Raktamokshana (रक्तमोक्षणम्)

Raktamokshana is one of the 5 Panchakarmas practiced in Ayurveda. Raktamokshana literally means blood letting procedure. The vitiated 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. It is one of the shodhana (cleansing or detox) chikitsa described in Ayurveda. Indications, contraindications, types, eligibility criteria, procedure, effects and other relevant details on Raktamokshana have been described in Ayurveda literature.

Introduction

Raktamokshana is the unique para-surgical therapy which has references only in Ayurveda, raktamokshana is a treatment aspect where in “rakta” meaning blood when 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 or physician. Commonly called as blood detox therapy it has widespread advantages in various skin diseases as well as systemic disorders.

Raktamokshana is is primarily a treatment of choice for diseases where the rakta dhatu is vitiated with any of the 3 doshas namely vata, pitta and kapha. However, the tools or instruments and the procedure of Raktamokshana varies for as per the vitiating dosha. This is the basis for various types of raktamokshana procedures practiced in Ayurveda.

Etymology

In Vachasapatyam, the term Raktamokshanam has been explained in Samskrt as below,

रक्तमोक्षणं, क्ली, (रक्तस्य मोक्षणम् ।) शोणित- स्रावः । (Vachs)

Meaning: The procedure in which Shonit (samskrit term for blood, synonym for rakta) srava (means secretion or flow) happens is known as Raktamokshana.

Classification

The panchakarma therapy Raktamokshana is classified into various types based on the use of tools and the targeted dosha vitiating Rakta. These types and sub-types are listed below,

Classification of Raktamokshana procedure

Using Shastra (Using some surgical instrument)	Without Shastra (Using non-surgical tools)
Siravyadha (venesection)	Jalauka avacharana (leech therapy)
Pracchana (scraping)	Shringa avacharana (using horn)
	Alabu avacharana (using alabu fruit)
	Ghati yantra avacharana  (using pot)

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.

Indications

Rakmokshana is done primarily to remove the vitiated rakta dhatu out if the body. such necessity arises when there are certain medical conditions like,

(sush.sutr.25.10,12-15)M

mutravriddhi (hydrocele)

Dakodar (ascites)

vidradhi

kushta

sopha

arbuda

visarpa

granthi

stanyaroga

galashaluka etc

Contraindications

Contraindications (sush.shar.8.3)

Who are not fit for siravyadha,

Bala (child)

Vriddha (very old)

Garbhini (pregnancy)

Klaibya

Kasa

Shwasa

Sosha

Shranta

Kshatakshina

Pakshaghata

Murccha

Vamita

Ashthapita

Virikta

Madhyakarshita

Etc

Procedure

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

Purvakarma – 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) – 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.

Patient is informed and educated about the whole procedure, is asked to remain in good and pleasant environment, calm and happy.  

Pradhana karma (main procedure)

On the day of siravyadhana karma, abhyanga(massage) 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.

Different asanas are mentioned according to the vein chosen to puncture. (sush.shar.8.6)

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 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 shuddhi or purification is decided by Vaidya.

Patient is observed throughout the procedure for complications which if occurs medications are given immediately. Also observed for for ayoga(improper) and atiyoga (excessive) lakshana or symptoms and management is done or procedure is again planned accordingly.

Paschat karma (after procedure)

Post procedure care- 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 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)

PRACCHANA KARMA

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

Procedure

Purva karma

Pradhana karma

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)

Paschat karma

JALAUKA AVACHARANA

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.

Procedure (sush.sutr.13.21)

Purva karma –