The 8th chapter of Sharirasthana of Sushruta Samhita is named as Sira Vyadha Vidhi Shariram Adhyaya. This chapter deals with the procedure of puncturing the vein / phlebotomy.
Table of Contents
Sira Vyadha Vidhi- Procedure of puncturing the vein / phlebotomy
अथातःसिराव्यधविधिंशारीरंव्याख्यास्यामः ॥१॥
यथोवाचभगवान्धन्वत्तरिः ॥२॥
Now we will expound the chapter by name Sira Vyadha Vidhi – procedure of puncturing vein / phlebotomy; as revealed by the venerable Dhanvantari.
Vyadhana Anarha – person unsuitable for puncturing
बालस्थविररूक्षक्षतक्षीरुपरिश्रान्तमद्यपाध्वस्त्रीकर्शितवमितविरिक्तास्थापितानुवासितजागरितक्लीबकृशगिर्भिणीनां
कासश्र्वासशोषप्रवृद्धज्वराक्षेपकपक्षाघातोपवासपिपसामूर्च्छाप्रपीडितानां चसिरांनविध्येत्,याश्चाव्याध्याः। व्यध्याश्चादृष्टाः ।दृष्टाश्चायन्त्रिताः, यन्त्रिताश्चानुत्थिताइति॥३॥
Contraindications for siravedha –
The siras – veins should not be punctured in –
– children,
– the old aged,
– persons who are dry, wounded, debilitated, fearful,
– those who are greatly fatigued,
– those who have consumed wine,
– those who are exhausted by long walk or
– those who are exhausted due to indulgence in excessive sexual activities
– those who have had vomiting or purgation,
– those who have been administered decoction and oil enemas,
– those who have kept awake at night,
– impotent persons
– emaciated persons
– pregnant women
– those who are suffering from cough, dysponea, consumption, high fever, convulsions, partial paralysis, starvation, thirst and fainting
Below mentioned siras also should never be punctured –
– those which are contraindicated / prohibited from puncturing
– those siras which are indicated for puncturing but are not visible
– those siras which are clearly visible but cannot be controlled (or held for puncturing)
– those siras which are not raised / engorged, though controlled
Vyadhana Arha – Suitable for puncturing
शोणितावसेकसाध्याश्चयेविकाराःप्रागभिहितास्तेषुचापक्वेष्वन्येषुचानु क्तेषुयथाभ्यासंयथान्यायंचसिरांविध्येत् ॥४॥
Siravedha or vein puncture as a therapeutic measure should be conducted in all diseases which are curable by raktamokshana i.e. bloodletting, as explained earlier in Sutra Sthana section, chapter 14 of the same treatise (Sushruta Samhita).
With one’s clinical / surgical experience and practice and also after adopting appropriate measures and procedures, siravedha can also be done in other diseases which have not become pakva i.e. mature (ripened, suppurated), also in those diseases which have not been indicated for shonitavaseka – bloodletting.
प्रतिषिद्धानामपिचविषोपसर्गेआत्ययिकेचसिराव्यधनमप्रतिषिद्धम्॥५॥
Siravyadha i.e. puncturing of vein is not prohibited even in the veins contraindicated for puncturing when a person is severely affected by poisons or in conditions of emergency.
Vyadhana Vidhi – Procedure of puncturing
तत्र स्निग्धस्विन्नमातुरं यथादोषप्रत्यनीकं द्रवप्रायमन्नं भुक्तवन्तंयवागूंपीतवन्तंवायथाकालमुपस्थाप्यसीनंस्थितंवाप्राणानबाधमानोवस्त्रपटचर्मान्तर्वल्कललतानामन्यतमेनयन्त्रयित्वानातिगाढंनातिशिथिलंशरीरप्रदेशमासाद्य प्राप्तंशस्त्रमादायसिरांविध्येत् ॥६॥
Snehana and Swedana – As part of preparatory measures, the patient should be administered with –
– snehana – oleation and
– swedana – sudation and
Drava Anna – to the patient who has been administered with snehana and swedana, liquid food or yavagu i.e. thick gruel should be given. These foods should have opposite qualities as those of the aggravated doshas.
Positioning the patient – Proper time for conducting siravyadha is decided. The patient who has undergone snehana and swedana and drava anna as mentioned above should be made to sit in erect posture, on a chair, close to the physician.
Tying bands – Later he should be tied with either of the below mentioned things –
– bands of clothes
– leather
– inner bark of trees,
– creeper or any other such materials
They should be tied taking care that –
– the patient’s life is not endangered
– he is not controlled or restrained from movement,
– the band is tied neither very firmly nor very loosely
Later, the physician should search for proper site for conducting the puncture and the sira at that site shall be punctured, using appropriate instrument.
Contraindications for doing vein puncture
नैवातिशीतेनात्यष्णेनप्रवातेनचाभ्रिते॥
सिराणांव्यधनंकार्यमरोगेवाकदाचन ॥७॥
Vein puncture should not be done on –
– very cold days
– very hot days
– days on which there is heavy breeze,
– very cloudy day,
– healthy persons
तत्रव्यध्यसिरांपुरुषंप्रत्यादित्यमुखमरत्निमात्रोच्छ्रितेउपवेश्यासनेसक्थ्नोराकुञ्चितयोर्निवेश्यकूर्परे सन्धिद्वयस्योपरि हस्तावन्तर्गूढाङ्गुष्ठकृतमुष्टी मन्ययोःस्थापयित्वायन्त्रणशाटकंग्रीवामुष्ट्चोरुपरिपरिक्षिप्यान्येनपुरुषेणपश्चात्स्त्थितेनवामहस्तेनोत्तानेन शाटकान्तद्वयं ग्राहयित्वाततो-ब्रूयात्दक्षिणहस्तेनसिरोत्थापनार्थंनात्यायतशिथिलं यन्त्रमावेष्टयेति,असृकस्त्रावणार्थं तयन्त्रंपृष्ठमध्येपीडयेति, कर्मपुरुषंचवायुपूर्णमुखंस्थापयेत्; एषउत्तमाङ्गगतानामन्तर्मुखवर्जानांसिराणांव्यधनेयन्त्रणविधिः ।
पादव्यध्यसिरस्यपादंसमेस्थानेसुस्थितंस्थापयित्वाऽन्यंपादमीषत्संकुचितमुच्चैःकृत्वाव्यध्यसिरंपादंजानुसन्धेरधःशातकेनावेष्ट्चहस्ताभ्यांप्रपीड्चगुल्फंव्यध्यप्रदेशस्योपरिचतुरड्गुलेप्लोतादीनामन्यमेनबद्धावापादसिरांविध्येत्।
अथोपरिष्ठाद्धस्तौगूढङ्गुष्ठकृतमुष्टीसम्यगासने स्थापयित्वा सुखोपविष्टस्य पूर्ववद्यन्त्रंबद्धवाहस्तसिरांविध्येत् ।
गृध्रसीविश्वाच्योःसङ्कुचितजानुकूर्परस्य।
श्रोणिपृष्टस्कन्धेषून्नामितपृष्ठस्यावाक् शिरस्कस्योपविष्टस्य विस्फूर्जितपृष्ठस्यविध्येत् ।
उदरोरसोः प्रसारितोरस्कस्योन्नामितशिरस्कस्य विस्फूर्जितदेहस्य।
बाहुभ्यामवलम्बमानदेहस्यपार्श्वयोःअनामितमेढ्रस्यमेढ्रे।
उन्नमितविदष्टजिह्वाग्रस्याधोजिह्वायाम् ।
अतिव्यात्ताननस्यतालुनिदन्तमूलेषुच ।
एवंयन्त्रोपायानन्यांश्चसिरोत्थापनहेतूनबुद्धचाऽवेक्ष्यशरीरवशेनव्याधिवशेनचविदध्यात् ॥८॥
Controlling / manipulating the veins of the head –
Positioning the patient – The person who is selected for siravyadha is made to sit on a chair facing east. The chair should be of the height of his forearm. The person should sit on the chair flexing his legs at the knees. He should keep his elbows on his knees and clench his fists.
Applying force – The patient is now asked to keep his clenched fists on the nape of his neck on both sides and press on the nape.
Binding – Now a binder is taken and is passed above his neck and fists. The person standing behind the chair on which the person is seated will hold the two ends of the binder. Raising his left hand slightly he ties a knot. The knot is not very tight but sufficient enough to raise the veins. Then, he tightens the binder at the middle of the patient’s back.
Instruction to the patient – Now, the patient is asked to inflate his mouth with air.
This is the method of controlling or manipulating the veins of the head which are not spreading inwards, for puncturing.
Controlling / manipulating the veins of the legs (lower limbs) –
Positioning the patient – To conduct siravedha in the legs i.e. to puncture the leg veins, the patient should place his one leg firmly on an even place like couch / cot. He should slightly flex and rise the other leg above.
Binder – After positioning the patient as said above, a binder should be wrapped below the knee of the leg in which siravyadha is to be done.
Conducting vein puncture – Now, the physician should knead the ankle of the patient with the help of his hands after tying a band of cloth or any such material about four angula (8 cm) above the site of puncture. After this, he should puncture the vein of the leg.
Controlling / manipulating the veins of the hands (upper limbs) –
Positioning of the patient – The siras of the arm – upper limb shall be punctured after the patient keeps his hands as explained earlier – with tightly clenched fists with thumb inside the fists, with other fingers wrapping it and by making the patient to sit comfortably. He should be manipulated as described earlier following which the veins should be punctured.
Manipulation and puncturing the other veins
| Veins to be punctured | Position in which vein should be punctured |
| In Gridhrasi – sciatica and Visvaci – painful condition of the arm | With knee (in gridhrasi) and elbows (in visvaci) flexed |
| Veins of the pelvis, back and shoulders | By expanding the back of the patient by making the him sit, raising his back and lowering his head |
| Veins of the abdomen and chest | With the patient expanding his chest, raising his head and stretching (expanding) his body |
| Veins of the flanks | When the body is resting on the arms |
| Veins of the penis | When the penis is erect |
| Veins of the tongue | Below the tongue while the tongue is kept lifted up and biting its tip |
| Veins of the palate and root of the teeth | When the person keeps his mouth very wide open |
Thus, even in places of body wherein siravyadha has not been indicated, the vein puncture should be done by binding the place with suitable yantra or anuyantra and by adopting effective methods of control or manipulation which causes the vein to rise, so that it can be easily punctured. Puncturing of the vein should be done based on the nature of the body of the patient and the nature of the disease.
Vyadhapramana- size of the puncture
मांसलेष्ववकाशेषुयवमात्रंशस्त्रंनिदध्यात्,अतोऽन्यथाऽर्धयवमात्रंव्रीहिमात्रंवाव्रीहिमुखेन, अस्थ्नामुपरिकुठारिकयाविध्येदर्धयवमात्रम् ॥९॥
| Region of the body wherein puncturing needs to be done | Size of the puncture |
| Muscular regions of the body | Size of yava – barley grain |
| In other areas i.e. areas other than muscular areas of the body | Size of Half Yava or one vrihi (paddy) Puncturing should be done using Vrihimukha Sastra – Trocar or Puncturing needle |
| Veins on the bones | Size of Half Yava Puncturing should be done using Kutharika – small surgical axe |
Vyadhana Kala- suitable time
व्यभ्रेवर्षासुविध्येत्तुग्रीष्मकालेतुशीतले ॥
हेमन्तकाले मध्याह्रेशस्त्रकालस्त्रयः स्मृताः ॥१०॥
Time of instrumentation for siravyadha are three, depending on the seasons.
| Season in which puncturing of vein should be done | Conditions |
| Varsa Rtu – rainy season | On days which are not cloudy |
| Grisma Rtu – summer | At a time when it is cool |
| Hemanta Rtu – winter | At midday |
Samyak Viddha Laksana – proper puncture
सम्यक्शस्त्रनिपातेनधारयायास्रवेदसृक्॥
मुहर्तं रुद्धा तिष्ठेच्चसुविद्धांतांविनिर्दिशेत् ॥११॥
यथाकुसुम्भपुष्पेभ्यःपूर्वंस्रवतिपीतिका॥
तथासिरासुविद्धासु दुष्टमग्रे प्रवर्तते॥१२॥
When the instrumentation towards siravyadha – puncturing of vein has been done in a proper way and the blood let out properly, the below mentioned signs can be observed –
– blood flows out in stream, for a time period of one muhurta – 28 minutes and
– later, the bleeding stops on its own accord
Simily – Giving an analogy to explain bleeding after siravedha, Acharya says that only vitiated blood flows out first after the siras have been punctured just like a yellow-colored liquid flows out from the Kusumbha flowers, when these flowers are crushed.
Asrava – absence of flow
मूर्च्छितस्यातिभीतस्य श्रान्तस्यतृषितस्यच ॥
नवहन्तिसिराविद्द्धास्तथाऽनुत्थितयन्त्रिताः ॥१३॥
Below mentioned are the conditions in which the blood does not easily flow out when the siras are punctured –
– in those who have fainted,
– in those who are greatly afraid,
– in those exhausted
– in those who are thirsty,
– in conditions when the veins are not properly raised for puncturing through manipulations
Conditions wherein puncturing should be done in the noon
क्षीणस्यबहुदोषस्यमूर्च्छयाऽभिहतस्यच ॥
भूयोऽपराह्वविस्राव्यासाऽपरेद्युस्त्र्यहेऽपिवा॥ १४॥
Puncturing should be done in the afternoon or on the next or third day the below mentioned kinds of persons –
– those who are debilitated,
– those who have great accumulation of doshas,
– those who are afflicted by murcha – fainting
Samshamana
रक्तंसशेषदोषंतुकुयोदपिविचक्षणः ॥
नचातिनिःस्त्रुतंकुर्याच्छेषंसंशमनैर्जयेत् ॥१५॥
The physician / surgeon who is conducting siravyadha – bloodletting through vein puncture, may at times allow little quantity of vitiated blood inside the body after having let majority of vitiated blood out of the body, but should never allow blood to flow out in excess. The doshas which have been left over in the body after bloodletting should be later mitigated with suitable palliative therapies.
Sravapramana- quantity offlow
बलिनोबहुदोषस्यवयःस्थस्यशरीरिणः ॥
परंप्रमाणमिच्छन्तिप्रस्थंशोणितमोक्षणे ॥१६॥
According to the opinion of experts, 1 prastha – 640ml approximately – of blood should be allowed to flow out after puncturing the vein while conducting siravyadha in –
– strong persons
– persons having great accumulation of doshas and
– persons who are of suitable age i.e. middle age
Vyadhasthana – place of puncturing
तत्र पाददाहपादहर्षचिप्पविसर्पवातशोणितवातकण्टकविचर्चिकापाददारी प्रभृतिवुक्षीप्रमर्मणउपारिष्ठाद् द्यङ्गुल्लेव्रीहिमुखेनसिरांविध्येत्, शेलीपदेतच्चिकिस्तितेयथावक्ष्यते, कोष्ट्तकशिरः, खञ्जपङ्गुलवातवेदनासुजङ्घायां, ऊरुमूलसश्रीतांगलगण्डे, एतेनेतरसक्थिबाहूचव्याख्यातौ; विशेषतस्तुवामबाहौकूर्परसन्धेरभ्यन्तरतोबाहुमध्ये प्लीह्रि कनिष्ठिका-नामिकयोर्मध्येवा, एवंदक्षिणबाहौयकृद्दल्ये(कफोदरेच), एतामेवचकासश्वासयोरप्यादिशन्ति, गृध्रस्यमिवविश्र्वाच्यां, श्रोणिंप्रतिसमन्ताद् ह्यङ्गुलेप्रवाहिकायांशूलिन्यां, परिवर्तिकोपदंशशूकदोषशुक्रव्यापत्सुमेढ्रमध्ये, वृषणयोःपार्श्वेमूत्रवृध्द्यांनाभेरधश्चतुरङ्गुलेसेवन्यादकोदरे, वामपार्श्वेकक्षास्तनयोरन्तरेऽन्तर्विद्रधौपार्श्वशूलेच, बाहुशोषावबाहुकयोरप्येके, वदन्त्यंसयोरन्तरे, त्रिकस्सन्धिमध्यगतांतृतीयके, अधःस्कन्धसन्धिगतामन्यतरपार्श्वसंस्थितांचतुर्थके, हनुसन्धिमध्यगरामपस्मारे, शङ्खकेशान्तगतामुरोऽपाङ्गललाटेषुचोन्मदे, जिह्वारेगेष्वधोजिह्वायांदन्तव्याधिषुच, तालुनितालुनितालव्येषुकर्णयोरुपरिसमन्ताम्कर्णशूलएतद्रोगेषुच, गध्राग्रहणेनासारोगेषुचनासाग्रे, तिमिराक्षिपाकप्रभृतिष्वक्ष्यामयेषूपनासिकेलालट्चामपाङ्ग्चांवा, एताएवशिरोरोगाधिमन्थप्रभृतिषुरोगेष्विति ॥१७॥
| Conditions / diseases in which siravedha – vein puncture is to be done | Site / Vein for conducting vein puncture |
| Pada daha – burning sensation of feet / soles Pada harsa – tingling or tenderness in the feet / soles Cippa – whitlow Visarpa – erysipelas, herpes Vatasonita – gout Vatakantaka – ankle joint sprain Vicarcika – skin disease, eczema Padadari – fissures in the soles etc. | Sira situated 2 angula – 4 cm above the Ksipra Marma (vital spot present in between big toe and the next toe)
Instrument used – Vrihimukha Sastra – trocar, thick needle |
| Slipada – filariasis | The method of puncturing the vein shall be described in the chapter dealing with its treatment (Chikitsa Sthana, chapter 19) |
| Krostukasirsa – inflammation of knee joint Khanja – limping Pangu – lameness Vata Vedana – pains caused by aggravated vata
| In janghas – calves,
Location – four angula – 8 cm above the ankle joint |
| Apaci – tumor occurring in the neck, lymphadenitis of the neck | 2 angula – 4 cm below the Indrabasti Marma (a vital spot located at the center of the calf muscle) |
| Gridhrasi – sciatica | 4 angula – 8 cm – either above or below the knee joint |
| Galaganda – tumor occurring in the neck, Thyroid swelling, Goiter | Vein present at the root / base of the thigh |
| Pliha – diseases / enlargement of spleen | In the left arm, either at the inner side of the elbow joint or at the center of the arm or in the area between little and ring fingers |
| Yakriddalyodara – abdominal enlargement caused due to increase in size of liver – hepatomegaly and Kaphodara – abdominal enlargement caused by increased kapha | In the right arm, at the same places mentioned for vein puncture in case of enlargement of spleen above (no 7) |
| Kasa – cough Swasa – dyspnea, breathing disorders | In the same places mentioned above (in pliha and yakriddalyodara) |
| Visvaci – pain in the arms | As explained in Gridhrasi – sciatica |
| Pravahika – dysentery Sula – pain in the abdomen, colic | 2 angula – 4 cm in front of the pelvis – pubic symphysis |
| Parivartika, Upadamsa, Suka Dosa – all are diseases of penis Diseases of semen | In the middle of the penis |
| Mutra vriddhi – hydrocele | On the sides of the scrotum |
| Dakodara / Jalodara – ascites | Below the umbilicus, 4 angula – 8 cm at the left side of the raphae of the abdomen |
| Antar-vidradhi – internal abscess Parsva-sula – pain in the flanks | In between the axilla and breasts, on the left flank |
| Bahusosa – wasting of arms Apabahuka – loss of movement of arm | Between two shoulders |
| Tritiyaka Jwara – tertian fever | Middle of trika – upper back |
| Chaturthaka Jwara – quartan fever | Below the shoulder joint of lower jaw, near the ear |
| Apasmara – epilepsy, memory disorders | Vein situated in the middle of the joint of the lower jaw, near the ear |
| Unmada – insanity, psychoses | In the temple and border of hairs in the head, at the outer angle of the eye and forehead |
| Jihva danta roga – diseases of the tongue and teeth | Above the ears |
| Loss of smell perception and diseases of the nose | Tip of the nose |
| Timira – partial blindness Aksi-paka – ulceration of the eye Diseases of the eye | At upanasika – base of the nose or Forehead or Outer angle of the eye |
| Shiroroga – Diseases of the head Adhimantha – disease of the eye, glaucoma Other such diseases | Base of the nose, forehead and outer angle of the eyes |
Dusta Vyadha – Improper puncturing
दुष्टव्यधा विंशति:-दुर्विद्धाऽतिविद्वा कुञ्चितापिच्चिताकुटिताऽप्रस्रुताऽत्युदीर्णाऽन्तेविद्धापरिशुष्काकूणितावेपिताऽनुत्थितविद्धाशस्त्रहतातिर्यग्विद्धाविद्धाऽव्यध्याविद्रुताधेनुकापुनःपुनर्विद्धासिरास्नाय्वस्थिसन्धिमर्मसुचेति ॥१८॥
DustaVyadha or improper puncturing of vein is of twenty types. They are as below mentioned –
– Durviddha,
– Atividdha,
– Kuncita,
– Piccita,
– Kuttita,
– Aprasrta,
– Atyudirna,
– Anteviddha,
– Parisuka,
– Kunita,
– Vepita,
– AnuthitaViddha,
– Sastrahata,
– Triyakviddha,
– Aviddha,
– Avyadhya,
– Vidruat,
– Dhenuka,
– Punahpunar viddha and
– Mamsa Siran Snayu- AsthiSandhi Marma viddha
तत्रयासूक्ष्मशस्त्रविद्धाऽव्यक्तमसृक्स्रवतिरुजाशोफवतीचसादुर्विद्धा, प्रमाणातिरिक्तविद्धायामन्तःप्रविशतिशोणितंशोणितातिप्रवृत्तिर्वासाऽतिविद्धा, कुण्ठश्स्त्रप्रमथिता पृथुलीभावमापन्ना पिच्चिता, अनासादितापुनःपुरन्तयोश्चबहुशःशस्त्राभिहताकुटिता, शीतभयमूर्च्छाभिरप्रवृत्तशोणिताअप्रस्रुता, तीक्ष्ण्महामुखशस्त्रविद्धाऽत्युदीर्णा, अल्परक्तस्राविण्यन्तेविद्धा, क्षीणशोणितस्यानिलपूर्णापरिशुष्का, चतुर्भागादादिताकिंचित्प्रवृत्तशोणिताकूणिता, दुःस्थानबन्धनाद्वेपमानायाः शोणितसंमोहोभवतिसावोपिता, अनुत्थिरविद्धायाम छीन्नातिप्रवृत्तशोणिताक्रियासङ्गकरीशस्रहता, तिर्यक्प्रणिहितशस्त्राकिंचिच्छेषातिर्यग्विद्धा, बहुशः क्षताहीनशस्त्रप्रणिधानेनाविद्धा, अशस्त्रकृत्याअव्यध्या, अनवस्थितविद्धा, विद्रुता, प्रदेशस्यबहुशोऽवघटनादारोहद्व्यधामुहुर्मुहुःशोणितस्त्रावाधेनुका, सूक्ष्मश्स्त्रव्यधनाद्वहुशो बिन्ना पुनःपुनर्विद्धा, स्नाय्वस्थिरासन्धिमर्मसुविद्धा, स्नाय्वस्थिसिरासन्धिमर्मसुविद्धारुजांशोफंवैकल्यंमरणंचापादयति॥२९॥
Durviddha–
It is the puncture of the vein made by a minute sharp instrument.
Features –
– Invisible blood flow
– Pain
– Swelling
Atividha–
Inn this type, the measurement of the puncture done on the vein is more than what is required.
Features –
– bleeding takes place inside the body i.e. blood flow goes into the body or
– the blood flows out in large quantity i.e. excessive bleeding takes place
Kuncita– is similar to atividha.
Piccita–
It is a puncture done with a blunt instrument.
Features – the vein which has been crushed by such a blunt instrument attains more breadth or thickness.
Kuttita–
This happens due to repeated puncture done in the site of the vein wherein the vein is not easily available for puncture (repeated attempts on an unclear vein).
Features – Damage of even the other veins in the vicinity of the vein over which the puncture was attempted.
Aprasrta–
In this condition, blood is not let out from the vein which has been punctured. This happens due to the effect of coldness, fear or fainting.
Atyudirna–
In this type, the puncture of the vein is made by a sharp and thick instrument.
Antebhihata–
In this type of puncturing, there is scanty flow of blood from the sira.
Parisuska–
It is a condition in which there is less blood in the sira but it is filled with air.
Kunita–
It is a condition which occurs due to a puncture done on a quarter portion of the vein.
Features – less bleeding occurs.
Vepita–
In this, the binding is made at an improper place.
Features – Blood does not come out due to the trembling of siras or due to siravyadha done with trembling hands of the surgeon.
AnuthitaViddha –
It presents with the same symptoms as those of vepita explained above.
Sastrahata–
In this, there is excessive cutting of the vein during the procedure.
Features – Copious flow of blood and stoppage of functions of the vein and the related body part / parts.
Tiryakviddha–
This happens when the instrument used for siravyadha is pushed into the sira through its side and also slightly and as a consequence, the sira is not cut or punctured completely, as it should.
Apaviddha–
It is a condition in which multiple wounds are caused due to inadequate usage of the instrument (for puncturing the vein).
Avyadhya–
This condition occurs when
– the puncture is not done by the instrument or
– when the siras which are unfit / contraindicated for puncturing are punctured by the instrument
Vidruta–
It is punctured when the veins are unsteady (or when the physician is unsteady in his mind).
Dhenuka –
It is that condition in which the body part is repeatedly hit with the purpose of raising the sira for siravyadha.
Features – repeated bleeding.
Punah Punar viddha–
In this, the sira is punctured multiple times because of the sharp instrument used for the procedure being small (minute).
Mamsa sira snayu asthi sandhi marma viddha – Puncture done on the vital spots located in / on muscles, veins, ligaments, bones, and joints gives rise to pain, swelling, deformity or death.
Complications of Sira Vedha (vein puncture) and their remedies
सिरासुशिक्षितोनास्तिचला ह्येताः स्वभावतः॥
मत्स्यवत्परिवर्तन्तेतस्माद्यत्नेनताडयेत् ॥२०॥
अजानतागृहीतेतुशस्त्रेकायनिपातिते ॥
भवन्तिव्यापदश्चैताबहवश्चाप्युपद्रवाः ॥२१॥
स्नेहादिभिःक्रियायोगैर्नतथालेपनैरपि ॥
यान्त्याशुव्याधयःशान्तिंयथासम्यक्सिराव्यधात् ॥२२॥
सिराव्यधश्चिकित्सार्धंशल्यतन्त्रेप्रकीर्तितः ॥
यथाप्रणिहितःस्म्यग्बस्तिःकायचिकित्सिते ॥२३॥
Some verse here:-
The sira need to be punctured with great efforts and skill because –
– there is no one who is specially or precisely trained in puncturing the sira and
– the sira is by nature slippery and it turns like the fish
If the physician / surgeon conducts instrumentation for puncturing the veins on the body without having complete knowledge of the procedure, he would undoubtedly give rise to many diseases and complications.
The diseases and complications which are produced due to improper puncturing of siras do not subside quickly by snehana and other therapies and also by external application of medicaments etc. unlike those caused by proper puncturing of siras.
Just like vasti chikitsa i.e. enema therapy is considered as half treatment in the field of Kaya-Chikitsa (inner or general medicine), Siravyadha – vein puncture or venesection is considered as half treatment in Salya-tantra (surgical school).
Varjya-avoidable
तत्र स्निग्धस्विन्नवान्तविरिक्तास्थापितानुवसितानुवसितसिराविद्धैः परिहर्तव्यानि क्रोधायासमैथुनदिवास्वप्नवाग्व्यायामयानाध्ययनस्थानासनचङ्क्रमणशीतवातातपविरुद्धासात्म्या जीर्णान्याबललाभात्, मासमेके, मन्यन्ते । एतेषां विस्तरमुपरिष्ठाद्वक्ष्यामः ॥२४॥
The persons who have undergone therapies like snehana, swedana, vamana, virecana, asthapana vasti, anuvasana vasti and siravyadha should avoid the below said until they obtain strength or for a period of one month after these therapies (as per some authorities) –
– krodha – anger,
– ayasa – exertion,
– maithuna – copulation,
– divasvapna – day sleep,
– vak – speaking loudly,
– vyayama – physical exercises,
– yana – riding,
– adhyayana – study(in high pitch),
– sthana asana – sitting for long time,
– chankramana – walking too much,
– shitavata – cold breeze,
– atapa – sunlight,
– viruddha, asatmya, ajirna ahara – foods which are incomputable and unaccustomed and also indigestion
Rakta Moksana Krama – methods of blood
सिराविषाणतुम्बैस्तुजलौकाभिःपदैस्तथा॥
अवगाढं यथापूर्वंनिर्हरेद्दुष्टशोणितम् ॥२५॥
अवगाढेजलौकास्यात् प्रच्छन्नं पिण्डितेहितम् ॥
सिराऽङ्गव्यापकेरक्तेशृङ्गालाबूत्वचिस्थिते ॥२६॥
Below mentioned are the different methods of removing the vitiated blood from the body. Raktamoksana – bloodletting or removal of vitiated blood should be done using one of the below mentioned procedures –
– siravyadha – puncturing the vein, venipuncture, venesection,
– visana – sucking through a horn,
– tumbi – sucking through a pitcher gourd,
– jalauka – application of leech or
– prachana – incising or scraping
Each preceding one (reverse of given chronology) being said to be the best method for deeper tissues (vitiated blood located in the deeper tissues).
When the vitiated blood is deep seated, jalauka (leeches) should be administered.
When the blood is clotted, pracchana i.e. incising / scraping the skin is beneficial.
When the vitiated blood has spread in the entire body, siravyadha i.e. venesection is ideal.
When the vitiated blood is present only in the skin, visana / srnga or alabu i.e. horn or pitcher gourd shall be used to suck the vitiated blood and they will be beneficial.
इति श्रीसुश्रृतसंहितायांशारीरस्थानेसिराव्यधविधिशारिरं नामाष्टमोऽध्यायः ॥८॥
Thus ends the eighth chapter by name Siravyadha Vidhi in Sarira Sthana of Susruta Samhhita.
