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== Siravyadha (venesection method of Raktamokshana) ==

== Siravyadha (venesection method of Raktamokshana) ==

siravyadha – literally means venesection, a type of ayurvedic procedure where certain vein is punctured, so the blood can flow for certain period for eradication of vitiated rakta and pitta dosha. This is a controlled procedure and occurs under the observation of a Vaidya or physician.

Siravyadha is a type of raktamokshana wherein the vitiated blood is let out of the body by puncturing a vein (also known as venesection method). The blood flows for certain period till eradication of vitiated rakta and vitiating [[Doshas (दोषाः)|doshas]] contained in it. This is a controlled procedure and performed under the observation of a skilled Vaidya or physician. This method of raktamokshana is usually indicated in conditions like kushtha (skin diseases) , shopha (certain types of swellings), arbuda (tumours), visarpa (erysipelas), granthi (nodules) etc.<ref>Sushruta Samhita (Sutrasthanam Adhyaya 25 Sutra 10-15)</ref> However there are some contraindications for this procedure as well. Since through this procedure significant amount of blood can flow out of the body it is not suitable in children, old age, pregnant ladies. Also in conditions like klaibya (impotency), pakshaghata (paralysis like nurological disorders), extreme wekness, debilitating diseases, giddiness, tiredness sivavyadha is contraindicated. <ref>Sushruta Samhita (Sharirasthanam Adhyaya 8 Sutra 3)</ref>

=== Indications ===

=== How Siravyadha is performed? ===

Siravyadha is done under the exper supervision of a learned [[Vaidya (वैद्यः)|vaidya]]. The patient is first thoroughly examined by ashtavidha pariksha and dashavidha pariksha. Apart from these blood pressure, temperature etc are also examined. If required certain biochemical test are also conducted.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

=== Procedure of Siravyadha ===

The whole procedure is divided in three sections which are purva karma, pradhana karma and paschat karma

 

it includes the few procedures which are essential to be done before the siravyadhana karma or venesection.

 

Collection of materials- materials and equipment’s required for siravyadhana karma are kept ready before hand, this includes cold and hot water, cotton swabs, gauze, needles, oil or ghee etc. and medicines for the management of complications if any.

 

Patient is examined with the help of parameters like ashtavidha pariksha and dashavidha pariksha. Apart from these blood pressure, temperature etc are also examined. If required certain biochemical test are also conducted.

==== Atura siddhata (preparation of patient) ====

==== Atura siddhata (preparation of patient) ====

patient or individual who is fit for siravyadha is prepared for the procedure 2-3 days before the actual siravyadhana karma. It includes snehapana, which means patient or individual is administered ghee or oil orally in increasing pattern until the Vaidya decides for a period of 2 to 3 days.  normal light food as diet should be given for three days of snehapana. And on the day of siravyadha just before the karma yavagu(rice gruel) is given to patient to avoid giddiness.

The preparation starts 3-5 days before the actual procedure. It includes snehapana, which means patient or individual is administered ghee or oil (depending on his medical condition) orally in increasing pattern until the Vaidya decides for a period of 2 to 3 days.   

 

 

 

A vaidya selects the vein to be punctured. The vein is raised by tapping on it with fingers. A needle is carefully inserted, and the vitiated blood is let flow.

Diet- There are some specific diet plans whic need to be followed while taking the ghee or oil and even just a day before the actual procedure. And on the day of siravyadha just before the karma yavagu (rice gruel) is given to patient to avoid giddiness.

The quantity of the blood is decided by the Vaidya based on certain parameters mentioned in treatises. (sush.shar.8.16)

==== Pradhana karma of siravyadha ====

Abhyanga and swedana- On the day of siravyadhana karma, [[Abhyanga (अभ्यङ्गम् )|abhyanga]] is done with oil and swedana or sudation is performed. This is either whole body or affected part only, which is decided by the Vaidya.

Based on the quantity, quality, colour etc of blood and symptoms shuddhi or purification is decided by Vaidya.

The patient is given a specific position depending upon the vein location selected to puncture.  A vaidya selects the vein to be punctured. The vein is raised by tapping on it with fingers. A needle is carefully inserted, and the vitiated blood is let flow. The quantity of the blood to let flow is decided by the Vaidya based on certain parameters mentioned in treatises. (sush.shar.8.16) Based on the quantity, quality, colour etc of blood and symptoms, level of shuddhi or purification is decided by Vaidya. In this entire procedure the patient is continuously monitored to forsee the complications if any arise and also to decide the level of purification achieved through the process. Once the desired amount of blood is removed out the procedure is stopped by Vaidya. A tight dressing is applied if needed to stop the bleeding. Gentle massage is done around the punctured area.

Light food, which is easily digestible, mildly unctuous, devoid of sourness needs to be taken. Yusha, yavagu, peya are administered mostly. Patient is advised to avoid exercise, cold, windy exposure, day sleep, pungent alkaline substances in food, excess talking, grief etc for one month.<ref>Sushruta Samhita (Sharirasthanam Adhyaya 8 Sutra 6-16)</ref>

 

 

Light food, which is easily digestible, mildly unctuous, devoid of sourness is intaken. Yusha, yavagu, peya are administered mostly.Patient should avoid exercise, cold, windy exposure, day sleep, pungent alkaline substances in food, excess talking, grief etc for one month. (sush.shar.8.16)

== Prachhana Karma (Scraping method of Raktamokshana) ==

== Prachhana Karma (Scraping method of Raktamokshana) ==

It’s a type of raktamokshana where in the area affected is scraped or lacerated with sharp instruments like needle etc.

The term prachhana means scraping or lacerating. Thus a type of raktamokshana wherein the vitiated blood is let out of the body by performing scraping or creating lacerations over the affected part is known as prachhana karma. After making the necessary preparations and assessing the patient thoroughly prachhana is planned. The affected area is cleaned well. Bandhana (ligation) is done above the site of pracchana. A sharp instrument like needle or similar surgical tool is taken and scraping or scarring is done over the surface of skin to avoid injuries to muscle, tendons bones, veins. Only the superficial capillaries get scarred and bleeding occurs. Pracchana is done in a certain manner, straight, not too superficial not too deep not in any oblique way. <ref>Sushruta Samhita (Sutrasthanam Adhyaya 14 Sutra 26)</ref> The blood can let flow for certain period until the Vaidya decides which is based on certain parameters. This whole procedure occurs under the thorough observation of Vaidya in controlled environment. The wound is lastly cleaned and bandaged using medicated oil or ghee.

 

 

Materials and equipments required for the procedure is kept ready before hand. Medicines required for complications if any are also kept ready.

 

Patient is assessed carefully and thoroughly using parameters lile dasha vidha(prakriti, dosha etc) and ashtavidha pariksha(naadi, bladder and bowel movements etc). Also, blood pressure, temperature, pulse etc are also examined.

 

Patient is well informed about the procedure beforehand and is required to be in a good and pleasant environment.

 

The affected area should be cleaned well.

 

Bandhana(ligation) is done above the site of pracchana.

 

A sharp instrument like needle for example is taken and scraping or scarring is done over the surface of skin to avoid muscle, tendons bones, veins.  

 

Only the superficial capillaries get scarred, and bleeding occurs.

 

Pracchana is done in a certain manner, straight, not too superficial not too deep not in any oblique way. (sush.sutr.14.26)

 

The blood can let flow for certain period until the Vaidya decides which is based on certain parameters.

 

This whole procedure occurs under the thorough observation of Vaidya in controlled environment.

 

The wound is cleaned and bandaged using medicated oil or ghee.  

== Jalauka avacharana (Leech therapy for Raktamokshana) ==

== Jalauka avacharana (Leech therapy for Raktamokshana) ==