Marvels of Parasurgical Procedures in Ayurveda - Leech Application
MARVELS OF PARA-SURGICAL
PROCEDURES IN AYURVEDA WITH
SPECIAL REFERENCE TO
Dr. Praveen Kumar Choudhary
Associate Professor, Deptt. Of Shalya Tantra
Tibbia College, Govt of Delhi
RAKTAMOKSHANA: THE HALF OF ALL
Dehasya rudhiram mulam
Blood is the base of life and one should do
all efforts to preserve it.
It is a dhatu and dosha both, when
vitiated, it should be drained within
The maximum amount of drainage of blood
is one prastha say 54 tola or 600 ml.
It should not exceed the above-mentioned
IMPORTANCE OF RAKTAMOKSHANA
Tvakdosha Granthya Shopha roga Shonitajascha
ye, Raktamokshana Sheelinam na bhavanti
Skin diseases, Neoplastic disorders, Inflammatory
disorders and other disorders caused by vitiation of
blood don’t occur in the individuals who undergo
TOOLS FOR BLOODLETTING
Without using Shastra (Minimal Invasive):
1. Shring or Horn: By sucking action
2. Alabu or Gourd or cupping by
3. Jalaukavacharana or Leech therapy
With Shastra (Invasive):
1. Pracchana (Scraping)
2. Siravedha or venepuncture
SHRINGA OR HORN
Its use is specific to Vata disorders being
Snigdha in nature.
Dimensions: It is a kind of Nadiyantra. This
denotes the horn of cow. Its length is 18
angula on average and the attaching portion
(mouth) has the diameter of 3 angula. The
sucking end has a hole of the size of
mustard seed. Its shape is just like the
nipple of the breast (Stanakara).
APPLICATION OF SHRINGA
Snehana, Svedana, Pracchana at the
desired site of bloodletting and the Sringa is
placed. It has two openings, one is small
and another is broad enough. Broad
opening is placed on the wound while the
small opening is used to suck the air by
mouth. When you suck by mouth through
the hole in horn; it will create vacuum in the
horn. It will help the blood to let out. The
mouth should be closed to maintain vacuum
in the horn. When you want to remove the
Shringa, hole should be open down.
ALABU YANTRA/TUMBI/ GOURD
It is specifically used in vitiation of Kapha dosha. If
the blood is vitiated with the pitta dosha, then this
Alabu Yantra should not be used for the purpose of
bloodletting. It is because the fire is used to create
vacuum in the Alabu; therefore, it may enhance the
The diameter of the Alabu yantra is 3-4 angula and it
has two openings on either side. Where Alabu is
used, the redness and congestion develops, hence
blood congestion reduced in deeper places.
TECHNIQUE OF USING ALABU
It works on the principle of vacuum extraction. A
lamp is placed at the site of application of Alabu and
the lamp is ignited. The lamp remains in the ignited
form till the air remains in the Alabu. When all of
the air is used in the Àlabu, the lamp goes off.
Owing to this action, vacuum develops inside the
Alabu. The Alabu is remained in the same position
for ten to fifteen minutes. It is better to have
Pracchana at the place of application of Alabu, so
that the maximum blood would come out. Now a
day, a glass is used to cover the lamp instead of Alabu. This
procedure is named as cupping.
Pracchana-karma is adopted when
doîas are situated in tvak and blood
is remained in PiàÅita state. With the
help of sharp instrument, the cuts
are applied on the desired body
parts from below upward. In this
process, utmost care must be taken
to save vital structures. The
instrument should be Riju
(straight), Asankirna (not very near
to each other), Sukshma (small and
fine), Sama (even), AnavagaÅha (not
very deep), Anuttana (Not very
superficial) and Ashu (quick).
VÂgbhaòa has said that instrument
Sira – Veins, Dhamani – Artery or
Meridians, Srotasa – Hollow spaces meant
for secretion and absorption.
It is a channel through which nutrients are
provided to the tissues. The speed of the
contents inside it, is slow. One more
definition of Sira is that in which blood is
flown towards heart without pulsation are
We cannot correlate exactly the Sira
to vein or artery or lymphatic but it
is more closer to the veins. It has
been mentioned in the ancient texts
that Siras are meant for providing
nutrition to the dhatus by sarana
mechanism. In this connection, it may
be stated that the nutrients when
absorbed from intestine, will bring
to liver by the portal vein and in the
foetus, it is the umbilical vein that
provides means of nutrition to the
foetus. Moreover, arteries do have
TECHNIQUE OF SIRAVEDHANA
The patient is prepared with the
snehana and svedana and he or she
may be given the diet having opposite
quality of the predominant dosha.
The patient may be allowed to
sit, erect or lying in bed according to
the ease. The tourniquet of
cloth, leather or bark of a tree is
applied on the part. The tourniquet
may not be too tight or too loose. It
is followed by the puncture with
appropriate instrument. Before
sirÂvedhana, the sirÂ must be fixed
After bloodletting, the wound should be washed
with the fresh water and the opening must be
bandaged after putting oil-soaked gauze. The
patient is provided with light, dipaniya and
anushnashita food after the procedure.
After the puncture, blood comes out in the form
of stream and it stops by its own. The pain and
flow of blood subside after a little bit time.
The frequency of symptoms reduces after
STANDARDIZATION OF SIRAVEDHA
We may use Hypodermic niddle of 24 G size in
place of conventional instruments such as
Ara, Kutharika, Brihimukha.
It is an invasive procedure; therefore, explain
properly to the patients.
The maximum amount should not exceed say 54
tola or 540 Ml.
Concept of Avedhya sira:
Most of these siras are in Head, neck and
abdominal regions. Most of the sira of extremities
are safe to puncture.
Concept of Dustavedha:
It is due to the lack of skill while puncturing a sira.
BENEFITS OF SIRAVEDHA
Removal of Toxic metabolic wastes.
Stimulates new blood cell formation.
May stimulates bone marrow.
Cure the ailments fast in comparison to other
The bloodletting with the help of leech is
painless or noninvasive way of bloodletting.
It resides in the water, hence being Sita in
nature pacifies pitta dosha.
Not only it relieves pitta but also it cures a
wide range of ailments.
Available in abundance in the ponds. It may
be cultivated in the leech tanks and the
same may be prepared with ease in the
premises of the hospital or clinic.
INDICATIONS OF LEECH
Doshas are situated in the deeper tissues.
More physiological, feasible (no
pain), rational and result oriented.
Children, old ages, women, king, person of
soft constitution and coward.
Gulma, Arsha, Vidradhi, Kushtha, Vatarakta,
Galaroga, Visha and Visarpa.
The concept of poisonous and non poisonous
nature of the leeches has been discussed at large
in Ayurveda. It has been mentioned that
poisonous leeches reside in dirty habitat and
non-poisonous leeches reside in fresh water
Six types of leeches are poisonous in nature e.g.
Krishna, Karbura, Alagarda, Indrayudha, Samud
Alagarda has long hair all over the body especially on
lateral aspect of the body. It can be compared with
Hirudinaria Granulosae. It is abundant in states of
Tamilnadu, Kerala, M.P. and U.P. It often attacks human
beings. Romasha Mahaparshva Krishnamukhi (Su)
Indrayudha is one among poisonous
leeches. The dorsal aspect of the body is
covered with multicoloured lines like
rainbow. It can be compared with
Hemodipsa ornata. It is a common species
found in India. It is recorded from the hill
track of the Assam. Its bite is unlike that of
other leeches is painful. It may sometime
prove fatal as the leech carries septic
POISONOUS LEECHES IN MODERN MEDICINE
Hemodipsa jajanica and Manellensia:
thorough nuisance both for humans and
Horse leech: It is said to attack the
breathing passage of horse and it is 6 to 8
inches in length. On extension it may be of
30 cm long.
Broad in its middle part.
Has slow movement and deformed shape.
Attach to the victim or patient with difficulty.
Sucks less quantity of blood.
Non-poisonous Jalaukas live in deep and
fresh water where there is the abundance of
lotus, algae etc.
The leech, which is used for therapeutic
purpose is known as Hirudo medicinalis.
The symptoms of Savisha Jalauka bite as
have been mentioned in Sushruta are
related to infection. It may be due to the
bacteria present in the leech gut
IMPORTANCE OF JALAUKAVACHARANA
As a swan can separates the water from a mixture
of milk and water; likewise, a Jalauka can separate
impure blood from the pure and it sucks impure
blood only. A.H.Su. 42/26
Leech saliva contains many metabolically active
enzymes and they have a diverse functions.
SYMPTOMS OF POISONOUS LEECH BITE
These are the symptoms pertain to bacterial
MODE OF ACTION
The therapeutic benefits of the leech bite
doesn’t relate with the average 5 to 10 ml of
bloodletting during bite but the continuous
oozing of blood for 10 hours or more is the
The goal is to produce a minimally adequate
venous outflow from the tissue.
Not only it reduces congestion but also it
helps in neogenesis.
MODE OF ACTION
It is true that continuous bleeding in the bite wound
is not merely due to the anti coagulants but other
pharmacologically active substance may also play
This can be proved by the fact that conventional
anticoagulants can never be a substitute of leech
Hirudin: Proteolytic and Thrombin specific
inhibitor. It retards coagulation of blood
Bdelin: Plasmin inhibitor. It checks
destruction of tissue and good in case of
Eglin: Potent inhibitor of elates and
chymotrypsin. It effectively blocks the
inflammatory response induced after
localized trauma or surgery.
Hementin: Anticoagulant, it degrades
fibrinogen and fibrin.
Collagenase and Apyrase: Inhibitor of platelet
Hyaluronidase: Most important acting principle
in leech saliva. It also has antibiotic properties
in addition to its natural properties. The skin
penetration becomes easy.
Vasodilators: It is histamin like substance but it
doesn’t cause allergic reactions.
Antibiotics: The antibiotics are produced by
symbiotic bacterium Aeromonas hydrophylla.
ROLE OF LEECH IN MEDICAL THERAPEUTICS
Plastic and reconstructive surgery: It
reduced the oedema associated with
grafting; therefore improve the blood
circulation. It causes more chances of graft
Prevention of necrosis: Improves tissue
perfusion. Provide enough time for
capillaries to grow. Neogenesis is an added
Oedema: Leech provides immediate
reduction of swelling by sucking blood and
by the action of seeping due to Hirudin.
ROLE OF LEECHES
Pains of varied etiology
Researches are on to find out anti-tumour
activity of leech saliva.