Presented By Name: Dr. Prathamesh V. Karpe BAMS, MS(Shalyatantra)

Country: INDIA

3rd International Conference and Exhibition on 

Traditional & Alternative MedicineAugust 03-05, 2015 Birmingham, UK 

In Association with

Concept of Raktamokshan (blood letting) in Non-

Healing woundDr. Prathamesh V. Karpe BAMS, MS(Shalyatantra)

Consulting surgeon & Lecturer in Dept. of Shalyatantra, GAM&RC Shiroda Goa

It is one of the Panchakarma (five purificatory procedures) viz

1)vaman- medicinal induced emesis 2)virechan- medicine induced purgation 3)Basti- medicated enema 4)Nasya- nasal medications 5) Raktamokshan- blood letting

What is Raktamokshan??

It is indicated in all Raktapradoshaja vikara- disorders caused due to vitiation in the blood.

When the procedures like snehana-rukshana, Sheeta-Ushna doesn’t give relief, Raktamokshan is indicated.

Indications

1. Oedema all over the body2. Excessive intake of sour,spicy-pungent and salty food3. Pandu-Anaemia4. Bleeding hemmorrhoids5. Udar- ascitis6. Rajyakshma- TB7. Oedema in pregnancy

contraindications

Types of Raktamokshana

सि�रा�वे�धVein puncturing

प्रच्छा�न्न- incising

श्रुं �ग- Animal horn application

जलौ�का�Leech therapy

अलौ�बु - dried bitter gourd घटी�- mudpot

सि�रा�वे�धVein puncturing

प्रच्छा�न्न-incising

श्रुं �ग- Animal horn application

जलौ�का�Leech therapy

अलौ�बु - dried bitter gourd घटी�- mudpot

Superficial incisions from above to downwards direction (anulom gati) in vertical fashion are given on the affected part after snehan and swedana.

Not performed on joints, marmasthana, across veins, tendons etc

Indicated when there is any thick lesion on the skin, after snake bite, tumors etc.

Prachhan karm’- प्रच्छा�न्न

Indicated in Vata dominant rakta dushti. Pricks or incision are given on the skin after

snehan and swedan, animal horn is placed with its broader end on the skin and from tapering end blood is sucked out.

Principle of vaccum is applied

shrunga श्रुं��ग- Animal horn

This can be termed as ‘Vein-puncture’ and is one of the easiest mode of ‘Raktamokshan’. Sushruta gives utmost importance to this technique.

सिरा�वे धVein puncturing

Supremacy of ‘Sira Vyadhan’

Sira Vyadhan

Other procedures

Selection of suitable patient Snehan- Swedan (half hour before) at the site of Sira-vedh. Laghu Aahar (Light semi-solid diet) like Yavagu etc. Coagulatory disorder like haemophilia should be rulled out.

Similarly, precautionary measures to be taken while handling the Anaemia, Diabetes, Hepatitis, HIV patients.

After Mangal & Swasti vachan (prayer) patient is given either supine position or slight propped-up position.

Now, a vein is selected for vene- section & a tourniquet or bandage is applied a little above the site of Sira Vyadhan.

Sira-vedha (Poorva karma)

Blood letting by ‘Sira Vyadhan’ is performed preferably in Sharad reetu as Pitta is vitiated more in this season.

Better to avoid Grishma reetu (i.e. last 15 days of April, May & first 15 days of June). Ideally, this should be performed in comfortable, cool & pleasant weather.

Time suitable for ‘Sira Vyadhan’

It is indicated in all types of diseases with rakta vitiation

Visarpa Kushta Vranashotha Vidhradi aamavastha Vatarakta Yakrutodara Non healing ulcers tumours

Indications for ‘Shira- Vyadhan

Blood letting should not be done in following condition:

young children & very old people Ruksha/ Kshat/ Ksheen/ Krish– extremely weak, under-

nourished & debilitated patients. Bheeru i.e. Timid person exhausted person Stree karshit i.e. Excessive sex indulgence After Vaman, Virechan & Basti karma

Contra- indication of ‘Shira- Vyadhan

In Insomnia & Sleeplessness conditions Pregnancy Klaibya i.e Impotency Anaemic & Haemophilic Patient Patients suffering from Cough, Breathlessness,

Muscular wasting, High grade fever, Convulsive disorders, Paralysis, Giddiness & patients who are Fasting or Thirsty or dehydrated or malnourished.

Cont…..

1.Brihee- mukh Shastra – superficial vein puncturing.

2.Kutharika Shastra- When vein is crossing bone3.Vetas Patra- When vein is fine4.Aara Shastra- When vein is big & large amount of

blood has to be removed.

Instruments or Material Used

Faulty technique Collapse of vein due to ‘Shock’ Low BP/ Obesity/ Anxiety neurosis Over exertion Extreme weakness Dehydration Fear Loosening of tourniquet Blunt instrument ‘Sira- Vyadhan’ done without prior Fomentation In Text books, this is further divided according to Shastra-

dosh, Rogi- dosh, Yantra- dosh, Sira- dosh & Vaidya- dosh.

Causes of failure of ‘Shira- Vyadhan

Laghav- Feeling of lightness Vedana shanti – Relief from pain Vyadhi weg parikshay- Arresting further progress of

disease Manh prasad- Feeling of wellbeing Raktum Swayamev Avatishthhate- Haemostasis by its

own Shuddha i.e. Fresh/ purified/ clear blood is seen at the

end

Sign of Proper or Adequate Blood letting

Sirobhitap- Headache with warmness Aandhyam -Blurring of vision Adhimanth- Glaucoma Timir pradurbhav- Errors of refraction Dhatu kshay- Loss of tissue (Emaciation) Aakshepak-Convulsive disorder Daah- Burning sensation Pakshaghat- Hemiplegia or Monoplegia Hikka- Hiccup Swash, Kaas- Dysponea, Coughing Pandurog- Anaemia Maran- Death

Sign of Excessive/ Over Blood letting

As the very basis of life for ‘Leeches’ is water, since

their site of dwelling is ‘Jal’ i.e. water, the ‘Leeches’ are known as ‘Jaloka’.

Definition of ‘Jaloka’

Poisonous Non- poisonous

1) Krishna 1)Kapila 2) Karbuda 2)Pingala 3)Alagarda 3)Shankh- mukhi 4) Saamudrika 4)Mushika 5)Indra- yudha 5)Pundarik-mukhi 6)Go-chandana 6)Saavarika

Types

अग्रे� स्रवेति� दुष्टा�स्र� का � म्भा�दि!वे पी#ति�का� / (अ.ह्रू. � . 28/37)

Vitiated blood flows out first, just like the yellow juice from the seeds of the Kusumbha before its oil flows out.

After sufficient bleeding, the flow stops by itself; it should be considered as pure (unvitiated blood) and further flow shouldn’t be attempted.

Mode of action of Raktamokshan

It helps in relieving pain, burning sensation Reduces inflammation Reduces infection Restores sensation of the part Helps in healing of ulcers

Snehan- internal and external olevation Swedan- fomentation Cleaning the part from where raktamokshan to be

performed Tying tourniquets in case of siravedha

Preparatory procedures

Clinical evidence based result

Vrana shotha-cellulitis After leech application 5th day

Jalaukavacharan in non healing venous ulcer

Before jalaukavacharana

After jalaukavacharana

Raktamokshana if used after proper diagnosis and evaluation gives instant results compare to other pallaitive or conservative treatment.

It is very much economical and cost effective.

No much man power is required unlike other panchakarma procedures

If not used cautiously then may even prove fatal.

Conclusion

THANK YOU

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Traditional Medicine-2016London, UK

October 03-05, 2016