Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Raktapitta is a bleeding disorder wherein the blood (rakta) vitiated by pitta flows out of the orifices (openings) of the body. Bleeding occurs due to some internal cause or as an effect of some chronic and stubborn diseases and importantly in the absence of injury.
Related Reading Raktapitta: Cluster Of Bleeding Disorders: Meaning, Definition
Nidana (Causes) of Raktapitta
Below mentioned are the causes (etiological factors) of Raktapitta disease –
- Gharma / Aatapa – Excessive exposure to heat of Sun
- Vyaayaama – Excessive physical exercise
- Shoka – Excessive grief
- Adhwa – Excessive walking
- Vyavaaya – Excessive indulgence in sexual activities
- Teekshna – Excessive consumption of intense, strong and damaging foods
- Ushna – Excessive consumption of hot foods (hot to touch)
- Kshaara – Excessive consumption of alkalis or alkaline foods
- Lavana – Excessive consumption of salts or salty foods (or tastes)
- Amla – Excessive consumption of sour foods (or tastes)
- Katu – Excessive consumption of pungent and spicy foods (or tastes)
- Vidahi Anna – Corrosive food
Gross causative factors –
According to Charaka,
- Urdhwaga Raktapitta (raktapitta in which the bleeding of contaminated blood takes place in the upward directions and from upward passages or orifices) is caused by Snigdha-Ushna sevana (consumption of unctuous and hot foods together)
- Adhoga Raktapitta (raktapitta in which the bleeding of contaminated blood takes place in the downward directions and from downward passages or orifices) is caused by Ruksha-Ushna sevana (consumption of dry and hot foods together)
Samprapti (Pathogenesis) of Raktapitta
The disease Raktapitta develops and manifests as the pathogenesis runs through the below mentioned steps in that order –
- Pitta aggravated by the above said causes leaves its sites and reaches rakta (blood).
- Being a mala (waste product) of rakta, the pitta on getting mixed with rakta attains quantitative increase.
- The pitta in turn vitiates the rakta. Due to the heat of Pitta, the drava dhatu or the liquid portion (fluid) of other tissues like mamsa (muscles), meda (fat) etc oozes out of their respective tissues and gets admixed with rakta.
- This further enhances the quantity of rakta, beyond the limits of normal quantity.
- This also enhances the quantity of blood flowing in the blood vessels creating immense pressure in the blood vessels.
- Due to the pressure of the blood and heat of pitta, the walls of the blood vessels get damaged and the blood starts flowing through various openings of the body.
- Bleeding occurs through mouth, nose, ears, eyes, skin, anus, penis and vagina.
- This bleeding of blood vitiated by pitta through various orifices of the body is called Raktapitta.
Acharya Sushruta explains the Samprapti (pathogenesis) of Raktapitta in a simple way and tells –
The pitta which becomes vidagdha (burnt or corroded) by the above mentioned etiological factors quickly reaches the rakta (blood) and causes its vidaha (burns the blood). This rakta contaminated by vikrita (vitiated) and vidagdha pitta flows out of the orifices in the upward or downward or in both directions. While flowing upwards, the bleeding in raktapitta occurs through nasa (nasal openings), akshi (eyes), karna (ears) and aasya (mouth). The raktapitta flowing downwards bleeds through medhra (urinary passages in men and women), yoni (vagina in women) and guda (anal opening). Severely aggravated raktapitta moves side-ways and bleeds through the orifices in the skin (romakupas)
Poorvarupa (premonitory symptoms) of Raktapitta
- Ananna abhilasha – loss of interest in food
- Bhuktasya vidaha – burning (very quick digestion?) of consumed food
- Shukta amla gandha – smell of sour fermented liquid (from the mouth)
- Shukta amla rasa – taste of sour fermented liquid (sour and fermented liquid) from the mouth
- Shukta amla udgaara – sour belching or belching having taste of fermented liquid
- Abheekshna chardi – severe, uncontrolled and projectile vomiting
- Charditasya bheebatsataa – scary look and gesture of the person who has vomited
- Swara bheda – hoarseness of voice
- Gaatra sadana – feeling of tiredness in the whole body
- Paridaaha – feeling of burning sensation in the body
- Mukhaad dhuma aagamana iva – feeling as if the fumes are coming out of the mouth
- Loha gandha – smell of iron from the mouth
- Lohita gandha – smell of blood from the mouth
- Matsya gandha – smell of fish (fishy odor) from the mouth
- Rakta harita haaridratwam anga avayava shakrut mootra sweda laalaa singhaanaka aasya karna mala – Reddish, greenish and turmeric colored discoloration of body, body parts, feces, urine, sweat, saliva, nasal dirt or discharges, oral dirt or discharges and ear discharges
- Anga vedana – body pains
- Lohit neela peeta shyaavaanaam archishyataam cha roopaanaam swapne darshanam abheekshnam iti – ferocious and scary figures having red, blue, yellow or bluish black color are seen in dreams
- Shiro gurutwam – heaviness of head (Vagbhata)
- Aruchi – tastelessness (Vagbhata)
- Kasa – cough (Vaghata)
- Shwasa – dyspnoea, shortness of breath (Vagbhata)
- Bhrama – giddiness (Vagbhata)
- Klama – fatigue (Vagbhata)
- Sheeta kaamitwam (Sushruta)
Routes and Dosha association
Raktapitta Marga and Dosha samsarga (Routes of Raktapitta and dosha association)
Based on the direction of flow of vitiated blood (blood vitiated by pitta), Raktapitta is said to be of 2 types i.e.
Urdhwa Raktapitta – Raktapitta in which bleeding occurs in upward direction, from orifices in the upper parts of the body. Caused by Snigdha Ushna Sevana – associated with Kapha Dosha. Leads to movement of Rakta in upward direction and bleeding through nostrils, eyes, ears, nose.
Adhoga Raktapitta – Raktapitta in which bleeding occurs in downward direction, from orifices in the lower parts of the body. Caused by Ruksha Ushna sevana, associated with Vata Dosha. Leads to downward movement of Rakta and bleeding through urinary passages, vagina, anal orifice.
Ubhaya margaga Raktapitta – Caused by combination of the above two, with influence of Vata and kapha Dosha. Leads to movement of Rakta in both upper and lower direction and leads bleeding through all orifices. mentioned passages.
Classification of Raktapitta
Raktapitta is classified as follows –
Based on the direction of bleeding:
- Urdhwaga Raktapitta
- Adhoga Raktapitta
Based on the dosha predominance:
- Tridoshaja Raktapitta
Lakshanas (symptoms) of Doshaja Raktapitta
Kaphaja Raktapitta – In the raktapitta associated with kapha, the blood is thick (Sandra), pale (pandu varna) and unctuous (snigdha).
In the raktapitta associated with Vata, the blood will be blackish blue or blackish brown (shyava) or reddish yellow or golden yellow (aruna) in color, thin / dilute (tanu), dry (ruksha) and associated with froth (sa phenam)
In the Raktapitta associated with Pitta, the blood will have black (Krishna) or decoction like (kashayabham) color. The blood resembles the urine of cow (gomutra sannibham), with mixture of many colors (mechaka). It will also have resemblance with agara dhuma (soot of chimney) and collyrium (anjanabham).
(Raktapitta having association of 2 doshas) – In Vatapittaja, Vatakaphaja and Kaphapittaja Raktapittas, symptoms of 2 doshas will be present in mixed proportions
Sannipataja or Tridoshaja Raktapitta – In Raktapitta caused by association of all the 3 doshas, the symptoms of all the 3 doshas will be present in mixed proportions
Just Before Finishing –
This article covers the causative factors, premonitory symptoms, symptoms and pathogenesis of Raktapitta
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