Siravyadha Method Of Bloodletting: Procedure, Precautions, Benefits

Article by – Dr Renita D’Souza
Siravedha is a procedure of bloodletting by puncturing. This procedure is carried out to eliminate local toxic substances from blood. It is also called Siravyadha. 

In Ayurveda, Siravedha method is considered as half of the treatment of shalyatantra (science of surgery), as enema is considered in kayacikithsa (science of general medicine).

Bloodletting is considered as one among the 5 detoxification procedures, as per Sushruta. Bloodletting is also called Raktamokshana.
Read related: Raktamokshana Benefits, Types, Procedure, Indications

It is highly beneficial in removing the vitiated blood from the body, which causes autoimmune disorders like psoriasis, eczema, allergies etc and other blood related diseases as mentioned in Ayurveda.

Indications for Venesection (siravedha):
Those diseases which are not cured by using cold or hot treatments as per Ayurveda, are cured by venesection.
Benign tumors, lumps, glandular swellings
Insanity
Epilepsy
Abscess
Pain in flanks, heels, wrists
Dysentery
Goiter
Sciatica
Cervical lymphadenitis
Sinovitis of the knee
Burning sensation in soles and feet
Rheumatoid diseases
Curved nails

Contraindications for siravedha:
Who have not undergone unction and sudation therapy, who had excess sudation
Those affected by diseases of vata origin.
Pregnant women, women in puerperium
Indigestion
Bleeding disorders
Dyspnoea, Cough,
Diarrhea, Vomiting
Ascites, Anemia, Anasarca
Who have been taking fatty material and who are currently undergoing the five purificatory therapies.
Dehyration, Acute fever, Paralysis, Convulsions
Those who are exhuasted, afraid, emaciated, fasting,  vigilance in night, impotency.

Containdicated vein:
Those veins which are invisible, visible but are inaccessible to instruments and those veins which are collapsed should not be punctured as they would account for failure.

Duration and season for venesection:
Anushnasheetha kala – neither too cold nor too hot season is preferred for venesection.
Reason – at extreme cold season bleeding doesn’t occur properly and extreme hot weather cause excessive bleeding which leads to giddiness, burning sensation and fainting.

During rainy season – on cloud-free sky
Winter season – during mid noon
During emergencies, the above rules may be violated – In extreme cold climate, the patient should be subjected to sudation in closed chambers and then local sudation done prior to venesection.
In extreme hot conditions, cooling measures should be done prior to venesection.

Quantity of Blood eliminated during the procedure:
Bloodletting should be done for more than 1 prastha (768 ml).

Age limit for venesection: 
Above 16 and below 70 years of age.

Instruments used in venesection:
In fleshy parts – vrihimukha instrument( a type of lancet) is used to puncture the vein to the size of a rice grain.
Veins over bones – punctured with kuthari instrument (axe like instrument), to the size of half a barley.
Read related: Alabu Avacharana – Bloodletting Method Using Bottle gourd

Preparation of the patient for venesection:
Patient is oleated, after performing auspicious rites and having taken rice with unctuous meat soup should be formented with heat of fire or sunlight.
Then he is made to sit on a stool of the height of the knee.
A soft band of cloth should be tied round his head at the lower border of the hairs.
With his elbows kept on his knees, neck should be massaged briskly with fists holding balls of cloth.
Patient is made to strain by clasping his teeth, coughing and inflating cheeks, so that veins are visible.
From his back, the neck should be tied with a band of cloth and tightened with his index fingers within it; this is the mode of restraining veins except those which are inside the mouth.

Siravyadha procedure:
Physician should tap the raised vein with his middle finger to engorge it. Holding the sharp instrument (kutari) with left hand, aim its tip to the middle portion of the vein without shaking the hand. Then the vein should be punctured by tapping or pressing the sharp instrument.

Post procedure care:
The tourniquet should be released slowly.
The site is washed with cold water.
The puncture of the vein should be bandaged with a cotton swab soaked in sesame oil.

Read related – Leech Therapy Procedure, Benefits, Side Effects, Treatment

Regimen followed after venesection:
Food and drinks which are neither very hot nor very cold, which are light and carminative are suitable.
Avoid –  anger, fear, exhaustion, day sleep, sexual intercourse, driving, riding on vehicles, study, exposure to cold wind and water,  prolonged sitting in same place, incompatible food, intake of food when previous food is not digested, for 1 month. These activities will increase Pitta Dosha which further vitiates blood tissue.

Importance of food regime after venesection:
By the use of tourniquit, the doshas traverse retrograde and affects the blood. Hence the patient should adhere to wholesome food and restricted activities till the doshas return back to their own abodes and as the body has unstable blood during that period and digestive power has to be protected.

Observations during Siravyadha:
Flow of blood
When the puncture is proper, the blood flows out in a steady stream and stops when the tourniquet is released.
When the puncturing is inadequate, a little quantity of blood flows for a short time like an oil leak.
If the puncture is extensive, the blood will gush out and is arrested with great difficulty.

Features of ideal Siravedha –
Flow of bleeding occors for 48 minutes and ceases to flow spontaneous.
Brings lightness in body, reduces intensity of the ailments and gives peace of mind.

Features of inadequate Siravyadha –
Oedema, burning sensation, redness, suppuration and pain.

Features of excessive venesection
Headache, blindness, adimantha (disease of eye), timira(partial blindness), depletion of tissues, convulsions, burning sensation, hemiplegia, monoplegia, hiccups, dysnoea, cough, anemia and proves fatal if uncontrolled.

Signs of person with pure blood:
Clarity of complexion and of sense organs, unhindered digestive activity, happiness, endowed with good nutritional status and strength.

Read related – Shringa Method Of Bloodletting Therapy – Procedure, Benefits

Management of complications:
Inadequate venesection –
If scanty bleeding occurs, paste of cardamum, camphor, tagara (Valeriana jatamansi), kusta (Saussurea lappa), devadaru ( Cedrus deoodara), vidanga (Embelia ribes), chitraka (Plumbago zeylanica), Trikatu, karanja (Pongamia pinnata), any 3 or 4 herbs mixed with  rock salt and sesame oil is applied over ulcer. this increases the bleeding.

In excessive venesection –
1. Paste of lodra, licorice, patranga, red ochre, sarjarasa, rasanjana (water extract of tree turmeric), shalmali flower, conch, sukthi, black gram, barley, wheat are applied.
2. Powder from barks of shala, sarjarasa, arjuna, iremeda, meshasringi, cinnamon etc is made paste with honey and applied over the ulcer.
3. Paste of samudraphena bhasma, laksha powder with honey applied and bandaged with silk cloth.
4. Cold food / drinks, chilled cotton sterile pads, cold sprinkles, cold climate is useful to arrest bleeding
5. Cauterization and alkali application.
6. Kakolyadi kwatha, honey with sugar for drinking
7. Drinking blood of deer, pig, rabbit or buffalow
8. Diet – milk with green gram, meat soup

In fainting –
If the patient faints, tourniquet should be released, fanned and puncturing is attempted again. If he faints again, venesection is done on the next day or the third day.

Precautionsvenesection:
1. Venesection is conducted above 16 years upto the age of 70 years.
2. Excessive venesection leads vata diseases,  hence venesection procedure should be done with utmost precaution in indicated vata diseases.
3.Two bloodlettings should not be conducted simultaneously.
4. Bloodletting can be done once in 7 days for 3 – 4 settings.
5. If bloodletting is not carried out onthe first day, it should be done on 2nd day preceded by oleation and sudation therapy.
6. Healthy persons should not be subjected to venesction unnecessarily.
Read related – Understanding Blood Functions, Vitiation And Treatment As Per Ayurveda

Haemostatic measures
Sandhana – method of surgical approximation of edges of the wound
Skandhana – coaggulation by cold methods
Pachana – heating to contract veins and arrest bleeding
Dahana – electric cauterization

Type of blood flow in involment of various doshas:
Blood vitiated by vata – dark brown in color,non unctuous, clear, frothy and flow will be with force.
Blood vitiated by pitta – yellowish black color, foul smell, not coagulated due to heat and with rainbow-halo.
Blood vitiated with kapha – unctuous,pale, thready, slimy and thick.
Blood vitiated by combination of two doshas – mixed features
Blood vitiated by three doshas – filthy and turbid

Repeatation of the process in excessively vitiated blood:
The vitiated blood should be let out again in the same evening or the next day. If the blood is vitiated excessively, then it should be removed again after a fortnight, after processing the body with sneha(fats).

Sites of venesection depending on disorders:
1. In burning sensation and horripilation of feet, cervical spondylosis, herpes, gout, calcaneal spur – 2 angula (3 cm) above shipramarma (vital area in between the great toe and the second toe)
2. In pain due to vata, patellar bursitis – 4 angula(6 cm) above ankle joint – at union of anterior and posterior tibial veins.
3. In sciatica, brachial neuritis – 4 angula(6 cm) above or below knee joint.
4. In cervical lymphadenitis – 2 angula(3 cm) below indrabasti(vital area in center of the calf muscle)
5. In goiter – femoral vein on both thighs, axillary or cephalic veins in arms.
6. In spleenomegaly – veins at or near left kurpara sandhi (median cubital vein) or veins between little and ring fingers.
7. In ascites, dysnoea and cough – veins at right kurpara sandhi
8. In dysentry and pain –  vein situated 2 angula(3 cm) apart from pelvis.
9. In fissure in ano, gonorrhea, seminal diseases and diseases in penis etc – (vein situated on penis)
10. In hydrocoele – testicular vein
11. In hernia, pleural pain – venesection on bracheo cephalic, axillary and mammary veins (parshva, kaksha, stana madya sira).
12. In frozen shoulder – veins between shoulder(amsa).
13. In tritiyaka fever – veins near trika sandhi (shoulder blades)
14. In chaturthika fever – veins on lateral side below shoulders
15. In epilepsy – veins in middle of anusandhi(mandibular joint)
16. In insanity – veins in/around thorax, outer canthus of eye and forehead
17. In diseases of tongue, oral cavity, palate – sublingual veins, veins in the region of tongue, lips, palate,
18. In ear disorders – veins above the ears
19. In nasal diorders – veins at tip of nose
20. In eye disorders – veins nea nose, forehead, outer canthus of eyes.

Research done on Ayurvedic Siravedha procedure:
Clinical study done to evaluate efficacy of Siravyadha on lumbar spondylosis (1)

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