अथातो रक्तपित्तकासनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १॥
We will now expound the chapter Raktapitta and Kasa nidana – diagnosis of bleeding disease and cough; thus said Atreya and othergreat sages. (1)
Raktapitta nidana – samprapti – causes and pathogenesis
भृशोष्णतीक्ष्णकट्वम्ललवणातिविदाहिभिः । कोद्रवोद्दालकैश्चान्नैस्तद्युक्तैरतिसेवितैः ॥२॥
कुपितं पित्तलैः पित्तं द्रवं रक्तं च मूर्छिते । ते मिथस्तुल्यरूपत्वमागम्य व्याप्नुतस्तनुम् ॥३॥
पित्तं रक्तस्य विकृतेः संसर्गाद् दूषणादपि । गन्धवर्णानुवृत्तेश्च रक्तेन व्यपदिश्यते ॥४॥
प्रभवत्यसृजः स्थानात् प्लीहतो यकृतश्च तत् ॥५॥
Foods which are extremely hot (heat producing), penetrating pungent, sour and salty; those causing heart burn during digestion, kodrava, uddalaka and such others which tend to increase pitta, bring about the increase of pitta which combines with the liquid rakta (blood). Both of them, thus attaining identical properties spread to the entire body. Pitta being a bye-product of rakta, because of its co-existence, tendency of vitiation, possessing identical smell and colour, is spoken of as rakta itself. It starts flowing out from the seats of rakta (blood) and also from yakrit and pliha (liver and spleen). (2-5)
Purvarupa – premonitory symptoms
शिरोगुरुत्वमरुचिः शीतेच्छा धूमकोऽम्लकः । छर्दिश्छर्दितबैभत्स्यं कासश्वासौ भ्रमः क्लमः ॥६॥
लोहलोहितमत्स्यामगन्धास्यत्वं स्वरक्षयः । रक्तहारिद्रहरितवर्णता नयनादिषु ॥ ७॥
नीललोहितपीतानां वर्णानामविवेचनम् । स्वप्ने तद्वर्णदर्शित्वं भवत्यस्मिन् भविष्यति ॥८॥
Heaviness of the head, loss of appetite, desire for cold comforts, feeling of hot fumes coming out of the mouth, sour belching, vomiting, vomitted material causing fear, cough, increased/difficultbreathing, giddiness, exhoustion (without any effort), smell of iron, blood, fish or undigested raw smell in the mouth, loss of voice (feeble voice) red, deep yellow or green colour of the eyes etc (skin, urine, faeces) inability to descriminate blue, red and yellow colours, and seeing things of these colours only in dreams – these are the premonitary symtoms. (6-8)
Lakshana characteristic features
ऊर्ध्वं नासाक्षिकर्णास्यैर्मेद्रयोनिगुदैरधः । कुपितं रोमकूपैश्च समस्तैस्तत् प्रवर्तते ॥ ९ ॥ Blood comes out from the nose, eyes, ears and mouth in the upper parts of the body and from penis (urethra) vagina, (genital tract and urethra) and rectum in the lower parts and from all the hair follicles in case of combination of all (the three doshas). (9)
ऊर्ध्वं साध्यं कफाद्यस्मात्तद्विरेचनसाधनम् । बह्वौषधं च पित्तस्य विरेको हि वरौषधम् ॥१०॥
अनुबन्धी कफो यश्च तत्र तस्यापि शुद्धिकृत् । कषायाः स्वादवोऽप्यस्य विशुद्धलेष्मणो हिताः ॥ ११ ॥
किमु तिक्ताः कषाया वा ये निसर्गात् कफापहाः ॥ १२ ॥
Raktapitta with bleeding from the upper parts is sadhya (easy to treat) because of its association with kapha, purgation is the prescribed therapy for this condition, among the many therapies for pitta purgation is best and this also purifies (rectifies) kapha, the secondary dosha, kasayas (recipes like powder, decoctions, pills wetbolus etc) which have sweet taste are good for purifying kapha. What to speak, then of recipes of bitter and astringent tastes which are by nature alliviators of kapha (in other words they are mos efficacious). (10-12)
Notes In diseases which discharge materials from inside through the natura! orifices of the body in any one direction, the ideal method of treatment is to cause reversal of that direction. For egin case of vomiting, administring of purgatives; in case of diarrhoea administering emeties are such therapies. This is known as Pratimarga harana Chikitsa. Even for Raktapitta, this therapy is prescribed, purgation in case of bleeding from upward direction, and emesis in case of bleeding from downward direction; easiness or difficulty in treatment is decided on this basis also.
अधो याप्यं चलाद्यस्मात्तत् प्रच्छर्दनसाधनम् । स्वल्पौषधं च पित्तस्य वमनं न वरौषधम् ॥१३॥
अनुबन्धी चलो यश्च शान्तयेपि न तस्य तत् । कषायाश्च हितास्तस्य मधुरा एव केवलम् ॥१४॥
Raktapitta with bleeding from the lower parts is yapya (controllable but persisting for long time) because, its is associated with vata, and emesis is the (prescribed) method of treatment (for this type ) ; there are few therapies (for vata), emesis is not the ideal treatment for pitta, even it does not subdue vata, the associate dosha, so also the recipes with astringent taste, only those of sweet taste are suitable. (13-14)
कफमारुतसंसृष्टमसाध्यमुभयायनम् । अशक्यप्रातिलोम्यत्वादभावादौषधस्य च ॥१५॥
न हि संशोधनं किञ्चिदस्त्यस्य प्रतिलोमनम् । शोधनं प्रतिलोमं च रक्तपित्ते भिषग्जितम् ॥१६॥
एवमेवोपशमनं सर्वशो नास्य विद्यते । संसृष्टेषु हि दोषेषु सर्वजिच्छमनं हितम् ॥१७॥
Raktapitta with bleeding in both/directions is asadhya (impossible to cure) because of association of both kapha and vata, reverse directional therapy being impossible, non – availability of any other therapies (drugs), any kind of purifactory therapy not becoming an anti – directional therapy in this condition, but these are the prescribed methods of treatment for raktapitta. Hence complete relief of the disease in all respects is not possible, the treatment of combination of doshas, only palliative therapies are suitable. (15-17)
तत्र दोषानुगमनं सिरास्त्र इव लक्षयेत् । उपद्रवांश्च विकृतिज्ञानतः – तेषु चाधिकम् ॥ १८ ॥
आशुकारी यतः कासस्तमेवातः प्रवक्ष्यते ॥१९॥
The symptoms of doshas are to be understood in the same way as described for the blood circulating in the veins and the complications (secondary diseases etc) as described in Vikrtijnana (chapter 11 of sharira sthana). (18-19)
Among these(complications/secondary diseases) kasa (cough) is the one manifesting auickly (more commonly) hence it is described here.
Notes: : Features of doshas in the blood are the following – blood associated with vata will be bluish – red in colour, dry (non-slimy) and thin; that associated with pitta is yellowish or green in colour, foul smelling, hot and very thin; that associated with kapha is white or pale in colour, very slimy, heavy and thick.
Kasa nidanam – diagnosis of cough
पञ्च कासाः स्मृता वातपित्तश्रेष्मक्षतक्षयैः । क्षयायोपेक्षिताः सर्वे बलिनश्चोत्तरोत्तरम् ॥ २०॥
Kasa (cough) is five; such as from vata, pitta, slesma (kapha), ksata (injury to lungs ) and ksaya (wasting or depletion of tissues); excepting ksayaja (arising from depletion of tissues) the remaining are powerful in their succeeding order. (20)
Purvarupa- premonitary symptoms
शूकपूर्णाभकण्ठत्वमस्वास्थ्यं हृदयस्य च ॥ २१ ॥ Their premonitory symptoms are – irritation in the throat, loss of appetite, feeling as though the throat is full of thorns and discomfort (uneasines) in theregion of heart. ( 21 )
Samprapti – pathogenesis
तेषां भविष्यतां रूपं कण्ठे कण्डूररोचकः
कषायविज्जलासात्म्यकट्वम्ललवणोषणैः । रूक्षशीतगुरुस्निग्धोत्क्लेदिपर्युषिताशनैः॥२२॥
धारणोदीरणायासरात्र्यहःस्वप्नजागरैः । अन्यैश्च तद्विधैर्धातुक्षयावरणकारिभिः ॥२३॥
क्रुद्धः प्रतिहतोऽपाने यदापानः प्रपद्यते । ऊर्ध्वं रसस्य स स्थाने तिष्ठन्नुरसि पीड्यते ॥ २४ ॥
उदानेन सजंस्तत्र कण्ठे चानुप्रपूर्य च । वाहिनीर्गलमूर्धस्थास्ततोऽङ्गान्युत्क्षिपन्निव ॥ २५ ॥
क्षिपन्निवाक्षिणी पृष्ठमुरः पार्श्वे च पीडयन् । विवृतत्वान्मुखेनैति भिन्नकांस्योपमध्वनिः ॥२६॥
यस्मात्तस्मात्स वर्णौजोबलमांसक्षयावहः ॥२७॥
By over – indulgence in foods which are astringent, highly moist, unaccustomed, bitter, pungent, sour, salty, pungent, dry, cold, hard to digest, fatty, which produce nause and which are stale (kept over night); suppression or premature initiation of the urges of the body, exertion, keeping awake at nights, sleeping during day and such other causes which bring about either depletion or hinderance (to their funtion) of the dhatus, the apana vata getting increased and obstructed moves upwards to the site of rasa (heart) and causes discomfort in the chest. Combining with udana, it fills up the passages of the throat, makes for violent movement of the body, eyes, back, chest and flanks, producing pain in these comes out of the open mouth, producing sound like that of a broken bronze (bell); also lead to decrease / depletion of colour ( and complexion) brilliance (vigour), strength and physique. (22-27)
हेतुभेदात् प्रतीघातभेदो वायोः सरंहसः । यद्रुजाशब्दवैषम्यं कासानां जायते ततः ॥२८॥
Due to diferent causes, different divisions and seats of vata getting involved, there occurs differences in the nature of pain and sound in different kinds of cough. (28)
Lakshana – clinical features
कुपितो दातलैर्वायुः शुष्कोरः कण्ठवक्त्रताम् । हृत्पार्श्वोरः शिरःशूलं मोहक्षोभस्वरक्षयान् ॥२९॥
करोति शुष्ककासंचमहावेगरुजास्वनम् । सोऽङ्ग्रहर्षी कर्फ शुष्कं कृच्छ्रान्मुक्त्वाल्पतां व्रजेत् ॥३०॥
पित्तात् पीताक्षिक फता तिक्तास्यत्वं ज्वरो भ्रमः । पित्तासृग्वमनं तृष्णा वैस्वर्यं धूमको मदः ॥ ३१ ॥
प्रततं कासवेगेन ज्योतिषामिव दर्शनम् । कफादुरोऽल्परुड्यूर्धहृदयं स्तिमितं गुरु ॥३२॥
कण्ठोपलेपः सदनं पीनसच्छर्घरोचकाः । रोमहर्षो घनस्निग्धश्वेतश्लेष्मप्रवर्तनम् ॥३३॥
Vata undergoing increase by (indulgence in) factors increasing it, causes dryness of the chest, throat, and mouth, pain in the heart, flanks, chest and head, delusion, ksobha (tossing, shaking of the body), loss of voice, produces dry cough of great force, pain and sound, and frequent horripilations, it brings out dry (non. slimy) sputum with difficulty and then gets reduced – these are the symptoms of Vata kasa.
In Pittaja kasa there is yellow colour in the eyes and sputum bitter taste in the mouth, fever, giddiness, vomiting of bile and blood, thirst, change of voice, feeling of hot fumes, toxicity and sight of flashes of light (rays, objects) due to continuous coughing.
In Kaphaja kasa there is mild pain in the chest and absence of movement, feeling of heaviness in the head and (region of ) the heart, coating ( of sputum) in the throat, debility, running in the nose, vomiting, loss of appetite, horripilations and expectoration of thick, slimy and white sputum. (29-33)
Ksataja Kasa – cough due to injury to lungs
युद्धाद्यैः साहसैस्तैस्तैः सेवितैरयथाबलम् । उरस्यन्तःक्षते वायुः पित्तेनानुगतो बली ॥३४॥
कुपितः कुरुते कासं कफं तेन सशोणितम् । पीतं श्यावं च शुष्कं च ग्रथितं कुथितं बहु ॥ ३५ ॥
ष्ठीवेत् कण्ठेन रुजता विभिन्नेनेव चोरसा । सूचीभिरिव तीक्ष्णाभिस्तुद्यमानेन शूलिना ॥३६॥
पर्वभेदज्वरश्वासतृष्णावैस्व र्यकम्पवान् । पारावत इवाकूजन् पार्श्वशूली ततोऽस्य च ॥३७॥
क्रमाद्वीर्यं रुचिः पक्तिर्बलं वर्णश्च हीयते । क्षीणस्य सासृङ्मूत्रत्वं स्याच्च पृष्ठकटीग्रहः ॥३८॥
By engaging in combat, and such other strenous physical activities which are beyond one’s capacity, there occurs a tear ( injury ) inside the chest (lungs); then vata getting aggravated (increased) along with pitta, produces cough; the patient brings out kapha (sputum) which is mixed with blood, yellow or black in colour, dry (non-slimy ) solidified, putrified and copious, has pain in the throat, feels as though the chest is being torn apart, or pricked by sharp needles, or spears, pain in the joints, fever, increased / difficult breathing, thirst, change of voice, tremors, breathes making cooling sound like a pegion, has severe pain in the flanks, loses vigour, appetite, digestive power, strength and colour in succession, becomes emaciated, passes urine mixed with blood and suffers from catching pain in the back and waist. These are the symptoms of Ksatajakasha. (34-38)
Ksayaja kasa
वायुप्रधानाः कुपिता धातवो राजयक्ष्मिणः । कुर्वन्ति यक्ष्मायतनैः कासं ष्ठीवेत् कफं ततः ॥३९॥
पूतिपूयोपमं पीतं विस्त्रं हरितलोहितम् । लुप्येत इव पार्श्वे च हृदयं पततीव च ॥ ४० ॥
अकस्मादुष्णशीतेच्छा बहाशित्वं बलक्षयः । स्त्रिग्धप्रसन्नवकात्वं श्रीमद्दर्शननेत्रता ॥४१॥
ततोऽस्यक्षयरूपाणि सर्वाण्याविर्भवन्ति च ॥ ४२ ॥
इत्येष क्षयजः कासः क्षीणानां देहनाशनः । याप्यो वा बलिनां तद्वत् क्षतजोऽभिनवौ तु तौ ॥४३॥
सिध्येतामपि सानाथ्यात्- साध्या दोषैः पृथक् त्रयः । मिश्रा याप्या द्वयात्सर्वे जरसा स्थविरस्य च ॥४४॥
In persons suffering from rajayaksma (pulmonary tuberculosis) all the three doshas with the predominance of vata undergo increase by the causes of rajayaksma and produce cough; the patient coughs and brings out kapha (sputum) having putrid smell, resembling pus, yellow green and red in colour, he feels that this flanks are being pulled out with force, his heart falling down without any other reason, desires warmth and cold altrnately, eats large amount of food, (but) loses strength, his facial appearance becomes pleasant with eyes being bright and lustruous, next follow all the other symptoms of ksaya (consumption, depletion of tissues). These are the features of Ksayaja kasa which destroy the body of emaciated (weak) persons, or persists for the rest of the life in strong persons. Similar is ksataja kasa also, both are curable, if only, they are of recent onset and with the availability of effective treatment. (39-43)
The three kinds arising from individual doshas are sadhya (curable), those of combination of any two doshas are yapya (controllable but persist), so also all the types in the aged persons because of oldage. (44)
कासाश्वासक्षयछर्दिस्वरसादादयो गदाः । भवन्युपेक्षया यस्मात्तस्मात्तं त्वरया जयेत् ॥ ४५ ॥
By neglecting kasa (cough) many other diseases such as svasa (difficult breathing), ksaya (consumption), chardi (vomiting), svarasada (loss of voice) etc, develop, hence it (kasa) should be cured (treated) quickly. (45)
॥ इति तृतीयोऽध्यायः ॥ Thus ends the Third chapter.
