Chapter CXLVIII - The Nidanam of Raktapittam (Haemorrhage)

Dhanvantari said:—Now I shall discourse on the Ætiology and symptoms of Raktapittam (Hæmorrhage). The bodily Pittam deranged through such factors as excessive ingestion of Kodrava and Uddalaka (grains) or extremely hot, bitter, acid, or saline things, or of those which are followed by an acid re-action in the stomach, or through the agency of those which accelerate the process of metabolism and increase the metabolic heat in the organism, deranges, in its turn, the liquid bile which by gradually contaminating the blood, courses with it throughout the system. Owing to a similarity which exists between the blood and the bile, in colour, smell, origin and morbific effect, this bile-charged blood in Hæmorrhage is called blood in the parlance of the Ayurveda.^[1] The blood in Hæmorrhage rises from the spleen, liver, bloodvessels, and the receptacle of blood. Heaviness of the head with a non-relish for food, desire for cold things and cool contracts, vertigo, darkness of vision, nausea, vomiting with a belching sensation, cough, laboured or difficult breathing (dyspnœa) with a sensation of fatigue or exhaustion, a fishy smell in the mouth, redness of the face, redness, blueness or yellowness of the conjunctiva, inability to distinguish a red colour from the yellow or blue, dreams of insanity in sleep and an absence of fever are the symptoms which mark the premonitary stage of Raktapittam. There is hæmorrhage either from any of the super-clavicular cavities of the body, such as the ears, the nose, or the eyes, or from any of the downward passages, such as the anus, penis or vagina. Sometimes the deranged blood flows out in jets through the pores of the skin. Hæmorrhage from any of the superclavicular passages of the body, readily yields to medicine inasmuch as the deranged Kapham which serves as the exciting factor of the disease in these cases, may be easily curbed with the help of purgatives. In such cases, a medicine which helps the purging of the deranged Pittam (bile) is a far better remedy than that which arrests its secretion, more so because the deranged Kapham which invariably acts in concert with the disordered Pittam in such cases, gets the chance of being eliminated from the system. Drugs of a sweet or astringent taste, as well as those which generate Kapham in the system, or increase glandular secretions of the organism, or are bitter or pungent, should be deemed beneficial in these cases.

Palliation is the only remedy possible in cases where Hæmorrhage occurs from any of the downward passages of the body, since the administration of emetics is the only treatment admissible. The patient in such a case should be looked upon as a person whose days are numbered. A little of any of the drugs which help the elimination of the deranged Pittam, and a little other medicine to subdue the concomitant symtoms may be given to a Raktapitta patient of unimpaired strength and of not much disordered Pittam. Sweet and astringent substances are good for patients of the foregoing type. Cure is almost hopeless in the case of a patient in whom both the derenged Vayu and Kapham act in concert with the deranged Pittam and serve as the exciting factors of the disease. A case of Raktapittam, in which Hæmorrhage occurs from both the upward and downward passages of the body, baffles all medicine since purgatives and emetics are the only two remedies which can be given with benefit in this disease. In short, emetics may be given with advantage even in a case of Raktapittam where the morbific principles act in concert. It is needless to say that the last-named type of the disease is fatal as a spear-dart of the God Shiva, since many a distressing and unfavourable symtoms are found to supervene from the outset.