Difference between Raktapitta and Prameha

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

Why should we differentiate between the two different diseases Raktapitta and Prameha?

Basically, we know that Raktapitta and Prameha are two different diseases which have been explained in Ayurveda treatises. So, we get a doubt so as to why we need to differentially discuss about these two conditions.

The Reason for this is that Acharya Charaka has made a point so as to how to differentiate these two conditions in one of the verses in the context of ‘Prameha Chikitsa’ – chapter dealing on the treatment of Prameha, in Chikitsa Sthana, Chapter 6. Well, this means that from clinical perspective we should know the difference between these two conditions.

But here we are not differentiating the entire diseases.

Charaka has explained this difference while explaining a variant of Raktapitta – Mutragata Raktapitta i.e. a condition wherein there is bleeding or visible blood or bloody urine caused due to the mutually contaminated blood and urine affecting the urinary passages.

In one of the 20 types of Prameha called ‘Rakta Meha’ there is bloody urine or blood mixed urine going out of the body through urinary passages. It is the differentiating of this condition with Raktapitta that Acharya Charaka is speaking about. This differentiation is not only necessary from the point of view of diagnosis but also to chart out the treatment protocols for both, since the line of treatment differs in both conditions.

So, in this article I will be discussing the differences between Raktapitta, mainly adhoga raktapitta i.e. bleeding from the lower tracts of the body including the urinary tract and Rakta Meha, a type of Prameha, a sub-type of Pittaja Prameha to be precise.

Mutragata Raktapitta v/s Rakta Meha

Raktapitta – Raktapitta is a condition wherein rakta and pitta mutually contaminate each other in the process of causing the disease and hence the name. This is due to the ashraya ashrayi bhava i.e. resident and residence relationship between these tow physical entities, rakta or blood being the residence and pitta being the resident. They always have a tendency to vitiate or contaminate each other.

Raktapitta manifests in multiple directions and tracts of the body. Urdhwaga Raktapitta is when bleeding occurs from the upper tracts – nose, eyes, mouth etc. Adhoga Raktapitta is when bleeding occurs from the lower tracts – urinary passages, anal opening etc. Tiryakgata Raktapitta is when bleeding occurs from the sideward tracts – skin. This is not pure blood. It is the blood which has been contaminated by pitta.

In this discussion our focus is on adhoga raktapitta with special reference to ‘mutramarga gata raktapitta’ i.e. bleeding through urinary tract.

On the other hand, we have yet another condition wherein there is bleeding from urinary tract.

Rakta Meha – Rakta Meha is a type of Pittaja Prameha wherein there is bloody urine passing through the urethra. Here also we are speaking about the same two factors which would contaminate each other i.e. pitta and rakta – pitta the causative dosha and rakta the tissue expelled through urine, but it is Prameha and not Raktapitta.

In this condition the person voids urine which is foul smelling, hot on touch, salty in taste and resembles blood in colour.

This is exactly why we need to differentiate between these two conditions.

Differentiation between Raktapitta (Mutragata) and Prameha (Rakta Meha)

हारिद्रवर्णं रुधिरं च मूत्रं विना प्रमेहस्य हि पूर्वरूपैः।
ये मूत्रयेत्तं न वदेत् प्रमेहं रक्तस्य पित्तस्य हि स प्रकोपः॥च.चि.६/५४।

If the colour of the urine excreted in prameha is turmeric yellow or red in colour or if blood itself is excreted through the urine without the prior manifestation of the prameha purvarupa i.e. premonitory symptoms of prameha (and also the signs and symptoms of prameha) then this condition should not be diagnosed as prameha. This case should be diagnosed as Raktapitta.

Discussion

From the above said reference it is clear that the ‘prameha purvarupa’ i.e. premonitory symptoms of prameha are the key detrimental factor for differentiation or differential diagnosis of these two conditions. The presence or absence of these purvarupas will determine if the bleeding from the urinary tract is prameha or raktapitta.

Let us sum up this way –

Purvarupas are those symptoms that a disease would be manifested in future. Putting it the other way, purvarupas are feeble symptoms of ‘yet to be manifested disease’. Purvarupas are specific for a disease. The purvarupas of a specific disease will cause that specific disease only and not any other disease.

Related Reading – Purvarupa

So, if premonitory symptoms of Raktapitta are formed, the would-be disease is Raktapitta. Similarly, the premonitory symptoms of Prameha will cause Prameha disease in future.

Premonitory symptoms of Prameha

स्वेदोऽङ्गगन्धः शिथिलाङ्गता च शय्यासनस्वप्नसुखे रतिश्च।
हृन्नेत्रजिह्वाश्रवणोपदेहो घनाङ्गता केशनखातिवृद्धिः॥
शीतप्रियत्वं गलतालुशोषो माधुर्यमास्ये करपाददाहः।
भविष्यतो मेहगदस्य रूपं मूत्रेऽभिधावन्ति पिपीलिकाश्च॥च.चि.६/१३-१४॥

The premonitory symptoms of prameha are –

• Sweating,
• Bad body odour,
• Looseness of body parts,
• Liking for constantly lying down on bed, sitting and sleeping and hence leading an easy and relaxed life,
• Feeling as if there is coating in the region of heart, eyes, tongue and ears,
• Heaviness of the body / corpulence
• Excessive growth of hair and nails,
• Liking towards cold things and comfort,
• Dryness of throat and palate,
• Sweetness in the mouth,
• Burning sensation in hands and legs,
• Ants swarming around the urine

If the above said premonitory symptoms are present before manifestation of bloody urine or blood mixed urine, it should be diagnosed as prameha.

On the contrary if there is bleeding from the urinary tract i.e. bloody urine is seen to be excreted without the premonitory symptoms of prameha being manifested, it should be diagnosed as adhoga or mutra marga gata raktapitta.

This is also the differential diagnosis of these two conditions.

Adhoga Raktapitta will of course be associated with causative factors, pathogenesis, premonitory symptoms and symptoms of raktapitta.

Need of knowing the differences between Rakta Meha and Mutra Marga Gata Raktapitta

Though Rakta Meha and Mutraga Raktapitta are identical conditions in terms of bleeding from urinary tract they need to be differentiated.

The knowledge of the differences between these two conditions helps in –

• Differential diagnosis of these two conditions which will help in planning the treatment.
• Planning a proper protocol of treatment because both these conditions need to be treated on different lines of treatment including therapies, medicines and dietetic regimen. Mutraga Raktapitta needs Raktapitta line of treatment. Following the pratimargaharana type of treatment, since it is a bleeding disorder manifesting from lower direction and tracts, the treatment of choice will be vamana i.e. emesis. The therapies in Raktapitta should be in opposite direction of bleeding. On the other hand, Prameha i.e. Rakta Meha shall be treated on the linens of prameha chikitsa, especially on the lines of treating pittaja prameha.