Chapter XLV - Symptoms and Treatment of Hemorrhage (Rakta-pitta)

Now we shall discourse on the Chapter which deals with the symptoms and) medical treatment of Hemorrhage (Rakta-Pitta-Pratishedha). 1.

Cause and Pathology:—

Excessive indulgence in grief, fright or anger, excessive physical labour, exposure to the sun and fire, constant use of pungent, acid, saline and alkaline food, or, of articles of fare which are keen or heat-making in potency, or incompatible in their combination, or are followed by deficient gastric or intestinal digestion are the factors which tend to aggravate the Rasa (chyle), which, in its turn, aggravates the Pitta. The aggravated Pitta thus imperfectly assimilated affects or invades in virtue of its own essence the blood (lit. leads to its imperfect digestion) which finds an outlet through the upper or the lower channels of the body or through the both. The deranged blood accumulated in the Amashaya (stomach) finds out an upward outlet, while it flows out through the lower orifices in the event of its continuing in a similar state in the Pakvashaya (intestines), and it escapes through both the upward and downward orifices in the event of its being deranged and accumulated in both the Amashaya and the Pakvashaya. According to several authorities, the ejected blood in the disease comes from the spleen and the liver. 2.

Prognosis:—

A case of Rakta-pitta in which the blood finds outlet through an upward channel of the body is amenable, while palliation is all that is possible in a case in which it flowes out through a downward orifice of the body. A case marked by the emission of blood through both these outlets, upward and downward, should be regarded as incurable. 3.

Premonitory Symptoms:—

A sense of lassitude in the limbs, desire for cooling things, a sense as if fumes are rising in the throat, vomiting and fetor of blood in the breath are the symptoms which usher in an attack of Rakta-pitta. The number of the cases of Rakta-pitta as well as the aggravation of the different Doshas involved in each case should be ascertained from the colour and nature of the ejected blood (as described before in Chap. XlV-Sutra-sthana). 4–5.

Supervening Symptoms:—

Weakness, laboured breathing, cough, fever, vomiting, mental aberration (lit: a state like intoxication), yellowness of complexion, burning sensation in the body, epileptic fits, acidity of the stomach, restlessness, extreme pain in the region of the heart, thirst, loss of voice (D. R. loose stool), heat in the head, fetid expectoration, aversion to food, indigestion and absence of sexual desire (D. R. bending of the body after sexual act) are the usual complications in a case of Rakta-pitta. 6.

Symptoms of Incurable Types:—

In a case of Rakta-pitta the emitted matter resembling the washings of meat or drug-decoction, or turbid water or fat or pus, or being liver-coloured or dark-black or blood-red in colour or looking like a ripe Jambu-fruit or blackish blue or variously coloured like a rain-bow or having a very fetid smell as well as the presence of the above mentioned supervening symptoms—these are the indications which show that the case should be given up as incurable. 7.

General Principles of Treatment:—

It is improper to arrest the emission of blood immediately at the outset of the disease if the patient be a sufficiently strong man, in as much as such a procedure may bring on an attack of^[1] Pandu-roga, Grahani, Kushtha (cutaneous diseases), Gulma, or fever or enlargement of the spleen. An attack in which the blood makes a downward course should be arrested with emetic medicines, while purgatives should be exhibited in a case in which the blood finds an upward course. But weak patient, under the circumstances, should be treated in both cases with soothing remedies. Fasting should be first enjoined in the case of an excessive emissionof^[2] of blood in respect of a strong patient with an unimpaired digestion and an unemaciated frame. A Peya prepared with a small quantity of rice should be given to the patient after fastingof^[3]. Tarpana measures, decoctions of digestive drugs, as well as a variety of medicinal lambatives and Ghritas should be the proper applications in the disease under discussion. Purgation should be induced with the compound of Draksha, Yashti-madhu, Kashmarya and sugar, while vomiting should be induced with an emetic compound consisting of Yashti-madhu mixed with honey. 8—11.

Articles of Fare:—

The use of milk, the drugs of cold-producing potency (e.g., the drugs of the Utpaladi group), essence of the meat of an animal of the Jangala group, soup of Satina (cerials), Shali- rice, Shashtika -grains, leaves of Patola, Shelu, Sunishanna, Yuthika and Sindhuvara (Nirgundi) as well as the tender sprouts of Vata and Atimukta (Tinduka) as pot-herbs and cooked with clarified butter are recommended as diets. Soup of the meat of pigeons, Shamkha (conch) and tortoise as well as the gruels mentioned before mixed with the expressed juice of Dhatri and pomegranate and with a profuse quantity of clarified butter should be given to the patient as diet. Milk should be duly cooked in combination with the drugs of the Utpaladi group, and the cream therefrom should be likewise prescribed with a copious quantity of honey and sugar. Cold Pradchas, honey, sugar, and clarified butter arc said to be beneficial in cases of Rakta-pitta. 12—13.

An experienced physician should prescribe any one of the four Iambatives composed of the powders of the flowers of Madhuka, Shobhanjana, Kcvidara or of Priyangu, mixed with honey to be licked up by a patient suffering from Rakta-pitta. Similarly lambatives of Durba, or the tender leaves of Vata, or of white Karnika pasted together with the honey should be given to be licked up by the patientof^[4]. Dates and other friuts of the same therapeutic virtue, taken with honey, would prove efficacious in the disease. 14—15.

Medicinal compounds mentioned in connection with the treatment of Raktatisara (blood-dysentery) may be as well employed with advantage in the present instance. A piece of sugar-cane devoid of its skin and crushed should be kept immersed in cold water contained in a new earthen pitcher. The picther with its lid off should be kept in an open place for a night. Its contents duly strained in the morning should be given with powdered Utpala and honey to a patient suffering from Rakta-pitta. A cold infusion of Jambu, Amra and Arjuna should be taken with honey. As an alternative, the expressed juice of Udumbara fruit should be taken (with honey). 16—A.

The best six Yogas:—

A paste (Kalka) of Trapusi -roots in combination with honey and washings of rice or two Tolas of the pasted Yashti-madhu should be taken (with the same vehicles). A compound consisting of Chandana, Yashti-madhu, and Rodhra taken in equal parts or Karanja- seeds made into a paste with sugar and honey should be similarly used In a similar way, the pith of Ingudi together with Yashti-madhu should be taken. As an alternative, salt (Saindhava) and Karanja- seeds turned into a paste with curd-cream should be taken lukeworm for three days in succession by a person suffering from an attack of Rakta-pitta. The six preceding medicinal compounds act as excellent cures for the disease under discussion. 16.

Pathya should be employed as an errhine after the manner of Avapida-Nasya in the event of the blood passing through the nostrils. In case of excessive hemorrhage (in the disease) the patient should drink blood in combination with honey, or eat a goat’s raw liver with the bile. 17.

Clarified butter duly cooked with the admixture of an adequate quantity of the expressed juice of (the bark of) Palasha trees should be taken, when cool, in combination with honey, or clarified butter prepared by churning the milk duly cooked with the expressed juice of (the bark of) the Vanaspati- trees (Vata, etc.) should be used with sugar. A Pala weight of each of Draksha, Ushira, Padmaka and sugar should be kept immersed in cold water during the (whole) night. This cold infusion would cure a case of Rakta-pitta. A draught of milk with an equal quantity of water is also recommended for a patient comforming to a proper regimen of diet and conduct. 18.

The watery secretion of the dung of a horse or a bull should be taken with honey and sugar. In the alternative, powders of the seeds of Vastuka or (of the roots, of Tanduliyaka -plants should be licked with honey. A lambative formed of Laja (parched paddy) and Anjanaof^[5] mixed with honey, or powdered Tuga-kshiri mixed with honey and sugar should be licked. A patient suffering from an attack of Rakta-pitta should take a compound of Draksha, Tikta-rohini, Yashti-madhu and sugar with cold water, or lick a compound of pulverised Pathya, Ahinsra and Rajani with clarified butter. 19.

The compound of (blue), Utpala Saurashtra mrithika (red earth), Priyangu, Lodhara, polens of lotus and sugar mixed together and taken with honey and a decoction of Vasaka would speedily stop the emission in a virulant type of Rakta-pitta. Similarly a compound consisting of flowers of Khadira, Jambu, Arjuna, (red) Kovidara, Shiris ha, Lodhra, Asana, Shalmali and Shigru, pounded together and mixed with honey should be licked by the patient in a case of Rakta-pitta. 20—21.

The alkaline water prepared with the ashes of Indivara and taken with honey, powdered Karanja -seeds taken with honey and clarified butter and the decoction of Jambu, Arjuna and Amra —these three compounds prove curative in cases of Rakta-pitta. A paste made of the roots and flowers of Matulunga should also be taken with the washings of rice. 22—23.

A solution of milk or water saturated with sugar should be applied into the nostrils in the event of bleeding from the nose. The expressed juice of grapes, clarified butter prepared by churning milk or the expressed juice of sugar-cane should be taken cold (through the nostrils) in combination with sugar²³⁴. All cooling measures and sweet-drugs should be employed in the present disease 24—25.

Asthapana and Anuvasna:—

The application of an Asthapana-Vasti charged with milk duly cooked with the drugs of the Vidari-gandhadi group and mixed with honey, clarified butter, sugar and Draksha, proves extremely efficacious in the disease under discussion. The application of an Anuvasna-Vasti charged with clarified butterof^[6] would be attend-ded with equal benefit. The drugs known as Priyangu, Lodhra; Sauviranjana, Gairika, Utpala, Suvarna-gairika, Kaliyaka, conch-shell, Chandana, sugar, Ashva-gandha, Ambuda, Yashti-madhu, Mrinala and Saugandhika, taken in equal parts, should be pounded together and mixed with copious quantities of milk, honey and clarified butter. This solution should be injected into the rectum after the manner of Nirudha-Vasti. The patient should be sprinkled with cold water and given his diet with milk after which clarified butter duly cooked with Yashti-madhu should be injected into the rectum of the patient after the manner of Anuvasana-Vasti. This measure proves extremely beneficial in cases of down-coursing Rakta-pitta and violent types of blood-dysentery. In the case of an excessive discharge of blood, if the patient be strong enough, vomiting should be induced after the cessation of the blood-discharge. 26-27.

Urethral-injections composed of the aforesaid drugs should be applied (after the manner of Uttara-vasti) in the event of bleeding from the bladder. Measures laid down in connection with the treatment of Rakta-pitta should be resorted to in cases of bleeding-piles. In cases of menorrhagia as well as in cases of excessive bleeding incidental to any surgical operation, the above measures (of the medical treatment) should be adopted by an experienced physician. The subsequent treatment of the cases should be determined by the nature and intensity of the deranged bodily Doshas as well as of the blood involved therein. 28-29.

 

Thus ends the forty-fifth chapter of the Uttara-Tantra in the Sushruta Samhita which deals with (the symptoms and) the medical treatment of Rakta-pitta.

Footnotes and references:

[1]:

Both Cakrapāni and Vrinda read “hṛtapāṇ?ugrahaṇī etc.” i.e., they say that it may bring on an attack of heart-disease also.

[2]:

Both Cakrapāni and Vrinda read “ūrddhaṃ pravṛddhadoṣasya” i.e., in cases of upward emission. There is also another variant “ūrddhaṃ pravṛddhadoṣasya” i.e., in cases of excessive upward emission or in cases where a good deal of the vitiated Doshas takes an upward course.

[3]:

Additional Text:—Meat-essence (Rasa) and soup (Yusha) seasoned with clarified butter prepared from cow’s milk.

[4]:

Dallana takes only Durbā and Vata under one rccipt. Some commentators would prescribe all these together under one recipt.

[5]:

Kālānjana is a variant, in place of Lāja and Anjana. For Kālānjana Dallana reads Sauvirānjana. This should be the proper reading because there is a word in the receipe which shows that there will be only one thing and not two.

[6]:

Śrikantha Datta, the commentator of Vrinda, would mix sugar with the juice of sugar-cane only and not with the other two. All these should be applied into the nostrils.