PG Module 8

INDICATIONS

प्रच्छानेनैकदेशस्थं —————————–|

प्रच्छानं पिण्डिते वा स्यात्—————————–|[i]

[स०-पिण्डिते रक्ते प्रच्छानं वा स्यात्|]

[आ० र०-प्रच्छानस्य विषयान्तरमाह-प्रच्छानमिति| पिण्डिते-घने|]

According to Ācārya Vāgbhaṭa, Pracchāna is the method of Raktamokṣaṇa used for the management of Ekadeśasthita Doṣa and Piṇḍitadoṣas.

बलदोषप्रमाणाद्वा विशुद्ध्या रुधिरस्य वा|

रुधिरं स्रावयेज्जन्तोराशयं प्रसमीक्ष्य वा||१९||[ii]

It is also mentioned by Ācārya Caraka that, the bloodletting should be done by considering the strength of the person, Doṣa, location of the disease, and has to be done until pure blood starts to flow out.

CONTRA INDICATIONS

Patients with bleeding disorders.

METHOD OF APPLICATION

Pūrva karma

After local abhyanga followed by Nāḍī Svedana, the area is properly cleaned by anti-septic preparations. Then the patient is allowed to be seated in comfortable posture and torniquet is tied 4inch above the area for Pracchāna.

Pradhānakarma

गात्रं बध्वोपरिदृढं रज्ज्वा पट्टेन वा समम्|

स्नायुसन्ध्यस्थिमर्माणि त्यजन् प्रच्छानमाचरेत्|

अधोदेशप्रविसृतैः पदैरुपरिगामिभिः|

न गाढग़नतिर्यग्भिर्न पदे पदमाचरेत्|७|[iii]

According to Vāgbhaṭa Ācārya the incisions are made after binding the above site with cloth or torniquet and made the area clearly visible. The area should be away from Snāyu, Sandhi, Asthi and Marma. The incisions should not be too deep. 

तत्र, ऋज्वसङ्कीर्णं सूक्ष्मं सममनवगाढमनुत्तानमाशु च शस्त्रं पातयेन्मर्मसिरास्नायुसन्धीनां चानुपघाति ||२६||[iv]

Suśruta Ācārya also opines similarly. It is advised to do in areas devoid of Marma, Sirā, Snāyu and Sandhi. The incisions should be made after torniquet is bind and it should be small, linear, quick and not too deep.

Paścāt karma

After cleaning the area with proper antiseptic solution, proper bandaging has to be done. Medicines like Jātyādi Ghṛta and Yaṣṭimadhu cūrṇa can also be applied.

SAMYAK LAKṢAṆA

लाघवं वेदनाशान्तिर्व्याघेर्वेगपरिक्षयः |

सम्यग्विस्राविते लिङ्गं प्रसादो मनसस्तथा ||३३||[v]

Samyak lakṣaṇa of any type of Raktamokṣaṇa  may include Lāghava (lightness), Vedana Śānti (reduction in pain), Vyādhivega Parikṣaya (reduction in recurrent attacks of disease) and Mana Prasāda (clarity of mind).

COMPLICATIONS OF PRACCHĀNA AND THEIR MANAGEMENT WITH AYURVEDA AND MODERN MEDICINES

• Excessive bleeding
• Increase in redness and swelling
• Increased pain
• Infection of wound and fever

Before starting it should be confirmed that the patient is not affected with any bleeding disorders.

Clean the wound with antiseptic solutions

Arresting the blood by proper banding and immobilise the area as much as possible.

Antibiotics in the form of ointments like Neosporin, bacitracin etc. as well as internally can be given to avoid infection like amoxicillin-clavulanate, cephalexin, doxycycline, dicloxacillin etc.

Ayurveda medicines that can be used externally include Triphala kvātha, pañcavalkala kvātha, murivenna, etc. and internal medications include Āragvadhādi Kaṣāya, Guggulu tiktakam Kaṣāya, triphala guggulu, etc.

[i] AH. Sū. 26/54

[ii] C. Sū. 24/19

[iii] A. S. Sū. 35/7

[iv] Su. Sū.14/26

[v] Su. Su. 14/32-33

INDICATIONS

विसर्पविद्रधिप्लीहगुल्माग्निसदनज्वरान्|

मुखनेत्रशिरोरोगमदतृड्लवणास्यताः||३||

कुष्ठवातास्रपित्तास्रकट्वम्लोद्गिरणभ्रमान्|

शीतोष्णस्निग्धरूक्षाद्यैरूपक्रान्ताश्च ये गदाः||४||

सम्यक्साध्या न सिध्यन्ति ते च रक्तप्रकोपजाः|[i]

Visarpa, Vidradhi, Plīha, Gulma, Agni sadana, Jvara, Mukha roga, Netra roga, Śiro roga, Mada, Truṭ, Lavana Āsyata, Kuṣṭha, Vātarakta, Raktapitta, Katu-Amlodgāra, Bhrama, diseases which are not subsided by Śīta-Uṣṇa and Snigdha-Rūkṣa Upakramas, and Raktaprakopaja Vyādhis.

CONTRA INDICATIONS

न तूनषोडशातीतसप्तत्यब्दस्रुतासृजाम्|

अस्निग्धास्वेदितात्यर्थस्वेदितानिलरोगिणाम्||६||

गर्भिणीसूतिकाजीर्णपित्तास्रश्वासकासिनाम्|

अतीसारोदरच्छर्दिपाण्डुसर्वाङ्गशोफिनाम्||७||

स्नेहपीते प्रयुक्तेषु तथा पञ्चसु कर्मसु|

नायन्त्रितां सिरां विध्येन्न तिर्यङ्गाप्यनुत्थिताम्||८||

नातिशीतोष्णवाताभ्रेष्वन्यत्रात्ययिकाद्गदात्|[ii]

Children below 16 years, aged above 70 years, Atisnigdha, Asvedita, Atyartha svedita, Anila rogiṇa, Garbhiṇī, Sūtikā, Ajīrṇa, Śvāsa, Kāsa, Atisāra, Udara, Chardi, Pāṇḍu, Sarvāṅga śopha, Snehapīta, Undergone Pañcakarma, non-visible veins, tortured veins, deep veins, too hot and cold climates, too sunny and windy days, and also patients with serious systemic disorders.

METHOD OF APPLICATION

Pūrva karma

तत्र स्निग्धस्विन्नमातुरं यथादोषप्रत्यनीकं द्रवप्रायमन्नं भुक्तवन्तं यवागूं पीतवन्तं वा यथाकालमुपस्थाप्यासीनं स्थितं वा प्राणानबाधमानो वस्त्रपट्टचर्मान्तर्वल्कललतानामन्यतमेन यन्त्रयित्वा नातिगाढं नातिशिथिलं शरीरप्रदेशमासाद्य प्राप्तं शस्त्रमादाय सिरां विध्येत् ||६||[iii]

The procedure is advised to do in persons who are given proper Snehana and Svedana. Then according to the Doṣa vitiation respective Yavāgū can be given, which is Drava Prāya (more liquid) diet. Before administering the procedure, the kala, the fitness of the patient for Sirā Vyadha has to be ensured. After tying the torniquet above the selected area the needle has to be inserted. It should not be too deep and unstable.

PradhānaKarma

बलिनो बहुदोषस्य वयःस्थस्य शरीरिणः |

परं प्रमाणमिच्छन्ति प्रस्थं शोणितमोक्षणे ||१६||[iv]

The blood has to be collected in a measuring jar. The pravara mātrā advised for raktamokṣaṇa  is I prastha (13.5 pala = Approx. 650ml). The blood has to be observed for the Duṣṭi Lakṣaṇas.

Paścāt Karma

The torniquet has to be loosened after the required amount of blood is collected. The needle has to be removed immediately and antiseptic application has to be done.

SAMYAK LAKṢAṆA

सम्यग्विद्धा स्रवेद्धारां यन्त्रे मुक्ते तु न स्रवेत्|[v]

If the Vyadhana is done properly the blood will flow out in streamline without any breakage. It automatically stopes with the removal of the Śastra.

AYOGA LAKṢAṆA

अल्पकालं वहत्यल्पं, दुर्विद्धा तैलचूर्णनैः||[vi]

If mildly punctured the blood will flow out only for little time and the amount of blood that comes out will be very less.

ATIYOGA LAKṢAṆA

सशब्दमतिविद्धा तु स्रवेद्दुःखेन धार्यते||[vii]

If excessively punctured the blood will flow out in excess with sound. The condition also become very difficult to arrest the blood.

[i] AH. Sū. 27/3-5

[ii] AH. Sū. 27/6-9

[iii] Su. Śā. 8/6

[iv] Su. Śā. 8/16

[v] AH. Sū. 27/34

[vi] AH. Sū. 27/34

[vii] AH. Su. 27/35

Is the method of sucking impure blood from the body using cow^,s horn.

For the purpose of Śṛṅga Avacāraṇa the horn of the cow which is hollow inside is used. Broad end of the horn is meant for applying on the skin during the procedure of bloodletting. At the narrow tip of the horn, a hole is made into the hollow of the horn. This hole is covered with a cloth and then the air in the hollow is sucked with the mouth so that it facilitates bleeding as it creates vaccum inside the horn. Alternatively the hole in the tip of the horn is fitted with a rubber tube. Further, the free end of the tube is fitted with a 50ml syringe.

GUṆA

उष्णं समधुरं स्निग्धं गवां शृङ्गं प्रकीर्तितम् | Su.Su.13/5

Śṛṅga is hot, slightly sweet and unctuous.

INDICATIONS

तस्माद्वातोपसृष्टे तु हितं तदवसेचने [४] ||५||  Su.Su.13/5

Śṛṅga is indicated in Vāta vitiated conditions.

PROCEDURE

At first Pracchāna should be done at the site of lesion. For this parallel incisions are made on the lesion with the help of a scalpel blade. Incising should be done from distal part to the proximal part of the body. When bleeding starts the broad end of the horn is applied on the lesion so as to consist the incisions. This is then held firmly pressing against the skin applying adequate pressure, and then the piston of the syringe is withdrawn. This creates a vacuum within the horn and thus draws the blood from the incisions. This state is maintained for several minutes and then the piston is released and the horn is also removed. The wound is cleaned, and then bandaged.

The observation of the client for assessing the therapeutic effect as well as management of the client following the Raktamokṣaṇa is done as in the procedure of Sirāvyadha.

ALĀBU

Alābu refers to the bitter bottle guard. This is the method of accomplishing bloodletting  by bitter bottle guard . It is made into a hollow round by removing its soft core after making a hole its tip. 

GUṆA

अलाबु कटुकं रूक्षं तीक्ष्णं च परिकीर्तितम् |.   Su.Su.13/5

Alābu is pungent, rough and sharp.

INDICATIONS

तस्माच्छ्लेष्मोपसृष्टे तु हितं तदवसेचने ||७||   Su.Su.13/5

Alābu is indicated in Kapha vitiated conditions.

PROCEDURE

First Pracchāna should be done. For this parallel incisions are made on the lesion with the help of scalpel blade. Incising should be done from distal part to the proximal part of the body. When there occurs bleeding, a cotton piece soaked in oil is lighted and is placed inside the Alābu. Now the mouth of the Alābu is applied on the incised area to involve the incised wounds. The Alābu is applied by holding it horizontally so that the flame of the burning cotton does not come in contact with the body. The cotton inside the Alābu burns till the oxygen is available and then gets extinguished. As it removes the oxygen from the air with in the Alābu a vacuum is generated with in the Alābu. This draws blood from the incised wounds. After sometime the Alābu is removed. The blood in the wound is cleaned and then bandaged.

GHAṬĪYANTRA – AVACĀRAṆA

Instead of Alābu if a small earthen pot is used for bloodletting then it is known as Ghaṭīyantra Avacaraṇa.

GUṆA, INDICATIONS AND PROCEDURE

Similar to Alābu