1. Presented By Name: Dr. Prathamesh V. Karpe BAMS, MS(Shalyatantra) Country: INDIA Presented By Name: Dr. Prathamesh V. Karpe BAMS, MS(Shalyatantra) Country: INDIA 3 rd International Conference and Exhibition on Traditional & Alternative Medicine August 03-05, 2015 Birmingham, UK In Association with

2. Dr. Prathamesh V. Karpe BAMS, MS(Shalyatantra) Consulting surgeon & Lecturer in Dept. of Shalyatantra, GAM&RC Shiroda Go a

3.  It is one of the Panchakarma (five purificatory procedures) viz 1)vaman- medicinal induced emesis 2)virechan- medicine induced purgation 3)Basti- medicated enema 4)Nasya- nasal medications 5) Raktamokshan- blood letting

4.  It is indicated in all Raktapradoshaja vikara- disorders caused due to vitiation in the blood.  When the procedures like snehana-rukshana, Sheeta- Ushna doesn’t give relief, Raktamokshan is indicated.

5. 1. Oedema all over the body 2. Excessive intake of sour,spicy-pungent and salty food 3. Pandu-Anaemia 4. Bleeding hemmorrhoids 5. Udar- ascitis 6. Rajyakshma- TB 7. Oedema in pregnancy

6. Types of Raktamokshana सिरावेध Vein puncturing प्रच्छान्न - incising श्रुंग - Animal horn application जलौका Leech therapy अलाबु - dried bitter gourd घटी - mudpot

7. सिरावेध Vein puncturing प्रच्छान्न -incising श्रुंग - Animal horn application जलौका Leech therapy अलाबु - dried bitter gourd घटी - mudpot

8.  Superficial incisions from above to downwards direction (anulom gati) in vertical fashion are given on the affected part after snehan and swedana.  Not performed on joints, marmasthana, across veins, tendons etc  Indicated when there is any thick lesion on the skin, after snake bite, tumors etc.

10.  Indicated in Vata dominant rakta dushti.  Pricks or incision are given on the skin after snehan and swedan, animal horn is placed with its broader end on the skin and from tapering end blood is sucked out.  Principle of vaccum is applied

12.  This can be termed as ‘Vein-puncture’ and is one of the easiest mode of ‘Raktamokshan’. Sushruta gives utmost importance to this technique.

13. Supremacy of ‘Sira Vyadhan’ Sira Vyadhan Other procedures

14.  Selection of suitable patient  Snehan- Swedan (half hour before) at the site of Sira-vedh.  Laghu Aahar (Light semi-solid diet) like Yavagu etc.  Coagulatory disorder like haemophilia should be rulled out. Similarly, precautionary measures to be taken while handling the Anaemia, Diabetes, Hepatitis, HIV patients.  After Mangal & Swasti vachan (prayer) patient is given either supine position or slight propped-up position.  Now, a vein is selected for vene- section & a tourniquet or bandage is applied a little above the site of Sira Vyadhan.

15.  Blood letting by ‘Sira Vyadhan’ is performed preferably in Sharad reetu as Pitta is vitiated more in this season.  Better to avoid Grishma reetu (i.e. last 15 days of April, May & first 15 days of June). Ideally, this should be performed in comfortable, cool & pleasant weather.

16.  It is indicated in all types of diseases with rakta vitiation  Visarpa  Kushta  Vranashotha  Vidhradi aamavastha  Vatarakta  Yakrutodara  Non healing ulcers  tumours

17.  Blood letting should not be done in following condition:  young children & very old people  Ruksha/ Kshat/ Ksheen/ Krish– extremely weak, under- nourished & debilitated patients.  Bheeru i.e. Timid person  exhausted person  Stree karshit i.e. Excessive sex indulgence  After Vaman, Virechan & Basti karma

18.  In Insomnia & Sleeplessness conditions  Pregnancy  Klaibya i.e Impotency  Anaemic & Haemophilic Patient  Patients suffering from Cough, Breathlessness, Muscular wasting, High grade fever, Convulsive disorders, Paralysis, Giddiness & patients who are Fasting or Thirsty or dehydrated or malnourished.

19. 1.Brihee- mukh Shastra – superficial vein puncturing. 2.Kutharika Shastra- When vein is crossing bone 3.Vetas Patra- When vein is fine 4.Aara Shastra- When vein is big & large amount of blood has to be removed.

20.  Faulty technique  Collapse of vein due to ‘Shock’  Low BP/ Obesity/ Anxiety neurosis  Over exertion  Extreme weakness  Dehydration  Fear  Loosening of tourniquet  Blunt instrument  ‘Sira- Vyadhan’ done without prior Fomentation  In Text books, this is further divided according to Shastra- dosh, Rogi- dosh, Yantra- dosh, Sira- dosh & Vaidya- dosh.

21.  Laghav- Feeling of lightness  Vedana shanti – Relief from pain  Vyadhi weg parikshay- Arresting further progress of disease  Manh prasad- Feeling of wellbeing  Raktum Swayamev Avatishthhate- Haemostasis by its own  Shuddha i.e. Fresh/ purified/ clear blood is seen at the end

22.  Sirobhitap- Headache with warmness  Aandhyam -Blurring of vision  Adhimanth- Glaucoma  Timir pradurbhav- Errors of refraction  Dhatu kshay- Loss of tissue (Emaciation)  Aakshepak-Convulsive disorder  Daah- Burning sensation  Pakshaghat- Hemiplegia or Monoplegia  Hikka- Hiccup  Swash, Kaas- Dysponea, Coughing  Pandurog- Anaemia  Maran- Death

23. As the very basis of life for ‘Leeches’ is water, since their site of dwelling is ‘Jal’ i.e. water, the ‘Leeches’ are known as ‘Jaloka’.

24. Poisonous Non- poisonous 1) Krishna 1)Kapila 2) Karbuda 2)Pingala 3)Alagarda 3)Shankh- mukhi 4) Saamudrika 4)Mushika 5)Indra- yudha 5)Pundarik-mukhi 6)Go-chandana 6)Saavarika

27. अग्रे स्रवति दुष्टास्रं कुसुम्भादिव पीतिका / ( अ. ह्रू. सु. 28/37) Vitiated blood flows out first, just like the yellow juice from the seeds of the Kusumbha before its oil flows out. After sufficient bleeding, the flow stops by itself; it should be considered as pure (unvitiated blood) and further flow shouldn’t be attempted.

28.  It helps in relieving pain, burning sensation  Reduces inflammation  Reduces infection  Restores sensation of the part  Helps in healing of ulcers

29.  Snehan- internal and external olevation  Swedan- fomentation  Cleaning the part from where raktamokshan to be performed  Tying tourniquets in case of siravedha

30. Vrana shotha-cellulitis After leech application 5 th day

31. Before jalaukavacharanaAfter jalaukavacharana

32.  Raktamokshana if used after proper diagnosis and evaluation gives instant results compare to other pallaitive or conservative treatment.  It is very much economical and cost effective.  No much man power is required unlike other panchakarma procedures  If not used cautiously then may even prove fatal.

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