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Raktamokshana is one of the 5 [[Panchakarmas (पञ्चकर्माणि)|Panchakarmas]] practiced in Ayurveda. Raktamokshana literally means blood letting procedure. The vitiated [[Rakta Dhatu (रक्त धातु)|rakta]] inside body which is causing various different illnesses and not responding to the general line of treatment with internal medicines is removed out of the body through this procedure. It is one of the shodhana (cleansing or detox) type of [[Chikitsa (चिकित्सा)|chikitsa]] described in Ayurveda. Indications, contraindications, types, eligibility criteria, procedure, effects and other relevant details on Raktamokshana have been described in Ayurveda literature in depth.  

Raktamokshana (रक्तमोक्षणम्) is one of the 5 [[Panchakarmas (पञ्चकर्माणि)]] practiced in Ayurveda. Raktamokshana literally means blood letting procedure. The vitiated [[Rakta Dhatu (रक्त धातु)|rakta (रक्तम्)]] inside body which is causing various different illnesses and not responding to the general line of treatment with internal medicines is removed out of the body through this procedure. It is one of the shodhana (शोधनम् | cleansing or detox) type of [[Chikitsa (चिकित्सा)|chikitsa (चिकित्सा | treatment)]] described in Ayurveda. Indications, contraindications, types, eligibility criteria, procedure, effects and other relevant details on Raktamokshana have been described in Ayurveda literature in depth.  

== Introduction ==

== परिचयः ॥  Introduction ==

Acharya Sushruta has given equal importance to Rakta dhatu like doshas. So much so that he believes that Rakta dhatu should be considered as the 4th Dosha in body. While praising the role of rakta in sustaining the life he says that,<blockquote>देहस्य रुधिरं मूलं रुधिरेणैव धार्यते | तस्माद्यत्नेन संरक्ष्यं रक्तं जीव इति स्थितिः ||४४|| (Su Su 14.44)</blockquote>Meaning: Rakta is the root of deha ([[Sharira (शरीरम्)|shariram]] / Physical body) and that is the only one which holds (sustians) this deha. Thus one should carefully guard Rakta since that is the life.  

Acharya Sushruta has given equal importance to Rakta dhatu (रक्त धातु) like doshas (दोषाः). So much so that he believes that Rakta dhatu should be considered as the 4th Dosha in body. While praising the role of rakta in sustaining the life he says that,<blockquote>देहस्य रुधिरं मूलं रुधिरेणैव धार्यते | तस्माद्यत्नेन संरक्ष्यं रक्तं जीव इति स्थितिः॥ (Su Su 14.44)</blockquote>Meaning: Rakta is the root of deha (देहम् / [[Sharira (शरीरम्)|shariram शरीरम्]] / Physical body) and that is the only one which holds (sustains) this deha (देहम्). Thus one should carefully guard Rakta since that is the life.  

Owing to this crucial role of rakta in maintaining the human body it becomes necessary to keep the rakta dhatu in healthy state. If it gets afflicted by any dosha it can certainly dispaly various signs and symptoms of diseases. In some instances when the impurities in rakta are so hugi when those cant be treated with medicines are need to taken out there has to be a way through which this can be facilitated. Raktamokshana thus provides the method and therapy to cleanse the Rakta dhatu.   

Owing to this crucial role of rakta in maintaining the human body it becomes necessary to keep the rakta dhatu in healthy state. If it gets afflicted by any dosha it can certainly display various signs and symptoms of diseases. In some instances when the impurities in rakta are so much when those cant be treated with medicines are need to taken out there has to be a way through which this can be facilitated. Raktamokshana thus provides the method and therapy to cleanse the Rakta dhatu.   

Raktamokshana is the unique para-surgical therapy which has references only in Ayurveda literature which dates back to 2000BC. Raktamokshana is a modality of treatment where in “rakta” meaning blood which is vitiated is let out of the body using surgical instruments (and non-surgical instruments) in certain quantities and in a controlled manner under the observation of a certified [[Vaidya (वैद्यः)|Vaidya]] or physician. Commonly called as blood detox therapy it has widespread advantages in various skin diseases as well as systemic disorders wherever the vitiated [[Rakta Dhatu (रक्त धातु)|rakta dhatu]] is involved. Rakta dhatu can get vitiated with any of the 3 [[Doshas (दोषाः)|doshas]] namely vata, pitta and kapha. The tools or instruments and the procedure of Raktamokshana varies as per the vitiating dosha. This is the basis for various types of raktamokshana procedures practiced in Ayurveda.  

Raktamokshana is the unique para-surgical therapy which has references only in Ayurveda literature which dates back to 2000BC. Raktamokshana is a modality of treatment where in “rakta” ([[Rakta Dhatu (रक्त धातु)|Rakta Dhatu  | रक्त धातु]]) meaning blood which is vitiated is let out of the body using surgical instruments (and non-surgical instruments) in certain quantities and in a controlled manner under the observation of a certified [[Vaidya (वैद्यः)]] or physician. Commonly called as blood detox therapy it has widespread advantages in various skin diseases as well as systemic disorders wherever the vitiated [[Rakta Dhatu (रक्त धातु)|rakta dhatu]] is involved. Rakta dhatu can get vitiated with any of the 3 [[Doshas (दोषाः)|doshas]] namely vata (वातः), pitta (पित्तम्) and kapha (कफः). The tools or instruments and the procedure of Raktamokshana varies as per the vitiating dosha. This is the basis for various types of raktamokshana procedures practiced in Ayurveda.  

== Etymology ==

== व्युत्पत्त्तिः ॥  Etymology ==

In Vachasapatyam, the term Raktamokshanam has been explained in Samskrit as below,<blockquote>रक्तमोक्षणं, क्ली, (रक्तस्य मोक्षणम् ।) शोणित- स्रावः । (Vachas)<ref>Vachaspatyam ([https://sa.wikisource.org/wiki/%E0%A4%B6%E0%A4%AC%E0%A5%8D%E0%A4%A6%E0%A4%95%E0%A4%B2%E0%A5%8D%E0%A4%AA%E0%A4%A6%E0%A5%8D%E0%A4%B0%E0%A5%81%E0%A4%AE%E0%A4%83/%E0%A4%B0 pg 4/076])</ref></blockquote>Meaning: The procedure in which Shonit (samskrit term for blood, synonym for rakta) srava (means secretion or flow) happens is known as Raktamokshana.

In Vachasapatyam, the term Raktamokshanam has been explained in Samskrit as below,<blockquote>रक्तमोक्षणं, क्ली, (रक्तस्य मोक्षणम् ।) शोणित- स्रावः । (Vachas)<ref>Vachaspatyam ([https://sa.wikisource.org/wiki/%E0%A4%B6%E0%A4%AC%E0%A5%8D%E0%A4%A6%E0%A4%95%E0%A4%B2%E0%A5%8D%E0%A4%AA%E0%A4%A6%E0%A5%8D%E0%A4%B0%E0%A5%81%E0%A4%AE%E0%A4%83/%E0%A4%B0 pg 4/076])</ref></blockquote>Meaning: The procedure in which Shonit (samskrit term for blood, synonym for rakta) srava (means secretion or flow) happens is known as Raktamokshana.

== Classification ==

== रक्तमोक्षणभेदाः॥  Classification ==

The panchakarma therapy Raktamokshana is classified into various types based on the use of tools and the targeted [[Doshas (दोषाः)|dosha]] vitiating [[Rakta Dhatu (रक्त धातु)|Rakta]].<ref>Sushruta Samhita (Sutrasthanam Adhyaya 13 Sutra 4)</ref><ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 26 Sutra 53)</ref>  These types and sub-types are listed below,  

The panchakarma therapy Raktamokshana is classified into various types based on the use of tools and the targeted [[Doshas (दोषाः)|dosha]] vitiating [[Rakta Dhatu (रक्त धातु)|Rakta]].<ref>Sushruta Samhita (Sutrasthanam Adhyaya 13 Sutra 4)</ref><ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 26 Sutra 53)</ref>  These types and sub-types are listed below,  

{| class="wikitable"

{| class="wikitable"

|+Classification of Raktamokshana procedure

|+Classification of Raktamokshana procedure

!Using Shastra  

!Using Shastra (शस्त्रम्)

(Using some surgical instrument)  

(Using some surgical instrument)  

!Without Shastra

!Without Shastra (अशस्त्रम्)

(Using non-surgical tools)

(Using non-surgical tools)

|-

|-

|Siravyadha (venesection)

|<nowiki>Siravyadha (सिराव्यधम् | venesection)</nowiki>

|Jalauka avacharana (leech therapy)

|<nowiki>Jalauka avacharana (जलौकावचरणम् | leech therapy)</nowiki>

|-

|-

|Pracchana (scraping)

|<nowiki>Pracchana (प्रच्छानम् | scraping)</nowiki>

|Shringa avacharana (using horn)

|<nowiki>Shringa avacharana (शृङ्गावचरणम् | using horn)</nowiki>

|-

|-

|

|

|Alabu avacharana (using alabu fruit)

|<nowiki>Alabu avacharana (अलाबु अवचरणम् | using alabu fruit)</nowiki>

|-

|-

|

|

|Ghati yantra avacharana  (using pot)

|<nowiki>Ghati yantra avacharana  (घटियंत्र अवचरणम् | using pot)</nowiki>

|}

|}

== Indications ==

== रक्तमोक्षण-अर्हाः॥  Indications ==

Rakmokshana is done primarily to remove the vitiated rakta dhatu out of the body. Such necessity arises when there are certain medical conditions like below wherein thus Raktamokshana is indicated.

Rakmokshana is done primarily to remove the vitiated rakta dhatu out of the body. Such necessity arises when there are certain medical conditions like below wherein thus Raktamokshana is indicated.

# Apachi (enlargement of glands)

# Apachi (अपची | enlargement of glands)

# Arbuda (tumor like growths)

# Arbuda (अर्बुद | tumor like growths)

# Arsha (piles/haemorrhoids)

# Arsha (अर्श | piles/haemorrhoids)

# Daha (burning sensation)

# Daha (दाह | burning sensation)

# Sopha (swelling)

# Sopha (शोफः | swelling)

# Dushta artava (menstrual disorders)

# Dushta artava (दुष्टार्तवम् | menstrual disorders)

# Kushta (skin disorders)

# Kushta (कुष्ठम् | skin disorders)

# Raktapitta (bleeding disorders)

# Raktapitta (रक्तपित्तम् | bleeding disorders)

# Tandra (malaise)

# Tandra (तन्द्रा | malaise)

# Vatarakta (arthritis)

# Vatarakta (वातरक्तम् | arthritis)

# Gaurava (heaviness)

# Gaurava (गौरवम् | heaviness)

# Pleeha roga (spleen related diseases)

# Pleeha roga (प्लीहारोगाः | spleen related diseases)

# Yakrit roga (liver disorders)

# Yakrit roga (यकृतरोगाः | liver disorders)

# Raktaja vikara (blood vitiation and disorders) Etc<ref>Sushruta Samhita (Sutrasthanam Adhyaya 25 Sutra 10-12)</ref> <ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 27 Sutra 3-5)</ref>  

# Raktaja vikara (रक्तजविकाराः | blood vitiation and disorders) Etc<ref>Sushruta Samhita (Sutrasthanam Adhyaya 25 Sutra 10-12)</ref> <ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 27 Sutra 3-5)</ref>

Acharya Sushruta has also praised the efficacy of Raktamokshana by quoting that if Raktamokshana is done as a preventive therapy in those who are prone to Twak-doshas (skin related diseases),  or tendencies to develop Granthi (tumors), Shopha (swellings) and Rakta dhatu related disorders, they can prevent the occurrence of these.<blockquote>त्वग्दोषा ग्रन्थयः शोफा रोगाः शोणितजाश्च ये | रक्तमोक्षणशीलानां न भवन्ति कदाचन ||३४|| (Sush. Samh. 14.34)<ref>Sushruta Samhita (Sutrasthanam Adhyaya 14 Sutra 34)</ref></blockquote>

Acharya Sushruta has also praised the efficacy of Raktamokshana by quoting that if Raktamokshana is done as a preventive therapy in those who are prone to Twak-doshas (त्वग्दोषाः | skin related diseases),  or tendencies to develop Granthi (ग्रन्थी | tumors), Shopha (शोफाः | swellings) and Rakta dhatu related disorders, they can prevent the occurrence of these.<blockquote>त्वग्दोषा ग्रन्थयः शोफा रोगाः शोणितजाश्च ये | रक्तमोक्षणशीलानां न भवन्ति कदाचन ||३४|| (Sush. Samh. 14.34)<ref>Sushruta Samhita (Sutrasthanam Adhyaya 14 Sutra 34)</ref></blockquote>

== Contraindications ==

== रक्तमोक्षण-अनर्हाः॥  Contraindications ==

In Raktamokshana vitiated blood is removed out of the body. Rakta in nonvitiated state protects and holds the body and thus called the root of body and life. Therefore its removal should be done with utmost care. If done inappropriately or when contraindicated it has potential to develop fatal complications hence contraindications to this procedures should be properly known. There are certain physiological and pathological conditions wherein the procedure of Raktamokshana is not recommended. The states where Raktamokshana is contraindicated are listed below,<ref>Sushruta Samhita (Sutrasthanam Adhyaya 8 Sutra 17)</ref> <ref>Ashtangaa Hrudayam (Sutrasthanam Adhyaya 27 Sutra 6-8)</ref>

In Raktamokshana vitiated blood is removed out of the body. Rakta in non-vitiated state protects and holds the body and thus called the root of body and life. Therefore its removal should be done with utmost care. If done inappropriately or when contraindicated it has potential to develop fatal complications hence contraindications to this procedures should be properly known. There are certain physiological and pathological conditions wherein the procedure of Raktamokshana is not recommended. The states where Raktamokshana is contraindicated are listed below,<ref>Sushruta Samhita (Sutrasthanam Adhyaya 8 Sutra 17)</ref> <ref>Ashtangaa Hrudayam (Sutrasthanam Adhyaya 27 Sutra 6-8)</ref>

# Baala (children)

# Baala (बालाः | children)

# Bhiru(who is afraid)

# Bhiru(भिरु | who is afraid)

# Daurbalya (weak)

# Daurbalya (दुर्बलाः | weak)

# Garbhini(pregnant)

# Garbhini(गर्भिणी | pregnant)

# Pandu (anaemia)

# Pandu (पाण्डु | anaemia)

# Pakshaghata (paralysis)

# Pakshaghata (पक्षाघातम् | paralysis)

# Vriddha (elderly)

# Vriddha (वृद्धाः | elderly)

# Person in whom it is indicated but the pre-procedures like Snehanam (oleation therapy) and swedanam (sudation) are not done or overdone.  

# Person in whom it is indicated but the pre-procedures like Snehanam (स्नेहनम् | oleation therapy) and swedanam (स्वेदनम् |  sudation) are not done or overdone.

# Shwasa and kasa ( medical conditions presented as dyspnoea or coughing)

# Shwasa (श्वासः) and kasa (कासः) (medical conditions presented as dyspnoea or coughing)

# Srvanga shotha (generalised swelling all over the body)

# Srvanga shotha (सर्वाङगशोथः | generalised swelling all over the body)

# Related to the weather or time to perform Raktamokshanam- In extremely cold or hot weather, excessively windy or cloudy weather  

# Related to the weather or time to perform Raktamokshanam- In extremely cold or hot weather, excessively windy or cloudy weather  

== Siravyadha (venesection method of Raktamokshana) ==

== सिराव्यधम्॥  Siravyadha (venesection method of Raktamokshana) ==

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>

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 (कुष्ठ | skin diseases) , shopha (शोफः | certain types of swellings), arbuda (अर्बुद | tumours), visarpa (वीसर्प | erysipelas), granthi (ग्रन्थी | 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 (क्लैब्यम् | impotency), pakshaghata (पक्षाघातः | paralysis like nurological disorders), extreme wekness, debilitating diseases, giddiness, tiredness sivavyadha is contraindicated. <ref>Sushruta Samhita (Sharirasthanam Adhyaya 8 Sutra 3)</ref>

=== How Siravyadha is performed? ===

=== सिराव्यधकर्मम्॥  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.  

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

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

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

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.   

The preparation starts 3-5 days before the actual procedure. It includes snehapana (स्नेहपानम्), 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.   

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.

Diet- There are some specific diet plans which 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 (यवागु | rice gruel) is given to patient to avoid giddiness.

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

==== प्रधान कर्मम्॥  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.

[[Abhyanga (अभ्यङ्गम् )|Abhyanga (अभ्यङ्गम्)]] and swedana (स्वेदनम्)- 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.

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.

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 (शुद्धिः) 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 needs to be taken. Yusha (यूषम्), yavagu (यवागु), peya (पेया) 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>  

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

== प्रच्छान कर्मम्॥  Prachhana Karma (Scraping method of Raktamokshana) ==

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.

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 (बन्धनम् | 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 capiप्रllaries 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.

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

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

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.  

Jalauka (जलौका) 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]] (सुश्रुत संहिता). 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 ===

=== पद्धतिः ॥  Procedure ===

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>  

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.  

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

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

* 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.

* 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.

* 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" />  

* 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" />  

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

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

“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.

“Shringa” (शृङ्गम्) means horn and “avacharana” (अवचारणम्) 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 suction.

=== Procedure ===

=== पद्धतिः॥  Procedure ===

* 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.

* 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.  

* 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 amount of blood is removed through this type of a procedure and thus in patients who are sukumara (सुकुमारः | delicate) this kind of bloodletting is performed.

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

* 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.

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

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

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

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

== अलाबु अवचरणम्॥  Alabu avacharana (Traditional Cupping therapy for Raktamokshana) ==

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>

Alabu (अलाबु) 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 ===

=== पद्धतिः॥  Procedure ===

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

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

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

== घटीयंत्र अवचरणम्॥ 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 method is same as alabu therapy. Only ghati or pot is used instead of alabu.

This is a type of bloodletting procedure using “ghati” (घटी) 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.

== Practical considerations ==

== Practical considerations ==

* Raktamokshana is done in consideration with rogi bala (strength of patient) and strength of disease.  

* Raktamokshana is done in consideration with rogi bala (बलम् | strength of patient) and strength of disease.

* The type of raktamokshana procedure suitable for a particular patient or diseased condition is selected basedon multiple factors like vitiating dosha, affected part of body, strength of the patient etc.  

* The type of raktamokshana procedure suitable for a particular patient or diseased condition is selected basedon multiple factors like vitiating dosha, affected part of body, strength of the patient etc.  

* Raktamokshana is the choice of treatment when the vitiated rakta dhatu doesnt respond to the regular line of shamana chikitsa or the condition keeps on relapsing indicting that rakta is aggravated to a level which can not be balanced unless the vitiated rakt adhatu is removed out of the body.  

* Raktamokshana is the choice of treatment when the vitiated rakta dhatu doesnt respond to the regular line of shamana chikitsa or the condition keeps on relapsing indicting that rakta is aggravated to a level which can not be balanced unless the vitiated rakt adhatu is removed out of the body.