Treatment of bleeding disease in Vaghbhat's Ashtang Hridayam

 Treatment of bleeding disease in Vaghbhat's Ashtang Hridayam

We shall now expound the chapter Raktapitta chikitsa treatment of raktapitta (bleeding disease); thus said Atreya and other great sages.

Raktapitta Sadhyasadhyata  (prognosis of bleeding disorders)

 Raktapitta which is of upward direction (bleeding from the upper parts of the bocy such as nose, mouth, ears) seen in a strong person, of mild bouts (of bleeding), produced by any one dosa, of recent onset, appearing at a fovourable time and having no complications (secondary affections) should be treated. Raktapitta which is of downward direction (bleeding from the urethra, rectum, and vagina), that produced by two dosas, recurring often after subsiding and changing from one channel (site) to the other ( often) should be controlled. That which bleeds heavily, found in a person who has poor digestive power, produced by all the three dosas and that manifesting in both the direction should be rejected. 1-3a. 

Raktapitta chikitsa krama (Procedure of treatment)

Having (clearly) determined the cause, direction, the mala (cheif causative dosa), anubala (secondary dosas), the strength (of the patient and the diesease), the condition of the desa (habitat and the body of the patient vis a vis his constitution) and kala (season and the stage of the diseases), treatment of raktapitta should be commenced either with langhana (therapies to make the body thin) or brmhana (therapies to make the body stout) with either sodhana (purifactory therapies) or samana (palliative therapies). 3b-4.

That (raktapitta) which is produced by santarpana (over nourishment) in a strong person, caused by many dosas should be treated by vireka (purgation therapy) if it is of upward direction and by vamana (emesis therapy) if it is of downward direction or by samana (palliative) and brmhana (stoutening, nourishing therapies) after finding out whether the patient is fit for langhana and brmhana therapies. 5-6a.

When it is of upward direction, administration of drugs having samana (mitigating the dosas tastes, viz, bitter and astringent, fasting and drinking sadangodaka devoid of sunthi should be adhered to; in case of downward direction, it should be the use of sweet taste which is nourishing. 6b-7. 

Notes: Sadangodaka or shadanga paniya is drinking water prepared by boiling with six drugs viz, ghana (musta), candana, sunthi, ambu (valaka), parpata and usira. In this disease it should be prepared without sunthi.

In case of upward direction, tarpana should be given first (as food) and in case of downward direction, peya should be given first. 8a. 

Notes: Tarpana’ is prepared with flour of corns mixed with cold water and added with ghee (and sugar) and made neither too thin nor too thick in constitence. It is a nourishing menu; ‘Peya’ is gruel prepared by boiling corns (especially broken rice) in water and allowing small quantity of precipitate to remain in it.

If the patient is eating well and strong, the impure blood (that is flowing out) should not be stopped; if done so, it is going to produce diseases. If otherwise, (patient not eating well and is weak) it (bleeding) should be stopped soon, as it is going to kill the patient, quickly. 8b-9a. 

Virecana yoga in Raktapitta (Purgative recipes)

A lehya (confection) should be prepared as per procedure with the decoction and paste of trivrit and syama and sugar. It should be licked one panitala ( karsa) per dose. A modaka (bolus) prepared from trivrt, triphala, syama, pippali, along with sarkara (sugar) and madhu (honey) cures raktapitta caused by all the dosas, of the upward direction, dropsy and fever. Similarly the bolus prepared with equal quantities of trivrt, and sita (sugar) and one fourth part of the pippali. 9b-11. 

Vamana yoga (Emetic recipes)

Tarpana mixed with (powder of) phala (madana) and added with sita ( sugar ) and madhu ( honey) should be used for vamana (emesis ) followed by drinking either sugar water, honey water, water boiled with madhuka, milk or sugarcane juice. 12-13a. 

After purificatory therapies, the other regimen of these therapies, such as drinking mantha, peya etc. (liquids foods) should be adhered to, protecting the strength (of the body constantly). 13b. 

Notes : Mantha is thin watery beverage containing corn flour, milk, sugar etc., churned well. It also means a cold infusion of drugs well churned and then sweetened. 

Draksadi mantha mentioned in the treatment of fever (vide, chapter1-55-58 ) or that prepared from fruits which mitigate pitta (should be used). 14a. 

Mantha or pancasara (sweet syrup) prepared from madhu (honey), kharjura, mrdvika, parusaka, sita (sugar) and water, added with ghrta (ghee) and laja saktu (flour of fried paddy) may be used; for those who have poor digestion and desire sour taste, mantha prepared from dadima and amalaka. 14b-15. 

Peya prepared from drugs in the following (three half verses and next, (four) in quarter-verses, should be made of (in adhoga raktapitta-downward bleeding)-viz. 1. Kamala, utpala kinjalka, prsniparni and priyangu, 2. Usira, sabararodhra, Srngavera and kucandana, 3. Hreebera, dhatakipuspa bilvamadhya (majja) and duralabha, 4. Bhunimba, sevya and jalada, 5. Masura and prsniparni, 6. Vidarigandha and mudga, 7. Bala, sarpis (ghrta) and harenuka. 16-18.

Meat of animals of desert-like region which are cold in potency should be processed seperately in water with of drugs mentioned above and from that (cold infusion) juice (meat soup) yavagu (gruel) should be prepared). It should be cooled and added with sugar and honey (and used) or meat juice (soup) with slight sour taste or not having sour taste, fried in ghee and added with sugar ( may be used). 19-20. 

Grains with spike, legumes (pulses) and vegetables which are easily digestable and cold (in potency) mentioned in annasvarupa vijnana (chapter 6 of Sutrasthana) are best suited for raktapitta (bleeding disease). 21. 

Water mentioned earlier (sadanga paniya without sunthi), water boiled and cooled, honey water or syrup of fruits (Any one of these) should be used for drinking. 22.

Meat of rabbit along with vastuka (saka) is beneficial when there is constipation, (meat of ) tittiri (black partridge) boiled with the decoction of udumbara is beneficial when there is predominance of maruta (vata). Similarly the (meat of) peacock boiled in the decoction of plaksa and the (meat of) fowl/poultry boiled in the decoction of nyagrodha. 23-24a. 

Any cause which gives rise to raktapitta (bleeding disease) should be avoided. 24b. 

Vasakalpa 

Fresh juice of vasa mixed powder of phalini, mrt (saurastri), rodhra, anjana (rasanjana) and maksika (honey) alleviates bleeding disease; or fresh juice of atarusaka either mixed with sugar and honey or alone, or decoction of it (atarusa) cures raktapitta immediately. It ( vasa) is its (of raktapitta) best medicine. 25-26. 

Anya Kalpa (Other recipes) 

The following three decoctions of drugs added with honey and sugar cure bleeding disease, 1. Patola, malati, nimba, the two candana and pad-maka, 2. rodhra, vrsa, tanduliya, krsnamrt, and madayantika, 3. satavari, gopakanya, the two kakoli and madhu-yastika.

Decoction of bark of palasa, cooled and added with sugar should be consumed or the juice of (fresh) dung of either a cow or a horse may be licked after making it thick (by boiling) adding honey and ghee. 29.

If the blood (coming out ) is found clotted, the excreta of pigeon may be licked, mixing it with honey. 30a.

If there is too much of bleeding, then the blood of animals of desert like regions or the uncooked liver along with the bile of a goat may be eaten. 30b-31a. 

(Powder of) candana, usira, jalada, laja, mudga, kana and yava soaked in the decoction of bala (kept overnight) and used, cures bleeding disease. 31b-32a. 

Essence (supernatant fluid of a solution) of candana, ambhoja, sevya, mrt and heated potsherd (dipped in water), cooled and mixed with sugar and honey controls profuse bleeding. 32b-33a. 

Pieces of sugar-cane are crushed a little and put into water kept in a new pot, which is kept protected (from insects, flies etc.) in the open air for a night. Next morning, the water is stirred well, mixed with honey, made fragrant with the well bloomed flower of lotus and consumed; it acts likewise (stops heavy bleeding) 33b-34.

Those decoctions described in pittajvara may also be used (in this disease). treatment of 35a. 

Ksira prayoga (Recipes of milk in raktapitta)

Decoctions the digesminant and bleeding is not When by the use of these tive power gets increased / p* mitigated, then goat’s milk cows milk should be boiled with five times its quantity nal quantity) should cons drugs of laghu pancamu or milk boiled with jiva and nagara-each one may be consumed. ater (and reduced to its origid or cow’s milk boiled with the id mixed with sugar and honey rsabhaka, draksa, bala, goksura, rately mixed with ghee or sugar 35b-38a. 

Gokantaka and of abhiru, or with the Milk boiley relieves the bleeding associated with (four) parnis, cinary passage. Milk boiled with mocarasa pain, especiallial in bleeding from the rectum; or milk is especially and tender leaves of vata or that boiled boiled with pya and utpala with sunthi. 38b-40a.

Bleedin nent prescribed for bleeding diarrhoea and they may also be adopted in this diseases. 40b. 

After drinking decoction mixed with milk, the patient should eat his foo,ith milk only. He should drink ghee cooked with the dru mentioned for preparing decoctions. 

Vasa ghrta 

The vasa plant with its repieces is boiled in eight parts and head (leaves) cut into ter and decoction reduced to one-eighth part, medicate is prepared from it using its own flowers as paste. After co with honey. This cures bleeding g, it is consumed mixed Pease, abdominal tumor casued by pitta, fever, dyspnoea, ch, heart disease, jaundice, blindness, visarpada (herpes voice) and svarasada (feeble) 42-44a. 

Palasa ghrita (Trayamana ghrta) 

Juice of stalks of Medicated ghee prepared with the flowers of palasa and paste of the sal honey it cures bleeding disease; similarayonsumed with from trayamana. that prepared 44b-45a. 

In case of bleeding from the throat, the slimy, mixed with kapha or solidified. then thed being prepared from the stalks of utpala, ambojarealkali) kesara or filaments of lotus flowers) syama (padma(flowers of) madhuka-each one seperately should) or mixed with honey and ghee. 46.

If the bleeding is from the rectum, enema therapy is especially suitable. 47a.

In case of bleeding from the nose and the blood is unvitiated, then nasal drops with the drugs mentioned for decoctions earlier, prepared either with milk or juice of sugarcane etc. may be put into the nose, or milk etc. mixed with sugar or cold water alone is beneficial; so also the juice of flowers of dadima, stone of mango fruit (the kernal inside the stone) or juice of Sadvala (durva). 47b-49a.

The drugs belonging to the cold group (possessing cold potency) should be made use of for application over the body, oil massage, bath etc. 49b.

The external and internal medicines described in the treatment of pittajvara (fever of pitta origin) are beneficial in bleeding disease also; similarly also those precribed in Ksataksina (consumption due to injury to chest). 50.