Bloodletting - An Ayurvedic perspectiveHS Sathish, DB Vaghela
Department of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0022-3859.85223
Source of Support: None, Conflict of Interest: None
After going through the article entitled "Clinical uses of the medicinal leech: A practical review",  as I could not find the details of Ancient Indian Surgery which has probably the first detailed, rational, systematic description of leech therapy for various illnesses.
In this regard, being an Ayurvedic student, it is my small effort to inform the people who are unaware of this ancient Indian traditional practice, which is there in Ayurvedic texts and is being practiced successfully. I am herewith sharing some information which is found in our Ayurvedic texts.
Sushruta, Father of Indian Surgery, has given all the information regarding bloodletting in detail in his treatise, "Sushruta Samhita".  In this treatise, definition of Jalauka (leech), its types, habitat, handling of leeches, indications, contraindications, method of application and post-leech application wound care have been described in detail.
Raktamokshana, in other words bloodletting, is a kind of Para surgery directed for the treatment of specifically Raktaja roga (blood-borne) diseases, along with other many surgical diseases.
To expel out the vitiated blood, seven procedures are advocated: Venesection (Sira Vedhan), horn application (Sringa Avacharana), gourd application (Alabu Aavacharana), leech application (Jalauka Avacharana), scrapping (Pracchanna Karma), cupping glass application (Ghati Yantra Avacharana), and needle application (Suchi Avacharana).
The process of Raktamokshana can be traced back to the Vedic period only and not beyond that. In the Koushika sutra of Athravaveda,  references of bloodletting (Raktamokshana) by leech application are available.
Sushruta and Vagbhata  focused on the Raktamokshana in detail. In Sushruta Samhita and Ashtanga Sangrahas, separate chapters on venesection (Siravyadha) are found.
Bloodletting as a method of treatment is indicated in gouty arthritis, filariasis, herpes, tumors, various skin disorders, genital infections, abscess, inflammatory condition, cellulitis, painful ulcers, chronic ulcers resulting from snake bite, etc.
In the following cases, bloodletting is contraindicated: Generalized swelling, swelling in debilitated persons, swelling caused by sour diet and swelling in those suffering from anemia, piles, phthisis and in pregnancy.
Leech in Ayurveda is known as Jalauka. Six poisonous and six nonpoisonous strains of leeches have been identified [Table 1]. Not all the strains of leeches mentioned by Sushruta are identifiable today. His description of the techniques for bleeding by leeches was masterly and bore witness to a therapeutic practice which was used all over the world even in the first half of the 20 th century.