Diseases of the Respiratory System (J00-J99),.pptx
Critical analysis of raktha mokshana
3. 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.
7. 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)
8. 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)
10. USEFUL METHODS IN NETRA ROGAS
Raktha Mokshana
JALUKAVACHANA SIRAVEDHANA
11. 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 .
13. 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
14. Definition of Jaluka
जलमासामायुिरतत जलायुकाःजलमासामोकइतत
जलौकसः 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.
जलौकासस्तु सुखिना रक्तस्रािाय योजयेत ् ॥
15. Scientific classification
Kingdom : Animalia
Phylum : Annelida
Class : Clitellata
Order : Hirudinea
Family : Hirudidae
Genus : Hirudo
Species : H. medicinalis
Binomial name: Hirudo medicinalis
16. Types
Savisha
• Krishna
• Karbura
• Alagarda
• Indrayuka
• Samudrika
• Gochandana
Nirvisha
• Kapila
• Pingala
• Mooshika
• Pundarimuki
• Sankumukhi
• Savarika
(Su Su 13/11) (Su Su 13/12)
17. 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.
19. 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.
20. Paramasukumaro-ayam
• Royal
• Rich
• Young
• Aged
• Ladies
• Not brave
• Weak
• Delicate
निाढ्यबालस्थविर ीरुदुबबलनारीसुकु माराणामनुग्रिाथं
िरमसुकु मारोऽय िोखणतािसेचनोिायोऽश हितो जलौकसः||
(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:-
21. 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
23. 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
ग्रथेतरा तनिाकल्कयुक्तेअम् शस ििरप्लुताः
अिण्न्थसोमे तक्रे िा िुनश्चाश्िाशसता जले||
(Ah Su 26/40)
24. 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.
25. 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.
26. 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.
27. 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..)
28. Patient is allowed to maintain the position
till bleeding stops.
If bleeding is excessive-raktha sthambhana
upayas.
Pad & bandage with Durva ghritham.
29. • 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
32. (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.
शिरो नेत्र विकरेषु ललाट्ा मोक्षयेण्त्सराम्
अिाङ्गयाम ्उिनास्याम ् िा ……
33. 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.
35. 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.
36. िूयालसे िोखणतमोक्षण च हित तथैिाप्युिनािन च |
कत्स्नो विधिश्चेक्षणिाकघाती यथावििान श षजा प्रयोज्यः ||
(Su ut 12/45)
Raktha moksha is the treatment of choice for
puyalasa.
Should be done after Snehana and Swedana.
37. 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.
38. आनुििान्त रोगे शसरा विस्रािणम् ||
(A S UT 14/13)
As a measure of managing complication
of arma, visravanam can be done.
39. 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.
40. तत्र व्रणिुक्ले त्रत्रित ् तनरूिेण त्रत्र: वििक्ि सविब:
िाययेत ् | शसरा च विध्येत् | दुष्ट िेष च विण्डित
अक्षक्षगमसक् जलौकोश : अििरेत ् || (A S Ut 14/18)
In savrana sukla, intially sarpirpana is done and
later Siramokshana; followed by Jalukavacharana, if
remnants are not cleared.
41. 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
42. एि अस्य अनुििान्तरुज: शसरा मोक्षयेत् ||
(A S Ut 19/10)
If the pain is not subsided in abhishyanda and
adhimantha, sira moksha should be done.
43. 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.
44. 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
45. ण्स्नग्िस्य छहदबतित: शसरव्यिह्र्तासज:॥
वििरक्तस्य च ित्माबनु तनशलबिेदावििुद्धित:॥
(A H Ut 16/48)
In chronic diseases of eye, Snehana, Vamana
and Rakthamoksha using Siravedha are
done for complete recovery.
47. 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.
50. 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.
51. 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.
बन्िनगुणास्तु चत्िार: शसरा कडिरामेद: कफात्मका:॥
(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.
53. 1. Jyotir.M.Astanga Samgraha with Sasilekha Commentary by Indu. Varanasi.
Chaukhamba Sanskrit Sansthan; 2009.
2. Acharya.J.T.Susrutha samhita of Susrutha with Nibandhasangraha of Sri
Dalhanacharya. edition reprint.Varanasi:ChoukambhaOrientalia;2009.
3. Harisadasiva p. Astanga hridaya of Vagbhata, with sarvangasundara and
ayurveda rasayana. edition reprint. Varanasi: Chaukhamba Sanskrit
Sansthan,2011.
4. Swaid A , Latief M. D, Rashid A, Anita T. Hirudotherapy /Leech therapy:
Applications and Indications in Surgery. Archives of Clinical Experimental
Surgery.2012;review article:
5. Mehdi. Eye Diseases and Leech Therapy.
http://www.leechestherapy.com/eye_diseases.php (accessed 20th January 2013).
6. American Huridotherapy Association. Leech therapy and Eye Diseases.
http://www.amazingleeches.com/eye-diseases.html (accessed 21st January 2013).
7. Sathish HS, Bahgel MS, Bhuyan C, Vaghela DB, Narmada MD, Midhun. Outline of
Researches in Raktha moksha.Int.J.Res Ayur Pharma. Sep-Oct2013; review article:
8. Ingole AR, Dhabarde DM, Kamble MA, Potnis VV. Modern Touch to Traditional
Leech Therapy: A Review. Research Journal of Pharmaceutical, Biological and
Chemical Sciences. July-Sep 2013; Volume 4, Issue 3
9. Abdullah S, Latief MD, Rashid A, Tewari A. Hirudotherapy /Leech therapy:
Applications and Indications in Surgery. Arch Clin Exp Surg. 2012; 1(3): 172-180,
review article:
Notas del editor
For all rogis the base of roga is raktha, so raktha sravana is a very important procedure
Prachanna- Blood letting through multiple incision in any localizes areaप्रच्छानेनैकदेशस्थम्.........
Used when blood vitiated by vata pitta kapha respectively
Hirudin :- acts as a potent anticoagulant (blood thinner). It inhibits blood coagulation by binding to thrombin.
Calin :- Inhibits blood coagulation by blocking the binding of von Willebrand factor to collagen. Inhibits collagen- mediated platelet aggregation.
Destabilase :-Dissolves fibrin and has thrombolytic effects.
Hirustasin :- Inhibits kallikrein, trypsin, chymotrypsin, neutropholic cathepsin G.
Bdellins :- Anti-inflammatory effect and inhibits trypsin, plasmin and acrocin.
Hyaluronidase(spreading factor) :- Facilitates the penetration and diffusion of pharmacologically active substances into the tissues and has antibiotic properties.
Tryptase inhibitor :- Inhibits proteolytic enzymes of host mast cell.
Eglins :- Anti-inflammatory. Inhibit the activity of alpha-chymotrypsin, chymase, substilisin, elastase, cathepsin G
Factor Xa inhibitor :- Inhibits the activity of coagulation factor xa by forming equimolar complexes
Complement inhibitors :- replace natural complement inhibitors if they are deficient
Carboxypeptidase A inhibitors :- Increases the inflow of blood.
Histamine like substances :-Vasodilator. Increases the inflow of blood at the bite site.
Acetylcholine :- Vasodilator.
Anesthetic-like substances :- Reduce pain during biting by a leech
Collagenase :- Reduces collagen.
stomatorrhagia.- BLEEDING FROM THE GUMS & OTHER PARTS OF MOUTH