Sunday, March 22, 2009



Rakta Mokshana with Jaloukas (Blood Letting with Leech Therapy)


Blood letting therapy is considered by some ancient ayurvedists as one among the famed "Panchakarmas" - five purification therapies. While Charaka considered Vamana (emesis), Virechana (purgation), Nasya (instillation of medication into the nose), and 2 types of Bastis (enemata) the five main purification therapies, Sushruta considered Vamana, Virechana, Nasya, Basti (one type), and Rakta Mokshana the five therapies. In addition to the tridoshas of Vata, Pitta, and Kapha, Sushruta considered Rakta to be the fourth dosha. Because Rakta Mokshana corrects the imbalances of Rakta, it is considered to be amongst the Panchakarma.

There are a variety of ways to perform blood letting. They are briefly as follows:

1. Sira vyadha- puncturing a vein by using a sharp instrument to allow the toxic blood to drain

2. Pracchana- Making a superficial scratch on the skin and allowing the blood to ooze slowly.

3. Shringa- Making a wound on the skin and draining the blood by creating a vacum with an animal horn.

4. Alabu- Using a dried vegetable gourd to drain blood with a suction technique

4. Jalouka- Using non-poisonous leeches

Of the variety of techniques mentioned above, jalka is the only one that is commonly practiced in ayurvedic hospitals. The others are almost obsolete now, but may be practiced by some traditional vaidyas and folklore practitioners.

Over the last few years, I've been fortunate to see leech therapy a few times at the hospital attached to my college. My classmate agreed to go through the process for her stubborn acne. She underwent one sitting and discontinued after that. As she only went through the procedure once, she did not benefit much from it. In the past two weeks, I've seen two leech procedures for a patient suffering from pustular acne. A postgrad student at our college is studying the effect of rakta mokshana using leeches in patients with acne. In addition to four sittings of leech therapy, the patients are instructed to take oral medication as well. His initial findings have been encouraging, but the efficacy of the overall treatment can only be evaluated in a few months.

Procedure of Jalouka:


Leeches:
The leeches selected for rakta mokshana should be non poisonous. They should be stored in fresh water, which should be changed every 3-4 days. While the classics state that they should be fed with algae and other natural food, the leeches can survive without food for quite a long time.

Selection of Patients:
While the other panchakarma therapies can be associated with many complications, jalouka therapy very rarely results in complications. In fact classical ayurvedic texts say that this can be administered to children, the elderly, pregnant women, and those of delicate constitutions. Thus there is a wide range of patients who can be chosen for this procedure.

The Site:
The site may be on the actual lesion or in an area nearby. The procedures I saw were administered on the specific lesions.

Method:
1. The area is exposed well and leech is placed on the skin. Sometimes the leech begins to suck itself. If it does not start sucking, a small would should be made in the skin and the leech reintroduced to the area. The classics mention rubbing the area with rough substances or making a linear incision in the area. Nowadays, a sterile needle is used to make a small wound.


2. After the leech attaches itself, a piece of sterile gauze is dipped in water and then placed over the leech.
3. The leech is left undisturbed until it falls off by itself or until the patient feels pain or itching in the area. This indicates that the leech is sucking pure blood (without toxins).
4. The wound is covered with the powder of yastimadhu (Glycyrrhiza glabra) and then covered with a sterile gauze piece.
5. THe leech is then induced to vomit the toxic blood that it has just sucked. If vomiting is not induced, the leech enters a toxic state called "Indra Mada" and then dies. Vomiting is induced by sprinkling the powder of haridra (Curcuma longa) on the leeches mouth. This usually makes the leech vomit on its own. If there is any residual blood in the leech, it can even be manually milked from its tail end to head end.
6. The leech should not be used again for rakta mokshana for at least 7 days, as mentioned by the classics. While some hospitals use the same leeches for different patients, it is advisable to use the leeches for one patient only and then discard them. There has not been any research about the transmission of hematogenous diseases through leeches. Until such research is done, reusing leeches should be highly discouraged.

Indications of Rakta Mokshana

It is considered the main line of treatment in any diseases where rakta dosha/dhatu is affected. This mainly refers to all skin diseases, called Kushta in ayurveda. It can even be used in cases of Arbuda, Granthi, and Gulma, which can be compared to various neoplastic growths.

Rakta Mokshana has been described in detail in many of the ayurvedic classical texts. Unfortunately nowadays it takes a backseat to more traditional ayurvedic therapies. It is encouraging that some centers are doing much needed research in this area.


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