E-ISSN:2456-3110

Review Article

Haemostatic

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

An Ayurvedic perspective of Haemostatic Measures - A Review Article

B Gayathri K.1*, Padma.2, M Sweta K.3, Surendranath D.4
DOI:

1* K B Gayathri, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

2 Padma, Associate Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

3 K M Sweta, Professor & HOD, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

4 Dhyan Surendranath, Associate Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

The Raktadhatu i.e., the blood is given greater importance in life sciences, especially in the field of surgery. Acharya Susruta has even considered it as an important Dosha as Tridoshas in the etiopathology of diseases, its curative measures and in maintenance of health. To prevent loss of this entity, Acharya Susruta has elaborately described this under a specific heading namely Chaturvidha Rakta Sthambhana Upayas, namely Sandhana, Skandana, Dahana and Pachana. Sandhana is applying Kashayarasa Dravyas in different forms, suturing, ligation, application of pressure and pressure bandages etc. Skandhana is application of cold by any means. Pachana is application of caustic ashes and alkalis. Dahana is to burn by different means. In above methods haemostasis is achieved by inducing vasoconstriction, coagulation, mechanical and physical obliteration of vessels. Thus Skandana, Sandhana, Pachana, Dahana are the absolute haemostatic measures, understanding of which will equip surgeons to face haemorrhage with every available resources.

Keywords: Raktadhatu, Rakta Sthambhana, Sandhana, Skandana, Dahana, Pachana, Haemostatic

Corresponding Author How to Cite this Article To Browse
K B Gayathri, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.
Email: 		K B Gayathri, Padma, K M Sweta, Dhyan Surendranath, An Ayurvedic perspective of Haemostatic Measures - A Review Article. J Ayu Int Med Sci. 2022;7(10):182-185.
Available From
https://www.jaims.in/jaims/article/view/2132

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-28 2022-09-30 2022-10-07 2022-10-14 2022-10-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by K B Gayathri, Padma, K M Sweta, Dhyan Surendranathand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

The Raktadhatu i.e., the blood is given greater importance in life science, especially in the field of surgery. Acharya Susruta has even considered it as important as Tridoshas in the etiopathology of diseases, its curative measures and in maintenance of health. He states ‘the life is sustained by proper functioning of blood, and the body itself is rooted to Rakta. Rakta is life; hence it is to be protected by any means.[1] Susruta Samhita and other treatises of Shalyatantra has given many measures to maintain and nourish Raktadhatu and to stop bleeding. Acharya Susruta the father of ancient surgery, was the first to name, classify and describe those under a specific heading namely Chaturvidha Rakta Sthambhana Upayas.

 Haemorrhage is defined as the loss of blood from a damaged vessel. It is classified in to three types 1) Arterial haemorrhage 2) Venous haemorrhage 3) Capillary haemorrhage. In arterial haemorrhage, bleeding is bright red in colour, spurting as a jet which rises and falls in time with the pulse. In venous haemorrhage, it is darker red in colour, and has a steady and copious flow. Whereas capillary haemorrhage is of bright red in colour, often rapid, ooze. Further, based on the duration of haemorrhage, it is classified in to Acute, Chronic and Acute on chronic haemorrhages.[2]

Treatment of haemorrhage in general are aimed at 2 main outcomes: Stopping the blood loss and restoring the lost blood.[2] Similar concepts have been explained in ayurvedic treatises as well in detail.

Haemostasis[2]: Coagulation is the process by which blood changes its state from liquid to gel. It potentially results in haemostasis, the cessation of blood loss from a damaged vessel, followed by repair. There are three essential steps in blood coagulation: 1) A complex cascade of chemical reaction occurs in the blood involving more than a dozen blood coagulation factors in response to rupture of the vessels or damage to blood itself. As a result, the formation of a complex of activated substances takes place which collectively called as prothrombin activator. 2) The prothrombin activator catalyses conversion of prothrombin in to thrombin. 3) The clot is formed when thrombin acts as an enzyme to convert fibrinogen into fibrin fibers that enmesh platelets, blood cells, and plasma.

Haemostasis is achieved by Pressure; Packing; Position and rest; operative Procedures such as suturing, knotting and cauterisation; Also, by the use of local haemostatic agents like Gelatine sponge, Oxidised cellulose, Collagen sponge, Microfibrillar collagen powder, Topical thrombin, Bone wax, Gelatine matrices, Topical EACA and topical cryoprecipitate.

The haemostatic measures in Ayurveda are categorised under four headings by Acharya Susruta 1) Sandhana; 2) Skandana; 3) Dahana; 4) Pachana. To be used as per severity and type in the order- Skandana, Sandhana, Dahana, Pachana.3

Skandanam: It is the first method of haemostasis through coagulation of blood by cold application.[4] This method can be used in visible bleedings and contusions externally. In the context of Jaloukavacharana Atiyoga, it is managed by pouring cold water (Sheetabhiradbhihi Parisheka) as first line of management.[5] This method is also told in bleeding haemorrhoids and ulcers.[6]

Sandhanam: The word Sandhana means ‘to unite’. In this context that is to approximate wound edges. Acharya Susrutha describes that; it can be achieved by the use of Kashaya Rasa Dravyas. Mechanical method of wound approximation is suturing techniques.[4] Hence Sandhana Karma also includes application of pressure bandages, suturing, application of a haemostatic clamp to a blood vessel and ligation. As in Jalouka Atiyoga application of pressure bandage is told.[5] Lodhradi (Priyangu (Callicarpa microphylla), Patanga (Caesalpinia sappan), Sarjarasa (Shorea robusta), Rasanjan (Extract of Berberia aristata), Salmalipushpa (Salmalia malbarica), Masa (Vigna mungo), Yava (Alhagi camelorum)), Hareetakyadi, Shalmali Piccha, and Panchavalkala Dravyas are used here in the form of powders, paste, decoction etc., internally and externally as both local and systemic haemostatic agents.[4,7]

This procedure may be useful in capillary haemorrhages, bleeding from peptic ulcers, tropical haemorrhages like abrasions, haemorrhage due to systemic illness like intracranial bleeding, bleeding disorders (Raktapitta) like thrombocytopenia etc.

Pachana: Pachana is the 3rd category of haemostatic measure i.e., to ripen or to digest by using the Bhasmas (ash). Bhasma of Kshouma, Vastra etc., Mrutkapala, Anjana, Mruduksharas


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(mild caustic alkali preparations) like Shanka, Shukti, Kapardhika, Spatika bhasmas are used here.[4,7] This method can be used in capillary haemorrhages, sub-mucosal haemorrhages, tropical haemorrhages etc.

Dahana: Superior most among all four, if haemostasis is not achieved by above methods Agnikarma is the definitive option.[4] The word Dahana means burning or cauterizing. Dahanopakaranas like Agnikarma shalaka, Taila, Guda, Sneha are used. Such references can be found in Kadara Chikitsa i.e., excision followed by Taila Dahana in order to obliterate the feeding vessel and achieve haemostasis.[8] And in amputations Tailadi Dahana is told to manage excessive bleeding.[9] Now a days, electric thermal cautery is used widely.

Combined use of above measures is told in most of the situations. Astringent powders and application of pressure with hand and bandaging, Simultaneous use of both Pachana and, Skandhana Dravyas. Pressure bandages anointed with bee wax etc. and Dahana with Tapta Shalaka (red hot metallic instrument) are told in scattered references.[5,6,7] 

Discussion

Even though there are clinical evidences for the efficacy of these Raktasthambhana Upayas, it is very much in need to understand the mode of action of above measure. That would aid the judicial and appropriate use of these haemostatic methods.

The application of cold reduces the blood flow and capillary permeability by causing vasoconstriction of arterioles enabling coagulation of blood and there by achieving haemostasis.

In Sandhana, when mucous membrane or tissue exposed to astringent drugs if taken internally may causes shrinkage and are often used to check discharge of blood, serum or mucous secretions. Similarly, externally applied astringents cause mild coagulation of skin proteins, dry, harden, and protect the skin. In present practices some of the astringent drugs like Alum [KAl (SO4)2] is common drug administered as a local application to stop the bleeding in dental surgeries.

Similarly, the astringent drugs described in the Sandhana Karma may have the effects like vasoconstriction or stimulating the prothrombin

net formation which helps in trapping the platelets at the site of injury or absorb water from the tissue or helps in reducing the bleeding time. Suturing techniques, Ligation and pressure bandages are acts by creating a mechanical obliteration of vessel lumen.

The application or dusting of the Bhasma/Ksharas in the affected area told under Pachana Karma, may digest protein in the local tissue which stimulates coagulation of the blood as in bleeding haemorrhoids. Along with the chemical properties, both Skandana and Pachana also acts as physical inhibiter similarly as bone wax and gelatine matrices.

The procedure Dahana increases the local temperature which causes coagulation necrosis of tissue protein and leads to obliteration of blood vessels. Further it helps in clotting of the blood.

Along with absolute haemostatic measures, replacement of lost volume and nutritional supplements contributing to haemopoiesis also has been taken cared by ancient surgeons of India. Intake of cold water, cold decoctions prepared with sweet and astringent drugs, jaggery, honey, sugarcane juice, milk, meat soups etc., which are rich in glucose, proteins, potassium, sodium, magnesium, iron and many other minerals and nutrients has been told.

Conclusion

Surgeons have to always face haemorrhage, mild to severe in their day-to-day practice as a daily encounter. The detailed analysis of literature would reveal that, the main two objectives of management of haemorrhage have been well understood, addressed and documented by Ayurvedic surgeons, especially by Acharya Susruta, i.e., to achieve haemostasis and to restore the lost blood.

The haemostatic measures told in classics of Shalyatantra, the Chaturvidha Rakta Sthambhanopaya are highly scientific, practical, effective and still holds good in this 21st century, the era of advanced technologies.

Thus Skandana, Sandhana, Pachana, Dahana are the absolute haemostatic measures, understanding of which will equip surgeon to face haemorrhage with least available resources.



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Reference

1. Susruta, Susruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Acharya ‘Kavyatirtha’. Sootrasthana. Ch.14, Ver.44. Reprint, 2019 edition, Varanasi: Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.66.

2. Sriram Bhat M. SRB’s Manual of Surgery. 6th Ed. New Delhi: Jaypee Brothers Medical Publishers; 2019.

3. Susruta, Susruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Acharya ‘Kavyatirtha’. Sootrasthana. Ch.14, Ver.39-42. Reprint, 2019 edition, Varanasi: Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.66.

4. Dalhana, Commentator. Susruta, Susruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Acharya ‘Kavyatirtha’. Sootrasthana. Ch.14, Ver.39-42. Reprint, 2019 edition, Varanasi: Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.66.

5. Susruta, Susruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Acharya ‘Kavyatirtha’. Sootrasthana. Ch.13, Ver.22-23. Reprint, 2019 edition, Varanasi: Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.58.

6. Cheppatt Achyutha variyar, editor, (1st ed.). Ashtanga Sangraha of Vagbhata, Sootra Sthana; Chapter 36, Varanasi: Chowkhambha Sanskrit Series, 2006.

7. Cheppatt Achyutha Variyar, editor, (1st ed.). Ashtanga Hrudaya of Vagbhata, Sootra Sthana; Chapter 27, Verse 48-50. Varanasi: Chowkhambha Sanskrit Series, 2006.

8. Susruta, Susruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Aharya ‘Kavyatirtha’. Chikitsasthana. Ch.20, Ver.23-26. Reprint, 2019 edition, Varanasi: Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.479.

9. Dalhana, Commentator. Susruta, Sushruta Samhita, edited by Vaidya Jadavaji Trikamji Aacharya Narayan Ram Acharya ‘Kavyatirtha’. Sootrasthana. Ch.12, Ver.4-8. Reprint, 2019 edition, Varanasi : Choukhambha Sanskrit Sansthan, Kashi Sanskrit Series 316;2019.p.59.


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