Nadi sweda with Tila taila for 15 minutes 2.Abhyanga with Tila taila for 15 minutes 3.Shashtika shali pinda sweda for 15 minutes 4.Jalaukavacharana with 10 leeches over L4-S1 region for 30 minutes 5.Internal medication: Ajamodadi churna 3gm with warm water 12/3/17 1.Sar udwarth

1. DEPARTMENT
OF
PANCHAKARMA
6/30/2017 1

2. CRITICAL ANALYSIS OF RAKTHAMOKSHANA
Guided by:
Dr.Lohith.B.A
h.o.d
SDMCAH, Hassan
Department of Panchakarma
SDMCAH, Hassan
Presenter
Dr.Vinitha.V
2nd year P.G.Scholar
6/30/2017 2

3. CONTENTS
• INTRODUCTION
• DEFINITION
• IMPORTANCE
• INDICATION
• CONTRA-INDICATION
• TYPES
• PRACHANA
• SIRAVEDHA
• JALAUKAVACHARANA
• ALABU
• SRUNGA
• WASTE MANAGEMENT
• MODE OF ACTION
• CONCLUSION
6/30/2017 3

4. INTRODUCTION
Raktamokshana is a unique procedure among the
Shashtra karma indicated in different diseases where
gross vitiation of Rakta is present.
Sushrutha, the father of ancient Indian surgery,
describes about physiological and pathological role of
Rakta in various disorders.
According to Acharya Vagbhata and Sushrutha,
Raktamokshana is one among the PANCHA-
SHODHANA.
6/30/2017 4

5. Susrutha
• Vamana
• Virechana
• Basthi
• Nasya
Vagbhata
• Vamana
• Virechana
• Basthi
• Nasya
• Raktamoksha
Charaka
• Vamana
• Virechana
• Anuvasana
• Niruha
• NasyaRaktamokshana
Raktamokshana
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6. ‘Rakta’ means: colored, dyed, tinged, painted, Red,
crimson, blood red.
‘Mokshana’ - derived from the root ‘moksha’ means ‘to
relieve’ or ‘to let out’.
“Raktasya Mokshanam Raktasrava”
Letting out the impure blood from the body is
known as Raktamokshana.
6/30/2017 6

7. IMPORTANCE
• सिराव्यधिश्चिकित्िािं िम्पूर्णं वा धिकिश्त्ितम ्|
शल्यतन्त्रे स्मृतो यद्वद्बश्स्तिः िायधिकिश्त्िते|
(As Su 36/3)
• ते ि शीतोष्र्णाश्स्िग्िरूक्षद्ययिः िववदोषप्रतितपक्षयिः
िम्यगप्युपक्रान्त्तािः िाध्या अपप ि सिद्ध्यश्न्त्त|
ते ि रक्तप्रिोपजािः तस्मात्तेष्वत्युद्रिक्तरक्तपव्ावर्णाय
यथास्वं सिरां पवद्ध्येत ्||७||
(As.Su 36)
6/30/2017 7

8. INDICATION Vidrathi , Kushta, Ekadesaja sopha ,
Shlipada,Visarpa , Arbuda,Granthi ,
Stanaroga,Oshta kopa, Krimidantha,
Kshudra roga ,Vishajushta sonitha
Upadamsa etc
CONTRA
INDICATION
Sarvanga sopha, Pandu , Arsa, Udara,
Sosha, Kliba, Pakshaghata, Atisara,
Chardi, Kamala, Akshepaka,Kshina
etc
6/30/2017 8

9. Sastra
> Prachana
> Siravedha
Asastra
> Jalaukavacharana
> Srunga
> Alabbu
> Ghati yantra
6/30/2017 9
CLASSIFICATION

10. Type Indications
Srunga Vata dushta rakta
Avagadha thama dosha
Rakta in twak
Sukumara purusha
kandu,
Suptha
Sparsanasa
Siravedha Tridoshaja raktha dushti
Sarvanga gatha dushti
Prachana Uttana rakta
Ekadesa pinditha raktha
6/30/2017 10

11. Type Indication
Jalauka Pitta dushta rakta
Gradhitha rakta
Avgadha dosha
Twaksthitha raktha
Sukumara purusha
Toda
Daha
Ghati yantra Kapha – Vata dushta
6/30/2017 11

12. Type Indication
Alabu Kaphadushta rakta
Avagadha tara Dushta rakta in
twak
Sukumara purusha
6/30/2017 12

13. ACTION
प्रच्छािं पपश्डिते वा स्यात् अवगाढे जलौिििः
त्वक्स्थे अलाबुघटीधिङ्गम् सशरयवव्यापिे अिृश्ज
वाताद्रदिाम वा िृङ्गजलौिोलाबुस िः क्रमात् ॥
(Ah.Su 26/54-55)
 Prachanna - Localized .
 Jaluka - Deep seated.
 Alabu, Gadi, Shringa - Localized in skin area.
 Siravedhana - Entire body.
 Shringa - Vata
 Jaluka - Pitta
 Alabu - Kapha
6/30/2017 13

14. • Jalauka - Hastha pramana
• Alabu - 12 Angula
• Srunga - 10 Angula
• Prachana - 1 Angula
6/30/2017 14

15. SIRAVEDHA
• One of the important
methods of Raktamokshana.
• Puncturing a vein for
therapeutic purpose.
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16. Precautions
• Routine blood investigations should be done prior to
procedure (BP, CT, BT, Hb %, HbSAG, HIV)
• Blood sugar
• Inform the patient before pricking
• ECG
• Thrombolytics
• Hemophilia
6/30/2017 16

17. Materials required-
• Hot and cold water
• Gauze piece and swabs
• Bandages
• Tourniquet
• Sphygmomanometer
• Marking glass beaker
• Scalp vein (NO 20)
• Needle no- 18,16, 20 etc
• Suitable Oil
• Nadi sweda yantra
• Spirit or panchavalkala
quatha
6/30/2017 17

18. 6/30/2017 18

19. • One Prastha is advocated as the maximum limit of
blood letting with excessively vitiated doshas.
As per Dalhana
• 1 Prastha- uttama matra(768 ml)
• ½ Prastha- madhyama matra(384 ml)
• ¼ Prastha- hina matra(192 ml)
6/30/2017 19

20. Vyadha sthana
• Grudhrasi &
Vishvachi - 4 angula above or below janu sandhi
• Apabahuka &
Bahusosha - 4 angula above or below kurpara
• Apasmara - Hanu sandhi madhya
• Unmada - Uro Apanga Lalata
• Kroshtukasirsha – 4 angula above gulpha sandhi
• Vata sonitha &
vata kantaka - 2 angula above kshipramarma
• Plihodara - Kurpara sandhi of vama bahu
6/30/2017 20

21. complications
• Blow vein - Choose other place for puncturing
• Hematoma - Cold pack application
• Hypovolemic shock - Sprinkle cold water
- proper ventilation
- IV Fluid
• Infection - Maintain aseptic precautions
• Hemophobia - Use eye pad
6/30/2017 21

22. JALAUKAVACHARANA
• Jalukavacharana involves an initial bite with leeches,
which is usually a painless bite, followed by the
sucking of 5 to 15 ml of blood
6/30/2017 22

23. Savisha jalauka Nirvisha jalauka
Habitat- originates in
decomposed urine and fecal
matter of toads and poisonous
fish, ponds of stagnant and
turbid water.
Habitat- originates in
decomposed vegetable matter,
in the putrefied stems of
aquatic plants, clear water.
Thick in middle portion Strong and well built
Lean in both ends Strong suckers
Slow movement, less active fast
Ugly in look, unable to catch
the host
Blue colored lining in dorsal
side of body
Small quantity blood Back side – kashaya in colour
6/30/2017 23

24. 6/30/2017 24

25. Precautions
The digestive tract of the medicinal leech is colonized
by two bacterias : Aeromonas veronii and Rikenella.
Aeromonas veronii may cause wound infections and
septicaemia in humans.
 These infections can be prevented by treating the
leech prior to the application with Haridra(Turmeric)
Curcuma longa.
Itching - Dushi visha vati, Bilwadi gudika
Increased pain- Dushi visha vati, Bilwadi gudika
6/30/2017 25

26. • Hemophobia
• Hypovolumic shock
• Blown vein
• Abhyanga , upanaha etc – Jalauka wont bite
6/30/2017 26
Avoided

27. THERAPEUTIC ACTION
• Thrombolytic,
• Anti-inflammatory,
• Immune-stimulating,
• Raises Nutrition Of Tissues,
• Strengthens Tissues Immunity.
6/30/2017 27

28. Recent advancement
Jalaukavacharana after dry cupping
6/30/2017 28

29. PRACHANA
• Blood letting through
multiple incision in any
localized area.
6/30/2017 29

30. PRECAUTIONS
• Routine blood
investigations should be
done prior to procedure
(BP, CT, BT, Diabetes,
HBSAG, Hb% HIV)
• Inform the patient before
pricking
• ECG
• Thrombolytics
• Hemophilia
• Avoid capillaries and
blood vessels
COMPLICATIONS
• Hypovolemic shock –
Sprinkle cold water
IV Fluid
• Infection - Maintain
aseptic precautions
• Hemophobia - Use eye
pad
6/30/2017 30

31. 6/30/2017 31

32. SRUNGA
• Sucking through mouth using a cow’s horn.
• Done in areas of loss of sensation
6/30/2017 32

33. 6/30/2017 33

34. ALABU
• Vacuum extraction using vegetable called Alabu (or
bottle gourd) in condition like grandi etc.
6/30/2017 34

35. 6/30/2017 35

36. difficulties
• Availability
• Sterilization
6/30/2017 36

37. Modified alabu
6/30/2017 37

38. 6/30/2017 38

39. 6/30/2017 39

40. 6/30/2017 40
ALABU CUPPING
Traditional method Recent advancement
Medicinal benefit No medicinal benefit
Comparatively
difficult to perform
Easy
Difficult to clean Easy to clean

41. Waste management
6/30/2017 41

42. Procedure and
waste
Category Type of waste Treatment and
disposal option
Gloves, cotton, Category No. 6 Soiled Waste (Items
contaminated with body
fluids including cotton,
dressings, soiled plaster
casts, lines, bedding and
other materials
contaminated with blood.)
incineration/
autoclaving/ micro
waving
Needle Category No 4 Waste Sharps (Needles,
syringes, scalpels, blades,
glass, etc. that may cause
puncture and cuts. This
includes both used and
unused sharps)
Disinfecting
(chemical
treatment/
autoclaving/
micro-waving and
mutilation /
shredding
Blood Category No. 1 Human Anatomical Waste
(Human tissues, organs,
body parts)
Incineration/ deep
burial
6/30/2017 42

43. COLOUR TYPE OF WASTE
YELLOW Blood, experimental animals,
discharge from hospitals, waste
from laboratory etc
RED Microbiology & Biotechnology
waste
BLUE Needles, Syringes, Scalpels
blades, Glass etc
BLACK Chemicals, Insecticides etc
6/30/2017 43

44. 6/30/2017 44

45. Waste management
6/30/2017 45
MOT
CHEMICAL
TREATMEN
T
STP
OTHER
WASTE
PRODUC
TS

46. • 10 patients of gridhrasi having acute pain were
selected.
• Deepana pachana with ajamodadi churna 3gm Bd
with warm water, sasneha tila yavagu in the morning
time
• Sarvanga abhyanga with Tila taila and bashpa sweda.-
for 3 days and on third day siravedha.
• It was founds that there is highly significant relief in
the symptoms of gridhrasi.
6/30/2017 46

47. • Study says that raktamokshana is considered as ardha
chikithsa and due to asraya asrayi bhava,it acts on pitta
dosha also.
• By raktamokshana, sroto sodhana is achieved which
further helps in abatement of Kushta.
6/30/2017 47

48. CASE
NAME : XX
AGE : 32
SEX : Male
RELIGION : Hindu
MARITAL STATTUS: Unmarried
OCCUPATION : Driver
ADDRESS : Channarayapattan,
Hassan
D.O.A : 11/3/17
D.O.D :19/3/17
OP NO:027301
IP NO : 18723

49. CHIEF COMPLAINTS:
Pain in low back region radiating to left lower
limb since 1 year.
ASSOCIATED COMPLAINTS
Feeling of heaviness in the left leg

50. SPINE EXAMINATION
• Inspection:
Standing position:
- Lumbar hallows: symmetrical
- Pelvis: pelvic tilt absent
- Scoliosis, kyphosis, lordosis: Absent
- Swelling: Absent
- Redness: Absent

51. SPINE EXAMINATION
• Inspection:
Standing position:
- Lumbar hallows: symmetrical
- Pelvis: pelvic tilt absent
- Scoliosis, kyphosis, lordosis: Absent
- Swelling: Absent
- Redness: Absent

52. Palpation:
- Door bell sign: positive (L4-S1)
- Paraspinal muscles: tenderness present
- Raised temperature: Absent

53. Range of movement of lumbar spine:
- Forward bending: restricted
- Backward bending: restricted
- Lateral bending: restricted
Coin picking test: positive
Straight leg raised test(SLRT)
- Active: Left- >30 ◦ Right- Negative
- Passive: Left- >40 ◦ Right- Negative
Bow string test: positive
Lasegue’s test: positive

54. Day Treatment
11/3/17 1.Sar udwarthana followed by sarvanga
parisheka with dhanyamla and DMQ
2.Sthanika pinda sweda with lavana and
chinch (danyamla dipping)
3.Anuvasana basti with pipplyadi taila
12/3/17 Same above
4.Erandamooladi niruha basti
13/3/17 Same above
Basti - NB and AB
6/30/2017 54

55. Day Treatment
14/3/17 1.Sar abynga with dhanvantara taila follwed by
jambeera pinda sweda
2.Sthanika pinda sweda with lavana and chinch
(danyamla dipping)
3.Basti – NB and AB
15/3/17 1.Sar abynga with dhanvantara taila follwed by
jambeera pinda sweda
2.Sthanika pinda sweda with lavana and chinch
(danyamla dipping)
3.Basti – NB and AB
16/3/17 Same above
4.Upanaha with kolakulathadi churna +rsna
+saindhava+dhanvantara taila over left knee joint
6/30/2017 55

56. Day Treatment
17/3/17 1.Sar abynga with dhanvantara tailafollwed by SSPS
2.Sthanika pinda sweda with lavana and chinch
(danyamla dipping)
3.Basti NB and AB
4.Siravedha over left leg
18/3/17 1.Sar abynga with dhanvantara tailafollwed by SSPS
2.Upanaha with kola kulathadi churna +rasna
+saindhava+dhanvantara taila over left knee joint
6/30/2017 56

57. Day Treatment
19/3/17
1.Sar abynga with dhanvantara tailafollwed by SSPS
2.Upanaha with kola kulathadi churna +rasna
+saindhava+dhanvantara taila over left knee joint
6/30/2017 57

58. RESULTS
PARAMETE
RS
BT AT
PAIN ++++ +
PRICKING
TYPE OF
PAIN
+++ nil
GOURAVA ++ nil

59. MODE OF ACTION OF RAKTAMOKSHANA
 In Raktamokshana dushita rakta along with vitiated
doshas are removed.
The susceptibility of Rakta towards impurity is too
much versatile.
Therefore Dushita (vitiated) Rakta from the related
Siras (veins) should be let out to protect the health or
to manage the disease.
6/30/2017 59

60.  Raktamokshana is indicated in disease of Raktaavrita
vata. It is said to have artihara property and produces
quick relief from symptoms.
 By the Raktamokshana, probably there may be
breaking down of obstruction (Avarana) which helps
in normal movement of Vata, there by restoring the
normal circulation and function of Vata.
6/30/2017 60

61.  Dushitha dosha nirharana improves the quality of
rakta.
 It acts on kandara, sira, mamsa, snaayu and corrects
the dhatu nirmanakrama by the act of srotoshodhana.
 It also cures the vatika symptoms along with
symptoms produced by kapha dosha.
6/30/2017 61

62. CONCLUSION
• If there is no significant improvement even after
panchakarma treatment, it has to be understood that
underlying pathology is raktavrutha vata .
• There comes the importance of Raktamokshana.
Which gives fast and better relief from the
symptoms.
• Raktamoksha is a simple procedure and can be
practiced even in OPD levels.
6/30/2017 62

63. THANK YOU
6/30/2017 63