SIRAVYADHA VIDHI (BLOOD LETTING/VENESECTION)

SHUDHA RAKTA LAKSHANA (FEATURES OF PURE BLOOD)

• Slightly sweet and salt in taste 
• Neither cold nor hot
• Resembling the colour of lotus, Indragopa insect, gold, blood of sheep and rabbit

EFFECTS OF VITIATED BLOOD ON THE BODY

Blood usually gets vitiated by Pitta and Kapha. It produces diseases mentioned below

• Visarpa- Herpes
• Vidradhi – Abscesses
• Pleeha – Disease of the spleen, or Splenomegaly
• Gulma – Tumors of the abdomen 
• Agnisadana – Dyspepsia
• Jvara –  fever
• Mukha, Netra Shiroroga – diseases of the mouth, eyes and the head
• Mada – Intoxication- toxicity
• Trut – excessive thirst
• Lavanasyata – salty taste in the mouth,
• Vatasra- Gout
• Pittasra- bleeding disease
• Belching with pungent and sour tastes in mouth and dizziness.
• Diseases which give us hard time curing, in which we don’t get results even after appropriate cold or hot, unctuous or dry treatment should be understood to be originated from aggravated rakta/blood. 

In order to drain out the vitiated blood in these diseases blood letting is done.

INDIVIDUALS UNSUITABLE FOR VENESECTION

• Who are less than 16years old and more than 70 years of age
• who have had no bleeding previously due to any cause
• who have undergone excess of Snehakarma and sweating therapies(Swedanam)
• Chardi – Vomiting
• Pandu – Anemia
• Chardi – Vomiting
• Dropsy
•  Those suffering from diseases of Vata origin, 
• The pregnant woman, the woman in parturition, 
• Those suffering from bleeding diseases, indigestion, Shwasa (dyspnoea)
• Kasa – cough, cold
• Atisara – Diarrhoea, dysentery
• Udara – Ascites, intestinal obstruction/enlargement of the abdomen
• Those who have been given fat, ghee or oil to drink, as a part of oleation therapy(Snehana karma)
•  Who are undergoing the Panchakarma treatment.

THINGS TO KEEP IN MIND DURING VENESECTION

• Without enforcing control on the body, the vein should not be cut.
• The vein which is horizontal, that which has not been raised up
• Should not be done on very hot or cold, too windy, or cloudy days.

SELECTION OF VENESECTION SITE

It can be done by following mentioned tips

• DISEASES OF HEAD AND EYE – Veins situated on the forehead, outer angle of the eyes or the area around the nose should be cut
• DISEASES OF THE EAR – Veins near the ear.
• DISEASES OF THE NOSE – Vein situated at the tip of the nose
• RHINITIS – vein located in the nose and forehead, Jaw or palate.
• TUMOURS OF PARTS ABOVE THE SHOULDER – Vein situated in the tongue, lips, lower Jaw or palate.
• IN TUMOURS OF PARTS ABOVE THE SHOULDER – Veins in neck region, ears, temples, jaw or the head.
• ALL DISEASES OF THE HEAD – Vein situated in between the eyebrows.
• VIDHRADHI (ABSCESS) AND PAIN ION FLAK REGION– vein situated between the flanks, Axilla and breast
• EVERY THIRD DAY FEVER(TRITIYAKA JVARA) – vein in the centre of the shoulders.
• EVERY FOURTH DAY FEVER (CHATURTHAKA JVARA) – Below the shoulder.
• DYSENTERY WITH PAIN – Vein situated two Angula away from the pelvis.
• DISEASES OF PENIS OR SEMEN – Vein situated in the penis.
• APACHI OR GLANDULAR ENLARGEMENT OF NECK – Vein situated in the thigh.
• GRIDHASI OR SCIATED – Vein situated four Angula below or above the knee joints.
• GOITER – Vein situated two Angula below the indrabasti (a vital spot in the centre of calf muscles)
• GOUT, PADAHARSHA (TINGLING SENSATION IN FEET), VIPADIKA (FISSURES IN FEET), Vatakantaka(sprain of the foot or Ankle), Chippa (A diseases of the nails of the toes) – Vein situated two Angula above the Kshipramarma  (A vital Spot in between the big toe and the next toe to it)
• VISHVACHI (PAIN IN THE ARMS just like Sciatica but in arms) – Venesection of sciatica should be done.

If the veins are not visible, another vein which is devoid of vital spots and situated nearby, should be cut.

VENESECTION RITUALS AND PROCEDURE

• The patient should follow Snehana procedure first.
• All the necessary equipments for blood letting should be kept ready.
• The person should be strong, should perform Auspicious rites and have boiled rice with meat soup and ghee.
• For sudation/sweating the person should be exposed to sunlight or fire heat.
• He is asked to sit on a stool of his knee height 
• A band of soft cloth is tied around his head at the lower border of the hair or his hairline.
• He should keep elbows on his knees.
• A pad of cloth is held in fists and patients neck is massaged briskly with fists.
• Patient is asked to Grind the teeth, cough, inflate the mouth to enlarge the cheeks.
• Trunk should be wound with a band of cloth, fixed with the knots at the back
• His neck should also be tied with a band of cloth and tightened
• By this mode we raise the deep seated veins.
• Then the physician taps the raised vein with his middle finger tripped off by the thumb, noticing the elevation, once again he raises it by kneading it with the thumb, then holding the axe with his left hand, places its edge on the middle portion of the vein and applies the small cut with Axe without Shaking.
• Axe should be lifted up in the same way, tapping and kneading of the vein is done for making more blood to come out. 

INSTRUMENTS FOR PERTICULAR VEINS

• The vein- of the nose should be cut with the Vrihimukha Sastra (the Lancet with its face shaped like a grain of rice after raising the tip)
• The vein situated underneath the tongue should be cut by asking the patient to keep the tip of the tongue raised and biting it holding it firmly by the upper row of teeth. 
• The veins of the hands should be cut when the patient is sitting comfortably, keeping his arm straight without bending at elbow, he should clench the first with the fingers folded inside, a band of cloth is tied four Angula above the site of cutting. 
• The veins of the flanks are cut by keeping the arms hanging loose,
• Foot veins – feet are kept steady, the foreleg is massaged briskly from the knee towards the Ankle with the hands, the other leg is kept slightly bent, by tying a band similar to the method described for hand venesection.
• On fleshly parts of the body, the Vrihimukha Sastra (Lancet) should be used and the vein is cut to the size of a rice grain only,
• Veins on the bones should be cut to the size of half Yava (barley) by using the axe. 

SAMYAK VIDH LAKSHANA

When the cutting is proper

• The blood flows out in a steady stream.
• Bleeding stops when the control (tourniquet) is released or untied.

ASMYAKA VIDHA

When the cutting is inadequate

• The blood flow is only for a short time and that too less in quantity
• In this condition it should be rubbed with oil mixed with lime powder to increase the bleeding.

ATI VIDH LAKSHANA AND CAUSES

When the cut is LARGE

• The blood flows out with a sound and stops with great difficulty. 
• Fear, fainting, loose tourniquet, blunt instruments, over- satiation (excess eating), debility, holding the urges of urine, faeces etc.

REASONS FOR LESS FLOW

•  Not doing swedana therapy prior to the bloodletting, is the causes of absence of blood flow.
• When the blood is not flowing out in sufficient quantity, the cut end of the vein should be smeared with oil which is processed in Vidanga, Haridra, Vyosha (Trikatu), Nata, Lavana. But when the blood is flowing out properly, the cut site should be smeared with warm oils and salt. 

THINGS YOU SHOULD KNOW

• Vitiated blood always flows out first, its color is like the yellow- juice from the second seeds of Kusumbha before its oil flows out.
• The flow stops by itself after sufficient bleeding. Blood after that should be considered as pure or unvitiated blood and further flow should not be encouraged.
• If the patient faints during the flow, the touriniquet should be released, to make him conscious, he should be fanned with fans and procedure should be continued. If the patient faints again, bloodletting should be postponed for a day or two.

DUSHITRAKTA LAKSHANA- CHARACTERISTICS OF IMPURE BLOOD

• VATA VITIATED BLOOD – It will be blue or crimson in color, dry, non slimy, flows with force, clear and frothy
• PITTA VITIATED BLOOD – It will be yellow or black, foul smelling, because of increase of heat not too thick, mixed with glistening particles.
• KAPHA VITIATED BLOOD – It will be unctuous in nature, color is pale/yellowish or white, has small threads, slimy and thick.
• If it is vitiated by two doshas or all three, it will have features of all.

SRAVA PRAMANA – QUANTITY OF BLOOD FLOW

• Vitiated blood more than one Prastha that is 768 ml should not be allowed to flow out, even in strong patients.
• Excess bleeding can lead to either death or dreadful diseases of vata origin. In this type of situation, oil massage, milk mixed with blood are the treatment.
• After the sufficient flow of blood, torniquet should be removed slowly, wash the site with cold water, cover the cut end of the vein with a swab soaked in oil and bandage the area.
• If there is still vitiated rakta, it should be removed again either in the same evening or next day or It should be removed again after a fortnight according to patient’s bala or strength, after administering proper Snehana therapy. 
• If it’s just a small residue of vitiated blood left, then it will not cause any harm and so it’s allowed to stay. So, excess flow of blood should not be attempted, it’s better to leave a little dosha instead. 
• Such residual blood can also be removed by shringa(sucking horn) and Jalauka(leech). 
• It can be purified by cold comforts, by formulations prescribed for Raktapitta (bleeding diseases) or by panchkarma purification therapies.

IF BLEEDING DOES NOT STOP

If the bleeding does not stop following methods should be adopted 

• the orifice of the wound should be smeared with the powder of either Rodhra, Priyangu, Pattanga, Masha (black gram), Yashti (licorice), Gairika, Mritkapala (pot shred), Kshana Masha, ash of flax or of the bark and sprouts of trees with milky Sap
•  by cold infusion prepared from drugs of Padmakadi Gana – vide chapter 15 should be taken as a drink;
•  the same vein should be cut again and the ends of the vein should be touched with a red hot rod. (cautery) with a red hot rod. 

DIET

• Foods which are neither very hot nor very cold
• Which are light or easy to digest
•  Which enhances digestive fire or hunger are suitable after the raktamokshana because after bloodletting procedure, the body has decreased digestive fire.

FEATURES OF A PERSON WITH HEALTHY/PURE BLOOD

• Color and complexion is enhanced
• Power of sense organs is enhanced.
• Good perception of objects by sense organs.
• Enhanced digestive fire or improved hunger.
• Enjoyment of life comforts with good nutrition and immunity.