1. INTRODUCTION Raktha mokshana a para surgical procedure gaining popularity around the world, is being widely practiced. A number of diseases can be cured by this treatment method. Raktha- the vehicle to carry and transport absorbed nutrients, oxygen, metabolites etc. from place to place, correction of any abnormality in the blood by taking it, out solves a number of problems.

2. IMPORTANCE OF RAKTHAMOKSHANA : (A S Su 36) 3. TYPES 4. JALUKAVACHARANA Jalukavacharana involves an initial bite with medicated leeches, which is usually a painless bite, followed by the sucking of 5 to 15 ml of blood 5. PRACHANNA Blood letting through multiple incision in any localized area SIRAVEDANA Vene puncture, which can be done in any part of the body. (AH Su 26/54) 6. SHRINGA Sucking through mouth using a cows horn. Done in areas of loss of sensation ALABU Vaccum extraction using vegetable called Alabu (or bottle gourd) in impounded like grandi. (AH Su 26/54) 7. Action AH Su 26/54-55 Prachanna - localised . Jaluka - deep seated. Alabu, Gadi, Shringa - localized in skin area. Siravedhana - entire body. Shringa - Vata Jaluka - Pitta Alabu - Kapha 8. USEFUL METHODS IN NETRA ROGAS Raktha Mokshana JALUKAVACHANA SIRAVEDHANA 9. Indications Puyalasa. Complicated conditions of Arma. Savrana Sukla. Pittaja Timira. Abhishyandas. Adhimanthas Pilla rogas In Glaucoma, Macular Degeneration and Conjunctivitis, Rakthamokshana is a unique prophylactic therapy which are found to be effective . 10. JALOOKAVACHARANA 11. NAMAMI DHANWANTHARIM Leech Therapy & Lord Dhanthwanthiri Upholding a medicinal leech in the right front hand, The God of Medicine, Lord Dhanthwanthiri, enlightens the world about the importance of leech therapy from time immemorial. Crawling through millennia the leeches have entered the I C U to save the human organism NAMAMI DHANWANTHARIM Leech Therapy & Lord Dhanthwanthiri Upholding a medicinal leech in the right front hand, The God of Medicine, Lord Dhanthwanthiri, enlightens the world about the importance of leech therapy from time immemorial. Crawling through millennia the leeches have entered the I C U to save the human organism 12. Definition of Jaluka II (Su S 13/9) Since jala is their life, they are called as Jaluka or since they are habituated to water they are called as Jalooka. (Ah Su 26/35) Leeches should be made us for letting out blood from sukumaras. 13. Scientific classification Kingdom : Animalia Phylum : Annelida Class : Clitellata Order : Hirudinea Family : Hirudidae Genus : Hirudo Species : H. medicinalis Binomial name: Hirudo medicinalis 14. Types Savisha Krishna Karbura Alagarda Indrayuka Samudrika Gochandana Nirvisha Kapila Pingala Mooshika Pundarimuki Sankumukhi Savarika (Su Su 13/11) (Su Su 13/12) 15. A FDA determined that leeches are medical devices because they meet the definition of a medical device under the Food Drug and Cosmetic Act. Under the law, a medical device is an article intended to diagnose, cure, treat, prevent, or mitigate a disease or condition, or to affect a function or structure of the body, that does not achieve its primary effect through a chemical action, and is not metabolized. India's health ministry has also decided to recognize and market leech therapy for a range of diseases from arthritis to hematomas. 16. THERAPEUTIC ACTION Thrombolytic, Anti-inflammatory, Immuno-stimulating, Raises Nutrition Of Tissues, Strengthens Tissues Immunity. 17. Components of leech -saliva 1) Hirudin :- Acts as a potent anticoagulant . 2) Calin :- Inhibits blood coagulation . 3) Destabilase :- Dissolves fibrin and has thrombolytic effects 4) Bdellins :- Anti-inflammatory effect and inhibits trypsin, plasmin and acrosin. 5) Hyaluronidase :- Spreading factor. 6) Eglins Factor Xa inhibitor :- Inhibits the activity of coagulation factor Xa by forming equimolar complexes 7) Complement inhibitors :- Replace natural complement inhibitors if they are deficient. 7. Carboxypeptidase A inhibitors :- Increases the inflow of blood. 8. Acetylcholine :- Vasodilator. 9. Anesthetic-like substances :- Reduce pain during biting by a leech Research Journal of Pharmaceutical, Biological and Chemical Sciences. 18. Paramasukumaro-ayam Royal Rich Young Aged Ladies Not brave Weak Delicate || (Su Su 13/3) Jalukavacharana is best among the Rakthamokshanoupayas because it is easy and convenient to the patients. Also it is best suited for:- 19. Indications cited by medical practitioners of leech therapy are as follows: a modern view Inflammatory Reactions Hypertension. Varicose Veins. Hemorrhoids. Arthrosis, osteoarthritis, eriarthritis and rheumatoid arthritis Thrombophlebitis, thrombosis and embolism. Hematomas . GI tract hepatitis, cholecystitis, pancreatitis, stomach ulcers. Chronic skin diseases, like scabies, psoriasis, eczematous dermatitis, and chronic ulcers. Respiratory disorders - Asthma, acute rhinopharyngitis and spasmodic coryza. Etc. External ear and chronic ear infections. Eye diseases, including cataracts, glaucoma, traumatic injuries and inflammation. Dental problems, like gingivitis, paradontitis, gingival odema, etc Hirudotherapy /Leech therapy: Applications and Indications in Surgery 20. TURMERIC POWDER DURVA GHRITA TRIPHAL KASHAYA COTTON SAINDAVA LAVANA JALUKA 21. Leeches kept short time in water containing Haridra raw rice wash water, then washed & kept in fresh water is used for therapy. STERLISATION OF THE LEECHES || (Ah Su 26/40) 22. The digestive tract of the medicinal leech is colonized by two bacterias : Aeromonas veronii and Rikenella. Aeromonas veronii may cause wound infections and septicaemia in humans. These infections can be prevented by treating the leech prior to the application with Haridra(Turmeric) Curcuma longa. 23. Skin is rubbed with mrutikka (earth powder), or pricked with a needle for blood. In palpebral conjunctiva if Jaluka is not catches directly use hibiscus bud for scratching. 24. Usually inner surface of upper & lower lids are the parts applied. Evert the upper & lower lids, protect the cornea by covering it with everted lids. Apply the leech in the inner surface of lids conveniently. 25. Cleanse area with distilled water soaked sterile gauze. Allow leech to attach large posterior end first ; direct smaller head end to the desired site. Apply the other leeches if necessary. Monitor leeches until they fill with blood (10- 20 minutes). Usually the leech falls off itself (if not , use salt/ haridra etc..) 26. Patient is allowed to maintain the position till bleeding stops. If bleeding is excessive-raktha sthambhana upayas. Pad & bandage with Durva ghritham. 27. Treatment of Rogi Wiping Wipe out the blood with a clean cotton. Prathisaranam :-with Saindava Seka :- with medicated kwatha. Cleaning :- by removing the clots. Bandage :- Apply a mixture of Madhu and honey on the site and bandage carefully. (Cheenabandhanam) Treatment of Jalauka Sprinkle Haridra powder on the mouth of Jalauka If the leech is not vomiting blood by the above process, squeeze the leech from tail to mouth Put the Jalauka in clean water and check if it moves well which is the indication of proper removal of blood from leech. Once a leech is applied, it should not be applied again for 7 days 28. (A.S Su 36) 29. , , , , , , , , , , , , (Su.su 14/28, Su Sa. 8/3) 30. (Ah Su 27/9) 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. 31. Patient should be allowed to lie on a table without pillow with the foot end raised. Fomentation should be done on forehead. Patient puts his fists on his neck. An assistant then puts a bandage round the neck and fists and pulls it to make the vein stands out. Patient is then asked to blow out with his mouth closed. The protruded vein on the painful area should be punctured using a curved surgical knife. Very little quantity of blood may come out in this procedure. 32. As raktha has the qualities like dravatha, spandhata, by its chalana swabhava and savasarathwa, doshas can spread all over the body with special affinity towards pitta sthana. Here the manifestation of disease is modulated by raktha as among shatkriya kala Sushrutha specifies that prasara can occur only with the help of raktha. Stana of Netra is Pitta Raktha and Pitta has Asrayasrayee Bandha. 33. | || (Su ut 12/45) Raktha moksha is the treatment of choice for puyalasa. Should be done after Snehana and Swedana. 34. Sannipathaja Sandhigata vyadhi When undergoes supression it will discharge thick purulent and foul smelling discharge. Though all the three dosas are vitiated, pitta dominates the disease process involving mamsa and rakta. 35. || (A S UT 14/13) As a measure of managing complication of arma, visravanam can be done. 36. In complication of arma Growth to reach krishna mandala Growth penetrating to deep tissues like mamsa. Growth involving blood vessels and tendons Growth extending Dristi mandala These can be controlled by Rakthamoksha, since the cause for these complication is rakta. 37. : : | | : || (A S Ut 14/18) In savrana sukla, intially sarpirpana is done and later Siramokshana; followed by Jalukavacharana, if remnants are not cleared. 38. In this Krishnamandala is disintegrated due to increase of Pitta. The damage is seen in Krishna mandala and Drstimandala; producing pain, redness and watering. Sira vyadha initially expells dusta rakta; but remaining small quantity of coagulated blood deposited in the inner side is cleared by using jalukavacharana 39. : || (A S Ut 19/10) If the pain is not subsided in abhishyanda and adhimantha, sira moksha should be done. 40. Abhishyanda is a disease in which there is sroto syandana in all the channels of head and neck Due to its nidana, Sarva deha syandana takes place and it will lead to Siro abhisyanda. Later Netra abhisyanda will be produced when there is Khavaigunya associated with achaksusya sevana Samprapthi involves Khavaigunya which guided through Shirovaha and Netravaha siras for the manifestation of the disease. Since siras are upadatus of raktha. Raktha moksha is applicable for Abhishyanda. 41. A deeper insight of Kriyakalagata samprapthi ghataka of Adhimantha reveals that pathological manifestation of Adhimantha is guided through Shirovaha and Netravaha siras Where siras are upadhatu of Raktha and it is an important Netra bhandhana. The etymological derivation of Sira says that Saranath Siraha. with the help of this reference, Ciliary processes, which continuously ooze aqueous humour, can be compared with Netravaha sira. ADHIMANTHA 42. : : : (A H Ut 16/48) In chronic diseases of eye, Snehana, Vamana and Rakthamoksha using Siravedha are done for complete recovery. 43. Roga Dosa predominance 4 types of Utklista Raktha Kukunaka Tridosa & Raktha Pakshmoparodha Tridosha Suskakshipaka Tridosa Puyalasa Tridosa & Pitta Bisa Vartma Tridosa Potaki Kapha Amloshitha Pitta Alpa Sopa Tridosa 3 types of Abhishyanda (P,K,R) Pitta, Kapha, Rakta 3 types of Adhimantha (P,K,R) Pitta, Kapha, Rakta 44. The common symtoms of all the Pilla rogas are:- So it shows the clear involvement of Rakta and Pitta. So it should be be clear that Raktamoksha is useful. 45. PHYCTANULAR CONJUCTIVITIS BEFORE TREATMENT AFTER TREATMENT 46. Savrana Sukla BEFORE TREATMENT AFTER TREATMENT 47. DISSERTATIONS EVALUATION OF THE EFFICACY OF JALAUKAVACHARANA IN THE MANAGEMENT OF ANJANANAMIKA by Dr.V.P. Naganur From the study 90% of patients got relief from kandu, daha, toda, ruja. 10% has the mild improvement due to chronic history of disease,deep seated etc. MANAGEMENT OF ADHIMANTHA WITH SPECIAL REFERENCE TO SIRAVYADHA by Dr.Ashwini.m.j 70% of patients had marked improvement, 25% of patients had moderate improvement and 5% had mild improvement. 48. Raktamoksha is a simple procedure and can be practiced even in OPD levels. Since the stana of Netra is Pitta; Rakta and Pitha had Asryasrayee Banda, it should be clear that there in predominance of Rakta in allmost all types of eye diseases. : : : (A.S.Sh 5/51) (All the parts of eye are properly alligned together by Aksi bandana, the components involves Sira, Kandara and Meda.) Siras are upadhatu of Raktha The etymological derivation of Sira says that Saranath Siraha. To conquer over the disease in Netra, a focused approach would be by Rathamoksha, as it controls Raktha, pacifies pitta and also removes shonithavarana. 49. 1. 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