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Introduction

Blood, it is the most important and unique tissue that a human body possess. Blood is the only liquid tissue that a human body has. There are numerous functions that this liquid tissue performs in our body and thus this tissue can also be called as the basis of life. Also, it is the only tissue that can reach to the minutest sections of the body as well thus it acts as the source of nutrition and oxygen to the whole body. This tissue that holds such an importance in the normal functioning of the body, if any kind of disorder is observed in this system, then it needs immediate and close attention, from both modern and ayurvedic aspects it is extremely important to very closely monitor the disorders related to blood and proper treatment at the right time is of utter importance. In Ayurveda one such disorder, related to blood is mentioned that needs proper attention to it, Acharya Charak has even mentioned this disorder under the title of “mahagada” means a disorder/disease that is very difficult to treat. Mahagada is a group of 8 disorders that are extremely difficult to treat and are grouped together by Acharya.

What is Raktapitta?

The etymology of this name Raktapitta, comes forward as follows- “Raktayuktampittam Raktapittam”, so it is very easily understandable from the etymology itself that a disorder where the rakta is consisting of pitta is called as Raktapitta, now, the point of importance here to note is that rakta is a dhatu that is very commonly related to pitta dosha, as they are related to each other through the ashraya-ashrit bhava. So, rakta that includes of pitta here in this context means that the pitta that is aggravated, so, when the rakta is consisting of aggravated pitta dosha then that disorder is known as Raktapitta.A disorder in which the rakta is seen flowing out of the body is said to be rakta pitta, now, this flow of rakta outside the body is not normal and is seen without any cuts or wounds. Since this rakta is flowing outside the body without any injury, the route of flow of this blood outside body is the natural orifices present in the body. These are 4 for upper body and 3 for lower body and except for these natural openings the pores present all over the body (romakoopa) are also a possible source for outflow of blood.

This disorder is mainly raktaj in nature. But the main dosha that affects is pitta dosha. Also, the rakta is what appears outside of the body first, thus the name “Raktapitta”. So, the blood flow in this disorder is mainly due to internal reasons. The question raised is, there are many disorders that can lead to bleeding without any injury, such as, kshya, kshina, raktatisar, raktaarsha, rajyakshma, so, what is the main difference through which we can differentiate between the reasons of blood flow? First of all, being the comparison of symptoms that will be stated later, but the most common difference being that in this disorder the rakta is being affected by the aggravated pitta, while in other disorders, the rakta that comes out of orifices are not affected or very nominally affected by pitta dosha. So this rakta that comes out of the body is dushit while the rakta that is released in other disorders is not actually dushit in nature. Acharya Charak has mentioned, in chikitsa sthana, chapter 4, that, the way Agni (fire) consumes the whole of grasses and forest in to its grasp very fastly, in the very same manner, this disorder, Raktapitta (that consists of aggravated pitta that is of hot and tikshna nature thus comparable to fire) very rapidly leads to deterioration of human body and consumes it, making the person ill. This also depicts very clearly that this disorder needs fast and proper treatment as soon as possible or the patient can become non-treatable with time. In we see which disorder the Raktapitta is comparable to? It can be said to be comparable with hemorrhagic blood disorders.

Hemorrhagic blood disorders-

it is a pathological condition, or a group of conditions, in which there is a problem with body’s blood clotting process, now in this condition, the person can loses a lot amount of blood from a simple injury or the bleeding can start on its own. All types of disorders has some reasons or causative features for it, for Raktapitta these causative features are as follows-

Causative factors of Raktapitta (nidan) :

Raktapitta is pitta pakopaj disorder so, the causes that lead to aggravation of pitta doshas will be the reason of Raktapitta as well, which are as follows-

1. Excessive consumption of ushna, tikshna, kshara, amla, lavana and katu substances.
2. Excessive walking in sun/basking in sun
3. Excessive sexual activity
4. Excessive consumption of vidahi substances.
5. Excessive anger, fear, anxiety etc.
6. Use of lavana rasa or kshara with milk
7. Use of substances like, sarshapa, lehsun etc

The reason why these substances become the reason of rakta pitta are because according to samanya vishesh siddhanta, any substances that are of similar qualities will lead to increase of that specific factor while if the qualities of substances are opposite then that will lead to decrease of that substance or guna. So, now if we compare between the two then it is very easily observed the similarity of gunas in the causative factors and pitta, thus leading to aggravation of pitta. As for the manasik karana mentioned, such as getting angry, feeling fear, anxiety etc all these factors, they actually produce or increase the production of hormones like, adrenaline and cortisol, after release of this hormone the body activates the fight or flight mode, during which the brain shuts the blood away from the digestive system and increases its flow towards muscles which is a basic preparation body does to get ready for physical exertion. Heart rate, blood pressure and resp. rate is increase, in this whole procedure the body temperature is increased that will lead to increase of pitta due to similarity in qualities, now attention should be averted towards the fact that this process does not affect the body if this happens once in a while, because this mechanism is created in our body for such emergency situations etc only, but if this process keeps on repeating because the person gets angry very often or fears too much or any such emotion that leads to such changes in body, then this will affect the normal physiology of the body in a negative way, i.e. increasing and aggravating the pitta dosha that further leads to different kinds of disorders.

Samprapti:

The thought of pathophysiology of bleeding disorders in ayurvedic and modern sciences are very different from each other, as some of the common causes of bleeding disorders mentioned by modern science are- deficiency of vitamins like vitamin k, vitamin b12 etc; genetic disorders ,like sickle cell anemia, absence of coagulation factors( there are 12 coagulating factors in absence of even 1 or 2 of these factors can lead to delayed coagulation or other issues that can lead to excessive blood loss even from small injuries), reduction of platelet counts etc, each factor affects the bleeding in different ways that can cause such disorders.But the ayurvedic science sees the pathophysiology of Raktapitta (bleeding disorders) in a different light, which is as follows-

Acharya Charak In Charak chikitsa forth sthan, states the progression of Raktapitta as, on consumption of pitta aggravating and rakta affecting causes, the pitta dosha gets aggravated, this aggravated pitta moves forwards towards rakta dhatu, and since the two (i.e. pitta and rakta) are of similar qualities and are bound in ashraya ashrit bhava, the aggravated pitta gets mixed in rakta and leads to dushti of rakta dhatu, now this dushit rakta gets circulated in the whole body, which affects the other dhatus, that is as follows, the mamsa dhatu due to increased heat of aggravated pitta in rakta dhatu, it melts down ( can be seen as dhatu kshinta) mixes with the circulating fluid , increases the volume of circulating blood, now, this increased volume of blood searches for an outlet, thus going out of body through the natural orifices.

Types of Raktapitta:

Rakta pitta can be classified into various categories that can be according to-

On the basis of classification(7)

1. On the basis of route of blood getting out of body(3)

Basically there are two routes through which the dushit blood gets out of body, these can be through the openings in upper body (urdhawag Raktapitta) or through the openings in lower body (adhog Raktapitta), but, when there is too much dushti of rakta and the doshas go through the tiryak rogmarga, when that happens, the blood while searching for outlets can come out of pores of body as well (known as romakoopa) along with the body openings from the upper and the lower body. The symptoms of the three types Raktapitta on the basis of route of blood getting out of body is as follows-

Sadhyata-Asadhyata of Raktapitta:

Rakta pitta is a maha-gada, so it is not a disorder that is easily treatable, but in some conditions it is treatable while in others they are not. The factors that affect it is as follows-

Sadhya Raktapitta

Some general factors that decide if the disease is easily treatable or not are-

Urdhwag Raktapitta-

Urdhwag Raktapitta, is the Raktapitta in which pitta dosha is associated with the kapha dosha and rakta is pitta kapha dushit, so in such a condition, first thing to remember is, that the treatment procedure for Raktapitta states that the  treatment should be done in opposite direction to that of flow of blood, and in Raktapitta it is pittaj dosha that is affected the most, in Urdhwag Raktapitta the blood flow is through the upper body orifices, so the treatment should be as such that the flow of it is from the lower direction i.e. the lower body, then for that we have two options, that are, virechan and basti, out of these two, the panchakarma procedure that helps in treatment of both urdhwag Raktapitta and the vitiated pitta dosha, then the best option we see is virechan, so we have a procedure that ensures the treatment of both the pitta and urdhwag flow of rakta, this is one reason why it is comparatively easily treatable. Also, the options for internal medicine are vast as the drugs with guna like, tikta rasa, laghu guna, Kashaya and madhur rasa that leads to reduction of both the kapha and pitta, thus, increasing the chances of better treatment and recovery.

• If the patient has strength, mentally and physically, then the patient is more chances to be recovered along with the treatment.
• New Raktapitta is much easily manageable.
• The disease without any complications.
• From the point of seasons, Raktapitta that occurs in the seasons of Hemant and shishir rutu are easily manageable the reason being that these seasons are cold and pitta does not get that severely aggravated.

Management of Raktapitta:

Acharya Charak explains the chikitsa of Raktapitta in chikitsa sthana chapter 4, which states-

If the patient suffering from Raktapitta is bala-van, i.e. has mental and physical strength, he is consuming food well, in such a patient it is advisable to not stop the flow of blood instantaneously mainly because, the blood that is coming out of body in this period is not the pure blood but it is dushit blood, so it’ll be better for the patient if that blood is excreted out of body system, so that the body then consist of suddha rakta in system with the help of medication etc. If, the reason of Raktapitta, i.e. the reason of dushit pitta dosha is improper digestion leading in formation of aama in the body of patient, in such a case, patient should be advised langhan chikitsa, i.e. he/she should consume light diet and let their Agni to be strengthens gradually. As we do know that there are two main routes for the blood to go out of the body, that are, the upper tract (urdhwag Raktapitta) and the lower tract (adhog Raktapitta), in such condition, the line of treatment chosen first for urdhwag Raktapitta is, langhan, and for adhog Raktapitta it is tarpan, reason being that, in urdhwag Raktapitta, there is association of kapha dosha, for whose treatment, langhan is suitable in the category of no-drug therapy, and in the adhog Raktapitta, since there is association of vataj dosha it is essential in this part that the vata should subside, for which, tarpan this therapy id decided.

Sanshodhan chikitsa for Raktapitta:

Pratimarga cha haranam Raktapitte vidheyathe ''Pratimaarga (Viruddha) Maarga Harana (Shodhana): Eliminating the causative, vitiated Dosha from the opposite direction of its manifestation is the key to management of Rakta Pitta.

It  follows a simple rule, that is, that the procedure done should be opposite to the flow of blood, so if the blood is coming out through the upper body tracts, the procedure done should be virechan and for adhog Raktapitta, the procedure done is, vaman. For Urdhvaga Raktapitta Kashaaya and Tikta Rasa are essnetial. Virechana should be given (using Nishottara, Haritaki, Aragvadha, Indrayana etc. For Adhoga Raktapitta Shamana Dravya and Madhura Rasa is to be used. Vamana should be done using Indrayav, Musta, Madana, Yashti etc. In this part of treatment, one thing of importance is that, for the urdhwag Raktapitta the treatment is much easier than the adhog Raktapitta, because for the treatment of urdhwag Raktapitta, the procedure used is virechan, in virechan the point to be noted is that, this procedure can reduce both the pittaj and kaphaj dosha efficiently, but in adhog Raktapitta, the procedure used is vaman, which is useful or very beneficial to reduce or shodhan of vataj dosha. This is the reason why urdhwag Raktapitta is easily treatable than Adhog Raktapitta.

Formulations used:

Formulations used for the treatment for Raktapitta comes in various forms, that are- rasa/ bhasma/ pishti/ vati/ kwatha/ asava- arishta/ ghrita/ paka/ avleha/ khanda and all these forms are used for treatment according to the need and palatability, severity etc of the patients. Some of the formulations are as follows-

Raktapittantak rasa, pittantak rasa, bola parpati, gairik bhasma, shankha bhasma, praval bhasma, praval pishti, praval panchamruta, ushirasava, kanakasav, tiktaka ghrita, vasavleha etc. all such formulations can be used easily for the treatment of Raktapitta.

Discussion

Raktapitta, a bleeding disorder, in which the blood is, flows out of the body, Without any external injury, this disorder is closely related to hemorrhagic disorders, whose main reasons are said to be vitamin k deficiency, vitamin B12 deficiency, absence of coagulation factors, reduction of platelet count etc, but can Raktapitta be actually , closely related to bleeding disorders, let us see what are the common bleeding disorders that a person faces , as in seen earlier all those type of bleeding disorders that occurs through different body openings are all considered in it, so when we see the upper body openings we have 4 openings, which are, ears, eyes, nose and mouth, these are the openings and bleeding through them are called as, otorrhagia, sub-conjunctival hemorrhage/intra-ocular hemorrhage, epistaxis, hematemesis/hemoptysis,

if we see the causes of these disorders from a modern point of view, these go as follows-

1. Otorrhagia- caused due to injury in the internal ear or intracranial disorders.
2. Sub-conjunctival hemorrhage- injury of blood vessels supplying to eyes or in some issues of the brain.
3. Epistaxis- injury to internal mucosa, brain tumor or other underlying cranial pathology, hypertension etc.
4. Hematemesis- ulceration of the esophagus, stomach and intestine. Here bleeding is found along with vomitus.
5. Hemoptysis- when blood is seen along with spitting or coughing, this is an indication of chest or lung pathology.

Similarly for the lower body, the 3 openings mentioned are- vagina, anus and penis. Where for excessive vaginal bleeding, modern has mentioned menorrhagia, for anal bleeding it’s Malena, for urinary tract, its hematuria, if blood is through the penis with sperms, then it’s called haematospermia. In Ayurveda also, all the specific systems in whose disorders bleeding is possible through various pathways is mentioned separately and Raktapitta is not related to that, so, to say that Raktapitta is exactly bleeding disorders will not be exactly correct, but to some point it relates. So, I do not agree that Raktapitta is exactly bleeding disorders.

Conclusion

Raktapitta, it is a very grave disorder that needs to be taken proper care of, in the absence of which, the disease can show some very dangerous advancements and become incurable as well, that is why it should always be taken seriously and should be provided adequate treatment according to the patient, along with pathya-apathya, and the patient should be properly informed about its condition and its chances of recovery, everything should be taken care of properly, also, one important factor that is like a booster for development of disease should be avoided like, mental causes such as stress, anxiety, anger etc.,

Even in absence of physical features, these mental features can have very evident affect as well.