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ISSUE 2 (2017) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Patil S.G. et.al., Raktamokshana and its Practical Utility in Netra Rogas, Int. J. Ayu. Alt. Med., 2017; 5(2): 73-76

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REVIEW ARTICLE Scientific Journal Impact Factor 5.733 (2015) by InnoSpace Sci. Res., Morocco

Index Copernicus Value (2015) – 80.04

RAKTAMOKSHANA AND ITS PRACTICAL UTILITY IN NETRA ROGAS

Sarika Govindrao Patil1*, Vidya Boinwad2 , Deepali Sherekar3

1. Former Associate Professor, Dept. of Shalakyatantra, Government Ayurved College, Nanded,

Contact No. +91 9421054120, Email - sarikamm252@gmail.com

2. Assistant Professor, Dept. of Kaychikitsa, Government Ayurved College, Nanded, Contact No. +91 9503609432, Email - vboinwad@rediffmail.com

3. Assistant Professor, Dept. of Panchkarma, Government Ayurved College, Nanded, Contact No. +919405047341, Email - dr.deepali.sherekar@gmail.com

Article Received on - 20th May 2017 Article Revised on - 6th July 2017 Article Accepted on - 7th July 2017

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ISSUE 2 (2017) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Patil S.G. et.al., Raktamokshana and its Practical Utility in Netra Rogas, Int. J. Ayu. Alt. Med., 2017; 5(2): 73-76

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REVIEW ARTICLE *Corresponding Author Sarika Govindrao Patil Former Associate Professor, Dept. of Shalakyatantra, Government Ayurved College, Nanded, Contact No. +91 9421054120, Email - sarikamm252@gmail.com

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ABSTRACT: Eye diseases are rampant today because of the unhealthy surrounding,

environmental factors and change in lifestyle. Medical science has limited number of drugs having only symptomatic relief, not the total cure. In Ayurveda, the treatment like Shodhanchikitsa (detoxification) destroys the complete pathophysiology of diseased condition. Raktamokshana (bloodletting) is one of the detoxification techniques of Panchkarma for the treatment of RaktajaVyadhi. Acharyas described the Raktamokshana in the management of various Netrarogas. Jaluokavachana(Leech Therapy) is one of the form of Raktamokshana, practiced since ancient times specially in Netrarogas, as Jaluoka is sheet (decongestion) in nature and madhur and pittahara. Thus to prove the efficacy and practical utility of Raktamokshana in eye diseases, review of all literature is must, as well as to spread the awareness about this therapy this study paper is designed.

Key Words: Raktamokshana, Netravyadhi, Jaluokavacharan, Vedhya Vyadhi

INTRODUCTION Shalakyatantra one of the eight branches of Ayurveda explains the detail structure, functions and treatment of Eye [1]. Aacharya Sushruta was the greatest proponent of this science who systematically and elaborately dealt with anatomical structures of eye. According to the treatment modality Sushruta divided the Netravyadhi into surgical and parasurgical procedures [2]. Raktamokshana is one of the parasurgical procedure in which vitiated pitta dosha and rakta get let out from the body. Jaluokavacharan i.e. Leech therapy is form of Raktamokshana, practiced since ancient times to treat Netrarogas. The properties of Jaluokas are sheet, madhur and pittahar as well as efficacy has been emphasized in the raktadushtijanyavyadhi, so Jaluoka (Leech) application will be helpful in Netrarogas, as eye is site of pitta dosha pradhanavyadhi. Now a day’s various eye diseases require chronic treatment and chances of recurrence like Glaucoma, Conjunctivitisetc. So for the better results and patient compliance we can treat this diseases by Raktamokshana. Aacharya Sushruta clearly mentioned Vedhya Netraroga i.e. can be treated with Vedhan i.e. Raktamokshana therapy.

AIM AND OBJECTIVES 1. To review Raktamokshana therapy mentioned

in Ayurvedic literature. 2. To study the practical utility of

Raktamokshana and its mode of action in Netrarogas.

MATERIAL AND METHODS All the literatures described in Brihatrayi, Laghutrayi was studied and data collected from some personal experiences, regarding Raktamokshana therapy. Sushruta mentioned Raktamokshana one of the important treatment of different types of Urdhwajatrugata Vyadhi. Raktamokshana is of two types [3]:-

I. Shastravisravan – done with the help of surgical instrument.

a. Prachanna – Bloodletting through local multiple incisions.

b. Siravyadha – Venous puncture. II. AnushastraVisravan – done without use of

metal instruments. a. Jaluokavacharana – application of leech. b. Shrunga – sucking through cow’s horn. c. Alabu – vacuum extraction by using

vegetable called Alabu (Bottle gourd).

Table 1: Provide appropriate Title

RAKTAMOKSHANA AND ITS PRACTICAL UTILITY IN NETRA ROGAS

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Sr. Type Indication According to doshas Purification of blood from 1. Pracchan Two/Three doshas An area of one angula 2. Siravyadhana Tridosha & Raktadushti Entire body 3. Jaluka Pittadosha An area of one hasta (palm) 4. Shrung Vatadosha An area of ten anguli 5. Alaba Kapha An area of twelve anguli

According to this, practically we can apply Jaluoka and Siravyadha for Raktamokshana in Netravyadhies. Indication of Raktamokshana[4]:- Skin disorders, Shotha (swelling), Daha (burning sensation) severe pain, Raktaabhishyanda (conjunctivitis), Visarpa (herper zoster), Paka and various eye diseases. Contra indications [5]:- Generalized swelling, swelling in debilitated person, caused by sour diet, and that in those suffering from Pandu, Arsha, Udar and Garbhini. Procedure of Raktamokshana[6]:- The procedure is divided into 3 parts – 1. Purvkarma (pre-operative procedure): In

the preoperative procedure, Snehana (oleation) internal and external, swedana (hot fomentation with steam to whole body).

2. Pradhan Karma (operative procedure): a) By using jaluoka (leech): The patient is

made to lie on bed comfortably. The leech is applied over the affected part. The leech starts to suck blood when its mouth becomes raised and appears like horses hoof. If the leech does not suck blood a drop of milk is put at the spot or a small prick with sterilized needle is taken. Wet cotton is kept over the body of leech to keep it moist and alive. The leech leaves the spot after a while or is deliberately removed when the patient experiences pricking pain at the site. (This pain indicates that the Leech is sucking pure blood).

b) Siravedha (venous puncture): The patient is asked to lie comfortably over a bed. The air cuff of sphygmomanometer is tied over the bicep muscle of hand. The patient is asked to clench his fist tightly. The cuff is inflated and the desired vein (medial cubital is preferred) is punctured with a sterilized scalp vein (butterfly) needle. Cuff is removed and the blood is collected in a kidney tray. When the sufficient quantity of blood is drawn the needle is withdrawn and patient is asked to loosen his fist. A cotton swab is pressed over the wound.

3. Paschat karma (post operative procedure): If bleeding continues from the diseased site finepowder lodhra (Symplocosracemosa), yastimadhu (Glycyrrhiza glabra),

raktachandana (Pterocarpus santalinus) etc. are applied. The area is covered is wet cloth or a thin paste of cooling dravya like chandana is applied. The patient is advice to take rest and can be given light diet or milk later in the evening. Rice flour is applied to whole body of jaluoka and little saindhav lavana (rock salt) and oil is applied to its mouth. And it is squeezed gently from tail to mouth in order to remove the sucked blood.

Aacharyas give detailed description of collection of Jaluokas, how to store them, selection of Jaluoka and purification of leech for application. According to Samhitakara, Jaluoka should be carefully identified and properly purified before using in Jaluokavarcharana. Netravyadhi: Netra is the site of Aalochak pitta. Most of the netragatvyadhi have pitta and raktadushti. Aacharya Sushruta mentioned some specific eye diseases under the heading of Vedhya Vyadhi. These are Sirotpata, Siraharsha, two types of Akshipaka, Anyotovata, Puyalasa Vataparayay, 4 types of Adhimandha and Abhishyandha, which having raktadushti[7]

1. Puyalasa (Dacryocystitis): It is a sannipatik-sandhigatavyadhi producing a swelling at kannikasandhi (inner canthus). It can be correlated with acute dacryocystitis. Raktamokshana is the treatment of choice. The siras of frontal region (lalata) should be selected for Jaluokavacharana[8].

2. Upanaha: It is a Sandhigatavyadhi, can be compared with lacrimal cyst. Yogaratnakara and Dhalana advised Pracchan for this.

3. Pothaki (Trachoma): It is a chronic contagious disease of conjunctive and cornea characterized by follicle formation and caused due to chlamydia trachomatic. Pracchan karma is done at the upper tarsal conjunctiva.

4. Sirotpata and Siraharsha: Aacharya Yogaratnakara advised Siravedha for both these diseased condition. It is compared with allergic hyperemia of eye on panus (as in glaucoma) or advanced stage of episcleritis and iridocyclitis[9].

5. Savarana Sukla: Both siravedha and Jaluokavacharna indicated. Siravedha initially expels dustarakta but remaining small quantity of coagulated blood deposited in the inner side is cleared by leech application. [10]

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6. Avranasukla (Corneal opacity): Aacharya Vaghata advised repeated Raktamokshana when the sukla (opacity) became thick and stable[11].

7. Abhisyanda (conjunctivitis) and Adhimandha (Acute Glaucoma): In vataj, pittaj and raktajaabhisyanda and adhimanda leeches should be applied around the eye to induce bloodletting. It prevents further aggravation of doshas. Jaluoka applied at frontal or outer canthus or near nose region[12].

8. Anyatovata: There will be acute pain in jugular vein region of neck, eye or temporal region due to vitiated vata and constriction of the eye.

9. Vataparyay: The disease can be defined as a disease producing alternate attack of pain in eye, eyebrow or eyelashes with visual disturbances and structural changes in the shape and size of the eye.

10. Akshipaka: Aacharya Sushruta advised Raktamokshana in both Sashopha and Ashophapak[13].

Nowadays leeches are used by ophthalmologists and hirudotherapists to treat inflammatory and traumatic conditions such as keratitis, chorioretinitis, uveitis, peri-orbital hematoma, sub retinal hemorrhage, glaucoma and cataract.

DISCUSSION Raktamokshanais an effective blood purification therapy in which carefully controlled small quantity of blood is removed. Due to this vitiated pitta dosha get neutralized and decreased the raktadushti. The local effect is due to several active leech substances which the leech introduces at the site of application like Hirudin, Calin, Hyaluronidase. Hirudin is anti coagulant which inhibits conversion of fibrinogen to fibrin thus preventing blood clotting.[14] Mode of action of Hirudo therapy [15]:- When leeches bite, they create a tunnel to the lymphatic system; remove toxins from the lymph system. The main effect of the medicinal leech on the body includes.

1. Decreased blood clotting. 2. Thrombolytic. 3. Anti-ischemic (improving blood supply etc.)

tissues and organ. 4. Anti hypoxia (improving blood supply

(oxygen) to the tissues and organ. 5. Draining the blood and lymph system of

toxins and blood clots restoration of the micro circulation.

6. Recovery of neuromuscular impulses transmission and restoration of vascular permeability.

7. Bacteriostatic.

CONCLUSION Raktamokshana done by Jaluokavacharana and siraveda is a safe, effective and promising choice of treatment in Raktaj Netravyadhi. By this we also prevent the further aggravation of the diseased condition like conjunctivitis, glaucomaandiritis. It also helps to reduce the frequency of recurrence in conditions like seasonal conjunctivitis, trachoma, herpes zoster. Hence there is need of more clinical trials of Raktamokshana in eye diseases to prove the efficacy of procedure. REFERENCES

1. Priyavrat Sharma, Sushruta Samhita with Dalhana Commentary Part-I, Reprint Edition, 2005, Choukhamba Vishvabharti, Varanasi. 2005, p. 44.

2. Ibid; Part-III, p.148. 3. Ibid; Part-I, p. 149. 4. Ibid; p.152. 5. Ibid, p.149-50 6. Ibid; p. 138-140. 7. Priyavrat Sharma, Sushruta Samhita with Dalhana Commentary,

Part-III, Reprint Edition, Choukhamba Vishvabharti, Varanasi. 2005, p.149.

8. Ibid; p.173. 9. Ibid; p. 169. 10. Kaviraj Atridev Gupt, Editor. Vaidya Yadunandana Upadhyaya

Ashtanga Hridya Vidyotini Bhashya commentary, 13th Ed., Chaukhambha Sanskrit Sansthan, Varanasi. 2000, p. 488.

11. Ibid; p. 488-450. 12. Priyavat Sharma Sushruta Samhita with Dalhana Commentary

Part-III, Reprint Edition, Choukhamba Visvabharti, Varanasi, 2005, p. 151.

13. Vaidya Shri. Lakshmipati Shastri, Edt. Shri. Bhramhashankar Shastri, Yogaratanakar Vidyotini Commentary, Uttarardha, 17th Ed., Chaukhambha Sanskrit Santhan, Varanasi, 2002, p. 392.

14. Whitakar IS, Rao J, Izadi, Butler PE. Historialarticle: Hirudo-medicinalis: Ancient Origin of, and trends in the use of medicinal leeches throughout history. Br J Oral Maxillofac SURG.2004;42;133-7 (PUBMED)

15. Jaluokavacharana (Hirudotherapy): A Unique Para surgical Measure article published in International Journal of Ayurveda and Pharma Research ISSN-2322-0910, 2015; 3(2) 29-34.

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Patil S.G. et.al., Raktamokshana and its Practical Utility in Netra Rogas, Int. J. Ayu. Alt. Med., 2017; 5(2): 73-76

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