Raktapitta Nidanam – 9th Chapter Of Madhav Nidanam

Introduction

Raktapitta is an important disease described in Ayurveda characterized by abnormal bleeding from various parts of the body due to vitiation of Rakta Dhatu and Pitta Dosha. In Madhava Nidanam it is stated that Raktapitta is due to the aggravation of Pitta; owing to its hot and sharp qualities, Pitta vitiates the Rakta Dhatu and causes bleeding from different orifices of the body. The disease is closely related to wrong eating habits, over consumption of hot, sour, salty and pungent foods and other factors that aggravate Pitta. The clinical picture of Raktapitta varies according to the direction of bleeding. The direction is broadly classified into Ūrdhvaga (upward), Adhoga (downward) and Ubhayaga (upward and downward). The Nidana aspect is useful for knowing the causative factors, pathogenesis and clinical features of the disease which is a foundation to understand the disease for proper diagnosis and management of the disease according to Ayurvedic principles.

Raktapitta Nidanam - 9th Chapter Of Madhav Nidanam

Raktapitta Nidana (Etiological Factors)

घर्मंव्यायामशोकाध्वव्यवायैरतिसेवितैः ।
तीक्ष्णोष्णक्षारलवणैरम्लैः कटुभिरेव च ॥१॥ (सुश्रुत संहिता, उत्तरतन्त्र, अध्याय 45 , श्लोक 3)

Excessive exposure to heat, physical exercise, grief, long-distance travel, sexual activity, and excessive consumption of sharp, hot, alkaline, salty, sour and pungent substances are described as causative factors.

Samprapti (Pathogenesis)

पित्तं विदग्धं स्वगुणैर्विदहत्याशु शोणितम् ।
ततः प्रवर्तते रक्तमूर्ध्वं चाधो द्विधाऽपि वा ॥२॥
ऊर्ध्वं नासाक्षिकर्णास्यैर्मेढ्रयोनिगुदैरधः ।
कुपितं रोमकूपैश्च समस्तैस्तत्प्रवर्तते ॥३॥ (सुश्रुत संहिता, उत्तरतन्त्र, अध्याय 45 , श्लोक 4–5)

Samprapti is the order of the pathological events which constitute the course of a disease.Raktapitta manifests upward through the nose, eyes, ears and mouth; downward through the penis, vagina and anus; or through all the body’s hair follicles. The Samprapti of Raktapitta as per Ayurvedic principles described in Mādhava Nidānam is as follows –

Nidana Sevana: Constant exposure to diet and lifestyle factors which provoke Pitta.
Pitta Prakopa: The etiological factors aggravate the Pitta doṣha.
Rakta Duṣṭi: Rakta Dhatu becomes vitiated because of the close association and similar qualities of aggravated Pitta.
Rakta-Pitta Saṃmurchana: Raktapitta is the pathological development of Rakta which is caused by the interaction of vitiated Pitta and Rakta.
Srotoduṣṭi: Impairment of the blood-carrying channels leads to abnormal bleeding.

Raktapitta Purvarupa (Premonitory Symptoms)

सदनं शीतकामित्वं कण्ठधूमायनं वमिः ।
लोहगन्धिश्च निःश्वासो भवत्यस्मिन् भविष्यति ॥४॥ (सुश्रुत संहिता – उत्तरतन्त्र, अध्याय 45 श्लोक 7)

According to Madhava Nidanam, a person who is about to develop Raktapitta may experience weakness, a desire for cold substances, a smoky or burni ng sensation in the throat, vomiting, and a blood-like smell in the breath.

Kaphaja Raktapitta Lakṣaṇa (Symptoms)

सान्द्रं सपाण्डु सस्नेहं पिच्छिलं च कफान्वितम् । (चरक संहिता, चिकित्सास्थान, अध्याय 4, श्लोक 10)

Kaphaja Raktapitta is a variant of Raktapitta in which Kapha Dosha is predominant. According to Madhava Nidanam, the blood is Sandra (thick), Paṇḍu (pale or whitish in colour), Snigdha (oily or unctuous) and Picchila (sticky or slimy) in nature. In simple words, Kaphaja Raktapitta is a type of bleeding in which the blood has thick, pale, oily and sticky characteristics

Vataja Raktapitta Laksaṇa (Symptoms)

श्यावारुणं सफेनं च तनु रूक्षं च वातिकम् ॥५॥ (चरक संहिता, चिकित्सास्थान, अध्याय 4, श्लोक 11)

Vataja Raktapitta is a form of Raktapitta in which Vāta Doṣa is predominantly aggravated or involved.Madhava Nidanam describes the blood to be Syava-Aruṇa (dark reddish or brownish-red in colour), Sa-Phenam (frothy), Tanu (thin or watery), Rukṣa (dry in nature). Simply put, Vataja Raktapitta has dark reddish, thin, frothy and dry blood. It indicates aggravated Vata Doṣha.

Pittaja Raktapitta Laksana (Symptoms)

रक्तपित्तं कषायाभं कृष्णं गोमूत्रसन्निभम् ।
मेचकागारधूमाभमञ्जनाभं च पैत्तिकम् ॥६॥ (चरक संहिता, चिकित्सास्थान, अध्याय 4 , श्लोक 12)

Pittaja Raktapitta is a type of Raktapitta characterized by the predominance or aggravation of Pitta Dosha.As per Madhava Nidanam, the color of the blood can be Kasayabha (color of the decoction or astringent medicine), Kṛṣṇa (dark color), Gomutra-sannibha (the color of cow’s urine), Mechaka (dark or blackish), Agara-dhumabha (the color of the smoke coming out of the chimney or soot), and Anjanabha (color of collyrium or black eye cosmetic).

Dvandvaja And Sannipataja Raktapitta Laksana (Symptoms)

संसृष्टलिङ्गं संसर्गात्त्रिलिङ्गं सान्निपातिकम् ।
ऊर्ध्वगं कफसंसृष्टमधोगं पवनानुगम् ॥७॥
द्विमार्गं कफवाताभ्यामुभाभ्यामनुवर्तते ॥ (चरक संहिता, चिकित्सास्थान, अध्याय 4 , श्लोक 13)

Any two among the three Doshas, namely Vāta, Pitta, and Kapha, cause Dvandvaja Raktapitta. In accordance with the first line of the śhloka, the presence of Saṃsṛṣṭa-liṅgam implies that the features of the two Doshas are seen simultaneously. Thus, there will be variation in the clinical features according to the two Doshas involved.
All the three Doshas namely Vāta, Pitta, and Kapha together lead to Sannipataja Raktapitta. Triliṅgam Sannipātikam refers to the involvement of the symptoms of all the three Doshas simultaneously.

Dosha Association In Urdhvaga And Adhoga Raktapitta

ऊर्ध्वगं कफसंसृष्टमधोगं पवनानुगम् ॥७॥
द्विमार्गं कफवाताभ्यामुभाभ्यामनुवर्तते ॥ (चरक संहिता, चिकित्सास्थान, अध्याय 4 , श्लोक 14)

In Madhava Nidanam, Urdhvaga Raktapitta is caused by Kapha Doṣha, while Adhoga Raktapitta is caused by Vata Doṣa. Urdhvaga Raktapitta is the condition where there is bleeding through the upper channels, including nose, eyes, ears and mouth, and in this case, Kapha is the Doṣa associated with the condition. Adhoga Raktapitta is the condition where there is bleeding through the lower channels, including urinary, anal, and genital passages, and in this case, Vāta is the Doṣa associated with the condition.

Urdhvaga Raktapitta: Predominantly associated with Kapha Doṣha.
Adhoga Raktapitta: Predominantly associated with Vata Doṣha.
Ubhayaga Raktapitta: Associated with both Kapha and Vāta Doṣhas

Sadhya-Asadhyata (Prognosis)

ऊर्ध्वं साध्यमधो याप्यमसाध्यं युगपद्गतम् ॥ (सुश्रुत संहिता, उत्तरतन्त्र, अध्याय 45 , श्लोक 4)

Urdhvaga Raktapitta (upward bleeding) is Sadhya (curable), Adhoga Raktapitta (downward bleeding) is Yapya (manageable), while Raktapitta which comes at the same time through both means is Asadhya (incurable in the ancient text).

Prognosis Based On Strength And Disease Severity

एकमार्गं बलवतो नातिवेगं नवोत्थितम् ।
रक्तपित्तं सुखे काले साध्यं स्यान्निरुपद्रवम् ॥८॥ (चरक संहिता, चिकित्सास्थान, अध्याय 4 , श्लोक 22)

Curing of raktapitta becomes possible when there is bleeding from only one opening, the patient is strong, the bleeding is not very heavy, the ailment is recent, the season is good, and there are no complications.

Prognosis Depending On Dosha Involved

A Rakta-pitta case with one Doṣha is said to be curable (Sadhya), but with the involvement of two Doṣhas it is manageable (Yapya). All three Doṣas in Raktapitta make it an incurable disease (Asadhya), especially when there is poor digestion strength, fast bleeding, weakness of the body from the disease, old age, and lack of food intake.

Type Or Condition	Prognosis
Urdhvaga Raktapitta	Sadhya — curable
Adhoga Raktapitta	Yapya — manageable
Ubhayaga Raktapitta	Asādhya — incurable
Ekadoṣaja	Sadhya
Dvidoṣaja	Yāpya
Tridoṣaja	Asadhya

Raktapitta Upadrava (Complications)

दौर्बल्य – श्वास – कास – ज्वर – वमथु – मदाः पाण्डुता – दाह – मूर्च्छा ।
भुक्ते घोरो विदाहस्त्वधृतिरपि सदा हृद्यतुल्या च पीडा ॥

तृष्णा कोष्टस्य भेदः शिरसि च तपनं पूति निष्टीवनत्वं ।
भक्तद्वेषाविपाकौ विकृतिरपि भवेद्रक्तपित्तोपसर्गाः ॥११॥ (सुश्रुत संहिता, उत्तरतन्त्र, अध्याय 45 , श्लोक 9)

According to Madhava Nidanam, there may be many Upadravas related to Raktapitta, such as Daurbalya, which means weakness; Svasa or breathlessness; Kasa or cough; Jwara or fever; Vamathu or vomiting; Paṇḍuta or anaemia; Daha or burning sensation; Murccha or fainting; severe burning of the chest after eating, restlessness; chest pain; Tṛṣṇa or excessive thirst; loose stools; burning sensation of head; foul smell in expectoration; Bhaktadveṣa or aversion to food; Avipaka or indigestion, etc.

Raktapitta Asadhya Lakshana (Symptoms)

मांसप्रक्षालनाभं कुथितमिव च यत् कर्दमाम्भोनिभं वा ।
मेदः पूयास्रकल्पं यकृदिव यदि वा पक्वजम्बूफलाभम् ॥
यत् कृष्णं यच्च भृशमतिकुणपं यत्र चोक्ता विकारा-
स्तद्वर्ज्यं रक्तपित्तं सुरपतिधनुषा यच्च तुल्यं विभाति ॥१२॥ (सुश्रुत संहिता,उत्तरतन्त्र, अध्याय 45 , श्लोक 10)

The condition of raktapitta is categorized under Asadhya in Ayurveda due to the presence of abnormal features in the blood. The abnormal features include:

Blood looks like water used for cleaning raw meat.
Muddy-looking blood.
Fat-like or purulent blood.
Liver-like or jamun-colored blood.
Black or very foul-smelling blood.
companies with serious complications.
Rainbow-like appearance of blood.

लोहितं च्छर्दयेध्यस्तु बहुशो लोहितेक्षणः ।
लोहितोद्गारदर्शी च म्रियते रक्तपैत्तिकः ॥१३॥ (सुश्रुत संहिता, सूत्रस्थान, अध्याय 33, श्लोक 24)

The above statement indicates that the diagnosis is fatal if a patient continuously vomits out blood, has reddened eyes, and regurgitates blood through eructation.

Conclusion

The Raktapitta Nidanam as described in Madhava Nidanam gives systematic knowledge about the causative factors, pratyankara lakshaṇa, rupa, hetu, samudaya, vibhāga, kriyākala, and prognosis of the Raktapitta disease. It is the disease that causes bleeding due to the vitiation of Pitta Doṣa and Rakta Dhatu from various parts of the body. The vibhāga of the disease into Ūrdhvaga, Adhoga, and Ubhayaga explains the nature of bleeding as well as the relation of disease with the particular Doṣa. The discussion about the Sādhya, Yāpya, and Asādhya conditions gives additional importance for the evaluation of the severity of the disease along with its complications.