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वमनं हि न पित्तस्य हरणे श्रेष्ठमुच्यते। यश्च तत्रान्वयो वायुस्तच्छान्तौ चावरं स्मृतम् ॥१६॥
Emesis is not so efficacious for elimination of pitta and it is also ineffective in alleviation of vata responsible for the downward flow.
english translation
तच्चायोगावहं तत्र कषायं तिक्तकानि च। तस्माद्याप्यं समाख्यातं यदुक्तमनुलोमगम् ॥१७॥
Moreover, astringents and bitter drugs are not applicable there. Hence hemorrhage from the lower parts is considered palliable.
english translation
रक्तपित्तं तु यन्मार्गौ द्वावपि प्रतिपद्यते। असाध्यमिति तज्ज्ञेयं पूर्वोक्तादेव कारणात् ॥१८॥
[Poor prognosis in severe bleeding] In cases where blood comes out from both the routes, raktapitta is incurable because no effective evacuative measure is applicable.
english translation
नहि संशोधनं किञ्चिदस्त्यस्य प्रतिमार्गगम्। प्रतिमार्गं च हरणं रक्तपित्ते विधीयते ॥१९॥
In raktapitta, elimination of dosha from the opposite route is recommended.
english translation
एवमेवोपशमनं सर्वशो नास्य विद्यते। संसृष्टेषु च दोषेषु सर्वजिच्छमनं मतम् ॥२०॥
Thus, the three types (on the basis of the routes of bleeding) of raktapitta progression (udarka) have been described.
english translation