1. The document discusses the procedure of Siravyadha, or bloodletting therapy, in Ayurveda. It describes the 700 veins in the body, which originate from the umbilicus, and the appropriate sites on the body for bloodletting for different diseases. 2. The preparation, positioning of the patient, and technique for puncturing veins of appropriate size in different body areas are explained. Signs of proper, inadequate, and excessive blood flow are also outlined. 3. Contraindications for bloodletting such as age, health status, and timing are mentioned. The importance of bloodletting for curing diseases from their root is highlighted.

1. SIRAVYADHANA
Presented by
Dr.Subham patra
PG Scholar
Dr SUBHAM PATRA

2. INTRODUCTION
• Etymology of Siravyadha
• Sira:
• सिनौ तौतत इतत सिरा – That means which binds or a quantity bound together.
 It is formed from the root to bind
 Any tubular vessel of the body – nerve, vein, artery, tendon;
 As they are binding the whole body together by transporting blood to all over the body
• Vyadha:
• व्यधननमतत व्यध: । that gives meaning of cuts
•
• व्यध (ताड) + अऩ व्यध - To pierce, to transfix, to hit, strike, wound
•
• By which the blood is being taken all over the direction is "Sira". Its piercing is known as "Siravyadha"
Dr SUBHAM PATRA

3. ORIGIN OF SIRA
• All the Siras present in the body originate from the Umbilicus, and from there, they spread to
all directions.
• Prana resides in the veins of the Umbilicus and it is the seat of the veins.
• The Umbilicus is surrounded by Siras similar to the axle hole being surrounded by spokes.
Dr SUBHAM PATRA

4. NUMBER AND DISTRIBUTION OF
SIRAS
• Siras are 700 in number.
• By these Siras, the entire body is constantly nourished, kept moistened to perform actions
such as flexion, extension, contraction, dilation etc., similar to a large field being nourished by small
channels of water.
Dr SUBHAM PATRA

5. VEDHYA AND AVEDHYA SIRAS:
• Acharyas described Vedhya Siras are those which can be interfered within surgical process
and they present no serious complications, when affected. It is also mentioned that through these
veins only the safer bloodletting should be done for curing various diseases.
• Avedhya Siras are those on which the injury must be avoided during surgery. In Vedic period,
there is no mention about Avedhya or Vedhya Siras. Although they have mentioned that in
vascular injury the outflow of the blood should be checked.
• In Samhita period, Charaka described two Vedhya Siras in connection with the disease
Unmada, Vishamajwara and Apasmara at two places i.e. Shankha Pradesha and Keshanta
Pradesha.
Dr SUBHAM PATRA

6. VEDHYA & AVEDHYA SIRA’S
• There are 700 sira’s in number
• Vedhya sira – 602
• Avedhya sira – 98
• The avedhya siras are divided in three regions
• Shakhagata – 16
• Kostagata – 32
• Urdhavjatrugata – 50
• Harmful result are anticipated by puncturing avedhya sira
Dr SUBHAM PATRA

7. DISEASE SITE OF SIRAVYADHA
Padadaha, Padaharsha, Apabahuka,
Chippa, Visarpa, Vatshonita, Vatakantaka, Padadari,
Vicharchika
2 Angula above Kshipra Marma with Vrihimukha Shastra
Vataja Shlipada 4 Angula above the Gulpha Sandhi
Pittaja Shlipada 4 Angula above the Gulpha Sandhi
Kaphaja Shlipada 4 Angula above the Kshipra Marma
Kroshtukasheersha, Khanjaka, Pangu,
Vata Vedana
4 Angula above the Gulpha
Apachi 4 Angula below Indrabasti Marma
Gridhrasi 4 Angula above or below Janu Sandhi
Galaganda Urumula Sira
SITES OF SIRAVYADHA IN LOWER
EXTREMITIES:
Dr SUBHAM PATRA

8. DISEASE SITE OF SIRAVYADHA
Galaganda, Gala Vidradhi Sira in the Uru
Gridhrasi 4 Angula above or below Janu
Apachi 2 Angula below Indrabasti
Kroshtukasheersha, Sakthi Vata Ruja 4 Angula above the Gulpha
Padadaha, Vatashonita, Padaharsha, Chippa,
Vipadika, Padadari and
Vatakantaka
2 Angula above Kshipra Marma
SHOWING THE SITES OF SIRAVYADHA
ACCORDING TO VAGBHATA
Dr SUBHAM PATRA

9. SIRAVYADHA INDICATIONS
• Diseases of the skin, tumours, swelling and diseases arising from blood will never occur in
persons indulging in bloodletting (generally in Sharad Ritu).
• Bloodletting is the method of treatment indicated in diseases caused due to the vitiation of
Raktadhatu like Visarpa, Vidradhi, Pliha, Gulma, Agnisadana, Jwara, Mukha Roga, Netra Roga,
Shiro Roga, Mada, Trishna, Lavanasyata, Kushta, Vatarakta, Raktapitta, Katu and Amlodgara,
Bhrama etc.
Dr SUBHAM PATRA

10. SIRAVYADHA CONTRA INDICATIONS
• Siravyadha should not be done in the following persons:
 Bala and vruddha,
 Ruksha, kshatakshina,
 Bhiru
 Parishranta,
 Madyapa
 Adhvastrikarshita,
 Vamita and virikta
 Asthapita and jagarita
Dr SUBHAM PATRA

11.  Anuvasita
 Kliba,
 Krisha and Garbhini,
 Kasa and Shwasa,
 Pravruddha Jwaravastha
 Akshepaka Vata, Pakshaghata,
 those who doing Upavasa
 those who are afflicted with Pipasa and Murccha.
Dr SUBHAM PATRA

12. IMPORTANCE OF SIRAVYADHA
1. The Siravyadha is considered to be the half or even some scholars as complete treatment in Shalya Tantra as
Basti in Kaya Chikitsa.
2. By the Siravyadha alone, all the diseases will be cured from their roots, just like rice and other crops in the field
dry out completely by removing the bunds of field.
3. The diseases which are not cured by Sneha, Lepa etc. are cured instantaneously by Siravyadha.
4. Those who undergo RaktaMokshana regularly at proper time will not be afflicted with Tvak Dosha, Granthi,
Shopha and other Raktaja Roga.In Chikitsa, Acharya Sushruta quotes the benefits of Raktamokshana that, it
only purifies the channels but also lets the other parts become free from disease and the action is faster than
other remedies.
Dr SUBHAM PATRA

13. SIRAVYADHA VIDHI (PROCEDURE)
• PURVAKARMA
1. Sambhara Samgraha
2. Atura Chayana
3. Atura Siddhata
Dr SUBHAM PATRA

14. SAMBHARA SAMGRAHA:
For better performance of Siravyadha and for the management of the complications, the following materials
should be arranged prior to the procedure:
 Cot, Stools, pots of water, pieces of cloth (gauze piece, swabs)
 Sira Bandhana materials (thick cloth, tourniquet etc.) sphygmomanometer, kidney trays, marking
glass beaker, scalp vein (No.20), Kutharika Shastra, Vrihimukha Shastra.
 Tail for Snehana, cotton pad for fomentation, Nadi swedana yantra or Bashpa Swedana Yantra
 Washing materials (spirit, Panchavalkala Kwatha etc.), chairs, dressing table.

Dr SUBHAM PATRA

15. ATURA CHAYANA:
• Raktamokshana should be done according to the procedures (yathanyaya). It is left to the
discretion of the surgeon to do Siravyadha even in those sira, which are contraindicated for
vyadhana, for example in case of poisoning and other emergency conditions. Routine blood
investigations, blood group, blood sugar, blood coagulation profile etc. should be carried out as
preoperative assessment of the patient.
Dr SUBHAM PATRA

16. ATURA SIDDHATA
• Snehana internally for 2-3 days and then Abhyanga and swedana to the affected part or to the
whole body should be done on the day of Siravyadha. Yavagu which does not aggravate Dosha
but pacifies the Dosha should be given just before the Siravyadha in order to prevent Murccha,
bhrama etc.
Dr SUBHAM PATRA

17. PRADHANA KARMA
1. Siravydhanartha Asana
2. Siravyadha and Nirakshana
3. Samyaka Yoga-Ayoga-Atiyoga Lakshanas of Siravyadha
4. Vyapada and its Chikitsa
Dr SUBHAM PATRA

18. SIRAVYADHANARTHA ASANA
• Bloodletting should be done by the physician on the day which is neither very cold nor very hot,
neither before sudation (Swedana) therapy nor after too much of sudation. It should be adopted
after the patient has been satisfied with a drink of Yavagu (thin gruel) mixed with ghee or oil. Acharya
Sushruta has mentioned different position of patients in different diseases of Siravyadha.
Dr SUBHAM PATRA

19. SIRAVYADHA FOR SHIRA(HEAD)
• First Abhyanga and Svedana should be done. Afterwards he should be made to sit on a soft stool of the height of the
knee, placing elbows on his knees, placing the feet together comfortably on the floor and facing the sun.
• At the level of the lower border of the hairs of the head, a tight bandage should be tied making use of moist cloth, leather
or inner bark of the tree.
• The patient should then be asked to keep the thumbs inside his fists, cover them with cloth and clench them as hard as he
can, accompanied with biting the teeth as hard as possible, inflating his mouth.
• Another person standing behind the patient should put a long piece of cloth around the neck of the patient, make a knot
over the nape of patient’s neck, insert the index finger of his left hand into the knot, twist the knot to tighten the knot
around the neck taking care not to block the respiration.
• This will be the method to control and raise the veins of head which are facing inwards and which are forbidden.
Dr SUBHAM PATRA

20. FOR SHAKA (LOWER
LIMBS)
• For puncturing the leg veins, leg should be well placed
straight on an even surface, while the other leg is slightly
flexed and held at a higher level than the leg to be
venopunctured. Cloth (Yantrana Shataka) should be tied
above the janu.
Dr SUBHAM PATRA

21. FOR SHAKA (UPPER LIMBS)
• The hand should be madde fist and cloth should be tied above the kupara.
• Strangling with the cloth, clenching the fist, grinding the jaws, inflating the mouth, tapping on the
vein are all meant to raise the pressure inside the veins.
Dr SUBHAM PATRA

22. VYADHANA PRAMANA (SIZE OF PUNCTURE)
• In muscular areas, puncturing should be of the size of the Yava (barley grain) in other
areas it should ½ Yava or one Vrihi (rice) using a Vrihimukha Shastra. Veins on the bones
should be punctured to the size of ½ of Yava using a Kutharika Shastra.
Dr SUBHAM PATRA

23. VYADHANA KALA (SUITABLE TIME) FOR SIRAVYADHA
• Three suitable times of Siravyadha are mentioned. During Varsha Ritu, it should be done on
days which are not cloudy; during Grishma Ritu at the time which is cool; during Hemanta Ritu at
mid-day.
Dr SUBHAM PATRA

24. SIRAVYADHANA AND NIRIKSHANA
• The physician should raise the vein by tapping on it with his middle finger triggered by the thumb.
On finding that the vein has risen up and full on touch, he should hold the Kutharika with his left
hand keeping its handle up, place it on the vein, tap it with his middle finger triggered by the
thumb or press it with the middle of the thumb. At places where the vein is hidden or the skin is
thick, pressing with the thumb should be done
• After puncturing the vein, vitiated Rakta may flow out in inadequate quantity (Hina Srava), proper
quantity (Samyaka Srava) and more in quantity with jiva Rakta (Ati Srava). Further Samyaka Srava can
be divided into Pravara Shuddhi, Madhyama Shuddhi and Hina Shuddhi according to the symptoms
obtained by proper puncturing
Dr SUBHAM PATRA

25. SRAVA PRAMANA (QUANTITY OF
FLOW)
• One Prastha is advocated as the maximum limit of bloodletting in a storng adult person with
excessively vitiated Dosha. In this regard Dalhana advised that blood should be let out in order of 1
Prastha (768ml), ½ Prastha (384ml) and 1/4th Prastha (192ml) for Uttama, Madhyama and Hina Matra
respectively.
Dr SUBHAM PATRA

26. SAMYAK VYDHA LAKSHANAS
(PROPER PUNCTURE)
• When proper instrumentation (puncturing) has been done, blood flows out in a stream for a
period of one Muhurta and then stops on its own without any measures. This should be
understood as proper puncturing.
• Just as yellow liquid flows out first from flowers of Kusumbha (when crushed) similarly vitiated
blood flows out first when veins are punctured. The persons who are debilitated, who have great
accumulation of Dosha or who are afflicted by fainting, Siravyadha should be done in the
afternoon or on the next or on the third day.
Dr SUBHAM PATRA

27. ASRAVA DOSHA (EFFECTS OF
ABSENCE OR INADEQUATE FLOW)
• If the vitiated blood is not let out in sufficient quantity it gives rise to Shopha, Daha, Raga,
Paka and Vedana. It occurs due to puncturing of Avedhya Sira or puncturing of the Sira by the thin
instrument.
Dr SUBHAM PATRA

28. COMPLICATION & MANAGEMENT
• If the vitiated Rakta does not flow out then Ela, Kushtha, Tagara, Pathya, Bhadradaru, Vidanga,
Chitraka, Trikatu, Agardhuma, Haridra, Arkankura, naktamala Phala either three or four or as many
as available or these drugs should be powdered, mixed with more quantity of salt and oil should
be rubbed on the mouth of wound and by this vitiated Rakta flows out properly.
Dr SUBHAM PATRA

29. ATISRAVA DOSHA (EFFECTS OF
EXCESS FLOW)
• Siravyadha if done during the time of summer (excess heat), and after excessive Swedana, if
the puncturing is done improperly and unskilled or inexperienced physician, then the blood flows
out in abnormal quantity.
• Other factors are incision made with an old instrument, patient having fear, taken too much
food, one whose body is not favorable due to Mada, Murccha, Shrama. Such excess flow of blood
produces Shirobhitapa, Andhya, Adhimantha, Timira, Dhatu kshaya, Akshepaka, Daha,
Pakshaghata, Ekangavata, Hikka, Shwasa, Kasa, Pandu, Murccha and death.
Dr SUBHAM PATRA

30. MANAGEMENT OF MURCCHA
DURING SIRAVYADHA
• One of the major complications which may leads to sudden death is Murccha. If patient become
unconscious while performing Siravyadha, the following points should be considered:
 Immediate removal of the instrument from the wound.
 Cold water sprinkling .
 Consolation and assurance to the patient.
Dr SUBHAM PATRA

31. MANAGEMENT OF ATISRAVA:
• When the blood flows out excessively powder of Lodhra, madhuka, Priyangu, Patanga, gairika,
Sarjarasa, Shalmali Pushpa, Shankha, Shukti, Masha, Yava and Godhuma should be sprinkled and
pressed with the tip of finger on the wound or Churna of bark of Sala, Sarja, Arjuna, Meshashrungi,
Dhava and ash of Kshauma or powder of Samudraphena and Laksha may be sprinkled then a
bandage is tied tightly using any bandaging material.
• The patient should be covered with moist cloth, put in a cold room, treated with application of
poultices and pouring liquids in cold condition, or the area may be burnt either with Kshara or
Agnikarma.
Dr SUBHAM PATRA

32. RAKTASRAVA NIRODHA KARMA
(METHODS OF PREVENTING BLEEDING)
• There are four methods of preventing bleeding from the vein
1. Sandhana – Joining the edges of the wound
2. Skandana – Promoting clotting
3. Pachana – Closing the wound
4. Dahana – Burning or Cauterization
• Drugs which are astringent will join or unite the wound; Drugs which are cold makes the blood to
clot, Ash or Alkali drugs will adhere and closes the wound and Cauterization will constrict the veins.
Dr SUBHAM PATRA

33. PASCHATA KARMA
1. Atura Paricharya
2. Parihara Vishaya
Dr SUBHAM PATRA

34. ATURA PARICHARYA
• After completion of procedure whenever blood flow stops
automatically, yantrana should be removed.
 Tight dressing should be applied on the wound and massage
around the wound by any oil to prevent Antha Tvaka Rakta Srava
(Ecchymosis).
 By the depletion of tissue due to bleeding, the Agni becomes weak
and Vata becomes aggravate. Hence, the patient should be treated
with food which are not very cold, which are light, unctuous, which
promote blood formation and either slightly sour or devoid of sour.
 The food which consists of takra with yusha, yavagu, peya should be
given to the patient.
Dr SUBHAM PATRA

35. PARIHARYA VISHAYA
• After bloodletting the patient should avoid Vyayama, Exposure to Sheeta vayu , Diwaswapna, use
of Kshara dravya, Katu Ahara, Shoka, Atibhashya, Ajeerna till he attains good strength.
• All these must be avoided for atleast one month.
Dr SUBHAM PATRA

36. MODE OF ACTION
1. Raktaprasadana: This occurs by the stimulation of Yakruta and Pliha, which are the root of Raktavaha Srotas. When these organs are
corrected then the whole of the Raktavaha Srotas gets corrected. Raktamokshana decreases the work load on Raktavaha Srotas and
thusyakrutandPliha.TheSandrata(Prithvi),Dravata(Jala)andpressureonRaktavahaDhamani(Vayu)arecorrected.
2. PittaShodhana:ByRaktamokshanaPiitaShodhanaoccursasRaktaistheseatof Pitta.
Dr SUBHAM PATRA

37. ACCORDING TO MODERN SCIENCE
Bloodletting acts in a following way:
 The diminution of the mass of the blood by which the overloaded capillary or large vessels of
affected part may be relieved.
 The modification of the force and frequency of the heart’s action.
 A change in the composition of the blood takes place after letting. The proportion of serum
becomes increased after bleeding. It facilitates more production of pure blood.
Dr SUBHAM PATRA

38. ACCORDING TO MODERN SCIENCE
 To lessen the abundance of vitiated blood. If this blood is bleed, the morbid materials of blood will
be less. The purpose of bloodletting is to give the bone marrow an opportunity to replace the old
stagnant blood contaminated with toxins, with fresh blood cells.
• The letting of blood removes iron from the blood stream through increased red blood cell production
which is potential health benefit. Excess iron binds to cholesterol and causes oxidation, which can lead
to plaque buildup in the arteries. Thus, bleeding possibly does lead to lowered cardiovascular disease.
Dr SUBHAM PATRA

39. Dr SUBHAM PATRA