Ayurveda Perspectives on the Physiology of Blood
Prof. Sangeeta Gehlot
Department of Kriya Sharir
faculty of Ayurveda, IMS, BHU
based on the lecture available at Ayurveda Perspectives on the Physiology of Blood
Ayurvedic physiology is based on Tridosha, Dhatu, Agni, Mala, and Srotas. Among seven Dhatus, the first one is Rasa while Rakta Dhatu is the second Dhatu. Blood is the liquid connective tissue that is in fluid form. Rasa and Rakta all together can be considered as blood because both are liquid and in continuous circulation in an intravascular compartment and their measurement is described in “Anjali Pramana”. Rasa is formed after the complete digestion of food and due to its continuous circulation, it is called ‘Rasa.The function of Rasa Dhatu is ‘Preenana’ means nutrition. The Rakta Dhatu has been considered as the most vital tissue among all seven Dhatus since it has been considered as ‘Pranayatana’ or a ‘seat of life.
दशैवायतनान्याहुः प्राणा येषु प्रतिष्ठिताः |
शङ्खौ मर्मत्रयं कण्ठो रक्तं शुक्रौजसी गुदम्||
In the body ‘Prana’ or vital life force resides in 10 places.
Shankha –Temporal region
Marma Traya – Heart, Bladder, and Head
Kantha – Throat.
Rakta – Blood.
Shukra – Semen
Ojas – immune system.
The word ‘Rakta’ is derived by adding ‘kta’ prefix in ‘Ranja’ Dhatu. Amarkoshakar has described the synonym of Rakta as-
Rudhir, Lohit, Asraj,Shonit, Kshataja.
In circulation ‘Rakta’ Dhatu mixed with Rasa Dhatu circulates in the body. If we separate the Rasa dhatu i.e. the plasma then the remaining part can be said as ‘Rakta’
तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा|
युनक्ति प्राणिनं प्राणः शोणितं ह्यनुवर्तते||
Here Prana means oxygen. Oxygen is transported to body tissues by combining with the hemoglobin (Hb) of R.B.C. Modern physiology has also considered blood as a fluid of life. Blood carries oxygen from the lungs to all the parts of the body. And also blood carries carbon dioxide from all the parts of the body to the lungs.
Description of Rakta Dhatu
रञ्जितास्तेजसा त्वापः शरीरस्थेन देहिनाम्|
अव्यापन्नाः प्रसन्नेन रक्तमित्यभिधीयते ||
Rasa is the first Dhatu formed after complete digestion of food. Due to the continuous circulation it is called as Rasa Dhatu.Rakta Dhatu is the unvitiated, clear red colored fluid formed from the Aapya (watery) Rasa by the action of Tejas (Ranjaka Pitta) present in body. When Raktagini acts on Rasa Dhatu from the Prasadabhaga Rakta dhatu is formed.
रज रंजने तेन रंजनः रागवर्णयुक्तः रागकृत् च धातु रक्तम् इत्यर्थो भवतिl
Rasa and Rakta Dhatu-
रसतीति रसो द्रवधातुरुच्यते, तेन रुधिरादीनामपि द्रवाणां ग्रहणं भवति|
While describing the circulation of Rasa by the action of Vyan Vayu , Chakrapani has described Rasa as which includes all the circulating fluid in body including Rakta.
“तेजोभूतः परं सूक्ष्मः स रक्तरस उच्यतेl
(Aantanka Darpan on M.N.33/4 )
Vijayrakshit commenting on Madhav Nidan commentary i.e. in Aatanka Darpan has explained Rasa Rakta as the minutest and completely digested material. It can be used only after the absorption of digested material because after that it circulates in the blood. As acute blood loss of more than 10 percent leads to a condition like hypovolemic shock which may be fatal.According to Susruta Rakta Dhatu is also responsible for increase or decrease in other Dhatus. Blood supplies nutrition to all the tissues and if it is itself deficient will lead to improper nutrition to all the tissues. Also, ischemia and hypoxia may lead to tissue death. Hence, nutritional status of all the tissue depends on the status of Rasa and Rakta Dhatu.
Formation of Rakta Dhatu
All Dhatus get nourishment through Aahara Rasa. They also get nourishment from the preceding Dhatu i.e. Rakta Dhatu gets nourished by Sukshma Bhag of Rasa Dhatu.
तेजो रसानां सर्वेषां मनुजानां यदुच्यते|
पित्तोष्मणः स रागेण रसो रक्तत्वमृच्छति||
The Teja of Rasa in human beings with the heat of Pitta acquiring red color brings redness to Rasa and transformed into Rakta.
स खल्वाप्यो रसो यकृत्प्लीहानौ प्राप्य रागमुपैति ||
Susruta has mentioned that Rasa Dhatu which is predominant in water content after reaching in liver and spleen is converted into Rakta.
यत्तु यकृत्प्लीह्नोः पित्तं तस्मिन् रञ्जकोऽग्निरिति सञ्ज्ञा, स रसस्य रागकृदुक्तःI
While describing Ranjaka Pitta, Sushruta has mentioned that Pitta which resides in the liver and spleen performs the coloration of Rasa into Rakta is known as Ranjakagini. Sharangdhar has also mentioned that the pitta which resides in the liver converts Rasa into Rakta i.e. Ranjakapitta. The entire nutrients required for the synthesis of blood cells are taken from Rasa Dhatu. The liver synthesizes haem, clotting factors and proteins of plasma, and nutrients like vitamin B12, folic acid
Role of Stomach in Erythropoesis
आमाशयाश्रयं पित्तं रञ्जकं रसरञ्जनात्|
आमाशयस्थन्तु रसस्य रञ्जनाद्रञ्जकम्||
Vagbhata has mentioned the stomach as the site of Ranjaka pitta which is responsible for the coloring of Rasa. It means he was aware of the role of the stomach in erythropoiesis because the intrinsic factor is synthesized by the parietal cells of the stomach. Intrinsic factor is required for the absorption of Vitamin B12 and for the DNA synthesis of R.B.C. precursors in the bone marrow.
Chakrapani while commenting on Ch.Su.28/4 has included the view of Harita. According to which transformation of Rasa into Rakta takes place in seven days.
1st day – White color
2nd day – Kapota color
3rd day- Greenish color
4th day- Haridra color
5th day – Padmaka color
6th day – Kinshulka color
7th day – Aalta color (dark red )
Role of bone marrow ( Majja dhatu) in erythropoiesis
स्थूलास्थिषु विशेषेण मज्जा त्वभ्यन्तराश्रितः |
अथेतरेषु सर्वेषु सरक्तं मेद उच्यते |
Majja Dhatu also plays an important role in formation of Rakta Dhatu.Majja is present in the cavities of large bone In large bones where as Sarakta Meda is present in cavities of small bones. At the time of birth, all marrow is red bone marrow. But with the advancement of age, some of it is converted into yellow bone marrow. Red bone marrow is present in ribs, vertebrae, sternum cranium and upper part of long bones. Red bone marrow is precursor of blood cells. Ratio of blood cell precursor and fat cells is 1:1.
मज्जा सर्वाङ्गनेत्रगौरवं चl
Susruta has mentioned Sarvang Netra Gauravam i.e. heaviness in the eye and body.
In Ashtanga Sangraha Rakta Gaurav has been mentioned as a feature of Majja Vriddhi. Rakta Gaurav indicates the increased viscosity of blood present in polycythemia. Disorders due to vitiation of Majja Dhatu are Murcha (fainting), Bhrama( dizziness), Timira (perception of darkness) manifest also in conditions of anemia due to a decrease in blood volume or blood disorders. This indicates that our Acharyas were well-versed in the relation of Majja dhatu and erythropoiesis.
Rasavaha and Raktavaha Srotas
रसवहानां स्रोतसां हृदयं मूलं दश च धमन्यः|
Rasavaha Srotas Mool is Hriday and Rasavahi Dhamini. Hriday is the reservoir of blood and causes pumping of blood and Dhamini causes the circulation of blood.
शोणितवहानां स्रोतसां यकृन्मूलं प्लीहा च|
The roots of Raktavaha Srotas is liver and spleen. The role of liver in erythropoiesis is well known. R.B.C. synthesis occurs in the liver and spleen between 3rdto 5th month of intrauterine life. Liver stores some important factors like vitamin B12, folic acid, and iron. Spleen is the slaughterhouse of R.B.C.
तयोर्मूलं यकृत्प्लीहानौ रक्तवाहिन्यश्च धमन्यः
Aacharya Susruta has also considered Raktavaha Dhamini as the root of Raktavaha Srotas. Therefore, Raktavaha Srotas includes both hemopoetic and cardiovascular systems. It may be due to the fact that both precursors of hemopoetic stem cell and angioblast are formed from blood islands during embryological development.
Chakrapani has explained Sroto Mulam as it means that Mool of Srotas may be the anatomical seat of respective Srotas, the primary seat of pathology of that Srotas or may be the site of manifestation of that disease. In Rasapradoshaja disorders Pandu, Tandra,Angamarda,Tama are present. These features are also present in anemia.
Factors affecting formation and quality of Rakta Dhatu
विधिना शोणितं जातं शुद्धं भवति देहिनाम्|
देशकालौकसात्म्यानां विधिर्यः सम्प्रकाशितः||
Factors which affects the formation and quality of Rakta Dhatu are-
- Code of conduct
- Desh satmya
- Kaala satmya
- Oaka satmya
Diet – Use neither too hot nor too cold and Laghu Aahara is good for Rakta Dhatu. While Amla and Lavana substances and alcoholic beverages vitiate the Rakta Dhatu. Food substances like Kulatha, Tila, and meat of animals living in water, marshy regions are responsible for the vitiation of Pitta Dosha and thus vitiate the Rakta Dhatu.
Code of conduct– sleeping after day after meal, excessive anger, exposure to the sun, suppressing urges like vomiting, exertion, injury, not performing Rakta Mokshan at proper time. All these cause wastage of Pitta and Kapha Dosha and thus vitiate Rakta Dhatu.
Desh Satmya– It is related to habitat. It determines the attributes due to procreation or movement of food substances in a particular locality or their acclimatization to that region. The individual residing at high altitudes has physiological polycythemia deep sea diving leads to oxygen toxicity, carbon dioxide toxicity, and decompression sickness.
Kaala stands for time of day, day, night, season, and status of an individual i.e. Avashthik. Rakta Dhatu gets vitiated in Sharad ritu by its virtue. Contemporary science also illustrates that concentration of hemoglobin index varies in accordance with age and sex. In females, the blood indices vary according to their physiological state like menstruation.
Factors vitiating the Rakta Dhatu
Dietary factors – Excessive intake of food having Katu, Amla, Lavana Rasa, Kshara, Ushna, Teekshna substances. Food substances like Souviraka, Sura, Sukta, Madya, Virudhasana, Adhyashana, Ajeerna, etc.
Behavioural factors – Day sleep after having Guru, Snigdha Dravya, exposure to sunlight, anger, holding the urge of vomiting.
Seasonal factors– Sharad ritu.
Panchbhautic Composition of Rakta Dhatu
विस्रता द्रवता रागः स्पन्दनं लघुता तथा |
भूम्यादीनां गुणा ह्येते दृश्यन्ते चात्र शोणिते || (Su.Su.14/9)
Aacharya Susruta has explained the Panchabhautic composition of blood as Visrata i.e. typical smell is due to Prithvi Mahabhuta,liquidity is due to Jala Mahabhuta, Raga or red color is due to Agni Mahabhuta, Spandan or pulstaion is due to Vayu Mahabhuta ,Laghuta or lightness is attributed to Aakash Mahabhuta.
Features of Shuddha Rakta
सुखान्वितं तु(पु)ष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति||
One who has –
- Clarity of sense of organs and their subjects: All Indriyas perform their functions.
- Desire of continuous and strong digestive power.
- Urges appear at proper time.
- Happiness, contentment, and good strength. These are considered features of Shuddha Rakta. All these features are not found in an anemic person eg. An anemic person get easily fatigued.
गुञ्जाफलसवर्णं च विशुद्धं विद्धि शोणितम्||
इन्द्रगोपकप्रतीकाशमसंहतमविवर्णं च प्रकृतिस्थं जानीयात् ||
Blood which resembles molten gold, Indragopa, lotus flower, Laksha, or berry of Abrus Precatarius should be understood as pure. It is Asahant i.e. neither too thick nor too thin. Due to this property blood doesn’t clot in the intravascular compartment. Arundatta commenting on ‘Asahant’ mentioned it as ‘Dravam’. The pure blood doesn’t stain the cloth while the impure blood stains the cloth in such a way that it doesn’t get cleaned.
अनुष्णशीतं मधुरं स्निग्धं रक्तं च वर्णतः |
शोणितं गुरु विस्रं स्याद्विदाहश्चास्य पित्तवत् ||
Further Susruta has mentioned the quality of blood as it is neither Ushna nor Sheeta, MadhuraRas, Snigdha,red in color, heavy, foul smelling like color of the sheep and rabbit.
मधुरं लवणं किञ्चिदशीतोष्णमसंहतम्||
Aacharya Hemadri has mentioned ‘Hemamanjistha’ i.e. as the color of the stem Manjistha is red from inside. While commenting on the word ‘Hema’ Arundatt mentioned that ‘Hemkankam’ means the color of the blood is red heated gold. This red color of the blood is due to red-colored hemoglobin. When hemoglobin combines with oxygen the brightness of blood increases. Variations in the color of the blood in different individuals are due to variations in the concentration of hemoglobin. The reason behind giving different shades of blood is that color of blood is different in different ‘Prakriti’ individuals which has been proved by different recent scientific research.
Characteristics of impure or vitiated Rakta Dhatu
Rakta Dhatu vitiated by-
- Vata Dosha- Slightly reddish or black, non-slimy, thin flowing quickly, and non-clotting.
- Pitta Dosha- Color becomes bluish-yellow, green, or black, red, unpleasant smelling, not liked by ants and flies, and non-clotting.
- Kapha Dosha- color becomes similar to solution of Gairika, slightly white, slimy unctuous, cold, and thick, has threads, resembles a muscle.
- Tridosha- resembles to Kanjika(rice gruel), foul smelling.
Functions of Rakta Dhatu
देहस्य रुधिरं मूलं रुधिरेणैव धार्यते |
तस्माद्यत्नेन संरक्ष्यं रक्तं जीव इति स्थितिः ||
Blood itself is life. Body is supported and maintained by blood itself, so it should be protected by all efforts.
If blood volume decreases, hemoglobin or RBC count decreases individuals may go into shock and in extreme deficiency or loss may be died.
रक्तं वर्णप्रसादं मांसपुष्टिं जीवयति च,
Rakta bestows color, and nourishment to muscles and maintains life activities. In anemic conditions, the color becomes pale and dull. The transport of nutrients to all body tissues is performed by the blood.
धातूनां पूरणं वर्णं स्पर्शज्ञानमसंशयम् |
स्वाः सिराः सञ्चरद्रक्तं कुर्याच्चान्यान् गुणानपि ||१४||
( Su. Sha.7/14)
It gives nourishment to Dhatu as well as is responsible for the perception of tactile stimuli.
तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा|
युनक्ति प्राणिनं प्राणः शोणितं ह्यनुवर्तते||
Pure blood results in good strength, complexion, happiness, and longevity. It plays an important role in sustenance of life.
Role of Rakta Dhatu in Organogenesis
Rakta Dhatu along with other Dosha and Dhatu plays an important role in the formation of organs like Yakrita (liver), Pliha (spleen), Phuphusa (lungs), Unduka (appendix), Guda(anus), Basti (bladder), Jihva (tongue), Vrikka (Kidney), Vrishana (testes), Hriday ( heart) and pranavaha dhamnies( vessels carrying Prana Vata). All these organs derived with the help of Rakta have high vascularity and some organs like the liver, spleen, lungs, and heart also act as reservoirs of blood.
Features of Rakta Dhatu Sara Purush
तद्विशुद्धं हि रुधिरं बलवर्णसुखायुषा|
युनक्ति प्राणिनं प्राणः शोणितं ह्यनुवर्तते||
Individuals having Rakta as constitutional essence have ears, eyes, face, tongue, nose, lips, palm of hand, sole of feet, nails, forehead, and genitals that are unctuous and red in color. And the individual is also handsome. Psychological traits like happiness, genius, enthusiasm, moderate strength and inability to face difficulties, and intolerance to pain, and heat has been described.
Susruta has mentioned that the body parts are unctuous and copper color. These traits are used clinically for the assessment of the nutritional status of Rakta Dhatu and also for the assessment of clinical conditions like anemia.
Features of Rakta Kshaya
परुषा स्फुटिता म्लाना त्वग्रूक्षा रक्तसङ्क्षये|
Aacharya Charak has mentioned roughness, dryness, of skin, craving for sour and cold things as features of Rakta Kshaya.
शोणितक्षये त्वक्पारुष्यमम्लशीतप्रार्थना सिराशैथिल्यं च
Susruta has also mentioned roughness of skin, desire of cold and sour things.
शोणितक्षये सति वातवृद्धौ तत्प्रत्यनीकाम्लरसेच्छा,
तथा रक्तस्य द्रवत्वात्तत्क्षये तेजोवृद्धौ शीतप्रार्थनाऽपि; केचित्“
अग्नीषोमीयत्वाद्रक्तस्य तत्तुल्यगुणयोरम्लशीतयोः प्रार्थना
(Dalhana commentary on Su.Su. 15/9)
Dalhana has explained that the desire for sour substances is due to aggravation of Vata dosha. Sour substances suppress the aggravated Vata. Due to Rakta Kshay there is loss of fluid content in the body and the result is increase in hotness which leads to enhanced desire for cold things. Looseness of veins may be due to hypovolemia in case of blood loss. All these features are very similar to those characters which are found in anemic state of body.
Sour Rasa is predominant in Tej Mahabhuta. It is needed for Rakta to regain its physiological status with the help of correcting Bhutagini of Rakta Dhatu. In cold season Agni increses.Rakta Kshay causes Vata Vriddhi which leads to a craving of Amla rasa because Amla Rasa is Vata Shamak. Rakta Kshay is associated with Pandu and Agnimandya. Amla is Pitta vardhaka here sambhavaja with Rakta it increases Agni.
Due to decreased quantity of blood, individuals may go into hypotension. So, in this situation collapsed torturous vein in low circulatory volume leads to hypoproteinemia and vessel wall losing its tonicity.
धातुक्षयात् स्रुते रक्ते मन्दः सञ्जायतेऽनलः |
पवनश्च परं कोपं याति तस्मात् प्रयत्नतः ||
Dhatu Kshay leads to aggravation of Vata and decreased digestive power.
Features of Rakta Vriddhi
रक्तं रक्ताङ्गाक्षितां सिरापूर्णत्वं च
Rakta Vriddhi causes red coloration of body and eye, fullness of vessels.Rakta Vriddhi causes Sirapurnata means fullness of vessels which ultimately leads to high volume pulse. It causes skin diseases like Vidradhi(abscess), Visarpa(erysipelas), Kustha(skindisorder), Vyanga(depigmentataion), disease of spleen, Vatarakta (gout), Gulma(abdominal tumour), Upkusha(disease of gums), Kamala, loss of Agni and red coloration of urine.
Metabolism of Rakta Dhatu
Nutrient part of Rakta Dhatu nourishes the next Dhatu i.e. Mansa Dhatu. Malarupi Pitta is formed as waste. Malarupi Pitta may be considered as Bilirubin which is formed after the breakdown of R.B.C. Kandara i.e. tendon and Sira i.e. blood vessel is formed as Updhatu. The possible explanation regarding Sira and Kandara may be that Rakta Kshaya and Rakta Vriddhi are directly reflected through the condition of Siras. Looseness of Siras in Rakta Kshaya and fullness in Rakta vriddhi is found. Embryologically blood cells and blood vessels have same origin. So, in Ayurveda Sira has been considered as Updhatu of blood.
Management of blood loss
- In extreme blood loss, consumption of blood with honey or consumption of raw liver with its content is advised.
- Use of Rakta as nasal drop is indicated in the treatment of Krimija Shiroroga.
- Drinking of fresh blood of deer, cow, buffalo or goat because of the belief that it gets immediately transformed into live blood.
- Enema can also be given with a amixture of this blood with Darbha (Desmostachya bipinnata) powder.
Methods of Haemostasis
Sandhana: It means union and is done with the help of astringent substances.
Skandana: It means clotting and is done with the help of cold substances.
Pachana: styptic for a closing wound is done by ash.
Dahana: Cauterization is done which causes constriction of blood vessels.
All these steps are used in a sequential manner.
- Rasa and Rakta Dhatu can be considered as blood because they both are in a liquid state, which gets circulated in the intravascular compartment (heart and blood vessel), and have functional similarities.
- Distributed throughout the body due to the action of Vyan Vata on the heart and blood vessels (cardiovascular system), quite similar to blood.
- Rasa and Rakta Dhatu carries all the nutrients along with Oja and nourishes and protects all the tissues.
- Rasa and Rakta Dhatu and Dhatusarata have been described in order to clinically assess the functional status.
- Diet and regimen, Deshasatmya, Kalasatmya, and Oakasatmya have been described as affecting the formation of Shuddha Rakta Dhatu.
- Measures for blood loss and blood clotting have been also described.