Chapter 9 – Raktapitta Nidana

The 9th chapter of Madhava Nidana deals with Raktapitta i.e., Diagnosis of the Haemorrhagic Disorders. Hereditary bleeding disorders occur due to the absence or deficiency of specific clotting proteins. The three most common hereditary bleeding disorders are hemophilia A (factor VIII deficiency), hemophilia B (factor IX deficiency) and von Willebrand disease

घर्म – व्यव्याम – शोकाध्व – व्यवायैरतिसेवितैः |
तीक्ष्णोष्ण – क्षार – लवणैरम्लैः कटुभिरैव च || १||
पित्तं विदग्धं स्वगुणैर्विदहत्याषु शोणितं |
ततः प्रवर्तते रक्तमूर्ध्वं चाधो द्विधा अपि वा || २ ||

gharma – vyavyāma – śōkādhva – vyavāyairatisēvitaiḥ |
tīkṣṇōṣṇa – kṣāra – lavaṇairamlaiḥ kaṭubhiraiva ca || 1||
pittaṁ vidagdhaṁ svaguṇairvidahatyāṣu śōṇitaṁ |
tataḥ pravartatē raktamūrdhvaṁ cādhō dvidhā api vā || 2 ||

These factors vitiate pitta —

• Gharma — Overexposure to the sun;
• Vyayama — excessive physical exercise,
• Shoka — grief,
• Adhva — traveling long distances on foot and
• Vyavaaya — sexual intercourse,
• Tikshna, Ksara, Lavana Amla Katu ati sevana — as also excessive use of sharp, hot, alkaline, salty, acidic, and pungent substances.

The vitiated pitta in turn provokes the rakta and causes it to flow out of the body through upper and lower orifices. 1 – 2

ऊर्ध्वं नासाक्षि – कर्णास्यैर्मेद्र – योनि – गुदैरधः |
कुपितं रोमकूपैश्च समस्तैस्तत् प्रवर्तते || ३ ||

ūrdhvaṁ nāsākṣi – karṇāsyairmēdra – yōni – gudairadhaḥ |
kupitaṁ rōmakūpaiśca samastaistat pravartatē || 3 |

The upper orifices in the context include the

• Nasa — nostrils,
• Akshi — eyes,
• Karna — ears, and
• Aasya — mouth while the
• Medhra — urethra,
• Yoni — vagina, and
• Guda — rectum are the lower passages.

In the disease raktapitta, the blood comes out from these passages and if the ailment has attained severe conditions, blood might come out of the hair follicles of the skin. 3

Premonitary symptoms of Raktapitta —

सदनं शीतकामित्वं कण्ठधूमायनम् वमिः |
लोहगन्धिश्च निःश्वासो भवत्यस्मिन् भविष्यति || ४ ||

sadanaṁ śītakāmitvaṁ kaṇṭhadhūmāyanam vamiḥ |
lōhagandhiśca niḥśvāsō bhavatyasmin bhaviṣyati || 4 ||

The Premonitary symptoms of Raktapitta are –

• Sadana — Depression
• Sheeta Kamitvam — Desire for cold things
• Kantha Dhumayanam — Feeling of fumes coming out of the throat
• Vami — Vomiting
• Loha Gandhi Nishvasa — And iron like smell in the respiration. 4

Shleshma Type of Raktapitta –

सान्द्रं सपाण्डु सस्नेहं पिच्छिलं च कफान्वितम् |

sāndraṁ sapāṇḍu sasnēhaṁ picchilaṁ ca kaphānvitam |

If kapha is associated with the disease (raktapitta), the blood coming out could be

• Sandra — thick,
• Sa Pandu — yellowish white,
• Sa sneham — greasy and
• Picchila — sticky.

Vata type of Raktapitta –

श्यावारुणं सफेनं च तनु रूक्षं च वातिकं ||५ ||

śyāvāruṇaṁ saphēnaṁ ca tanu rūkṣaṁ ca vātikaṁ ||5 ||

If vata is associated with the disease (raktapitta), the blood could be

• Shyava Aruna — blackish red,
• Sa phenam — frothy and
• Tanu — thin. 5

रक्तपित्तं कषायाभं कृष्णं गोमूत्रसन्निभम् |
मेचकागारधूमाभमञ्जनाभं च पैत्तिकम् || ६ ||

raktapittaṁ kaṣāyābhaṁ kr̥ṣṇaṁ gōmūtrasannibham |
mēcakāgāradhūmābhamañjanābhaṁ ca paittikam || 6 ||

If Pitta alone is with the disease (raktapitta), the blood coming out of could be black and resembling a decoction of medicines, or cows, urine, manifesting black pigment of a mechaka, chimney soot or antimony. 6

संसृष्टलिङ्गं संसर्गात् त्रिलिङ्गं सान्निपातिकम् |

sansr̥ṣṭaliṅgaṁ sansargāt triliṅgaṁ sānnipātikam |

If the combination of two or three doshas is associated with the disease (raktapitta) their specific features are also found together.

Prognosis of Raktapitta –

ऊर्ध्वगं कफ संसृष्टमधोगं पवनानुगम् |
द्विमार्गं कफ – वाताभ्यामुभाभ्यामनुवर्तते || ७ ||

ūrdhvagaṁ kapha sansr̥ṣṭamadhōgaṁ pavanānugam |
dvimārgaṁ kapha – vātābhyāmubhābhyāmanuvartatē || 7 ||

The upward one (raktapitta) is due to the association of kapha and the downward is due to the association of vata; And kapha and vaata together will generate conditions for both the upward and downward rakta pitta. 7

ऊर्ध्वं साध्यमधो याप्यमसाध्यं युगपद्गतम् |

ūrdhvaṁ sādhyamadhō yāpyamasādhyaṁ yugapadgatam |

The upward variety of the disease raktapitta is easy to cure whereas the downward one persists all through the life and that of both directions is impossible to cure.

Curability of the Raktapitta –

एकमार्गं बलवतो नातिवेगं नवोत्थिथम् || ८ ||
रक्तपित्तं सुखे काले साध्यं स्यान्निरुपद्रवम् |

ēkamārgaṁ balavatō nātivēgaṁ navōtthitham || 8 ||
raktapittaṁ sukhē kālē sādhyaṁ syānnirupadravam |

It (disease raktapitta) is easy to treat if there is bleeding from any one passage. The disease could be cured if it has involved a person who is strong, if the bleeding is not profuse, if the ailment is of recent origin, if it has manifested in a suitable season and if it is not having other implications. 8

Curability of raktapitta as per dosha involvement –

एकदोषानुगं साध्यं द्विदोषं याप्यमुच्यते || ९ ||
यत् त्रिदोषमसाध्यं स्यान्मन्दाग्नेरति वेगवात् |
व्याधिभिः क्षीणदेहस्य वृद्धस्यानश्नतश्च यत् || १० ||

ēkadōṣānugaṁ sādhyaṁ dvidōṣaṁ yāpyamucyatē || 9 ||
yat tridōṣamasādhyaṁ syānmandāgnērati vēgavāt |
vyādhibhiḥ kṣīṇadēhasya vr̥ddhasyānaśnataśca yat || 10 ||

The raktapitta of a single dosha involvement is curable. Cases of dual dosha affliction of the disease is prolong-able. If there is involvement of all the three doshas and if the patient suffers from lack of appetite, if the bouts of raktapitta are fast, the body of the patient is emaciated, if he is of an advanced age and if the patient cannot accept food, the disease should be considered as incurable. 9-10

Complications of Raktapitta –

दौर्बल्य – श्वास – कास – ज्वर – वमथु – मदाः पाण्डुता – दाह – मूर्च्छा
भुक्ते घोरो विदाहस्त्वधृतिरपि सदा हृद्यतुल्या च पीडा |
तृष्णा कोष्टस्य भेदः शिरसि च तपनं पूति निष्टीवनत्वं
भक्तद्वेषाविपाकौ विकृतिरपि भवेद्ररक्तपित्तोपसर्गाः || ११ ||

daurbalya – śvāsa – kāsa – jvara – vamathu – madāḥ pāṇḍutā – dāha – mūrcchā
bhuktē ghōrō vidāhastvadhr̥tirapi sadā hr̥dyatulyā ca pīḍā |
tr̥ṣṇā kōṣṭasya bhēdaḥ śirasi ca tapanaṁ pūti niṣṭīvanatvam
bhaktadvēṣāvipākau vikr̥tirapi bhavēdraraktapittōpasargā || 11 ||

The complications associated with hemorrhagic disorders –

• Daurbalya — Weakness
• Shvasa — Dyspnea
• Kasa — Cough
• Jvara — Fever
• Vami — Vomiting
• Madah — Intoxication
• Panduta — Anemia
• Daha — burning sensation
• Murccha –Fainting
• Vidaha — Severe heart burn
• Hrdaya Tulya Pida — Intolerable pericardial pain
• Trshna –Thirst
• Koshta Bheda — Loose bowels
• Sira Tapanam — Sensation of glowing heat in the head
• Puti Nishtivanam — Purulent expectoration
• Bhakta Dvesha — An aversion to food
• Avipaka — Indigestion etc., 11

Incurability of Raktapitta –

मांसप्रक्षालनाभं कुथितमिव च यत् कर्दमाम्भोनिभं वा
मेदः पूयास्रकल्पं यकृदिव यदि वा पक्वजम्बूफलाभम् |
यत् कृष्णं यच्च भृशमतिकुणपं यत्र चोक्ता विकारा –
स्त्द्वर्ज्यं रक्तपित्तं सुरपतिधनुषा यच्च तुल्यं विभाति || १२ ||

mānsaprakṣālanābhaṁ kuthitamiva ca yat kardamāmbhōnibhaṁ vā
mēdaḥ pūyāsrakalpaṁ yakr̥diva yadi vā pakvajambūphalābham |
yat kr̥ṣṇaṁ yacca bhr̥śamatikuṇapaṁ yatra cōktā vikārā –
stdvarjyaṁ raktapittaṁ surapatidhanuṣā yacca tulyaṁ vibhāti || 12 ||

Patients in whom blood coming out resembles the color of water which mutton has been washed or a decaying matter or muddy water with lot of silt, fat, pus, piece of liver, ripe fruit of jambu (Eugina jambolina), which is black or blue in colour, which smells like a cadaver or resembles a rainbow and who have one or more of the problems cited above; they are to be refused treatment. 12

येन चोपहतो रक्तं रक्तपित्तेन मानवः |
पश्येद् दृश्यं वियच्चापि तच्चासाध्यमसंशयम् || १३ ||

yēna cōpahatō raktaṁ raktapittēna mānavaḥ |
paśyēd dr̥śyaṁ viyaccāpi taccāsādhyamasanśayam || 13 ||

If the patient of raktapitta sees everything blood red everywhere including the sky, he has undoubtedly reached an incurable stage. 13

लोहितं च्छर्दयेध्यस्तु बहुशो लोहितेक्षणः |
लोहितोद्गारदर्शी च म्रियते रक्तपैत्तिकः || १४ ||

lōhitaṁ cchardayēdhyastu bahuśō lōhitēkṣaṇaḥ |
lōhitōdgāradarśī ca mriyatē raktapaittikaḥ || 14 ||

If a patient of raktapitta vomits profuse blood, his eyes becomes red, has blood eructation and if he sees everything bloodred in color, he might soon expire. 14

इति श्रीमाधवविरिचिते माधवनिदाने रक्तपित्तनिदानं समाप्तम् ||9 ||

iti śrīmādhavaviricitē mādhavanidānē raktapittanidānaṁ samāptam ||9 ||

Thus concludes the chapter on Raktapitta.

Source —

1. Bleeding disorders