Siravyadha is an ayurvedic process by Puncturing a vein for therapeutic purposes. In modern science, it is known as therapeutic phlebotomy.

1. By-
Dr. Ayesha Tasneem M.Z
1st yr PG Scholar
Dept of Shalya Tantra
SKAMCH&RC
Bengaluru
Guided by :
Dr. Shailaja S V
HOD
Dept of Shalya Tantra
SKAMCH&RC,
Bengaluru
1

2. Contents
•Introduction
•Rakta – Chaturtha Dosha
•Importance of Raktamokshana
•Types of Raktamokshana
•Siravyadha
• Importance of Siravyadha
• Contraindications & Indications
• Siravyadha vidhi
• Discussion
• Conclusion
2

3. Introduction
• Raktamokshana is one of the para surgical procedure.
• It is one among the shodhanakarma (Panchakarma) according to Acharya
Sushruta and Acharya Vagbhata. Acharya Charaka has also mentioned the
procedure of raktamokshana but did not consider it under panchakarma.
• The process of Raktamokshana can be traced back to the Vedic period only and
not beyond. In the Koushika sutra of Atharvaveda, references of bloodletting
(Raktamokshana) by leech are available.
• The Raktamokshana is one of the important procedures carried out in various
Shalya tantra vyadhis.
3

4. •Derivation
The word Raktamokshana comprises of two words viz. ‘Rakta’
& ‘Mokshana’
Rakta :blood
Mokshana: Derived from the root ‘Moksha’ means ‘ to relive’ or
‘ to let out’ (Shabdakalpadruma)
Therefore letting out blood is known as Raktamokshana.
•Synonyms
Avasechana
Raktanirharana
Raktavisravana
Shonitamokshana
4

5. Rakta- Chaturtha Dosha
तदेभिरेव शोणितचतुर्थेः संिवस्थर्तत प्रलयेष्वप्यववरहितं शरीरं
िवतत | (Su.Su.21/3)
The three doshas along with Shonita the fourth are
considered the cause of The Origin, Existence and
Destruction of the body.
5

6. • नतथ देिेः कफादस्थत न वित्तान्न च मारुतात् |
शोणितादवि वा तनत्यं देि एतैथतु धाययते|| (Su.Su.21/4)
The body never exists without Kapha, Pitta, Maruta and also
Shonita, These are Necessary to Sustain the Individual.
• एवं दोषाेः कदाचचदेकशो स्ददशेः समथताेः शोणित सहिता वा अनेकधा
प्रसरस्न्त | (Su.Su.21/28)
Dosha prasara happens either individually, in combination of two
or three doshas or in combination with Shonita.
6

7. • देिथय रुचधरं मूलं रुचधरेिैव धाययते |
तथमाद्यत्नेन संरक्ष्यं रक्तं जीव इतत स्थर्ततेः (Su.Su.14/44)
While explaining the importance of rakta, Acharya Sushruta has
mentioned that rakta is root for body & does nourishment of it. It
is said to be life of body so it should be protected.
• कफो वाते स्जतप्राये वित्तं शोणितमेव वा। यहद क
ु प्यतत वा तथय क्रियमिे
चचक्रकस्त्सते।। यर्ोल्बिथय दोषथय तत्र कायं भिषस्जजतम्। (Ch.Chi. 5 /27-
28)
When Kapha, Pitta or Shonita are vitiated while Vata is under
control, then respective kriya has to be done for treating the
aggravated doshas (Kapha, Pitta and Shonita-Raktamokshana)
7

8. रक्तथय मोक्षिं रक्तमोक्षिम्|
Letting out Blood for therapeutic use.
8

9. त्वजदोषा ग्रन्र्य: शोफा रोगा: शोणितजाश्च ये।
रक्तमोक्षिशीलानां न िवस्न्त कदाचन॥ (Su.Su.14/34)
Person who undergo Raktamokshana ,will not suffer
from any kind of Twakdosha, Granthi, Sopha and Roga
due to dushta rakta
9
Importance of Raktamokshana

10. Types of
Raktamokshana
Sashastra
Pracchana Siravyadha
Ashastra
Jalouka Shringa Alabu
10

11. 11
Pracchana : Multiple Pricks are made in a specific
manner, till there is appearance of blood
- Indicated when vitiated rakta is viscous/ Localised
- Balawan
Siravyadha: Puncturing a vein for therapeutic
purpose
- Indicated: Vitiation of all doshas pervading the
entire body
balawan
Sashastra Raktamokshana

12. 12
Jaloukacharana : Blood Letting using Jalauka (leech)
for Theurapetic purpose
- Pitta dosha , Param Sukumara
Shringa Avacharana : Blood letting using Cow horn
-blood vitiated by Vayu and pitta
-Indicated when localized in Skin Area, Sukumara
Shringa Properties
Virya – Ushna Guna – snigdha
Rasa – Madhura doshaghna - vata
Alabu avacharana :
- Blood vitiated by Kapha and vata Dosha
- Indicated when localized in Skin Area, Sukumara
Properties-
Rasa – Katu Guna- Ruksha, teekshana
Doshagna - Kapha

13. Puncturing a vein for therapeutic purpose 13

14. Among all the treatment
methods for sadhya rogas,
Siravyadha is the best, just like
how the paddy and other crops
die out completely by removing
the bunds of the field, this
procedure helps to eliminate
the disease completely.
(A.S.Su.36/2)
14
When other treatments fail, siravyadha has to be
done for raktaprakopaja vikaras. A.S.Su.36
Importance of Siravyadha

15. स्नेहादिदि: दियायोगैनन तथा लेपनैरदप।
यान्त्याशु व्याधय: शादन्ततिं यथा सम्यक् दसराव्यधात् ॥
(Su.Sha.8/22)
The conditions which do not subside with
snehana, lepa etc those conditions will subside
with proper siravyadha.
15

16. Rakta is the Adhishtana for all the vikaras, there is no
other dushya like Rakta. hence Siravyadha is the
first/important procedure. (A.S.Su.36)
भसरादयधस्श्चक्रकत्साधं शल्यतन्त्रे प्रकीततयतेः| (Su.Sha.8/23)
Siravyadha is considered as the Ardha Chikitsa In
ShalyaTantra.
16

17. • अथाविस्राव्ााः सिााङ्गशोफाः, क्षीणस्् चाम्लभोजननिनित्ाः ,
पाण्डुरोग््शासोदररशोविगिभाणीनाां च श्ि्थिाः| (Su.Su.14/24) -
Individuals with
•Sarvanga Shopha
•Ksheena because of Alma rasa pradhana bhojana
•Person with Pandu, Arshas, Udara, Shosha,
Garbhini.
17
Contraindications of Siravyadha

18. According to (Su.Sa.8/3) Siravyadha should not be done in the
following persons
• Bala (very young) and Sthavira (very old).
• Ruksha, Kshatakshina (wounded and debilitated).
• Bheeru (timid persons), as there will be "tamobahulata", they will
faint by seeing the blood.
• Parisranta (tired persons).
• Madhyapa (alcoholics).
• Adhvastrisarsita (emaciated as a result of long journey and sexual
intercourse).
18

19. • Vamita and Virikta (those who have undergone Vamana and
Virechana therapies).
• Asthapita and Jagarita (those who have undergone
asthapanavasti and who have not slept at night).
• Anuvasita (those who have undergone Anuvasanavasti).
• Kliba (impotent).Krisha and Garbhini (emaciated and pregnant
women).
• Kasa and Shwasa. Pravruddha Jwaravastha (chronic fevers).
• Akshepaka vata, Pakshaghata.
19

20. •Those doing Upavasa (fasting) and those who are afflicted
with Pipasa and Moorcha.
•Those veins which are prohibited from puncturing
(Avedhya Siras), which are invisible though indicated for
puncturing, which are visible but not controlled (from
moving apart which are not raised (engorged by pressure
from a tourniquet etc.) though controlled, such veins
should not be punctured.
• Siravyadha should not be done for those who are below
16 and above 70 years of age. (Vagbhatta).
20

21. Indications of Siravyadha
स्रादया ववद्रधयेः िञ्च िवेयुेः सवयजादृते |
क
ु ष्ठातन वायुेः सरुजेः शोफो यश्चैकदेशजेः||
िाल्यामयाेः श्लीिदातन ववषजुष्टं च शोणितम ् |
अबुयदातन ववसिायश्च ग्रन्र्यश्चाहदतश्च ते ||
त्रयथत्रयश्चोिदंशाेः थतनरोगा ववदाररका |
… क्षुद्ररोगाश्च िूयशेः || (Su.Su.25/12-16)
21
• Vidradhi (5 types except
tridoshaja)
• Vataja Saruja Kushta
• Shopha
• Palyaamaya
• Shlipada
• Vishajushta Shonita
• Arbuda
• Visarpa
• Granthi
• Stanaroga
• Vidarika
• Kshudra Rogas, etc

22. •Few more conditions added by vagbhata like the
vyadhi which arise out of pitta and kapha disease
which don’t respond to sheeta/ushna, snigdha/ruksha
chikitsa should be understood as being born from
dushta rakta and raktamokshana should be
performed.
22

23. Kala Maryada for Siravyadha
•नैवाततशीते नात्युष्िे न प्रवाते न चाभिते |
भसरािां दयधनं काययमरोगे वा कदाचन ||(Su.Sha.8/7)
Siravyadha should not be performed in Extreme cold,
extreme hot, windy and cloudy day.
It is prohibited in healthy individual.
दयिे वषायसु ववध्येत्तु ग्रीष्मकाले तु शीतले |
िेमन्तकाले मध्याह्ने शथत्रकालाथत्रयेः थमृताेः || (Su.Sha. 8/10)
Varsha Rutu : When the Sky is Clear
Grishma Rutu : When it is Cool
Hemanta Rutu : During Afternoon
23

24. Instruments Used for Siravyadha
24
Kutarika
Vrihimukha
Ara
Vetasapatra
Suchi

25. Vyadhana Pramana
• मांसलेष्ववकाशेषु यवमात्रं शथत्रं तनदध्यात्, अतोऽनन्यर्ाऽनधययवमात्रं व्री
हिमात्रं वा व्रीहिमुखेन, अथ्नामुिरर क
ु ठाररकया ववध्येदधययवमात्रम्||
(Su. Sha.8/9)
25
• 1 Yava Size with
Vrihimukha Shastra
Mamsala Area
( Fleshy Area)
• ½ Yava Size or to
the dept of vrihi seed
In Other Areas
• ½ yava Depth with
Kutharika Shastra
Over bony
Area

26. Site Of Siravyadha
Sl.No Disease Site
1 Vatashonita, Padadari, Padadaha, Avabahuka,
Chippa, Visarpa, Vatakantaka, Vicharchika
2 Angula above the Kshipra marma
2 Krostukashirsha, Khanja, Panga, Vatavedana 4 Angula Above Gulpha Sandhi
3 Gridhrasi 4 Angula either above or below Janu Sandhi
4 Vishwachi 4 Angula either above or below koorpura
sandhi
5 Apachi 2 Angula below Basti Marma
6 Galaganda Urumoola Sira
7 Pliharoga Sira present near Vama (left)Koorparaor
Sandhior Between Kanishta And Anamika
8 Yakrutdalyudara, kaphodara, shwasa Dakshina (Right) Koorpara Sandhigata Sira or
Sira Between Dakshina Kanishta And Anamika
9 Pravahika, Shoola Sira Present 2 Angula Around the Shroni
10 Parikartika, Upadamsha, Shukra Roga, Shukra
roga , Shukra dosha
Medhramadhya
11 Mootravruddhi Siras Behind the Medhra
26

27. 27
Sl. No Disease Site
12 Jalodara 4 Angula Below and to left of Nabhi
13 Antravidhradhi, Parshwashoola Between Kaksha (left Axilla) And
Stana (breast)
14 Bahushosha, Avabahuka Siras between Amsa (Shoulder)
15 Tritiyaka jwara Trikasandhi Madhya
16 Chaturthaka jwara Below Amsa Sandhi In Either of the
Parshwa
17 Apasmara Sira in Hanusandhi Madhya Bhaga
18 Unmada Shankha Madhya and Keshaanta or
urahapradesha or in lalata pradesha
or apanda sira
19 Jihwa and danta roga Jihwa adhobhaga sira
20 Taluroga Talugata sira
21 Karna roga Karna urdhwagata sira
22 Mukha roga Siras near talu, ostha, hanu,jihwa
23 Nasaroga Nasagrasira
24 Peenasa Sira between Nasa and lalata

28. 28
Sl.NO Diseasae Site
25 Timira , Akshepaka, Adhimanta, Shiroroga Upanasika sira or lalata sira or
apanga sira
26 Jatrudhawa Granthi Greeva, karna, shankha
27 Vataja sleepada 4 angula above gulpha sandhi
28 Pittaja sleepada 4 angula below gulpha sandhi
29 Kaphaja shleepada 4 angula above kshipra marma

29. •Inform the patient about the procedure
•Take Consent
•Investigations- TC,DC,Hb%,CT,BT,RBS,HIV,HbsAg
•Check Blood Pressure
•Advice to Stop Thrombolytic medicine 2-7 days before
the procedure
•Patient is advised to have food before the procedure
•Aseptic precautions have to be maintained
•Materials required for the procedure should be kept ready
29
Considerations before Raktamokshana

30. Purvakarma
•Snehana- Sthanika Abhyanga is done with suitable taila
to the part where siravyadha is to be done
•Swedana- Nadi Sweda is given after abhyanga
•A Liquid diet of Yavagu has to be given
•Patient is made to sit comfortably.
30

31. •Taila for Abhyanga
•Nadi Sweda Yantra for swedana
•Surgical Spirit
•Cotton swabs, Guaze pieces
•Bandage Roll
•Tourniquet
•Scalp Vein set No.16 ,18, 20
•Kidney Tray/ Glass Beaker to collect and Measure the
amount of Blood drained.
31
Purvakarma : Materials Required

32. •Tourniquet is tied above the site of siravyadha.
•A suitable vein is selected, palpate to see the
prominance of the vein.
•The patient is informed and then the vein is punctured
•As blood starts coming out, it is collected in measuring
jar/glass beaker.
•Blood is allowed flow out till it stops on its own unless
32
Pradhana karma

33. Stanika Abhyanga
Siravyadha
33

34. • After this, the needle is removed and bandage is applied over the site.
34
Paschat karma

35. Raktamokshana Pramana
•One Prastha(~640ml) is the Uttama
matra(Maximum Limit) for Vayashta, Balina,
Bahudosha (Su.Sa.8/16)
35

36. • In SiraGranthi : In case of Varicose
veins, due to venous hypertension there
is stretching of the veins which causes
pain, After siravyadha, by the removal of
blood there is decrease in pressure in the
veins thus reducing pain.
• Stasis of blood is removed by
Siravyadha.
36
Probable Mode of Action of raktamokshana
• Siravyadha helps to increase pumping action of vein by creating negative pressure.
• Diffusion of RBC into the tissue , its lysis and release of haemosiderin causing
pigmentation is all avoided as RBCs are removed by Raktamokshana
• The free iron is utilized by the fresh blood flowing in, thus pigmentation doesn’t
occur.
• The breakdown of RBC also stimulates histamine at the site causing vasodilation,
vascular permeability and itching which may further lead to eczema, but all this is
prevented by the removal of the blood(RBC)
• Exchange of nutrients is possible now possible

37. Siravyadha
Removes dushta
Rakta
Normal vata Gati
Restored
Vyana vayu
carries shuddha
rasa rakta to twak
Regeneration of
tissues
Shamana of
Vyadhi
37
Mode of Action in Kushta

38. • सम्यक्शथत्रतनिातेन धारया या स्रवेदसृक् |
मुिूतं रुद्धा ततष्ठेच्च सुववद्धां तां ववतनहदयशेत्|| (Su.Sha.8/11)
A well and successful viddha
sira,bleeds in a stream and
spontaneously stops
after a muhurta.
• यर्ा क
ु सुम्ििुष्िेभ्येः िूवं स्रवतत िीततका |
तर्ा भसरासु ववद्धासु दुष्टमग्रे प्रवतयते||(Su.Sha.8/12)
The vitiated blood is seen first to flow out of an opened sira, like a
yellow juice oozes out of kusumbha flower. 38
Samyak Viddha Lakshana

39. •सम्यजगत्वा यदा रक्तं थवयमेवावततष्टते।
शुद्धं तदा ववजातनयात ् सम्यस्जवस्राववतं च तत ्॥
(Su.Su.14/32)
A spontaneous Cessation of Rakta srava would indicate that
the peron is purified and proper raktamokshana occured
•लाघवं वेदनाशास्न्तदयायधेवथगिररक्षय:।
सम्यस्जवस्राववते भलङ्गंप्रसादोमनसथतर्ा॥ (Su.Su 14/33)
Laghuta- lightness
Vedana shanti – cessation of pain
Vyadhiroga prashamana- decrease in the intensity of
vyadhi
Prasanna mana ( cheerfulness / relaxed)
39

40. • तदतूर्च्ााश्रतार्ाानात्- who are
suffering from mada,
moorcha,shrama.
• िार्विण्तूत्रसांगगनात्- Who does
Vata, vit, mootra vega
Dharana.
• Nidrabhibhuta- who is
sleepy/drowsy
• Bheetanam- who are afraid
• दुहदयने- Not suitable Kala
• दुववयध्दे- improper vyadhana
• शीतवातयो: - Cold and Vata
Predominant
• अस्थवन्ने- Without Swedana
• िुक्तमात्रे- Just after having food
40
Heena Vidha Karana

41. Heena Viddha lakshana
•तद्दुष्टं शोणितमतनहरययमािं शोफ दाि राग िाक
वेदना जनयेत् ॥ (Su.Su.14/29)
The vitiated rakta which is not eliminated causes
Shopha, kandu, raga, daha, paka and vedana
41

42. • Accoording to Su.Su.14/35
If Blood doesn’t flow out then ela, kushtha, tagara, patha,
bhadradaru, vidanga, chitraka, trikatu, Agaradhuma, haridra,
arkankura, naktamala phala. powder of either three, four or as
many as available of these drugs mixed with good amount of
saindhava lavana & tila taila should be rubbed on the vrana
mukha.
42
Management of Ayoga

43. According to Su. Su 14/30
•Atyushne- done in ati ushna kala
•Atisvinne- ati swedana
•Atividdhe- Deeper cut
•Ajnaihi visravitam- Done by a person who is not
well versed or who inexperienced
•Atipravartite- Excess Letting of Rakta
43
Atiraktasrava karana

44. •Shirobhitapa
•Andhyam
• Adhimanta
•Timira
•Dhatu kshaya
•Akshepaka
•Pakshaghata
•Ekanga Vikara
•Hikka
•Shwasa
•Kasa
•Pandu
•Marana
44
Atiraktasrava lakhana

45. •Powder of lodhra, madhuka, priyangu, patanga, gairika,
sarjarasa, rasanjana, shalmali pushpa, shankha, sukthi,
masha, yava and godhuma sprinkled and pressed into the
wound with the tip of finger. i.e avachurnana
•Bandhana - Then it should be bandaged tightly
•Covering with cold moist cloth, application of cold
poultices and pouring cold liquids.
•If bleeding is not stopped by these measure then
agnikarma or ksharakarma is done.
•Dedoction of drugs of kakolyadi gana made sweet by
adding sugar and honey is given for pana.
•Rakta Sthambhana Upaya- Sandhana, Skandhana, Pachana,
dahana
45
Atiyoga chikitsa

46. Complications and its management
•Blown vein- Choose another place for
puncturing
•Infection- Maintain Aseptic Precautions,
Antibiotics
•Thrombophlebitis- Hot compress, Crepe
Bandage, Anticoagulants
•Shock- Elevation of Lowerlimbs, IV Fluids,
Vasoconstrictors.
46

47. • Raktamokshana is an effective
procedure in various conditions. Like in
Dushtavrana it helps in quicker healing
by improving blood circulation.
• In Siragranthi it relieves symptoms like pain, burning sensation,
itching, pigmentation by removing stasis of vitiated blood.
• In the earlier stages of Vranashotha,Vidradhi, etc it helps in
reducing inflammation.
• In Indralupta it removes vitiated doshas which promotes
nourishment and regrowth of hair. It helps in the better
absorption of the lepa, taila applied.
• For localised conditions Raktamokshana can be done by
Pracchana(Angulamatrasya), Jalouka(Hastamatram), Shringa
and Alabu (Dwadashangulam) where as Siravyadha is said to be
Sarvangashodhini- (Sha.U.12/26)
47
Discussion

48. Conclusion
• Rakta is an entity as important as the doshas.
• Raktamokshana is a type of Shodhana concerned with the removal
of dushita rakta.
• Raktamokshana is indicated in various shalya tantra vyadhis like
Dushta vrana, vranashotha, Granthi, Arshas, vidradhi and kshudra
rogas like indralupta, accordingly it can be used in various other
conditions also.
•त्वजदोषा ग्रन्र्य: शोफा रोगा: शोणितजाश्च ये।
रक्तमोक्षिशीलानां न िवस्न्तकदाचन॥
(Su.Su.14/34)
In people who undergo Raktamokshana, Twakdosha, granthi, sopha
and rogas due to dushta rakta will not occur.
48

49. 49