By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Master Charaka emphasizes the administration of Panchakarma measures in the treatment of Kushta – skin disorders. Since in Kushta there will be enormous accumulation of the doshas in the system, the disease and its symptoms will be stubborn to many medicines. The cure will not be comprehensive and recurrences are possible. Therefore, the morbid doshas are expelled from time to time i.e., repeated cleansing is necessary in the treatment protocol of kushta. Each therapy of Panchakarma has its own utility in different stage of the disease and in case of different dosha predominance. Amongst them Raktamokshan – bloodletting too is highly beneficial in the treatment of Kushta.
Read – Charaka Kushta Nidana: 5th chapter

Raktamokshan – Benefits in kushta

Rakta – blood is one of the elements involved in the pathogenesis of kushta. Therefore, contamination of blood and this blood afflicting the skin and body parts to a great extent is mandatory in the causation of skin disorders according to Ayurveda. From this perspective bloodletting becomes an important therapy in the treatment of kushta.

Indication for raktamokshan

Bloodletting and purgation are the most important therapies in the treatment of pittaja kushta – skin disorders caused by predominant vitiation of pitta. Therefore, these therapies shall be preferred when pitta predominant symptoms are seen in kushta.

Both purgation and bloodletting are useful in combination in the treatment of pittaja kushta or selectively administered i.e. either purgation or bloodletting as and when needed, depending on the decision of the physician.

Blood and pitta are having residence-resident relationship. Pitta is located in the blood. Vitiation of pitta might cause vitiation of blood and vice versa. This is also the reason for administering bloodletting in pitta predominant kushta. Apart from Vatarakta, Kushta is another condition wherein master Charaka has detailed the administration of bloodletting.
Read – Charak Samhita Kushta Chikitsa – 7th Chapter

Raktamokshanam in Kushta

Prachanna – In the presence of aggravation of doshas in small quantity in kushta or when the doshas are seated in superficial tissues prachanna i.e. scraping of the afflicted region should be done. Following this, bloodletting should be done using srnga – horn or alabu – gourd.
Sira vyadha – On the other hand, in the presence of aggravation of doshas in large quantity in kushta or when the doshas are deep seated in deeper tissues bloodletting should be done by venesection method.
Read – Blood Letting Therapy – Siravyadha – Astanga Hrudaya Sutrasthana 27

Method of Bloodletting in Kushta

In skin disorders wherein the lesions are fixed, hard and circular in shape, firstly sudation should be administered using prastara (stone slab) or nadi (tubular) forms of sudation. Following this, the afflicted region should be rubbed using an instrument called kurcha. Kurcha is a brush shaped instrument having sharp and pointed bristles used for rubbing.

After rubbing, the contaminated blood shall be removed from those regions of kushta. Once the contaminated blood has been expelled from the region of kushta the complications get subsided. Following this, the afflicted areas are provided with sudation. For this, the meat of animals and birds living in the anupa (marshy regions) and audaka (aquatic) regions should be boiled, tied in a bolus and used for providing sudation over the kushta areas.

Following this, to remove the contaminated blood the areas should be scraped using sharp instruments. Alternatively when the physician learns that doshas are aggravated in lesser proportions and are located superficially, the kushta area should be scraped and the morbid blood removed using horn or gourd. When the doshas are aggravated in larger proportions and located in deeper tissues venesection should be preferred for bloodletting.
Read – Raktamokshana Benefits, Types, Procedure, Indications

Lepa after Raktamokshana

Master Charaka explains different kinds of lepa i.e. medicinal pastes which can be applied on the areas of the body afflicted by kushta immediately after raktamokshana. Master Charaka also provides us with rules for application of lepas. Lepas shall be applied after having cleansed the patient by administration of therapeutic emesis and purgation and also after removal of morbid blood through bloodletting. Only when the medicinal pastes are applied after the completion of these therapies, they would be highly effective in treating the skin disorders. This means that bloodletting is one of the mandatory therapies which need to be done before administration of medicinal pastes or use of anointments.
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