‘Raktamokshan’ (Bloodletting) means-
Rakta-mokshana means to let out the vitiated blood.
Principle of ‘Raktamokshan’ (Bloodletting):
According to Ayurvedic classic (Ref: Ashtang Hridayam by Maharshi Vagbhata Su. Ch. 11/Verse 26), During Raktamokshana, Rakta Dhatu is let out along with vitiated Doshas where Rakta Dhatu is predominant. The susceptibility of Rakta towards impurity is so versatile that the classics were compelled to agree upon Rakta as a fourth Dosha. Therefore Dushita (vitiated) Rakta should be let out to protect the health or to remove the disease. Rakta-mokshana also decreases the quantum of enhanced Pitta, henceforth Doshas and Pittaja Vyadhi are too relieved or cured by this therapy.
Classification of ‘Raktamokshan’ (Bloodletting):
‘Raktamokshan’ (Bloodletting) is of two types –
1) Shastra visravana: It is done with the help of surgical instruments. i.e. Prachchanna, Siravyadha
2) Anushastra visravana: It is done without the help of surgical instruments. i.e. Jalauka (Leech Application), Shrunga, Alabu, Ghati
‘Siravyadha’ belongs to ‘Shastra visravana’. It is an invasive procedure and consider as ‘Ayurvedic venepuncture’ procedure.
‘Siravyadha’ (Ayurvedic venepuncture) – A Procedure review:
It should be done under the following manner.
Purva Karma (Pre Procedure):
- Indications of ‘Siravyadha’ : For ‘Swastha’ (Healthy individual) and ‘Aatura’ (Diseased one).
- Contraindications of ‘Siravyadha’
- Proper Instrumentations
- To make the patient fit for ‘Siravyadha’
- Take written inform consent
Pradhana Karma (Main Procedure):
- Position of patient or healthy individual
- Consideration of correct vein according to disease
- Locking of the vein
Pashchat Karma (Post Procedure):
- Proper dressing and tight bandaging
- Diet and advice
- Follow up
Indications for Bloodletting:
In Swastha (healthy person) : According to Sushruta (School of Ayurvedic Surgery), Skin diseases, tumors, swelling and diseases arising from vitiated blood will never occur in persons indulging in bloodletting (generally in Sharada Rhitu or Autumn season). (Ref: Su. Su. 14/34)
In Atura (diseased person) : Bloodletting is indicated where Rakta Dhatu is vitiated by Doshas and in Shotha (oedema), Daha (burning), Paka (pus formation), Rakta Varna (redness of the skin), Asra Visruti (bleeding conditions), Vata Rakta (gout), Kustha (skin diseases), Vata diseases having severe pain, Pani Roga (diseases of the palm), Slipada (filariasis), blood vitiated by poisons, Granthi (tumors), Arbuda (malignant tumor), Apachi (goiter), Rakta Adhimantha (one type of eye disease), Vidari (skin crack), Stana Roga (breast disease), debility, Raktabhishyanda (conjunctivitis due to vitiated blood), Tandra (stupor), Puti Ghrana (bad smell of the nose), Puti Asya (bad smell of mouth), Yakrit Pleeha (diseases of liver and spleen), Visarpa (erysipelas), Vidradhi (abscess), Pirikas (eruptions), Paka of Karna, Ostha, Ghrana, Vaktra (ulceration of ears, lips, nose & mouth), Shiro Ruja (headache), Upadansha (venereal diseases) and Rakta-pitta (perpura). (Ref: Su. Su. 14/22; Ch. Su. 24/12-16).
Contraindications for Bloodletting: Vein should not be punctured in children and in the old age person, persons who are Ruksha, wounded, debilitated, fearful, greatly fatigued, consumed wine exhausted by long walk or woman (copulation), who have had vomiting or purgation, who have been administered decoction enemas or oil enemas, who have kept awake at night, the impotent, emaciated, the pregnant, who are suffering from cough, dyspnoea, consumption, high fever, convulsions, partial paralysis, starvation, thirst and fainting.
As bloodletting is very necessary in the above mentioned diseases ideally, leeches should be applied; however ‘Siravyadha’ (Ayurvedic venepuncture) is the last choice. Even in those who are prohibited for it, when they are affected by poisons or are in an emergency, ‘Siravyadha’ (Ayurvedic venepuncture) can be done. (Ref: Su. Sha. 8/5).
Those veins which are prohibited from puncturing, which are invisible though indicated for puncturing, which are visible but not controlled (from moving apart), which are not raised (engorged by pressure from a tourniquet etc.) though controlled (such veins should not be punctured). (Ref: Su. Sha. 8/3).
‘Siravyadha’ (Ayurvedic venepuncture) should not be done on days which are very cold, very hot, with heavy breeze and very cloudy and never in the healthy persons (except Sharada Rhitu or autumn season). (Ref: Su. Sha. 8/7).
Also, ‘Siravyadha’ (Ayurvedic venepuncture) should not be done in those who have swelling all over the body, who are emaciated due to intake of sour food (for a long time), who are suffering from disease such anaemia, haemorrhoids, abdominal enlargement, consumption, dropsy and the pregnant women. (Ref: Su. Su. 14/24).
Proper Instrumentations : Following material should be arranged prior to the ‘Siravyadha’ (Ayurvedic venepuncture) procedure i.e. proper place (atmosphere of room where ‘Siravyadha’ would be carried out must be pleasant), water container, hot water, cold water, gauze piece, swabs, bandages, tourniquet, sphygmomanometer, kidney trays, marking glass beaker, bard parker’s knife handle, surgical blades no. 11/12, scalp vein (no. 20), Ayurvedic massage oil , hot fomentation machine, aseptic and antiseptic solutions, chairs, dressing table etc.
Make patient fit for ‘Siravyadha’ (Ayurvedic venepuncture):
- Temperature – pulse – respiration and blood pressure should be taken as prior to ‘Siravyadha’ (Ayurvedic venepuncture).
- Routine blood investigations, blood group, blood sugar etc. should be carried out as pre-operative assessment of the patient.
- Sharirika bala(physically strength) and Manasika bala (psychological state of the patient) should be assessed.
- The patient should be duly fomented and anointed with oily preparations. Liquid diet or gruel should be given prior to the entire procedure.
Take inform consent : It is more advisable to take written inform consent of the patient before going to ‘Siravyadha’ (Ayurvedic venepuncture) as it gives information regarding the procedure to the patient and also it is useful in medico-legal cases in favor of the physician.
Vyadhana Pramana (Size of venepuncture) : In muscular areas, puncturing should be of the size of the Yava (barley grain) and in other areas it should half of Yava (barley grain). Veins on the bones should be punctured to the size of half of Yava (barley grain).
Vyadhana Kala (suitable time) for Siravyadha : During Varsha Rhitu (rainy season), ‘Siravyadha’ (Ayurvedic venepuncture) should be done on days which are not cloudy; during Grishma Rhitu (summer season) at the time which is cool; during Hemanta Rhitu (winter season) at mid day. (Ref: Su. Sha. 8/10)
‘Siravyadha’ (Ayurvedic venepuncture) procedure: Bloodletting should be done by the physician on the day which is neither very cold nor very hot, neither before fomentation nor after too much of fomentation. It should be adopted after the patient has been satisfied with a drink of thin gruel. (Ref: Su. Su. 14/31).
The patient should be asked to sit nearby (the physician) in erect posture; then he should be tied with either tourniquet or band of cloth, leather, inner bark of trees, creeper or any other material without endangering his life; controlled/restrain from movement neither very firmly nor very loosely; then search of the site of puncture with the appropriate instrument. (Ref: Su. Sha. 8/6)
Characteristics of proper puncture: When proper venepuncture has been done, blood flows out in a stream for some time then stops on its own accord; this should be understood as proper puncturing.
Quantity of flow: In persons who are strong enough and have great accumulation of Doshas and who have suitable age (middle age), expert desire maximum 640 ml of blood should be allowed to flow out after the procedure. (Ref: Su. Sha. 8/16).
Symptoms of perfect venepuncture:
लागवं वेदनाशान्ति व्यार्धर्वेग: परिक्षय: |
शुद्धम तदा विजानीयात् सम्यक् विस्रावित च तत् || (Su. Su. 14/33)
Means, Feeding of lightness of the body, mitigation of suffering, subsiding of severity of the disease and cheerfulness of mind – are the symptoms of perfect venepuncture.
Complications of venepuncture:
One of the major complications which lead up to sudden death is unconsciousness due to psychogenic shock.
If patient become unconscious while performing ‘Siravyadha’ (Ayurvedic venepuncture), the following points should be considered –
- Immediate removal of the instrument from the wound.
- Cold sponging.
- Proper ventilation and aeration.
- Consolation and assurance to the patient.
- Further venepuncture done immediately after the management of unconsciousness.
- If the unconscious reappear then the patient should be called for venepuncture after 2 – 3 days.
Post procedure review:
Proper Massage & Dressing: After completion of procedure whenever blood flow stops automatically, proper dressing with the help of Ayurvedic dressing oil should be carried out and tight bandaging should be applied on the wound.
Diet & Advice: By the depletion of tissue due to bleeding, the Agni (digestive power) becomes weak and Vata becomes aggravated; hence the patient should be treated with food which are not very cold, which are light (easily digestible), unctuous, which promote blood formation and either slightly sour or devoid of sour. (Ref: Su. Su. 14/37-38)
After bloodletting, the patient should be asked for avoid exercise, copulation, cold breeze, day sleep, use of alkalis, pungent substances in food, grief, much conversation and indigestion till he attains good strength.