Ashtanga Sangraha Chapter 36, Siravyadha Vidhi – Venesection Procedure. Learn its importance, functions of impure blood, sites for venesection, and more.
अथातो सिराव्यधविधिं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
Siravyadha mahatvam – importance of venesection
बहवो हि रक्तावसेचनोपायाः प्रागभिहितास्तेषामन्येषां चविरेकादीनामुपक्रमाणां तत्साध्येष्वा मयेषु सिराव्यधः प्रधानम् । अमुना हि ते समूला: शोषमायान्ति केदारसेतुभेदेन शाल्यादय इव । तथा च ॥२॥
There are many methods of letting out blood which were described earlier. Among them and therapies like purgation etc., useful in curable diseases, venesection is the most important. By this only, all diseases will be cured from their roots just like rice and other crops in the field die out completely by removing the bunds of the field. (2)
सिराव्यधश्चिकित्सार्धं संपूर्णं वा चिकित्सितम् । शल्यतन्त्रे स्मृतो यद्वद्वस्तिः कायचिकित्सिते ॥३॥
Venesection is half the treatment or even full treatment in Shalya tantra (surgery), just as the enema therapy is described (as half the treatment or even full treatment) for all the diseases of Kayachikitsa (inner medicine). (3)
यथारक्तमधिष्ठानं विकाराणां विकारिणाम् । अन्यत्र हि तथा दूष्यं कर्मेदं प्रथमं ततः ॥४॥
Because blood is the seat for all diseases and there is no other dusya (tissue that gets vitiated) than blood in patients of such diseases; so this therapy (venesection) is the first (important). (4)
तत्राम्बु शारीरमाहारसारभूतं रसाख्यमविकृतमविकृतेन तेजसा रञ्जितमिन्द्रगोपाकारं च शशशोणितगुञ्जाफलालक्तकपद्मसुवर्णवर्णं धौतं च विरज्यमानं मधुरमीषल्लवणं स्निग्ध मसंहतमशीतोष्णं गुरु पित्तैकचयप्रकोपोपशमं सौम्याग्नेयं प्रकृत्या रक्तमाहुः । तथा दोषम् । दृष्यमिति केचित् । उभयात्मकमन्ये ॥५॥
The body water, known as Rasa which is the essence of the food, in its normal state, combining with the normal tejas (fire-like activity) aquires colour resembling the indrogopa (bright-red insect), blood of the rabbit, seeds of gunja, alaktaka (lac), lotus flower and molten gold; becomes sweet and slightly salt in taste, unctous, non-solid, neither cold nor hot (warm) and heavy; undergoes mild and profound increase and decrease to normal by the same causes of those of pitta; a mixture of cold and hot by nature, this is known as Rakta (blood). Some call it a dosha, some others a dusya ( tissue) and yet others call it as both. (5)
Dusta rakta karma – functions of impure blood
तच्चैवंविधमेव विधिवदाहारविहाराभ्यासाद्विशुद्धं बलवर्णसुखायुषां योनिः । इतरथा पुनः शरत्कालस्वभावादेव वा प्रदुष्टमभिष्यन्दाधिमन्थशुक्लार्मतिमिररक्तराजीशिरस्तोदभेददाहकण्डू कर्णरोगमुखपाकपूतिघ्राणास्योपदेहत्वगुल्मप्लीहविद्रधिवीसर्पज्वररक्त पित्तकुष्ठपिटकाश्ली पदोपदंशशङ्खशोफवातशोणितरक्तमेहक्षुद्ररोगाग्निस्वरनाशाङ्गगौरवसादारोचकाम्लोद्गारलवणा स्यताक्रोधमोहस्वेदमदमूर्छायसन्यासकम्प तन्द्रादीनाम् । ये च शीतोष्णस्निग्धरूक्षाद्यैः सर्वदोषप्रतिपक्षैः सम्यगप्युपक्रान्ताः साध्या अपि न सिध्यन्ति ते च रक्तप्रकोपजाः । तस्मात्तेष्वत्युद्रिक्तरक्तवित्रावणाय यथास्वं सिरां विध्येत् ॥६॥
This (blood), kept pure, by the habitual indulgence in suitable foods and activities, is the source for strength, colour, happiness and long life (of the person).
By causes opposite of the above and by the very nature of the sarat (autumn) season, it (blood) becomes abnormal and produces ophthalmia, adhimantha (glaucoma), suklarma (pterygium), blindness, pricking and splitting headache, pain, burning sensation and itching of the head, diesases of the ears, ulcerations of the mouth, bad smell from the nose, coating of the mouth, and skin, abdominal tumors, diseases of the spleen, abscess, herpes, fever, haemorrhagic diseases, leprosy and other skin diseases, boils, filariasis, veneral diseases, swelling of the temples, gout, heamaturia, ksudra roga, ( minor diseases), loss of digestive activity and voice, feeling of heavyness of the body, debility, loss of appetite, sour erectations, salty taste in the mouth, anger, delusion, perspiration, toxicity, fainting, deep coma, tremors, stupor etc; those diseases which though curable but still not responding to specific treatment such as by cold, heat, lubrication, dryness etc., indicated for the doshas, even though administered properly are also to be considered as arising from the increase (aggravation) of blood; hence, in these diseases, venesection should be done to drain out the aggravated blood. (6)
Siravyadha ayogya – persons unfit for venesection
न तु स्नेहपीतकृतपञ्चकर्मान्यतमगर्भिणीसूतिकाजीर्णकामलाक्लीबोनषोडशातीतसप्ततिव र्षाभिघातातिस्स्रुतरक्तादुष्टरक्तास्निग्धातिस्निग्धास्विन्नाक्षेपकपक्षाघातातिसारच्छर्दिश्वासकासोदर रक्तपित्तार्शःपाण्डुरोगसर्वाङ्गशोफपीडितानाम्। न चाव्यधनीयाश्चायन्त्रितानुत्थिता: सिरा: न तिर्यड्न चातिशीतोष्णवर्षवाताभ्रेषु । तत्र स्नेहपीतादिषु सम्यग्विद्धा अपि सिरा न स्त्रवन्त्य – तिस्त्रवंन्ति वा सम्यस्निग्धस्विन्नस्यपुनर्द्रवीभूता दोषाः शोणितमनुप्रविष्टाः सम्यक् प्रच्यवन्ते । न त्वेष निषेधो विषसंसृष्टोपसर्गात्ययिकव्याधिषु । प्रतिरोगं तु व्यधं प्रति विभागः ॥७॥
Venesection should not be done in persons who have drunk fatty substances (as part of lubrication therapy), who are undergoing any one of the five purificatory therapies, the pregnant lady, the woman in purpureum, those suffering from indigestion, jaundice, impotence; the aged, those less than sixteen years and more than seventy years of age, who are bleeding profusely from injury; those whose blood is not polluted, who are very dry, or lubricated too much, who have not undergone sudation therapy and those suffering from convulsions, hemiplegia, diarrhoea, vomiting, dyspnoea, cough, enlargement of the abdomen, bleeding disease, haemorrhoids, anaemia and general anasarca.
It should also be not done on the prohibited veins, on those which have not been raised up by suitable instruments (such a tieing a tourni quet, tape etc), in the side ward (horzizontal) direction and on days which are very cold very hot, rainy, windy and of cloudy sky.
In persons who have drunk fatty materials etc., (enumerated above) though venesection has been done properly, the flow of blood may be either very little or very large. In persons who have been administered oleation and sudation therapies adequately, the doshas having been liquified and mixing with the blood, will be eliminated out fully.
This prohibition is not prescribed in diseases due to poison, contact with bad things (infectious and contageous diseases) and emergencies. The method (of venesection) for particular diseases will be described in their contexts. (7)
Vyadha sthana – sites for venesection
शिरोनेत्ररोगेषुललाट्यामुपनास्यामपाङ्ग्यां वा । कर्णरोगेषु परितः कर्णौ। नासारोगेषु नासाग्रे । प्रतिश्याये तु नासाललाटस्थाः । मुखरोगेषु जिह्वौष्ठहनुतालुगाः । जत्रूर्ध्वग्रन्थिषु ग्रीवाकर्ण – शङ्खमूर्धगाः। अपस्मारे हनुसन्धिमध्यगाः | उन्मादेतूरोऽपाङ्गललाटगाः । विद्रधौ पार्श्वशूले च पार्श्वकक्षास्तनान्तरस्थाः । चतुर्थके स्कन्धाधोगतामन्यतरपार्श्वाश्रयाम्। तृतीयकें ऽसयोरन्तरे त्रिकसन्धिमध्यगताम्। प्रवाहिकायां शूलिन्यां श्रोण्याः समन्तात् द्व्यङ्गुले । निर्वृत्तोपदंशशुक्रव्यापत्सु मेढ्रे। गलगण्डं ऊरुमूलसंश्रिताम्। गृध्रस्यां जानुसन्धेरुपर्यधो वा चतुरङ्गुले। अपच्यामिन्द्रबस्तेरधस्तात् द्व्यङ्गुले । क्रोष्टुकशीर्षे सक्थिवातरुजासु च गुल्फस्योपरिष्टाच्चतुरङ्ग । श्लीपदेषु यथास्वं वक्ष्यते । दाहहर्षचिप्पवातशोणितवातकण्टकविदारिकापाद दारीप्रभृतिषु पादरोगेषु क्षिप्रमर्मण उपरिष्टात् द्व्यङ्गले । एतेनेतरसक्थिबाहू व्याख्यातौ । विशेषतस्तु वामभागाभ्यन्तरतो बाहुमध्ये प्लीहोदरे । एवमेव दक्षिणे बाहौ यकृदाख्ये । तथा कासश्वासयोरप्यादिशन्ति । गृध्रस्यामिव विश्वाच्याम्। बाहुशोषापबाहुकयोरप्येके । अदृश्यमानासु त्वेतास्वतिवृद्धस्य व्याधेरन्यव्याध्युक्तानामपि यथासन्नं व्यधः ॥८॥
In discases of the head and eyes, it shoud be done either on the forehead, near the nose or near the outer angle of the eyes; in diseases of the ears, around the ears; in diseases of the nose at its tip, in nasal catarrh on the veins seen on the nose and the forehead; in discases of the face on the veins seen in the tongue, lips, lower jaw and palate; in tumors above the sholders, on the veins of the neck, ears, temples and head; in epilepsy on the vein in the centre of the joint of the lower jaw (just below the temples); in insanity on those seen in the chest, outer angle of the eye, and the forehead; in abscesses and pain of the flanks on those seen in the middle of the flanks, axilla and the nipple; in fever of every fourth day, on the vein underneath the shoulder of any one side; in fevers of every third day on the vein at the innerside of the shoulder or at the centre of the shoulders; in dysentery and colic on the vein seen about two angulis around the pelvis; in veneral diseases and diseases of the sukra (semen) on the penis; in goitre (or other swellings in the neck) on the vein at the root of the thigh; in sciatica either four angulas above or below the knee joint; in scrofula about two angulas below the indrabasti (a vital spot in the centre of the calf); in krostuka sirsa (inflammatory swelling of the knee joint resembling the head of a jackal) and pain of vata origin of the thighs, on the vein seen about four angulas above the ankle joints; in filariasis, it will be described in its own context; in diseases of the foot such as burning sensation, sensitiveness, swelling of the nailbed, gout, sprain, fissures and cracks of the foot etc., it should be about two angulas above the ksipra marma (a vital spot in between the big toe and the next), in this description all the four extremities have been included; specially in cases of plihodara (splenomegaly) it should be done in the middle of the arm of the left side, in yakrdodara (hepatomegaly) in the middle of the right arm; it is the same even for cough and dyspnoea; in visvaci (pain of the arm) it is the same as was for sciatica; some opine that even for emaciation of the arm and loss of movement of the arm it is the same.
If these veins (mentioned above) are not visible and in diseases of very old persons, other veins which mentioned in other diseases but are vey near (to the site of the disease) can be cut. (8)
Vyadhana sadhana – materials required
प्रागेव चोपकल्पयेच्छयनासनोदकुम्भवस्त्रपट्टादि । तथा यथालाभं च तगरैलाशीतशिवकुष्ठपाठाविडङ्गभद्रदारुत्रिकटुकागारधूमहरिद्रार्काङ्कुरनक्तमालचूर्णमसृक्त्रावणाय। असृक् स्थाप नाय च लोध्रमधुकप्रियङ्गपत्तङ्गगौरिकरसाञ्जनशाल्मलीशङ्खयवगोधूममाषचूर्णम् । वटाश्वत्थाश्वकर्णपलाशबिभीतकसर्जार्जुनधन्वधातकीसालसारारिमेदतिन्दुकत्वगङ्करनिर्यासश्रीवेष्टक मृत्कपालमृणालाञ्जनचूर्णम् । क्षौममषीलाक्षासमुद्रफेन चूर्णं वा । तथान्यच्चातिस्रुतरक्तव्यापत्प्र तीकारोपकरणम्। सज्जोपकरणो हि वैद्यो न मोहमाप्नोति ॥ ९ ॥
The following materials are to be kept ready earlier to the commencement of the therapy – cot, stools, pots of water, pieces of cloth; all or as many as available of tagara, ela, sita, siva, kustha, patha, vidanga, bhadradaru, trikatu, agaradhuma, haridra, arkankura, naktamala and curma (slaked lime) to promote bleeding; lodhra, madhuka, priyangu, pattanga, gairika, rasanjana, salmali, sankha curna (ash of conch), yava, godhuma, masa, curna to stop the bleeding or vata, aswattha, aswakarna, palasa, vibhitaka, sarja, arjuna, dhanwana, dhataki, salasara, bark of arimeda, sprout and latex of tinduka, srivestaka, mrtkapala ( potsherds) mrnala, powder of anjana (antimony sulphide ), ashes of ksauma (fibres of atasi, Linum utitatissimum ) laksa (lac ) or powder of samudraphena (cuttle-fish) and also any other substances useful to stop the bleeding and its complications. The physician who is thus equipped, will not get illusioned (confused). ( 9 )
Siravyadha vidhi – procedure of venesection
अथ कृतस्वस्त्ययनमातुरं व्याधिबलसात्म्याद्यवेक्ष्य स्निग्धं जाङ्गलरसं यवागूं वा पाययित्वा मुहूर्तमात्रमाश्वासितं पूर्वाह्नेऽपराह्ने वाङ्गारतापोष्णबाष्पान्यतरेण स्विन्नं जानूच्छ्रिते मृदावासने जानुनिहितकूर्परं समस्थितपादं प्रत्यादित्यमुपवेशयेत् । केशान्ते च प्लोतचर्मवल्कलपट्टान्यतमेन बध्नीयात्। ततश्चायतेन वस्त्राङ्गुष्ठगर्भेण मुष्टिद्वयेनातुरो यथास्वंमन्ये निपीडयेद्दन्तैश्च दन्तान् । गण्डौ चाध्मापयेत् । पुरुषश्चैनं पृष्ठत ऊर्ध्वस्थ वस्त्रकृकाटिकान्तरन्यस्तवामप्रदेशिनीको नातिगाढं ग्रीवायां परिक्षिप्य वेष्टयन्वस्त्रं प्राणानबाधमानो यन्त्रयेदित्येषोऽन्तर्मुखवर्ज्यानां सिराणां व्यधने यन्त्रविधिः । ततश्चास्यवैद्योऽङ्गुष्ठविष्टब्धया मध्यमयाङ्गुल्या सिरांताडयेत्। उत्थिताञ्च स्पन्दमानां स्पर्शदां वाभिलक्ष्य वामहस्तेन कुठारिकामूर्ध्वदण्डां कृत्वा सिरामध्ये न्यस्य लक्षयित्वाचतथैवचमध्यमयाङ्गुल्याताडयेदङ्गुष्ठोदरेण वापीडयेत्। गूढबहलत्वक्प्रतिच्छ न्नायामङ्गुष्ठपीडनादुन्नमनमुपलक्षयेत् । उत्कसनेन क्रोधसंरम्भेण चापूर्यन्ते सिराः ॥१०॥
The physician after making the patient perform all the auspicious ceremonies, after determining the strength of the disease and habits of the patient, should give him either soup of meat of animals living in arid lands or a thick gruel mixed with fatty materials (ghee or oil) as a drink; allow him comfortable rest for about a muhurta (forty eight minutes ), either in the morning or in the afternoon. Then he should be made to perspire either by making him sit near a hearth, by allowing steam over him or by any other method.
Afterwards he should be made to sit on a soft stool of the height of the knee, placing his elbows on his knees, placing the feet together comfortably on the floor and facing the sun. At the level of the lower border of the hairs of the head, a tight bandage should be tied making use of moist cloth, leather or inner bark of the tree.
The patient should then be asked to keep the thumbs inside his fists, cover them with cloth and clench them as hard as he can, accompanied with biting the teeth (rows of teeth) one over the other as hard as possible, inflating his mouth. Another person standing behind the patient should put a long piece of cloth around the neck of the patient, make knot out of that cloth over the nape of the patient’s neck, insert the index finger of his left hand into the knot, twist the knot to tighten the band aruond the neck, taking care not to block the respirations. This will be the method to control and raise the veins which are facing inwards (in other words, placed deep underneath the skin) and which are forbidden.
Then the physician should raise the vein by tapping on it with his middle finger triggered by the thumb. On finding that the vein has risen up, is pulsating and full for touch, he should hold the Kutharika (axe) with his left hand keeping its handle up, place it on the vein in its centre, tap it with his middle finger triggered by the thumb or press it with the middle of the thumb. At places where the vein is hidden or the skin is thick, the cutting of the vein by pressing with the thumb should be carefully done.
The veins get filled (with blood) by coughing and voilent bouts of anger. (10)
Note: Strangling with cloth, clenching the first, grinding the jaws, inflating the mouth, tapping on the vein are all meant to raise the pressure inside the veins, so also coughing and bouts of anger. Kutharika or axe which was being used to cut the vein in those days must have had a vertical handle than a horizontal one as we find now-a-days. Hence the instruction to keep its sharp edge on the vein and tap the handle or press it with the fingers. Care should be taken to exert as much pressure on the axe that is just enough to cut the upper wall of the vein only but not to cut it into two parts.
अङ्गुष्ठेन तु नासाग्रमुन्नमय्य व्रीहिमुखेनोपनासिकां विध्येत् । उन्नमितविदष्टाग्रजिह्वस्याधो जिह्वायाः । विवृतास्यस्य तालुनि दन्तमूले च। ग्रीवासिरासु स्तनयोरुपरि यन्त्रयेत् | उदरोरसोः प्रसारितोरस्कस्योन्नमितशिरसः । बाहुभ्यामवलम्बमानस्य पार्श्वयोः । उन्नतमेढ्रस्य मेढ्रे । श्रोणिपृष्ठस्कन्धेषून्नमितपृष्ठ स्यावाक्शिरस उपविष्टस्य । विश्वाचीगृध्रस्योरनाकुञ्चिते कूपरे जानुनि च सुखोपविष्टस्य गूढाङ्गुष्ठबद्धमुष्टे र्व्यधनीयप्रदेशस्योपरि चतुरङ्गुले प्लोताद्यन्यतमेन च बध्वा हस्तसिराम् । एवमेकपादं सुसंस्थितं स्थापयित्वान्यपादमीषत्सङ्कुचितं तस्योपरि निधाय जानुसन्धेरधोहस्ताभ्यामागुल्पं निपीड्य पूर्ववद्वध्वापादसिरां विध्येत् । तत्र तत्र च तैस्तैरुपायैर्विकल्प्य यन्त्रयेत् ॥ ११ ॥
तत्र मांसलेष्वकाशेषु यवमात्रं व्रीहिमुखेन । अतोऽन्यथार्धयवमात्रं व्रीहिमात्रं वा । अस्थामुपरि कुठारिकयार्धयवमात्रम् । सर्वत्र चानुत्तानावगाढमृज्वसङ्कीर्णं मर्माद्यनुपघातिसिरामध्ये शस्त्रमाशु पातयेत् ॥१२॥
The vein near about the nose should be cut after raising the tip of the nose with the thumb; the vein underneath the tongue, after raising the tongue up and fixing its tips under the palate; those which are in the palate and root of the teeth after opening the mouth. The veins of the neck are to be raised from above the nipples; those of the abdomen and chest by expanding the chest and keeping the head erect; those of the flanks by raising the arms upward; those of the penis by holding it up; the veins of the pelvis, back and shoulder should be cut after making the patient sit with the back arched and head bent down; in viswaci (arm painful and not moving) and grdhrasi(sciatica) at the elbow and knee; in viswaci, the patient should be made the sit comfortably, extend his arm and hold his fist tight, a band is to be tied four angulis above the site of the raised vein and then the veins of the hand cut. In case of grdhrasi the patient should sit keeping one leg firmly on the ground and placing the other leg over the knee of the first leg, then the leg is massaged in downward direction starting from the knee to reach the ankle, a band is tied as aforesaid and then the vein in the foot cut; in other places the cutting is carried out as found suitable. (11)
At fleshy places, the cut shall be of the size of the barley and done with the Vrihimukha sastra or it may be half a yava or that of a rice grain; on the bones it should be done with Kutharika to the size of half-a-barley; in all cases where the vein is not raised, is deep seated, curved, found in a network, on vital points and on those which are prohibited, the instrumentation should be carried out quick. (12)
एकप्रहाराभिहता धारया या स्रवेदसृक् । मुहूर्तरुद्धा तिष्ठेच्च सम्यग्विद्धेति तां विदुः ॥ १३ ॥ अल्पकालं वहत्यल्पं दुर्विद्धा तैलचूर्णनैः । सशब्दमतिविद्धा तु स्त्रवेत्दुःखेन धार्यते ॥१४॥
The vein getting cut by only one stroke, the blood flowing out in a stream and stopping within one muhurta (48 minutes) are the features of a proper venesection; bleeding for a short duration; of very little quantity even after application of oil and lime are the features of inadequate cutting; bleeding accompanied with sound, large in quantity and very difficult to stop the flow are the features of excess or overcutting. (13-14)
सम्यग्विद्धानामपि च सिराणामवहनकारणानि मूर्छा भयं यन्त्रशैथिल्यमतिगाढत्वमत्याशितता क्षामत्वं कुण्ठशस्त्रव्यधो मूत्रितोच्चारितत्वं दुःस्विन्नता कफावृतव्रणद्वारता चेति । अथाप्रवृत्तिकारणं यथास्वमुपलक्ष्य प्रतिकुर्यात् । तगरादिचूर्णेन च तैललवणप्रगाढेन सिरामुखमवचूर्णयेत्। पृष्ठमध्ये चातुरं पीडयेत् । एवं साधु वहति । सम्यक् प्रवृत्ते कफानिलोपशमनरक्ताविच्छेदनार्थष्मणलवणतैलबिन्दुभिः सिरामुखं सिञ्चेत् ॥१५॥
Even though venesection has been done properly, the flow of blood will not be adequate some times, due to the patient fainting or getting afraid, poor instrumentation (poor controlling and raising), too tight bandaging above, taking large quantity of food earlier, emaciation, cutting with a blunt instrument, patient having the urges of urine, faeces etc. at the time of cutting, inadequate sudation therapy and the orifice of the cut being covered by kapha.
Hence, the physician should find out the exact cause for poor flow mentioned above and adopt appropriate remedial measures. The place of the cut should be rubbed with the powder of drugs like tagara and others, mixed with oil and salt, the patient should be hit in the middle of his back. By these measures when the flow of blood increases, the place of the cut should be sprinkled with warm drops of oil and salt, to mitigate kapha and vata and to prevent clotting of blood. (15)
अग्रे स्त्रवति दुष्टास्त्रं कुसुम्भादिव पीतिका । सम्यक्त्रुत्वा स्वयं तिष्ठेच्छुद्धं तदिति नाहरेत् ॥ १६ ॥
Bad (impure) blood comes out first just as the yellow coloured juice come out first of the kusumbha seeds (during its milling). After adequate flow pure blood stops by itself, it should not be allowed to flow out. (16)
यस्य तु स्त्रवति रक्ते मूर्छा जायते तस्य विमुच्य यन्त्रं शीतसलिलार्द्रपाणिस्पर्शेन व्यजनवायुनाश्रोत्रसुखेन वचसा च समाश्वासयन्नुपशमय्य मूर्छा पुनः स्रावयेत् । पुनर्मुर्छत्यपरेद्युस्त्र्यहेऽपि वा। परंतु रुधिरावसेचनप्रमाणं प्रस्थः । अतोऽन्यथा व्याधिदेहर्तुबलमपेक्षेत ॥१७॥
If during the bleeding the patient faints the band and other controls should be removed, cold water sprinkled over his face, the body touched with moist hands, fanned, air blown into his ears by mouth, consoling him with courageous words and thus making him regain consciousness. After he regains consciousness, the therapy may by continued. If he becomes unconscious again, venesection should be postponed to the next day or the third day.
The maximum quantity of blood to be let out shall be one prastha (by measure); more allowance depends upon the strength of the patient’s body and the season. (17)
Notes: In the context of therapies such as emesis, purgation and blood letting, one prastha is thirteen and half palas. In terms of metric measure, one pala is about 48ml. and thirteen and half palas will be about 648ml.
Dustarakta laksana – properties of impure blood
तत्र फेनिलमरुणं श्यावमच्छं रूक्षमस्कन्दिकषायानुरसं लोहगन्धि वेगस्त्रावि शीतं च रक्तं वातात् । गृहधूमाञ्जनोदककृष्णं पीतं हरितं विस्त्रं मत्स्यगन्धि कटुत्वान्मक्षिकानिष्टमौष्ण्याद स्कन्दि सचन्द्रकं गोमूत्राभं च पित्तात्। कोविदारपुष्पगैरिकोदकापाण्डु शीतं स्निग्धं स्कन्दि घनं पिच्छिलं तन्तुमद् व्रणद्वारावसादि लवणरसं वसागन्धि च कफात् । द्वन्द्वसङ्कीर्णं संसर्गात् । कंसनीलमाविलं दुर्गन्धं च सन्निपातात् । शुद्धमुक्तं प्राक् । ततः स्स्रुतरक्तस्य व्यधमनुलोममङ्ग ष्ठेनोपरुध्य शनैश्शनैर्यन्त्रमपनीयाश्वासयेत् । सतैलं च प्लोतं सिरामुखे दत्वाबनीयात् । संवेशयेच्चैनम ॥१८॥
If the blood is found to be frothy, slightreddish-blue in colour, thin, viscid, not clotting, astringent in its secondary taste, having the smell of iron, flowing out rapidly and cold to touch, it is to be considered as vitiated by (increased) vata; blood appearing black, resembling solution of chimney soot or anjana (antimony sulphide) or yellow and green in colour, emitting foul smell or smell of fish, not pleasant to the flies because of pungency, not clotting due to increased heat, having glistening particles and resembling cow’s urine are the features of blood vitiated by (increased) pitta; blood resembling flower of kovidara or a solution of red ochre or yellowish-white in colour, cold, unctous, clotting quickly, thick in consistence, slimy, having threads, blocking the orifice of the wound, salty and having the smell of muscle fat are the features of having been vitiated by (increased) kapha. Mixture of two features is seen if there is combination of two doshas and in case of vitiated by the all the three doshas together, the blood will be having the colour of bronze or is blue, turbid and of bad smell. The features of pure blood has been described earlier.
After the bleeding has stopped, the site of the cut is held by the thumb, the bandage and others removed slowly, a cloth dipped in oil placed on the opening of the vein and then bandaged tight. The patient should be allowed to sleep comfortably. (18)
Raktasthambhana upaya – methods to stop bleeding
अतिष्ठति तु रक्ते सिरामुखं सन्धातुं पूर्वोक्तैश्चूर्णैरवचूर्ण्याङ्गुल्यग्रेण पीडयेत् । शाल्मल्युपोदका पिच्छां वा व्रणमुखे दत्वा गाढं बनीयात् । मधूच्छिष्टप्रलिप्तं वा पट्टम् । शीताम्बुनावसिञ्चेत्। शीतमधुरकषायान्नपानसेकप्रदेहप्रवातवेश्मभिर्वा स्कन्दनायोपचरेत् । पद्मकादिक्काथं शर्करामधुमधुरंक्षीरमिक्षुरसमेणहरिणाजोरभ्रमहिषवराहाणामन्यतमस्य सिरां विध्वा रुधिरंमामं घृतभृष्टं वा पानं दद्यात् । तेनैव वा दर्भपादमृदितेनानुवासयेत् । स्निग्धैश्च यूषरसैर्भोजयेत्। व्यधादनन्तरं वा पुनस्तामेव सिरां विध्येत् । सर्वथा चानवतिष्ठमाने पाचनाय क्षारं दद्यात् । सङ्कोचयितुं वा सिरामुखं तप्तशलाकया दहेत् । न च क्षणमप्युपेक्षेत । क्षीणरक्तस्य हि वायुर्मर्माण्युपसगृह्य मूर्छासंज्ञानाशशिरः कम्पभ्रममन्यास्तम्भापतानकहनुभ्रंशहिध्मापाण्डुत्वबाधिर्यधातुक्षयाक्षेपकादीन् करोति । मरणं वा ॥१९॥
If the bleeding does not stop, the opening of the vein should be plugged with the powder of drugs mentioned previously and rubbed with the tip of the fingers or the slimy material of the salmali tree or of upodika should be applied over the wound and bandaged, or a cloth smeared with bees-wax may be tied. The part (may be) sprinkled with cold water. The patient should be given foods and drinks which are cold, sweet or astringent in taste; cold bath, cold application of pastes, cold breeze and a cold room to make the blood clot.
The patient should be given decoction of (drugs of) padmakadigana, milk, sugar-cane juice; fresh blood of deer, antelope, goat, camel, buffalo, boar or any other animal, obtained by cutting its vein, or the blood fried in ghee should be given as a drink, or such blood churned well with the roots of the darbha grass should be administered as enema; soup of pulses or of meat mixed with ghee should be given alongwith food; the same vein is to be cut once again (at a lower place) (if a second cutting is needed).
In spite of all these, if the bleeding does not stop, alkalies (mixed with water) should be applied, to cause an ulcer; the orifice of the cut vein should be touched with red hot iron rod to cause constriction of the orifice; these should not be delayed even for a minute. Loss of blood leads to increase of vata which in turn, affects the vital organs and produces fainting, loss of consciousness, tremors of the head, giddiness, stiffness of the neck, tetanus, ptosis of the lower jaw, hiccup, anaemia, deafness, depletion (loss) of the tissues, convulsions or even death. (19)
प्राणः प्राणभृतां रक्तं तत्क्षयात् क्षीयतेऽनलः । वर्धते चानिलस्तस्माद्युक्तया बृंहणमाचरेत् ॥२०॥
Blood is the life of all living beings, its decrease causes decrease of the body heat (temperature) and increase of vaata. so the patient should be given strengthening foods. (20)
अशुद्धं तु रक्तमपराह्नेऽन्येर्वा पुनः स्त्रावयेत् । ततोऽपि शेषं सर्वथा वाप्यविस्त्राव्यरक्तस्य शीतसेकप्रदेहविरेकोपवासस्निग्धमधुरान्नपानैः प्रसादयेत् । मासमात्रं वा स्नेहादिभिरूपचर्य पुनर्विध्येत् । दुर्व्यधातिव्यधकुटिततिर्यग्व्यधादेर्व्यधदोषात्व्यापदो याः स्थुस्ता यथास्वं साधये दिति । भवति चात्र ॥ २१ ॥
Bad blood remaining inside should be let out in the same evening or the next day. If still some residue remains or if it is not possible to let it out, it should be purified within the body itself by administering cold bath, cold applications, purgation therapy; fasting, use of fatty and sweet foods and drinks. After one month of such regimen, he may be administered oleation and other therapies properly and venesection done again. The complications arising from inadequate, excess, improper, cutting horizontally and other defective venesection should be treated by appropriate drugs and methods. (21)
उन्मार्गगा यन्त्रनिपीडनेन स्वस्थानमायान्ति पुनर्न यावत् । दोषाः प्रदुष्टा रुधिरं प्रपन्ना-स्तावद्धिताहारविहारभाक् स्यात् ॥ २२ ॥
Some verses more :
The patient should adhere to only healthy (suitable) foods and habits till all the doshas which have gone out of their normal seats return back to their normal places by control (treatement) of the blood. ( 22 )
नात्युष्णशीतं लघुदीपनीयं रक्तेऽपनीते हितमन्नपानम् । तदाशरीरं ह्यनवस्थितासृगग्निर्विशेषादिति रक्षितव्यः ॥२३॥
The food, during the period after blood letting should neither be too hot nor too cold, it should be easily digestable, and kindling the appetite, because the digestive fire (activity) should be protected as the body will be weak by depletion of blood. (23)
प्रसन्नवर्णेन्द्रियमिन्द्रियार्थानिच्छन्तमव्याहतपक्नृवेगम् । सुखान्वितं पुष्टिबलोपपन्नं विशुद्धरक्तं पुरुषं वदन्ति ॥ २४ ॥
The person is said to be possessing pure blood when the colour of his skin, the correlation between the sense organs and the sense objects (sense perception), the activity of digestion – are as good as to be desired and there is improvement in the nourishment of the body and strength, followed by happiness. (24)
॥ इति षट्त्रिंशोऽध्यायः ॥
Thus ends the thirty-sixth chapter.