Tarpana and Ahara in the treatment of Raktapitta

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Tarpana means nutrition. Tarpana or provision of nutritive foods is one of the key strategies of Raktapitta treatment protocol.
Any treatment or food which provides nutrition or is of nutritive value is called Tarpana. 

Tarpana in Raktapitta

Tarpana is mandatory in Raktapitta
Tarpana is obviously needed in the treatment of Raktapitta because there is severe loss of blood, weakness and many complications associated with bleeding.

It is said that Tarpana should be done after Langhana. Moreover, after Langhana the person will be weak and feels depleted. The nutrition should be provided and restored in these patients. Therefore Tarpana should be done after Langhana.

Tarpana in Urdhwaga Raktapitta

Tarpana should be done in Urdhwaga Raktapitta following Langhana
Acharya Charaka specifies to administer Tarpana in Urdhwaga Raktapitta (Raktapitta with upward course, the bleeding occurs through the orifices in the upper part of the body i.e. nose, ears, mouth, eyes).

After Langhana, Tarpana should be done in Urdhwaga Raktapitta and Peya (digestive gruels) should be given in Adhoga Raktapitta (Raktapitta with downward course, the bleeding occurs through the orifices in the lower part of the body i.e. anus, urinary tract and vagina).

Why Tarpana is needed in Urdhwaga Raktapitta?

According to Chakrapani, the commentator of Charaka Samhita, in Urdhwaga Raktapitta there is sama pitta (pitta associated with ama or unformed digestive juices or immature nutritive juices produced due to sluggish digestion) associated with kapha. Also urdhwaga raktapitta is caused by snigdha and ushna karanas (unctuous and hot foods). Langhana or lightening therapies, especially fasting is antagonistic to ama, kapha and snigdhata and is best applicable in Urdhwaga Raktapitta. On the contrary in the Adhoga Raktapitta sama pitta is associated with Vata and Adhoga Raktapitta is caused by Ruksha-Ushna karanas (dry and hot foods). Vayu and rukshata do not tolerate Langhana. Therefore Langhana should either be avoided or be given with caution in Adhoga Raktapitta.
Related reading – Langhana, Tarpana and Peya in Raktapitta

Gangadhara, the other commentator of Charaka Samhita opines that Langhana can be given in both Urdhwaga and Adhoga Raktapitta when they are cuased due to Santarpana (over-nutrition) and Langhana shall be avoided when both types of Raktapitta are caused due to Apatarpana (under-nutrition). In Urdhwaga Raktapitta caused by Santarpana, Tarpana should be given followed by Langhana and in Adhoga Raktapitta caused by Santarpana, Peya should be given after Langhana. In Urdhwaga Raktapitta caused by Apatarpana, Tarpana should be given straight away without administering Langhana. Similarly in Adhoga Raktapitta caused by Apatarpana, Peya should be given straight away withour giving Langhana.

But the interesting fact is that Langhana is anyway preferred in Urdhwaga Raktapitta except in that caused by Apatarpana. Thus, Langhana is given in Urdhwaga Raktapitta caused by Santarpana. Even if Urdhwaga Raktapitta is not caused by Santarpana, the association of ama, kapha and sneha makes it a candidate to receive Langhana in contrary to Adhoga Raktapitta where caution should be taken.

Since Langhana is anyhow given in Urdhwaga Raktapitta, there will be excessive fatigue associated with this condition in which there is already plenty of bleeding. Therefore Tarpana is needed in Urdhwaga Raktapitta and is not needed in Adhoga Raktapitta (wherein Tarpana is substituted by Peya).

Principles of administering Tarpana in Urdhwaga Raktapitta
Tarpana should be given in Urdhwaga Raktapitta – As already said, Tarpana should be given in Urdhwaga Raktapitta. After administering Langhana, one should wait for Samyak Langhana Lakshanas (Symptoms of properly administered Langhana). After these symptoms have been observed, Tarpana should be administered.

Tarpana after Langhana in Santarpanotta Urdhwaga Raktapitta – In Raktapitta caused by Santarpana or over-nutrition, Tarpana should be given after Langhana since Langhana is antagonistic to Santarpana and Santarpanotta vyadhis (diseases and conditions caused due to santarpana)

Tarpana without Langhana in Apatarpanotta Urdhwaga Raktapitta – In Raktapitta caused by Apatarpana or under-nutrition, Tarpana should be given straight away without administering Langhana since Langhana is further worsens the Apatarpanotta vyadhis (diseases and conditions caused due to apatarpana. Langhana and Apatarpana are both depleting in nature.

Tarpana without Langhana in Alanghita or Langhana anarha – Tarpana can be given straightaway without giving Langhana in Urdhwaga Raktapitta when the patient has not been subjected to Langhana or when he is not fit to undergo Langhana

Forms of Tarpana

Tarpana and its forms, as administered in Raktapitta
As already said, Tarpana means nutrition or nutritious products. Going by the words of Chakrapani, in his commentary on Cha.Chi.4/30, wherein he has mentioned ‘Tarpanam Ashanam’ which means ‘Tarpana in the form of food or diet’ and ‘Tena Yavaguhu Tarpanam cha graahyam’ which means ‘Tarpana should be taken in the form of Yavagu or gruels’, we can conclude that Tarpana in Raktapitta refers to good nutritious diet and gruels. Yavagu or gruels are also nutritious drinks.

To sum up, Tarpana in Raktapitta is provided in 3 forms –
Aushadha rupa Tarpana
Tarpana prepared with medicinal herbs in the form of nutritive drinks is beneficial in the treatment of Raktapitta.

Below mentioned are some of the medicinal preparations which also act like Tarpana.

Kharjuradi Brimhana – improves weight
Water boiled or processed with Kharjura (dates), Draksha (raisins), Amalaki (Indian gooseberry) and Parushaka (Grewia asiatica) should be cooled, added with sugar and be used as Tarpana.

Laja Tarpana
Powder of Laja (parched rice, puffed rice, fried paddy) should be mixed with plenty of ghee and honey and used as Tarpana

Adding sour taste (souring) to Tarpana:
Amla Rasa or sour taste can be added to the above said Tarpanas if –

• Presence of Mandagni – The patient has Mandagni (low digestion, sluggish metabolism)
• Amla Satmya – If sour taste is compatible for the person (sour tolerance)

Souring of Tarpana should be done by using (adding) the below mentioned juices to the prepared Tarpana –

• Amla Dadima Rasa – Sour pomegranate juice
• Amalaka Rasa – Juice of Indian Gooseberry (Emblica officinalis)

1. Ahara Rupa Tarpana

Tarpana is provided in the form of nutritious food (diet). Such nutritive ahara or food is of two types i.e. Shaka (vegetables) for vegetarians and Mamsa (meat) and Mamsarasa (meatsoup) for non-vegetarians.

Related Reading – Ahara in Raktapitta

1. Yavagu Rupa Tarpana

Tarpana is provided in the form of medicated gruels. The dual action of these Yavagus comes in handy in the treatment of Raktapitta. The yavagus apart from being light and nutritious diet also act as medicines since the gruels are prepared in the infusions or decoctions of disease modifying herbs (rather than being prepared with rice and water, infusions or decoctions are used in place of plain water).

One or more of the above mentioned recipes should be selected depending on the satmya (compatibility and practice) of the patients
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