27. SIRAVYADHA VIDHI ADHYAYA / सिराव्यध –
procedure of venesection
SUDDHA RAKTA LAKSHANA – PROPERTIES OF PURE BLOOD
Sira means vein. Vyadha means puncturing.
मधुरं लवणं किञ्जित् अशीतोष्णमसंहतम्
पद्मेन्द्रगोपहेमाविशशलोहितलोहितम्
लोहितं प्रभवः शुद्धं तनोस्तेनैव च स्थितिः
Shuddharakta Laksana- Features of pure blood:-
1. Slightly sweet and salt in taste
2. neither cold nor hot,
3. resembling the colour of lotus,
4. Indragopa insect,
5. gold,
6. blood of sheep and rabbit
- are the characteristic properties of pure blood;
· It is the cause of origin of the body,
· by it, is determined the condition of body as healthy or unhealthy.
EFFECT OF VITIATED BLOOD – DUSHTARAKA KARMA-
तत्पित्तश्लेष्मलैः प्राये दूष्यते कुरुते ततः
विसर्पविद्रधिप्लीहगुल्माग्निसदनज्वरान्
मुखनेत्रशिरोरोगमदतृड्लवणास्यताः
कुष्ठवातास्रपित्तास्रकट्वम्लोद्गिरभ्रमान्
शीतोष्णस्निग्धरूक्षाद्यैरूपक्रान्ताश्च ये गदाः
सम्यक्साध्या न सिद्ध्यन्ति ते च रक्तकोपजाः
1. Blood usually gets vitiated by Pitta and Kapha.
2. It produces diseases such as
· Visarpa- Herpes,
· Vidradhi – Abscesses,
· Pleeha – Disease of the spleen,
· 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 and dizziness.
Those curable diseases, not getting cured even after appropriate cold or hot, unctuous or dry treatment should be understood as being born from aggravated blood.
तेषु स्रावयितुं रक्तमुद्रिक्तं व्यधयेत्सिराम्
In order to drain out the vitiated blood in these diseases veins should be cut.
PERSONS UNSUITABLE FOR VENESECTION – SIRAVYADHA ANARHA –
न तूनषोडशातीतसप्तत्यब्दस्रुतासृजाम्
अस्निग्धास्वेदितात्यर्थस्वेदितानिलरोगिणाम्
गर्भिणीसूतिकाजीर्णपित्तास्रश्वासकासिनाम्
अतीसारोदरच्छर्द्दिपाण्डुसर्वाङ्गशोफिनाम्
स्नेहपीते प्रयुक्तेषु तथा पञ्चसु कर्मसु
नायन्त्रितां सिरां विध्येन्न तिर्यङ्गाप्यनुत्थिताम्
नातिशीतोष्णवाताभ्रेष्वेन्यत्रात्ययिकाद्गदात्
· Who are less than sixteen and
· more than 70 years of age,
· who have had no bleeding previously – any time due to any cause,
· who have undergone excess gone Snehakarma and sweating therapies,
· those suffering from diseases of Vata origin,
· the pregnant woman,
· the woman in parturition,
· those suffering from indigestion, bleeding diseases, Shwasa (dyspnoea),
· Kasa – cough, cold
· Atisara – diarrhoea, dysentery
· Udara – ascites, intestinal obstruction / enlargement of the abdomen,
· Chardi – Vomiting
· Pandu – anemia
· Chardi – Vomiting,
· dropsy;
· for those who have been given fat – ghee or oil to drink – as part of oleation therapy, and
· who are undergoing the Panchakarma treatment.
1. The vein should not be cut without enforcing control on the body – as described further,
2. that vein which is horizontal,
3. that which has not been raised up;
4. not on day which are very cold, very hot, very windy, or cloudy datys,
venesection should not be done.
SELECTION OF SITE OF VENESECTION- VYADHANA STHANA NIRDESHA-
शिरोनेत्रविकारेषु ललाट्यां मोक्षयेत्सिराम्
अपाङ्ग्यामुपनास्यां वा कर्णरोगेषु कर्णजाम्
नासारोगेषु नासाग्रे स्थिताम् नासाललाटयोः
पीनसे मुखरोगेषु जिह्वौष्ठहनुतालुगाः
जत्रूर्ध्वग्रन्थिषु ग्रीवाकर्णशङ्खशिरः श्रिताः
उरोपाङ्गाललाटस्था उन्मादे अपस्मृतौ पुनः
हनुसन्धौ समस्ते वा सिरां भ्रूमध्यगामिनीम्
विद्रधौ पार्श्वशूलेच पार्श्वकक्षास्तनान्तरे
तृतीयके असंयोर्मध्ये स्कन्धस्य अधश्चतुर्थके
प्रवाहिकायां शूलिन्यां श्रोणितो द्वयङ्गुले स्थिताम्
शुक्रमेढ्रामये मेढ्रे उरुगां गलगण्डयोः
गृध्रस्यां जानुनो अधस्तादूर्ध्वं वा चतुरङ्गुले
इन्द्रबस्तेरधो अपच्यां द्वयङ्गुले चतुरङ्गुले
ऊर्ध्वं गुल्फस्य सक्थ्यर्तो, तथा क्रोष्टुकशीर्षके
पाददाहे खुडे हर्षे विपाद्यां वातकण्टके
चिप्पे च द्वयङ्गुले विध्येदुपरि क्षिप्रमर्मणः
गृध्रस्यामिव विश्वाच्याम् यथोक्तानामदर्शने
मर्महीने यथासन्ने देशे अन्यां व्यधयेत् सिराम्
In diseases of the head and eyes
· veins situated on the forehead,
· outer angle of the eyes or
· the area around the nose should be cut;
In diseases of the ear,
· the veins near the ear;
in diseases of the nose,
· vein located at the tip of the nose;
in Rhinitis,
· vein located in the nose
· and forehead,
IN Diseases of the mouth,
5. in tumors parts above the shoulders,
· veins at neck,
· ears,
· temples,
· or the head,
6. in epilepsy
· veins at the junction of lower jaw
7. in all diseases of the head
· usually vein situated in between the eyebrows;
8. In Vidradhi (abscesses) and pain in the flanks,
· vein situated between the flanks, Axilla and breast;
9. in fever of every third day (Truteeyaka),
· vein in the centre of the shoulders;
10. in fever of every fourth day (chaturthaka) –
· that below the shoulder;
11.in dysentery accompanied with pain
· vein situated two Angula away from the pelvis,
12. in diseases of the semen and penis,
· vein situated in the penis;
13. in glandular enlargement of the neck (Apachi),
· that situated in the thigh;
14. in Gridhrasi- sciatica
· vein situated at four Angula below or above the knee joints;
15. in Apachi (goiter)
· vein situated about two Angula below the indrabasti- a vital spot in the centre of calf muscle;
16. in pain of thighs and Krostukasira (inflammatory swelling of the knee joint appearing like the head of a jackal),
· vein situated four angula above the ankle
17. In
· pada Daha (burning sensation of the sole ),
· Khuda (gout)
· Padaharsa- (tingling sensation in feet),
· Vipadika – fissures of the feet,
· Vatakantaka (sprain of the foot/ Ankle) and
· Chippa (A diseases of the nails of the toes),
· vein situated two Angula above the Kshipramarma- vital Spot in between the big toe and the next toe;
18. in Vishvachi- pain in the arms
· in the same way as that of Gridhrasi- sciatica should be cut.
19. If the veins are hot visible,
· another vein situated at nearby place, which is devoid of vital spots should be cut.
SIRAVYADHA VIDHI- BLOOD LETTING RITUALS AND PROCEDURE –
अथ स्निग्धतनु सज्जसर्वोपकरणो बली
कृतस्वस्त्ययनः स्निग्धरसान्नप्रभोजितः
अग्नितापातपस्विन्नो जानूच्चासनसंस्थितः
मृदुपट्टात्तकेशान्तो जानुस्थापितकूर्परः
मृष्टिभ्यां वस्त्रगर्भाभ्यां मन्ये गाढं निपीडयेत्
दन्तप्रपीडनोत्कास गण्डाध्मानानि चाचरेत्
पृष्ठतो यन्त्रयेच्चैनं वस्त्रमावेष्टयन्नरः
कन्धरायां परिक्षिप्य न्यस्यान्तर्वामतर्जनीम्
एषो अन्तर्मुखवर्ज्यानां सिराणां यन्त्रणे विधिः
1. The patient who should undergo Snehana procedure.
2. All the necessary equipments should be kept ready.
3. The person should be strong,
4. should perform Auspicious rites and
5. consume meat-juice and boiled rice mixed with ghee,
6. The person should be exposed to sunlight or fire for sweating.
7. He is asked to sit on a stool of the height of the knee.
8. A band of soft cloth should be tied around his head at the lower border of the hairs;
9. He should keep elbows on his knees,
10. His neck massaged briskly with fists in which pad of cloth is healed;
11.Grinding the teeth,
12. coughing,
13. inflating the mouth to enlarge the cheeks, should also be done his body
14. Trunk should be wound with a band of cloth, controlled – by knots at the back;
15. His neck should also be tied with a band of cloth and tightened
This is the mode of raising the deep seated veins.
ततो मध्यमया अङ्गुल्या वैद्यो अङ्गुष्ठविमुक्तया
ताडयेत् उत्थितां ज्ञात्वा स्पर्शाद्वा अङ्गुष्ठपीडनैः
कुठार्या लक्षयेन्मध्ये वामहस्तगृहीतया
फलोद्देशे सुनिष्कम्पं सिरां, तद्वच्च मोक्षयेत्
ताडयन् पीड्यंश्चैन्नां
16. Then the physician should tap the raised vein with his middle finger tripped off by the thumb;
noticing the elevation, or raising it, once again by kneading it with the thumb;
17.then holding the axe with his left hand,
18. place its edge on the middle portion of the vein and give up in the Axe without Shaking.
19.Axe should be lifted up in the same way, tapping and kneading the vein for making more blood to come out.
विध्येद्व्रीहिमुखेन तु
अङ्गुष्ठेनोन्नमध्याग्रे नासिकामुपनासिकाम्
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 and the surrounding areas of the near with the thumb.
अभ्युन्नतविदष्टाग्रजिह्वस्याधस्तदाश्रयाम्
The vein situated underneath the tongue,
· 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.
यन्त्रयेत्स्तनयोरूर्ध्वं ग्रीवश्रितेसिराव्यधे
पाषानगर्भहस्तस्य जानुस्थे प्रसृते भुजेकुक्षेरारभ्य मृदिते विध्येद्बद्धोर्ध्वपट्टके
For cutting the veins of the neck,
· they should be raised by manipulating the area above the breasts,
· the patient is made to hold a stone in each of his fists and
· keep the shoulders on his knees and outstretched;
· the body is massaged commencing with the pit of the stomach in the upward direction and
· then the vein is cut.
विधयेद्ह्स्तसिरां बाहावनाकुञ्चितकूर्परे
बद्ध्वा सुखोपविष्टस्य मुष्टिमङ्गुष्ठगर्भिणम्
ऊर्ध्वं वेध्यप्रदेशाच पट्टिकां चतुरङ्गुले
The veins of the hand be cut,
· when the patient is sitting comfortably,
· keeping his arm straight without bending at all elbow,
· clenching the fist with the fingers folded inside, a band of cloth tied,
· four Angula above the site of cutting.
विध्येदाललम्बमानस्य बाहुभ्यां पार्श्वयोः सिराम्
प्रदृष्टे मेहने जङ्घासिरां जानुन्यकुञ्चिते
The veins of the flanks be cut,
· by keeping the arms hanging loose;
Those of the penis
· when it is flaccid;
those of the calves
· when the leg is not folded at the knees
पादे तु सुस्थिते अधस्ताज्जानुसन्धेर्निपीडिते
गाढं कराभ्यामागुल्फं चरणे तस्य चोपरि
द्वितीये कुञ्चिते किञ्चितारूढे ह्स्तवत्ततः
बद्ध्वा विध्येत्सिराम्
Those of the feet be cut,
· when the feet are kept steady,
· the foreleg is massaged briskly from the knee downwards towards the Ankle with the hands,
· tying a band similar to the method described for hand,
· the other leg is kept slightly bent.
इत्थमनुक्तेष्वपि कल्पयेत्
तेषु तेषु प्रदेशेषु तत्तद्यन्त्रमुपायवित्
Thus the clever physician should adopt such methods of raising the veins appropriate to the places, by the techniques that are not mentioned here.
मांसले निक्षिपेद्देशे व्रीह्यास्यं व्रीहिमात्रकम्
यवार्धमस्थ्नामुपरि सिरां विध्यन् कुठारिकाम्
1. On fleshly parts,
· the Vrihimukha Sastra (Lancet) should be used
· and the vein cut to the size of a rice grain only;
2. the veins on the bones
· should be cut the size of half a (Yava) barley by using the axe.
to be continued
SAMYAK VIDDHA LAKSHANA
संयग्विद्धां स्रवेद्धारां यन्त्रे मुक्ते तु न स्रवेत्
When the cutting is proper,
· the blood flows out in a steady stream and
stops when the control (tourniquet) is released.
ASAMYAK VIDDHA LAKSHANA
अल्पकालं बहत्यल्पं दुर्विद्धा तैलचूर्णनैः
When the cutting is inadequate;
1. the flow is only for a short time
2. and less in quantity;
3. Then it should be rubbed with oil mixed with lime powder to promote more bleeding;
ATHIVIDDHA LAKSHANA
सशब्दमतिविद्धा तु स्रवेत् दुःखेन धार्यते
When the cut is more,
1. the blood flows out with a sound
2. and stops with great difficulty.
ASRUTI KARANA:- CAUSES FOR NON- FLOWING:-
भी मूर्च्छायन्त्रशैथिल्यकुण्ठशस्त्रातितृप्तयः
क्षामत्ववेगितास्वेदा रक्तस्य अस्रुति हेतवः
1. Fear,
2. fainting,
3. loose tourniquet,
4. blunt instruments,
5. over- satiation (excess eating),
6. debility,
7. patent urges- of urine, faeces etc,
8. absence of sweating therapy
- are the causes of absence of blood flow.
असम्यगस्रे स्रवति वेल्लव्योषनिशानतैः
सागारधूमलवणतैलैर्दिह्याच्छिरामुखम्
सम्यक्प्रवृत्ते कोष्णेन तैलेन लवणेन च
When the blood is not flowing out in sufficient quantity,
· the cut end of the vein should be smeared with oil processed with
· Vella (Vidanga),
· Vyosha (Trikatu),
· Haridra,
· Nata,
· Agaradhuma
· or Lavana,
when the blood is flowing out properly,
· the site should be smeared with warm oil and salt.
अग्रे स्रवति दुष्टास्रं कुसुम्भादिव पीतिका
· Vitiated blood flows out first, just like the yellow- juice form the second seeds of Kusumbha- before its oil flows out.
सम्यक्स्रत्वा स्वयं तिष्ठेच्छुद्धं तदिति नाहरेत्
After sufficient bleeding,
· the flow stops by itself;
· it should be considered as pure, unvitiated blood
· and further flow should not be attended.
यन्त्रं विमुच्य मूर्च्छायां वीजिते व्यजनैः पुनः
स्रावयेन्मूर्च्छति पुनस्त्वपरेद्युस्त्रयहे अपि वा
If during the time of bleeding,
the patient faints,
· then the touriniquet should be released,
· he should be fanned with fans to make him conscious and bleeding continued.
If he faints again,
· blood letting should be postponed to the next day or third day.
DUSHTARAKTA LAKSHANA- CHARACTERISTICS OF IMPURE BLOOD –
Blood vitiated by Vata,
वातात् श्यावरुणं रूक्षं वेगस्रावि अच्छफेनिलम्
· will be blue or crimson in color,
· dry- non slimy,
· flows with force,
· clear and
· frothy;
Blood vitiated by pitta
पित्तात् पीतासितं विस्रमस्कन्धौष्ण्यात्सचन्द्रिकम्
· will be yellow or black,
· has foul smell,
· not thick because of increase of heat and
· mixed with glistening particles,
Blood vitiated by Kapha
कफात् स्निग्धं असृक्पाण्डु तन्तुमत्पिच्छिल घनम्
· will be unctuous,
· pale -yellowish- white in color,
· has small threads,
· is slimy
· and thick;
By combination of 2 Doshas,
सस्पृष्टलिङ्गं संसर्गात् त्रिदोषं मलिनाविलम्
there will be mixed features.
Blood vitiated by all the Doshas will be dirty and thick.
SRAVA PRAMANA- QUANTITY OF FLOW:-
अशुद्धो बलिनो अप्यस्रं न प्रस्थात्स्रावयेत्परम्
अतिस्रुतौ हि मृत्युः स्याद्दारुणा वा चलामयाः
तत्राभ्यङ्गसक्षीररक्तपानानि भेषजम्
1. Vitiated blood more than one Prastha- (768 ml)
2. should not be allowed to flow out,
3. even in strong persons;
Excess bleeding will lead
to either death or dreadful diseases of vata origin.
In such condition,
· oil massage and
· drinking of milk mixed with blood are the treatment.
स्रुते रक्ते शनैर्यन्त्रमपनीय हिमाम्बुना
प्रक्षाल्य तैलप्लोताक्तं बन्धनीयं सिरामुखम्
After the flow of blood,
1. the controls should be removed slowly,
2. the site washed with cold water,
3. the cut end of the vein covered with a cotton swab soaked in oil and
4. bandaged.
अशुद्धं स्रावयेद्भुतः सायमहन्यपरे अपि वा
स्नेहोपस्कृतदेहस्य पक्षाद्वा भृशदूषितम्
· Vitiated blood should be removed again either in the same evening or next day;
· if the blood is found greatly vitiated with more quantity of Doshas.
· It should be removed again after a fortnight, after administering Snehana therapy.
किञ्चिद्धि शेषे दुष्टास्रे नैव रोगो अतिवर्तते
सशेषमप्यतो धार्यं न चातिस्रुतिमाचरेत्
If a small residue of vitiated blood inside, diseases do not get aggravated and so it can be allowed to stay, but excess flow of blood should not be attempted.
हरेच्छ्रिङ्गादिभिः शेषं प्रसादमथवा नयेत्
शीतोपचारपित्तास्रक्रियाशुद्धिविशोषणैः
दुष्टं रक्तमनुद्रिक्तमेवमेव प्रसादयेत्
Such residual blood may be removed by
· making use of the sucking horn (Shrunga)etc.
· or it can be purified of doshas by administering cold comforts,
· therapies prescribed for Raktapitta (bleeding diseases),
· purification therapies (Panchakarma) etc.
· and by methods of making the body thin.
Even the blood which is mildly vitiated by the Doshas but not increased in quantity should be treated by these methods.
रक्ते त्वतिष्ठति क्षिप्रं स्तम्भनीमाचरोत्क्रियाम्
रोध्रप्रियङ्गुपत्तङ्गमाषयष्ट्याहवगैरिकैः
मृत्कपालाञ्जनक्षौममषीकषीरित्वगङ्कुरैः
विचूर्नयेद्व्रणमुखं पद्मकादिहिमं पिबेत्
तामेव वा सिरां विध्येद्व्यधात्तस्मादनन्तरम्
सिरामुखं वा त्वरितं देहत्तप्तशलाकया
If the bleeding does not stop, methods to stop it should be adopted;
· the orifice of the wound should be smeared with the powder of either
1. Rodhra,
2. Priyangu,
3. Pattanga,
4. Masha (black gram),
5. Yashti (licorice),
6. Gairika,
7. Mritkapala (pot shred),
8. Kshana Masha,
9. ash of flax or
10. of the bark and sprouts of trees with milky Sap
11. 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
.
उन्मार्गगा यन्त्रनिपीडनेन स्वस्थानमायान्ति पुनर्न यावत्
दोषाः प्रदुष्टा रुधिरं प्रपन्नास्तावद्धिताहारविहारभाक् स्यात्
Because of tourniquet application,
· the Doshas temporarily get aggravated and may move to the other parts of the body.
· After the tourniquet is removed, they will come back to their normal places.
· But till such time, one should adhere to only healthy foods and activities.
नात्युष्णशीतं लघु दीपनीयं रक्ते अपनीते हितमन्नपानम्
तदा शरीरं ह्यनवस्थितासृगाग्निर्विशेषादिति रक्षितव्यः
Foods which are
1. neither very hot, very cold,
2. which are light(easy to digest)
3. and stimulating hunger
· are suitable after the removal of blood.
· This is because, after blood letting procedure,
· the body will be unstable with low digestion activity.
प्रसन्न वर्णेन्द्रियं इन्द्रियार्था निच्छन्तमव्याहत पक्तृवेगम्
सुखान्वितं पुष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति
1. Excellence of color and complexion,
2. improved power of the sense organs,
3. good perception of objects by sense organs,
4. good digestive activity,
5. enjoyment of comforts endowed with good nutrition and immunity
- are the characteristics of the person having non vitiated blood.
procedure of venesection
SUDDHA RAKTA LAKSHANA – PROPERTIES OF PURE BLOOD
Sira means vein. Vyadha means puncturing.
मधुरं लवणं किञ्जित् अशीतोष्णमसंहतम्
पद्मेन्द्रगोपहेमाविशशलोहितलोहितम्
लोहितं प्रभवः शुद्धं तनोस्तेनैव च स्थितिः
Shuddharakta Laksana- Features of pure blood:-
1. Slightly sweet and salt in taste
2. neither cold nor hot,
3. resembling the colour of lotus,
4. Indragopa insect,
5. gold,
6. blood of sheep and rabbit
- are the characteristic properties of pure blood;
· It is the cause of origin of the body,
· by it, is determined the condition of body as healthy or unhealthy.
EFFECT OF VITIATED BLOOD – DUSHTARAKA KARMA-
तत्पित्तश्लेष्मलैः प्राये दूष्यते कुरुते ततः
विसर्पविद्रधिप्लीहगुल्माग्निसदनज्वरान्
मुखनेत्रशिरोरोगमदतृड्लवणास्यताः
कुष्ठवातास्रपित्तास्रकट्वम्लोद्गिरभ्रमान्
शीतोष्णस्निग्धरूक्षाद्यैरूपक्रान्ताश्च ये गदाः
सम्यक्साध्या न सिद्ध्यन्ति ते च रक्तकोपजाः
1. Blood usually gets vitiated by Pitta and Kapha.
2. It produces diseases such as
· Visarpa- Herpes,
· Vidradhi – Abscesses,
· Pleeha – Disease of the spleen,
· 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 and dizziness.
Those curable diseases, not getting cured even after appropriate cold or hot, unctuous or dry treatment should be understood as being born from aggravated blood.
तेषु स्रावयितुं रक्तमुद्रिक्तं व्यधयेत्सिराम्
In order to drain out the vitiated blood in these diseases veins should be cut.
PERSONS UNSUITABLE FOR VENESECTION – SIRAVYADHA ANARHA –
न तूनषोडशातीतसप्तत्यब्दस्रुतासृजाम्
अस्निग्धास्वेदितात्यर्थस्वेदितानिलरोगिणाम्
गर्भिणीसूतिकाजीर्णपित्तास्रश्वासकासिनाम्
अतीसारोदरच्छर्द्दिपाण्डुसर्वाङ्गशोफिनाम्
स्नेहपीते प्रयुक्तेषु तथा पञ्चसु कर्मसु
नायन्त्रितां सिरां विध्येन्न तिर्यङ्गाप्यनुत्थिताम्
नातिशीतोष्णवाताभ्रेष्वेन्यत्रात्ययिकाद्गदात्
· Who are less than sixteen and
· more than 70 years of age,
· who have had no bleeding previously – any time due to any cause,
· who have undergone excess gone Snehakarma and sweating therapies,
· those suffering from diseases of Vata origin,
· the pregnant woman,
· the woman in parturition,
· those suffering from indigestion, bleeding diseases, Shwasa (dyspnoea),
· Kasa – cough, cold
· Atisara – diarrhoea, dysentery
· Udara – ascites, intestinal obstruction / enlargement of the abdomen,
· Chardi – Vomiting
· Pandu – anemia
· Chardi – Vomiting,
· dropsy;
· for those who have been given fat – ghee or oil to drink – as part of oleation therapy, and
· who are undergoing the Panchakarma treatment.
1. The vein should not be cut without enforcing control on the body – as described further,
2. that vein which is horizontal,
3. that which has not been raised up;
4. not on day which are very cold, very hot, very windy, or cloudy datys,
venesection should not be done.
SELECTION OF SITE OF VENESECTION- VYADHANA STHANA NIRDESHA-
शिरोनेत्रविकारेषु ललाट्यां मोक्षयेत्सिराम्
अपाङ्ग्यामुपनास्यां वा कर्णरोगेषु कर्णजाम्
नासारोगेषु नासाग्रे स्थिताम् नासाललाटयोः
पीनसे मुखरोगेषु जिह्वौष्ठहनुतालुगाः
जत्रूर्ध्वग्रन्थिषु ग्रीवाकर्णशङ्खशिरः श्रिताः
उरोपाङ्गाललाटस्था उन्मादे अपस्मृतौ पुनः
हनुसन्धौ समस्ते वा सिरां भ्रूमध्यगामिनीम्
विद्रधौ पार्श्वशूलेच पार्श्वकक्षास्तनान्तरे
तृतीयके असंयोर्मध्ये स्कन्धस्य अधश्चतुर्थके
प्रवाहिकायां शूलिन्यां श्रोणितो द्वयङ्गुले स्थिताम्
शुक्रमेढ्रामये मेढ्रे उरुगां गलगण्डयोः
गृध्रस्यां जानुनो अधस्तादूर्ध्वं वा चतुरङ्गुले
इन्द्रबस्तेरधो अपच्यां द्वयङ्गुले चतुरङ्गुले
ऊर्ध्वं गुल्फस्य सक्थ्यर्तो, तथा क्रोष्टुकशीर्षके
पाददाहे खुडे हर्षे विपाद्यां वातकण्टके
चिप्पे च द्वयङ्गुले विध्येदुपरि क्षिप्रमर्मणः
गृध्रस्यामिव विश्वाच्याम् यथोक्तानामदर्शने
मर्महीने यथासन्ने देशे अन्यां व्यधयेत् सिराम्
In diseases of the head and eyes
· veins situated on the forehead,
· outer angle of the eyes or
· the area around the nose should be cut;
In diseases of the ear,
· the veins near the ear;
in diseases of the nose,
· vein located at the tip of the nose;
in Rhinitis,
· vein located in the nose
· and forehead,
IN Diseases of the mouth,
- those situated in the tongue,
- lips
- lower jaw or
- palate
5. in tumors parts above the shoulders,
· veins at neck,
· ears,
· temples,
· or the head,
6. in epilepsy
· veins at the junction of lower jaw
7. in all diseases of the head
· usually vein situated in between the eyebrows;
8. In Vidradhi (abscesses) and pain in the flanks,
· vein situated between the flanks, Axilla and breast;
9. in fever of every third day (Truteeyaka),
· vein in the centre of the shoulders;
10. in fever of every fourth day (chaturthaka) –
· that below the shoulder;
11.in dysentery accompanied with pain
· vein situated two Angula away from the pelvis,
12. in diseases of the semen and penis,
· vein situated in the penis;
13. in glandular enlargement of the neck (Apachi),
· that situated in the thigh;
14. in Gridhrasi- sciatica
· vein situated at four Angula below or above the knee joints;
15. in Apachi (goiter)
· vein situated about two Angula below the indrabasti- a vital spot in the centre of calf muscle;
16. in pain of thighs and Krostukasira (inflammatory swelling of the knee joint appearing like the head of a jackal),
· vein situated four angula above the ankle
17. In
· pada Daha (burning sensation of the sole ),
· Khuda (gout)
· Padaharsa- (tingling sensation in feet),
· Vipadika – fissures of the feet,
· Vatakantaka (sprain of the foot/ Ankle) and
· Chippa (A diseases of the nails of the toes),
· vein situated two Angula above the Kshipramarma- vital Spot in between the big toe and the next toe;
18. in Vishvachi- pain in the arms
· in the same way as that of Gridhrasi- sciatica should be cut.
19. If the veins are hot visible,
· another vein situated at nearby place, which is devoid of vital spots should be cut.
SIRAVYADHA VIDHI- BLOOD LETTING RITUALS AND PROCEDURE –
अथ स्निग्धतनु सज्जसर्वोपकरणो बली
कृतस्वस्त्ययनः स्निग्धरसान्नप्रभोजितः
अग्नितापातपस्विन्नो जानूच्चासनसंस्थितः
मृदुपट्टात्तकेशान्तो जानुस्थापितकूर्परः
मृष्टिभ्यां वस्त्रगर्भाभ्यां मन्ये गाढं निपीडयेत्
दन्तप्रपीडनोत्कास गण्डाध्मानानि चाचरेत्
पृष्ठतो यन्त्रयेच्चैनं वस्त्रमावेष्टयन्नरः
कन्धरायां परिक्षिप्य न्यस्यान्तर्वामतर्जनीम्
एषो अन्तर्मुखवर्ज्यानां सिराणां यन्त्रणे विधिः
1. The patient who should undergo Snehana procedure.
2. All the necessary equipments should be kept ready.
3. The person should be strong,
4. should perform Auspicious rites and
5. consume meat-juice and boiled rice mixed with ghee,
6. The person should be exposed to sunlight or fire for sweating.
7. He is asked to sit on a stool of the height of the knee.
8. A band of soft cloth should be tied around his head at the lower border of the hairs;
9. He should keep elbows on his knees,
10. His neck massaged briskly with fists in which pad of cloth is healed;
11.Grinding the teeth,
12. coughing,
13. inflating the mouth to enlarge the cheeks, should also be done his body
14. Trunk should be wound with a band of cloth, controlled – by knots at the back;
15. His neck should also be tied with a band of cloth and tightened
This is the mode of raising the deep seated veins.
ततो मध्यमया अङ्गुल्या वैद्यो अङ्गुष्ठविमुक्तया
ताडयेत् उत्थितां ज्ञात्वा स्पर्शाद्वा अङ्गुष्ठपीडनैः
कुठार्या लक्षयेन्मध्ये वामहस्तगृहीतया
फलोद्देशे सुनिष्कम्पं सिरां, तद्वच्च मोक्षयेत्
ताडयन् पीड्यंश्चैन्नां
16. Then the physician should tap the raised vein with his middle finger tripped off by the thumb;
noticing the elevation, or raising it, once again by kneading it with the thumb;
17.then holding the axe with his left hand,
18. place its edge on the middle portion of the vein and give up in the Axe without Shaking.
19.Axe should be lifted up in the same way, tapping and kneading the vein for making more blood to come out.
विध्येद्व्रीहिमुखेन तु
अङ्गुष्ठेनोन्नमध्याग्रे नासिकामुपनासिकाम्
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 and the surrounding areas of the near with the thumb.
अभ्युन्नतविदष्टाग्रजिह्वस्याधस्तदाश्रयाम्
The vein situated underneath the tongue,
· 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.
यन्त्रयेत्स्तनयोरूर्ध्वं ग्रीवश्रितेसिराव्यधे
पाषानगर्भहस्तस्य जानुस्थे प्रसृते भुजेकुक्षेरारभ्य मृदिते विध्येद्बद्धोर्ध्वपट्टके
For cutting the veins of the neck,
· they should be raised by manipulating the area above the breasts,
· the patient is made to hold a stone in each of his fists and
· keep the shoulders on his knees and outstretched;
· the body is massaged commencing with the pit of the stomach in the upward direction and
· then the vein is cut.
विधयेद्ह्स्तसिरां बाहावनाकुञ्चितकूर्परे
बद्ध्वा सुखोपविष्टस्य मुष्टिमङ्गुष्ठगर्भिणम्
ऊर्ध्वं वेध्यप्रदेशाच पट्टिकां चतुरङ्गुले
The veins of the hand be cut,
· when the patient is sitting comfortably,
· keeping his arm straight without bending at all elbow,
· clenching the fist with the fingers folded inside, a band of cloth tied,
· four Angula above the site of cutting.
विध्येदाललम्बमानस्य बाहुभ्यां पार्श्वयोः सिराम्
प्रदृष्टे मेहने जङ्घासिरां जानुन्यकुञ्चिते
The veins of the flanks be cut,
· by keeping the arms hanging loose;
Those of the penis
· when it is flaccid;
those of the calves
· when the leg is not folded at the knees
पादे तु सुस्थिते अधस्ताज्जानुसन्धेर्निपीडिते
गाढं कराभ्यामागुल्फं चरणे तस्य चोपरि
द्वितीये कुञ्चिते किञ्चितारूढे ह्स्तवत्ततः
बद्ध्वा विध्येत्सिराम्
Those of the feet be cut,
· when the feet are kept steady,
· the foreleg is massaged briskly from the knee downwards towards the Ankle with the hands,
· tying a band similar to the method described for hand,
· the other leg is kept slightly bent.
इत्थमनुक्तेष्वपि कल्पयेत्
तेषु तेषु प्रदेशेषु तत्तद्यन्त्रमुपायवित्
Thus the clever physician should adopt such methods of raising the veins appropriate to the places, by the techniques that are not mentioned here.
मांसले निक्षिपेद्देशे व्रीह्यास्यं व्रीहिमात्रकम्
यवार्धमस्थ्नामुपरि सिरां विध्यन् कुठारिकाम्
1. On fleshly parts,
· the Vrihimukha Sastra (Lancet) should be used
· and the vein cut to the size of a rice grain only;
2. the veins on the bones
· should be cut the size of half a (Yava) barley by using the axe.
to be continued
SAMYAK VIDDHA LAKSHANA
संयग्विद्धां स्रवेद्धारां यन्त्रे मुक्ते तु न स्रवेत्
When the cutting is proper,
· the blood flows out in a steady stream and
stops when the control (tourniquet) is released.
ASAMYAK VIDDHA LAKSHANA
अल्पकालं बहत्यल्पं दुर्विद्धा तैलचूर्णनैः
When the cutting is inadequate;
1. the flow is only for a short time
2. and less in quantity;
3. Then it should be rubbed with oil mixed with lime powder to promote more bleeding;
ATHIVIDDHA LAKSHANA
सशब्दमतिविद्धा तु स्रवेत् दुःखेन धार्यते
When the cut is more,
1. the blood flows out with a sound
2. and stops with great difficulty.
ASRUTI KARANA:- CAUSES FOR NON- FLOWING:-
भी मूर्च्छायन्त्रशैथिल्यकुण्ठशस्त्रातितृप्तयः
क्षामत्ववेगितास्वेदा रक्तस्य अस्रुति हेतवः
1. Fear,
2. fainting,
3. loose tourniquet,
4. blunt instruments,
5. over- satiation (excess eating),
6. debility,
7. patent urges- of urine, faeces etc,
8. absence of sweating therapy
- are the causes of absence of blood flow.
असम्यगस्रे स्रवति वेल्लव्योषनिशानतैः
सागारधूमलवणतैलैर्दिह्याच्छिरामुखम्
सम्यक्प्रवृत्ते कोष्णेन तैलेन लवणेन च
When the blood is not flowing out in sufficient quantity,
· the cut end of the vein should be smeared with oil processed with
· Vella (Vidanga),
· Vyosha (Trikatu),
· Haridra,
· Nata,
· Agaradhuma
· or Lavana,
when the blood is flowing out properly,
· the site should be smeared with warm oil and salt.
अग्रे स्रवति दुष्टास्रं कुसुम्भादिव पीतिका
· Vitiated blood flows out first, just like the yellow- juice form the second seeds of Kusumbha- before its oil flows out.
सम्यक्स्रत्वा स्वयं तिष्ठेच्छुद्धं तदिति नाहरेत्
After sufficient bleeding,
· the flow stops by itself;
· it should be considered as pure, unvitiated blood
· and further flow should not be attended.
यन्त्रं विमुच्य मूर्च्छायां वीजिते व्यजनैः पुनः
स्रावयेन्मूर्च्छति पुनस्त्वपरेद्युस्त्रयहे अपि वा
If during the time of bleeding,
the patient faints,
· then the touriniquet should be released,
· he should be fanned with fans to make him conscious and bleeding continued.
If he faints again,
· blood letting should be postponed to the next day or third day.
DUSHTARAKTA LAKSHANA- CHARACTERISTICS OF IMPURE BLOOD –
Blood vitiated by Vata,
वातात् श्यावरुणं रूक्षं वेगस्रावि अच्छफेनिलम्
· will be blue or crimson in color,
· dry- non slimy,
· flows with force,
· clear and
· frothy;
Blood vitiated by pitta
पित्तात् पीतासितं विस्रमस्कन्धौष्ण्यात्सचन्द्रिकम्
· will be yellow or black,
· has foul smell,
· not thick because of increase of heat and
· mixed with glistening particles,
Blood vitiated by Kapha
कफात् स्निग्धं असृक्पाण्डु तन्तुमत्पिच्छिल घनम्
· will be unctuous,
· pale -yellowish- white in color,
· has small threads,
· is slimy
· and thick;
By combination of 2 Doshas,
सस्पृष्टलिङ्गं संसर्गात् त्रिदोषं मलिनाविलम्
there will be mixed features.
Blood vitiated by all the Doshas will be dirty and thick.
SRAVA PRAMANA- QUANTITY OF FLOW:-
अशुद्धो बलिनो अप्यस्रं न प्रस्थात्स्रावयेत्परम्
अतिस्रुतौ हि मृत्युः स्याद्दारुणा वा चलामयाः
तत्राभ्यङ्गसक्षीररक्तपानानि भेषजम्
1. Vitiated blood more than one Prastha- (768 ml)
2. should not be allowed to flow out,
3. even in strong persons;
Excess bleeding will lead
to either death or dreadful diseases of vata origin.
In such condition,
· oil massage and
· drinking of milk mixed with blood are the treatment.
स्रुते रक्ते शनैर्यन्त्रमपनीय हिमाम्बुना
प्रक्षाल्य तैलप्लोताक्तं बन्धनीयं सिरामुखम्
After the flow of blood,
1. the controls should be removed slowly,
2. the site washed with cold water,
3. the cut end of the vein covered with a cotton swab soaked in oil and
4. bandaged.
अशुद्धं स्रावयेद्भुतः सायमहन्यपरे अपि वा
स्नेहोपस्कृतदेहस्य पक्षाद्वा भृशदूषितम्
· Vitiated blood should be removed again either in the same evening or next day;
· if the blood is found greatly vitiated with more quantity of Doshas.
· It should be removed again after a fortnight, after administering Snehana therapy.
किञ्चिद्धि शेषे दुष्टास्रे नैव रोगो अतिवर्तते
सशेषमप्यतो धार्यं न चातिस्रुतिमाचरेत्
If a small residue of vitiated blood inside, diseases do not get aggravated and so it can be allowed to stay, but excess flow of blood should not be attempted.
हरेच्छ्रिङ्गादिभिः शेषं प्रसादमथवा नयेत्
शीतोपचारपित्तास्रक्रियाशुद्धिविशोषणैः
दुष्टं रक्तमनुद्रिक्तमेवमेव प्रसादयेत्
Such residual blood may be removed by
· making use of the sucking horn (Shrunga)etc.
· or it can be purified of doshas by administering cold comforts,
· therapies prescribed for Raktapitta (bleeding diseases),
· purification therapies (Panchakarma) etc.
· and by methods of making the body thin.
Even the blood which is mildly vitiated by the Doshas but not increased in quantity should be treated by these methods.
रक्ते त्वतिष्ठति क्षिप्रं स्तम्भनीमाचरोत्क्रियाम्
रोध्रप्रियङ्गुपत्तङ्गमाषयष्ट्याहवगैरिकैः
मृत्कपालाञ्जनक्षौममषीकषीरित्वगङ्कुरैः
विचूर्नयेद्व्रणमुखं पद्मकादिहिमं पिबेत्
तामेव वा सिरां विध्येद्व्यधात्तस्मादनन्तरम्
सिरामुखं वा त्वरितं देहत्तप्तशलाकया
If the bleeding does not stop, methods to stop it should be adopted;
· the orifice of the wound should be smeared with the powder of either
1. Rodhra,
2. Priyangu,
3. Pattanga,
4. Masha (black gram),
5. Yashti (licorice),
6. Gairika,
7. Mritkapala (pot shred),
8. Kshana Masha,
9. ash of flax or
10. of the bark and sprouts of trees with milky Sap
11. 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
.
उन्मार्गगा यन्त्रनिपीडनेन स्वस्थानमायान्ति पुनर्न यावत्
दोषाः प्रदुष्टा रुधिरं प्रपन्नास्तावद्धिताहारविहारभाक् स्यात्
Because of tourniquet application,
· the Doshas temporarily get aggravated and may move to the other parts of the body.
· After the tourniquet is removed, they will come back to their normal places.
· But till such time, one should adhere to only healthy foods and activities.
नात्युष्णशीतं लघु दीपनीयं रक्ते अपनीते हितमन्नपानम्
तदा शरीरं ह्यनवस्थितासृगाग्निर्विशेषादिति रक्षितव्यः
Foods which are
1. neither very hot, very cold,
2. which are light(easy to digest)
3. and stimulating hunger
· are suitable after the removal of blood.
· This is because, after blood letting procedure,
· the body will be unstable with low digestion activity.
प्रसन्न वर्णेन्द्रियं इन्द्रियार्था निच्छन्तमव्याहत पक्तृवेगम्
सुखान्वितं पुष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति
1. Excellence of color and complexion,
2. improved power of the sense organs,
3. good perception of objects by sense organs,
4. good digestive activity,
5. enjoyment of comforts endowed with good nutrition and immunity
- are the characteristics of the person having non vitiated blood.
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