In one who constantly indulges in anger, grief, fear, exertion, incompatible food, heat of the sun and fire, and pungent, sour, salty, alkaline, sharp, hot and strongly burning (vidāhi) foods, the rasa becomes spoiled and aggravates pitta. The pitta, thus burnt (vidagdha), quickly burns the blood by its own qualities. Then blood flows upward, or downward, or both ways.
The commentary says the cause and pathogenesis of raktapitta are stated first, since treatment follows the cause. Practising these constantly, the spoiled rasa aggravates pitta; the burnt, spoiled pitta, with its sharp and hot qualities, burns and spoils the blood, and then blood flows up or down. 'Sharp and hot' etc. refers to things beyond the listed pungent, sour, salty and alkaline, such as jyotiṣmatī and apāmārga fruits. Āyāsa is exertion; incompatible food is as taught in the hitāhitīya chapter. 'Anger, grief...' up to the list is the cause; 'constantly practising' onwards is the pathogenesis. Some read 'sharp, hot, sour, salty, daytime sleep and whatever is vidāhi'.
From the āmāśaya it goes upward, from the pakvāśaya it goes downward; when both are spoiled it flows both ways. Some say the blood's course is from the liver and spleen.
The commentary explains how the blood flows. Although blood's seats are the liver and spleen so that flow from the āmāśaya and pakvāśaya seems impossible, aggravated blood goes there too, so flow from them is possible. 'When both are spoiled' means both āmāśaya and pakvāśaya spoiled by contact with spoiled blood. It then gives the view of some: they say the course of blood is from the liver with the kālakhaṇḍa (spleen-adjacent tissue) and spleen. This is also accepted, since it is not refuted; there is no conflict with the earlier statement, because blood flows from the liver and spleen only after settling in the āmāśaya and pakvāśaya.
Key terms
āmāśaya
Site of undigested matter (upper digestive tract).
The commentary states the curability of the three kinds. Upward is curable when it lacks complications such as weakness, lacks signs of incurability such as blood like meat-washing water, and follows a single doṣa. It is palliable when it subsides then recurs or takes another path, has few complications and few incurable signs, and follows two doṣas. It is incurable when it has many complications and many signs of incurability and follows all three doṣas. Downward is palliable when it has few complications, no incurable signs and follows two doṣas; it is to be abandoned when it follows all three doṣas with incurable signs; it is curable when it follows a single doṣa without complications and without signs to be avoided. That going both ways is incurable when it follows all three doṣas with many complications and incurable signs; otherwise it is palliable.
There will be sinking (of the limbs), a desire for cold, a smoke-like sensation in the throat, vomiting, and breath smelling of iron in this (raktapitta) that is about to occur.
The commentary gives the premonitory signs. Sadana is limb-sinking or fatigue. Kaṇṭhadhūmāyana is a pain as if smoke were rising in the throat. 'In this' means in raktapitta.
The commentary extends the number and doṣa-excess of raktapitta by reference. 'By the signs of external blood' means by the signs described in the chapter on the discussion of blood, such as 'frothy and reddish'. The number is seven. An objection: raktapitta is blood burnt by pitta, so why is it named separately from pitta? Answer: because it becomes mixed with another blood. 'Excess of doṣa' means predominance of a doṣa.
Key terms
bāhyāsṛk
Blood as observed externally.
doṣocchriti
Predominance of a doṣa.
saṅkhyā
Number of kinds.
Adhikarana 7 (9) · Śloka 9
daurbalyaśvāsakāsajvaravamathumadāstandritādāhamūrcchā bhuktē cānnē vidāhastvadhr̥tirapi sadā hr̥dyatulyā ca pīḍā |
tr̥ṣṇā kaṇṭhasya bhēdaḥ śirasi ca davanaṁ pūtiniṣṭhīvanaṁ ca dvēṣō bhaktē'vipākō viratirapi ratē raktapittōpasargāḥ ||9||
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दौर्बल्यश्वासकासज्वरवमथुमदास्तन्द्रितादाहमूर्च्छा भुक्ते चान्ने विदाहस्त्वधृतिरपि सदा हृद्यतुल्या च पीडा |
तृष्णा कण्ठस्य भेदः शिरसि च दवनं पूतिनिष्ठीवनं च द्वेषो भक्तेऽविपाको विरतिरपि रते रक्तपित्तोपसर्गाः ||९||
Meaning of the śloka
Weakness, breathlessness, cough, fever, vomiting, intoxication-like state, drowsiness, burning, fainting; burning of food after eating, discontent; and always heart-like (cardiac-region) pain of an unusual kind; thirst, splitting of the throat, burning in the head, foul spitting, dislike of food, indigestion, and loss of delight even in pleasure: these are the complications (upasarga) of raktapitta.
The commentary gives the complications. Vamathu is vomiting; mada is intoxication as from areca nut; adhṛti is discontent; atulyā means extraordinary. Kaṇṭhasya bheda is splitting of the throat; davana is heat in the head; virati means loss of even pleasure. Some read 'bhukte ghoro vidāhaḥ', with the seventh case meaning genitive, i.e. severe burning of the food eaten. Others read 'koṣṭhasya bheda', explaining it as splitting of the stool in the koṣṭha. The two readings correspond to upward and downward flow. Some read 'pravitatasiratā' for 'śirasi ca davanam', explained as spread vessels in the body. Others read 'vinatir api bhavet' (bending of the body) or 'vikṛtir api bhavet' (contraction-type deformity) for 'viratir api rateḥ'.
Key terms
upasarga
Complication.
adhṛti
Discontent.
kaṇṭhabheda (kaṇṭhasya bheda)
Splitting of the throat, or koṣṭhabheda per a variant.
मांसप्रक्षालनाभं क्वथितमिव च यत् कर्दमाम्भोनिभं वा मेदःपूयास्रकल्पं यकृदिव यदि वा पक्वजम्बूफलाभम् |
यत् कृष्णं यच्च नीलं भृशमतिकुणपं यत्र चोक्ता विकारास्तद्वर्ज्यं रक्तपित्तं सुरपतिधनुषा यच्च तुल्यं विभाति ||१०||
Meaning of the śloka
Raktapitta that looks like meat-washing water, or as if boiled, or like muddy water, or like fat, pus and blood, or like liver, or like a ripe jambū fruit; that which is black or blue, extremely foul, and in which the stated complications are present, and that which looks like a rainbow: that raktapitta should be abandoned.
The commentary gives the signs of incurable raktapitta. Māṃsaprakṣālanābha is like water in which meat was washed; kardamāmbhonibha is like muddy water; medaḥpūyāsrakalpa is like fat, pus and blood; atikuṇapa is smelling like a rotten corpse. 'Stated complications' means those such as weakness and breathlessness in abundance. 'Abandon' means that even the upward or downward kind, called curable or palliable, becomes incurable if of this kind. Surapatidhanu is the rainbow. Some read 'kvathitam iva yakṛt', explaining it as like cooked kālakhaṇḍa (liver-like tissue).
Key terms
asādhya lakṣaṇa (asādhyalakṣaṇa)
Sign of incurability.
indradhanus (surapatidhanuḥ)
Rainbow (iridescent appearance).
kuṇapa
Putrid or corpse-like smell.
Adhikarana 9 (11) · Śloka 11
nādau saṅgrāhyamudriktaṁ yadasr̥gbalinō'śnataḥ |
tat pāṇḍugrahaṇīkuṣṭhaplīhagulmajvarāvaham ||11||
Raktapitta that is greatly increased should not be stopped (saṅgrāhya) at the outset in a strong person who is eating; for it brings on pāṇḍu, grahaṇī disorder, kuṣṭha, spleen disorder, gulma and fever.
The commentary says that in raktapitta in a strong person, arresting it at the start is forbidden. The raktapitta, which has greatly increased, is not to be arrested at first in a person who has strength and who eats; because if arrested at first it brings on pāṇḍu and the other diseases.
Key terms
saṅgrāhya
To be checked or arrested.
udrikta
Greatly increased.
Adhikarana 10 (12) · Śloka 12
adhaḥpravr̥ttaṁ vamanairūrdhvagaṁ ca virēcanaiḥ |
jayēdanyataradvā'pi kṣīṇasya śamanairasr̥k ||12||
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अधःप्रवृत्तं वमनैरूर्ध्वगं च विरेचनैः |
जयेदन्यतरद्वाऽपि क्षीणस्य शमनैरसृक् ||१२||
Meaning of the śloka
Downward-flowing raktapitta should be overcome by emetics, and upward-flowing by purgatives; or, in a depleted person, either may be overcome by pacifying measures (śamana).
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tarhi tatra kiṁ kuryādityāha- adhaḥpravr̥ttaṁ vamanairityādi| saṁśōdhanārhasya balavatō narasyādhōgaṁ raktapittaṁ bahudōṣaṁ vamanairjayēt, ēvaṁvidhasyōrdhvagaṁ virēcanairityarthaḥ| nanu, adhōgaṁ vātānugaṁ bhavati, ūrdhvagaṁ ca kaphānugaṁ, tat kathaṁ tayōrvamanavirēcanē yujyētē? satyaṁ, vyādhipratyanīkatvādyujyētē ēva; tathā ca tantrāntaraṁ- “adhōgaṁ vamanairdhīmānūrdhvagaṁ rēcanairjayēt”- iti| anyataradvēti ūrdhvagamadhōgaṁ vā kṣīṇasya puruṣasya śamanairjayēditi na vamanavirēkaiḥ; tathā ca tantrāntaram- “ūrdhvagaṁ vā'pyadhōgaṁ vā kṣīṇasya śamanairjayēt”- iti||12||
Meaning of the commentary
The commentary answers what is to be done. In a strong person fit for cleansing, downward raktapitta with much doṣa is overcome by emesis; upward by purgation. An objection: downward is with vāta and upward with kapha, so how are emesis and purgation suitable? Answer: they are suitable as they oppose the disease's direction, quoting another tantra: 'the wise man should overcome downward by emetics and upward by purgatives'. 'Either' means upward or downward in a depleted person is overcome by pacifying measures, not by emesis or purgation, quoting: 'upward or downward, in a depleted person, one should overcome by pacifying measures'.
After fasting, a peyā (thin gruel) with little rice should be given; meat juices and pulse soups prepared with surā and sneha; and tarpaṇa, pācana, licks, and various ghṛtas.
The commentary says that after fasting a peyā is prepared, and asks whether peyā alone is done. Tarpaṇa is parched-rice flour mixed with sugar in water cooked with grapes and madhuka, with ghṛta and honey. Pācana is drinking water cooked with hrībera, sandal, uśīra, parpaṭa and mustā. Licks are those to be described, made with madhuka and śobhāñjana flowers, with ghṛta and honey. Various ghṛtas are those such as vāsā ghṛta. In downward raktapitta peyā is beneficial if vāta is not strong; if vāta is strong, meat juice; in upward raktapitta tarpaṇa is beneficial, quoting another tantra. Some read 'after fasting, one should give light food with reason', explaining 'with reason' as in measure and opposing the disease.
Key terms
peyā
Thin gruel.
tarpaṇa
Nourishing drink of parched-grain flour.
vāsāghṛta
Ghṛta cooked with vāsā.
Adhikarana 13 (15) · Śloka 15
drakṣāmadhukakāśmaryasitāyuktaṁ virēcanam |
yaṣṭīmadhukayuktaṁ ca sakṣaudraṁ vamanaṁ hitam ||15||
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द्रक्षामधुककाश्मर्यसितायुक्तं विरेचनम् |
यष्टीमधुकयुक्तं च सक्षौद्रं वमनं हितम् ||१५||
Meaning of the śloka
A purgative with drākṣā, madhuka, kāśmarī and sugar is beneficial; and an emetic with yaṣṭīmadhu and honey.
The commentary names the drugs for the emesis and purgation mentioned before. The purgative with drākṣā and the rest is the mild purgative among the alternatives in the purgation-drug section; the emetic with yaṣṭīmadhu and honey is the mild emetic among the alternatives in the emetic-drug section.
Cool milks, jāṅgala meat juices, and soups of tīna with śāli and ṣaṣṭika rice; vegetables such as paṭola, śelū, suniṣaṇṇa, yūthikā, vaṭa, atimukta sprouts and sinduvāra, cooked in ghṛta, always, and likewise with āmalaka and pomegranate; juices of pigeon, conch and tortoise, and yavāgūs with much ghṛta; santānikā in milk cooked with the utpala group, with honey and sugar predominating; cooling pastes, sweet groups of drugs, and ghṛtas are wholesome for those with raktapitta.
The commentary lists foods after the emetic and purgative drugs. Cool milks are those boiled with utpala and similar drugs and cooled; they are for pitta-predominant cases. Jāṅgala juices are of eṇa, lāvaka and similar, for cases with vāta involvement. Tīna soups are of round pulses and are beneficial where kapha is involved. Śelū is a southern vegetable, or ślesmātaka per others; suniṣaṇṇaka is śiravālikā or catuṣparṇī; atimukta is āvantaka; sprouts means tender shoots of paṭola and others; sinduvāra is nirguṇḍī; these vegetables are beneficial with kapha involvement. Some read 'jīvantī' in the paṭola place. Pigeon juice is listed separately though jāṅgala juices already include it, to emphasise its special wholesomeness. Āmalaka and pomegranate are for flavouring. Santānikā is the upper thick layer of ghṛta. 'Cooling pastes' are pastes of the nyagrodha and other cooling groups; sweet groups are kākolī and similar, to be used by drinking and so on; ghṛtas cooked with the sweet groups are accepted on the basis of another tantra.
Key terms
jāṅgala rasa
Meat juice of dry-land animals.
santānikā
Thick upper layer of ghṛta or milk cream.
pāradavata / śaṅkha / kūrma rasa (pārāvata śaṅkha kūrma rasa)
The physician should make four licks with honey, from powdered flowers of madhūka, śobhāñjana, kovidāra and priyaṅgu, for the benefit and pacification of the blood. He may also lick sprouts of dūrvā and vaṭa with honey as the second ingredient; and sprouts of white karṇikāra; dates with honey are beneficial, and other fruits of similar quality.
The commentary says three licks are from the powdered flowers of madhūka and the rest taken one each, and the fourth from priyaṅgu flowers. Others: dūrvā and vaṭa sprouts with honey is one yoga; sprouts of white karṇikāra with honey is a second. Some take it as a single combined yoga, which the commentators do not accept because of agreement with another tantra. Some read 'dugdhadruma sprouts' for 'dūrvā and vaṭa', meaning vaṭa-type sprouts. 'With honey' means with honey added. Other fruits are those like kāśmarī, of the same quality as dates.
Key terms
leha
Medicinal lick.
priyaṅgu
A flowering herb used in bleeding conditions.
kharjūra
Date fruit.
Adhikarana 16 (21) · Śloka 21
raktātisāraprōktāṁśca yōgānatrāpi yōjayēt |21|
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रक्तातिसारप्रोक्तांश्च योगानत्रापि योजयेत् |२१|
Meaning of the śloka
The yogas taught for raktātisāra should also be applied here.
The commentary says this extends the treatment of raktapitta by reference: the yogas taught for raktātisāra, such as 'priyāla, mallikā'. After this, Kārttikakuṇḍa reads a yoga beginning 'the ash of blue lotuses with honey, strained', which Jejjaṭācārya reads later in the text beginning 'blue lotus ash with honey'.
Key terms
raktātisāra
Diarrhoea with blood.
atideśa
Extension of a rule by reference.
Adhikarana 17 (21-22) · Śloka 22
śuddhēkṣukāṇḍamāpōthya navē kumbhē himāmbhasā ||21||
yōjāyitvā kṣipēdrātrāvākāśē sōtpalaṁ tu tat |
prātaḥ srutaṁ kṣaudrayutaṁ pibēcchōṇitapittavān ||22||
Clean sugarcane pieces, pounded and combined with cold water in a new pot, are placed outside at night together with blue lotus. In the morning, strained, with honey added, it is drunk by one with raktapitta.
The commentary says clean sugarcane pieces are peeled cane crushed; combined with cool water in a new pot, set overnight in an open uncovered place. In the morning the strained liquid, with blue lotus powder and honey added, is drunk by the man with raktapitta.
The commentary says 'with honey' is understood to go with 'drink', although not said, by agreement with another tantra. The udumbara fruit is ground, the juice is taken, and drunk mixed with honey.
A paste of trapuṣī root, with honey and rice water; or a paste of yaṣṭīmadhu of akṣa measure; likewise candana, madhuka and rodhra in equal parts; or karañja seed with sugar and honey; the marrow of iṅguda likewise with madhuka; or lukewarm salt with karañja seed, with dadhimastu, taken for three days by the man troubled with raktapitta: these six are said to be the best yogas that remove raktapitta.
The commentary lists six most efficacious yogas. 'With honey' means honey of one karṣa; rice water in four times the paste. 'Akṣa measure' is one karṣa. 'Likewise' means with honey and rice water. The karañja seed yogas are beneficial in upward raktapitta involving kapha. Marrow of iṅguda is drunk with sugar and honey.
The commentary says the six yogas just described are also applicable when blood flows from the nose and in avapīḍana (nasal application). 'Beneficial' is supplied as the six yogas.
A long list of yogas: ghṛta cooked in the juice of palāśa tree, cooled with honey; or milk-ghṛta cooked with juices of vaṭa-type trees with sugar; drākṣā, uśīra, padmaka and sugar in water, kept overnight, or milk with equal water, for one on a wholesome diet; juice of horse-dung with honey, or of vṛṣa (vāsā), with sugar and honey; a lick of vāstuka seed powder with honey, or taṇḍulīya; parched-rice with añjana powder, or tugā with sugar and honey; drākṣā, sugar, tiktakarohiṇī in cold water with madhuka; pathyā, ahiṃsrā, rajanī with ghṛta.
The commentary explains: vanaspatis are vaṭa and similar; kṣīraghṛta is ghṛta from milk; 'milk or water equal' means milk and water in equal amounts. Some read 'a decoction of vāsā with sugar, or horse-dung juice with honey'. Vāstuka seed powder is that of ṭaṅka-vāstuka, with honey; taṇḍulīya likewise with honey; others read 'taṇḍulīya with honey and sugar, or vāstuka root'. Lājā is fried grain; añjana is rasāñjana; some read 'kālāñjana' as sauvīrāñjana. Tugā is a earth-derived substance like vaṃśarocanā, or vaṃśarocanā itself per others; it is licked with sugar and honey. Pathyā is harītakī, rajanī is haridrā, licked with ghṛta. This yoga is for raktapitta in the throat and spreading. Some read 'two rajanīs' and want the lick with cold water only; that reading is unjust because it conflicts with a similar tantra.
The commentary says this is the most efficacious yoga when the flow is strong. Utpala is blue lotus; mṛd is paddy-field clay; ambhoruha-kesara is lotus filament. Drinking the vāsā decoction with the powders of utpala, clay and the rest, mixed with sugar and honey, quickly checks the flow.
The commentary identifies gāyatrī as khadira, arjuna as kakubha, kovidāra as kāñcanāra, aśana as bījaka, and śigru as śobhāñjanaka.
Key terms
gāyatrī
Khadira per the commentary.
kovidāra
Kāñcanāra (Bauhinia).
śigru
Śobhāñjanaka (drumstick).
Adhikarana 25 (35) · Śloka 36
sakṣaudramindīvarabhasmavāri karañjabījaṁ madhusarpiṣī ca ||35||
jambvarjunāmrakvathitaṁ ca tōyaṁ ghnanti trayaḥ pittamasr̥k ca yōgāḥ |36|
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सक्षौद्रमिन्दीवरभस्मवारि करञ्जबीजं मधुसर्पिषी च ||३५||
जम्ब्वर्जुनाम्रक्वथितं च तोयं घ्नन्ति त्रयः पित्तमसृक् च योगाः |३६|
Meaning of the śloka
The water made from the ash of blue lotus with honey; karañja seed with honey and ghṛta; and water boiled with jambū, arjuna and āmra: these three yogas destroy pitta and blood conditions.
The commentary lists three yogas in raktapitta. The water made from the ash (alkali) of blue lotus, drunk with honey, is the first. Karañja seed licked with honey and ghṛta is the second. Water boiled with jambū and the like, drunk with honey, is the third. Of these, the last two are to be used when the raktapitta is in the throat.
मूलानि पुष्पाणि च मातुलुङ्ग्याः पिष्ट्वा पिबेत्तण्डुलधावनेन ||३६||
घ्राणप्रवृत्ते जलमाशु देयं सशर्करं नासिकया पयो वा |३७|
Meaning of the śloka
The roots and flowers of mātuluṅgī, ground and drunk with rice-washing water. When blood flows from the nose, water should be given quickly, or milk with sugar, through the nose.
The commentary says mātuluṅga is bījapūraka, or madhukarkaṭī per others. When raktapitta flows through the nose, sugar-water or milk with sugar is administered through the nose; some read 'nāsikayoḥ' (in both nostrils) for 'nāsikayā'.
The commentary gives further nasal yogas when blood flows from the nose. Grape juice with sugar through the nose; milk-ghṛta (cream-butter from churned milk) with sugar through the nose; sugarcane juice or cold water similarly; thus three yogas are to be made. It quotes another tantra: 'nasya with grape juice or with milk and ghṛta, or with sugarcane juice with sugar, promptly checks the blood'.
Key terms
nasya
Nasal administration.
drākṣārasa
Grape juice.
ikṣurasa
Sugarcane juice.
Adhikarana 28 (38) · Śloka 38
śītōpacāraṁ madhuraṁ ca kuryādviśēṣataḥ śōṇitapittarōgē |38|
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शीतोपचारं मधुरं च कुर्याद्विशेषतः शोणितपित्तरोगे |३८|
Meaning of the śloka
Cooling and sweet measures should be used, especially in raktapitta.
The commentary says this gathers the treatments stated in all the tantras: cooling treatment is to be applied externally too, in conditions such as burning.
An āsthāpana (decoction enema) of milk cooked with the vidārigandhādi group, mixed with grapes, ghṛta, honey and sugar, is said to be the best; and ghṛta is beneficial for the anuvāsana.
The commentary says that for the āsthāpana in raktapitta, milk is mentioned, and for the anuvāsana, ghṛta. That ghṛta is cooked with yaṣṭīmadhu, since uncooked sneha causes complications. Others prefer the ghṛta cooked in the milk boiled with vidārigandhādi.
With priyaṅgu, rodhra, añjana, gairika, utpala, suvarṇa (gold-red ochre), kālīyaka and red sandal; sugar, aśvagandhā, mustā and yaṣṭīmadhu; lotus stalk and saugandhika, ground in equal parts, one should give him a nirūha with milk, honey and ghṛta; then, after he is sprinkled with cool water and has eaten milk-rice, one should give an anuvāsana with ghṛta cooked with yaṣṭīmadhu. This destroys downward-flowing blood, and blood diarrhoea hard to cross (dustara), and is praised in purgation excess... (the verse is cut off).
The commentary lists further āsthāpana and anuvāsana. Añjana is sauvīrāñjana; gairika is ordinary red ochre; utpala is blue lotus (nāgakesara per others); suvarṇa is gold-coloured ochre with the ending dropped; kālīyaka is a drug like dāruharidrā; ambuda is mustā; yaṣṭikāhvaya is yaṣṭīmadhu; mṛṇāla is lotus filament (stalk); saugandhika is a variety of water lily. Equal parts of these, ground into a paste and combined with equal ghṛta, are used with milk for nirūha. Then, sprinkled with cool water and fed milk-rice, he is given the anuvāsana of yaṣṭīmadhu ghṛta. 'Downward-flowing blood' means downward raktapitta; 'blood diarrhoea' means raktātisāra; 'in purgation excess' means in over-purgation.
Key terms
nirūha
Decoction enema.
kālīyaka
A drug like dāruharidrā.
adhovaha
Downward-flowing (blood).
raktātisāra
Blood diarrhoea.
Adhikarana 31 (42) · Śloka 42
... vāmyaśca raktē vijitē balānvitaḥ ||42||
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... वाम्यश्च रक्ते विजिते बलान्वितः ||४२||
Meaning of the śloka
... and one who is strong may be made to vomit, once the blood has been overcome.
The commentary says that once raktapitta has been overcome by nirūha and anuvāsana, a person who has strength should be given emesis, to prevent downward flow. It adds that Kārttikakuṇḍa said much here, which is omitted here for fear of length.
The commentary says special treatment is stated for raktapitta in special sites. 'Of this kind' means like the āsthāpana and anuvāsana just described. 'Blood in the bladder' means in the basti and flowing in the urinary channel.
Key terms
uttarabasti
Enema through the urinary or genital passage.
mūtrāśaya
Bladder region.
Adhikarana 33 (43) · Śloka 43
pravr̥ttaraktēṣu ca pāyujēṣu kuryādvidhānaṁ khalu raktapaittam ||43||
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प्रवृत्तरक्तेषु च पायुजेषु कुर्याद्विधानं खलु रक्तपैत्तम् ||४३||
Meaning of the śloka
In cases where blood flows from the anus (pāyuja, i.e. from piles), the raktapitta procedure should also be applied.
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arśasaḥ atipravr̥ttau ca raktapittacikitsitamatidiśannāha- pravr̥ttaraktēṣvityādi| pāyujēṣu arśaḥsu||43||
Meaning of the commentary
The commentary extends raktapitta treatment to arśas (piles) and to excessive flow. Pāyuja means arising from arśas.
Key terms
pāyuja
Arising from the anus, i.e. from piles per the commentary.
This same procedure should be done by the knowing physician in women with asṛgdara (excessive menstrual bleeding), and in one who bleeds excessively after a surgical operation.
The commentary says this is the raktapitta-destroying procedure for downward flow. It is done not only in asṛgdara but also in one bleeding profusely after a surgical operation. Some read here the signs of asṛgdara: 'her groin, pelvis, back and kidneys burn, and it also quickly produces severe pain in the womb'. Those who read this do not read the signs of asṛgdara for the purification of semen and blood elsewhere.
Key terms
asṛgdara
Excessive menstrual or uterine bleeding.
śastrakarma
Surgical operation.
atipravṛtta rakta
Excessive bleeding.
Adhikarana 35 (45) · Śloka 45
trayāṇāmapi dōṣāṇāṁ śōṇitē'pi ca sarvaśaḥ |
liṅgānyālōkya kartavyaṁ cikitsitamanantaram ||45||
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त्रयाणामपि दोषाणां शोणितेऽपि च सर्वशः |
लिङ्गान्यालोक्य कर्तव्यं चिकित्सितमनन्तरम् ||४५||
Meaning of the śloka
Treatment should be done after noting the signs of all three doṣas, in the blood too, in every case.
The commentary asks whether the raktapitta procedure applies without distinction to raktapitta, asṛgdara and excess bleeding after operation, or should be adapted. It answers: after examining the signs of the doṣas, single, paired or combined, as taught in the chapter on discussion of blood, the treatment is done; in asṛgdara or bleeding after operation, the raktapitta-relieving method is applied. Here 'downward-flowing' is understood as being destroyed or as palliable, so a sannipāta case with intact flesh and agni is regarded as palliable (yāpya). Kārttikakuṇḍa reads a passage beginning 'āpātanikā... pregnant' here, which is not written because it is absent in the text.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे रक्तपित्तप्रतिषेधो नाम (सप्तमोऽध्यायः, आदितः) पञ्चचत्वारिंशत्तमोऽध्यायः ||४५||
Meaning of the śloka
Thus ends the chapter named Raktapittapratiṣedha, the forty-fifth chapter (the seventh from the beginning of this section), in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.