Charaka Raktapitta Chikitsa – 4th chapter

The fourth chapter of Charaka Chikitsasthana is called Raktapitta Chikitsa. Raktapitta disease is a collection of bleeding disorders such as nasal bleeding, bleeding through ear, heavy periods, rectal bleeding, urethral bleeding etc

For easy understanding, read about bleeding disorders and Ayurvedic treatment

अथातो रक्तपित्तचिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athāto raktapittacikitsitaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
Now we shall expound the chapter on the treatment on Rakta Pitta (a condition characterized by bleeding from different parts of the body)
Thus said lord Atreya [1-2]
विहरन्तं जितात्मानं पञ्चगङ्गे पुनर्वसुम्|
प्रणम्योवाच निर्मोहमग्निवेशोऽग्निवर्चसम्||३||
भगवन् रक्तपित्तस्य हेतुरुक्तः सलक्षणः|
वक्तव्यं यत् परं तस्य वक्तुमर्हसि तद्गुरो||४||
viharantaṃ jitātmānaṃ pañcagaṅge punarvasum|
praṇamyovāca nirmohamagniveśo’gnivarcasam||3||
bhagavan raktapittasya heturuktaḥ salakṣaṇaḥ|
vaktavyaṃ yat paraṃ tasya vaktumarhasi tadguro||4||
Lord Punarvasu, who is Jitatma – having self control, was on a stroll in a place called Pancha Ganga. Agnivesha, who was free from attachment, and whose speech was like fire, paid obeisance to him and enquirer, “On Lord; you have already described the etiology, signs and symptoms of Rakta Pitta. Oh Preceptor! Please tell us further details on this subject” [3-4]
Lord Punarvasu replied:
गुरुरुवाच-
महागदं महावेगमग्निवच्छीघ्रकारि च|
हेतु लक्षणविच्छीघ्रं रक्तपित्तमुपाचरेत्||५||
तस्योष्णं तीक्ष्णमम्लं च कटूनि लवणानि च|
घर्मश्चान्नविदाहश्च हेतुः पूर्वं निदर्शितः||६||
gururuvāca-
mahāgadaṃ mahāvegamagnivacchīghrakāri ca|
hetu lakṣaṇavicchīghraṃ raktapittamupācaret||5||
tasyoṣṇaṃ tīkṣṇamamlaṃ ca kaṭūni lavaṇāni ca|
gharmaścānnavidāhaśca hetuḥ pūrvaṃ nidarśitaḥ||6||
Rakta Pitta is a serious disease and it afflicts the patient with a great speed. Like fire, it manifests itself and affects swiftly. Therefore, the physician who is well versed in the etiology, signs and symptoms of this disease, should immediately take steps for its treatment.

Causes

Causes for Rakta Pitta:
Diet and activities that are
Ushna – hot
Tikshna – sharp
Amlam – sour
Katu – pungent
Lavana – saline
Heat of the sun and
Vidaha – Improper digestion leading to burning sensation of food [5-6]

blood clotting process

Pathogenesis

Raktapitta Samprapti – Pathogenesis:
तैर्हेतुभिः समुत्क्लिष्टं पित्तं रक्तं प्रपद्यते|
तद्योनित्वात् प्रपन्नं च वर्धते तत् प्रदूषयत्||७||
तस्योष्मणा द्रवो धातुर्धातोर्धातोः प्रसिच्यते|
स्विद्यतस्तेन संवृद्धिं भूयस्तदधिगच्छति||८||
tairhetubhiḥ samutkliṣṭaṃ pittaṃ raktaṃ prapadyate|
tadyonitvāt prapannaṃ ca vardhate tat pradūṣayat||7||
tasyoṣmaṇā dravo dhāturdhātordhātoḥ prasicyate|
svidyatastena saṃvṛddhiṃ bhūyastadadhigacchati||8||

Because of the above causative factors, Pitta gets vitiated and reaches Raktha (blood). Pitta and Rakta are directly related. Therefore, when it reaches Rakta and vitiates it, Rakta gets further aggravated because of the heating property of Pitta, these tissue elements get heated, as a result of which , there is exudation of more of liquids from these elements. These liquids get heated, as a result of which, there liquids get mixed up with Rakta (blood). This leads to increase in volume of blood and its expulsion. [7-8]

Definition

Definition of Rakta Pitta:-
संयोगाद्दूषणात्तत्तु सामान्याद्गन्धवर्णयोः|
रक्तस्य पित्तमाख्यातं रक्तपित्तं मनीषिभिः||९||
saṃyogāddūṣaṇāttattu sāmānyādgandhavarṇayoḥ|
raktasya pittamākhyātaṃ raktapittaṃ manīṣibhiḥ||9||

The disease is called Rakta Pitta by the Wise because
Pitta combines with Rakta
Both Pitta and Rakta have hotness as common feature.
Pitta imparts its dodo and colour to Raktha.
Hence, this disease is called as Raktapitta.[9]

Location

Adhishtana for Raktapitta – Location of Raktapitta:
प्लीहानं च यकृच्चैव तदधिष्ठाय वर्तते|
स्रोतांसि रक्तवाहीनि तन्मूलानि हि देहिनाम्||१०||
plīhānaṃ ca yakṛccaiva tadadhiṣṭhāya vartate|
srotāṃsi raktavāhīni tanmūlāni hi dehinām||10||

Adhishtana – root place for the disease Raktapitta is Pleeha – spleen and Yakrut – liver.
This disease affects Raktavaha Srotas – blood channels.

Types and symptoms

Rakpta Pitta types and Lakshana – Specific signs and symptoms:
सान्द्रं सपाण्डु सस्नेहं पिच्छिलं च कफान्वितम्|
श्यावारुणं सफेनं च तनु रूक्षं च वातिकम्||११||
रक्तपित्तं कषायाभं कृष्णं गोमूत्रसन्निभम्|
मेचकागार धूमाभमञ्जनाभं च पैत्तिकम्||१२||
संसृष्टलिङ्गं संसर्गात्त्रिलिङ्गं सान्निपातिकम्|१३|
sāndraṃ sapāṇḍu sasnehaṃ picchilaṃ ca kaphānvitam|
śyāvāruṇaṃ saphenaṃ ca tanu rūkṣaṃ ca vātikam||11||
raktapittaṃ kaṣāyābhaṃ kṛṣṇaṃ gomūtrasannibham|
mecakāgāra dhūmābham añjanābhaṃ ca paittikam||12||
saṃsṛṣṭaliṅgaṃ saṃsargāttriliṅgaṃ sānnipātikam|13|

Kaphaja Raktapitta

When the disease has Kapha dominance, the blood will be
Sandra – dense, viscous
Sa pandu – whitish discoloration
Sasneha – oiliness, unctuousness
Picchila – Sticky, Slimy

Vataja Raktapitta

When it is associated with Vata dominance, the blood will be
Shyava – Aruna – brownish red
Saphena – frothy
Tanu – thin
Rooksha – dry

Pittaja Raktapitta

When associated with Pitta, blood becomes
Kashaya (or pink red, like the colour of the Patala flower),
Black like the cow’s urine, Mechaka (greasy- black), Agara Dhuma (house soot) and Anjana (Black collyrium).

Samsarga – When vitiated by 2 Doshas, the signs and symptoms of the aggressive 2 Doshas are manifested in the blood
Sannipata – When vitiated by all the 3 Doshas, then the signs and symptoms of all the 3 Doshas are manifested. [11-13]

Sadhya Asadhyatva

Prognosis – Sadhya Asadhyatva:
एकदोषानुगं साध्यं द्विदोषं याप्यमुच्यते||१३||
यत्त्रिदोषमसाध्यं तन्मन्दाग्नेरतिवेगवत्|
व्याधिभिः क्षीणदेहस्य वृद्धस्यानश्नतश्च यत्||१४||
ekadoṣānugaṃ sādhyaṃ dvidoṣaṃ yāpyamucyate||13||
yattridoṣamasādhyaṃ tanmandāgnerativegavat|
vyādhibhiḥ kṣīṇadehasya vṛddhasyānaśnataśca yat||14||

The Rakta Pitta, associated with:
1 Dosha is curable.
2 Doshas it is palliable, or Yapya.
All the 3 Doshas, is incurable;
It also becomes incurable in the following conditions:
1. If the patient is having Mandagni (less power of digestion and metabolism)
2. Ativegavat – If the disease has an acute attack
3. If the patient is emaciated by diseases
4. Ksheena Deha – if the patient is debilitated
5. Vruddha – if the patient is aged
6. Anashna – If the patient is not able to eat. [13-14]

Determination of prognosis

Determination of prognosis on the basis of movement through different tracks:
गतिरूर्ध्वमधश्चैव रक्तपित्तस्य दर्शिता|
ऊर्ध्वा सप्त विधद्वारा द्विद्वारा त्वधरा गतिः||१५||
सप्त च्छिद्राणि शिरसि द्वे चाधः, साध्यमूर्ध्वगम्|
याप्यं त्वधोगं, मार्गौ तु द्वावसाध्यं प्रपद्यते||१६||
यदा तु सर्वच्छिद्रेभ्यो रोमकूपेभ्य एव च|
वर्तते तामसङ्ख्येयां गतिं तस्याहुरान्तिकीम्||१७||
यच्चोभयाभ्यां मार्गाभ्यामतिमात्रं प्रवर्तते|
तुल्यं कुणपगन्धेन रक्तं कृष्णमतीव च||१८||
संसृष्टं कफवाताभ्यां कण्ठे सज्जति चापि यत्|
यच्चाप्युपद्रवैः सर्वैर्यथोक्तैः समभिद्रुतम्||१९||
हारिद्रनीलहरितताम्रैर्वर्णैरुपद्रुतम्|
क्षीणस्य कासमानस्य यच्च तच्च न सिध्यति||२०||
यद्विदोषानुगं यद्वा शान्तं शान्तं प्रकुप्यति|
मार्गान्मार्गं चरेद्यद्वा याप्यं पित्तमसृक् च तत्||२१||
gatirūrdhvamadhaścaiva raktapittasya darśitā|
ūrdhvā saptavidhadvārā dvidvārā tvadharā gatiḥ||15||
sapta cchidrāṇi śirasi dve cādhaḥ, sādhyamūrdhvagam|
yāpyaṃ tvadhogaṃ, mārgau tu dvāvasādhyaṃ prapadyate||16||
yadā tu sarvacchidrebhyo romakūpebhya eva ca|
vartate tāmasaṅkhyeyāṃ gatiṃ tasyāhurāntikīm||17||
yaccobhayābhyāṃ mārgābhyāmatimātraṃ pravartate|
tulyaṃ kuṇapagandhena raktaṃ kṛṣṇamatīva ca||18||
saṃsṛṣṭaṃ kaphavātābhyāṃ kaṇṭhe sajjati cāpi yat|
yaccāpyupadravaiḥ sarvairyathoktaiḥ samabhidrutam||19||
hāridranīlaharitatāmrairvarṇairupadrutam|
kṣīṇasya kāsamānasya yacca tacca na sidhyati||20||
yadvidoṣānugaṃ yadvā śāntaṃ śāntaṃ prakupyati|
mārgānmārgaṃ caredyadvā yāpyaṃ pittamasṛk ca tat||21||

The movement of Rakta Pitta through upward (Urdhwaga Raktapita) and downward tracks (Adhoga Raktapita) has been described. There are 7 openings (Dvara) in upward track. There are 2 opening in the downward track. In the head (3), 7 holes namely, two eyes, two ears, two nostrils and oral cavity. Similarly, there are 2 openings downwards namely the anus and the genito- urinary track.
Sadhyam Urdhwagam – Raktha Pitta having upward movement is curable.
Yapyam tu Adhogam – If it moves downward then it is palliable.
If it moves through both the upward and downward and downward tracks, then it becomes incurable.
Sometimes, Rakta Pitta also becomes incurable in the following conditions:-
1. When bleeding takes place in excess through either of the upward and downward tracks;
2. When the blood has a smell like that of the dead body (Kunapa gandhi)
3. When it is exceedingly black
4. When it gets associated with both Kapha and Vata
5. When it gets obstructed in the throat
6. When it is associated with all the complications described in Nidanasthana and
7. When an emaciated patient has continuous coughing and the phlegm that comes out is yellow, blue, green or coppery in colour.
Rakta Pitta becomes palliable in the following conditions:-
1. When it is associated with 2 Doshas while moving through the tracks;
2. When it gets repeatedly alleviated and aggravated and
3. When it leaves 1 channel and gets manifested in another.[15-21]

Curability

एकमार्गं बलवतो नातिवेगं नवोत्थितम्|
रक्तपित्तं सुखे काले साध्यं स्यान्निरुपद्रवम्||२२||
ekamārgaṃ balavato nātivegaṃ navotthitam|
raktapittaṃ sukhe kāle sādhyaṃ syānnirupadravam||22||

Rakta Pitta is curable in the following conditions:-
1. When it is manifested only through 1 track (here it is to be interpreted as only upward track)
2. When the patient is physically strong
3. When the attack of the disease is not very acute
4. When the treatment is immediately after the attack
5. When the treatment is initiated immediately after the attack
6. When the disease is free from complications.[22]

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Specific etiological factors

स्निग्धोष्णमुष्णरूक्षं च रक्तपित्तस्य कारणम्|
अधोगस्योत्तरं प्रायः, पूर्वं स्यादूर्ध्वगस्य तु||२३||
ऊर्ध्वगं कफ संसृष्टमधोगं मारुतानुगम्|
द्विमार्गं कफ वाताभ्यामुभाभ्यामनुबध्यते||२४||
snigdhoṣṇamuṣṇarūkṣaṃ ca raktapittasya kāraṇam|
adhogasyottaraṃ prāyaḥ, pūrvaṃ syādūrdhvagasya tu||23||
ūrdhvagaṃ kaphasaṃsṛṣṭamadhogaṃ mārutānugam|
dvimārgaṃ kapha vātābhyām ubhābhyāmanubadhyate||24||

Factors which are Snigdha (unctuous, oily) and Ushna (hot) those which are hot and Rooksha (dry) cause Rakta Pitta. The hot and dryness cause the disease and oiliness and hotness are generally responsible for its upward movement.
Upward movement of the disease mostly leads to the association of Kapha and downward movement of the disease mostly leads to the association Vata.
Urdhwaga is associated with Kapha and
Adhoga is associated with Vata.
When the disease moves through both the tracks then both Kapha and Vayu become associated [23-24]

Raktapitta Chikitsa

Raktapitta Chikitsa: Avoid Stambhana Chikitsa in the beginning stage:
अक्षीण बल मांसस्य रक्तपित्तं यदश्नतः|
तद्दोषदुष्टमुत्क्लिष्टं नादौ स्तम्भनमर्हति||२५||
गलग्रहं पूतिनस्यं मूर्च्छायमरुचिं ज्वरम्|
गुल्मं प्लीहानमानाहं किलासं कृच्छ्रमूत्रताम्||२६||
कुष्ठान्यर्शांसि वीसर्पं वर्णनाशं भगन्दरम्|
बुद्धीन्द्रियोपरोधं च कुर्यात् स्तम्भितमादितः||२७||
तस्मादुपेक्ष्यं बलिनो बलदोषविचारिणा |
रक्तपित्तं प्रथमतः प्रवृद्धं सिद्धिमिच्छता||२८||
akṣīṇabalamāṃsasya raktapittaṃ yadaśnataḥ|
taddoṣaduṣṭamutkliṣṭaṃ nādau stambhanamarhati||25||
galagrahaṃ pūtinasyaṃ mūrcchāyamaruciṃ jvaram|
gulmaṃ plīhānamānāhaṃ kilāsaṃ kṛcchramūtratām||26||
kuṣṭhānyarśāṃsi vīsarpaṃ varṇanāśaṃ bhagandaram|
buddhīndriyoparodhaṃ ca kuryāt stambhitamāditaḥ||27||
tasmādupekṣyaṃ balino baladoṣavicāriṇā |
raktapittaṃ prathamataḥ pravṛddhaṃ siddhimicchatā||28||

Raktapitta Chikitsa: Avoid Stambhana Chikitsa in the beginning stage:

If Rakta Pitta occurs as a result of over nourishment (santarpana) and if the strength and the muscle and tissues of the patient are not depleted, then Stambhaan treatment (blockage) treated may not be administered at first.
If the bleeding is stopped by Sthambha treated at the beginning then it may cause:
Galagraha – obstruction in throat
Putinasya – putrid smell in the nose
Murcha – Fainting
Aruchi – Anorexia
Jvara – fever
Gulma – Phantum tumor
Plihan – enlargement of spleen
Anaha – constipation
Kilasa – a type of skin disease
Mutra Krcchra – dysuria
Kustha – obstinate of skin diseases including leprosy
Arshas – piles
Visarpa – erysipelas,
Varna Nasha – loss of complexion
Bhagandara – fistula in ano and
Inhibition of the functions of the senses
Therefore, a physician who is acquainted with body strength and Doshas, should in the beginning, refrain from stopping the bleeding if the patient suffering from Rakta Pitta.
A Physician who desires success in treatment should do so even if the attack of the disease is acute [25-28]

Langhana treatment

प्रायेण हि समुत्क्लिष्टमामदोषाच्छरीरिणाम्|
वृद्धिं प्रयाति पित्तासृक्तस्मात्तल्लङ्घ्यमादितः||२९||
मार्गौ दोषानुबन्धं च निदानं प्रसमीक्ष्य च|
लङ्घनं रक्तपित्तादौ तर्पणं वा प्रयोजयेत्||३०||
prāyeṇa hi samutkliṣṭamāmadoṣāccharīriṇām|
vṛddhiṃ prayāti pittāsṛktasmāttallaṅghyamāditaḥ||29||
mārgau doṣānubandhaṃ ca nidānaṃ prasamīkṣya ca|
laṅghanaṃ raktapittādau tarpaṇaṃ vā prayojayet||30||

Urdhwaga Raktapitta (bleeding from upper orifices) is associated with Pitta and Kapha. It occurs due to Snigdha – unctuous, oily and Ushna – hot qualities.
To counter Kapha, in the initial stages, Langhana – lightening therapy (to bring about lightness to the body, via fasting etc) is advocated.
Adhoga Raktapitta (bleeding through lower orifices), is due to Vata and Pitta. Here, Tarpana treatment (nourishing) is advocated. Tarpana is achieved by giving nourishing Yavagu (gruels). [29-30]

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Diet and Drinks

ह्रीबेर चन्दनोशीर मुस्त पर्पटकैः शृतम्|
केवलं शृतशीतं वा दद्यात्तोयं पिपासवे||३१||
ऊर्ध्वगे तर्पणं पूर्वं पेयां पूर्वमधोगते|
काल सात्म्यानुबन्धज्ञो दद्यात् प्रकृति कल्पवित्||३२||
जलं खर्जूर मृद्वीका मधूकैः सपरूषकैः|
शृत शीतं प्रयोक्तव्यं तर्पणार्थे सशर्करम्||३३||
तर्पणं सघृतक्षौद्रं लाजचूर्णैः प्रदापयेत्|
ऊर्ध्वगं रक्तपित्तं तत् पीतं काले व्यपोहति||३४||
मन्दाग्नेरम्लसात्म्याय तत् साम्लमपि कल्पयेत्|
दाडिमामलकैर्विद्वानम्लार्थं चानुदापयेत्||३५||
Hrībera candanośīra musta parpaṭakaiḥ śṛtam|
kevalaṃ śṛtaśītaṃ vā dadyāttoyaṃ pipāsave||31||
ūrdhvage tarpaṇaṃ pūrvaṃ peyāṃ pūrvamadhogate|
kāla sātmyānubandhajño dadyāt prakṛtikalpavit||32||
jalaṃ kharjūra mṛdvīkā madhūkaiḥ saparūṣakaiḥ|
śṛtaśītaṃ prayoktavyaṃ tarpaṇārthe saśarkaram||33||
tarpaṇaṃ saghṛtakṣaudraṃ lāja cūrṇaiḥ pradāpayet|
ūrdhvagaṃ raktapittaṃ tat pītaṃ kāle vyapohati||34||
mandāgneramlasātmyāya tat sāmlamapi kalpayet|
dāḍimāmalakairvidvānamlārthaṃ cānudāpayet||35||

If the patient is thirsty, he is given water boiled with-
Hrivera – Pavonia Odorata
Chandana – Santalum album
Usira – Vetiveria zizanioides
Musta – Cyperus rotundus
And Parpataka – Fumaria parviflora.
Or simple boiled and cooled water (sruta Sheeta) can also be given in this condition.
In Urdhwaga Raktapitta, Tarpana (nourishing drink) is given in the beginning.
In Adhoga Raktapitta, Peya (thin liquid drink) is given in the beginning.
The drug that is used for the preparation of Tarpana or Peya is determined by a physician who is acquainted with time Satmya, associated of Doshas, nature of the drugs and Kalpa (method of preparation).

For the purpose of Tarpana, water is boiled with
Kharjura – dates Phoenix dactylifera
Mrdvika – Grapes – Vitis vinifera
Madhuka – Madhuca longifolia and
Parushaka – Grewia asiatica
This water is cooled and added with sugar before administration.
The above recipe is prepared based on Shadanga Paneeya proportion – 1 part of herbs plus 64 parts of water, boiled and reduced to 32 parts, filtered.
Tarpana prepared with the powder of Laja (fried paddy) along with ghee and honey, is given to the patient to drink, in appropriate time. This potion cures Urdhvaga Rakta Pitta.
This Tarpana is made sour in taste for a person whose power of digestion is suppressed and who has a liking for the sour taste.
For making its sour,
Dadima – Pomegranate and
Amalaka – Emblica officinalis is used by a wise physician [31-35]

Wholesome foods

Raktapiite Pathyam:
शालि षष्टिक नीवार कोरदूष प्रशान्तिकाः|
श्यामाकश्च प्रियङ्गुश्च भोजनं रक्तपित्तिनाम्||३६||
मुद्गा मसूराश्चणकाः समकुष्ठाढकीफलाः|
प्रशस्ताः सूपयूषार्थे कल्पिता रक्तपित्तिनाम्||३७||
पटोल निम्ब वेत्राग्र प्लक्ष वेतस पल्लवाः|
किराततिक्तकं शाकं गण्डीरः सकठिल्लकः||३८||
कोविदारस्य पुष्पाणि काश्मर्यस्याथ शाल्मलेः|
अन्नपानविधौ शाकं यच्चान्यद्रक्तपित्तनुत्||३९||
शाकार्थं शाक सात्म्यानां तच्छस्तं रक्तपित्तिनाम्|
स्विन्नं वा सर्पिषा भृष्टं यूषवद्वा विपाचितम्||४०||
पारावतान् कपोतांश्च लावान् रक्ताक्षवर्तकान्|
शशान् कपिञ्जलानेणान् हरिणान्कालपुच्छकान्||४१||
रक्तपित्ते हितान् विद्याद्रसांस्तेषां प्रयोजयेत्|
ईषदम्लाननम्लान् वा घृतभृष्टान् सशर्करान्||४२||
कफानुगे यूषशाकं दद्याद्वातानुगे रसम्|
रक्तपित्ते यवागूनामतः कल्पः प्रवक्ष्यते||४३||
पद्मोत्पलानां किञ्जल्कः पृश्निपर्णी प्रियङ्गुकाः|
जले साध्या रसे तस्मिन् पेया स्याद्रक्तपित्तिनाम्||४४||
चन्दनोशीर लोध्राणां रसे तद्वत् सनागरे|
किरात तिक्तकोशीर मुस्तानां तद्वदेव च||४५||
धातकी धन्वयासाम्बुबिल्वानां वा रसे शृता|
मसूर पृश्निपर्ण्योर्वा स्थिरामुद्गरसेऽथ वा||४६||
रसे हरेणुकानां वा सघृते सबलारसे|
सिद्धाः पारावतादीनां रसे वा स्युः पृथक्पृथक्||४७||
इत्युक्ता रक्तपित्तघ्न्यः शीताः समधुशर्कराः|
यवाग्वः कल्पना चैषा कार्या मांसरसेष्वपि||४८||
śāli ṣaṣṭika nīvārakoradūṣapraśāntikāḥ|
śyāmākaśca priyaṅguśca bhojanaṃ raktapittinām||36||
mudgā masūrāścaṇakāḥ samakuṣṭhāḍhakīphalāḥ|
praśastāḥ sūpayūṣārthe kalpitā raktapittinām||37||
paṭola nimba vetrāgra plakṣa vetasapallavāḥ|
kirātatiktakaṃ śākaṃ gaṇḍīraḥ sakaṭhillakaḥ||38||
kovidārasya puṣpāṇi kāśmaryasyātha śālmaleḥ|
annapānavidhau śākaṃ yaccānyadraktapittanut||39||
śākārthaṃ śākasātmyānāṃ tacchastaṃ raktapittinām|
svinnaṃ vā sarpiṣā bhṛṣṭaṃ yūṣavadvā vipācitam||40||
pārāvatān kapotāṃśca lāvān raktākṣavartakān|
śaśān kapiñjalāneṇān hariṇānkālapucchakān||41||
raktapitte hitān vidyādrasāṃsteṣāṃ prayojayet|
īṣadamlānanamlān vā ghṛtabhṛṣṭān saśarkarān||42||
kaphānuge yūṣaśākaṃ dadyādvātānuge rasam|
raktapitte yavāgūnāmataḥ kalpaḥ pravakṣyate||43||
padmotpalānāṃ kiñjalkaḥ pṛśniparṇī priyaṅgukāḥ|
jale sādhyā rase tasmin peyā syādraktapittinām||44||
candanośīralodhrāṇāṃ rase tadvat sanāgare|
kirātatiktakośīramustānāṃ tadvadeva ca||45||
dhātakīdhanvayāsāmbubilvānāṃ vā rase śṛtā|
masūrapṛśniparṇyorvā sthirāmudgarase’tha vā||46||
rase hareṇukānāṃ vā saghṛte sabalārase|
siddhāḥ pārāvatādīnāṃ rase vā syuḥ pṛthakpṛthak||47||
ityuktā raktapittaghnyaḥ śītāḥ samadhuśarkarāḥ|
yavāgvaḥ kalpanā caiṣā kāryā māṃsaraseṣvapi||48||

Food used by a patient suffering from Rakta Pitta:
Shali – rice
Shastika – a type of rice
Neevara –
Koradusha
Prasantika
Shyamaka and
Priyangu – Callicarpa macrophylla
Drugs useful for the preparation of Supa (soup) and Yusha (drink) for a patient suffering from Rakta Pitta:
Mudga – Green gram
Masura – Masoor dal
Chanaka – Bengal gram
Makustha – Phaseolus aconitifolius and
Fruits of Adhaki – Cajanus cajan
Vegetables to be given to patients suffering from Rakta pitta:
Patola – Trichosanthes dioica
Nimba – Neem – Azadirachta indica
Vetragra
Plaksha – Ficus lacor
Leaves of Vetasa – Salix caprea
Kirata Tikta – Swertia chirata
Gandira – Canthium parviflorum
Kathillaka
Flowers of Kovidara – Bauhinia variegata and
Shalmali – Salmalia malabarica
These vegetables can be prepared by steam boiling, or by frying with ghee.
These can also be given in the form of vegetable soup.
The meat or meat soup of
Paravata, Kapota (pigeon), Lava, Raktaksha, Vartaka, Shasha (rabbit), Kapinjala, Ena, Harina (deer), Kalapucchaka. The meat should be fried with ghee and added with sugar.
If the disease is associated with Kapha, then vegetable soup (Yusha shaka) is preferred and if it is associated with Vata, then meat soup is preferred.

Yavagu recipes

Different Yavagu – medicated gruels:
1. Padmakinjalka (lotus androecium) and Utpala, Parni and Priyangu should be boiled in water. With this water, gruel is prepared.
2. Similar gruel can also be prepared with Chandana (sandalwood), Usheera (Vetiver), Lodhra (Symplocos racemosa) and ginger.
3. Greul can also be prepared with water of Kiratatikta (Swertia chirata), Usheera and Musta (Cyperus rotundus).
4. Yavagu prepared with Masura and Prishniparni is useful
5. Yavagu prepared with extract of Dhataki, Dhanvayasa, Ambu and Bilva
6. Yavagu of Sthira and Mudga – Green gram
7. Yavagu of Harenuka
8. Yavagu prepared with ghee and Bala (Sida cordifolia)
These gruels should be administered after self cooling and added with honey and sugar. yavagu can also be prepared using meat soups.

Diet based on stage of Raktapitta

Diet based on Rakta Pitta stages:
शशः सवास्तुकः शस्तो विबन्धे रक्तपित्तिनाम्|
वातोल्बणे तित्तिरिः स्यादुदुम्बररसे शृतः||४९||
मयूरः प्लक्ष निर्यूहे न्यग्रोधस्य च कुक्कुटः|
रसे बिल्वोत्पलादीनां वर्तकक्रकरौ हितौ||५०||
तृष्यते तिक्तकैः सिद्धं तृष्णाघ्नं वा फलोदकम्|
सिद्धं विदारिगन्धाद्यैरथवा शृतशीतलम्||५१||
śaśaḥ savāstukaḥ śasto vibandhe raktapittinām|
vātolbaṇe tittiriḥ syādudumbararase śṛtaḥ||49||
mayūraḥ plakṣa niryūhe nyagrodhasya ca kukkuṭaḥ|
rase bilvotpalādīnāṃ vartakakrakarau hitau||50||
tṛṣyate tiktakaiḥ siddhaṃ tṛṣṇāghnaṃ vā phalodakam|
siddhaṃ vidārigandhādyairathavā śṛtaśītalam||51||

If the patient suffering from Rakta Pitta develops constipation, then the meat of Shasha (rabbit) along with Vastuka is useful.
Jwara – fever
If there is predominance of Vayu, then Tittiri – Patridge boiled with the extract of udumbara (Ficus racemosa) is useful.
Following medicines are also useful.
1. Mayura (peacock) boiled with the decoction of Plaksha – Ficus lacor
2. Kukkuta (cock) boiled with the decoction of Nyagrodha – Ficus bengalensis
3. Vartaka and Krakra, boiled with the decoction of Bilva – Aegle marmelos ; Utpala etc:
If the patient is suffering from thirst, then, the following recipes are useful
1. Water boiled with bitter herbs
2. Fruit juice
3. Water boiled Vidarigandha etc. (Laghu Panca Mula) (49-51)

Drinks

ज्ञात्वा दोषावनुबलौ बलमाहारमेव च|
जलं पिपासवे दद्याद्विसर्गादल्पशोऽपि वा||५२||
jñātvā doṣāvanubalau balamāhārameva ca|
jalaṃ pipāsave dadyādvisargādalpaśo’pi vā||52||

After ascertaining that nature of the subsidiary Doshas, the strength and diet of the patient, water is given to him when he is thirsty till the limit of satisfaction is reached or in small quantities.[52]

Advice to avoid causative factors:
निदानं रक्तपित्तस्य यत्किञ्चित् सम्प्रकाशितम्|
जीवितारोग्यकामैस्तन्न सेव्यं रक्तपित्तिभिः||५३||
इत्यन्नपानं निर्दिष्टं क्रमशो रक्तपित्तनुत्|५४|
nidānaṃ raktapittasya yatkiñcit samprakāśitam|
jīvitārogyakāmaistanna sevyaṃ raktapittibhiḥ||53||
ityannapānaṃ nirdiṣṭaṃ kramaśo raktapittanut|54|

In Nidana 2:4, the causative factors of Rakta Pitta are described. A patient of Rakta Pitta who describes life and health should not resort to these factors.
Thus the diet and drinks for a person suffering from Rakta Pitta are described seriatim [53-54]

Shodhana treatment

Shodhana for Raktapitta – Panchakarma procedures:
वक्ष्यते बहुदोषाणां कार्यं बलवतां च यत्||५४||
अक्षीण बल मांसस्य यस्य सन्तर्पणोत्थितम्|
बहुदोषं बलवतो रक्तपित्तं शरीरिणः||५५||
काले संशोधनार्हस्य तद्धरेन्निरुपद्रवम्|
विरेचनेनोर्ध्वभागमधोगं वमनेन च||५६||
त्रिवृतामभयां प्राज्ञः फलान्यारग्वधस्य वा|
त्रायमाणां गवाक्ष्या वा मूलमामलकानि वा||५७||
विरेचनं प्रयुञ्जीत प्रभूतमधुशर्करम्|
रसः प्रशस्यते तेषां रक्तपित्ते विशेषतः||५८||
वमनं मदनोन्मिश्रो मन्थः सक्षौद्रशर्करः|
सशर्करं वा सलिलमिक्षूणां रस एव वा||५९||
वत्सकस्य फलं मुस्तं मदनं मधुकं मधु|
अधोवहे रक्तपित्ते वमनं परमुच्यते||६०||
ऊर्ध्वगे शुद्धकोष्ठस्य तर्पणादिः क्रमो हितः|
अधोगते यवाग्वादिर्न चेत्स्यान्मारुतो बली||६१||
vakṣyate bahudoṣāṇāṃ kāryaṃ balavatāṃ ca yat||54||
akṣīṇa bala māṃsasya yasya santarpaṇotthitam|
bahudoṣaṃ balavato raktapittaṃ śarīriṇaḥ||55||
kāle saṃśodhanārhasya taddharennirupadravam|
virecanenordhvabhāgamadhogaṃ vamanena ca||56||
trivṛtāmabhayāṃ prājñaḥ phalānyāragvadhasya vā|
trāyamāṇāṃ gavākṣyā vā mūlamāmalakāni vā||57||
virecanaṃ prayuñjīta prabhūtamadhuśarkaram|
rasaḥ praśasyate teṣāṃ raktapitte viśeṣataḥ||58||
vamanaṃ madanonmiśro manthaḥ sakṣaudraśarkaraḥ|
saśarkaraṃ vā salilamikṣūṇāṃ rasa eva vā||59||
vatsakasya phalaṃ mustaṃ madanaṃ madhukaṃ madhu|
adhovahe raktapitte vamanaṃ paramucyate||60||
ūrdhvage śuddhakoṣṭhasya tarpaṇādiḥ kramo hitaḥ|
adhogate yavāgvādirna cetsyānmāruto balī||61||

Let us know about the therapies that are administered to persons having exceedingly aggravated Doshas and physical strength.
Virechana (purgation) is given to a patient suffering from Urdhvaga Rakta Pitta and
Vamana (Emesis) is given to a patient suffering from Adhoga Rakta PItta, in the following circumstances:
1. If the strength and muscle tissue of the patient are not reduced,
2. If disease is caused because of Santarpana (over-nourishment)
3. If there is excess of aggravated Doshas
4. If the patient is physically strong because of seasonal effects.
5. If the time is conducive to the administration of elimination therapy i.e. if the reason is neither very hot nor very cold.
6. If the patient is suitable for the administration of these therapies
7. If the patient is free from complications, or if the recipe, to be administered, is not associated with any complications
For the purpose of Virechana (Purgation) a wise physician should administer along with liberal quantity of honey and sugar, the following recipes:
1. Trivrit – Ipomoea turpethum and Abhaya – Terminalia chebula
2. Fruits of Aragvadha – Cassia fistula
3. Trayamana – Gentiana kurroo
4. Gavakshi
5. Mulaka – Radish and Amalaki – Emblica officinalis

For Adhoga Raktapita, Vamana is an excellent therapy and it is administered by the following recipes:
1. Mantha prepared of Madana (Randia dumetorum) and added with honey and Sugar along with additional sugar and water
2. Mantha prepared of Madana (Randia dumetorum) and added with honey and sugar and added with sugarcane juice
3. The fruits of Vatsaka – Kutaja – Holarrhena antidysenterica
Musta – Cyperus rotundus
Madana – Randia dumetorum
Madhuka—Madhuca longifolia and
Madhu – honey

In Urdhvaga Rakta Pitta, when the bowels are cleaned by the administration of purgation, Tarpana etc. is gradually given to the patient.
In adhoga type of Rakta pitta, when the alimentary tract is cleaned by emesis, Yavagu etc, is given to the patient, if Vayu is not aggravated in excess [54-46]

Shamana treatments

Shamana Chikitsa – Alleviation therapy:
बल मांस परिक्षीणं शोकभाराध्व कर्शितम्|
ज्वलनादित्य सन्तप्तमन्यैर्वा क्षीणमामयैः||६२||
गर्भिणीं स्थविरं बालं रूक्षाल्प प्रमिताशिनम्|
अवम्यम विरेच्यं वा यं पश्येद्रक्तपित्तिनम्||६३||
शोषेण सानुबन्धं वा तस्य संशमनी क्रिया|
शस्यते रक्तपित्तस्य परं साऽथ प्रवक्ष्यते||६४||
अटरूषक मृद्वीकापथ्याक्वाथः सशर्करः|
मधुमिश्रः श्वास कास रक्तपित्त निबर्हणः||६५||
अटरूषक निर्यूहे प्रियङ्गुं मृत्तिकाञ्जने|
विनीय लोध्रं क्षौद्रं च रक्तपित्तहरं पिबेत्||६६||
पद्मकं पद्मकिञ्जल्कं दूर्वां वास्तूकमुत्पलम्|
नागपुष्पं च लोध्रं च तेनैव विधिना पिबेत्||६७||
प्रपौण्डरीकं मधुकं मधु चाश्वशकृद्रसे|
यवासभृङ्गरजसोर्मूलं वा गोशकृद्रसे||६८||
विनीय रक्तपित्तघ्नं पेयं स्यात्तण्डुलाम्बुना|
युक्तं वा मघुसर्पिर्भ्यां लिह्याद्गोश्वशकृद्रसम्||६९||
खदिरस्य प्रियङ्गूणां कोविदारस्य शाल्मलेः|
पुष्पचूर्णानि मधुना लिह्यान्ना रक्तपित्तिकः||७०||
शृङ्गाटकानां लाजानां मुस्तखर्जूरयोरपि|
लिह्याच्चूर्णानि मधुना पद्मानां केशरस्य च||७१||
धन्वजानामसृग्लिह्यान्मधुना मृगपक्षिणाम्|
सक्षौद्रं ग्रथिते रक्ते लिह्यात् पारावतं शकृत्||७२||
bala māṃsa parikṣīṇaṃ śokabhārādhva karśitam|
jvalanāditya santaptamanyairvā kṣīṇamāmayaiḥ||62||
garbhiṇīṃ sthaviraṃ bālaṃ rūkṣālpa pramitāśinam|
avamyama virecyaṃ vā yaṃ paśyedraktapittinam||63||
śoṣeṇa sānubandhaṃ vā tasya saṃśamanī kriyā|
śasyate raktapittasya paraṃ sā’tha pravakṣyate||64||
aṭarūṣaka mṛdvīkāpathyākvāthaḥ saśarkaraḥ|
madhumiśraḥ śvāsa kāsa raktapitta nibarhaṇaḥ||65||
aṭarūṣaka niryūhe priyaṅguṃ mṛttikāñjane|
vinīya lodhraṃ kṣaudraṃ ca raktapittaharaṃ pibet||66||
padmakaṃ padmakiñjalkaṃ dūrvāṃ vāstūkamutpalam|
nāgapuṣpaṃ ca lodhraṃ ca tenaiva vidhinā pibet||67||
prapauṇḍarīkaṃ madhukaṃ madhu cāśvaśakṛdrase|
yavāsabhṛṅgarajasormūlaṃ vā gośakṛdrase||68||
vinīya raktapittaghnaṃ peyaṃ syāttaṇḍulāmbunā|
yuktaṃ vā maghusarpirbhyāṃ lihyādgośvaśakṛdrasam||69||
khadirasya priyaṅgūṇāṃ kovidārasya śālmaleḥ|
puṣpacūrṇāni madhunā lihyānnā raktapittikaḥ||70||
śṛṅgāṭakānāṃ lājānāṃ mustakharjūrayorapi|
lihyāccūrṇāni madhunā padmānāṃ keśarasya ca||71||
dhanvajānāmasṛglihyānmadhunā mṛgapakṣiṇām|
sakṣaudraṃ grathite rakte lihyāt pārāvataṃ śakṛt||72||

Shamana Chikitsa – Alleviation therapy:
Alleviation therapy is useful for a patient suffering from Rakta Pitta in the following conditions:
1. If there is loss of strength and muscle tissue in the patient
2. If the patient is emaciated because of grief, carrying heavy load and walking long distance
3. If the patient is afflicted with the heat of the fire or sun rays;
4. If the patient is emaciated because of other diseases
5. If the patient is a pregnant lady, person of old age or very young
6. If the patient is habituated with taking unctuous food or if he takes small quantity of food for less number of times
7. If the patient is not suitable for emesis or Purgation therapies and
If the patient is suffering from consumption recipes for alleviation therapy are being described below:

1. The Kashaya of
Atarusaka – Vasa – Adhatoda vasica
Mrdvika – raisins and
Pathya – Terminalia chebula along with sugar and honey
Cures
Shvasa – Asthma
Kasa – bronchitis and
Rakta Pitta.

2. In the decoction of Atarusaka, the paste of
Priyangu – Callicarpa macrophylla
Mrttika – mud
Anjana – Collyrium
Lodhra – Symplocos racemosa and
Honey are added. This Kashaya cures Rakta Pitta.

3. A Kashaya prepared of
Padmaka Kinjalka (androecium) or Padma – Nelumbo nucifera
Durva – Cynodon dactylon
Vastuka
Utpala
Nagapuspa – Mesua ferrea and
Lodhra – Symplocos racemosa is taken along with the decoction of Vasa and honey.

4. A medicated liquid prepared of
Prapaundarika –
Madhuka – Madhuca longifolia and
Madhu – honey
In root of
Yavasa – Alhagi pseudalhagi and
Bhrngaraja – Eclipta alba
In the juice of the stool of horse or the one prepared of the root of
Yavasa – Alhagi pseudalhagi and
Bhrngaraja – Eclipta alba
In the juice of the stool of cow is taken along with Tandulambu (rice-wash).

5. Avaleha prepared of the powder of
Khadira – Acacia catechu
Priyangu – Callicarpa macrophylla
Kovidara – and
The flower of Shalmali – Salmalia malabarica
By adding honey it is given to the patient suffering from rakta pitta.

6. Avaleha prepared of the powders of
Shringataka – Tectona grandis
Laja – Fried paddy
Musta – Cyperus rotundus
Kharjura – Phoenix dactylifera and
Kesara (androecium) of Padma (Nelumbo nucifera) by adding honey is given to the patient.

7. The blood of animals and birds inhabiting arid land (Jangala) is taken as linctus by adding honey.
8. A linctus is prepared of the juice of the stool of horse and taken along with honey and ghee
9. If the blood is clotted, then the stool of Paravata mixed with honey is given to the patient in the form of a linctus.[62-72]

उशीर कालीयक लोध्र पद्मक प्रियङ्गुका कट्फलशङ्ख गैरिकाः|
पृथक् पृथक् चन्दन तुल्यभागिकाः सशर्करास्तण्डुलधावनाप्लुताः||७३||
रक्तं सपित्तं तमकं पिपासां दाहं च पीताः शमयन्ति सद्यः|
किराततिक्तं क्रमुकं समुस्तं प्रपौण्डरीकं कमलोत्पले च||७४||
ह्रीबेर मूलानि पटोलपत्रं दुरालभा पर्पटको मृणालम्|
धनञ्जयोदुम्बरवेतसत्वङ्न्यग्रोधशालेयय वासकत्वक्||७५||
तुगालतावेतस तण्डुलीयं ससारिवं मोचरसः समङ्गा|
पृथक् पृथक् चन्दनयोजितानि तेनैव कल्पेन हितानि तत्र||७६||
निशि स्थिता वा स्वरसीकृता वा कल्कीकृता वा मृदिताः शृता वा|
एते समस्ता गणशः पृथग्वा रक्तं सपित्तं शमयन्ति योगाः||७७||
uśīra kālīyaka lodhra padmaka priyaṅgukā kaṭphalaśaṅkha gairikāḥ|
pṛthak pṛthak Chandana tulyabhāgikāḥ saśarkarāstaṇḍuladhāvanāplutāḥ||73||
raktaṃ sapittaṃ tamakaṃ pipāsāṃ dāhaṃ ca pītāḥ śamayanti sadyaḥ|
kirātatiktaṃ kramukaṃ samustaṃ prapauṇḍarīkaṃ kamalotpale ca||74||
hrībera mūlāni paṭolapatraṃ durālabhā parpaṭako mṛṇālam|
dhanañjayodumbaravetasatvaṅnyagrodhaśāleyaya vāsakatvak||75||
tugālatāvetasa taṇḍulīyaṃ sasārivaṃ mocarasaḥ samaṅgā|
pṛthak pṛthak Chandanayojitāni tenaiva kalpena hitāni tatra||76||
niśi sthitā vā svarasīkṛtā vā kalkīkṛtā vā mṛditāḥ śṛtā vā|
ete samastā gaṇaśaḥ pṛthagvā raktaṃ sapittaṃ śamayanti yogāḥ||77||

Usira – Vetiveria zizanioides
Kaliyaka –
Lodhra – Symplocos racemosa
Padma – Nelumbo nucifera
Priyanguka – Callicarpa macrophylla
Katphala – Myrica nagi
Shankha – Trapa bispinosa and
Gairika- these drugs taken separately, is added with equal quantity of Chandana (Santalum album) and given to the patient along with sugar (in equal quantity) and Tandula Dhavana (rice wash).
These preparations instantaneously cure Rakta Pitta, Tamaka (Asthma), Pipasa (Morbid thirst) and Daha (burning sensation)

Kiratatikta – Swertia chirata
Kramuka (Pattika Lodhra)
Musta – Cyperus rotundus
Prapaundarika
Kamala – Nelumbo nucifera
Utpala
The roots of Hribera – Pavonia odorata
Leaves of Patola – Trichosanthes dioica
Duralabha
Parpataka
Mrnala
Dhananjaya (Arjuna) — Terminalia arjuna
Udumbara – Ficus racemosa
Bark of Vetasa – Salix caprea
Nyagrodha – Ficus bengalensis
Shaleya
Bark of Yavasaka – Alhagi pseudalhagi
Tunga
Lata (Priyangu)
Vetasa – Salix caprea
Tanduliya
Sariva – Cordia latifolia
Mocharasa—Salmalia malabarica and
Samangi (Varadha Kranta or Lajjalu) – Mimosa pudica

These drugs taken separately, along with equal quantity of Chandana (Santalum album), is given to the patient with sugar (in equal quantity) and Tandula Dhavana (rice wash).
These drugs can be administrated in the form of Sita Kasaya (Keeping the powder in water overnight in the water and then filtering), Svarasa (Juice), Kalka (paste or powder) Mrudita (infusion) or Sheeta (decoction).
Recipes prepared by taking all these drugs together or drugs of each of these groups separately, cure together or drugs of each of these groups separately, cure Rakthapitta [73-77]

मुद्गाः सलाजाः सयवाः सकृष्णाः सोशीरमुस्ताः सह चन्दनेन|
बलाजले पर्युषिताः कषाया रक्तं सपित्तं शमयन्त्युदीर्णम्||७८||
mudgāḥ salājāḥ sayavāḥ sakṛṣṇāḥ sośīramustāḥ saha candanena|
balājale paryuṣitāḥ kaṣāyā raktaṃ sapittaṃ śamayantyudīrṇam||78||

These drugs are soaked in the decoction of Bala and kept overnight:
Mudga – Vigna radiata
Laja – Fried paddy
Yava
Krushna
Usira -Vetiveria zizanioides
Musta – Cyperus rotundus and
Chandana – Santalum album
This recipe, if administered, cures acute form of Rakta Pitta[78]

वैदूर्य मुक्ता मणि गैरिकाणां मृच्छङ्खहेमामलकोदकानाम्|
मधूदकस्येक्षुरसस्य चैव पानाच्छमं गच्छति रक्तपित्तम्||७९||
उशीर पद्मोत्पल चन्दनानां पक्वस्य लोष्टस्य च यः प्रसादः|
सशर्करः क्षौद्रयुतः सुशीतो रक्तातियोग प्रशमाय देयः||८०||
प्रियङ्गुका चन्दन लोध्र सारिवा मधूक मुस्ताभय धातकी जलम्|
समृत्प्रसादं सह यष्टिकाम्बुना सशर्करं रक्तनिबर्हणं परम्||८१||
vaidūrya muktā maṇigairikāṇāṃ mṛcchaṅkhahemāmalakodakānām|
madhūdakasyekṣurasasya caiva pānācchamaṃ gacchati raktapittam||79||
uśīra padmotpala candanānāṃ pakvasya loṣṭasya ca yaḥ prasādaḥ|
saśarkaraḥ kṣaudrayutaḥ suśīto raktātiyoga praśamāya deyaḥ||80||
priyaṅgukā candana lodhra sārivā madhūka mustābhaya dhātakī jalam|
samṛtprasādaṃ saha yaṣṭikāmbunā saśarkaraṃ raktanibarhaṇaṃ param||81||

By taking the water soaked with-
Vaidurya,
Mukta – Pearl
Manigairika,
Mrut – mud
Shankha – conch
Hema – gold and
Amalaka, the water mixed with honey and sugarcane juice- rakta pitta cured.

In the decoction of
Usira – Vetiveria zizanoides
Padma – Nelumbo nucifera
Utpala and
Chandana – Santalum album
Red hot coal of earth is immersed.
Then the decoction is filtered and cooled.
To this decoction, sugar and honey is added and administered to the patient for the cure of blending in excess in Rakta Pitta.

The water soaked with
Priyanguka – Callicarpa marophylla
Chandana – Santalum album
Lodhra – Symplocos racemosa
Sariva – Sarsaparilla
Madhuka – Madhuca longifolia
Musta – Cyperus rotundus
Abhaya, Usheera and
Dhataki – Woodfordia floribunda
Is taken along with Mrt Pradada (water soaked with red hot clot of earth and cooled), decoction of Yastika and sugar. These are the excellent recipes for the stoppage of bleeding [79-81]

कषाययोगैर्विविधैर्यथोक्तैर्दीप्तेऽनले श्लेष्मणि निर्जिते च|
यद्रक्तपित्तं प्रशमं न याति तत्रानिलः स्यादनु तत्र कार्यम्||८२||
छागं पयः स्यात् परमं प्रयोगे गव्यं शृतं पञ्चगुणे जले वा|
सशर्करं माक्षिक सम्प्रयुक्तं विदारिगन्धादिगणैः शृतं वा||८३||
द्राक्षाशृतं नागरकैः शृतं वा बलाशृतं गोक्षुरकैः शृतं वा|
सजीवकं सर्षभकं ससर्पिः पयः प्रयोज्यं सितया शृतं वा||८४||
kaṣāyayogairvividhairyathoktairdīpte’nale śleṣmaṇi nirjite ca|
yadraktapittaṃ praśamaṃ na yāti tatrānilaḥ syādanu tatra kāryam||82||
chāgaṃ payaḥ syāt paramaṃ prayoge gavyaṃ śṛtaṃ pañcaguṇe jale vā|
saśarkaraṃ mākṣika samprayuktaṃ vidārigandhādigaṇaiḥ śṛtaṃ vā||83||
drākṣāśṛtaṃ nāgarakaiḥ śṛtaṃ vā balāśṛtaṃ gokṣurakaiḥ śṛtaṃ vā|
sajīvakaṃ sarṣabhakaṃ sasarpiḥ payaḥ prayojyaṃ sitayā śṛtaṃ vā||84||

If Rakta Pitta does not get alleviated even after the administration of the various types of Kashaya described before and by stimulation of the power of digestion as well as alleviation of Kapha, then, the physician should understand that Vayu is aggravated. For cure of this condition, the following are the excellent recipes:
1. Goat milk
2. Cow’s milk boiled with five times of water to be taken along with sugar and honey.
3. Cow’s milk boiled with herbs belonging to Vidari Gandhadi
4. Cow’s milk boiled with raisins and ginger
5. Cow’s milk boiled with Bala (Sida cordifolia) and Goksuraka (Tribulus terristris)
6. Cow’s milk boiled with Jivaka and Rishabhaka added with ghee and sugar. [82-84]

शतावरी गोक्षुरकैः शृतं वा शृतं पयो वाऽप्यथ पर्णिनीभिः|
रक्तं निहन्त्याशु विशेषतस्तु यन्मूत्रमार्गात् सरुजं प्रयाति||८५||
śatāvarī gokṣurakaiḥ śṛtaṃ vā śṛtaṃ payo vā’pyatha parṇinībhiḥ|
raktaṃ nihantyāśu viśeṣatastu yanmūtramārgāt sarujaṃ prayāti||85||

Milk boiled with-
Shatavari – Asparagus racemosus and
Goksuraka – Tribulus terrestris or with
Shalaparni – Desmodium gangeticum
Prishniparni – Uraria picta and
Mudgaparni – Phaseolus trilobus immediately stops bleeding especially when blood comes out through the urinary tract along with pain [85]

विशेषतो विट्पथसम्प्रवृत्ते पयो मतं मोचरसेन सिद्धम्|
वटावरोहैर्वटशुङ्गकैर्वा ह्रीबेर नीलोत्पल नागरैर्वा||८६||
कषाययोगान् पयसा पुरा वा पीत्वाऽनु चाद्यात् पयसैव शालीन्|
कषाययोगैरथवा विपक्वमेतैः पिबेत् सर्पिरतिस्रवे च||८७||
viśeṣato viṭpathasampravṛtte payo mataṃ mocarasena siddham|
vaṭāvarohairvaṭaśuṅgakairvā hrībera nīlotpala nāgarairvā||86||
kaṣāyayogān payasā purā vā pītvā’nu cādyāt payasaiva śālīn|
kaṣāyayogairathavā vipakvametaiḥ pibet sarpiratisrave ca||87||

When there is bleeding, especially through the Anus, then the following recipes are useful:
1. Milk boiled with Mocharasa
2. Milk boiled with either Vatavaroha (adventitious root of Vata) or Vata- Sunga (leafy buds of Vata)
3. Milk boiled with Hribera, Nilotapalaand Nagara
4. Recipes of drugs described before (vied verse nos, 65-71) along with milk.
After taking these recipes the patient should take Shali rice along with milk.
If there is excessive bleeding, then ghee boiled with the decoctions described above is administered [86-87]

Vasa Ghruta

वासां सशाखां सपलाशमूलां कृत्वा कषायं कुसुमानि चास्याः|
प्रदाय कल्कं विपचेद्घृतं तत् सक्षौद्रमाश्वेव निहन्ति रक्तम्||८८||
इति वासाघृतम्|
vāsāṃ saśākhāṃ sapalāśamūlāṃ kṛtvā kaṣāyaṃ kusumāni cāsyāḥ|
pradāya kalkaṃ vipacedghṛtaṃ tat sakṣaudramāśveva nihanti raktam||88||
iti vāsāghṛtam|

Decoctions are prepared of Vasa (Adhathoda vasica) along with its twigs, leaves, roots and flowers. Along with this decoction and the paste of Vasa, ghee is boiled honey is added to it. Administration of this recipe immediately stops bleeding [88]

पलाश वृन्त स्वरसेन सिद्धं तस्यैव कल्केन मधु द्रवेण|
लिह्याद्घृतं वत्सक कल्क सिद्धं तद्वत् समङ्गोत्पल लोध्र सिद्धम्||८९||
स्यात्त्रायमाणाविधिरेष एव सोदुम्बरे चैव पटोलपत्रे|
सर्पींषि पित्तज्वरनाशनानि सर्वाणि शस्तानि च रक्तपित्ते||९०||
palāśa vṛnta svarasena siddhaṃ tasyaiva kalkena madhu draveṇa|
lihyādghṛtaṃ vatsaka kalka siddhaṃ tadvat samaṅgotpala lodhra siddham||89||
syāttrāyamāṇāvidhireṣa eva sodumbare caiva paṭolapatre|
sarpīṃṣi pittajvaranāśanāni sarvāṇi śastāni ca raktapitte||90||

For the alleviation of Rakta pitta, all the following recipes are useful:
1. The ghee prepared by boiling with the juice and paste of the stalk of Palasha. This is used as linctus by liquifying with honey.
2. Similarly, ghee prepared with the paste of Vatsaka
3. Ghee prepared with the paste of Samanga, Utpala and Lodhra in a similar manner.
4. Ghee prepared in a similar manner, with Trayamana
5. Ghee prepared in a similar manner by Udumbara and leaves of Patola
6. Medicated ghees described earlier (in Cikistsa 3) for the alleviation of Pitta Jvara.[89-90]

अभ्यङ्ग योगाः परिषेचनानि सेकावगाहाः शयनानि वेश्म|
शीतो विधिर्बस्तिविधानमग्र्यं पित्त ज्वरे यत् प्रशमाय दिष्टम्||९१||
तद्रक्तपित्ते निखिलेन कार्यं कालं च मात्रां च पुरा समीक्ष्य|
सर्पिर्गुडा ये च हिताः क्षतेभ्यस्ते रक्तपित्तं शमयन्ति सद्यः||९२||
abhyaṅga yogāḥ pariṣecanāni sekāvagāhāḥ śayanāni veśma|
śīto vidhirbastividhānamagryaṃ pitta jvare yat praśamāya diṣṭam||91||
tadraktapitte nikhilena kāryaṃ kālaṃ ca mātrāṃ ca purā samīkṣya|
sarpirguḍā ye ca hitāḥ kṣatebhyaste raktapittaṃ śamayanti sadyaḥ||92||

Excellent recipes of Abhyanga (massage), Parisechana (sprinkling), Seka (spray), Avagaha (bath), Sayana (bed), Veshma( residence), Sita Vidhi( method of cooling), Basti (medicated enema) described for the alleviation of Pitta issued in their entirety for the treatment of Rakta Pitta. Before administration, the physician should keep in view the time and the dose of these recipes.
Sarpis (medicated ghee) and Guda (recipes prepared out of Jaggery), which are useful for patients suffering from Kshata (phithsis) are also useful for patients suffering from Kshata (Phithsis) are also useful in alleviating Rakta Pitta instantaneously.[91-92]

कफानुबन्धे रुधिरे सपित्ते कण्ठागते स्याद्ग्रथिते प्रयोगः|
युक्तस्य युक्त्या मधुसर्पिषोश्च क्षारस्य चैवोत्पलनालजस्य||९३||
मृणाल पद्मोत्पल केशराणां तथा पलाशस्य तथा प्रियङ्गोः|
तथा मधूकस्य तथाऽसनस्य क्षाराः प्रयोज्या विधिनैव तेन||९४||
kaphānubandhe rudhire sapitte kaṇṭhāgate syādgrathite prayogaḥ|
yuktasya yuktyā madhusarpiṣośca kṣārasya caivotpalanālajasya||93||
mṛṇāla padmotpala keśarāṇāṃ tathā palāśasya tathā priyaṅgoḥ|
tathā madhūkasya tathā’sanasya kṣārāḥ prayojyā vidhinaiva tena||94||

If in Rakta Pitta there is Kaphanubandha (vitiation of Kapha as a secondary pathology), and if it gets clotted while passing through the throat, then appropriately (in appropriate quantity) honey and ghee is used.
In the same manner, the Ksaras (alkali preparations) is prepared of the stalk of Utpala, Mrnala, Kesara (androecium) of Padma and Utpala, Priyangu, Madhuka and Asana is administered in the above mentioned conditions [93-94]

Shatavaryadi Ghrita

शतावरी दाडिम तिन्तिडीकं काकोलि मेदे मधुकं विदारीम्|
पिष्ट्वा च मूलं फलपूरकस्य घृतं पचेत् क्षीर चतुर्गुणं ज्ञः||९५||
कास ज्वरानाह विबन्ध शूलं तद्रक्तपित्तं च घृतं निहन्यात्|
यत् पञ्चमूलैरथ पञ्चभिर्वा सिद्धं घृतं तच्च तदर्थकारि||९६||
इति शतावर्यादिघृतम्|
śatāvarī dāḍima tintiḍīkaṃ kākoli mede madhukaṃ vidārīm|
piṣṭvā ca mūlaṃ phalapūrakasya ghṛtaṃ pacet kṣīra caturguṇaṃ jñaḥ||95||
kāsa jvarānāha vibandha śūlaṃ tadraktapittaṃ ca ghṛtaṃ nihanyāt|
yat pañcamūlairatha pañcabhirvā siddhaṃ ghṛtaṃ tacca tadarthakāri||96||
iti śatāvaryādighṛtam|

The recipe prepared by boiling ghee with the paste of
Shatavari – Asparagus racemosus
Dadima – Punica granatum
Tintidika – Rhus parviflora
Kakoli – Roscoea purpurea
Both the varieties of Meda – Polygonatum verticillatum
Madhuka – Madhuca longifolia
Vidari – Pueraria tuberosa
Root of Phala Puraka (Bija Puraka) — Citrus medica and
4 times of milk, is used by a physician
For curing:
Kasa – cough
Jvara – fever
Anaha – flatulence
Vibandha – constipation
Sula – colic pain and
Rakta Pitta.
Medicated ghee prepared by the five varieties of Pancha Mula (described in Chikista 1:1;41:45) has also got the above mentioned properties.[95-96]

कषाययोगा य इहोपदिष्टास्ते चावपीडे भिषजा प्रयोज्याः|
घ्राणात् प्रवृत्तं रुधिरं सपित्तं यदा भवेन्निःसृतदुष्टदोषम्||९७||
रक्ते प्रदुष्टे ह्यवपीडबन्धे दुष्टप्रतिश्याय शिरोविकाराः|
रक्तं सपूयं कुणपश्च गन्धः स्याद् घ्राणनाशः कृमयश्च दुष्टाः||९८||
नीलोत्पलं गैरिक शङ्खयुक्तं सचन्दनं स्यात्तु सिताजलेन|
नस्यं तथाऽऽम्रास्थिरसः समङ्गा सधातकीमोचरसः सलोध्रः||९९||
द्राक्षारसस्येक्षुरसस्य नस्यं क्षीरस्य दूर्वास्वरसस्य चैव|
यवासमूलानि पलाण्डुमूलं नस्यं तथा दाडिमपुष्पतोयम्||१००||
प्रियालतैलं मधुकं पयश्च सिद्धं घृतं माहिषमाजिकं वा|
आम्रास्थिपूर्वैः पयसा च नस्यं ससारिवैः स्यात् कमलोत्पलैश्च||१०१||
kaṣāyayogā ya ihopadiṣṭāste cāvapīḍe bhiṣajā prayojyāḥ|
ghrāṇāt pravṛttaṃ rudhiraṃ sapittaṃ yadā bhavenniḥsṛtaduṣṭadoṣam||97||
rakte praduṣṭe hyavapīḍabandhe duṣṭapratiśyāya śirovikārāḥ|
raktaṃ sapūyaṃ kuṇapaśca gandhaḥ syād ghrāṇanāśaḥ kṛmayaśca duṣṭāḥ||98||
nīlotpalaṃ gairika śaṅkhayuktaṃ sacandanaṃ syāttu sitājalena|
nasyaṃ tathā”mrāsthirasaḥ samaṅgā sadhātakīmocarasaḥ salodhraḥ||99||
drākṣārasasyekṣurasasya nasyaṃ kṣīrasya dūrvāsvarasasya caiva|
yavāsamūlāni palāṇḍumūlaṃ nasyaṃ tathā dāḍimapuṣpatoyam||100||
priyālatailaṃ madhukaṃ payaśca siddhaṃ ghṛtaṃ māhiṣamājikaṃ vā|
āmrāsthipūrvaiḥ payasā ca nasyaṃ sasārivaiḥ syāt kamalotpalaiśca||101||

In Rakta Pitta, when there is bleeding from the nose, the physician should administer the recipes of decoctions described here (verse nos. 73-74 of this chapter) in the form of Avapida (vide commentary for the meaning of this term) types of inhalation therapy.
This therapy is administered only when all the vitiated Doshas are excreted. If the Doshas are present then this leads to Dusta Pratisyaya (serious type of rhinitis) and Siro Vikara (diseases of the head). From the nose of the patient, bad smell of blood, pus and Kunapa gandha (smell of dead body) appears. He loses the sense of smell and dangerous types of Krimi (megots) appear in his nose.
The following recipes for inhalation are also recommended in this condition:
1. The paste of Nilotpala, Gairika, Sankha and Chandana, mixed with sugar solution
2. The juice of Amrasthi (the pulp inside the mango seed) and Samanga along with Dhataki, Moca Rasa, Lodhra, juice of Draksa and sugar cane Juice.
3. The juice of Durva along with milk
4. The paste of root of Yavasaka, and Palandu alongwith the juice of the flower of Dadima.
5. Ghee of either buffalo or goat, or the oil of Priyala prepared by boiling with the paste of madhuka and milk
6. Drugs like amrasthi described before along with milk.
7. Sariva, Kamala and Utpala along with Milk.[97-101]

भद्रश्रियं लोहित चन्दनं च प्रपौण्डरीकं कमलोत्पले च|
उशीरवानीरजलं मृणालं सहस्रवीर्या मधुकं पयस्या||१०२||
शालीक्षुमूलानि यवास गुन्द्रामूलं नलानां कुशकाशयोश्च|
कुचन्दनं शैवलमप्यनन्ता कालानुसार्या तृणमूलमृद्धिः||१०३||
मूलानि पुष्पाणि च वारिजानां प्रलेपनं पुष्करिणीमृदश्च|
उदुम्बराश्वत्थ मधूक लोध्राः कषायवृक्षाः शिशिराश्च सर्वे||१०४||
प्रदेह कल्पे परिषेचने च तथाऽवगाहे घृततैलसिद्धौ|
रक्तस्य पित्तस्य च शान्तिमिच्छन् भद्रश्रियादीनि भिषक् प्रयुञ्ज्यात्||१०५||
धारागृहं भूमिगृहं सुशीतं वनं च रम्यं जलवातशीतम्|
वैदूर्य मुक्तामणिभाजनानां स्पर्शाश्च दाहे शिशिराम्बुशीताः||१०६||
पत्राणि पुष्पाणि च वारिजानां क्षौमं च शीतं कदलीदलानि|
प्रच्छादनार्थं शयनासनानां पद्मोत्पलानां च दलाः प्रशस्ताः||१०७||
प्रियङ्गुका चन्दनरूषितानां स्पर्शाः प्रियाणां च वराङ्गनानाम्|
दाहे प्रशस्ताः सजलाः सुशीताः पद्मोत्पलानां च कलापवाताः||१०८||
सरिद्ध्रदानां हिमवद्दरीणां चन्द्रोदयानां कमलाकराणाम्|
मनोऽनुकूलाः शिशिराश्च सर्वाः कथाः सरक्तं शमयन्ति पित्तम्||१०९||
bhadraśriyaṃ lohita candanaṃ ca prapauṇḍarīkaṃ kamalotpale ca|
uśīravānīrajalaṃ mṛṇālaṃ sahasravīryā madhukaṃ payasyā||102||
śālīkṣumūlāni yavāsa gundrāmūlaṃ nalānāṃ kuśakāśayośca|
kucandanaṃ śaivalamapyanantā kālānusāryā tṛṇamūlamṛddhiḥ||103||
mūlāni puṣpāṇi ca vārijānāṃ pralepanaṃ puṣkariṇīmṛdaśca|
udumbarāśvattha madhūka lodhrāḥ kaṣāyavṛkṣāḥ śiśirāśca sarve||104||
pradeha kalpe pariṣecane ca tathā’vagāhe ghṛtatailasiddhau|
raktasya pittasya ca śāntimicchan bhadraśriyādīni bhiṣak prayuñjyāt||105||
dhārāgṛhaṃ bhūmigṛhaṃ suśītaṃ vanaṃ ca ramyaṃ jalavātaśītam|
vaidūrya muktāmaṇibhājanānāṃ sparśāśca dāhe śiśirāmbuśītāḥ||106||
patrāṇi puṣpāṇi ca vārijānāṃ kṣaumaṃ ca śītaṃ kadalīdalāni|
pracchādanārthaṃ śayanāsanānāṃ padmotpalānāṃ ca dalāḥ praśastāḥ||107||
priyaṅgukā candanarūṣitānāṃ sparśāḥ priyāṇāṃ ca varāṅganānām|
dāhe praśastāḥ sajalāḥ suśītāḥ padmotpalānāṃ ca kalāpavātāḥ||108||
sariddhradānāṃ himavaddarīṇāṃ candrodayānāṃ kamalākarāṇām|
mano’nukūlāḥ śiśirāśca sarvāḥ kathāḥ saraktaṃ śamayanti pittam||109||

Bhadra sirya, Lohita Chandana, praundaka, Kamala, Utpala, Usira, Vanira( a variety of Usira), Jala, Mrnala, Sahasra virya, Madhuka, Payasya, root of Trna , Radhi, Roots and flowers of aquatic plants and of the pond, astringent trees like Udumbara, Asvattha, Madhuka and Lodhra and all the cooling drugs issued as Pralepana(ointment) for the treatment of Rakta PItta.
The above mentioned drugs is used by the physician in recipes of Pradeha (thick ointment) for Shecana (sprinkling), Avagaha (bath) Ghrta (medicated ghee) and Taila (medicated oil) if he desires to cures Rakta Pitta.
If there is Daha (burning sensation), the patient should resort to Dhara Grhia ( the house which is cooled by the flow of water), Bhumi Grha( underground cellar) which is exceedingly cold, forests which are beautiful and cooled by water as well as wind and the touch of utensils prepared of Vaidurya, Mukta and Mani, which are cooled by cold water. For covering the beds, and seats, the leaves and flowers of aquatic plants, cooling silken clothes and leaves of Kadali, Padma as well as Utpal are very useful.
If there is burning sensation, then the following are useful:-
1. The touch of the paste of Priyanguka and Chandana
2. The touch of the beautiful and pleasing women
3. The wind caused by fan prepared of Padma and Utpala which is cooled by water

Other methods

Rakta Pitta is also alleviated by the following:
1. Sea shore and the bank of Lakes
2. Caves of Himalayas covered by snow:
3. Rising of the moon
4. Lotus pond
5. All things which are pleasing to the mind; and
6. Pleasant stories. [102-109]

Summary

तत्र श्लोकौ-
हेतुं वृद्धिं सञ्ज्ञां स्थानं लिङ्गं पृथक् प्रदुष्टस्य|
मार्गौ साध्यमसाध्यं याप्यं कार्यक्रमं चैव||११०||
पानान्नमिष्टमेव च वर्ज्यं संशोधनं च शमनं च|
गुरुरुक्तवान्यथावच्चिकित्सिते रक्तपित्तस्य||१११||
tatra ślokau-
hetuṃ vṛddhiṃ sañjñāṃ sthānaṃ liṅgaṃ pṛthak praduṣṭasya|
mārgau sādhyamasādhyaṃ yāpyaṃ kāryakramaṃ caiva||110||
pānānnamiṣṭameva ca varjyaṃ saṃśodhanaṃ ca śamanaṃ ca|
gururuktavānyathāvaccikitsite raktapittasya||111||

In this chapter on the “treatment of Rakta Pitta” the following topics, as instructed by the Preceptor, have been described:
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सितस्थाने
रक्तपित्त चिकित्सितं नाम चतुर्थोऽध्यायः||४||
ityagniveśakṛte tantre carakapratisaṃskṛte cikitsitasthāne
raktapitta cikitsitaṃ nāma caturtho’dhyāyaḥ||4||

1. Hetu or causative factors
2. Vrddhi or mode or aggravation
3. Sanja or definition
4. Sthana or location
5. Linga or signs and symptoms of each variety
6. Marga or the channels of manifestation
7. prognosis and palatability
8. Karya karma or the line of treatment
9. Useful diet and drinks
10. Harmful diet and drinks
11. Samshodhana or elimination therapy and
12. Shamana or alleviation therapy.[110-111]
Thus ends the 4th chapter dealing with the treatment of Rakta Pitta in Chikitsa Sthana of the text by Agnivesha, as redacted by Charaka.

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