Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Raktapitta is a bleeding disorder explained in Ayurveda wherein the rakta (blood) contaminated with pitta is expelled (bleeding) through upper and lower orifices (openings) of the body, including the small openings in the skin.
Though Raktapitta is an emergency condition, it is said that Stambhana or treatment to check bleeding should not be administered in the initial phases of treatment, especially in strong people.
Related reading – Stambhana in Raktapitta
In weak people stambhana should be given and the bleeding checked.
What to do after allowing the bleeding of contaminated blood in the initial stages of treatment?
After waiting for the initial phase of bleeding to be finished (by not stopping the bleeding), Langhana, Tarpana and Peya should be administered.
After analyzing the marga (course of bleeding), dosha anubandha (association of doshas), kala (seasonal factor), saatmya (compatibility of the patient) and nidana (causative factors), Langhana, Tarpana and Peya should be administered in the next stage of treatment in Raktapitta.
Meaning of Langhana, Tarpana and Peya
Langhana = Lightening therapies (treatments and medicaments which bring about lightness of the body)
Tarpana = Nutritive therapies, mainly include tarpana in the form of aushadha (medicated drinks), yavagu (nutritive gruels) and bhojana (nutritive foods)
Peya = Digestive liquid foods / diet (gruels)
Choice of treatment
Making choice between Langhana, Tarpana and Peya
Langhana, Tarpana and Peya are not chronological strategies and are not applicable in everyone. We need to analyze the disease condition and strength of the patient before making right choice or choices of these strategies.
The factors to be considered before making a choice of these treatment strategies are –
Marga – the course or direction of the disease should be carefully accessed. Raktapitta has 2 main margas i.e. Urdwha (upper or upward) and Adho (lower or downward). In Urdhwaga Raktapitta, the bleeding will have an upward course, bleeding occurring from nose, ear, eyes, mouth. In Adhoga Raktapitta, the bleeding will have a downward course, bleeding occurring from anal opening, urinary passage and vagina.
Dosha Anubandha – In Urdhwaga Raktapitta we can find association of Kapha. In Adhoga Raktapitta, we can find the association of Vata.
Kala – The seasonal factor should be considered because the strength of the patient will be good in Visarga Kala (cold predominant season) and the strength of the patient will be low in Adana Kala (heat predominant season)
Saatmya – The compatibility of the patient also should be carefully accessed. The tarpana comes in the form of gruels and food. Patients are either vegetarians or non-vegetarians or both. The practices of food shall not be enforced commonly on everyone and the treatment should be planned keeping in view about the food practices and compatibilities of the patient.
Nidana – The causative factors of Raktapitta also should be analyzed. Urdhwaga Raktapitta is caused by Snigdha-Ushna Karanas (unctuous and hot foods) while Adhoga Raktapitta is caused by Ruksha-Ushna Karanas (dry and hot foods). Treatment choices need to be in contrary with the causes.
Santarpanotta and Apatarpanotta Raktapitta
Before going into the details of Raktapitta I would like to touch upon another aspect of Raktapitta which is important for the whole discussion.
Santarpanotta Raktapitta is that which is caused by over-nutrition or over-saturation. In this condition, lightening therapies like Langhana etc should be administered.
Apatarpanotta Raktapitta is that which is caused by under-nutrition or less-saturation. In this condition, brimhana or strengthening (bulk promoting) treatments should be given.
Langhana in Raktapitta
In Raktapitta, the aggravated rakta and pitta gain further pathological increase due to the presence of excessive ama (immature essence of food or nutrition or improperly formed nutritional juices in circulation formed due to weak digestion).
Langhana or lightening therapies should be administered to digest and process this ama.
Though there are 10 types of Langhana, Upavasa Rupa Langhana (i.e. fasting or starving or giving away food or taking food in small parcels) is preferred.
Langhana shall be given if –
- The patient is fit for Langhana
- If the Raktapitta has been caused by Santarpana (Santarpanotta Raktapitta)
We have a reference from Chakrapani, the commentator of Charaka who tells that Langhana should be preferably given in Urdhwaga Raktapitta because –
- In Urdhwaga Raktapitta there is sama pitta (pitta associated with ama, unprocessed pitta)
- The associated dosha in urdhwaga raktapitta is Kapha,which being a drava dhatu (liquid component or element) will tolerate Langhana better
- Urdhwaga Raktapitta is caused by Snigdha Ushna Karanas (excessive use of unctuous and hot foods) and Langhana is antagonistic to Snigdha guna
On the other hand he opines that Langhana might not be well tolerated by those having Adhoga Raktapitta because it is associated with contrasting causes mentioned above, i.e. Adhoga Raktapitta is associated with Vata (which doesn’t tolerate Langhana) and is caused by Ruksha Ushna Gunas (dry and hot foods) and Langhana might increase the rukshata (dryness).
But Langhana is moreover selective and situational. Langhana can be and should be administered in both types of Raktapitta i.e. Urdhwaga and Adhoga Raktapitta and the implication is conditional.
The condition is that, Langhana shall be administered in Urdhwaga or Adhoga Raktapitta if and only if they are caused by Santarpana i.e. Langhana should be administered in –
- Santarpanotta Urdhwaga Raktapitta and
- Santarpanotta Adhoga Raktapitta
If both these conditions are caused by Apatarpana, Langhana shall be avoided.
According to Chakrapani, Langhana shall anyhow be tried with priority in Urdhwaga Raktapitta immaterial of it being Santarpanotta or Apatarpanotta since snigdha ahara and kapha are involved in this type of Raktapitta which are Langhana tolerant. But Langhana shall be administered with caution in Apatarpanotta Urdhwaga Raktapitta.
Tarpana in Raktapitta
Tarpana means nutrition.
Plans to provide good nutrition should be done in Raktapitta and shall be administered after Langhana.
Acharya Charaka specifies to administer Tarpana in Urdhwaga Raktapitta.
Principles of administering Tarpana in Urdhwaga Raktapitta –
- After symptoms of proper Langhana have been obtained following Langhana, Tarpana should be administered in Urdhwaga Raktapitta.
- In Santarpanotta Urdhwaga Raktapitta, Tarpana should be given after Langhana
- In Apatarpanotta Urdhwaga Raktapitta, Langhana shall be avoided and Tarpana should be given straight away.
Tarpana is provided in 3 forms –
- Aushadha rupa Tarpana – Tarpana prepared in the form of medicated nutritive drinks
- Ahara Rupa Tarpana – Tarpana in the form of food is of two types, Shaka (vegetables) for vegetarians and Mamsa (meat) and Mamsarasa (meatsoup) for non-vegetarians
- Yavagu Rupa Tarpana – Tarpana in the form of medicated gruels
One or more of the above mentioned recipes should be selected depending on the satmya (compatibility and practice) of the patients
Peya in Raktapitta
Peya means digestive liquid foods, mainly in the form of thin gruels. Apart from being nutritive, they kindle the fire and enhance digestion and metabolism.
Plans to provide peya should be done in Raktapitta and shall be administered after Langhana.
Acharya Charaka specifies to administer Peya in Adhoga Raktapitta.
Principles of administering Peya in Adhoga Raktapitta –
- After symptoms of proper Langhana have been obtained following Langhana, Peya should be administered in Adhoga Raktapitta.
- In Santarpanotta Adhoga Raktapitta, Peya should be given after Langhana
- In Apatarpanotta Adhoga Raktapitta, Langhana shall be avoided and Peya should be given straight away.