All the Haematological conditions may have their direct or indirect origin in blood or blood forming organs or may appear as the consequences of the other pathological conditions. Fortunately, the patients with such diseases are quite rare as the incidence rate is quite low.

ITP is one such condition where most of the cases are managed for quality of life. The primary purpose in such conditions of haematology is to conserve life and maintain with improvement in quality of life.

ITP is an acquired disorder leading to immune mediated destruction of platelets. It is characterized by muco-cutaneous bleeding with low or very low platelet count. Patient usually presents with ecchymoses and petechiae or incidentally found thrombocytopenic in the investigation like Complete Blood Count (CBC). The life threatening bleeding may take place in GIT or in CNS or even in retina.

In Ayurvedic perspective the ‘Rakta Dhatu’ is very important as its function has mentioned as ‘Jeevan’ i.e. it directly links with the life of an individual. ‘Yakrut and Pleeha’ (Liver and Spleen) are considered as the sites of origin of Raktavaha Srotas which conveys the affection of these organs structurally and functionally in the diseases of Raktavaha Srotas.

 

Hetu or Risk factors according to Ayurveda:

Hot and spicy foods, fried substances, sour and salty substances, food with preservatives, excess sun exposure are considered as the important etiological or risk factors in the vitiation of Raktavaha Srotas.

In Ayurvedic physiology the relationship in between Rakta Dhatu and Pitta Dosha has documented and well elaborated. Hence Pitta aggravating lifestyle and Pitta dominant personalities are also susceptible or predisposed for the production of haematological disorders and diseases.

Here a clinical experience of an ITP patient is presented to review the concepts of Ayurvedic Management and Treatment Principles in Raktavaha Srotas Disorders.

 

 Case - A female patient of 20 years old brought to the clinic by her parents for her chronic problem of low platelets count and anaemia. She was quite pale and the platelets were around 5000 and Haemoglobin count was about 8 Gm%, but she had no active bleeding. A Haematologist from Pune city diagnosed her as ‘Idiopathic Thrombocytopenic Purpura’ ( ITP).

ITP is an acquired disorder leading to immune mediated destruction of platelets. It is characterized by muco-cutaneous bleeding with low or very low platelet count. Patient usually presents with ecchymoses and petechiae or incidentally found thrombocytopenic in the investigation like Complete Blood Count (CBC). The life threatening bleeding may take place in GIT or in CNS or even in retina.

 

Clinical Examination- The patient was observed clinically and found with the signs and symptoms like paleness, tinnitus, anorexia, hair fall and severe weakness.

During her history taking her dietary and other lifestyle related conditions were probed and they were ‘Pitta Vitiating’, Also her constitutional analysis was ‘Pitta-Vata’ type.

As she was in a chronic condition which is termed as ‘Yapya’ (difficult to treat and only conservative treatment can be given) in character she was frustrated and depressed too. (Yapya Diseases may require lifelong treatment for the survival like DM, HT and Thyroid Disorders).

Ayurvedic diagnostic tools were utilized which were suggestive for ‘Pandu’ as a Diagnosis in Ayurvedic perspective. Considering the bleeding tendency and the natural course of the disease the ‘Rakta-Pitta’ disease was also considered in her management.

 

This leads to the increase in chances of Dosha vitiation in channels and may lead to bleeding through various macro and micro levels of circulation due to rise in the intra vascular hydrostatic pressure.

The Ayurvedic classics have elaborated both of these conditions and they have considered the Pitta Vitiation as a main culprit behind the pathology.

As per the classics ‘Rasa Dhatu’ and ‘Rakta Dhatu’ has a common medium through which they are nourished.

Vitiation in Pitta leads to vitiation in Rakta Dhatu qualitatively and quantitatively.  Rasa Dhatu has the nourishing component for the Rakta Dhatu which is reduced due to increase in hot potency of Pitta Dosha, this leads to decrease production of Rakta Dhatu. This is the target site for the drug action.

All the ancient classics of Ayurveda had mentioned the importance of ‘Grutapan’   (Intake of Medicated Cow Ghee) and Purification procedures like ‘Vaman and Virechan’ in the management of these conditions if the Doshas are aggravated profusely.  However patient was weak and not psychologically prepared for the strong therapies, therefore the palliative mode of therapy i.e. Shaman treatment was adopted for the management.

Course of treatment:

Medicated Ghee ‘Dadimadi Ghutum’ in a dose of 2 tsf in the morning period on an empty stomach which is a ‘Rasayan Kala’ was recommended. ‘Dadimadi Ghrutm’ is a drug of choice when a patient shows the anaemic features and hyperacidity associated symptoms with degenerative or autoimmune pathology specifically in Rasa and Rakta dhatu.

‘Ghrut’ as a medicated formulation is a Rasayan drug and it nourishes the ’Rasa and Shukra Dhatu’ and promotes the ‘Oja’ (Vital sap) formation. It pacifies the Pitta and Vata and improves the quality of voice or speech, skin complexion and eliminates the metabolic toxins and works as a systemic detoxifying agent. All these therapeutic properties of Ghrut are considered in the management of chronic diseases.

‘Dadim’ is an exceptional drug which has ‘Amla Rasa and Madhur Vipak’ and it pacifies the Pitta, promotes the Rasa and Rakta Dhatu production and arrests the degeneration process in the body. It stimulates ‘Dhatvagni’ and improves the formation, transformation and elimination processes to reverse the pathological consequences.

The second drug which was recommended for the patient was ‘Tapyadi Loha’ in a dose of 2 -2 after meals.

 It is again one of the Rasayan formulations for the diseases of ‘Raktavaha Srotas’. ‘Makshik’ is an important ingredient of this formulation which promotes the production of ‘Rakta Dhatu’ hence recommended in the management of various haematological conditions. In the classics it is recommended in psychological disturbances, liver disorders, ano-rectal conditions and in chronic fever. It is also recommended in the diseases where the ‘Raktapitta’ can occur as a complication of the primary disease.

The third drug used and it was ‘Mouktik Kamdudha’ 1- 0 -1 after meals to take care of ‘Ushna, Tikshna and Drava’ properties of vitiated Pitta. Due to these all properties the bleeding chances are increased hence in the management of the bleeding disorders even it is one of the drug.

‘Daruharidra’ was also prescribed to the patient. It is drug with ‘Tikta Rasa, Ushna Veerya and Ruksha Property. It promotes the wound healing by its detoxifying action. It might be working as a stimulator on the organs or the mechanisms which contribute in the blood formation and wound healing by some chemical mechanism. In traditional Indian culture ‘Haridra’ is used to arrest bleeding through wound. ‘Daruharidra’ was used as the substitute for ‘Haridra’ considering compliance of the patient.

Few of the occasions ‘Dhatri Rasayan’ was also used as per requirement.

With all these medicines and other therapeutic guidelines the Platelet count of the patient had improved gradually and stable around 100,000 and patient remained asymptomatic for about 7-8 years and even her pregnancy did not produced any major complications. Her haemoglobin levels are stable around 10 Gm%. 

Similarly other 2 patients were also treated with fruitful results noted. One of them was a 4 years old boy from Canada was on steroids but after Ayurvedic medicines he did not required the steroids in the 8 months of period and his platelet count had improved from 13000 to 80000.

The enthusiastic results in these patients are really encouraging for the Ayurvedic management of Haematological disorders like sickle cells anaemia, aplastic anaemia and other such hemorrhagic conditions.

 

Drug selection criteria for the management of Haematological Disorders-

 

1)    Tikta Rasa- Blood purifying, Pitta pacifying.

2)    Kashaya Rasa- Astringent effect, haemostatic action, blood purifying & Wound healing.

3)    Amla Rasa with Madhur Vipak- Dhatvagni stimulant,  Rasa and Rakta nourishing and Pitta pacifying effect.

4)    Sheet Veerya- Haemostatic, Pitta pacifying.

5)    Rakta Dhatvagni stimulant-  Increased  Production and proper transformation of Rakta Dhatu and eliminates the metabolic wastes.

6)    Virechan therapy- To eliminate the Mala Pitta from the body channels and to reduce the bleeding tendency of the blood and also useful for detoxification.

7)    Vaman- As mentioned in ‘Pandurog Chikitsa’ if Amashaya Dushti is present.

8)   Rasayan Drugs - Immune modulators which includes the immune boosting and suppression of autoimmune antibodies, adaptogenic, hepatoprotective and haematogenic.

 

Herbs and formulations useful in management of haematological conditions -

1)    Guduchi

2)    Shatavari

3)    Dadim

4)    Punarnava

5)    Amalaki

6)    Triphala

7)    Gairik

8)    Praval

9)    Mandur- Mandurvatak, Punarnava Mandur

10) Makshik

11) Loha- Tapyadi, Dhatri, Navayas.

12) Abhrak

13) Mouktik Kamdudha

14) Ghrutum- Pancha Gavya, Dadimadi, Pancha Tikta & Kalyanak

15) Dhatri  rasayan

16) Chyavanprash

17) Phalatrikadi Kashaya

18) Tiktak Kashaya.