Published On: Thu, Oct 6th, 2016

Siravyadha Chikitsa (Bloodletting) – Treatment in Ayurveda

Ayurveda has two major lines of treatments – shodhana (detoxification of the body to prevent the disease) and shamana (curing the disease by internal medication). The Shamana line of treatment is followed by the shodhana treatment many times. The panchakarma or five procedures are among the various types of shodhana.

The panchakarmas, according to Acharya Charaka are different from those postulated by Acharya Sushruta, who has given priority to surgery. According to Acharya Charaka, the five procedures are:

  • Vamana (emesis)
  • Virechana (purgation)
  • Astapana vasti (medicated decoction enema)
  • Anuvasana vasti (medicated oil enema)
  • Nasya (nasal infusion of medicines)

According to Acharya Sushruta, panchkarmas are:

  • Vamana (emesis)
  • Virechana (purgation)
  • Vasti (both oil and decoction enema)
  • Nasya (Nasal infusion of medicines)
  • Rakta mokshana (Bloodletting)

Concept of Bloodletting

The bloodletting procedure (Raktamokshana) is first mentioned in the Ayurvedic texts by Acharya Sushruta around 1000 BC.

Ayurveda works with the tridosha theory. (for details read the article “Tridosha for the Uninitiated, by the same author, Hinduism Now, May 2016). There are seven dhatus (bones and tissues) in human body which give balance to the body. Among the seven dhatus,  rakta (blood)  is considered as the second dhatu. Acharya Sushruta has given importance to rakta. As he was a surgeon, he postulated that blood or rakta can also cause diseases just like the tridoshas. To treat the diseases caused by the imperfections in blood, he adopted different bloodletting procedures.

Types of bloodletting

There are two types of Raktamokshana procedures.

  1. Vhastra visravan (surgical instruments are used)

Siravyadha (Venepuncture)

 Prachchana (multiple incisions)

  1. Anushastrra visravana (bloodletting by other means)

jaloukaavacharaNa (application of leeches),

shrungaavaharaNa (sucking of blood by cow’s horn)

Alaabu (vacuum extraction using gourds – especially bottle gourd).

Importance of Siravyadha

Acharya Sushruta gives utmost importance to this technique;

Siraavyadhaachikitsaardham  shalyatantre  prakirtitaH  ( sushruta sutrastaana)

The meaning of this quote is that 50% of shalyatantra (surgery) is covered up by siravyadha only. Sushruta and Vagbhata mention a number of diseases that can be cured through this technique.

Indications of Siravyadha

According to Acharya VagbhaTa, siravyadha is suggested to cure the following conditions:

Herpes, abscess formation, some of the spleen disorders, tumor in abdomen, severe dyspepsia, certain variety of eye pain and headache, gout, salty taste in mouth and some types of fever.

When patients with these conditions are not responding to the internal medication, the vaidya should plan the siravyadha line of treatment. Acharya Sushruta mentioned additional conditions like sciatica, goiter, sexually transmitted disorders like gonorrhea and syphilis, insanity and epilepsy, certain dental disorders and glaucoma which can also be cured by siravyadha.

Contraindications for Siravyadha

Acharya VagbhaTa and Acharya Sushruta both have an almost similar view while contraindicating siravyadha. Children (below 16 years), old aged (above 70 years), pregnant woman, recently delivered woman, person suffering from cough, vomiting, diarrhea, dysentery, having bleeding disorders  and anemia are unfit for siravyadha. The person should have good stamina to undergo this treatment.

Factors to be Considered for Siravyadhana

After selecting the suitable patient for siravyadha, vaidya should concentrate on certain factors before conducting the procedure.

  1. Purvakarma (Preparation of the patient and equipments)
  2. Pradhana karma (Actual procedure)
  3. Paschat karma (Post operative procedures)
  4. Examining the avedhya siras (Veins should not be injured)
  5. Rakta srava nirodha (Arrest of hemorrhage)


The day should be neither too cold nor too hot. It should not be cloudy or too windy. One hour before the actual procedure, patient should undergo oil massage and sauna/steam bath (snehana and swedana). He should consume ghee internally before starting the snehana and swedana. All these procedures help in removing the toxins from the body easily during siravyadha. The food consumed by the patient on the day of siravyadha should be only gruel or soup.

Pradhana Karma

Before starting the siravyadha procedure one should conduct prayer and some spiritual customs.  According to the disease, the instrument (shastra) should be selected. The commonly used shastra is vrihimukha (lancet).  The vein situated near the affected part should be selected. The person should be in such a posture that the vein bulges out. Tourniquet or band should be tied two inches above the affected part, for example in headache, vein from temporal region is selected. Patient should sit on a chair comfortably, should form a fist and press it near the vein. By this, vein becomes prominent and incision can be done easily. Amount of blood drained depends on the disease and spot where siravyadhana is conducted. The incision should be yava pramana or ardha yava pramaana (9 to10 mm or 4 to 5 mm). The vaidya should stop the blood when sufficient quantity of blood oozes out of the vein. After the stop of bleeding, one should put a bandage to the area with haemostatic herbs like haridra (turmeric) and laksha churna (powder made by lak).

Pashchat Karma

The patient should lie down in a room with good air and natural light. One should observe for excessive bleeding and his general health should be monitored. Proper measures are to be taken in case of excessive bleeding like applying of a cold path or application of haemostatic herbs.

Examination of avedhya siras (vein should not be injured)

Acharya Sushruta has given different names of veins that are to be excluded from siravyadha. At the different part of the body specific siras are mentioned like Oorvi (femoral vein),Lohitaksha (inguinal vein) in the lower limb. He mentions that the intelligent vaidya should have the proper knowledge of avedhya sira and spare these veins while doing the pradhana   karma.

Rakta srava nirodha (Arrest of haemorrhage)

While conducting this treatment procedure, the vaidya should be prepared with haemostatic drugs. In case of uncontrolled bleeding drugs like Lodhra (Siplocos Recimosa), yastimadhu (Licorice), gairica (haemetite calx) etc should be placed on the region and comperssed, even cold compression is advised. Cold milk and sweet drinks are given to the patient. These techniques are to be well versed by the vaidya.

This way the ancient sages like Acharya Sushruta ,Vagbhata were conducting the siravyadhana procedure. Acharya Sushruta mention that even a healthy person can undergo these procedures to relieve excessive blood pressure and to remove the toxins from the body.

Allopathic doctors used to practice this method for curing certain diseases like Glaucoma, lung congestion, hypertension etc. till the last century. However, it was not a common practice in Ayurveda during the last century. During the recent years, many vaidyas are again adopting these techniques in their practice and are getting good results.

We are blessed to have been handed over such great knowledge by our ancestors. It is up to us to ensure that this knowledge is understood and propagated all over the world for the benefit of mankind.


  1. Sushruta samhita sutra stana,
  2. Ashtanga hrudaya sutrastana 27th chapter,
  3. Shalyatantra Vignana by Dr M Ramasundar Rao

By – Dr. Shubhamangala Acharya

Disclaimer: The facts and opinions expressed within this article are the personal opinions of the author. Hinduism Now does not assume any responsibility or liability for the accuracy, completeness, suitability, or validity of any information in this article.

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