Decoding hemophilia -
A conceptual study of hemophilia in ayurvedic
and contemporary perspectives

Abstract :

The inherited deficiency of blood coagulation factors results in lifelong bleeding disorders collectively known as Hemophilias. The most commonly affected factors are Factor VIII (FVIII) and Factor IX (FIX), whose genes are located on the X chromosome. Mutations in these genes lead to X-linked recessive disorders, specifically Hemophilia A and B. According to the World Federation of Hemophilia (WFH), the global prevalence of Hemophilia A is approximately 1 in 10,000, and for Hemophilia B, 1 in 50,000. Patients experience spontaneous bleeding, prolonged bleeding post-trauma or surgery, and internal hemorrhages, particularly in joints and muscles. These episodes often result in pain, immobility, and long-term disability. While advancements in biomedical science, such as early diagnosis and recombinant factor therapy, have improved prognosis, challenges like treatment accessibility and the development of inhibitors persist—especially in resource-limited settings. Ayurveda, the traditional Indian system of medicine, offers a holistic view of disease that incorporates genetic, metabolic, and lifestyle factors. Although Hemophilia is not explicitly mentioned in Ayurvedic texts, several conditions such as Raktapitta, Pandu, Kamala, VataRakta, Shotha, and Yakrutadushti, Raktadushti bear striking resemblance in pathogenesis and clinical features. These arise primarily from the vitiation of Pitta Dosha and Rakta Dhatu, often associated with Ushna, Sara, and Drava gunas. The concept of Beeja Dosha and Adibala Pravritta Vyadhi parallels the genetic basis of Hemophilia. This article offers a comparative study of Hemophilia from both Ayurvedic and contemporary perspectives, emphasizing the potential of an integrative treatment approach to enhance symptom management and patient well-being, particularly in low-resource settings.

Keywords:

Hemophilia, Clotting Factors, Raktapitta , Genetic Disorders, Beeja Dosha

Introduction :

The inherited deficiency of blood coagulation factors leads to lifelong bleeding disorders commonly called Hemophilias. The factors most frequently found deficient in Hemophilias are factors VIII (FVIII) and IX (FIX), whose genes are located on the X chromosome and, when mutated, cause the X-linked recessive traits Hemophilia A and B[1]. WFH (World Federation of Hemoplilia) global estimate of the prevalence of bleeding disorders. [2] More than 1 in 10000 people is estimated to have a bleeding disorder.

Hemophilia A: 105 in 1 million* (more commonly cited as 1 in 10,000 + )

Hemophilia B: 28 in 1 million* (more commonly cited as 1 in 50,000 + )

Patients frequently suffer from spontaneous bleeding, prolonged bleeding after injuries or surgery, bleeding internally, mostly in joints, muscles, and the brain.[3] Each bleeding episode causes immobilization and severe pain and can result in permanent disability. Advances in biomedical science have significantly improved the prognosis through early diagnosis, prophylactic factor replacement therapy, and recombinant clotting factors. Yet, access to treatment remains a major challenge in low-resource settings, and the development of inhibitors (neutralizing antibodies against clotting factors) complicates therapy in 20–30% of patients with severe Hemophilia.

Ayurveda, the traditional Indian system of medicine, offers a holistic understanding of health and disease that includes genetic, metabolic, and lifestyle factors. According to Aacharya Sushruta, Blood is the primary nourisher of the body, and it is through blood that the body is sustained. Therefore, one must carefully protect the blood, because in reality, blood itself is life. [4] Though Hemophilia is not directly mentioned in the Ayurvedic classics, the liver as a root organ, along with the clotting nature of blood described in the Samhitas, shows a conceptual resemblance to the etiology of Hemophilia. Several disorders (Raktapitta, Pandu, Kamala, VataRakta, Shotha, and Raktadushti, Yakrutadushti) from Samhitas have resemblance to Hemophilia in pathogenesis and symptomatology. These are due to Pitta Dosha dushti and Rakta Dhatu dushti because of ushna, sara and drava guna vikruti. The concept of Beeja Dosha (genetic defects) and Adibalapravritta vyadhi (hereditary diseases) in Ayurveda corresponds with the genetic etiology observed in Hemophilia. [5]

An integrative approach combining evidence-based Ayurvedic support with standard modern Hemophilia care may offer enhanced outcomes. There is a growing need to explore such integrative models for chronic genetic disorders, especially in resource-limited countries where access to lifelong factor therapy remains inadequate.

This article aims to present a comprehensive review and conceptual correlation of Hemophilia with Ayurvedic principles. It explores clinical similarities, etiological overlaps. Through a detailed comparative analysis of classical Ayurvedic descriptions and contemporary medical literature, the study seeks to establish Ayurvedic equivalents or explanations for Hemophilia and its manifestations. Analyzing the scope of Ayurvedic therapies in reducing symptoms and improving patient well-being, and highlighting the importance of future clinical research in establishing integrative protocols.

While factor replacement remains the cornerstone of treatment, Ayurveda may contribute significantly in preventive care, symptomatic relief, and lifestyle management. Hence, bridging the gap between traditional and modern approaches could pave the way for holistic, patient-centered care.

AYURVEDIC PERSPECTIVE :

Coming Soon….

MODERN PERSPECTIVE :

Bleeding disorders reportedly affect 1 in 1000 individuals globally. The most prevalent bleeding disorders are Hemophilia A and B and von Willebrand disease. The inherited deficiency of blood coagulation factors leads to lifelong bleeding disorders commonly called Hemophilias. The factors most frequently found deficient in Hemophilias are factors VIII (FVIII) and IX (FIX), whose genes are located on the X chromosome and, when mutated, cause the X-linked recessive traits Hemophilia A and B.  

There are two common types of Hemophilia[33] – Both have the same symptoms.

  • Hemophilia A is the most common form and is caused by having low levels of clotting factor VIII (8). It is also called factor VIII deficiency.
  • Hemophilia B, also known as Christmas Disease, is caused by having low levels of clotting factor IX (9). It is also called factor IX deficiency.

Genetic defects in the FVIII & FIX genes that cause Hemophilia A & Hemophilia B include point mutations, deletions, insertions and gene inversions.

Prevalence Rate

WFH global estimate of the prevalence of bleeding disorders. More than 1 in 10000 people is estimated to have a bleeding disorder.

  • Hemophilia A : 105 in 1 million* (more commonly cited as 1 in 10,000 + )
  • Hemophilia B : 28 in 1 million* (more commonly cited as 1 in 50,000 + )

Etiology :

A deficiency or dysfunction of either factor VIII or factor IX compromises the activation of factor X, so that the ensuing steps of the coagulation cascade are also compromised and fibrin de-position is either inefficient or non-existent.

Signs & Symptoms :

  • Big bruises
  • Bleeding into muscles and joints
  • Spontaneous bleeding (sudden bleeding inside the body for no clear reason)
  • Prolonged bleeding after getting a cut, removing a tooth, or having surgery.
  • Bleeding for a long time after an accident, especially after an injury to the head.

Bleeding complications :

  1. Haemarthrosis – spontaneous/frequent and disabling in severe Hemophilia
  2. Soft tissue haematomas
  3. Intracranial haemorrhage
  4. Excessive bleeding after surgery (including dental surgery)
  5. Haematuria, epistaxis (less common)
  6. Hemophiliac arthropathy and joint deformity

COMPARATIVE STUDY :

Comparative Framework: Ayurvedic vs contemporary Perspective on Hemophilia :

Sr. No.Hemophilia (contemporary view)Hemophilia (Ayurvedic view)References
1Liver involvement- Clotting Factor (VIII & IX) formation takes place in liver.Formation of Rakta Dhatu from Rasa Dhatu takes place in liver.# स खलु आप्यो रसः यकृत्प्लीहानौ प्राप्य रागमुपैति । सु.सू. १४/४
# यत्तु यकृत्प्लीह्नोः पित्तं तस्मिन् रंजकोग्निरिति संज्ञा । स च रसस्य रागकृत् । सु.सू. २१/१०
2Prolonged Bleeding- Bleeding occurs and doesn’t clot /stop due to deficiency of clotting factorsDue to the increase in the Ushna Guna of Dushit Pitta, heat is imparted to the Rakta (blood), making it Aaskandi meaning it does not clot quickly.# पित्तात् पीतासितं रक्तं स्त्यायत्यौष्ण्याच्चिरेण च ॥ च. सू. २४/२०
# पित्तात् पीतासितं विस्रमस्कन्द्यौष्ण्यात्सचन्द्रिकम् ।। वा. सू. २७/४०
# श्यावं विस्त्रमनिष्टं पिपीलिकामक्षिकाणामस्कान्द च पित्तदुष्टम् || सु. सू. १४/२२
3Bruises-Vayu avrutta by Rakta causes burning pain within the skin and muscle, redness associated with swelling, and the appearance of patches or blotches on the skin are observed.# रक्तावृते सदाहाऽर्तिस्त्वमांसान्तरजा भृशम् । भवेच्च रागी श्वयथुर्जायन्ते मण्डलानि च।। वा.नि. १६/३३
4Lifelong Treatment-Diseases which are caused by defects in the father’s Shukra (semen) and the mother’s Artava (ovum), are known as Adibala Pravritta (hereditary diseases). These deseases are considered Yapya (with lifelong treatment)# तत्रादिबलप्रवृत्ता ये शुक्रशोणितदोषान्वयाः कुष्ठार्शः प्रभृतयः, तेऽपि द्विविधाः मातृजाः पितृजाश्च । सु.सू. २४/६

NIDANAPANCHAK : 

  • Dosha – Tridosha ( Pitta Pradhanata )
  • Dushya – Dhatu : Rasa, Rakta, Mansa

                       – Mala : Pitta ( Rakta Dhatu Mala )

  • Srotas – Raktavaha Srotas
  • Avayava – Yakrut
  • Hetu : Beeja Dosha

Samprapti :

Lakshane ( Signs & Symptoms )

  1. Big bruises
  2. Bleeding into muscles and joints
  3. Spontaneous bleeding (sudden bleeding inside the body for no clear reason)
  4. Prolonged bleeding after getting a cut, removing a tooth, or having surgery.

Discussion:

This study shows that Hemophilia, though described in modern medicine as a genetic deficiency of clotting factors VIII and IX, has many similarities with conditions explained in Ayurveda. Modern science explains the disease through mutations on the X chromosome leading to defective clot formation. Ayurveda describes a comparable concept through Beeja Dosha and Adibala Pravritta Vyadhi, which refer to hereditary disorders passed from parents to children.

Both systems agree on the central role of the liver. Modern medicine identifies the liver as the main site for clotting factor synthesis, while Ayurveda considers the Yakrut (liver) as the root of Raktavaha Srotas and the place where Rakta Dhatu (blood) is formed. The Ayurvedic qualities of Ushna and Drava Guna of Pitta and Rakta explain the tendency for prolonged bleeding and difficulty in clotting seen in Hemophilia.

The clinical symptoms like spontaneous bleeding, joint hemorrhages, and easy bruising match the descriptions of Raktapitta, Vatarakta, Raktavrutta Vata, Pandu and Kamala in Ayurvedic Samhitas. Modern treatment mainly depends on factor replacement therapy, but it has challenges such as high cost, limited availability, and development of inhibitors. Ayurveda offers supportive care through balancing Pitta and Rakta, strengthening the liver, and using diet and lifestyle to reduce bleeding tendencies. More clinical researches are required for this to prove it scientifically.

Conclusion:

Hemophilia can be understood in both modern and Ayurvedic frameworks with many overlapping concepts. Modern medicine explains it as a genetic clotting factor deficiency, while Ayurveda links it to Pitta Dosha, Rakta Dhatu, and Beeja Dosha. The liver’s role in both systems shows a strong connection between the two approaches.

Combining standard modern therapy with scientifically validated Ayurvedic methods may improve symptom control and patient quality of life, especially where advanced treatment is hard to access. More studies can be and need to be done to evaluate the same.

References :

  1. https://www.semanticscholar.org/paper/Hemophilia-and-related-bleeding-disorders
  2. https://www.haemophilia.org.au/HFA/media/Documents/Haemophilia/Haemophilia-booklet.pdf
  3. K Sembulingam and Prema Sembulingam, Essentials of Medical Physiology, Tenth Edition Jaypee Brothers Medical Publishers (P) Ltd. New Delhi. Page no. 123
  4. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay14, verse44, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  5. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay24, verse06, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  6. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay14, verse04, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  7. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay21, verse10, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  8. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sharirasthan, Adhyay04, verse25, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  9. Ravi Dutta Tripathi edited Charaka Samhita, Vimansthan, Adhyay5, verse8, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  10. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sharirasthan, Adhyay09, verse12, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  11. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sharirasthan, Adhyay04, verse10, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  12. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay03, verse04, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  13. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay42, verse08, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  14. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay01, verse11, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  15. Ravi Dutta Tripathi edited Charaka Samhita, Sutrasthan, Adhyay01, verse60, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  16. DRAVYAGUNA VIJNYAN (PART I & II) by DR. A.P. DESHPANDE and DR. SUBHASH RANADE, published by Proficient Publishing House in 2016
  17. Ravi Dutta Tripathi edited Charaka Samhita, Sutrasthan, Adhyay24, verse20, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  18. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay27, verse40, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  19. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay14, verse22, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  20. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay11, verse04, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  21. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay14, verse22, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  22. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay27, verse02, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  23. Kaviraj Ambikadatta Shashtri edited Sushrut Samhita, Sutrasthan, Adhyay14, verse21, (Ayurved Tatva Sandipika Hindi Commentry), Chaukhamba Sanskrit Sansthan, Varanasi 2023
  24. Ravi Dutta Tripathi edited Charaka Samhita, Sutrasthan, Adhyay28, verse11, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  25. Brahmanand Tripathi edited Ashtanga Hridayam, Sutrasthan, Adhyay11, verse04, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  26. Ravi Dutta Tripathi edited Charaka Samhita, Chikitsasthan, Adhyay04, verse08, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  27. Brahmanand Tripathi edited Ashtanga Hridayam, Nidanasthan, Adhyay03, verse03, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  28. Ravi Dutta Tripathi edited Charaka Samhita, Chikitsasthan, Adhyay16, verse11, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  29. Ravi Dutta Tripathi edited Charaka Samhita, Chikitsasthan, Adhyay16, verse34, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  30. Ravi Dutta Tripathi edited Charaka Samhita, Chikitsasthan, Adhyay26, verse13,14,15, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  31. Ravi Dutta Tripathi edited Charaka Samhita, Chikitsasthan, Adhyay12, verse08, Hindi commentar and Marathi translation by Vd. Vijay Shankar Kale, Chaukhamba Sanskrit Pratisthan Delhi 2020
  32. Brahmanand Tripathi edited Ashtanga Hridayam, Nidanasthan, Adhyay16, verse33, (Nirmala Hindi Commentry), Chaukhamba Sanskrit Pratisthan Delhi 2022
  33. https://www.bartshealth.nhs.uk/haemophilia-centre-at-the-royal-london-hospital
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