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

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

Commonly known as leech therapy or hirudotherapy, this is a procedure mentioned only in Ayurveda. A particular type of leech is chosen for the removal of vitiated blood from the body. The whole procedure takes pace in a controlled manner under the observation of a Vaidya. Jalauka avacharana has high efficacy in treatment of blood related disorders and thus is one of the supreme treatment aspects in management of it.

Jalauka is the samskrit term which refers to the leech. It is a slimy blood sucking ectoparasite that live in water. Jalauka or leeches are of many different types. Some are also toxic in nature while some of them are medicinal. Only certain types of jaluaka having therapeutic or medicinal benefit are selected to be used for raktamokshanam or blood letting therapy in Ayurveda. Thus blood letting with the help of leeches is known as leech therapy or hirudotherapy.  This is a unique procedure mentioned only in [[Sushruta Samhita (सुश्रुतसंहिता)|Sushrut Samhita]]. Jalauka removes the vitiated blood from the body. The whole procedure takes pace in a controlled manner under the observation of a Vaidya. Jalauka avacharana has high efficacy in treatment of blood related disorders and thus is one of the supreme treatment aspects in management of it. It is generally selected method for raktamokshana when the vitiated blood affects small limited part of the body which means it is used as a local treatment. It is generally not indicated in systemic disorders spread all across the body caused by vitiated rakta dhatu.  

=== Procedure ===

=== Procedure ===

(sush.sutr.13.21)

In this method along with the patient, the jalaukas are also need to be prepared. Types of jalaukas and maintenance of jaluakas has been described in depth in Sushruta samhita. <ref name=":0">Sushruta Smahita (Sutrasthanam Adhyaya 13)</ref>

* The area or selected site for raktamokshana of affected body part is prepared by abhyanga (applications of oil), swednam (sudation /fomentation) for ease of [[Doshas (दोषाः)|dosha]] nirharana (expulsion of morbid doshas) in the form of rakta mokshana. After swedana “neem” churna (powder of Azardiracta indica) is rubbed gently. The procedure and preparation may differ as per the practice and experience of a vaidya.

Collection of materials- equipment’s and leeches which are to be used in the procedure are kept ready. The jalauka or leech is prepared as well by keeping it in turmeric water for certain period. certain Equipments and medicines for complications if any are also kept ready like cotton gauge, turmeric powder, towels etc.

* This takes place to remove any dead superficial skin. Also helps easy attachment of jalauka or leech.

 

* In this method of raktamokshanam, the prepared jalauka(leech) is held with a small clean cloth or cotton etc and placed on the desired site. The jalauka when applied attaches itself to the skin surface and starts intaking blood. Attempts are made to make jalauka get attached to the site. Once it attaches, drops of cold water is poured continuously to keep it wet and active since it lives in the water. Later after the leech starts sucking blood [[Vaidya (वैद्यः)|Vaidya]] observes the whole process. There are few parameters which decides whether the jalauka(leech) is attached appropriately, when to stop, how to stop therapy and many other. These are decided by the Vaidya itself. For example, when the leech gets attached, it attains a horse-shoe shape. The sucking action is like the breathing pattern of a human.

Patient is examined thoroughly using parameters like dashavisha(prakriti, dosha, disease etc) and ashta vidha pariksha (naadi, bowel, bladder etc). also pulse blood pressure etc is examined.

* There are certain signs and symptoms based on which a Vaidya decides whether to stop the therapy or not and whether necessary quantity of vitiated blood has been removed from the body appropriately. After the therapy, jalauka (leech) is removed by sprinkling some herb/salt/turmeric over the mouth of leech.  

 

* After detaching the leech, the site is wiped with clean cotton, and might be washed with herbal decoction. Later medicated ghee is applied at the site and compression is done.  

Snehana and swedana- snehana in the form of local abhyanga is done at the site where therapy is to be done. After abhyanga, local fomentation or swedanam is done for ease of dosha nirharana (expulsion of morbid doshas) in the form of rakta mokshana. After swedana “nimba” churna (powder of Azardiracta indica) is rubbed gently. This takes place to remove any dead superficial skin. Also helps easy attachment of jalauka or leech.

* Leech is also taken care of after the procedure. Jalauka (leech) is made to vomit the vitiated blood that it had sucked during the procedure. This is also done skillfully, so as the leech should not be harmed. the leech is made to vomit the entire quantity of sucked blood, this is important step done by Vaidya to avoid disease that might affect leech. <ref name=":0" />

 

Patient or individual is well acknowledged about the procedure before the therapy. Clean clothes, good and pleasant atmosphere is maintained before, during and after the procedure.

 

The prepared jalauka(leech) is held with a small clean cloth or cotton etc and placed on the desired site. The jalauka when applied attaches itself to the skin surface and starts intaking blood.  

 

Jalauka(leech) if not attached by itself drop of milk, honey is poured. Small scrapping with needle is done as well for easy access of the jalauka(leech).

 

Drops of cold water is poured continuously over the site for cooling action if required.

 

Later after the leech starts sucking blood Vaidya observes the whole process.

 

There are few parameters which decides whether the jalauka(leech) is attached appropriately, when to stop, how to stop therapy and many other. These are decided by the Vaidya itself. For example, when the leech gets attached, it attains a horse-shoe shape. The sucking action is like the breathing pattern of a human.  

 

There are certain signs and symptoms based on which a Vaidya decides whether to stop the therapy or not,and vitiated blood has been removed from the body appropriately.  

 

After the therapy, jalauka (leech) is removed by sprinkling saindhava(rock salt) over the mouth of leech.

 

After detaching the leech, the site is wiped with clean cotton, and washed with panchavalkala Kashaya (herbal decoction). Later “shatadhauta ghrita” is applied at the site and compression is done.

 

 

Leech is also taken care of after the procedure. Jalauka (leech) is made to vomit the vitiated blood in taken during the procedure. This is also done skilfully, so as the leech should not be harmed. the leech is made to vomit the entire quantity of sucked blood, this is important step done by Vaidya to avoid disease that might affect leech. (sush.sutr.13.18)

== Shringa Avacharana (Suction therapy using cow's horn for Raktamokshana) ==

== Shringa Avacharana (Suction therapy using cow's horn for Raktamokshana) ==

“Shringa” means horn and “avacharana” means application

“Shringa” means horn and “avacharana” means application. Thus, Shringavacharana literally translates to application of horn. Precisely, shringa avacharana means blood letting with the help of cow’s horn. But now a days, an empty syringe is used in the place of cow's horn of which the anterior 1/5th part is removed to facilitate suciton.

 

Thus, it literally translates to application of horn”, precisely, shringa avacharana means blood letting with the help of cow’s horn. But now a days, an empty syringe is used of which the anterior 1/5th part is removed.  

=== Procedure ===

=== Procedure ===

A 5 ml syringe is taken, and its anterior 1/5th part is removed.  It is placed carefully at the site of pracchana in such a way that the anterior part lies on the skin surface and the piston part towards the Vaidya or physician.  

* Once the patient screening and examination is thoroughly done the procedure is planned. Usually done to treat a localized affliction and not for generalized health conditions. Initially the area where blood letting is to be done is cleaned and dried thoroughly. Pracchana karma (see above sections for details) or scraping with needle is done at the site where shringa avacharana is to be done.

 

* A syringe prepared to perform raktmaokshan is kept on the site and the piston is pulled to slowly to create a negative pressure. This mechanism draws blood inside the syringe. Very little amoun tof blood is removed through this type of a procedure and thus in patients who are sukumara (delicate) this kind of bloodletting is performed.  

The piston is closed before placing the syringe. After the application the piston is pulled slowly to create a negative pressure in the vacuum. This mechanism draws blood inside the syringe.

* The syringe is removed, and the wound is bandaged with medicated ghee.

 

* The shringa or horn itself contains vata pacifying properties, thus when this method is done classically there are far higher results, but with syringe the results achieved are quite clos ethe original method.

Approx. 2-5 ml of blood is drawn with this therapy. Thus, in patients who are sukumara (sensitive) this kind of bloodletting is performed.

* This whole procedure requires skill of a [[Vaidya (वैद्यः)|Vaidya]] and occurs under the strict observation of a Vaidya.

 

The syringe is removed, and the wound is bandaged with herbal ghee (eg. Jatyadi ghruta).

 

The shringa or horn itself contains vata shamana properties, thus when this this method is done classically there are far higher results, but with syringe the effects remain nearly same.

 

This whole procedure requires skill of a Vaidya and occurs under the strict observation of a Vaidya.

== Alabu avacharana (Traditional Cupping therapy for Raktamokshana) ==

== Alabu avacharana (Traditional Cupping therapy for Raktamokshana) ==

Alabu is a fruit cum vegetable which is white in colour and soft in texture, more commonly known as bottle gourd (Lagenaria vulgaris). This is a type of bloodletting where dried alabu (bottle gourd) is used and vacuum is created using ignited candle to draw blood thus is a unique and less common bloodletting procedure.

Alabu refers to a fruit cum vegetable which is white in color and soft in texture, more commonly known as bottle gourd (Lagenaria vulgaris). This is a type of bloodletting where dried alabu (bottle gourd) is used and vacuum is created using ignited candle to draw vitiated blood thus is a unique but at the same time less commonly practiced bloodletting procedure.<ref>Sushruta Samhita (Sutrasthanam Adhyaya 13 Sutra 8)</ref>

=== Procedure ===

=== Procedure ===

All the materials and equipment’s which are required for the procedure are kept ready beforehand. This includes, cotton gauge, needle, bandages etc.

All the materials and equipment’s which are required for the procedure are kept ready beforehand.

 

Alabu phala (bottle gourd) is dried and the contents are emptied. Later a circular small hole is made at one end.

Alabu phala (bottle gourd) preparation: It needs to be dried and the contents emptied to make it eligible to be used for procedure. Later a circular small hole is made at one end.

The site for alabu application is scraped with needle, minute laceration is created performing pracchana karma.  

The site for alabu application is scraped with needle, minute laceration is created performing pracchana karma.  

Later the wound is cleaned and bandaged with herbal ghee.  

Later the wound is cleaned and bandaged with herbal ghee.  

This is not a very common procedure and done in a controlled environment under the observation of a Vaidya.

This is not a very common procedure and done in a controlled environment under the observation of a skilled Vaidya.

 

== Ghati Yantra Avacharana (Suction therapy using pot for Raktamokshana) ==

== Ghati Yantra Avacharana (Suction therapy using pot for Raktamokshana) ==

This is a type of bloodletting procedure using “ghati” meaning pot. Here a vacuum is created using ignited candle and using negative pressure blood is drawn.

This is a type of bloodletting procedure using “ghati” meaning pot. Here a vacuum is created using ignited candle and using negative pressure blood is drawn. This method is same as alabu therapy. Only ghati or pot is used instead of alabu.

 

This method is same as alabu therapy. Only ghati or pot is used instead of alabu.

== Practical considerations ==

== Practical considerations ==

Raktamokshana is done in various sittings, which means therapy is done until the Vaidya decides whether doshas have been expelled out appropriately.

* Raktamokshana is done in various sittings, which means therapy is done until the Vaidya decides whether doshas have been expelled out appropriately or not.

== Mode of action ==

== Mode of action ==

Although blood letting is also known to modern medical system, the application of it in it and in Ayurveda is quite different. Various methods employed in raktamokshana in Ayurveda are not in practice in modern medical science e.g. jalaukavacharana. There are certain researches which have tried to find out the plausible mechanism of action in various types of Raktamokshana procedure. <ref name=":1">Abdualkader AM, Ghawi AM, Alaama M, Awang M, Merzouk A. Leech therapeutic applications. ''Indian J Pharm Sci''. 2013;75(2):127-137.</ref>

 

 

(Indian journal of pharmaceutical sciences, Leech Therapeutic applications)

 

(Dr. vasant c patil,principles and practice of panchakarma fifth edition, chaukhamba publications, chap 15th page no. 586,604)

 

Systemic bloodletting is restricted to few conditions for e.g., Polycythaemia, hemochromatosis, but Raktamokshana has shown its miraculous effects in many diseases.  

 

Bloodletting in any form requires removal of blood at a superficial level, might be from capillaries or superficial distribution of veins. Raktamokshana removes the old, damaged blood cells and helps formation of new, this reduces the workload on liver and spleen.

 

Removal of small quantities of blood, reduces volume of blood from body which directly impacts the pressure of blood over the blood vessels and heart.

 

In conditions of necrosis, or graft implantations, leeches or raktamokshana is used to establish adequate blood supply locally.

Many studies have found that leeches have various bioactive molecules in their secretions (e.g., Hirudin). These molecules have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant functions and many others.

Many studies have found that leeches have various bioactive molecules in their secretions (e.g., Hirudin). These molecules have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant functions and many others. Leech is a distinct example of an invertebrate, which possesses a highly developed mechanism by which they prevent blood clotting. There are many studies stating the anticancer effects of leech saliva extracts. Since coagulation is related to metastasis and tumour progression, blocking the cascade can have an antitumour effect.<ref name=":1" />

Leech is a distinct example of an invertebrate, which possesses a highly developed mechanism by which they prevent blood clotting. There are many studies stating the anticancer effects of leech saliva extracts. Since coagulation is related to metastasis and tumour progression, blocking the cascade can have an antitumour effect.

Systemic bloodletting is restricted to few conditions for e.g., Polycythaemia, hemochromatosis in modern medical science, but Raktamokshana has shown its miraculous effects in many diseases. The major difference behind the applicability of this procedure in 2 streams is that, modern medicine looks at it as a quantitative removal of blood while Ayurveda considers this procedure as a purification by eliminating rakta dhatu vitiated by doshas and not as blood. The difference between blood and rakta dhatu makes the huge difference between perspectives of Ayurveda and modern medical system to look at the blood letting procedure. Bloodletting in any form requires removal of blood at a superficial level, might be from capillaries or superficial distribution of veins. Raktamokshana removes the old, damaged blood cells and helps formation of new, this reduces the workload on liver and spleen. Removal of small quantities of blood, reduces volume of blood from body which directly impacts the pressure of blood over the blood vessels and heart. In conditions of necrosis, or graft implantations, leeches or raktamokshana is used to establish adequate blood supply locally.<ref>Principles and practice of panchakarma fifth edition by Dr. vasant c patil, Chaukhamba publications, chap 15th page no. 586,604</ref>

== References ==

== References ==

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[[Category:Ayurveda]]

[[Category:Ayurveda]]