MARVELS OF PARA-SURGICAL PROCEDURES IN AYURVEDA

WITH SPECIAL REFERENCE TO RAKTAMOKSHANA

Dr. Praveen Kumar

Lecturer, Deptt. Of Shalya Tantra

WHY RE-ORIENTATION?

Vaksaushthave Arthavigyane Pragalbhye karmanaipune, Tadabhyase cha siddhou cha yatetadhyanantagah. Su. Su. 3/56

After finishing study one should make efforts to attain excellence of speech, understanding, boldness, dexterity, practice and successful management.

HOW TO REFINE KNOWLEDGE?

Satatadhyana Vadah Paratantra- avalokanam, Tadvidacharya seva Buddhimedha karo ganah – Sushruta

Continuous study, debates / seminars, study of different sciences, regard of preceptors make a person intelligent and skilled.

IMPORTANCE OF PANCHAKARMA AS PER SUSHRUTA

Snehadisvanabhigya yaschedyadishu cha karmasu, Sa nihanti janam lobhat kuvaidya nripadoshatah.

Su. su. 3/52 The quack who is ignorant of unction and

excision etc kills the people out of greed due to negligence of the state.

RAKTAMOKSHANA: THE HALF OF ALL THERAPIES

Dehasya rudhiram mulam Blood is the base of life and one should

do all efforts to preserve it. It is a dhatu and dosha both, when

vitiated, it should be drained within physiological limits.

The maximum amount of drainage of blood is one prastha say 54 tola or 600 ml.

It should not exceed the above-mentioned limit.

IMPORTANCE OF RAKTAMOKSHANA

Tvakdosha Granthya Shopha roga Shonitajascha ye, Raktamokshana Sheelinam na bhavanti Kadachanah

Skin diseases, Neoplastic disorders, Inflammatory disorders and other disorders caused by vitiation of blood don’t occur in the individuals who undergo regular bloodletting.

TOOLS FOR BLOODLETTING

Without using Shastra (Minimal Invasive):

1. Shring or Horn: By sucking action

2. Alabu or Gourd or cupping by vaccum action

3. Jalaukavacharana or Leech therapy

With Shastra (Invasive):1. Pracchana (Scraping)2. Siravedha or venepuncture

INDICATIONS OF DIFFERENT MODALITIES

Doshik base: Vata – Shringa, Pitta – Jalauka, Kapha –

Alabu, Generalized – Siravedha, Local – Pracchana

Condition of blood: Avagadhe Jalauka syat, Pracchanam

pindite hitam, Sira angavyapake rakte, shringalabu twachi sthite Su. Sha. 8/26

SHRINGA OR HORN

Its use is specific to Vata disorders being Snigdha in nature.

Dimensions: It is a kind of Nadiyantra. This denotes the horn of cow. Its length is 18 angula on average and the attaching portion (mouth) has the diameter of 3 angula. The sucking end has a hole of the size of mustard seed. Its shape is just like the nipple of the breast (Stanakara).

APPLICATION OF SHRINGA

Snehana, Svedana, Pracchana at the desired site of bloodletting and the Sringa is placed. It has two openings, one is small and another is broad enough. Broad opening is placed on the wound while the small opening is used to suck the air by mouth. When you suck by mouth through the hole in horn; it will create vacuum in the horn. It will help the blood to let out. The mouth should be closed to maintain vacuum in the horn. When you want to remove the Shringa, hole should be open down.

ALABU YANTRA/TUMBI/ GOURD

It is specifically used in vitiation of Kapha dosha. If the blood is vitiated with the pitta dosha, then this Alabu Yantra should not be used for the purpose of bloodletting. It is because the fire is used to create vacuum in the Alabu; therefore, it may enhance the Pitta dosha.

The diameter of the Alabu yantra is 3-4 angula and it has two openings on either side. Where Alabu is used, the redness and congestion develops, hence blood congestion reduced in deeper places.

TECHNIQUE OF USING ALABU

It works on the principle of vacuum extraction. A lamp is placed at the site of application of Alabu and the lamp is ignited. The lamp remains in the ignited form till the air remains in the Alabu. When all of the air is used in the Àlabu, the lamp goes off. Owing to this action, vacuum develops inside the Alabu. The Alabu is remained in the same position for ten to fifteen minutes. It is better to have Pracchana at the place of application of Alabu, so that the maximum blood would come out. Now a day, a glass is used to cover the lamp instead of Alabu. This procedure is named as cupping.

PRACHCHANA KARMA

Pracchana-karma is adopted when doîas are situated in tvak and blood is remained in PiàÅita state. With the help of sharp instrument, the cuts are applied on the desired body parts from below upward. In this process, utmost care must be taken to save vital structures. The instrument should be Riju (straight), Asankirna (not very near to each other), Sukshma (small and fine), Sama (even), AnavagaÅha (not very deep), Anuttana (Not very superficial) and Ashu (quick). VÂgbhaòa has said that instrument must not be applied on the same part that has been treated first. Pracchana karma is also done prior to the application of the Shringa and Alabu.

SIRAVEDHANA

Sira – Veins, Dhamani – Artery or Meridians, Srotasa – Hollow spaces meant for secretion and absorption.

It is a channel through which nutrients are provided to the tissues. The speed of the contents inside it, is slow. One more definition of Sira is that in which blood is flown towards heart without pulsation are Siras.

SIRAVEDHANA

We cannot correlate exactly the Sira to vein or artery or lymphatic but it is more closer to the veins. It has been mentioned in the ancient texts that Siras are meant for providing nutrition to the dhatus by sarana mechanism. In this connection, it may be stated that the nutrients when absorbed from intestine, will bring to liver by the portal vein and in the foetus, it is the umbilical vein that provides means of nutrition to the foetus. Moreover, arteries do have pulsations and the veins are devoid of any pulsation. It again clarifies that the Siras are more closely associated with the veins.

TECHNIQUE OF SIRAVEDHANA

The patient is prepared with the snehana and svedana and he or she may be given the diet having opposite quality of the predominant dosha. The patient may be allowed to sit, erect or lying in bed according to the ease. The tourniquet of cloth, leather or bark of a tree is applied on the part. The tourniquet may not be too tight or too loose. It is followed by the puncture with appropriate instrument. Before sirÂvedhana, the sir must be fixed and should be made prominent. To achieve good results of puncture, it is necessary that the surgeon should have good skills and the instruments should be sharp.

ADEQUATE VENEPUNCTURE

After bloodletting, the wound should be washed with the fresh water and the opening must be bandaged after putting oil-soaked gauze. The patient is provided with light, dipaniya and anushnashita food after the procedure.

After the puncture, blood comes out in the form of stream and it stops by its own. The pain and flow of blood subside after a little bit time.

The frequency of symptoms reduces after adequate siravedha.

STANDARDIZATION OF SIRAVEDHA We may use Hypodermic niddle of 24 G size

in place of conventional instruments such as Ara, Kutharika, Brihimukha.

It is an invasive procedure; therefore, explain properly to the patients.

The maximum amount should not exceed say 54 tola or 540 Ml.

CONTD.

Concept of Avedhya sira: Most of these siras are in Head, neck and

abdominal regions. Most of the sira of extremities are safe to puncture.

Concept of Dustavedha: It is due to the lack of skill while puncturing a

sira.

BENEFITS OF SIRAVEDHA

Removal of Toxic metabolic wastes. Stimulates new blood cell formation. May stimulates bone marrow. Cure the ailments fast in comparison to other

modalities.

JALAUKAVACHARANA

The bloodletting with the help of leech is painless or noninvasive way of bloodletting.

It resides in the water, hence being Sita in nature pacifies pitta dosha.

Not only it relieves pitta but also it cures a wide range of ailments.

Available in abundance in the ponds. It may be cultivated in the leech tanks and the same may be prepared with ease in the premises of the hospital or clinic.

INDICATIONS OF LEECH

Doshas are situated in the deeper tissues.

Pitta predominance. More physiological, feasible (no pain),

rational and result oriented. Children, old ages, women, king,

person of soft constitution and coward. Gulma, Arsha, Vidradhi, Kushtha,

Vatarakta, Galaroga, Visha and Visarpa.

POISONOUS LEECHES

The concept of poisonous and non poisonous nature of the leeches has been discussed at large in Ayurveda. It has been mentioned that poisonous leeches reside in dirty habitat and non-poisonous leeches reside in fresh water ponds.

Six types of leeches are poisonous in nature e.g. Krishna, Karbura, Alagarda, Indrayudha, Samudrika, Gochandana.

CONTD.

Alagarda has long hair all over the body especially on lateral aspect of the body. It can be compared with Hirudinaria Granulosae. It is abundant in states of Tamilnadu, Kerala, M.P. and U.P. It often attacks human beings. Romasha Mahaparshva Krishnamukhi (Su)

POISONOUS LEECHES

Indrayudha is one among poisonous leeches. The dorsal aspect of the body is covered with multicoloured lines like rainbow. It can be compared with Hemodipsa ornata. It is a common species found in India. It is recorded from the hill track of the Assam. Its bite is unlike that of other leeches is painful. It may sometime prove fatal as the leech carries septic bacteria.

POISONOUS LEECHES IN MODERN MEDICINE

Hemodipsa jajanica and Manellensia: thorough nuisance both for humans and cattle.

Hemodipsa zeylanica Hemodipsa montara Hemodipsa blanchard Horse leech: It is said to attack the

breathing passage of horse and it is 6 to 8 inches in length. On extension it may be of 30 cm long.

UNHEALTHY JALAUKA

Broad in its middle part. Vistirna Has slow movement and deformed shape. Attach to the victim or patient with difficulty. Sucks less quantity of blood.

HEALTHY JALAUKA

Non-poisonous Jalaukas live in deep and fresh water where there is the abundance of lotus, algae etc.

The leech, which is used for therapeutic purpose is known as Hirudo medicinalis.

The symptoms of Savisha Jalauka bite as have been mentioned in Sushruta are related to infection. It may be due to the bacteria present in the leech gut symbiotically.

IMPORTANCE OF JALAUKAVACHARANA

As a swan can separates the water from a mixture of milk and water; likewise, a Jalauka can separate impure blood from the pure and it sucks impure blood only. A.H.Su. 42/26

Leech saliva contains many metabolically active enzymes and they have a diverse functions.

SYMPTOMS OF POISONOUS LEECH BITE

Acute cellulitis Kandu Jvara Daha Chardi Angamarda These are the symptoms pertain to

bacterial infection.

MODE OF ACTION

The therapeutic benefits of the leech bite doesn’t relate with the average 5 to 10 ml of bloodletting during bite but the continuous oozing of blood for 10 hours or more is the main benefit.

The goal is to produce a minimally adequate venous outflow from the tissue.

Not only it reduces congestion but also it helps in neogenesis.

MODE OF ACTION

It is true that continuous bleeding in the bite wound is not merely due to the anti coagulants but other pharmacologically active substance may also play good role.

This can be proved by the fact that conventional anticoagulants can never be a substitute of leech bite.

LEECH SALIVA

Hirudin: Proteolytic and Thrombin specific inhibitor. It retards coagulation of blood

Bdelin: Plasmin inhibitor. It checks destruction of tissue and good in case of necrosis.

Eglin: Potent inhibitor of elates and chymotrypsin. It effectively blocks the inflammatory response induced after localized trauma or surgery.

Hementin: Anticoagulant, it degrades fibrinogen and fibrin.

LEECH SALIVA

Collagenase and Apyrase: Inhibitor of platelet aggregation

Hyaluronidase: Most important acting principle in leech saliva. It also has antibiotic properties in addition to its natural properties. The skin penetration becomes easy.

Anaesthetic agent Vasodilators: It is histamin like

substance but it doesn’t cause allergic reactions.

Antibiotics: The antibiotics are produced by symbiotic bacterium Aeromonas hydrophylla.

ROLE OF LEECH IN MEDICAL THERAPEUTICS

Plastic and reconstructive surgery: It reduced the oedema associated with grafting; therefore improve the blood circulation. It causes more chances of graft acceptence.

Prevention of necrosis: Improves tissue perfusion. Provide enough time for capillaries to grow. Neogenesis is an added advantage.

Oedema: Leech provides immediate reduction of swelling by sucking blood and by the action of seeping due to Hirudin.

ROLE OF LEECHES

Pyogenic lesions Haematoma Pains of varied etiology Varicose veins Skin disorders Burger’s disease Researches are on to find out anti-

tumour activity of leech saliva.

THANK YOU