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Rakthamokshana Karma (Blood letting)Presented byDR. DKR.KEERTHI RATHNADR.GGTD. DE SILVADR.WR.PREETHI SURANGANIEDR.MFM.SHILMY
To define the rakthamokshana karmaTo describe the types of rakthamokshana karma To describe the mechanism, procedure and clinical usage of leech therapy To indicate the complication of leech therapy
IntroductionBloodletting 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.
Definition of Rakthamokshana The word Rakta means: - coloured, dyed, tinged, painted, Red, crimson, blood red.Mokshana: 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.
Normal blood 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.
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.
Historical background of blood letting
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.
Ancient instrument for blood lettingLeeches sharpened sticks, sharks teeth, knives.Scarificators The "superficial" vessels were attacked, a springloaded lancet, or a glass cup that contained heated air, producing a vacuum within.
Ancient instrument for blood letting..
Interior of spring lancets
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.
Types of Raktha Mokshana
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.
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.
CONTRAINDICATIONS, , , , , , , , , , , , (Su.su 14/28, Su Sa. 8/3)
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 veinsShould tap the raised vein with physicians middle finger tripped off by the thumb;
Pradhana karmaThe lancets (shastra) is incerted quickly neither too deep nor superficial in the middle of the vein without injuring the marma pointsThe maximum quantity of blood that may be let out should not exceed one prastha
Siravyadha ..Paschat karma:apply spirit Fine powder of haridra and laksha to the site of blood letting Samsarjena karma followed.
Action of siravyadha:Choice of treatment in Pittaand Rakta Reduces intravascular pressure and volume which will reduce pain and swelling Reduce the breakage of RBC, in turn reduces pigmentation and itching.
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
AnushastravishravanaJaluka -Pitta Shringa-VataAlabu -Kapha 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.
Shrungavacharanascratching 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.
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 painIn 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.
Jalauka II(Su S 13/9)Since jala is their life, they are called as Jaluka or since they are habituated to water they are called as Jalooka.
Scientific classification :Kingdom: Animalia
Binomial name: Hirudomedicinalis
Types of leechesPoisonous leeches Non- poisonous leeches KapilaKrishna Pingala Karbura KapilaAlagarda PundarikhiIndrayudha SavarikaSaamudrika Mushika Gochandana Shankamuki
Indications of leech therapy (jalaukavacharana) DiseasesCharakaSusruthaVagbhata1Skin diseases( Kushtha)+++2 Erysipelas (Visarpa)+++3Boils and carbuncles (pidaka)++-4Abscesses (vidradi)+++5Ring worm (dadru)+--6Scabies (pama)+--7Tumours (arbuda)-+-8Eczema (vicarchika and charmadala)+--
Other indication of leech therapy Peripheral vasculardiseases Diabetic foot ulcerNon healing ulcer Thrombosed HaemorrhoidsTenosynovitisVitiligoWartsFoot Corn
Contraindications of leech therapy (jalaukavacharana)Absolute Hemophilia Severe AnaemiaErosive 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
Mode of action of hirudotherapyWhen 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 clottingthrombolytic (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 clotsrestoration of the microcirculationrecovery of neuromuscular impulse transmissionrestoration of vascular permeabilitybacteriostatic (death of microorganisms, causing inflammation)immunostimulatory
The important constituents present in the leech salivaHirudin - 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
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.
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
TURMERIC POWDERCOTTON COTTON
Purva Karma (Before procedure)the patient should be subjected to snehana (oleation) and swedana (fomentation), to enhance the mobilit