Sushruta Samhita Sutrasthana Chapter 14: Shonitavarnaniya Adhyaya (Description of Blood)

The 14th chapter of Sutrasthana of Sushruta Samhita is named as Shonitavarnaniya Adhyaya. This chapter deals with the Description of Blood.

अथातः  शोणितवर्णनीययमध्यायं व्याख्यास्यामः ।१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥

We will now expound the chapter called Sonita Varnaniya- description of blood; as revealed by the venerable Dhanvantari.

 Rasa-Rakta utpatti: Production of blood

तत्र पाञ्चभौतिकस्य चतुर्विधस्यं षड्रसस्य द्विविधवीर्यस्याष्टविधवीर्यस्यवाऽनेकगुणस्योपयुक्तस्याहारस्य सम्यक्परिणतस्य यस्तेजोभूतः  सारः परमसुक्ष्म स ’रसः’ इत्युच्यते, तस्य ह्र्दयं स्थानं स ह्र्दयाच्चतुर्विशतिधमनीरनुप्रविश्योर्ध्वगा दश दशाधोगामिन्यश्च- तस्त्रश्च  तैर्यग्गाः कृत्स्नं शरीरमहरहस्तर्पयति वर्धयति धारयति यापयति चाद्दष्टहेतुकेन कर्मणा।

When the food (that we consume) which is composed of pancabhutas (five basic elements of nature – prithvi – earth, ap – water, teja – fire, vayu – wind and akasa – ether), is of four types (peya – drinkables, lehya – lickables, bhojya – chewable and bhaksya – eatables), having six tastes (madhura – sweet, amla – sour, lavana – salt, katu – pungent, tikta – bitter and kasaya – astringent), of two potencies (usna – hot and sita – cold) or eight potencies (usna – hot, sita – cold, snigdha – unctuous, ruksa – dry, guru – heavy, laghu – light, mrdu – soft and tiksna – sharp) and possessing many properties, consumed in proper way, gets digested properly (and completely) by the action of digestive fire – the vital essence of such food is formed. This essence is known as ‘Rasa’. (This rasa is very subtle – thin and suitable to move through even the minute channels in the body).

Hrdaya – heart is the seat of this rasa. This rasa, from the heart, travels through twenty four dhamanis (arteries) – ten of them going upwards, ten going downwards and four going side-wards / obliquely – nourishes the entire body constantly, causes growth of the body, supports and maintains it.

The adrshta (invisible causes) i.e. the effect of the deeds done in the past life is also responsible for these events to occur. The status of rasa which is constantly travelling (circulating) in the body can be inferred by its increase, decrease or the abnormalities it produces.  

This ‘rasa’ which is constantly moving in the entire body, in its different parts, organs, doshas, dhatus (tissues), malas (excreta) and viscera.

There is a debate related to this rasa so as to whether rasa is soumya (cold in properties and action) or taijasa (hot in properties and actions). The reply is – since rasa is a liquid possessing properties such as unctuousness, enliving (sustaining life), nourishing, supporting etc, it shall be considered to be soumya only i.e. cold in properties and actions.

Formation of rakta: Blood from rasa tissue

स खल्वाप्यो रसो यकृत्प्लीहानौ प्राप्य रागमुपैति ।४॥

The rasa which is apya i.e. predominantly made up of water (possesses properties and actions similar to that of water) on reaching yakrit (liver) and pliha (spleen) attains red colour (and becomes blood tissue).

Definition (formation) of rakta: Blood tissue

श्लोकौ चात्र भवत:-
रञ्जितास्तेजसा त्वापः शरीरस्थेन देहिनाम्
अव्यापन्नाः प्रसन्नेन रक्तमित्यभिधीयते । ॥५॥

Two more verse here:-

This Apya Rasa i.e. rasa having appearance, properties and action similar to that of water (water- like rasa) after getting red colour by the action of Tejas (heat, fire-like agency – ranjaka pitta located in the liver and spleen in this context, since pitta is a representative of fire in the body) present in the body (in the liver and spleen) remaining un-vitiated and clear, comes to be called as Rakta (blood).

Formation of Rajas: Menstrual blood

रसादेव स्त्रिया रक्तं रजः संज्ञं प्रवर्तते ।
तद्वर्षाद्वादशादूर्ध्वं याति पञ्चाशतः क्षयम् ॥६॥
आर्तवं शोणितं त्वाग्रेयम्, अग्रीषोमीयत्वाद्रर्भस्य ॥७॥

From the Rasadhatu itself is produced the blood in women and is called as Rajas (menstrual blood).  This blood named rajas starts flowing after the age of twelve years and diminishes (stops) by fifty years of age.

Though this rajas, which is also known as artava is formed from the rasa itself, it is agneya (fiery – possesses the properties of fire) in nature (unlike rasa which is watery in nature). It will not have the watery nature of rasa because the garbha (embryo / foetus) has the qualities of both fire and water.

Jivarakta

पाञ्चभैतिकं त्वपरे जीवरक्तमाहुराचार्याः ॥८॥

Other authors opine that the jivarakta (blood which is in the form of life or the blood which supports all life activities) is formed by mahabhutas (all five elements of nature – earth, water, fire, wind / air and ether).

Qualities of Mahabhutas in Blood

विस्त्रता द्रवता रागः स्पन्दनं लघुता तथा।
भूम्यादीनां गुणा ह्येते दृश्यन्ते चात्र शोणिते ॥९॥

Bad smell, liquidity, red colour, throbbing and levity are the qualities of prithvi (earth) and other bhutas (elements of nature) respectively. They are also found in the blood (since blood is made up of pancha mahabhutas).

Note:

Visrata – bad smell of the blood is the quality of prthvi (earth element). Dravata – liquidity of the blood is the quality of ap / jala (water element). Raga – red colour of the blood is the quality of teja / agni (fire element). Spandana – throbbing in the blood is the quality of vayu (air element). Laghuta – lightness of the blood is the quality of akasa (ether element).

Dhatuutpatti: Genesis of other tissues (chronology of formation of tissues):- 

रसाद्रक्तं ततो मांसं मांसान्मेदः प्रजायते ।
मेदसोऽस्थि ततो मज्ज्ञः शुक्रं तु जायते ॥१०॥ 

From rasa dhatu – rakta dhatu (blood) gets formed.
Then, from the rakta, the mamsa (muscle tissue) is formed.
From mamsa (muscle tissue), medas (fat or adipose tissue) is formed.
From Medas (fat tissue), asthi dhatu (bone tissue) is formed.
From asthi (bone), majja (bone marrow) tissue is formed.
Finally from majja (bone marrow), shukra (semen, reproductive tissue) is formed.

Rasa nourishes all tissues

तत्रैतेषां धातूनामन्नपानरसः प्रीणयिता॥११॥

Rasa – the essence of foods and drinks is the supplier of nutrients for all these dhatus (tissues).

Man is the product of rasa

रसजं पुरुषं विद्याद्रसं रक्षेत् प्रयत्नतः ।

अन्नात्पानाश्च मतिमानाचाराच्चाप्यतन्द्रितः ॥१२॥

Man is born from rasa (essence of food). Hence this rasa should be protected (prevented from vitiation or loss) by all efforts. Therefore a wise person should carefully (without any lassitude) exercise care in consuming foods and drinks and other activities.

Rasa Nirukti: Definition of Rasa:-

तत्र”रस”गतौधातुः अहरर्गच्छतीत्यो रसः ॥१३॥

The verbal root meaning of the term ‘Rasa’ is ‘Ras’. Ras – means movement. That which moves constantly is called Rasa. The word Rasa is derived from its root word Ras and is in constant movement in its channels and hence called Rasa.

Dhatu Parinama Kala-time for formation of tissues:-

स खलु त्रीणि कलासहस्त्राणि पञ्चदश च कला एकैकस्मिन् धाताववतिष्ठतेः; एवं मासेन रसः शुक्रं स्त्रीणां चार्तवं भवति ॥१४॥भवति चात्र:-
अष्टादशसहस्त्राणि सङ्ख्चा ह्यस्मिन् समुच्चये ॥
कलानां नतिः प्रोक्ता स्वतन्त्रपरतन्त्रयो ः ॥१५॥

For a time period of three thousand and fifteen kala, this rasa stays in each dhatu. Gradually it is transformed into other dhatus. In this way, rasa becomes (transforms) shukra – semen, sperms – in men and artava – menstrual blood, ovum – in women in a time period of one month. Thus, it takes around one month for rasa to be transformed into shukra or artava.

One verse here,

Taken this way, according to this (Sushruta Samhita) and also other treatises, the number of kalas required (for the transformation of rasa into sukra) will be eighteen thousand and ninety.

Rasagati: Nature of movement of rasa

स शब्दार्चिर्जलसन्तानवदणुना विशेषेणानुधावत्येवं शरीरं केवलम् ॥१६॥

As said, rasa dhatu is in constant movement and it keeps circulating throughout the body in subtle ways. Rasa dhatu moves sideways like the continuity of sound. It circulates upwards just like the flame and downwards just like water.

Action of Vajikarana medicines (Aphrodisiacs)

वाजीकरण्यस्त्वोषधयः स्वबलगुणोत्कर्षाद्विरेचनवदुपयुक्ताः शुक्तं शीघ्रं विरेचयन्ति ॥१७॥

When the Vajikarana i.e. aphrodisiac medicines are used, they quickly cause purgation (elimination) of shukra dhatu, just like a virechana aushadi i.e. purgative drug, by the virtue of their increased strength (power), qualities or both.

यथाहि पुष्पमुकुलस्थो गन्धो न शक्यमिहास्तीति वक्तुं, नैव नास्तीति; अथ चास्ति, सतां भावानमभिव्यक्तिरिति ज्ञात्वा, केवलं सौक्ष्म्यान्नाभिव्यज्यते; स एवं विवृतपत्रकेशरे पुष्पेकालान्तरेणाभिव्यक्तिं गच्छतिः एवं बालानामपि वयः परिणामाच्छुक्रपादुर्भावो भवति,रोमराज्यादयश्च विशेषा नारीणाम् ॥१८॥

The smell can neither be said as ‘present’ nor as ‘absent’ in the context of a flower bud. It is present (deficiently, in a latent form) in view of the dictum (that thing / qualities) ‘that which exists must manifest’. The smell due to their minuteness will not manifest (not be recognized) in the bud stage of the flower. The same smell would in due course of time become well manifest when the bud develops into flower and opens its petals and filaments. Similarly in children, though the shukra (semen) is present (in a latent and unexpressed way, just like the smell of the bud), its manifestation i.e. production and elimination (ejaculation) occurs only after the change of age in them i.e. when the children mature into adults. This condition i.e. adolescence is also marked by the appearance of romaraji etc i.e. appearance of beard, moustache, hairs around the genitals etc. In women (girls) along with the appearance of pubic hairs, the menstrual blood gradually accumulates (in the uterus) leading to growth (development) of breasts, uterus and vagina.

स एवान्नरसोवृद्धानां (जरा) परिपक्वशरीरत्वादप्रीणनो भवति ॥१९॥

The same annarasa i.e. essence of food will not be able to satisfy the nutrition and nourishment of the old aged people since their body (tissues) are over-matured due to senility.

Dhatu nirukti: Definition of Dhatu

त  एते शरीधारणद्धातव इत्युच्यन्ते ॥२०॥

Since they support (maintain) the body, these (rasa, rakta, mamsa, meda, asthi, majja, shukra) are called dhatus (tissues).

Relationship of increase and decrease of dhatus with shonita (blood)

तेषां क्षयवृद्धि शोणितनिमिन्ति, तस्मात्तदधिकृत्य वक्ष्यामः । तत्र फेनिलमरुणं कृष्णं परुषं तनु शिघ्रगमस्कन्दि च वातेन दुष्टं ; नीलं हरितं श्यावं विस्त्रमनिष्टं पिपीलिकामक्षिकाणामस्कन्दि च पित्तेनह् दुष्टं गौरिकोदकप्रतीकाशं स्निग्धं शितलं बहलं पिच्छिलं चिरस्त्रावि मांसपेशीप्रभं च श्लेष्मदुष्टं ; सर्वलक्षणसंयुक्तं काञ्जिकाभं विशेषतो दुर्गन्धि च सिन्नपातदुष्तं ; द्विदोषलिङ्ग संसृष्टम् ॥२१॥

The decrease and increase of these tissues is caused by blood. Therefore we shall elaborate on that (blood) now.

Features of ‘blood vitiated by vata’ – The blood vitiated by vata is frothy, slightly reddish or black, non-slimy, thin, quick flowing and non-clotting in nature.

Features of ‘blood vitiated by pitta’ – The blood vitiated by pitta is blue, yellow, green or black in colour. It will have an unpleasant smell, not liked by ants and flies and non-clotting in nature.

Features of ‘blood vitiated by kapha’ – The blood vitiated by kapha would have the colour similar to the solution of gairika (red ochre), is unctuous, cold, thick, slimy, flowing slowly and resembles the muscles.

Features of ‘blood vitiated by all the three doshas’ – The blood vitiated by all the three doshas will have all the features (mentioned in blood vitiated by individual doshas), resembles kanjika (rice gruel) and has a very bad smell especially.

Features of ‘blood vitiated by two doshas’ – The blood vitiated by combination of two doshas will have features of any two doshas in the blood.

Shuddha Rakta: Pure Blood

इन्द्रगोपकप्रतीकाशमसंहतमविवर्णं च प्रकृतिस्थं जानीयात् ॥२२॥

The blood should be considered to be normal when it –

–        resembles indragopa (cochineal) insect,
–        is bright red in colour,
–        is not thick,
–        is not discoloured

Rakta  Moksana arha, anarha: Persons fit and unfit for blood  lettings

विस्त्राव्याण्यन्यत्र वक्ष्यामः ॥२३॥
अथाविस्त्राव्या:- सर्वाङ्गशोफः  क्षीणस्य चाम्लभोजननिमित्तः , पाण्डुरोग्यर्शसोदरि-शोषिगर्भिणीनां च श्वयथवः ॥२४॥

Persons fit for blood will be described elsewhere (chap. 8 of Sarira Sthana). Persons unfit for bloodletting are –

–        those who have swelling all over the body,
–        those who are emaciated due to intake of sour foods(for a long time),
–        those who are suffering from diseases such as anaemia, haemorrhoids, abdominal enlargement, consumption
–        pregnant women and
–        those who are suffering from dropsy

Rakta Mokshana vidhi-procedure of bloodletting

शस्त्रविस्त्रवणं द्विविधं-प्रच्छानं सिराव्यधनं च ॥२५॥

Rakta Visravna (letting out blood using a sharp instrument) is of two kinds,

1. Pracchana – scratching and
2. Siravyadhana – vein puncturing / venesection

1.   Pracchana-scratching/lacerating the skin

तत्र, ऋज्वसंकीर्णं सूक्ष्मं सममनवगाढमनुत्तानमाशु च शस्त्रं पातयेन्मर्मसिरास्नायुसन्धीनां चानुपघाति ॥२६॥

Scratching or lacerating the skin should be done in a straight line, those lines should not be joining together, fine, even, not too deep and not very superficial. The procedure (scratching) should be done by using the instrument very quickly without damaging the vital spots, veins (blood vessels), ligaments and joints.

2.  Sira Vyadha-Puncturing the vein

तत्र दुर्दिने दुर्विद्धे शीतवातयोरस्विन्ने भुक्तमात्रे स्कन्दत्वाच्छोणितं  न स्त्रवत्यल्पं  वा स्त्रवति ॥२७॥
मदमूर्च्छाश्रमार्तानां वातविण्मूत्रसंगिनाम् ॥
निद्राभिभूतभीतानां नृणां नासृक् प्रवर्तते ॥२८॥

The blood would become thick and does not flow out as much as it is required to flow or flows in lesser quantity if sira vyadha is done in the below mentioned conditions –

–        if done on a cloudy day
–        if the puncture is done in an improper way,
–        if one gets affected with cold and breeze
–        if sudation has not been done earlier to vein puncture / venesection
–        if it is done after the meals

The blood does not flow out after bloodletting procedure has been done in people suffering from the below mentioned conditions –

–        intoxication,
–        fainting,
–        exertion,
–        who have (used to) suppressed the urges of flatus, faeces and urine
–        those in grip of sleep,
–        those who are scared (in fear)

Asravya Dosha: Effect of absence or inadequate flow:-

तद्दुष्टं शोणितमनिर्ह्रियमाणं शोफदाहरागपाकवेदना जनयेत् ॥२९॥ 

Below mentioned symptoms are manifested if the vitiated blood is not let out in sufficient / proper quantity –

–        swelling
–        burning sensation
–        redness
–        ulceration
–        pain

Atisravya Dosha: Effects of excess flow

अत्युष्णेऽतिस्विन्नेऽतिविद्धेऽज्ञौर्विस्त्रावितमतिप्रवर्तते तदतिप्रवृत्तं शिरोऽभितापमान्ध्यमधिमन्थतिमिरप्रादुर्भावं धातुक्षयमाक्षोपकं दाहं पक्षाघातमेकाङ्गविकारं हिक्कां श्वासकासौ पाण्डुरोगंमरणं चापादयति ॥३०॥

Excessive blood flow following vein puncture (bloodletting) occurs –

–        if it is done during the time of great heat i.e. summer
–        if done in those who have been given with excessive sudation,
–        if excessive or too deep cut / puncture has been done,
–        if done by an ignorant (unskilled, inexperienced) person (physician, surgeon),

When blood flows out in excess it would produce –

–        headache,
–        blindness,
–        glaucoma,
–        depletion of tissues,
–        convulsions,
–        burning sensation,
–        hemiplegia,
–        monoplegia,
–        hiccup,
–        dyspnoea,
–        cough,
–        anaemia,
–        death

Ideal conditions to conduct bloodletting

तस्मान्न शीते नात्युष्णे नातितापिते ।
यवागूं प्रतिपीतस्य शोणितं मोक्ष्ययेद्भिषक् ॥३१॥

Hence bloodletting should be done by the physician,

–        on the day which is neither very cold nor very hot,
–        neither without sudation nor having done sudation in excess and
–        the patient having consumed Yavagu (thin gruel)

How to identify that the blood has been drained properly?

सम्यग्गत्वा यदा रक्तं स्वयमेवावतिष्ठते ।
शुद्धं तदा विजानीयात् सम्यग्विस्त्रावितं च तत् ॥३२॥

The blood which stops all by itself after adequate flow should be considered as pure (not vitiated) and as properly drained.

Samyak Visravana: Signs of proper blood flow

लाधवं वेदनाशान्तिर्व्याधेर्वेगपरिक्षयः ।
सम्यग्विस्त्राविते लिङ्गं प्रसादो मनसस्तथा ॥३३॥

Below mentioned are the symptoms of proper blood flow (following bloodletting) –

–        feeling of lightness of the body,
–        pacification of pain / disease (mitigation of suffering),
–        subsiding of severity (bouts) of the disease
–        cheerfulness / pleasantness of the mind

Benefits of Bloodletting

त्वग्दोषा ग्रन्थयः शोफा रोगाः शोणियजाश्च ये ।
रक्तमोक्षणशिलानां न भवन्ति कदाचय ॥३४॥

When bloodletting is done as and when required, one will never suffer from diseases of the skin, tumours, oedema and diseases arising from blood.

Srava Pravartana: Increasing the flow if there is inadequate flow

अथ खल्वप्रवर्तमाने रक्ते एलाशीतशिवकुष्ठतगरपाठाभद्रदरुविडङ्गचित्रकटुकागारधूमहरिद्रार्काङ्कुरनक्तमालफलैर्यथालाभं त्रिभिश्चतुर्भिः समस्तैर्वा चूर्णीकृतैर्लवणतैलप्रगाढैर्व्रणमुखमवघर्षयेत् , एवं सम्यक  प्रवर्तते ॥३५॥

In case of inadequate flow of blood or if it does not flow out as much as it is required to, due to any reason, the below mentioned herbs should be taken either three, four or all of them as many as available. They should be powdered, mixed with an adequate quantity of salt and oil. The mixture should be taken and rubbed on the opening of the wound. By doing this, the blood would flow out properly. The herbs used for this purpose are –

–        Ela
–        Sita
–        Siva
–        Kustha
–        Tagara
–        Patha
–        Bhadradaru
–        Vidanga
–        Chitraka
–        Trikatu
–        Agaradhuma
–        Haridra
–        Arka ankura
–        Naktamala
–        Phala

Atisrava Nirodha: Controlling heavy bleeding:-

अथातिप्रवृत्ते  रोध्रमधुप्रियङ्गगैरिकसर्जरसरसाञ्जनशाल्मलीपुष्पशङ्खशुक्तिमाषयवगोधूमचूर्णौः शनैः शनैर्व्रणमुखमवचूर्ण्यङ्गुल्यग्रेणावपीडयेत् ; सालसर्जार्जुनारिमेदमेषश्रृङ्गधवधन्वनत्वग्भिर्वा चूर्णिताभिः क्षौमेण वा ध्मापितेन समुद्रफेनलाक्षाचूर्णैर्वा, यथोक्तैर्व्रणबन्धनद्रव्यैर्गाढं बध्नीयात् , षीताच्छादनभोजनागारैः शीतैः प्रदेहपरिषेकैश्चोपचरेत्, क्षारेणाग्रिना वा दहेद्यथोक्तं, व्यधादन्तरं तामेवातिप्रवृन्तां सिरां विध्येत्; काकोल्यादिक्वाथं वा शर्करामधुमधुरं पाययेत्, एणहरिणोरभ्रशशमहिषवराहाणं वा रुधिरं; क्षीरयूषरसैः सुस्निग्धैश्चाश्नीयात्, उपद्रवांश्च यथास्वमुपचरेत् ॥३६॥

In case of atipravritti i.e. excessive bleeding, the powder of the below mentioned herbs shall be sprinkled over the wound and pressed into the wound with the tip of the fingers –

–        Rodhra
–        Madhuka
–        Priyangu
–        Patanga
–        Gairika
–        Sarjarasa
–        Rasanjana
–        Salmali pushpa
–        Sankha
–        Sukthi
–        Masa
–        Yava and
–        Godhuma

Recipe 2 –

Alternatively, the powder of the below mentioned herbs should be sprinkled in the same way –

–        Sala
–        Sarja
–        Arjuna
–        Arimeda
–        Mesasringi
–        Dhava
–        Dhavnana

Recipe 3 –

The powders of the below mentioned too shall be used as the above said –

–        Ash of Kshauma – flax or
–        Powder of Samudraphena and Laksa

Then a bandage may be tied tightly using any suitable bandaging material.

Later, the site should be covered with cold things (like leaf of lotus, wet cloth etc). The patient should be given cold foods, made to live in a cold room, applied with cold medicinal pastes (poultices) prepared from drugs having cold potency, and the site shall be sprinkled / bathed or poured with cold liquids (decoctions prepared with drugs having cold potency).

If the bleeding does not stop in spite of all these measures, the site (veins in that site) should be burnt (cauterized) with caustic alkali or fire.

If after the puncture of a vein if the bleeding does not stop, the same vein shall be cut (punctured) once again at another site.

The decoction prepared from the drugs belonging to the Kakolyadi Gana group of herbs (vide. Chapter 38) should be given to drink after having added and sweetened with sugar and honey.

Alternatively the blood of the deer, antelope, camel, rabbit, buffalo or boar may be given to drink.

Or the person (patient) may be made to drink the blood of deer, antelope, camel, rabbit, buffalo or boar.

Or he may take an unctuous meal (added with more of ghee or oil) along with milk, soup of grains or meat.

If any complications have appeared, they shall be treated accordingly (as suggested in the classics).

Dietetic protocol in excessive bleeding

धातुक्षयात् स्त्रुते रक्ते मन्दः संजायतेऽनलः ।
पवनश्च परं कोपं याति तस्मात् प्रयत्नतः ॥३७॥
तं नानिशीतैर्लधुभिः स्निग्धैः शोणितवर्धनैः ।
ईषदम्लैरनम्लैर्वा भोजनैः समुपाचरेत् ॥३८॥

Some more Verse here:-  

Excessive bleeding leads to depletion of other tissues in the body. This in turn leads to depletion of digestive fire and severe aggravation of vata. Hence the patient should be treated with foods (and things) which are –

–        not very cold,
–        light (easily digestible),
–        unctuous,
–        promote blood formation, and
–        either slightly sour or devoid of sour

Raktasrava Nirodha Krama: Methods of preventing bleeding:-

चतुर्विधं यदेतद्धि रुधिरस्य निवारणम् ।
संधानं स्कन्दनं चैव पाचनं दहनं तथा॥३९॥
व्रणं कषायः  संधत्ते रक्तं स्कन्दयते हिमम् ।
तथा संपाचयेद्द्भस्म दाहः संकोचयेत् सिरा ः ॥४०॥

There are four types of methods to prevent excessive bleeding. They are –

1.    Sandhana – joining the edges of the wound
2.    Skandana – promoting the process of clotting
3.    Pacana – cooking (ama etc associated with blood)
4.    Dahana – cauterization / burning using alkali or fire

Kashaya – astringent drugs / decoctions are useful for sandhana – unification of the edges of the wound.

Hima – cold things help / promote skandana i.e. clotting of blood.

Bhasma – ash or alkali helps in pacana i.e. cooking of wounds.

Daha – burning by fire (thermal cauterization) helps in dahana i.e. cauterization by causing constriction of the veins.

Sequence of treatments to check excessive bleeding

अस्कन्दमाने रुधिरे संधानानि प्रयोजयेत् ।
संधाने भ्रश्यमाने तु पाचनैः समुपाचरेत् ॥४१॥
कल्पैरेतैस्त्रीभिर्वैद्यः प्रयतेत यथाविधि।
असिद्धिमत्सु चैतेषु  दाहः परम इष्यते ॥४२॥

If the blood does not clot, then sandhana should be considered i.e. methods of promoting union (joining of the edges of the wound).

If sandhana i.e. joining the edges of the wound fails, then it shall be treated with pacana (with digestives).

Initially the physician should put all efforts and try to stop bleeding by these three methods only (sandhana, skandana and pacana).

If these measures do not succeed, then burning with fire (thermal cauterization) is the best method to check the bleeding.

Excessive bloodletting should not be done

शेषदोषे यतो रक्ते न व्याधिरतिवर्तते
सावशेषे ततः स्थेयं न तु कुर्यादतिक्रमम् ॥४३॥

Even if a small quantity of vitiated blood is left over in the body (not eliminated), it would not aggravate the diseases or even if little quantity of vitiated doshas remain in the blood. Hence it is important to stop the bleeding so as to allow a proper quantity of blood to remain in the body. On the other hand, too much treatment (causing excessive bleeding) should not be undertaken (since it is harmful).  

Blood is the root cause for the existence of the body

देहस्य रुधिरं मूलंरुधिरेणैव धार्यते ।
तस्माद्यत्नेन संरक्ष्यं रक्तं जीव इति स्थितिः ॥४४॥

Blood is the root (cause) of the body. The body is supported and maintained by the blood itself. Therefore the blood should be protected with all efforts since blood itself it (the indicator) of life.

Balancing Vata after bleeding

स्त्रुतरक्तस्य सेकाद्यैः शीतैः प्रकुपितेऽनिले ॥
शोफं सतोदं कोष्णेन सर्पिषा परिषेचयेत् ॥४५॥

After bleeding, Vata gets aggravated by bathing (showering, streaming) the area (from where bleeding has occurred) with cold liquids etc (which are methods of controlling the bleeding). This aggravated vata gives rise to swelling along with pricking (throbbing) pain. This should be treated by bathing the area (from where bleeding has occurred) with lukewarm ghee.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने शोणितवर्णनीयो नाम चतुर्दशोऽध्यायः ॥१४॥

 Thus ends the Fourteenth chapter Sonitavarnaiya by name in Sutra Sthana of Susruta Samhita.