पञ्चचत्वारिंशोऽध्यायः अथातो रक्तपित्तप्रतिषेधं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Chapter which deals with the symptoms and medical treatment of Hemorrhage (Rakta-Pitta Pratisedha). 1
Cause and Pathology of Raktapitta
क्रोधशोकभयायास विरुद्धान्नातपानलान् । कट्वम्ललवणक्षार- तीक्ष्णोष्णातिविदाहिनः ॥ २ ॥ नित्यमभ्यस्यतो दुष्टो रसः पित्तञ्च कोपयेत् । विदग्धं स्वगुणैः पित्तं विदहत्याशु शोणितम् । ततः प्रवर्तते रक्तमूर्ध्वञ्चाधो द्विधाऽपि वा । आमाशयाद् ब्रजेदूर्ध्वमधः पक्वाशयाद् ब्रजेत् । विदग्धयोर्द्वयोश्चापि द्विधाभागं प्रवर्त्तते । केचित् सयकृतः प्लीह्नः प्रवदन्त्यसृजो गतिम् ॥ ३ ॥
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 provoke the Rasa (chyle), which in its turn, aggravates the Pitta. The aggravated Pitta thus imperfectly assimilaed affects or invades in virtue of its own essence the blood (lit. leads to its imperfect digestion) which finds an outlet through the both above and down openings. The deranged blood accumulated in the Amasaya (stomach ) finds out an upward outlet, while it flows out through the lower orifices in the event of it continuing in similar state in the Pakvasaya (in testines), and it escapes through both the upward and downward orifices in the event of its being deranged and accumulated in both the Amasaya and the Pakvasaya. According to several authorities, the ejected blood in the disease comes from the spleen and the liver. 2-3
Prognosis of Rakta Pitta
ऊर्ध्वं साध्यमधो याप्यमसाध्यं युगपद्गतम् ॥ ४॥
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 inwhich it flowers 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. 4
Premonitory Symptoms of Raktapitta
सदनं शीतकामित्वं कण्ठधूमायनं वमिः । लोहगन्धिश्च निःश्वासो भवत्यस्मिन् भविष्यति ॥ ५ ॥ बाह्यासृग्लक्षणैस्तस्य सङ्ख्यादोषोच्छ्रितीर्विदुः ॥६॥
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 symtoms which usher in an attack of Rakta-pitta. The number of the cases of Rakta-pitta as well as the aggravation of the different Dosas involved in each case should be ascertained from the colour and nature of the ejected blood (as described before in Chap. XIV-Sutra-Sthana). 5-6.
दौर्बल्यश्वासकासज्वरवमथुमदाः पाण्डुता दाहमूर्च्छा भुक्ते चान्ने विदाहस्त्वधृतिरपि सदा हृद्यतुल्या च पीडा । तृष्णा कण्ठस्य भेदः शिरसि च दवनं पूतिनिष्ठीवनञ्च द्वेषो भक्तेऽविपाको विरतिरपि रते रक्त पित्तोपसर्गाः ॥ ७ ॥
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. 7
Symptoms of incurable Types
मांसप्रक्षालनाभं क्वथितमिव च यत् कर्दमाम्भोनिभं वा मेदःपूयास्त्रकल्पं यकृदिव यदि वा पक्कजम्बूफलाभम् । यत् कृष्णं यच्च नीलं भृशमतिकुणपं यत्र चोक्ता विकारास्तद् वर्ज्यं रक्तपित्तं सुरपतिधनुषा यच्च तुल्यं विभाति ॥ ८ ॥
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 symptomsthese are the indications which show that the case should be given up as incurable. 8
General Principles of Treatment Raktapitta
नादौ संग्राह्यमुद्रिक्तं यदसृग् बलिनोऽश्वतः । तत् पाण्डुग्रहणीकुष्ठ- प्लीहगुल्मज्वरावहम् ॥ ९ ॥ अधःप्रवृत्तं वमनैरूर्ध्वगं च विरेचनैः ।जयेदन्यतरच्चापि क्षीणस्य शमनैरसृक् ॥ १० ॥ अतिप्रवृद्धदोषस्य पूर्वं लोहितपित्तिनः । अक्षीणबलमांसाग्ने: कर्तव्यमपतर्पणम् ॥ ११ ॥ लङ्गितस्य ततः पेयां विदध्यात् स्वल्पतण्डुलाम् । तर्पणं पाचनं लेहान् सर्पषि विविधानि च ॥ १२ ॥ द्राक्षामधुककाश्मर्य-सितायुक्तं विरेचनम् । यष्टीमधुकयुक्तञ्च सक्षौद्रं वमनं हितम् ॥ १३ ॥
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, as such a procedure may bring on an attack of Pandu-roga, Grahani, Kustha (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 emission¹ 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 fasting² 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 Draksa, Yasti-madhu, Kasmarya and sugar, while vomiting should be induced with an emetic compound consisting of Yasti-madhu mixed with honey. 9-13.
1. Both Cakrapani and Vinda read “हत्पारुडुग्रहणी” etc. ie, they say that it may bring on an attack of heart-disease also.
पयांसि शीतानि रसाश्च जाङ्गलाः सतीनयूषाश्च सशालिषष्टिकाः । पटोलशेलूसुनिषण्णयूथिका वटातिमुक्ताङ्कुरसिन्दुवारजम् ॥ १४ ॥ हितञ्च शाकं घृतसंस्कृतं सदा तथैव धात्रीफलदाडिमान्वितम् । रसाश्च पारावतशङ्खकूर्मजास्तथा यवाग्वोऽभिहिता घृतोत्तराः ॥ १५ ॥ सन्तानिकाश्चोत्पलवर्गसाधिते क्षीरे प्रशस्ता मधुशर्करोत्तराः । हिमा: प्रदेहा मधुरा गणाश्च ते घृतानि पथ्यानि च रक्तपित्तिनाम् ॥ १६ ॥
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), Sali-rice, Sastika-grains, leaves of Patola, Selu, Sunisanna, 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, Samkha (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 Pradehas honey, sugar, and clarified butter are said to be beneficial in cases of Rakta-pitta. 14-16.
1. Both Cakrapani and Vrnda read” “i.e. in cases of upward emission. There is also another variant “y” i.e. in cases of excessive of excessive upward emission or in cases where a good deal of the vitiated Dossas takes an upward course.
2. Additional Text: Meat-essence (Rasa) and soup (Yusa) seasoned with clarified butter prepared from cow’s milk.
मधूकशोभाञ्जनकोविदारजैः प्रियङ्गुकायाः कुसुमैश्च चूर्णितैः । भिषग् विदध्याच्चतुरः समाक्षिकान् हिताय लेहानसृजः प्रशान्तये ॥ १७ ॥ लिह्याच्च दूर्वावटजांश्च पल्लवान् मधुद्वितीयान् सितकर्णिकस्य च । हितञ्च खर्जूरफलं समाक्षिकं फलानि चान्यान्यपि तद्गुणान्यथा ॥ १८ ॥
An experienced physican should prescribe any one of the four lambatives composed of the powders of the flowers of Madhuka, Sobhanjana, Kovidara or of Priyangu, mixed with honey to be licked up by a patient suffering from Rakta-pitta. Similarly lambatives of Durba, or the tender leves of Vata or of white Karnika pasted together with the honey should be given to be licked up by the patient.’ Date and other friuts of the same therapeutic virtue, taken with honey would prove efficacious in the disease. 17-18.
रक्तातिसारप्रोक्तांश्च योगानत्रापि योजयेत् ॥ १९ ॥ शुद्धेक्षुकाण्डमापोथ्य नवे कुम्भे हिमाम्भसा | योजयित्वा क्षिपेद्रात्रावाकाशे सोत्पलन्तु तत् ॥ २० ॥ प्रातः स्स्रुतं क्षौद्रयुतं पिबेच्छोणितपित्तवान् । पिबेच्छीतकषायं वा जम्ब्वाम्रार्जुनसम्भवम् ॥ २१ ॥ उदुम्बरफलं पिष्ट्वा पिबेत् तद्रसमेव वा ॥ २२ ॥
Medicinal compounds mentioned in connection with the treatment of Raktatisara (bloodydysentery) 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 Udumbra fruit should be taken (with honey ). 19-22.
1. Dalhana takes only Durba and Vata under one Recipe. Some commentators would prescr all these together under one recipe.
त्रपुषीमूलकल्कं वा सक्षौद्रं तण्डुलाम्बुना । पिबेदक्षसमं कल्कं यष्टीमधुकमेव वा । चन्दनं मधुकं रोध्रमेवमेव समं पिबेत् ॥ २३ ॥ करञ्जबीजमेवं वा सिताक्षौद्रयुतं पिबेत् । मज्जानमिङ्गुदस्यैवं पिबेन्मधुकसंयुतम् ॥ २४ ॥ सुखोष्णं लवणं बीजं कारचं दधिमस्तुना | पिबेद् वाऽपि त्र्यहं मर्त्यो रक्तपित्ताभिपीडितः । रक्तपित्तहराः शस्ताः षडेते योगसत्तमाः ॥ २५ ॥
The best six Yogas — A paste (Kalka) of Trapusi root in combination with honey and washings of rice or two Tolas of the pasted yasti-madhu should be taken (with the same vehicles ). A compound consisting of Candana, Yasti-madhu, and Rodhra taken in equal parts or Karanja-seeds made into a paste with sugar and honey should be similaly used in a similar way, the pith of Ingudi together with Yastimadhu 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 exce lent cures for the disease under discussion. 23-25.
पथ्याश्चैवावपीडेषु घ्राणतः प्रस्नुतेऽसृजि ॥ २६ ॥ अतिनिस्स्रुतरक्तो वा क्षौद्रयुक्तं पिबेदसृक् । यकृद् वा भक्षयेदाजमामं पित्तसमायुतम् ॥ २७ ॥
Pathya should be employed as an errhine in the manner of Avapida-Nasya in the event of the blood passing through the nostrils. In case of excessive haemorrhage (in the disease) the patient should drink blood in combination with honey or a goat’s raw liver with the bile. 26-27.
पलाशवृक्षस्वरसे विपक्कं सर्पिः पिबेत् क्षौद्रयुतं सुशीतम् । वनस्पतीनां स्वरसैः कृतं वा सशर्करं क्षीरघृतं पिबेद् वा ॥ २८ ॥ द्राक्षामुशीराण्यथ पद्मकं सिताः पृथक् पलांशान्युदके समावपेत् । स्थितं निशां तद्रुधिरामयं जयेत् पीतं पयो वाऽम्बुसमं हिताशिनः ॥ २९ ॥
Clarified butter duly cooked with the admixture of an adequate quantity of the expressed juice of (the bark of) Palasa 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 Draksa, Usira, 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. 28-29.
तुरङ्गवर्च:स्वरसं समाक्षिकं पिबेत् सिताक्षौद्रयुतं वृषस्य वा । लिहेत् तथा वास्तुकबीजचूर्णं क्षौद्रान्वितं तण्डुलसाह्वयं वा ॥ ३० ॥ लिह्याच्च लाजाञ्जनचूर्णमेकमेवं सिताक्षौद्रयुतां तुगाख्याम् । द्राक्षां सितां तिक्तकरोहिणीञ्च हिमाम्बुना वा मधुकेन युक्ताम् । पथ्यामहिंस्त्रां रजनीं घृतञ्च लिह्यात् तथा शोणितपित्तरोगी ॥ ३१ ॥
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 Tanduliya-plants should be licked with honey. A lambative formed of Laja (parched paddy) and Anjanal mixed with honey, or powdered Tuga-ksiri mixed with honey and sugar should be licked. A patient suffering from an attack of Rakta-pitta should take a compound of Draksa, Tikta-rohini, Yasti-madhu and sugar with cold water, or lick a compound of pulverised Pathya, Ahinsra and Rajani with clarified butter. 30-31.
वासाकषायोत्पलमृप्रियङ्ग-लोध्राञ्जनाम्भोरुहकेशराणि । पीत्वा सिताक्षौद्रयुतानि जह्यात् पित्तासृजो वेगमुदीर्णमाशु ॥ ३२ ॥
1. Kalanjana is a variant, in place of Laja and Anjana. For Kalanjana Dalhana reads Souviranjana. 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.
गायत्रिजम्ब्वर्जुनकोविदार- शिरीषरोधाशनशाल्मलीनाम् । पुष्पाणि शिग्रोश्च विचूर्ण्य लेहो मध्वन्वितः शोणितपित्तरोगे ॥ ३३ ॥
The compound of (blue), Utpala Sourastra mrthika (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, Sirisa, Lodhra, Asana, salmali and sigru, pounded together and mixed with honey should be licked by the patient in a case of Rakta-pitta. 32-33.
सक्षौद्रमिन्दीवरभस्मवारि करञ्जबीजं मधुसर्पिषी च। जम्ब्वर्जुनाम्रक्कथितञ्च तोयं घ्नन्ति त्रयः पित्तमसृक् च योगाः ॥ ३४ ॥ मूलानि पुष्पाणि च मातुलुङ्गयाः पिष्ट्वा पिबेत् तण्डुलधावनेन ॥ ३५ ॥
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. 34-35.
घ्राणप्रवृत्ते जलमाशु देयं सशर्करं नासिकया पयो वा । द्राक्षारसं क्षीरघृतं पिबेद् वा सशर्करञ्चेक्षुरसं हिमं वा ॥ ३६ ॥ शीतोपचारं मधुरञ्च कुर्याद् विशेषतः शोणितपित्तरोगे ॥ ३७॥
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 sugar¹. All cooling measures and sweet-drugs should be employed in the present disease. 36-37.
द्राक्षाघृतक्षौद्रसितायुतेन विदारिगन्धादिविपाचितेन । क्षीरेण चास्थापनमग्र्यमुक्तं हितं घृतञ्चाप्यनुवासनार्थम् ॥ ३८ ॥
1. Srikantha Datta, the commentator of Vrnda, would mix sugar with the juice of sugar-cane only and not with the other two. All these should be applied into the nostrills.
प्रियङ्गुरोधाञ्जनगैरिकोत्पलैः सुवर्णकालीयकशङ्खचन्दनैः । ॥३९॥ सिताश्वगन्धाम्बुदयष्टिकाह्वयैर्मृणालसौगन्धिकतुल्यपेषितैः निरूह्य चैनं पयसा समाक्षिकैर्घृतप्लुतैः शीतजलावसेचितम् । क्षीरौदनं भुक्तमथानुवासयेद् घृतेन यष्टीमधुसाधितेन च ॥ ४० ॥ अधोवहं शोणितमेष नाशयेत् तथातिसारं रुधिरस्य दुस्तरम् । विरेकयोगे त्वति चैव शस्यते वाम्यश्च रक्ते विजिते बलान्वितः ॥ ४१ ॥
Asthapana and Anuvasana – The application of an AsthapanaBasti charged with milk duly cooked with the drugs of the Vidarigandhadi group and mixed with honey, clarified butter, sugar and Draksa, proves extremely efficacious in the disease under discussion. The applicaton of an Anuvasna-Basti charged with clarified butter¹ would be attended with equal benefit. The drugs known s Priyangu, Lodhra, Sourviranjana, Gairika, Utpala, Suvarnagairika, Kaliyaka, conch-shell, Candana, Sugar, Asvagandha, Ambuda, Yasti-madhu, Mrnala and Sougandhika, 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 in the manner of Niruha-Basti. The patient should be sprinkled with cold water and given his diet with milk after which clarified butter duly cooked with Yasti-madhu should be injected into the rectum of the patient in the manner of Anuvasana-Basti. This measure proves extremely beneficial in cases of down-coursing Rakta-pitta and violent types of blooddysentery. 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. 38-41.
एवंविधा उत्तरबस्तयश्च मूत्राशयस्थे रुधिरे विधेयाः । प्रवृत्तरक्तेषु च पायुजेषु कुर्याद् विधानं खलु रक्तपैत्तम् ॥ ४२ ॥ विधिश्चासृग्दरेऽप्येष स्त्रीणां कार्यो विजानता । शस्त्रकर्मणि रक्तं वा यस्यातीव प्रवर्तते ॥ ४३ ॥ त्रयाणामपि दोषाणां शोणितेऽपि च सर्वशः । लिङ्गान्यालोक्य कर्तव्यं चिकित्सितमनन्तरम् ॥ ४४ ॥
1. Srikantha Datta, the commentator of Vnda, advised to mix sugar with the juice of sugar-cane only and not with the other two. All these should be applied into the nostrils.
Urethral-injections composed of the aforesaid drugs should be applied (in the manner of Uttara-Basti) 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 Dosas as well as of the blood involved there in. 42-44.
इति सुश्रुत संहितायामुत्तरतन्त्रे रक्तपित्तप्रतिषेधव्याख्यानाम पञ्चचत्वारिंशोऽध्यायः ॥ ४५ ॥
Thus ends the forty-fifth chapter of the Uttara-Tantra in the Susruta Samhita which deals with (the symptoms and) the medical treatment of Rakta-Pitta.