Logical Explanation of ‘Management of vitiation of Raktavaha Srotas’ as mentioned by Charaka

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Raktavaha Srotas are the channels of the body which are responsible for formation and distribution of blood tissue to the entire body. The roots of these channels lie in the Yakrit – liver and Pliha – spleen. According to Master Sushruta, along with liver and spleen, the raktavahini dhamanis i.e. the arteries which carry the blood are also considered as raktavaha srotas.

Principles of treating the diseases caused due to vitiation of raktavaha srotas (and vitiated blood)

विधि शोणिते अध्याये रक्तजानां भिषक् जितम्॥(च.सू.२८/२५)

The raktaja rogas i.e. diseases caused due to vitiation of blood and raktavaha srotas – blood conveying channels should be managed on the lines of treatment and management explained in the chapter ‘Vidhi shonitiya’ of Charaka Sutra Sthana.

The main treatment principles / management of vitiation or contamination of blood conveying channels are –

कुर्यात् शोणित रोगेषु रक्त पित्त हरीं क्रियाम्।

विरेकं उपवासं च स्रावणं शोणितस्य च॥(च.सू.२४/१८)

The management includes:

The same principles of treatment also fit into the treatment of Liver and Spleen disorders because they are roots of raktavaha srotas.

1. Raktapitta hara kriyam: Treating on the lines of management of Raktapitta (bleeding disorders)

Raktapitta is a condition caused by joint vitiation and mutual contamination of rakta – blood and pitta. There is always a susceptibility for this to happen because the blood and pitta share an inseparable bond of ashraya – residence and ashrayi – resident. Here, blood is the ashraya and pitta is ashrayi. Rakta and pitta getting vitiated by their own etiological factors will later contaminate each other and cause bleeding from upward, downward and sideward directions. They are called urdhwaga, adhoga and tiryagata raktapitta respectively.

Raktapitta is also caused due to rakta vriddhi – pathological increase of blood tissue.

Apart from this, we need to see where this rakta has its origin from. It is manufactured and distributed at the roots of raktavaha srotas i.e. yakrit – liver, pliha – spleen and raktavahini dhamanis – i.e. vessels / arteries carrying blood all through the body. The raktavaha srotas – the blood conveying channels are connected to their roots.

Treatment principles of raktapitta vis-à-vis bleeding disorders is applicable in the treatment of diseases related to and caused by vitiation or damage to the raktavaha srotas.

This also means that the treatment of raktapitta is also applicable in the treatment of liver disorders. This shows that when the liver or spleen are vitiated or contaminated, there would be ‘bleeding tendencies’ in the body. Putting it the other way, when there is bleeding from any orifice of the body, the involvement of the liver or spleen also should be thought of.

So, the principles of treatment of raktapitta are applicable for –

–        Disorders arising due to the contamination of raktavaha srotas
–        Liver disorders
–        Spleen disorders
–        Disorders related to the arterial system
–        Diseases manifesting due to inadequate supply of blood and nutrition

2. Virechanam: Therapeutic purgation

Virechana is the best treatment for high pitta conditions and pitta disorders. It is also the best treatment for contamination and diseases of the blood.

Virechana helps to control the hyperactivity of pitta in the body and also its sub-units. Ranjaka Pitta, a subtype of pitta, is located in the liver and spleen. Its hyperactivity can damage the liver, spleen, blood vessels and also the blood cells / tissue. Virechana will take care of the pitta aggravation, expel the morbid pitta and help in healing of liver and spleen, while destroying the diseases occurring therein. Virechana also cleanses and rejuvenates the haemopoietic system and makes way for production of good quality and quantity blood.

There are five subtypes of pitta and they are interrelated. Their health and disturbance influence each other. Virechana balances pitta. In other terms, it helps in balancing each pitta and also their interrelated chemistry.

3. Upavaasam: Therapeutic starvation / fasting  

Excessive buildup of ama, kapha or pitta can affect the liver and spleen and cause blocks in the raktava srotas and raktashaya components of these organs. This meddles with proper, qualitative and quantitative production of blood and its distribution. Same events can happen when ama gets associated with pitta (sama pitta) or kapha (sama kapha) or rakta (sama rakta).

The origin of ama and accumulation of kapha is from the stomach, the sluggish digestive fire (mandagni) therein. This leads to indigestion and formation of intermediate products of digestion which are not conducive for health. This is called ama. It is a sticky substance and is toxic in nature. It can get adhered within the channels and cause blocks. It also diminishes the digestive fire and the tissue fires. This ama can get associated with tissues, including rakta and with doshas – including pitta and kapha, disturbing their normal functioning.

Therapeutic starvation / planned fasting will help in dissolution of these pathogenic components and clear the blockages. Upavasa is also a kind of langhana – lightening therapy, much needed in these conditions.

Upavasa also helps in digesting ama and kindling the digestive fire. Therefore, it forms an important inclusion in the treatment of diseases of raktavaha srotas and diseases pertaining to liver, spleen and blood vessels.

Upavasa also helps in proper formation of blood – qualitative and quantitative.

4. Raktamokshana: Bloodletting

Abnormal increase in blood i.e. rakta vriddhi also causes enlargement of spleen and liver as mentioned amongst the signs and symptoms of the mentioned condition.

Apart from that, increase in blood can also cause pressure in these organs, hamper the formation of good quality blood and might open up the gates for many diseases to occur in the process. The symptoms / disease conditions mentioned in the context of rakta vriddhi are the coexisting conditions for a liver or spleen enlargement and also are the diagnostic tools of the same.

Amongst many other pathological conditions, rakta vriddhi also causes raktapitta, the treatment of which has also been included in the treatment of diseases having their origin from vitiation of raktavaha srotas (as discussed in point 1, above).

Therapeutic bloodletting will release the pressure built up in the raktavaha srotas, including liver and spleen and finetune the hemopoietic system. This enables the formation of proper quantity and quality of blood. This also is preventive and curative of many conditions caused due to contamination of blood carrying channels and also diseases caused by morbid blood. Master Sushruta has considered Rakta – blood as chaturtha dosha – the fourth dosha. Raktamokshana would prevent the bleeding tendencies in the body and hence diseases like raktapitta.