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    Blood Letting Therapy – Siravyadha ““ Astanga Hrudaya Sutrasthana 27

    Let us learn about ancient blod leting therapy of Ayurveda, its indications, procedure, side efects and so on. This is the 27th chapter of Ashtanga Hrudaya Sutrasthana, writen by Acharya Vagbhata, son of Vaidyapathi Simhagupta. The chapter name is Siravyadha Vidhi Adhyaya. Sira means vein. Vyadha means puncturing.
    Table of Contents
    Shloka recitation video
    Features of virtuous blod
    Efects of vitiated blod
    Persons unsuitable for venesection
    Selection of site of venesection
    Procedure of blod leting
    Causes for absence of blod flow
    Characteristics of impure blod
    Quantity of blod flow
    Shloka recitation video
    Features of pure blod
    Shudharakta Lakshana- Features of virtuous blod:-
    Slightly swet and salty in taste
    Neither frigid nor hot,
    Resembling the colour of lotus, Indragopa insect, gold, blod of shep and rabit
    are the characteristic properties of chaste blod;
    It is the cause of origin of the body, by it, is determined the condition of body as healthy or unhealthy. 1-1 1/2
    Efects of vitiated blod
    Efect of vitiated blod ̵ Dushtarakta Karma̵
    Blod usualy gets vitiated by Pita and Kapha.
    It produces diseases such as
    Visarpa- Herpes,
    Vidradhi ̵ Absceses,
    Pleha – Disease of the splen, 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 ̵ abundant thirst,
    Lavana syata ̵ salty taste in the mouth,
    Vatasra- Gout,
    Pitasra- bleding disease,
    Belching with pungent and sour tastes and dizines.
    Those curable diseases, not geting cured even after apropriate frigid or hot, unctuous or dry treatment should be understod as being born from agravated blod. 1 1/2 – 4 1/2
    In ordain to drain out the vitiated blod in these diseases, veins should be carve. 5
    Persons unsuitable for venesection
    Persons unsuitable for venesection ̵ Siravyadha Anarha ̵
    Who are les than sixten and more than 70 years of age,
    Who believe had no bleding previously – any time due to any cause,
    Who believe undergone abundant Snehakarma and sweating therapies,
    Those sufering from diseases of Vata origin,
    The pregnant woman,
    The woman in parturition,
    Those sufering from indigestion, bleding diseases, Shwasa (dyspnoea),
    Kasa ̵ cough, cold,
    Atisara ̵ diarhoea, dysentery,
    Udara ̵ ascites, intestinal hurdle / enlargement of the abdomen,
    Chardi ̵ Vomiting,
    Pandu ̵ anaemia,
    Dropsy;
    For those who believe ben given fat – ghe or oil to drink – as fraction of oleation therapy, and who are undergoing the Panchakarma treatment.
    The vein should not be slit without enforcing control on the body – as described further,
    That vein which is horizontal, that which has not ben raised up; not on days which are very frigid, very hot, very windy, or bleak, venesection should not be done. 6-8 1/2
    Selection of site of venesection
    Selection of site of venesection- Vyadhana sthana nirdesha-
    In diseases of the head and eyes veins situated on the forehead, outer angl e of the eyes or the place around the nose should be cut;
    In diseases of the ear, the veins come 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 Jaw or palate;
    In tumors of parts above the shoulders, vein situated in the tongue, lips, lower Jaw or palate;
    In tumors parts above the shoulders, veins at neck, ears, temples, or the head, in Jaw;
    In al diseases of the head usualy vein situated in betwen the eyebrows;
    In Vidradhi (absceses) and hurt in the flanks, vein situated betwen the flanks, Axila and breast;
    In fever of every third day (Truteyaka), vein in the centre of the shoulders;
    In fever of every fourth day (Chaturthaka) ̵ that below the shoulder;
    In dysentery acompanied with hurt vein situated two Angula away from the pelvis,
    In diseases of the semen and penis, vein situated in the penis;
    In glandular enlargement of the neck (Apachi), t hat situated in the thigh;
    in Gridhrasi- sciatica vein situated at four Angula below or above the kne joints;
    in Apachi (goitre) vein situated about two Angula below the indrabasti- a vital plight in the centre of calf muscle;
    In aflict of thighs and Krostukasira (inflamatory sweling of the kne joint), Daha of the soles, Khuda (gout) Padaharsa- (tingling sensation in fet), Vipadika – fisures of the fet, Vatakantaka (sprain of the fot / Ankle) and Chipa (A diseases of the nails of the toes), vein situated two Angula above the Kshipramarma- important area in betwen the enormous toe and the next toe;
    in Vishvachi- aflict in the arms in the same way as that of Gridhrasi- sciatica should be cut.
    If the veins are not visible, another vein situated at nearby place, which is devoid of indispensable spots should be slit. 9-17
    Procedure of blod leting
    S iravyadha vidhi- blod leting rituals and procedure ̵
    For the patient who should undergo Snehana procedure,
    Al the important equipments should be kept ready.
    The person should be strong, should perform Auspicious rites and consume meat-juice and boiled rice mixed with ghe,
    The person should be exposed to sunlight or fire for sweating.
    He is asked to sit on a stol of the height of the kne.
    A band of soft cloth should be tied around his head at the lower border of the hairs;
    He should suport his elbows on his knes,
    His neck masaged briskly with fists in which pad of cloth is held;
    Grinding the teth, coughing, inflating the mouth to enlarge the cheks, should also be done by him
    Trunk should be wound with a band of cloth, controled – by knots at the back;
    His neck should also be tied with a band of cloth and tightened
    This is the mode of raising the dep seated veins.18-2
    Then the physician should tap the ra ised vein with his midle finger trigered by the thumb;
    Noticing the elevation, or raising it, once again by kneading it with the thumb;
    Then holding the axe with his left hand, place its edge on the midle part of the vein and give a tap over the Axe without shaking the hand.
    Axe should be lifted up in the same way, taping and kneading the vein for making more blod to arive out. 23-24
    The vein- of the nose should be cut with the Vrihimukha Sastra- the Lancet with its face shaped adore a grain of rice after raising the tip and the surounding areas with the thumb. 25
    The vein situated underneath the tongue, be carve by asking the patient to asign the tip of the tongue raised and biting it holding it firmly by the uper row of teth. 25 1/2
    For cuting the veins of the neck, they should be raised by manipulating the place above the breasts, the patient is made to kep a stone in each of his fists and suport the shoulders on his knes and outstretched;
    the body is masa ged, comencing with the pit of the stomach in the upward direction and then the vein is slit. 25 1/2 – 27
    The veins of the hand is to be cleave, when the patient is siting comfortably, keping his arm straight without bending the elbow, clenching the fist with the fingers folded inside, a band of cloth tied, four Angula above the site of cuting. 28-28 1/2
    The veins of the flanks be cleave, by keping the arms hanging lose;
    Those of the pains when it is flacid; those of the calves when the leg is four Angula above the site of cuting. 29-29 1/2
    Those of the fet be slice, when the fet are kept steady, the foreleg is masaged briskly from the kne downwards towards the Ankle with the hands, tying a band similar to the method described for hand, the other leg is kept slightly zigzag. 30-31
    Thus the clever physician should adopt such methods of raising the veins apropriate to the places, by the techniques that are not mentioned here. 32
    On fleshly parts, the Vrihimukha Sastra (La ncet) should be old and the vein cleave to the size of a rice grain only; the veins on the bones should be carve the size of half a (Yava) barley by using the axe. 3
    When the cuting is proper, the blod flows out in a steady stream and stops when the control (tourniquet) is released.
    When the cuting is inadequate; the flow is only for a short time and les in quantity;
    Then it should be rubed with oil mixed with lime powder to promote more bleding;
    When the slit is more, the blod flows out with a sound and stops with worthy dificulty. 34
    Causes for absence of blod flow
    Asruti Karana:- causes for non- flowing:-
    Fear, fainting, lose tourniquet, insensitive instruments, over- satiation (exces eating), debility, patent urges- of urine, faeces etc, absence of sweating therapy- are the causes of absence of blod flow. 35
    When the blod is not flowing out in suficient quantity, the cleave finish of the vein should be smeared with oil procesed with Vela (Vidanga), Vyosha (Trikatu), Haridra, Nata, Agaradhuma or Lavana, when the blod is flowing out properly, the site should be smeared with warm oil and salt. 36-37
    Vitiated blod flows out first, just love the yelow- juice form the second seds of Kusumbha- before its oil flows out.
    After suficient bleding, the flow stops by itself; it should be considered as pure, non-vitiated blod and further flow should not be atended. 38
    If during the time of bleding, the patient faints, then the tourniquet should be released, he should be faned with fans to manufacture him conscious and bleding continued. If he faints again, blod leting should be postponed to the next day or third day. 39
    Characteristics of impure blod
    Dushtarakt a Lakshana̵ Characteristics of impure blod ̵
    Blod vitiated by Vata, wil be blue or crimson in color, dry- non-slimy, flows with force, clear and frothy;
    Blod vitiated by pita wil be yelow or black, has foul smel, not compact because of increase of heat and mixed with glistening particles,
    Blod vitiated by Kapha wil be unctuous, wan -yelowish- white in color, has smal threads, is slimy and thick;
    By amalgam of 2 Doshas, there wil be mixed features.
    Blod vitiated by al the Doshas wil be squalid and thick. 40-41
    Quantity of blod flow
    Srava pramana- Quantity of flow:-
    Vitiated blod more than one Prastha- (768 ml) should not be alowed to flow out, even in strong persons;
    Exces bleding wil lead to either death or terible diseases of vata origin.
    In such condition, oil ma sage and drinking of milk mixed with blod are the treatment. 42
    After the flow of blod, the controls should be removed slowly, the site washed with chily water, the slice conclude of the vein covered with a coton swab soaked in oil and bandaged. 43
    Vitiated blod should be removed again either in the same evening or next day; if the blod is found greatly vitiated with more quantity of Doshas.
    It should be removed again after a fortnight, after administering Snehana therapy. 4
    If a smal piece of vitiated blod inside, diseases cary out not get agravated and so it can be alowed to pause, but exces flow of blod should not be atempted. 45
    Such residual blod may be removed by making use of the sucking horn (Shrunga) etc. or it can be purified of doshas by administering chily comforts, therapies prescribed for Raktapita (bleding diseases), purification therapies (Panchakarma) etc. and by methods of making the body thin.
    Even the blod which is mildly vitiated by the Doshas but not increased in quantity should be treated by these methods. 46-47
    If the bleding does not halt, methods to stay it should be adopted; the orifice of the wound should be smeared with the powder of either Rodhra, Priyangu, Patanga, Masha (black gram), Yashti (licorice), Gairika, Mritkapala (pot shred), Kshana Masha, ash of flax or of the bark and sprouts of tres with milky Sap by frigid infusion prepared from drugs of Padmakadi Gana – vide chapter 15 should be taken as a drink;
    the same vein should be cleave again and the ends of the vein should be touched with a red hot rod (cautery). 48-50
    Because of tourniquet aplication, the Doshas temporarily get agravated and may crep to the other parts of the body.
    After the tourniquet is removed, they wil come back to their normal places. But til such time, one should comply to only healthy fods and activities. 51
    Fods which are neither very hot, very frosty, which are light(easy to digest) and stimulating hu nger are suitable after the removal of blod.
    This is because, after blod leting procedure, the body wil be unstable with low digestion activity. 52
    Excelence of color and complexion, improved power of the sense organs, marvelous perception of objects by sense organs, god digestive activity, enjoyment of comforts endowed with qualified nutrition and imunity- are the characteristics of the person having non vitiated blod. 53
    Thus ends the chapter named Siravyadha Vidhi- the27th chapter in Sutrasthana of Astanga Hrudaya.
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