Raktamokshan

1. RAKTAMOKSHANA
(BLOOD LETTING)
PRESENTED BY:
Dr. SUBHAM PATRA
1ST YEAR PG SCHOLAR
DEPT OF SHALYATANTRA
GUIDED BY:
DR C .THYAGARAJA
DR SIDDANAGOUDA A. PATIL
DR PRABAKAR H TASEEN
DR CHANDRA BHUSHAN SINHA
Dr Subham patra

2. CONTENT
.
 Introduction
 Etymology
 Synonyms
 Importance of rakta mokshana
 Classification of rakta mokshana
 Indication
 Contraindication
Dr Subham patra

3. The Rakta Mokshana procedure is considered one among the Pancha
Shodana.
Rakta Mokshana is a process of letting the vitiated blood, as a treatment
procedure in disease caused by Rakta or Pitta which is carried out either
by using sharp surgical instruments or by means of parasurgical
measures.
INTRODUCTION
T
Dr Subham patra

4. Etymology
Rakta Mokshana is formed by two words Rakta and Mokshana.
Rakta
The word Rakta is derived from the root ‘Raj’ means to give colour to the body.
“Rajathe Angam Iti anena Iti Raktam”
Mokshana:
“Moksha–Avasun” Dhatu when suffixed with ‘Yu’, means to release, Liberate or to
shed or causing to flow, to let, to separate, to expel, to drive out, to pass.
So the process in which the vitiated blood is expelled out from the body.
It means Rudhirasravana or Rakta Mokshana
Dr Subham patra

5. Synonyms of Rakta Mokshana
 Asravisravana
 Shonithamokshana
 Rakthanirharana
 Raktashruti
 Rakthasravana
 Rakthaharana
Dr Subham patra

6. Importance of Rakta Mokshana
• Rakta Mokshana is the ideal treatment when the Dosha are vitiated
in Dhatu antargata.
• In Raktaja and Pittaja Roga only Rakta Mokshana can provide
benefit which is equal to the combined effect of all other treatment
modalities.
• The disease which cannot be cured either by Snigdha or Rooksha
and Sheeta or Ushna Chikitsa then Rakta Mokshana is the ultimate
therapy.
• Siravyadha, which is a type of Rakta mokshana, is considered as
ardha Chikitsa as Vasti in Kaya Chikitsa. This show how important is
Rakta mokshana.
Cont.
Dr Subham patra

7. • It is one of the ashu phala prada chikitsa, in the similar way it
can be used in emergency situationalso.
• Pliha helps in controlling of rakta ghatakas and it cleans
rakta,and in small quantity it acts as reserviour of rakta
Importance of Rakta Mokshana
Dr Subham patra

8. It is mainly of two types
• Sa Shastra – Siravyadhana
Prachanna
• Anushartram /Nishastra – Shrunga
Alabu
Jalouka
Ghatee Yantra
Classification of Rakta Mokshana
Dr Subham patra

9. FLOW CHART SHOWING CLASSIFICATION OF RAKTAMOKSHANA
Rakta Mokshana
Sa Shastra Anushastra Vidhi
Sira Vyadhana Prachanna
Jalouka Sringa Ghatee yantra Alabu
Classification of Rakta Mokshana
Dr Subham patra

10. Sushruta Charaka Vagbhata Sharangadhara
Shrunga Shrunga Shrunga Shrunga
Jalouka Jalouka Jalouka Jalouka
Alabu Alabu Tumbi Alabu
Prachanna Suchi Prachanna Siravyadha
Siravyadha Prachanna Siravyadha -
Vigharshana Siravyadha Ghatiyantra -
Classification of Rakta Mokshana according
to different Acharya
Dr Subham patra

11. INDICATIONS of RAKTA MOKSHANA
 Indication of Rakta mokshana according to Depth of Lesion
• Uttana - Prachanna
• Avaghada - Jalouka
• Twakstitha – Alabu / Ghatiyantra
• Sarvadaihika - Siravyadhana
 Indication of Rakta Mokshana According to Limit of Area of Dosha Nirharana
• Dhashangula - Shrunga
• Hastamatra - Jalouka
• Dwadashangula – Alabu.
Dr Subham patra

12. Shodana Snehapeeta, Vamita, Virikta, Astapita, Anuvasita
Physiological
condition
Garbini, Bala, Bhiru, Parishrantha, Upavasa, Pipasa, Jagarita, Krusha
Diseased conditions Swasa, Kasa, Shosha, Moorchita, Pravrudha jwara, Akshepaka,
Pakshaghata, Sarvanga shopha, Pandu, Rooksha, Strikarshita,
Madyapeeta(mada), Kleeba, Arsha, Udara(Jalodara, vatodara, pittodara.
Contraindications of Rakta Mokshana
Dr Subham patra

13. • Vata – Shringa,
• Pitta – Jalauka,
• Kapha – Alabu,
• Generalized – Siravedha,
• Local – Pracchana
INDICATIONS OF DIFFERENT MODALITIES
On Doshik base:
Dr Subham patra

14.  Its use is specific to Vata disorders being Snigdha in
nature.
 Dimensions:
• It is a kind of Nadiyantra.
• This denotes the horn of cow.
 Its length is 18 angula on average and the attaching
portion (mouth) has the diameter of 3 angula
 The sucking end has a hole of the sizeof mustard seed.
SHRINGA
Dr Subham patra

15. Dr Subham patra

16. APPLICATION OF SHRINGA
• Snehana, Svedana, Pracchana at the desired site of
bloodletting and the Sringa is placed.
• It has two openings, one is small and another is
broad enough. Broad opening is placed on the
wound while the small opening is used to suck the
air by mouth.
• When you suck by mouth through the hole in horn;
it will create vacuum in the horn.
• It will help the blood to let out. The mouth should be
closed to maintain vacuum in the horn.
• When you want to remove the Shringa, hole should
be open down.
Dr Subham patra

17. JALAUKAVACHARANA (LEECH THERAPY)
• The bloodletting with the help of leech is
painless or noninvasive way of bloodletting.
• It resides in the water, hence being Sita in nature
pacifies pitta dosha.
• Not only it relieves pitta but also it cures a wide
range of ailments.
• Available in abundance in the ponds. It may be
cultivated in the leech tanks and the same may
be prepared with ease in the premises of the
hospital or clinic.
Dr Subham patra

18. INDICATIONS OF LEECH
• Doshas are situated in the deeper tissues.
• Pitta predominance.
• More physiological, feasible (no pain), rational and result oriented.
• Children, old ages, women, king, person of soft constitution and
coward.
• Gulma, Arsha, Vidradhi, Kushtha, Vatarakta, Galaroga, Visha and
Visarpa.
Dr Subham patra

19. TYPES OF JALAUKA
The concept of poisonous and non poisonous nature of the leeches has been
discussed at large in ayurveda. It has been mentioned that poisonous leeches
reside in dirty habitatand non-poisonous leeches reside in fresh water ponds.
• Krishna
• Karbura
• Alagarda
• Indrayudha
• Samud rika
• Gochandana
SAVISHAJALAUKA NIRVISHAJALAUKA
• Kapila
• Pingala
• Shankhumukhi
• Mushika
• Pundarika mukhi
• Savarika
Dr Subham patra

20. • Krishna: Krishna varni and pruthu sira yukta
• Karbura: long like varmi matsya and unnata kukshi
• Algarda: romayukta sharira, maha parshva and Krishna varna mukhi
• Indrayudha: indradhanusha (rainbow) sadrusha vividha Rekha yukta
• Samudrika: Krishna and peeta bindu yukta and vichitra pushpa akriti chitra yukta
• Gochandana: go vrisha sadrusha dwibhaga yukta in adho bhaga and anu mukhi
• Kapila: manashila sadrusha peeta varna on prushtha bhaga, snigdha prushtha yukta and mudga
sadrusha varna
• Pingala: kinchita rakta varna, vruta kaya, pingala varni, fast moving (aashuga)
• Shankhumukhi: yakruta varni, shighra payini, dirgha, and tikshna mukhi
• Mushika: mushika sadrusha aakruti, varna and durgandha yukta
• Pundarika mukhi: mudga sadrusha harita varna yukta, kamala pushpa sadrusha
mukha
• Saavarika: snigdha, padma varni and 18 angula long. (used for rakta mokshan in animals)
Dr Subham patra

21. SAVISHA JALAUKA
• Broad in its middle part.
• Vistirna
• Has slow movement and deformed
shape.
• Attach to the victim or patient with
difficulty.
• Sucks less quantity of blood.
• Non-poisonous Jalaukas live in deep
and fresh water where there is the
abundance of lotus, algae etc.
• The leech, which is used for therapeutic
purpose is known as Hirudo
medicinalis.
• The symptoms of Savisha Jalauka bite
as have been mentioned in Sushruta
are related to infection. It may be due
to the bacteria present in the leech gut
symbiotically.
NIRVISHA JALAUKA
Dr Subham patra

22. COLLECTION
• Jalauka should be kept in a bottle with broad lid filled with water.
• Feed them with powder of dried meat and aquatic bulbs leaves of water plants
• The water should be changed every third day and feed should be dropped
Dr Subham patra

23. PURVA KARMA (BEFORE PROCEDURE)
• The patient should be subjected to snehana (oleation) and swedana (fomentation), to
enhance the mobility of dosha
• Fresh leeches should be taken, and a mixture of mustard and turmeric paste in
water should be applied upon them.
Dr Subham patra

24. PRADHANA KARMA
• The patient should be made to sit or lie down
• The leeches should be hold at its neck and should be applied directly to theaffected
part.
• They should be covered with wet cotton and cold water should be poured on them
from above time to time
Dr Subham patra

25. PASCHATA KARMA
(AFTER PROCEDURE)
• The site should be cleaned with normal saline and
bandaging should be done after sprinkling turmeric
powder with bee honey to the bleeding site.
• After falling off, the leeches should be made to vomit.
• This is carried out by applying turmeric powder at
their mouths.
• When the blood comes from the anterior sucker, gentle
squeezing from caudal to front end is required for
proper emesis
• If the leech is active when placed in water, it indicates
that the vomiting is proper.
Dr Subham patra

26. SYMPTOMS OF POISONOUS LEECH BITE
• Acute cellulitis
• Kandu
• Jvara
• Daha
• Chardi
• Angamarda
These are the symptoms pertain to bacterialinfection.
Dr Subham patra

27. MODE OF ACTION
• The therapeutic benefits of the leech bite doesn’t relate with the average 5 to 10 ml
of bloodletting during bite but the continuous oozing of blood for 10 hours or more is
the main benefit.
• The goal is to produce a minimally adequate venous outflow from thetissue.
• Not only it reduces congestion but also it helps in neogenesis.
• It is true that continuous bleeding in the bite wound is not merely due to the anti
coagulants but other pharmacologically active substance may also play good role.
• This can be proved by the fact that conventional anticoagulants can never be a
substitute of leech bite.
Dr Subham patra

28. ALABU YANTRA/TUMBI/ GOURD
• It is specifically used in vitiation of Kapha dosha. If the blood is vitiated with the
pitta dosha, then this Alabu Yantra should not be used for the purpose of
bloodletting. It is because the fire is used to create vacuum in the Alabu; therefore,it
may enhance the Pitta dosha.
• The diameter of the Alabu yantra is 3-4 angula and it has two openings oneither
side. Where Alabu is used, the redness and congestion develops, hence blood
congestion reduced in deeper places.
Dr Subham patra

29. TECHNIQUE OF USING ALABU
 It works on the principle of vacuum extraction.
 A lamp is placed at the site of application of Alabu and the lamp is ignited.
 The lamp remains in the ignited form till the air remains in the Alabu.
 When all of the air is used in the Àlabu, the lamp goes off. Owing to this
action, vacuum develops inside the Alabu.
 The Alabu is remained in thesame position for ten to fifteen minutes.
 It is better to have Pracchana at the place of application of Alabu, so that the
maximum blood would come out.
 Now a day, a glass is used to cover the lamp instead of Alabu.
 This procedure is named as cupping.
Dr Subham patra

30. SIRAVEDHANA
 Sira vyadhana is one of the types of Raktamokshana which is carried out by using
an instrument having pointed end like needle.
 Particular veins are selected and punctured according to the standard guidelines
mentioned by Sushruta basing on the disease.
 Vyadhana is one among the sixty vranopakramas mentioned by Sushruta and
one among the thirty six vranopakramas mentioned by Charaka.
 As Sira are slippery in nature and move to and fro like a fish, there is a need of
experience and skill for the surgeon to become perfect in sira vyadhana
procedure.
Dr Subham patra

31. Etymology of Siravyadha
Sira:
सिनौ तौतत इतत सिरा – That means which binds or a quantity bound together.
Vyadha:
व्यधनिमतत व्यध: । that gives meaning of cuts
व्यध (ताड) + अऩ व्यध - To pierce, to transfix, to hit, strike, wound
By which the blood is being taken all over the direction is "Sira". Its piercing is
known as "Siravyadha"
Dr Subham patra

32. INSTRUMENTS REQUIRED
Dr Subham patra

33. Dr Subham patra

34. Dr Subham patra

35. TECHNIQUE OF SIRAVEDHANA
Poorvakarma:
• Snehana karma – consume meat-juice and boiled rice mixed withghee,
• Sweda karma - niragni sweda ( eg : sun light, heat with a light, fireetc.)
• Tied a band above the veins
• Should tap the raised vein with physician’s middle finger tripped off by the thumb
Dr Subham patra

36. PRADHANA KARMA
• The lancets (shastra) is incerted quickly neither too deep nor superficial inthe
middle of the vein without injuring the marma points
• The maximum quantity of blood that may be let out should not exceed one prastha
Dr Subham patra

37. SIRAVYADHA
IN
SIRA GRANTHI
Dr Subham patra

38. PASCHAT KARMA:
• Apply Fine powder of haridra and laksha to the site
of bloodletting
• Tight bandaging is to be done.
Dr Subham patra

39. ACTION OF SIRAVYADHA:
• Choice of treatment in Pitta and Rakta
• Reduces intravascular pressure and volume which will
reduce pain and swelling Reduce the breakage of RBC, in
turn reduces pigmentation and itching.
Dr Subham patra

40. PRACCHANA
 Prachanna is a technique of letting the vitiated blood out of the body from a
localized lesion in the superficial layer of the skin by making pricking wounds
with the help of a sharp, pointed surgical instrument.
 Prachanna is indicated when there is Sthanika (localized) congregation of
vitiated Dosha, along with Rakta. The blood is stagnated and coagulated in the
layers of skin is drained by Prachanna.
 In Prachanna blood is drained along with the stagnated fluids (Rasa and
Lasika) rich with the deranged Dosha. Every cut that is made in the skin drains
the area of about one Angula around it.
Dr Subham patra

41. PRACCHANA KARMA IN INDRALUPPTA
Dr Subham patra

42. THANK YOU
THANKYOU
Dr Subham patra