2. Objectives
To define the rakthamokshana karma
To describe the types of rakthamokshana karma
To describe the mechanism, procedure and clinical
usage of leech therapy
To indicate the complication of leech therapy
3. Introduction
Bloodletting has a long, venerable history of use in
traditional and pre-scientific medicine.
It is still used in alternative medicine as part of Unani,
Ayurveda, and traditional Chinese medicine.
It is one of pancakarma therapy which belong to the
shodhana karma of Ayurvedic treatment.
4. Definition of Rakthamokshana
The word ‘Rakta’ means:
रक्त - coloured, dyed, tinged, painted, Red, crimson,
blood red.
Mokshana: मोक्षण
The word ‘Mokshana’ is derived from the root ‘moksha’
means ‘to relieve’ or ‘to let out’. Therefore letting out of
blood is known as Raktamokshana.
5. Normal blood
प्रसन्न वर्णेन्द्न्ियं इन्द्न्ियार्ाा ननच्छन्तमव्याहत पक्तृवेगम्।
सुखान्द्न्वतं पुन्द्टिबलोपपन्नं ववशुद्धरक्तं पुरुषं वदन्द्न्त ॥५३॥
Excellence of color and complexion, improved power
of the sense organs, good perception of objects by
sense organs, good digestive activity, enjoyment of
comforts endowed with good nutrition and immunity-
are the characteristics of the person having non
vitiated blood.
6. Dushtarakta Lakshana (
characteristics of impure blood)
Blood vitiated by Vata, will be blue or crimson in color,
dry- nonslimy, flows with force, clear and frothy.
Blood vitiated by pitta will be yellow or black, has foul
smell, not thick because of increase of heat and mixed
with glistening particles.
Blood vitiated by Kapha will be unctuous, pale -
yellowish- white in color, has small threads, is slimy
and thick.
By combination of 2 Doshas, there will be mixed
features.
Blood vitiated by all the Doshas will be dirty and thick.
8. Historical background of blood
letting …..
bloodletting technique Sravana being described in
approximately the 6th or 7th century B.C. in the Ayurvedic
surgery.
Greek humorism (black bile, yellow bile, blood, and
phlegm) spread, gradually became Europe's chief medical
practice.
And arrived in Asia, where it was adopted by Islamic
cultures and adapted in the form of Unani in about the 10th
century A.D.]Avicenna was a proponent of Unani.
Today, the term phlebotomy refers to the drawing of blood
for hemochromatosis, polycythemia vera, porphyria
cutanea tarda.
9. Ancient instrument for blood
letting
Leeches
sharpened sticks, shark’s teeth, knives.
Scarificators
The "superficial" vessels were attacked, a
springloaded lancet, or a glass cup that contained
heated air, producing a vacuum within.
12. Cupping instrument
Once a scarificator was used to slice and dice the
patient, a cup was often placed over the wound
as a receptacle for the blood. Cups were made of
tin, brass, rubber, horn, and most commonly
glass.
14. Types of raktamokshana
01. Pracchana
Multiple incisions are made with Scalp blade,
vertically & parallel to the course of local blood
vessels at the desired site.
15. 2. Siravyadha
Siravyadha is done with
sharp instrument and as
such it is a more severe
form of blood – letting.
Indications:
The bad blood causes
abscess, enlargement of
the spleen and liver ,loss
of appetite, fever, disease
of mouth, eye and head,
Vericose vein, loss of
consciousness.
17. Siravyadhanapoorvakarma:
Snehana karma – consume meat-juice and boiled rice
mixed with ghee,
Sweda karma - niragni sweda ( eg : sun light, heat with
a light, fire etc.)
Tied a band above the veins
Should tap the raised vein with physician’s middle
finger tripped off by the thumb;
18. Pradhana karma
The lancets (shastra) is incerted quickly neither too
deep nor superficial in the middle of the vein without
injuring the marma points
The maximum quantity of blood that may be let out
should not exceed one prastha
19. Siravyadha …..
Paschat karma:
apply spirit Fine powder
of haridra and laksha to
the site of blood letting
Samsarjena karma
followed.
20. Action of siravyadha:
Choice of treatment in Pitta and Rakta
Reduces intravascular pressure and volume which will
reduce pain and swelling Reduce the breakage of RBC,
in turn reduces pigmentation and itching.
21. 3. Rakthamokshana by suchi
Charaka has
indicated suchi
blood letting
. Most probably he
means that blood
letting should be
donne by needling
and made to ooze
out the blood from
the site of blood
23. Alabu
creating vacuum and extracting blood through the
vacuum using a bottle guard or Alabu; Pungent, rough
Medium sized alabu selected.
Dried in hot sun Round hole is made at the bottom
and contents emptied.
Procedure: Incisions is made on the skin Leaf is
placed near the incision Candle is
placed on the leaf and ignited Covered with bottom of
alabuyantra Vacuum is created in alabu and blood
rushes out.
24. Shrungavacharana
scratching the site, blood letting should be done by
means of the cow horn to which piece of thin urinary
bladder (of an animal) has been tide as a cover by a
thread , till blood is sucked out by manual mouth
suction.
26. Jalaukavacharana (Leech therapy)
It is considered as most unique and most effective
method of bloodletting.
It is safely indicated in all mankind including the
patients having poor threshold to pain
In Ayurveda and Sri Lankan traditional medicine, in
bloodletting therapy through leeches, purified and
cleaned medicinal leeches are applied in management
of various disorders, especially which are caused due to
vitiation of pitta and rakta dosha.
28. Jalauka ….
Scientific classification :
Kingdom : Animalia
Phylum : Annelida
Class : Clitellata
Order : Hirudinea
Family : Hirudidae
Binomial name : Hirudomedicinalis
31. Other indication of leech therapy
Peripheral vasculardiseases
Diabetic foot ulcer
Non healing ulcer
Thrombosed Haemorrhoids
Tenosynovitis
Vitiligo
Warts
Foot Corn
32. Contraindications of leech
therapy (jalaukavacharana)
Absolute Hemophilia
Severe Anaemia
Erosive gastritis and potential gastrointestinal bleeding
During chemotherapy ( or people who are on immunosuppressive
medication)
Individuals with HIV infection
Cachexia (of any cause)
Severe allergic diathesis (allergy to foreign proteins)
Hypotension
Active tuberculosis
Pregnancy
Mental disorders during acute episodes
Severely ill and bed ridden patients
Extremely fearful patient
33.
34. Mode of action of hirudotherapy
When leeches bite, they create a tunnel to the lymphatic system remove toxins
from the lymph system.
The main effects of the medicinal leech on the body include:
decreased blood clotting
thrombolytic (clot destruction)
antiischemic (improving blood supply to tissues and organs)
antihypoxia (improved blood supply oxygen to the tissues and organs)
hypertensive (normotensive)
draining the blood and lymph system of toxins and blood clots
restoration of the microcirculation
recovery of neuromuscular impulse transmission
restoration of vascular permeability
bacteriostatic (death of microorganisms, causing inflammation)
immunostimulatory
35. The important constituents present
in the leech saliva
Hirudin - It is a powerful anticoagulant, it inhibit blood
coagulation by preventing conversion of fibrinogen to fibrin.
Hyaluronidase - It breaks down the hyaluronic acid. As a
“spreading factor”, it opens the interstices, paving the way for other
active substances in leech saliva to reach the deeper tissues.
Hyaluronidase also possesses antibiotic property.
Destabilase - Amonomerizing enzymes that dissolves fibrin
Eglins - Are anti-inflammatory proteins. They inhibit the activity
of alpha-chymotrypsin, chymase, subtilisin, and the neutrophilic
proteinase elastase and cathepsin G.
Calin - Inhibits blood coagulation
36. The important constituents
preesent in the leech saliva …
Bdellins - Anti-inflammatory, inhibits
trypsin, plasmin, and acrosin.
Acetylcholine - Vasodilator
Histamine like substance - Vasodilator
Carboxypeptidase A inhibitor - Increases the
inflow of blood at the site of bite.
37. Collection
should be kept in a bottle with broad lid filled with
water.
Feed them with powder of dried meat and aquatic
bulbs leaves of water plants
The water should be changed every third day and feed
should be dropped
39. Purva Karma (Before procedure)
the patient should be subjected to snehana (oleation)
and swedana (fomentation), to enhance the mobility
of dosha
Fresh leeches should be taken, and a mixture of
mustard and turmeric paste in water should be applied
upon them.
40. Pradhana karma
The patient should be made to sit or lie down
The leeches should be hold at its neck and should be
applied directly to the affected part.
They should be covered with wet cotton and cold water
should be poured on them from above time to time
41. Paschata karma (after procedure)
The site should be cleaned with normal saline and
bandaging should be done after sprinkling turmeric
powder with beehoney to the bleeding site.
After falling off, the leeches should be made to vomit.
This is carried out by applying turmeric powder at
their mouths.
When the blood comes from the anterior sucker,
gentle squeezing from caudal to front end is required
for proper emesis
If the leech is active when placed in water, it indicates
that the vomiting is proper.
42. The leeches should be made to
vomit,applying turmeric powder at
leeches’s mouths.
43. bandaging should be done after sprinkling
turmeric powder to the bleeding site.
44. Complications of leech therapy
The bleeding was not controlled by applying pressure
with sterile gauze upon the wounds. Allergy to leech
bites, even severe allergic or anaphylactic reactions has
been reported .
45.
46. Research findings on
Rakthamokshana
1. Raut S.Y, Rasale P.L et.al study found that there is no
effect on sirawedha on RBC indices.
2. Motial .R and Shrilata K. study found that, the
combination of sarivadyasava and jalaukavacharana
showed a statistically highly significant response in
reducing the symptoms and signs of Yuvanapidaka.
3.Weinfeld AB and Yuksel E et.al study reveal that the
Leech therapy has been proven to help patients suffering
from venous diseases
4. Bapat RD and Acharya BS et.al mention that medicinal
leech is effective in the management of complicated
varicose veins, it heals ulcer, decreases the oedema and
limb girth, and decreases hyperpigmentation.
47. Research findings on
Rakthamokshana …
5. Dwivedi, A. P study found that applying leeches on
diabetic foot ulcer , Leech therapy improve the blood
circulation and reduce the congestion due to presence
of Carboxypeptidase. Leech application has anti-
inflammatory action nerves due to presence of
substance like Bdellin and Eglins in saliva, hence
correct diabetic neuropathy
6. A single course of leech therapy was effective in
relieving pain in the shortterm in patients suffering
from chronic lateral epicondylitis (Tennis elbow) and
reduced disability in intermediate-term.
48. Referances
Sathish H.S., Baghel M.S., Bhuyan C., Vaghela D.,B.., Narmada M.,G., Mithun B., , Outline of researches on
raktamokshana,11/09/2013
SushrutaSamhita – Ayurveda tattvasandipika commentary by
DrAmbikaDattaShastri, sutra sthana published by
Chaukhambhasamskritsamsthan, Varanasi; p. 43-46.
Vidyalankara.A, Ayurveda BrihatItihas.1st Ed. Varanasi; BhargavaBhushana
Press; 1960.p. 127.
"Leeching".Encyclopaedia Britannica.Encyclopaedia Britannica
Online.Encyclopaedia Britannica Inc
2013.Web.05<http://www.britannica.com/EBchecked/topic/750132/leeching>.
Textbook of Natural Medicine, Barnes & Noble, available on www.barnesand
noble .com/w/text book-of-natural-medicine-joseph-e-pizzorno/1100325443
Naturopathy Embraces the Four Humors, Jann Bellamy, Science-Based
Medicine, available on,science based medicine .org/index.php/naturopathy-
embraces-the four-humors/
