Chapter 2. Raktapitta Nidana
(Chapter on the Etio-Pathogenesis of Bleeding Disorders)
अथातोरक्तपित्तनिदानंव्याख्यास्यामः||१||
इतिहस्माहभगवानात्रेयः||२||
athātō raktapittanidānaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
Now, the etio-pathogenesis / NIDANA of raktapitta would be explained. Thus, said Lord Atreya. [1-2]
Synonym of raktapitta
पित्तं यथाभूतं लोहितपित्तमिति सञ्ज्ञां लभते, तद्व्याख्यास्यामः||३||
pittaṁ yathābhūtaṁ lōhitapittamiti sañjñāṁ labhatē, tad vyākhyāsyāmaḥ||3||
Also explained would be the origin of lohitapitta as an alternate name for pitta. [3]
Etiopathogenesis / nidana & samprapti
यदा जन्तुर्यवकोद्दालककोरदूषप्रायाण्यन्नानि भुङ्क्ते, भृशोष्णतीक्ष्णमपि चान्यदन्नजातं निष्पावमाषकुलत्थसूपक्षारोपसंहितं, दधिदधिमण्डोदश्वित्कट्वराम्लकाञ्जिकोपसेकं वा, वाराहमाहिषाविकमात्स्यगव्यपिशितं, पिण्याकपिण्डालुशुष्कशाकोपहितं, मूलकसर्षपलशुन-करञ्ज-शिग्रुमधुशिग्रु(खडयूष) भूस्तृणसुमुखसुरसकुठेरकगण्डीरकालमालकपर्णासक्षवकफ-णिज्झ-कोपदंशं, सुरासौवीरतुषोदकमैरेयमेदकमधूलकशुक्तकुवलबदराम्लप्रायानुपानं वा, पिष्टान्नोत्तरभूयिष्ठम्; उष्णाभितप्तो वाऽतिमात्रमतिवेलं वाऽऽमं पयः पिबति, पयसा समश्नाति रौहिणीकं काणकपोतं वा सर्षपतैलक्षारसिद्धं, कुलत्थपिण्याकजाम्बवलकुचपक्वैः शौक्तिकैर्वा सह क्षीरं बत्युष्णाभितप्तः
yadā janturyavakōddālakakōradūṣaprāyāṇyannāni bhuṅktē, bhr̥śōṣṇatīkṣṇamapi cānyadannajātaṁ niṣpāvamāṣakulatthasūpakṣārōpasaṁhitaṁ,dadhidadhimaṇḍōdaśvitkaṭvarāmlakāñjikōpasēkaṁ [2] vā, vārāhamāhiṣāvikamātsyagavyapiśitaṁ, piṇyākapiṇḍāluśuṣkaśākōpahitaṁ,mūlakasarṣapalaśunakarañjaśigrumadhuśigru(khaḍayūṣa [3] ) bhūstr̥ṇasumukhasurasakuṭhērakagaṇḍīrakālamālakaparṇāsakṣavakaphaṇijjhakōpadaṁśaṁ,surāsauvīratuṣōdakamairēyamēdakamadhūlakaśuktakuvalab
adarāmlaprāyānu
pānaṁ vā, piṣṭānnōttarabhūyiṣṭham; uṣṇābhitaptō vā'timātramativēlaṁ vāmaṁpayaḥ pibati, payasā samaśnāti rauhiṇīkaṁ [4] , kāṇakapōtaṁ vā sarṣapatailakṣārasiddhaṁ, kulatthapiṇyākajāmbavalakucapakvaiḥ śauktikairvā saha kṣīraṁpibatyuṣṇābhitaptaḥ [5] ;
adarāmlaprāyānu
pānaṁ vā, piṣṭānnōttarabhūyiṣṭham; uṣṇābhitaptō vā'timātramativēlaṁ vāmaṁpayaḥ pibati, payasā samaśnāti rauhiṇīkaṁ [4] , kāṇakapōtaṁ vā sarṣapatailakṣārasiddhaṁ, kulatthapiṇyākajāmbavalakucapakvaiḥ śauktikairvā saha kṣīraṁpibatyuṣṇābhitaptaḥ [5] ;
When a person consumes a diet or food consisting mostly of:
- Grains such as yavaka, uddalaka, and koradusha, in excess quantities, along with other food items that are
- tikshna ( sharply acting) such as legumes of nishpaava, black gram, horse gram and alkali, or with curd, whey, buttermilk, sour buttermilk or sour gruel
With such food articles, a person’s pitta gets vitiated and the quantity of blood in his body exceeds its normal quantity. Along with the increased quantity of vitiated blood in the system, vitiated pitta gets into the circulation and reaches raktavaha srotas and its organs like liver and spleen. Due to abhishyandi and guru qualities of rakta, obstructions in the channels occur leading to morbidity in rakta. [4]
- Meat of pig, buffalo, sheep, fish and cow,
- Vegetables of oil cake, pindalu (a tuber) and dried potherbs
- Upadamsha (chutney or salad) of radish, mustard, garlic, karanja, shigru, madhu shigru, kharabusa, bhustruna, sumukha, surasa, kutheraka, gandira, kalamala, parnasa, kshavaka and phanijzaka
- Drink of sura (wine), sauvira, tushodaka (types of vinegar), maireya, medaka, madhulaka (fermented beverages), shukta (sour beverage), sour preparations of kuvala and badara (types of jujube)
- Preparations of (rice) flour in excess after meals
- Excessive quantities of pishtanna (triturated grains)
- Unboiled milk in excessive quantity or frequently, especially after exposure to intense heat, or when recovering from a heat-stroke
- Rohini (vegetable) along with milk
- Kanakapota (a type of pigeon) cooked with mustard oil and alkali
- Milk along with sour beverages cooked with horse gram, oil cake, fruits or jambu and lakucha, when taken after exposure to intense heat.
Samprapti / pathogenesis
तस्यैवमाचरतः पित्तं प्रकोपमापद्यते, लोहितं च स्वप्रमाणमतिवर्तते तस्मिन् प्रमाणातिवृत्ते पित्तं प्रकुपितं शरीरमनुसर्पद्यदेव यकृत्प्लीहप्रभवाणां लोहितवहानां च स्रोतसां लोहिताभिष्यन्दगुरूणि मुखान्यासाद्य प्रतिरुन्ध्यात् तदेव लोहितं दूषयति||४||
tasyaivamācarataḥ pittaṁ prakōpamāpadyatē, lōhitaṁ ca [6] svapramāṇamativartatē| tasmin pramāṇātivr̥ttē pittaṁ prakupitaṁ śarīramanusarpadyadēva [7] yakr̥tplīhaprabhavāṇāṁ lōhitavahānāṁ ca srōtasāṁ lōhitābhiṣyandagurūṇi mukhānyāsādyapratirundhyāt [8] tadēva [9] lōhitaṁ dūṣayati||4||
तस्यैवमाचरतः पित्तं प्रकोपमापद्यते, लोहितं च स्वप्रमाणमतिवर्तते तस्मिन् प्रमाणातिवृत्ते पित्तं प्रकुपितं शरीरमनुसर्पद्यदेव यकृत्प्लीहप्रभवाणां लोहितवहानां च स्रोतसां लोहिताभिष्यन्दगुरूणि मुखान्यासाद्य प्रतिरुन्ध्यात् तदेव लोहितं दूषयति||४||
tasyaivamācarataḥ pittaṁ prakōpamāpadyatē, lōhitaṁ ca [6] svapramāṇamativartatē| tasmin pramāṇātivr̥ttē pittaṁ prakupitaṁ śarīramanusarpadyadēva [7] yakr̥tplīhaprabhavāṇāṁ lōhitavahānāṁ ca srōtasāṁ lōhitābhiṣyandagurūṇi mukhānyāsādyapratirundhyāt [8] tadēva [9] lōhitaṁ dūṣayati||4||
With such food articles, a person’s pitta gets vitiated and the quantity of blood in his body exceeds its normal quantity. Along with the increased quantity of vitiated blood in the system, vitiated pitta gets into the circulation and reaches raktavaha srotas and its organs like liver and spleen. Due to abhishyandi and guru qualities of rakta, obstructions in the channels occur leading to morbidity in rakta. [4]
Definition of raktapitta
संसर्गाल्लोहितप्रदूषणाल्लोहितगन्धवर्णानुविधानाच्च पित्तं लोहितपित्तमित्याचक्षते||५||
saṁsargāllōhitapradūṣaṇāllōhitagandhavarṇānuvidhānācca [12] pittaṁ lōhitapittamityācakṣatē||5||
Pitta gets the name lohitapitta because after mixing with blood it acquires the color and smell of blood. [5]
Prodromal symptoms / poorvarupa
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- अनन्नाभिलाषः, भुक्तस्य विदाहः, शुक्ताम्लगन्धरस उद्गारः, छर्देरभीक्ष्णमागमनं, छर्दितस्य बीभत्सता, स्वरभेदो, गात्राणां सदनं, परिदाहः, मुखाद्धूमागम इव, लोहलोहितमत्स्यामगन्धित्वमिव चास्यस्य, रक्तहरितहारिद्रत्वमङ्गावयवशकृन्मूत्रस्वेदलालासिङ्घाणकास्यकर्णमलपिडकोलिकापिडकानाम्, अङ्गवेदना, लोहितनीलपीतश्यावानामर्चिष्मतां च रूपाणां स्वप्ने दर्शनमभीक्ष्णमिति (लोहितपित्तपूर्वरूपाणि भवन्ति)||६||
tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilāṣaḥ, bhuktasya vidāhaḥ, śuktāmlagandharasa udgāraḥ, chardērabhīkṣṇamāgamanaṁ, charditasyabībhatsatā, svarabhēdō, gātrāṇāṁ sadanaṁ, paridāhaḥ, mukhāddhūmāgama iva, lōhalōhitamatsyāmagandhitvamiva cāsyasya,raktaharitahāridratvamaṅgāvayavaśakr̥nmūtrasvēdalālāsiṅghāṇakāsyakarṇamalapiḍakōlikāpiḍakānām [14] , aṅgavēdanā, lōhitanīlapītaśyāvānāmarciṣmatāṁ carūpāṇāṁ svapnē darśanamabhīkṣṇamiti (lōhitapittapūrvarūpāṇi [15] bhavanti)||6||
The prodromal symptoms of raktapitta include
- aversion to food,
- hot eructation just after meal,
- belches with smell and aftertaste of sour gruel,
- frequent vomiting,
- ugliness of vomitus,
- hoarseness of voice,
- malaise,
- radiating burning sensation,
- emittance of smoke from the mouth,
- smell of metal, blood, or fish ,
- mucus in the mouth,
- appearance of red, green or yellow spots in body parts, feces, urine, sweat, saliva, nose-secretion, excreta from mouth and ear and boils,
- bodyache, and
- frequent vision of red, blue, yellow, blackish and brilliant objects in dreams. [6]
Complications / upadrava
उपद्रवास्तु खलु दौर्बल्यारोचकाविपाकश्वासकासज्वरातीसारशोफशोषपाण्डुरोगाः स्वरभेदश्च||७||
upadravāstu khalu daurbalyārōcakāvipākaśvāsakāsajvarātīsāraśōphaśōṣapāṇḍurōgāḥ svarabhēdaśca||7||
Complications (of raktapitta) include
- debility,
- anorexia,
- indigestion,
- dyspnea,
- cough,
- fever,
- diarrhea,
- edema,
- emaciation,
- anemia and
- hoarseness of voice. [7]
Disease pathways / marga / manifestation of disease
मार्गौ पुनरस्य द्वौ ऊर्ध्वं, चाधश्च तद्बहुश्लेष्मणि शरीरे श्लेष्मसंसर्गादूर्ध्वं प्रतिपद्यमानं कर्णनासिकानेत्रास्येभ्यः प्रच्यवते, बहुवाते तु शरीरे वातसंसर्गादधः प्रतिपद्यमानं मूत्रपुरीषमार्गाभ्यां प्रच्यवते, बहुश्लेष्मवाते तु शरीरे श्लेष्मवातसंसर्गाद्द्वावपि मार्गौ प्रतिपद्यते, तौ मार्गौ प्रतिपद्यमानं सर्वेभ्य एव यथोक्तेभ्यः खेभ्यः प्रच्यवते शरीरस्य||८||
mārgau punarasya dvau ūrdhvaṁ, cādhaśca| tadbahuślēṣmaṇi śarīrē ślēṣmasaṁsargādūrdhvaṁ pratipadyamānaṁ karṇanāsikānētrāsyēbhyaḥ pracyavatē, bahuvātē tu śarīrē vātasaṁsargādadhaḥpratipadyamānaṁ mūtrapurīṣamārgābhyāṁ pracyavatē, bahuślēṣmavātē tu śarīrē ślēṣmavātasaṁsargāddvāvapi mārgau pratipadyatē, tau mārgaupratipadyamānaṁ sarvēbhya ēva yathōktēbhyaḥ khēbhyaḥ pracyavatē śarīrasya||8||
There are two routes of the manifestation of raktapitta -
- upwards / Urdhva and
- downwards / Adha.
In those having an excess of vata, rakta flows downwards / adha along with vata and patients bleed through the urinary tract and rectum.
Finally, in those having abundance of both kapha and vata, rakta comes out from the body with both the routes / ubhaya and thus bleeds through all the aforesaid orifices. [8]
Prognosis / sadhya asadhyata
तत्र यदूर्ध्वभागं तत् साध्यं, विरेचनोपक्रमणीयत्वाद्बह्वौषधत्वाच्च; यदधोभागं तद्याप्यं, वमनोपक्रमणीयत्वादल्पौषधत्वाच्च; यदुभयभागं तदसाध्यं, वमनविरेचनायोगित्वादनौषधत्वाच्चेति||९||
tatra yadūrdhvabhāgaṁ tat sādhyaṁ, virēcanōpakramaṇīyatvādbahvauṣadhatvācca; yadadhōbhāgaṁ tadyāpyaṁ, vamanōpakramaṇīyatvādalpauṣadhatvācca;yadubhayabhāgaṁ tadasādhyaṁ, vamanavirēcanāyōgitvādanauṣadhatvāccēti||9||
Amongst these,
URDHVA
- that which comes out of the upper orifices is curable / sadhya and
- is treatable by purgation / virecana due to availability of plenty of drugs for the purpose.
- That coming out from the lower orifices is palliable / yapya
- - because of being amenable to emesis / vamana and
- availability of lesser number of drugs for the purpose.
- That coming out from both the routes is incurable / ASADHYA
- because of non-applicability of both emesis and purgation and in want of suitable drugs. (9)
Origin of raktapitta
रक्तपित्तप्रकोपस्तु खलु पुरा दक्षयज्ञोद्ध्वंसे रुद्रकोपामर्षाग्निना प्राणिनां परिगतशरीरप्राणानामभवज्ज्वरमनु||१०||
raktapittaprakōpastu khalu purā dakṣayajñōddhvaṁsē rudrakōpāmarṣāgninā [16] prāṇināṁ parigataśarīraprāṇānāmabhavajjvaramanu||10||
Hystorically, raktapitta occured after jwara because of Rudra’s anger pervaded the human being at the time of destruction of Daksha's sacrifice. [10]
General principles of management
तस्याशुकारिणो दावाग्नेरिवापतितस्यात्ययिकस्याशु प्रशान्त्यै प्रयतितव्यं मात्रां देशं कालं चाभिसमीक्ष्य सन्तर्पणेनापतर्पणेन वा मृदुमधुरशिशिरतिक्तकषायैरभ्यवहार्यैः प्रदेहपरिषेकावगाहसंस्पर्शनैर्वमनाद्यैर्वा तत्रावहितेनेति||११||
tasyāśukāriṇō dāvāgnērivāpatitasyātyayikasyāśu praśāntyai prayatitavyaṁ mātrāṁ dēśaṁ kālaṁ cābhisamīkṣya santarpaṇēnāpatarpaṇēna vāmr̥dumadhuraśiśiratiktakaṣāyairabhyavahāryaiḥ pradēhapariṣēkāvagāhasaṁsparśanairvamanādyairvā tatrāvahitēnēti||11||
The disease is acute / asukaari in nature and becomes critical very quickly, spreading like bush fire.
Hence its treatment should be done immediately with
- saturating / santarpana or de-saturating / appatarpana
- mrdu / soft, sweet / madhura, sita / cold, tikta / bitter and kashaya / astringent
- pradeha - parisheka - avagaha / pastes, baths,
- vamanadi / emesis etc.
- after due consideration of dose / matra, desa / place and kala / time. [11]
Why urdhvaga raktapitta is sadhya?
भवन्ति चात्र- साध्यं लोहितपित्तं तद्यदूर्ध्वं प्रतिपद्यते|
विरेचनस्य योगित्वाद्बहुत्वाद्भेषजस्य च||१२||
विरेचनं तु पित्तस्य जयार्थे परमौषधम्|
यश्च तत्रान्वयः श्लेष्मा तस्य चानधमं स्मृतम्||१३||
bhavanti cātra- sādhyaṁ lōhitapittaṁ tadyadūrdhvaṁ pratipadyatē|
virēcanasya yōgitvādbahutvādbhēṣajasya ca||12||
virēcanaṁ tu pittasya jayārthē paramauṣadham|
yaśca tatrānvayaḥ [17] ślēṣmā tasya cānadhamaṁ smr̥tam||13||
The “upward” variety of raktapitta is curable / sadhya
- because of applicability of purgation / virechana and
- abundance of useful drugs.
- Sweet drugs are also applicable in this case. Hence, bleeding from the upper part is curable. [12-14]
भवेद्योगावहं तत्र मधुरं चैव भेषजम्|
तस्मात् साध्यं मतं रक्तं यदूर्ध्वं प्रतिपद्यते||१४||
bhavēdyōgāvahaṁ tatra madhuraṁ [18] caiva bhēṣajam|
tasmāt sādhyaṁ mataṁ raktaṁ yadūrdhvaṁ pratipadyatē||14||
In urdvaga raktapitta
- virechana is yogapaha
- kashaya - tikta rasas are kapha samana
- madhura rasa is pitta samana
- so URDHVAGA raktapitta is sadhya
Why adhoga raktapitta is yapya?
रक्तं तु यदधोभागं तद्याप्यमिति निश्चितम्|
वमनस्याल्पयोगित्वादल्पत्वाद्भेषजस्य च||१५||
वमनं हि न पित्तस्य हरणे श्रेष्ठमुच्यते|
यश्च तत्रान्वयो वायुस्तच्छान्तौ चावरं स्मृतम्||१६||
तच्चायोगावहं तत्र कषायं तिक्तकानि च|
तस्माद्याप्यं समाख्यातं यदुक्तमनुलोमगम्||१७||
raktaṁ tu yadadhōbhāgaṁ tadyāpyamiti niścitam|
vamanasyālpayōgitvādalpatvādbhēṣajasya ca||15||
vamanaṁ hi na pittasya haraṇē [20] śrēṣṭhamucyatē|
yaśca tatrānvayō [21] vāyustacchāntau cāvaraṁ smr̥tam||16||
taccāyōgāvahaṁ [22] tatra kaṣāyaṁ tiktakāni ca|
tasmādyāpyaṁ samākhyātaṁ yaduktamanulōmagam [23] ||17||
Hemorrhage from the lower parts / adhoga raktapitta is decidedly yapya / palliable
- because emesis / vamana has limited efficacy here and
- effective drugs are also a few.
- Emesis is not so efficacious for elimination of pitta and it is also ineffective in alleviation of vata responsible for the downward flow.
- Moreover, kashaya / astringents and tikta / bitter drugs are not applicable there.
Why ubhayaga raktapitta is asadhya?
रक्तपित्तं तु यन्मार्गौ द्वावपि प्रतिपद्यते|
असाध्यमिति तज्ज्ञेयं पूर्वोक्तादेव कारणात्||१८||
नहि संशोधनं किञ्चिदस्त्यस्य प्रतिमार्गगम्|
प्रतिमार्गं च हरणं रक्तपित्ते विधीयते||१९||
एवमेवोपशमनं सर्वशो नास्य विद्यते|
संसृष्टेषु च दोषेषु सर्वजिच्छमनं मतम् ||२०||
इत्युक्तं त्रिविधोदर्कं रक्तं मार्गविशेषतः||२१||
raktapittaṁ tu yanmārgau dvāvapi pratipadyatē|
asādhyamiti tajjñēyaṁ pūrvōktādēva kāraṇāt||18||
nahi saṁśōdhanaṁ kiñcidastyasya pratimārgagam|
pratimārgaṁ ca haraṇaṁ raktapittē vidhīyatē||19||
ēvamēvōpaśamanaṁ sarvaśō nāsya vidyatē|
saṁsr̥ṣṭēṣu ca dōṣēṣu sarvajicchamanaṁ matam [25] ||20||
ityuktaṁ trividhōdarkaṁ raktaṁ mārgaviśēṣataḥ|21|
In cases where blood comes out from both the routes, urdhvaga raktapitta is asadhya / incurable
- because no effective evacuative measure is applicable.
- In raktapitta, elimination of dosha from the opposite route is recommended.
Why some sadhya rogas becomes asadhya?
एभ्यस्तु खलु हेतुभ्यः किञ्चित्साध्यं न सिध्यति||२१||
प्रेष्योपकरणाभावाद्दौरात्म्याद्वैद्यदोषतः|
अकर्मतश्च साध्यत्वं कश्चिद्रोगोऽतिवर्तते||२२||
तत्रासाध्यत्वमेकं स्यात् साध्ययाप्यपरिक्रमात्|२३|
ēbhyastu khalu hētubhyaḥ kiñcitsādhyaṁ na sidhyati||21||
prēṣyōpakaraṇābhāvāddaurātmyādvaidyadōṣataḥ|
akarmataśca sādhyatvaṁ kaścidrōgō'tivartatē||22||
tatrāsādhyatvamēkaṁ syāt sādhyayāpyaparikramāt|23|
Some curable diseases do not get treated successfully because of
- the lack / abhava of attendants and equipments - preshya upakarana,
- uncontrolled self - atmyad
- and vaidya dosha / fault of the physician.
If treated well, sometimes the incurable disease may become curable / sadhya or yapya / palliable. [21-23]
Signs of incurable raktapitta / asadhya
रक्तपित्तस्य विज्ञानमिदं तस्योपदिश्यते||२३||
यत् कृष्णमथवा नीलं यद्वा शक्रधनुष्प्रभम्|
रक्तपित्तमसाध्यं तद्वाससो रञ्जनं च यत्||२४||
भृशं पूत्यतिमात्रं च सर्वोपद्रववच्च यत्|
बलमांसक्षये यच्च तच्च रक्तमसिद्धिमत्||२५||
येन चोपहतो रक्तं रक्तपित्तेन मानवः|
पश्येद्दृश्यं वियच्चापि तच्चासाध्यं न संशयः||२६||
raktapittasya vijñānamidaṁ tasyōpadiśyatē||23||
yat kr̥ṣṇamathavā nīlaṁ yadvā śakradhanuṣprabham|
raktapittamasādhyaṁ tadvāsasō rañjanaṁ ca yat||24||
bhr̥śaṁ pūtyatimātraṁ ca sarvōpadravavacca yat|
balamāṁsakṣayē yacca tacca raktamasiddhimat||25||
yēna cōpahatō raktaṁ raktapittēna mānavaḥ|
paśyēddr̥śyaṁ viyaccāpi taccāsādhyaṁ na saṁśayaḥ||26||
Now described are types of raktapitta, identified (by their physical appearance).
- Raktapitta which is black / krishna, nila / blue or of rainbow color and stains clothes is incurable.
- Bleeding which is of excessively fetid smell / puti gandha
- atimatra / in large quantities, and
- which is associated with all the complications / sarva upadrava particularly in weak and emaciated patients - bala mamsa kshaya is incurable.
- A patient, if sees things around him and the sky red / rakta, is certainly suffering from an incurable variant of the disease. [23-26]
तत्रासाध्यं परित्याज्यं, याप्यं यत्नेन यापयेत्|
साध्यं चावहितः सिद्धैर्भेषजैः साधयेद्भिषक्||२७|
tatrāsādhyaṁ parityājyaṁ, yāpyaṁ yatnēna yāpayēt|
sādhyaṁ cāvahitaḥ siddhairbhēṣajaiḥ sādhayēdbhiṣak||27||
- A patient suffering from the asadhya / incurable variant should be avoided / parityajyam,
- while the one with the palliable / yapya variant should be managed with efforts / yatna and
- the curable / sadhya one should be treated successfully with tried remedies / siddha bheshaja . [27]
Summary
तत्र श्लोकौ-
कारणं नामनिर्वृत्तिं पूर्वरूपाण्युपद्रवान्|
मार्गौ दोषानुबन्धं च साध्यत्वं न च हेतुमत्||२८||
निदाने रक्तपित्तस्य व्याजहार पुनर्वसुः|
वीतमोहरजोदोषलोभमानमदस्पृहः||२९||
tatra ślōkau- kāraṇaṁ nāmanirvr̥ttiṁ pūrvarūpāṇyupadravān|
mārgau dōṣānubandhaṁ ca sādhyatvaṁ na ca hētumat||28||
nidānē raktapittasya vyājahāra punarvasuḥ|
vītamōharajōdōṣalōbhamānamadaspr̥haḥ||29||
Now summarizing the chapter–
- Karana / Etiology,
- Nama nivrutthi / etymology of the disease,
- Purva rupa / prodroma,
- Upadrava / complications,
- Marga / routes,
- association of doshas,
- Sadhya asadhyatha / curability (or otherwise), with reasoning
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते|
निदानस्थाने रक्तपित्तनिदानं नाम द्वितीयोऽध्यायः||२||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē
nidānasthānē raktapittanidānaṁ nāma dvitīyō'dhyāyaḥ||2||
Thus ends the second chapter on diagnosis of raktapitta in Nidana Sthana in the treatise composed by Agnivesha and redacted by Charaka. [2]
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