Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Raktapitta is one of the most important topics discussed in Ayurveda. It is a disease entity wherein the ‘bleeding within the body’ without any evidence of injury or without the presence of injury or trauma have been explained.
Thus Raktapitta covers ‘hemorrhage disorders’ or bleeding disorders wherein there is bleeding from the mouth, nose, eye, ear, anus, genitals or skin.
In this condition the bleeding doesn’t involve true or frank blood (pure blood) as seen in rakta-arsha (bleeding piles) or rakta-atisara (bloody diarrhea).
In Raktapitta the blood contaminated with pitta flows out of the body. Thus Raktapitta is a disease entity wherein there is bleeding of ‘blood which has been contaminated by pitta’.
Read related: Charaka Raktapitta Nidana: 2nd Chapter
Definition of Raktapitta
The Rakta which has been contaminated or vitiated by Pitta is called Raktapitta.
The pitta which has gained (attained or acquired) raaga (redness) due to its admixture with rakta is called Raktapitta.
The pitta vitiated by its own aggravating factors (factors which vitiate pitta), further vitiates (corrodes) the rakta (blood) and this condition is called raktapitta.
When the rakta or blood flows (bleeding occurs) in the absence of injury or trauma, the condition will be called as Raktapitta.
Read related: Charaka Raktapitta Chikitsa – 4th chapter
Why does Raktapitta occur?
You always want to make best friends with the one who is always compatible with you. Rakta and Pitta are compatible elements of the body. Though Rakta or blood is a dhatu (tissue) and Pitta is a dosha (contaminant), they have an inseparable relationship. During the formation of Rakta, Pitta is formed as its waste, on regular basis.
Though Pitta is a waste, it is of dhatu swarupa i.e. it is protective, just like the tissues and participates in many activities of the body just like the dhatus or tissues. When the same pitta is disturbed or vitiated, it causes disturbances in the body leading to many diseases, chiefly inflammatory in nature.
Similarly, when blood is imbalanced in terms of quality and quantity, it tends to cause many diseases.
Now let us just imagine what might happen when these 2 elements combine in their vitiated forms!! Yes, when this happens, they vitiate and contaminate further, get increased in quantity (both being liquid elements), gets admixed with other tissue fluids and flow out of the body in the form of Raktapitta or ‘pitta contaminated blood’.
Read related: Bleeding Disorders: Ayurveda Treatment, Diet, Home Remedies
????? ??????? ‘Asrujaha Pittam’
According to this quotation, Pitta is said to be a byproduct of Rakta, formed in the form of its mala (excreta, metabolic waste, tissue waste). Thus, pitta is a metabolic waste formed during the metabolic formation of Rakta.
According to Ayurveda, the dhatus or tissues (7 in number) are formed one after the other in chronological form. It is wise to tell that one tissue takes part in the formation of its successive dhatu while nourishing itself. Rasa (lymph, plasma, liquid portion of the blood), Rakta (cellular part of the blood), Mamsa (muscles), Meda (fat), Asthi (bone), Majja (bone marrow) and Shukra (semen, reproductive tissue) are the 7 dhatus mentioned in Ayurvedic treatises. These tissues are formed in the chronological order mentioned.
In this context, let us limit our discussion to ‘only rakta formation’ in the chronology of dhatu formation.
When the ahara rasa or nutritional fluid (formed in the stomach after the digestion of the food) is put into circulation, it first reaches Rasa Dhatu (plasma or liquid portion of the blood) and helps in its formation.
Formation of Rakta from Rasa – After the action of Rasa Dhatu Agni (component of metabolic fire in the rasa dhatu, tissue fire of rasa) on the nutritional fluid (ahara rasa), Poshya Rasa Dhatu (rasa dhatu proper) is majorly formed to enrich the local rasa dhatu. At the same time, as a part of the same metabolic process, Poshaka Rasa Dhatu or Rasa dhatu meant for nourishing the next dhatu i.e. Rakta dhatu is formed. This nourishes the Rakta Dhatu and helps in its formation and enrichment. Kapha is formed as waste component. Stanya (breast milk) and Aartava (menstrual blood, ovum) are formed as sub-tissues or upadhatus.
Formation of Pitta from Rakta – When the Rakta Dhatu Agni (tissue fire of blood tissue) acts on the Poshaka Rasa Dhatu, Poshya Rakta Dhatu (rakta dhatu proper) is majorly formed to enrich the local blood tissue or rakta dhatu. At the same time, as a part of the same metabolic process, Poshaka Rakta Dhatu or Rakta Dhatu meant for nourishing the next dhatu i.e. Mamsa Dhatu (muscle tissue) is formed. This nourishes the Mamsa Dhatu and helps in its formation and enrichment. Here Pitta is formed as waste component of blood metabolism. Siras (blood vessels, veins) and Kandaras (tendons) are formed as upadhatus or sub-tissues).
Rakta and Pitta, thus have ‘Ashraya-Ashrayi Sambandha’ i.e. the inseparable relationship of an abode and tenant. Pitta is located in the Rakta. Thus any causative factor or factors which pathologically increase the quality and quantity of Pitta, also enhances the Rakta and vice versa. Similarly, medicines which tend to pacify or mitigate the vitiated pitta also tend to mitigate the vitiation of rakta.
Thus, in Raktapitt, though 2 different components i.e. Rakta and Pitta are involved in the pathogenesis, they should be seen and dealt as single component i.e. ‘rakta vitiated by pitta’ and not separately as rakta and pitta.
Charaka tells –
The disease raktapitta is called by that name because of the below mentioned causes –
Samyogaat – Samyoga means association or combination. The pitta always stays associated with rakta. This association causes vitiated pitta to contaminate rakta.
Dooshanaat – Dooshanaat means tendency to contaminate or vitiate. The pitta having samyoga with rakta tends to vitiate the rakta.
Saamaanyaad gandha varnayoho – Pitta attains similarity with rakta in terms of gandha (smell) and varna (color) i.e. in raktapitta, the pitta or color and smell of pitta is not identified separately since it gets blended with increased rakta in totality gaining the form of rakta, the vitiated pitta and rakta gets homologous.
Since pitta (not being identified or isolated) is being blended with rakta seems to belong to rakta inseparably (raktasya pittam), the disease is called raktapitta.
How does Raktapitta occur?
As already said, Raktapitta occurs due to the pathological amalgamation (admixture) of –
As already said, Raktapitta occurs due to the pathological amalgamation (admixture) of –
- Vitiated pitta
- Excessive Rakta (Rakta whose quantity has gained a pathological increase)
On getting exposed to the pitta vitiating causative factors (including pitta aggravating foods and activities), the pitta gets vitiated.
Due to the same causes, Rakta too gets quantitatively increased. As already said ‘Rakta and Pitta’ having aashraya aashrayi sambandha get pathologically increased by the same causes. Rakta Vriddhi (Pathological increase of Pitta) might occur independently also.
Causes which vitiate Rakta and Pitta include –
- Ushna – hot foods and exposure to heat
- Teekshna – Intense and irritating foods
- Amla – Excessive consumption of sour foods
- Lavana – Excessive consumption of salt or salty foods
- Katu – Excessive consumption of pungent foods
- Aatapa – Excessive exposure to heat of Sun
- Kshaara – Excessive consumption of alkalis
- Vidahi anna – Excessive consumption of corrosive foods etc
The pitta gets vitiated on consumption of the above said etiological factors.
The vitiated pitta by the virtue of being a waste product of rakta and by being associated with it in terms of aashraya and aashrayi, gets mixed with rakta which has undergone pathological increase in quantity.
On getting admixed with this excessive rakta, the vitiated pitta vitiates the rakta.
Due to excessive heat of Pitta, the drava bhaga or liquid component of the other tissues like mamsa (muscles), meda (fat) etc starts melting and gets added to the rakta.
Due to this addition of drava bhaga of other tissues of the body, the rakta increases in quantity (beyond its normal quantity). Along with Rakta, the quantity of Pitta also increases.
This enhances overall quantity of Rakta and Pitta.
This simultaneous pathological increase of rakta and pitta causes further vitiation of rakta from pitta.
This combined vitiation of rakta and pitta is called Raktapitta.
This blood contaminated with pitta (raktapitta) flows out of the orifices (openings) of the body.
Mechanism of bleeding in Raktapitta – Due to the above said causative factors blood is formed in excess but is formed in an immature, unprocessed and corrosive form (vidagdha rakta). As a result its mala or waste product i.e. pitta too is formed in excess quantity. As an effect of this or due to reflex stimulation or in order to balance the fluid levels, the fluid from various tissue flows into the blood and hence enhance the volume of rakta and also pitta beyond normal volumes (which is desired).
The pathological increase of volume of rakta and pitta simultaneously creates a pressure on the blood vessels. The heat of Pitta also damages the layers of the blood vessels. As a combined effect of pressure and heat, the blood vessels get damaged. The blood contaminated with pitta leaks or flows from the damaged blood vessels, depending on the quantum of damage.
The blood flows through nose, eye, ears, and mouth, penis, vagina, anus and skin orifices.
Just Before Finishing –
Bleeding occurs due to 2 reasons, one due to injury and the other due to absence of injury, due to some interior damage or secondary to some chronic or stubborn disease within the body. The second condition i.e. bleeding occurring in the absence of injury is called raktapittam, here the blood is not pure blood, and in fact it is the blood contaminated with pitta. In this article I have tried to explain the difference between frank blood and contaminated blood (raktapitta) as explained in Ayurvedic treatises in the context of raktapitta.
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