Physiological Aspect of Raktamokshana – A Critical Review

Raktamokshana refers to the letting of blood, which is used to treat a variety of diseases, particularly when there is raktadushti, as well as during physiological function. In Ayurveda surgery, the first complete rational, systematic description of raktamokshana for numerous ailments is stated. According to Acharya sushrut, a person who regularly takes bloodletting will not be impacted by ailments like as shopha (inflammation), twak dosha (skin problems), visarpa (erysipelas), granthi (tumour), and others. The primary goal of this research is to determine the most likely method of action and effect of raktamokshana. A literary review is undertaken utilising electronic databases such as Pubmed, Google Scholar, IJAM, and Ayurveda classics such as Charaka Samhita, Sushruta Samhita, Ashtang Sangrah, and Systematic Review Article Andhare et al.; JPRI, 33(63A): 107-112, 2021; Article no.JPRI.80016 108 so on. The goal was to assess the effectiveness and implications of raktamokshana in treating pathological diseases and preserving physiological function. According to the study, both Ayurveda and current science explain that raktamokshana, or significant blood loss, activates / initiates a plethora of beneficial physiological mechanisms, making the body attentive and adaptive to deal with numerous systemic problems.


INTRODUCTION
The entities that keep the body, mind, and prana (life) [1] together are known as dhatus (tissues). The second dhatu to form in the sequence is Rakta. Given its importance in supporting life, a few acharyas consider rakta to be a fourth dosha (physiological humour required for life) [2]. According to our ancient literature, rakta is responsible for the kshaya (depletion) and vriddhi (repair) of dhatus [3].
Charaka considers Rakta to be one of the Dasha pra-naayatana [4,5]. It is one of the Dasha Jeevitadhama, according to Astanga Hridaya [6]. It is one of the Dasha pranaayatana, according to Astanga Samgraha [7]. Raktavahastrotas play a vital part in raktadhatu metabolism. The yakrita (liver) and pleeha (spleen) are the two main organs [8]. The availability of strotas (channels) is required for unfettered blood circulation. Any vitiation in the middle causes strotodushti (channel aberration) in the form of atipravritii (excess formation), sang (obstruction), siragranthi (growth inside conduits), and/or vimarg-gaman (leaving its own channel and entering unusual channel) [9]. As seen in Table   1, it causes a variety of disorders. The objective of this review was to assess the effectiveness and implications of raktamokshana in treating pathological diseases and preserving physiological function.

METHOD
This review is undertaken utilising electronic databases such as Pubmed, Google Scholar, IJAM, and Ayurveda classics such as Charaka Samhita, Sushruta Samhita, Ashtang Sangrah, and so on.

Observations
Acharya Sushrut emphasises the function of Rakta in the third and most significant stage, Prasara, while listing the six Kriyakala kinds. The humours must be disseminated throughout many planes of the body, and rakta plays an important role in this phase. Rakta has a stronger physiological identity, and certain target-specific procedures (siravyadha ) are more easily applied to this level of bodily systems. The penetration of morbid doshas by Uttarotthara dhathu is now restricted [10].

4.
Vimarg-gaman (Entering some other channels after leaving its usual channel) The raktaja vikara is destroyed from its roots by the Raktamokshana ( Siravyadh) method, exactly as when the bunds of a field are broken, the crop of paddy, etc., is completely destroyed. This technique purifies the blood and makes the person lustrous; indriyas become clear or are able to detect their objects in a balanced/ideal manner; his digestive fire performs well; and his digestive fire is enriched with happiness, good nourishment, and vigour [11].
When vata prakopa is caused by kapha and pitta avarana, raktamokshana can help to remove the avarana of pitta and kapha dosha, allowing anuloma gati of vitiated vata to emerge, hence curing the vatika symptoms indirectly [12].
Pitta dosha should be addressed first in cases of samsrita dosha, because asayaasrayitva bhava of rakta and pitta raktamokshana aid to soothe vitiated pitta [13].
Pitta is a mala of rakta, and raktamokshana removes vitiated pitta together with rakta, assisting in the development of shudha rakta [14].
Pitta resides in rakta (blood) and sweda (sweat) as ashrayi (dependent) [15]. When pitta is vitiated and pitta-relieving medications are ineffective, bloodletting can help. Because both rakta and pitta are acquaintances, it is treatment for both.
The entire body is nourished by siras, and raktamokshana from sira is the sole means to alleviate vitiation of dosha affecting a vast portion of the body, as it has an influence on the entire body [17].

DISCUSSION
Sharp or blunt instruments can be used to perform Raktamokshan -

Using Sharp Implements
Prachhana and Siravedha are included:  Prachhana is a Sanskrit word that means "rapid sharp cuts."  Siravedha: piercing a vein with a needle straight.

Using Blunt Instruments
Shringa (animal horn), alaabu (dry gourd or long fruit of the Cucurbitaceae family), and ghatiyantra are examples of blunt implements (a medium sized bell like instrument with one end open).
One of the processes covered by ashastrakrita (without the use of sharp instruments) raktamokshan is the application of jalauka (Leech therapy) [18].
Ghatiyantra's main premise is to increase blood flow in the affected area. The metabolites that have accumulated in that location will be washed out and the discomfort will be eased. Cupping therapy [19] is credited to a variety of ancient sciences, although the underlying concept or mechanism of action was first mentioned in ayurveda classic books thousands of years ago.
Leeches produce a complex mixture of physiologically and pharmacologically active chemicals into wounds while feeding on blood. The antithrombotic agent hirudin is abundant in the saliva of leeches. As a result, it is useful in the treatment of cardiovascular illnesses that affect the heart, veins, and arteries.
The saliva of a leech has an inhibitory effect on thrombin. It also temporarily boosts blood flow to the targeted location. It also acts as a Xa coagulating factor inhibitor. As a result, it inhibits the coagulation cascade and acts as a fibrinolytic agent. In addition, leech saliva has analgesic, anti-diabetic, anti-microbial, and anti-metastatic properties [20].
Because visarpa (erysipals) cannot occur without rakta and pitta vitiation [22] bloodletting is considered the most important treatment. Bloodletting can be used to treat Gulma roga (abdominal tumours) that have not responded to other treatments [23]. Bloodletting is advised in the temporal area or border of hairline in the treatment of unmada (psychosis), vishamjwar (fever with irregular onset, symptoms, and duration), and apasmara (epilepsy) [24].
Bloodletting is based on an ancient medical concept in which blood and other physiological fluids were thought to be humours that needed to be balanced in order to stay healthy. Pittadosha and raktadhatu are similar in appearance. As a result, the vitiation of one leads to the vitiation of the other. And when rakta and pitta poisoning has reached a point where herbs or other treatments are no longer effective, raktamokshan comes to the rescue.
Hypertension, skin illnesses such as acne, urticaria, dermatitis, eczema, abscess, boils, and other illnesses can all benefit from bloodletting. Therapeutic phlebotomy is used to eliminate extra red blood cells from the body in disorders including hemochromatosis and polycythemia vera [25]. Few of the related studies were reviewed [26][27][28][29][30].

CONCLUSION
This is a thousand-year-old Ayurvedic precept that is less well-known. Bloodletting therapy is being successfully practised by a large number of educated ayurveda practitioners across the country. However, it still lacks mainstream appeal. The need of the hour is for practitioners and patients to become more aware of the benefits of this therapy. It can be used as a preventive measure to avoid the spread of bloodborne infections, as well as a therapeutic measure in the situations discussed in this paper. Yoga and meditation, which are two major parts of ayurveda, are well-accepted in the Western world. It also contains a number of other mysteries, such as raktamokshan, that must be investigated for the sake of the entire human race.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.

NOTE
The study highlights the efficacy of " Ayurvedic " which is an ancient tradition, used in some parts of India. This ancient concept should be carefully evaluated in the light of modern medical science and can be utilized partially if found suitable.