Treatment Principles Of Raktapitta – Bleeding Disorders

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Raktapitta is a bleeding disorder in which the blood contaminated by vitiated Pitta bleeds through the orifices of the body, both in upward and downward directions, including the skin orifices. 

Related Reading Raktapitta: Cluster Of Bleeding Disorders: Meaning, Definition

Raktapitta is a clinical emergency
Raktapitta is a clinical emergency and should be treated as quickly as possible, without any delay. Otherwise it is going to cause serious threat to life.

Sanskrit verse

Acharya Charaka mentions Raktapitta as a Mahagada (disease which is difficult to manage) and calls for quick action.

Charaka –
Raktapitta is a Mahagada (dreadful disease) which has Mahavega (having severe intensity in terms of heavy bleeding which is life-threatening) and is Sheeghrakari (that which destroys the body quickly just as a small spark of fire destroys a big heap of grass, i.e. quickly brings about death of an individual). Therefore a wise physician who has a clear-cut knowledge of the causative factors and signs and symptoms of raktapitta, i.e. a physician who has skills of diagnosing this condition as quickly as possible should treat it immediately, without any delay.

Treatment principles

Principles of treatment of Raktapitta

Nidana parivarjana

Nidana Parivarjanam – Avoiding the causative factors is the key
In any disease, avoiding the causative factors is considered as the prime approach towards healing. Even in Raktapitta this rule holds good. The patients of Raktapitta desirous of good health and life should keep away all the causative factors which are mentioned in Raktapitta Nidana i.e. causes of Raktapitta. These include foods and lifestyle practices which cause vitiation of pitta and rakta (blood).
Read related: Raktapitta Causes, Premonitory Symptoms, Symptoms, Pathogenesis 

Stambhana

Stambhana – Bleeding should not be stopped initially
In the initial stages of Raktapitta, stambhana treatment – measures targeting stoppage of bleeding should not be given. Since in Raktapitta it is not the pure blood but in fact is the blood contaminated with pitta that is flowing through bleeding, stambhana should not be given. The blood should be allowed to flow if the strength, muscle bulk and appetite of the patient has been preserved and are in good condition. In weak people stambhana should be immediately given.
Read related: Stambhana in Raktapitta: Styptic Therapy In Bleeding Disorders

Langhana, Tarpana & Peya – Lightening and Nutritive Therapies, Digestive liquid diets (gruels)
After allowing the bleeding to occur in the initial phases of Raktapitta, the below mentioned strategies should be planned.

Langhana

Lightening treatment to digest ama (unprocessed digestive juices in circulation, caused due to sluggish digestion) are administered initially
Read related: Langhana Therapy – A Unique Ayurvedic Treatment Principle

Tarpana

After Langhana, Tarpana – nutritious herbal drinks and diet including vegetables and meat (and meat soup) should be administered in Urdhwaga Raktapitta (Raktapitta having upward course)

Tarpana is given in different forms. They are –

  • Tarpana in the form of medicated drinks
  • Tarpana in the form of Yavagu (medicated gruels)
  • Tarpana in the form of Ahara (diet, including leafy vegetables, dhanya i.e. grain, food, mamsarasa i.e. meat soup etc)

Peya

Digestive liquid diet especially in the form of gruels should be given after Langhana in Adhoga Raktapitta (Raktapitta having downward course)
Read related: Role of Langhana, Tarpana and Peya in the treatment of Raktapitta

Diet in Raktapitta

Nutrition is essential in Raktapitta to combat complications of bleeding, to regularize metabolism and to provide strength to the patient.

Bhojana is provided in different forms, mainly in the form of Tarpana as mentioned above. Ayurveda has given a gist of essential and beneficial dietetic inclusions in Raktapitta. They are –

  • Yavagu – medicated gruels
  • Anna – cooked rice
  • Shaka – Leafy vegetables and food stuff prepared from them
  • Yusha Supa – Drinks and soups
  • Dhanya – Grains and millets and food stuff prepared from them
  • Mamsarasa – meat soup

Yusha, Shaka, Mamsarasa

Preference of Yusha, Shaka and Mamsarasa in Raktapitta

  • In Raktapitta having Kapha Anubandha (association of kapha) i.e. Urdhwaga Raktapitta (Raktapitta having upward course, bleeding through nose, ears, eyes, mouth) – Yusha (soups and drinks) and Shaka (leafy vegetables and dishes prepared from the same) shall be used
  • In Vata Anubandha Raktapitta (Raktapitta associated with Vata) i.e. Adhoga Raktapitta (Raktapitta having downward course, bleeding through anus, urinary tract and vagina) – Mamsa rasa (meat soup) should be preferably administered

Management of thirst

Principles of management of thirst in Raktapitta
Thirst is a common complaint in Raktapitta. This occurs due to severe blood loss and fluid loss. Thirst should be managed with top priority.

After having analyzed the strength of dosha, associated doshas (Kapha, Vata), atura bala (strength of the patient) and ahara shakti of the patient (capacity to take food), water shall be given as and when desired until the thirst comes down and the patient starts feeling better. Alternatively, small quantities of water shall be fed to the patient at regular intervals.

In presence of thirst in Raktapitta below mentioned forms of water should be given –

  • Water processed with bitter tasting herbs
  • Juices of fruits which alleviate thirst
  • Vidarigandhadi Gana sidda jala – Water processed with Vidarigandha group of herbs
  • Shruta sheeta jala – Boiled and cold water
  • Hreeberadi Paniya – Water processed with Hrivera (Coleus vettiveroides / Pavonia odorata), Raktachandana (Red Sandalwood), Usheera (Vetiveria zizanioides), Musta (Cyperus rotundus) and Parpataka (Fumaria parviflora)

Shodhana

Shodhana in Raktapitta (Panchakarma in Raktapitta)
Shodhana, especially Vamana (therapeutic emesis) and Virechana (therapeutic purgation) should be given in Raktapitta in patients whose bala (strength) and mamsa (muscle mass) are not reduced, if the Raktapitta is caused due to santarpana (excessive saturation), if there is bahu dosha (excessive morbidity) in the body of the patient, if there are no associated upadravas (complications) and if the patient is an eligible candidate to undergo Shodhana.

Pratimarga harana

Pratimarga Harana Chikitsa
In the treatment of Raktapitta, the doshas should be expelled from the opposite route of their course (opposite to the direction of bleeding). Following this pattern, Virechana should be administered in Urdhwaga Raktapitta (bleeding in upper passages, in upward direction) and Vamana should be administered in Adhoga Raktapitta (bleeding in lower passages, in downward direction).

After Vamana, Tarpana i.e. nourishing drinks and food should be administered in Urdhwaga Raktapitta and Yavagu, i.e. gruels (when Vayu is in control) or mamsarasa i.e. meat-soup (in vitiation of vata) should be administered in Adhoga Raktapitta.

Samshamani kriya

Samshamani Kriya
Medicines and formulations to pacify vitiated Pitta should be administered as a part of Samshamani Kriya. In this, many formulations including herbal teas, powders etc are administered. Samshamani also includes disease modifying medicines.

Mutramarga gata Raktapitta

Management of Mutramarga gata raktapitta (bleeding from urinary tract)
Shatavari Gokshura siddha ksheera – Milk processed with decoction of Shatavari (Asparagus racemosus) and Gokshura (Tribulus terrestris)

Chaturparni siddha ksheera – Milk processed with Shalaparni (Desmodium gangeticum), Prishniparni (Uraria picta), Mudgaparni (Phaseolus trilobus) and Mashaparni (Teramnus labialis)

Gudamarga gata Raktapitta

Management of Guda marga gata raktapitta (bleeding from rectum)
Mocharasa siddha ksheera – Milk processed with paste of Mocharasa (Gum of silk cotton tree)
Vata siddha ksheera – Milk processed with paste of shoots of Vata (Banyan tree)

Hreeveradi kalka siddha ksheera – Milk processed with paste of Hrivera (Coleus vettiveroides, Pavonia odorata), Neela utpala (blue variety of lotus) and Nagara (ginger)

Nasagata Raktapitta

Management of Nasa gata raktapitta (bleeding from nose)
Bleeding of blood contaminated with pitta from the nose is called Nasagata Raktapitta. This condition is categorized as subtype of Urdhwaga Raktapitta and should be addressed immediately.

Ghrita in Raktapitta

Use of herbal ghee in in Raktapitta
Medicated ghee should be used in Raktapitta to combat severe and stubborn bleeding. Some of the Ghritas which are highly beneficial in Raktapitta are –

  • Vasa Ghrita
  • Palasha Ghrita
  • Vatsaka Ghrita
  • Trayamana Ghrita
  • Audumbara Ghrita etc

Kshara in Raktapitta

Use of Kshara (alkalis) in Raktapitta
Kshara – alkalis should be used in Kaphanubandha Raktapitta (Raktapitta associated with kapha). When Kapha gets associated with Raktapitta, the blood gets clogged (clot) and blocked in the throat. Kshara should be used in this condition. The Ksharas of the below mentioned should be used in grathita raktapitta –

  • Utpala nala kshara – alkali prepared from petioles of water lily
  • Padhmaka kesara Kshara – alkali prepared from stamens of lotus
  • Mrunala Nala Kshara – alkali prepared from petioles of Mrunala, variety of lotus
  • Utpala kesara kshara – alkali prepared from stamens of water lily or blue variety of lotus
  • Palasha kshara – alkali prepared from Butea monosperma
  • Priyangu kshara – alkali prepared from Callicarpa macrophylla
  • Madhooka Kshara – alkali prepared from Madhooka longifolia
  • Asana kshara – alkali prepared from Pterocarpus marsupium

Bahya Chikitsa

Bahya Chikitsa (external treatments) in Raktapitta
Though Raktapitta is a bleeding disorder in which the bleeding should be controlled from within, external treatments are equally necessary to combat pitta and rakta. The external maneuvers include abhyanga, parishechana (sprinkling of medicated fluids over the body), pradeha (anointment of medicated pastes), sheeta upachara (cold comforts) etc.
Click to Consult Dr Raghuram Y.S. MD (Ayu)

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