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|title=Raktamokshana

|title=Raktamokshana

|titlemode=append

|titlemode=append

|keywords=Raktamokshana,Raktamokshana in ayurveda,Raktamokshana meaning,Raktamokshana Definition,Charak samhita,carakasamhitaonline, Indian System of Medicine, Bloodletting therapy, Leeach therapy, venesection

|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurved, Raktamokshana, Raktamokshana in ayurveda, Raktamokshana meaning, Asravisruti, shonitamokshana, raktanirharana, raktasravana, raktaharana, Indications of bloodletting therapy, Contraindications of bloodletting therapy, bloodletting Classification, Puncturing (pracchana), Venesection (siravyadha), Leech therapy (jalaukavacharana), Assessment of therapy

|description=Bloodletting is one of the five Panchakarma procedures mainly indicated in disorders due to excess vitiation of rakta and pitta dosha

|description=The word raktamoksha or raktamokshana literally means ‘to release blood’

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=carak samhita

|image_alt=charak samhita

|type=article

|type=article

}}

}}

{{Infobox

{{Infobox

|label6 = Date of first publication:

|label6 = Date of first publication:

|data6 = December 26, 2020

|data6 = December 26, 2020

|label7 = DOI

|label7 = DOI

|data7 =  Under process

|data7 =  [https://doi.org/10.47468/CSNE.2020.e01.s09.036 10.47468/CSNE.2020.e01.s09.036]

 

}}

}}

==Synonyms==

==Synonyms==

 

Asravisruti, shonitamokshana, raktanirharana, raktasravana, raktaharana etc.

Asravisruti, shonitamokshana, raktanirharana, raktasravana, raktaharana etc.

*Pregnant women [Su.Sa.Sutra Sthana.14/24]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

*Pregnant women [Su.Sa.Sutra Sthana.14/24]<ref name= Susruta> Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>

*In too cold and too hot climate [Su.Sa.Sutra Sthana.14/27]<ref name=Susruta/> [Su.Sa.Sharira Sthana.8/7]<ref name=Susruta/>

*In too cold and too hot climate [Su.Sa.Sutra Sthana.14/27]<ref name=Susruta/> [Su.Sa.Sharira Sthana.8/7]<ref name=Susruta/>

*Immediately after other panchakarma therapies[A.H. Sutra Sthana.27/6-8]<ref name=Hridaya/>

*Immediately after other panchakarma therapies [A.Hr. Sutra Sthana.27/6-8]<ref name=Hridaya/>

==Classification==

==Classification==

#Without surgical instruments (ashastra)

#Without surgical instruments (ashastra)

Bloodletting with surgical instruments is of two types[Su.Sa.Sutra Sthana.14/25]<ref name=Susruta/>

Bloodletting with surgical instruments is of two types [Su.Sa.Sutra Sthana.14/25]<ref name=Susruta/>

*Puncturing (pracchana)

*Puncturing (pracchana)

*Venesection (siravyadha)

*Venesection (siravyadha)

*Application of pot like instrument (ghatiavacharana)

*Application of pot like instrument (ghatiavacharana)

Nowadays, indigenous methods like using animal horns (shringaavacharana), gourd (alabuavacharana) and pot (ghati) are rarely used in practice. These might have been prevalent during ancient times. [Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.H.Sutra Sthana.26/53-55]<ref name=Hridaya/> In current times, the most common methods for bloodletting are puncturing, leech therapy and venesection. These three methods are described in details.

Nowadays, indigenous methods like using animal horns (shringaavacharana), gourd (alabuavacharana) and pot (ghati) are rarely used in practice. These might have been prevalent during ancient times. [Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.Hr.Sutra Sthana.26/53-55]<ref name=Hridaya/> In current times, the most common methods for bloodletting are puncturing, leech therapy and venesection. These three methods are described in details.

===Puncturing (pracchana)===

===Puncturing (pracchana)===

   

   

Pracchana is indicated in patients with good strength and if blood is accumulated locally or in clotted state.[Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.H.Sutra Sthana.26/53-55]<ref name=Hridaya/>

Pracchana is indicated in patients with good strength and if blood is accumulated locally or in clotted state.[Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.Hr.Sutra Sthana.26/53-55]<ref name=Hridaya/>

====Procedure====

====Procedure====

===Venesection (siravyadha)===

===Venesection (siravyadha)===

Siravyadha is indicated in the following conditions [Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.H.Sutra Sthana.26/53-55]<ref name=Hridaya/>

Siravyadha is indicated in the following conditions [Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.Hr.Sutra Sthana.26/53-55]<ref name=Hridaya/>

*If there is generalized vitiation of blood.  

*If there is generalized vitiation of blood.  

*In patients with good physical and mental strength.  

*In patients with good physical and mental strength.  

*Immediately after purificatory procedures like therapeutic emesis, purgation, enema etc. [Su.Sa.Sharira Sthana 8/3]<ref name=Susruta/>

*Immediately after purificatory procedures like therapeutic emesis, purgation, enema etc. [Su.Sa.Sharira Sthana 8/3]<ref name=Susruta/>

*In too cold and hot climatic conditions.

*In too cold and hot climatic conditions.

*In the diseases in which bloodletting is contraindicated [Su.Sa.ShariraSthana 8/7]<ref name=Susruta/> as mentioned above.  

*In the diseases in which bloodletting is contraindicated [Su.Sa.Sharira Sthana 8/7]<ref name=Susruta/> as mentioned above.  

====Procedure====

====Procedure====

Procedure of venesection with respect to site:

Procedure of venesection with respect to site:

Venesection is done in a comfortable position either sitting or lying down. The torniquet is tied above the site of venesection. The site of puncture is cleaned, and superficial visible vein is punctured to let the blood out. The method of venesection in various sites like head, legs, arms, pelvis, back, shoulder, abdomen, chest, flanks, penis (erected), tongue, palate and root of teeth is described. [Su.Sa.ShariraSthana 8/8]<ref name=Susruta/>

Venesection is done in a comfortable position either sitting or lying down. The torniquet is tied above the site of venesection. The site of puncture is cleaned, and superficial visible vein is punctured to let the blood out. The method of venesection in various sites like head, legs, arms, pelvis, back, shoulder, abdomen, chest, flanks, penis (erected), tongue, palate and root of teeth is described. [Su.Sa.Sharira Sthana 8/8]<ref name=Susruta/>

   

   

Various specific sites for venesection in different diseases are described in following table:  

Various specific sites for venesection in different diseases are described in following table:  

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[Su.Sa.ShariraSthana 8/9]<ref name=Susruta/>

[Su.Sa.Sharira Sthana 8/9]<ref name=Susruta/>

During the procedure, patient is observed for vital parameters like pulse and blood pressure.

During the procedure, patient is observed for vital parameters like pulse and blood pressure.

*In patients with poor mental and physical strength.

*In patients with poor mental and physical strength.

*In the conditions of burning and pricking sensation.  

*In the conditions of burning and pricking sensation.  

*[[Pitta]] [[dosha]] vitiation in blood ([[rakta]])[Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.H.Sutra Sthana.26/53-55]<ref name=Hridaya/>

*[[Pitta]] [[dosha]] vitiation in blood ([[rakta]])[Su.Sa.Sharira Sthana.8/25-26]<ref name=Susruta/>, [Dalhana on Su.Sa.Sutra Sthana.13/3]<ref name=Susruta/>, [A.Hr.Sutra Sthana.26/53-55]<ref name=Hridaya/>

====Procedure====

====Procedure====

Therapeutic procedure (pradhanakarma):  

Therapeutic procedure (pradhanakarma):  

Then the leech is applied over the site. If leech is not biting, superficial incision is made over the site. The leech sucks blood and swells in size. The leech is then covered with a piece of thin and wet cotton.

The leech is applied over the site. If leech is not biting, superficial incision is made over the site. The leech sucks blood and swells in size. The leech is then covered with a piece of thin and wet cotton.

Post -therapeutic procedure (pashchatkarma):  

Post -therapeutic procedure (pashchatkarma):  

===Clinical features of excess flow during bloodletting===

===Clinical features of excess flow during bloodletting===

Excess blood loss in bloodletting leads to headache, blindness, giddiness, depletion of tissues, seizures, burning sensation, hemiplegia, hiccups, dyspnea, cough, anemia and death may occur. [Su.Sa.Sutra Sthana 24/30]<ref name=Susruta/>

Excess blood loss in bloodletting leads to headache, blindness, giddiness, depletion of tissues, seizures, burning sensation, hemiplegia, hiccups, dyspnea, cough, anemia and death. [Su.Sa.Sutra Sthana 24/30]<ref name=Susruta/>

==Complications==

==Complications==

   

   

During leech therapy: Itching at the site of bite and non healing of bite wound are the other common complications in leech therapy. Allergic reactions may also happen during leech therapy.

During leech therapy: Itching at the site of bite and non healing of bite wound are the common complications in leech therapy. Allergic reactions may also happen during leech therapy.

During venesection and puncturing: Fainting is the most common complication during these procedures. There may be secondary infections at the site of puncture.

During venesection and puncturing: Fainting is the most common complication during these procedures. There may be secondary infections at the site of puncture.

==Safety precautions==

==Safety precautions==

Removal of blood in a controlled manner is effective in treating many diseases. Bloodletting influences the body physiology at multiple levels. Bloodletting results in leucocytosis and decreases the activity of heart and other body functions for a short duration. After that, the blood is formed by hyperleucocytosis; acceleration of tissue changes takes place and the nervous system also gets stimulated.<ref>Sarvesh KS, Kshipra R. Pachakarma parigyan A text book on panchakarma (principles and practices). Varanasi:Chaukhambha prakashak;2019.Chapter 10, Raktamokshana Karma;p.656.</ref> Increased levels of ferritin and body iron affect insulin resistance and may result in metabolic syndrome. This can be prevented by reducing its levels in the blood through bloodletting and thus can improve health.<ref name=SinghSK>Singh SK, Rajoria K, Medical leech therapy in Ayurveda and biomedicine e A review, J Ayurveda Integr Med, https://doi.org/10.1016/j.jaim.2018.09.003</ref>

Removal of blood in a controlled manner is effective in treating many diseases. Bloodletting influences the body physiology at multiple levels. Bloodletting results in leucocytosis and decreases the activity of heart and other body functions for a short duration. After that, the blood is formed by hyperleucocytosis; acceleration of tissue changes takes place and the nervous system also gets stimulated.<ref>Sarvesh KS, Kshipra R. Pachakarma parigyan A text book on panchakarma (principles and practices). Varanasi:Chaukhambha prakashak;2019.Chapter 10, Raktamokshana Karma;p.656.</ref> Increased levels of ferritin and body iron affect insulin resistance and may result in metabolic syndrome. This can be prevented by reducing its levels in the blood through bloodletting and thus can improve health.<ref name=SinghSK>Singh SK, Rajoria K, Medical leech therapy in Ayurveda and biomedicine e A review, J Ayurveda Integr Med, https://doi.org/10.1016/j.jaim.2018.09.003</ref>

A study on 15 patients of eczema, venesection (siravyadha) is found very effective in reducing burning sensation.<ref name=RavalHN>Raval HN, Thakar AB. Role of Raktamokshana by Jalaukavacharana and Siravedhana in the management of Vicharchika (Eczema). Ayu. 2012 Jan;33(1):68-72. doi: 10.4103/0974-8520.100314. PMID: 23049187; PMCID: PMC3456867.</ref> It is also observed effective in reducing the pain, stiffness and heaviness in sciatica<ref name=Vineet>J Vineet Kumar, Tukram SD et al. A comparative clinical study of Siravedha and Agnikarma in management of Gridhrasi (sciatica). Ayu. 2014 Jul-Sep;35(3):270-6. doi: 10.4103/0974-8520.153743.</ref> and lumbar spondylosis.<ref>F Joshi, V Mahanta et al. Effect of Agnikarma (therapeutic heat burns) and Raktamokshana (therapeutic bloodletting) in the management of Kati Sandhigata Vata (lumbar spondylosis). Ayu. 2019 Apr-Jun;40(2):79-88. doi: 10.4103/ayu.AYU_142_16. Epub 2020 Mar 20.</ref> It may remove the obstruction (avarana) of [[pitta] and [[kapha]] [[dosha]] leading to normal functions of [[vata dosha]].<ref name=Vineet/>

A study on 15 patients of eczema, venesection (siravyadha) is found very effective in reducing burning sensation.<ref name=RavalHN>Raval HN, Thakar AB. Role of Raktamokshana by Jalaukavacharana and Siravedhana in the management of Vicharchika (Eczema). Ayu. 2012 Jan;33(1):68-72. doi: 10.4103/0974-8520.100314. PMID: 23049187; PMCID: PMC3456867.</ref> It is also observed effective in reducing the pain, stiffness and heaviness in sciatica<ref name=Vineet>J Vineet Kumar, Tukram SD et al. A comparative clinical study of Siravedha and Agnikarma in management of Gridhrasi (sciatica). Ayu. 2014 Jul-Sep;35(3):270-6. doi: 10.4103/0974-8520.153743.</ref> and lumbar spondylosis.<ref>F Joshi, V Mahanta et al. Effect of Agnikarma (therapeutic heat burns) and Raktamokshana (therapeutic bloodletting) in the management of Kati Sandhigata Vata (lumbar spondylosis). Ayu. 2019 Apr-Jun;40(2):79-88. doi: 10.4103/ayu.AYU_142_16. Epub 2020 Mar 20.</ref> It may remove the obstruction (avarana) of [[pitta]] and [[kapha]] [[dosha]] leading to normal functions of [[vata dosha]].<ref name=Vineet/>

===Therapeutic phlebotomy===

===Therapeutic phlebotomy===

===Cupping therapy===

===Cupping therapy===

Through the cupping therapy, sub-atmospheric pressure suction is applied over a particular area which promotes peripheral blood circulation. It may also improve immunity. Altering the microenvironment through skin stimulation could transform into biological signals and may activate the neuroendocrine immune system. Some of the reported effects of cupping therapy are increasing pain threshold, improving local anaerobic metabolism, reducing inflammation, modulation of cellular immune system, promotion of skin’s blood flow and changing of biomechanical properties of skin.  The physiological and mechanical signals produced as a result of mechanical stress on skin and local anaerobic metabolism during cupping therapy may activate or inhibit gene expression. During wet cupping, the superficial scarifications also may activate the wound healing mechanism and gene expression.<ref>Aboushanab TS, AlSanad S. Cupping Therapy: An Overview from a Modern Medicine Perspective. J Acupunct Meridian Stud. 2018 Jun;11(3):83-87. doi: 10.1016/j.jams.2018.02.001. Epub 2018 Feb 7. PMID: 29436369.</ref>  

Through the cupping therapy, sub-atmospheric pressure suction is applied over a particular area which promotes peripheral blood circulation. It may also improve immunity. Altering the microenvironment through skin stimulation could transform into biological signals and may activate the neuroendocrine immune system. Some of the reported effects of cupping therapy are increasing pain threshold, improving local anaerobic metabolism, reducing inflammation, modulation of cellular immune system, promotion of skin’s blood flow and changing of biomechanical properties of skin.  The physiological and mechanical signals produced as a result of mechanical stress on skin and local anaerobic metabolism during cupping therapy may activate or inhibit gene expression. During wet cupping, the superficial scarifications also may activate the wound healing mechanism and gene expression.<ref>Aboushanab TS, AlSanad S. Cupping Therapy: An Overview from a Modern Medicine Perspective. J Acupunct Meridian Stud. 2018 Jun;11(3):83-87. doi: 10.1016/j.jams.2018.02.001. Epub 2018 Feb 7. PMID: 29436369.</ref>

==List of theses done==

==List of theses done==

==List of References==

==List of References==

The list of references for Raktamokshana in Charak Samhita can be seen[[Media:|here]]

The list of references for Raktamoksha in Charak Samhita can be seen[[Media:References_of_word_raktamoksha_in_charaka.pdf| here]]

 

==References==

==References==

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