveda

Abstract

Raktapitta, a critical disease discussed extensively in Ayurveda, is characterized by bleeding disorders resulting from the vitiation of blood (Rakta) and bile (Pitta). Acharya Charaka provides a comprehensive description of Raktapitta, including its etiology, pathogenesis, clinical features, classification, and therapeutic approaches. This article delves into the Ayurvedic understanding of Raktapitta as presented by Charaka and correlates it with modern medical concepts, particularly hemorrhagic disorders and conditions associated with bleeding tendencies. By bridging ancient wisdom with contemporary science, the article highlights the relevance of Ayurvedic principles in the management of bleeding disorders today.

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Introduction

Ayurveda, the ancient Indian system of medicine, offers profound insights into various diseases and their management. Among these, Raktapitta holds significant importance due to its potentially life-threatening nature. Raktapitta is described as a disorder involving excessive bleeding from different parts of the body, resulting from the vitiation of blood and Pitta dosha.

Acharya Charaka, one of the principal authors of Ayurvedic literature, provides an in-depth analysis of Raktapitta in the Charaka Samhita, particularly in the Chikitsa Sthana (therapeutics section). His treatise encompasses the causative factors, pathogenesis, clinical manifestations, prognosis, and treatment modalities of Raktapitta.

In modern medicine, bleeding disorders encompass a range of conditions characterized by abnormal bleeding due to defects in the blood vessels, platelets, coagulation factors, or the fibrinolytic system. Conditions such as hemophilia, thrombocytopenia, and vitamin K deficiency represent various aspects of bleeding disorders.

This article aims to explore Raktapitta as described by Acharya Charaka and establish correlations with contemporary medical understanding of hemorrhagic disorders. By analyzing the Ayurvedic concepts alongside modern pathology, we can appreciate the holistic approach of Ayurveda and its potential applications in today’s medical practice.

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Etiology (Nidana) of Raktapitta

Ayurvedic Perspective

Acharya Charaka attributes Raktapitta to several causative factors that lead to the vitiation of Pitta and Rakta:

1. Excessive Consumption of Pitta-provoking Foods:
   • Hot (Ushna), Sharp (Tikshna), Sour (Amla), Pungent (Katu), and Salty (Lavana) substances.
   • Overeating foods that are inherently hot and sharp aggravates Pitta dosha.
2. Environmental Factors:
   • Exposure to Heat (Gharma): Prolonged exposure to sunlight or heat increases Pitta.
   • Fire Burns (Annavidaha): Consuming overly hot food or getting burned can vitiate Pitta and Rakta.
3. Lifestyle Factors:
   • Suppression of Natural Urges: Particularly vomiting and purgation, leading to accumulation of Pitta.
   • Excessive Physical Activity: Overexertion heats the body, aggravating Pitta.
4. Psychological Factors:
   • Emotional Stress: Anger and stress can increase Pitta.
5. Previous Disorders:
   • Untreated Pitta Disorders: Conditions like Jwara (fever) if neglected can progress to Raktapitta.

Modern Correlation

In modern medicine, bleeding disorders can result from:

1. Dietary Factors:
   • Deficiencies in Vitamin K: Essential for synthesis of clotting factors.
   • Overconsumption of Substances Affecting Clotting: Such as alcohol, which can impair liver function.
2. Environmental Exposures:
   • Heat Stroke: Can cause coagulation abnormalities.
3. Lifestyle Factors:
   • Excessive Physical Strain: May lead to conditions like disseminated intravascular coagulation (DIC) in extreme cases.
4. Medications:
   • Anticoagulants: Use of drugs like warfarin can cause bleeding tendencies.
5. Psychological Stress:
   • Stress-Induced Hypertension: Can lead to hemorrhagic strokes.

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Pathogenesis (Samprapti) of Raktapitta

Ayurvedic Perspective

According to Charaka, the pathogenesis involves:

1. Vitiation of Pitta:
   • Aggravated by the aforementioned factors, Pitta becomes excessive and overheated.
2. Vitiation of Rakta (Blood):
   • Pitta, due to its fiery nature, enters and vitiates the blood.
3. Combination of Pitta and Rakta:
   • The mixing of Pitta and Rakta leads to their mutual increase due to their similar properties (Sadharmya).
4. Overflow of Vitiated Blood:
   • The heated and vitiated blood overflows from its channels and moves to other parts of the body.
5. Manifestation of Bleeding:
   • The vitiated blood finds outlets through various orifices and tissues, leading to bleeding from different sites.

Modern Correlation

In contemporary medicine, similar pathophysiological processes are observed:

1. Hyperthermia and Vasodilation:
   • Excessive heat leads to vasodilation, increasing blood flow and pressure in vessels.
2. Damage to Vascular Integrity:
   • High temperatures and toxins can damage the endothelium, leading to hemorrhage.
3. Coagulopathy:
   • Overactivation of coagulation pathways can deplete clotting factors, resulting in bleeding.
4. Platelet Dysfunction:
   • High levels of stress hormones can impair platelet function, contributing to bleeding.

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Clinical Features (Lakshana) of Raktapitta

Ayurvedic Description

Charaka details the clinical manifestations based on the route of bleeding:

1. Urdhvaga Raktapitta (Upward Movement):
   • Bleeding from upper orifices: nose, mouth, ears, eyes.
   • Symptoms may include vomiting of blood, nosebleeds, bleeding gums.
2. Adhoga Raktapitta (Downward Movement):
   • Bleeding from lower orifices: anus, urethra, vagina.
   • Manifested as blood in stool, urine, or menstrual abnormalities.
3. Both Routes (Ubhayaga):
   • Bleeding from both upper and lower orifices.
   • Considered more severe and difficult to treat.

Specific Symptoms Based on Dosha Association

1. Pittaja Raktapitta:
   • Blood is bright red, resembling copper or red lotus.
   • Accompanied by burning sensation, fever, thirst.
2. Vataja Raktapitta:
   • Blood is thin, frothy, and dark-colored.
   • Associated with pain, dryness, and roughness.
3. Kaphaja Raktapitta:
   • Blood is thick, sticky, and pale.
   • Accompanied by heaviness, nausea, and lethargy.
4. Sannipataja Raktapitta:
   • Mixed features of all three doshas.
   • Symptoms are severe and complex.

Modern Correlation

In modern medicine, bleeding manifestations include:

1. Epistaxis (Nosebleeds): Bleeding from the nasal mucosa.
2. Hematemesis: Vomiting of blood due to gastrointestinal bleeding.
3. Hemoptysis: Coughing up blood from the respiratory tract.
4. Melena and Hematochezia: Black tarry stools or fresh blood per rectum due to gastrointestinal bleeding.
5. Hematuria: Blood in urine indicating urinary tract bleeding.

Symptoms vary based on the underlying cause, such as liver disease, coagulation disorders, or vascular abnormalities.

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Classification of Raktapitta

Based on the Direction of Flow

1. Urdhvaga Raktapitta:
   • Bleeding occurs upwards through the upper orifices.
2. Adhoga Raktapitta:
   • Bleeding occurs downwards through the lower orifices.
3. Ubhayaga Raktapitta:
   • Bleeding occurs through both upper and lower routes.

Based on Dosha Predominance

1. Vataja Raktapitta
2. Pittaja Raktapitta
3. Kaphaja Raktapitta
4. Sannipataja Raktapitta: Involving all three doshas.

Based on Severity and Prognosis

1. Sadhya (Curable):
   • Single dosha involvement.
   • Recent onset and mild symptoms.
2. Yapya (Manageable):
   • Dual dosha involvement.
   • Chronic cases requiring ongoing management.
3. Asadhya (Incurable):
   • Involvement of all three doshas.
   • Severe symptoms with poor prognosis.

Modern Correlation

Bleeding disorders can be classified based on:

1. Etiology:
   • Coagulation Factor Deficiencies: Hemophilia A and B.
   • Platelet Disorders: Thrombocytopenia.
   • Vascular Disorders: Vasculitis.
2. Severity:
   • Mild: Minor bleeding episodes.
   • Moderate: Occasional spontaneous bleeding.
   • Severe: Frequent spontaneous bleeding, life-threatening hemorrhages.

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Diagnosis (Pariksha) of Raktapitta

Ayurvedic Approach

Diagnosis is based on:

1. Clinical Examination:
   • Observing the color, consistency, and amount of blood.
   • Assessing associated symptoms and doshic signs.
2. History Taking:
   • Dietary habits, lifestyle factors, and exposure to causative agents.
3. Assessment of Strength (Bala):
   • Evaluating the patient’s vitality and immunity.
4. Examination of Prognostic Indicators:
   • Signs indicating curability or incurability.

Modern Diagnostic Methods

1. Laboratory Tests:
   • Complete Blood Count (CBC): Assessing hemoglobin, hematocrit, platelet count.
   • Coagulation Profile: Prothrombin time (PT), activated partial thromboplastin time (aPTT), INR.
2. Imaging Studies:
   • Endoscopy: To locate sources of gastrointestinal bleeding.
   • Ultrasound/CT Scans: Detecting organ involvement.
3. Specific Tests:
   • Factor Assays: Identifying specific clotting factor deficiencies.
   • Bone Marrow Examination: In cases of hematological malignancies.

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Treatments for Raktapitta Mentioned in Charaka Samhita

Raktapitta is a serious condition in Ayurveda characterized by bleeding due to the vitiation of Pitta and Rakta (blood). The shlokas provided from the Charaka Samhita, specifically the chapter on Raktapitta Chikitsa (treatment of bleeding disorders), outline a comprehensive approach to managing this condition.

Below is a detailed summary of the treatments mentioned in the Charaka Samhita, categorized for clarity.

1. Initial Management

A. Langhana (Fasting or Light Diet)

• Purpose: To reduce the aggravated Pitta and facilitate the digestion of toxins (Ama).
• Application:
  • Fasting: Complete or partial fasting based on the patient’s strength.
  • Light Diet: Consumption of easily digestible foods.

Shloka Reference:

• Verse 29: Advises fasting as Raktapitta often increases due to the accumulation of Ama and aggravated Pitta.

B. Tarpana (Nourishing Therapy)

• Purpose: To provide hydration and nourishment without aggravating Pitta.
• Application: Especially in Urdhvaga Raktapitta (bleeding from upper passages).

Shloka References:

• Verses 30-34: Recommend administering cooling and soothing drinks prepared with specific herbs.

2. Dietary Recommendations

A. Cooling Foods and Drinks

• Grains:
  • Shali (rice), Shashtika (a type of rice), Nivara, Koradusha, Prashantika, Shyamaka, Priyangu.
• Legumes:
  • Mudga (green gram), Masura (red lentil), Chanaka (Bengal gram), Adhaki (pigeon pea).
• Vegetables and Greens:
  • Patola (pointed gourd), Nimba (neem), Kirata Tikta (Swertia chirata), Gandira, Kathillaka.
  • Flowers: Kovidara, Kashmarya, Shalmali.

Preparation Methods:

• Cooking: Vegetables can be cooked in ghee or prepared as soups.
• Meat Soups:
  • Birds: Pigeon, quail, partridge.
  • Animals: Rabbit, antelope, deer.

Shloka References:

• Verses 36-42: Detail the appropriate foods and their preparation methods for Raktapitta patients.

B. Avoidance of Pitta-Aggravating Foods

• Hot, Spicy, Sour, Salty Foods: These should be avoided as they can increase Pitta and worsen bleeding.

3. Herbal Formulations and Decoctions

A. Cooling Decoctions (Kashayas)

• Herbs Used:
  • Hribera, Chandana (sandalwood), Ushira (Vetiver), Musta (Cyperus rotundus), Parpataka.
• Preparation:
  • Herbs are boiled in water, cooled, and administered to the patient.

Shloka References:

• Verses 31, 44-47: Provide recipes for herbal decoctions beneficial in Raktapitta.

B. Medicated Rice Gruel (Peya and Yavagu)

• Purpose: To nourish and cool the body while being easy to digest.
• Ingredients:
  • Lotus Stamens, Prishniparni, Priyangu, Chandana, Ushira, Lodhra.
• Preparation:
  • Rice gruel is cooked with these herbs to enhance its therapeutic effect.

Shloka References:

• Verses 43-48: Explain the preparation of medicated gruels for Raktapitta patients.

4. Use of Medicated Ghee (Ghrita)

A. Vasa Ghrita

• Ingredients:
  • Vasa (Adhatoda vasica) leaves, branches, roots, flowers.
• Preparation:
  • A decoction of Vasa is prepared, and ghee is cooked with this decoction and the paste of Vasa.
• Benefits:
  • Effectively stops bleeding and pacifies Pitta.

Shloka Reference:

• Verse 88: Describes the preparation and benefits of Vasa Ghrita.

B. Other Medicated Ghees

• Herbs Used:
  • Palasha (Butea monosperma), Vatsaka (Holarrhena antidysenterica), Samanga (Rubia cordifolia), Utpala (water lily), Lodhra.
• Benefits:
  • These ghees are beneficial in managing bleeding and Pitta disorders.

Shloka References:

• Verses 89-90: Detail other ghee preparations useful in Raktapitta.

5. Milk Preparations

A. Medicinal Milk

• Types of Milk:
  • Goat’s Milk: Highly recommended for its cooling properties.
  • Cow’s Milk: Boiled with herbs.
• Herbs Used:
  • Vidari Kand, Draksha (raisins), Bala (Sida cordifolia), Gokshura (Tribulus terrestris).
• Preparation:
  • Milk is boiled with these herbs and sometimes combined with ghee and sugar.

Shloka References:

• Verses 83-85: Discuss various milk preparations and their benefits in Raktapitta.

6. Palliative Therapies (Shamana)

A. Herbal Mixtures and Linctus

• Ingredients:
  • Atarushaka, Mridvika (raisins), Haritaki, Lodhra, Priyangu, Honey.
• Preparation:
  • Decoctions, powders, or pastes are prepared and consumed.
• Benefits:
  • Alleviate bleeding, coughing, and breathing difficulties.

Shloka References:

• Verses 65-69: Provide formulations for patients who are weak and cannot undergo strong purificatory therapies.

B. Use of Honey and Ghee

• Purpose: To enhance the healing properties of herbs and provide nourishment.

7. Nasal Therapies (Nasya)

A. Medicated Nasal Drops

• When to Use: In cases of bleeding from the nose (Pratishyaya).
• Ingredients:
  • Decoctions of Lodhra, Utpala, Gairika (red ochre), Chandana, Honey.
• Benefits:
  • Stops nasal bleeding and pacifies Pitta.

Shloka References:

• Verses 97-101: Describe the preparation and administration of nasal medications for Raktapitta.

8. External Therapies

A. Cooling Applications (Pradeha)

• Ingredients:
  • Chandana, Ushira, Padma (lotus), Utpala, Vetiver, Clay, Red Sandalwood.
• Application:
  • Pastes are applied to the forehead, chest, and other areas to reduce burning sensations.

B. Cold Baths and Sprinkling (Parisheka and Avagaha)

• Purpose: To cool the body and alleviate Pitta symptoms.
• Methods:
  • Bathing with water infused with cooling herbs.
  • Sprinkling medicated water over the body.

Shloka References:

• Verses 105-106: Emphasize the use of external cooling therapies.

9. Lifestyle Modifications

A. Environmental Adjustments

• Rest in Cool Places:
  • Staying in rooms cooled by water fountains or in natural environments like forests with cool breezes.
• Use of Cooling Materials:
  • Wearing garments made of cooling fabrics.
  • Using bedding and cushions stuffed with lotus petals or sandalwood.

Shloka References:

• Verses 105-109: Suggest environmental and lifestyle changes to aid in the treatment.

B. Avoidance of Heat and Exertion

• Purpose: To prevent aggravation of Pitta and worsening of symptoms.
• Recommendations:
  • Avoid exposure to sunlight and heat.
  • Refrain from strenuous activities.

10. Purificatory Therapies (Shodhana)

A. Vamana (Therapeutic Emesis)

• When to Use: In Adhoga Raktapitta (bleeding from lower passages) and when Pitta is severely aggravated.
• Procedure:
  • Inducing vomiting using specific emetics like Madanaphala.

B. Virechana (Therapeutic Purgation)

• When to Use: In Urdhvaga Raktapitta (bleeding from upper passages).
• Procedure:
  • Administering purgatives such as Trivrit (Operculina turpethum), Haritaki, Amalaki.

Note: These therapies should be employed cautiously, considering the patient’s strength and associated conditions.

Shloka References:

• Verses 54-61: Discuss the use of purificatory therapies in Raktapitta.

11. Treatment of Complications

A. Addressing Vata Involvement

• Observation: If bleeding persists despite Pitta-pacifying treatments, Vata may be involved.
• Treatment:
  • Administration of nourishing and unctuous substances like medicated milk and ghee preparations.

Shloka Reference:

• Verse 82: Indicates the need to address Vata when symptoms do not subside.

12. Preventive Measures

A. Avoidance of Causative Factors

• Dietary Restrictions:
  • Avoid hot, spicy, sour, and salty foods.
• Lifestyle Adjustments:
  • Prevent exposure to heat and stress.
  • Maintain regular routines and adequate rest.

Shloka References:

• Verse 53: Advises avoiding all causative factors of Raktapitta.

Treatment Conclusion

The shlokas provide a holistic approach to managing Raktapitta, emphasizing:

• Dietary Management: Incorporating cooling and nourishing foods while avoiding aggravating substances.
• Herbal Formulations: Using specific herbs known for their cooling, hemostatic, and Pitta-pacifying properties.
• Therapeutic Procedures: Employing appropriate purificatory or palliative therapies based on the patient’s condition.
• Lifestyle Modifications: Adjusting the environment and daily activities to support healing.
• Individualized Care: Tailoring treatments according to the patient’s strength, the severity of symptoms, and the involvement of doshas.

By following these guidelines, practitioners aim to restore balance, stop bleeding, and rejuvenate the patient’s health.

Note: These treatments are based on classical Ayurvedic texts and are intended for educational purposes. Consultation with a qualified Ayurvedic practitioner is essential for personalized medical advice and treatment.

Modern Correlation

Management of bleeding disorders involves:

1. Identification and Management of Underlying Cause:
   • Treating liver diseases, correcting vitamin deficiencies, or managing coagulation disorders.
2. Blood Transfusions:
   • Packed Red Cells: To treat anemia due to blood loss.
   • Platelet Transfusions: In thrombocytopenia.
   • Fresh Frozen Plasma: Provides clotting factors.
3. Medications:
   • Vitamin K Supplementation: For deficiencies.
   • Desmopressin (DDAVP): Stimulates release of von Willebrand factor.
   • Antifibrinolytic Agents: Like tranexamic acid to prevent breakdown of clots.
4. Supportive Care:
   • Rest and Immobilization: To prevent further bleeding.
   • Cold Applications: Vasoconstriction to reduce bleeding.
5. Lifestyle Advice:
   • Avoiding NSAIDs that can exacerbate bleeding.
   • Preventing injuries.

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Dietary Management

Ayurvedic Recommendations

1. Foods to Include:
   • Grains: Shali (rice), Shashtika (a type of rice), and barley.
   • Legumes: Green gram (Mudga), lentils (Masura).
   • Vegetables: Bitter gourd, snake gourd.
   • Fruits: Grapes (Draksha), pomegranate (Dadima).
   • Dairy: Milk processed with cooling herbs.
2. Foods to Avoid:
   • Hot and Spicy Foods: That increase Pitta.
   • Sour and Fermented Foods: Aggravate Pitta.
   • Alcohol: Heating and Pitta-provoking.

Modern Dietary Advice

1. Iron-Rich Foods:
   • To address anemia due to blood loss.
   • Sources: Leafy greens, legumes, red meat.
2. Vitamin K-Rich Foods:
   • Essential for clotting factor synthesis.
   • Sources: Green vegetables like spinach, kale.
3. Hydration:
   • Adequate fluid intake to maintain blood volume.
4. Avoidance of Alcohol and NSAIDs:
   • As they can impair coagulation and worsen bleeding.

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Prognosis (Sadhya-Asadhya)

Ayurvedic Perspective

1. Sadhya (Curable):
   • Single dosha involvement.
   • Recent onset, mild symptoms.
   • Bleeding from a single route.
2. Yapya (Manageable):
   • Dual dosha involvement.
   • Bleeding from either upward or downward routes.
   • Requires ongoing management.
3. Asadhya (Incurable):
   • Involvement of all three doshas.
   • Bleeding from both routes and multiple sites.
   • Severe symptoms and poor response to treatment.

Signs of Poor Prognosis

• Black or Dark Blood: Indicates severe vitiation.
• Bleeding from Skin Pores: Suggests systemic involvement.
• Associated with Severe Upadravas (Complications): Such as high fever, loss of consciousness.

Modern Correlation

Poor prognosis is associated with:

1. Severe Coagulation Disorders:
   • Hemophilia with inhibitors.
   • Disseminated intravascular coagulation (DIC).
2. Underlying Malignancies:
   • Leukemia causing severe thrombocytopenia.
3. Organ Failure:
   • Liver failure impairing clotting factor synthesis.
4. Massive Hemorrhage:
   • Leading to shock and multi-organ dysfunction.

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Preventive Measures

Ayurvedic Guidelines

1. Avoidance of Causative Factors:
   • Maintaining a Pitta-pacifying diet and lifestyle.
2. Regular Detoxification:
   • Seasonal Panchakarma therapies to balance doshas.
3. Strengthening Digestion (Agni):
   • Using digestive herbs to prevent Ama accumulation.
4. Stress Management:
   • Practices like meditation and yoga.

Modern Recommendations

1. Regular Medical Check-ups:
   • Especially for individuals with known bleeding tendencies.
2. Vaccinations:
   • To prevent infections that can exacerbate bleeding.
3. Healthy Lifestyle:
   • Balanced diet, regular exercise, stress reduction.
4. Avoidance of Risk Factors:
   • Limiting alcohol, avoiding unnecessary medications that affect coagulation.

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Conclusion

Acharya Charaka’s comprehensive approach to Raktapitta highlights the intricate understanding of bleeding disorders in Ayurveda. By identifying the causative factors, pathogenesis, and clinical manifestations, Charaka provides a systematic methodology for diagnosis and management.

The correlation with modern medical concepts underscores the timeless relevance of Ayurvedic principles. While the terminology and explanations differ, the fundamental processes of bleeding disorders share similarities across both systems.

Integrating Ayurvedic wisdom with contemporary medical practices can enhance patient care, offering holistic management that addresses not only the physical symptoms but also the underlying imbalances and lifestyle factors contributing to the disease.

By adopting a personalized approach that considers individual constitution, diet, lifestyle, and psychological factors, healthcare providers can offer more effective interventions for bleeding disorders.

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References

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