Excessive indulgence in grief, fright or anger, excessive physical labour, exposure to the sun and fire, constant use of pungent, acid, saline and alkaline food, or, of articles of fare which are keen or heat-making in potency, or incompatible in their combination, or arc followed by deficient gastric or intestinal digestion are the factors which tend to aggravate the Rasa (chyle), which, in its turn, aggravates the Pitta. The aggravated Pitta thus imperfectly assimilated affects or invades in virtue of its own essence the blood (lit. leads to its imperfect digestion) which finds an outlet through the upper or the lower channels of the body or through the both. The deranged blood accumulated in the Amas'aya (stomach) finds out an upward outlet, while it flows out through the lower orifices in the event of its continuing in a similar state in the Pakvas'aya (intestines), and it escapes through both the upward and downward orifices in the event of its being deranged and accumulated in both the Amas'aya and the Pakvas'aya. According to several authorities, the ejected blood in the disease comes from the spleen and the liver. 2.
Prognosis: - A case of Rakta-pitta in which the blood finds outlet through an upward channel of the body is amenable, while palliation is all that is possible in a case in which it flowes out through a downward orifice of the body.A case marked by the emission of blood through both these outlets, upward and downward, should be regarded as incurable. 3.
A sense of lassitude in the limbs, desire for cooling things, a sense as if fumes are rising in the throat, vomiting and fetor of blood in the breath are the symtoms which usher in an attack of Rakta-pitta. The number of the cases of Rakta-pitta as well as the aggravation of the different Doshas involved in each case should be ascertained from the colour and nature of the ejected blood (as described before in Chap. XlV-Sutra-sthana). 4-5.
Weakness, laboured breathing, cough, fever, vomiting, mental aberration (lit: a slate like intoxication), yellowness of complexion, burning sensation in the body, epileptic fits, acidity of the stomach,restlessness, extreme pain in the region of the heart, thirst, loss of voice (D. R. loose stool), heat in the head, fetid expectoration, aversion to food, indigestion and absence of sexual desire (D. R. bending of the body after sexual act) are the usual complications in a case of Rakta-pitta. 6.
In a case of Rakta-pitta the emitted matter resembling the washings of meat or drug-decoction, or turbid water or fat or pus, or being liver-coloured or dark-black or blood-red in colour or looking like a ripe Jambu-fruit or blackish blue or variously coloured like a rain-bow or having a very fetid smell as well as the presence of the above mentioned supervening symptoms - these are the indications which show that the case should be given up as incurable . 7.