Sushruta Samhita Sharirasthana Chapter 8 Sira Vyadha Vidhi Shariram (Procedure of puncturing the vein / phlebotomy)

The eighth bankruptcy of Sharirasthana of Sushruta Samhita is known as as Sira Vyadha Vidhi Shariram Adhyaya. This bankruptcy offers with the process of puncturing the vein / phlebotomy.

Sira Vyadha Vidhi- Procedure of puncturing the vein / phlebotomy

अथातःसिराव्यधविधिंशारीरंव्याख्यास्यामः ॥१॥
यथोवाचभगवान्‌धन्वत्तरिः ॥२॥

Now we can expound the bankruptcy through title Sira Vyadha Vidhi – process of puncturing vein / phlebotomy; as published through the venerable Dhanvantari.

Vyadhana Anarha – particular person improper for puncturing

बालस्थविररूक्षक्षतक्षीरुपरिश्रान्तमद्यपाध्वस्त्रीकर्शितवमितविरिक्तास्थापितानुवासितजागरितक्लीबकृशगिर्भिणीनां
कासश्र्वासशोषप्रवृद्धज्वराक्षेपकपक्षाघातोपवासपिपसामूर्च्छाप्रपीडितानां चसिरांनविध्येत्,याश्चाव्याध्याः। व्यध्याश्चादृष्टाः ।दृष्टाश्चायन्त्रिताः, यन्त्रिताश्चानुत्थिता‌इति॥३॥

Contraindications for siravedha –

The siras – veins will have to no longer be punctured in –

–        kids,

–        the previous elderly, 

–        individuals who’re dry, wounded, debilitated, frightened,

–        those that are very much fatigued,

–        those that have ate up wine,

–        those that are exhausted through lengthy stroll or

–        those that are exhausted because of indulgence in over the top sexual actions

–        those that have had vomiting or purgation,

–        those that were administered decoction and oil enemas,

–        those that have stored conscious at evening,

–        impotent individuals

–        emaciated individuals

–        pregnant ladies

–        those that are affected by cough, dysponea, intake, prime fever, convulsions, partial paralysis, hunger, thirst and fainting

Below discussed siras additionally will have to by no means be punctured –

–        the ones which can be contraindicated / prohibited from puncturing

–        the ones siras which can be indicated for puncturing however aren’t visual

–        the ones siras which can be obviously visual however can’t be managed (or held for puncturing)

–        the ones siras which aren’t raised / engorged, even though managed

Vyadhana Arha – Suitable for puncturing

शोणितावसेकसाध्याश्चयेविकाराःप्रागभिहितास्तेषुचापक्वेष्वन्येषुचानु क्तेषुयथाभ्यासंयथान्यायंचसिरांविध्येत् ॥४॥

Siravedha or vein puncture as a healing measure will have to be performed in all sicknesses which can be curable through raktamokshana i.e. bloodletting, as defined previous in Sutra Sthana segment, bankruptcy 14 of the similar treatise (Sushruta Samhita).

With one’s scientific / surgical enjoy and observe and likewise after adopting suitable measures and procedures, siravedha may also be carried out in different sicknesses that have no longer develop into pakva i.e. mature (ripened, suppurated), additionally in the ones sicknesses that have no longer been indicated for shonitavaseka – bloodletting.

प्रतिषिद्धानामपिचविषोपसर्गे‌आत्ययिकेचसिराव्यधनमप्रतिषिद्धम्॥५॥

Siravyadha i.e. puncturing of vein isn’t prohibited even within the veins contraindicated for puncturing when an individual is significantly suffering from poisons or in prerequisites of emergency.

Vyadhana Vidhi – Procedure of puncturing

तत्र स्निग्धस्विन्नमातुरं यथादोषप्रत्यनीकं द्रवप्रायमन्नं   भुक्तवन्तंयवागूंपीतवन्तंवायथाकालमुपस्थाप्यसीनंस्थितंवाप्राणानबाधमानोवस्त्रपटचर्मान्तर्वल्कललतानामन्यतमेनयन्त्रयित्वानातिगाढंनातिशिथिलंशरीरप्रदेशमासाद्य प्राप्तंशस्त्रमादायसिरांविध्येत् ॥६॥

Snehana and Swedana – As a part of preparatory measures, the affected person will have to be administered with –

–        snehana – oleation and

–        swedana – sudation and

Drava Anna – to the affected person who has been administered with snehana and swedana, liquid meals or yavagu i.e. thick gruel will have to be given. These meals will have to have reverse qualities as the ones of the annoyed doshas.

Positioning the affected person – Proper time for accomplishing siravyadha is determined. The affected person who has passed through snehana and swedana and drava anna as discussed above will have to be made to sit down in erect posture, on a chair, on the subject of the doctor.

Tying bands – Later he will have to be tied with both of the underneath discussed issues –

–        bands of garments

–        leather-based

–        inside bark of bushes,

–        creeper or some other such fabrics

They will have to be tied taking care that –

–        the affected person’s lifestyles isn’t endangered

–        he isn’t managed or restrained from motion,

–        the band is tied neither very firmly nor very loosely

Later, the doctor will have to seek for correct web page for accomplishing the puncture and the sira at that web page will likely be punctured, the use of suitable software.

Contraindications for doing vein puncture

नैवातिशीतेनात्यष्णेनप्रवातेनचाभ्रिते॥
सिराणांव्यधनंकार्यमरोगेवाकदाचन ॥७॥

Vein puncture will have to no longer be carried out on –

–        very chilly days

–        extremely popular days

–        days on which there’s heavy breeze,

–        very cloudy day,

–        wholesome individuals

तत्रव्यध्यसिरांपुरुषंप्रत्यादित्यमुखमरत्निमात्रोच्छ्रिते‌उपवेश्यासनेसक्थ्नोराकुञ्चितयोर्निवेश्यकूर्परे  सन्धिद्वयस्योपरि हस्तावन्तर्गूढाङ्गुष्ठकृतमुष्टी मन्ययोःस्थापयित्वायन्त्रणशाटकंग्रीवामुष्ट्चोरुपरिपरिक्षिप्यान्येनपुरुषेणपश्चात्स्त्थितेनवामहस्तेनोत्तानेन  शाटकान्तद्वयं ग्राहयित्वाततो-ब्रूयात्‌दक्षिणहस्तेनसिरोत्थापनार्थंनात्यायतशिथिलं यन्त्रमावेष्टयेति,असृकस्त्रावणार्थं  तयन्त्रंपृष्ठमध्येपीडयेति, कर्मपुरुषंचवायुपूर्णमुखंस्थापयेत्; एष‌उत्तमाङ्गगतानामन्तर्मुखवर्जानांसिराणांव्यधनेयन्त्रणविधिः ।
पादव्यध्यसिरस्यपादंसमेस्थानेसुस्थितंस्थापयित्वाऽन्यंपादमीषत्संकुचितमुच्चैःकृत्वाव्यध्यसिरंपादंजानुसन्धेरधःशातकेनावेष्ट्चहस्ताभ्यांप्रपीड्चगुल्फंव्यध्यप्रदेशस्योपरिचतुरड्गुलेप्लोतादीनामन्यमेनबद्धावापादसिरांविध्येत्।
अथोपरिष्ठाद्धस्तौगूढङ्गुष्ठकृतमुष्टीसम्यगासने स्थापयित्वा सुखोपविष्टस्य पूर्ववद्यन्त्रंबद्धवाहस्तसिरांविध्येत् ।
गृध्रसीविश्वाच्योःसङ्कुचितजानुकूर्परस्य।
श्रोणिपृष्टस्कन्धेषून्नामितपृष्ठस्यावाक् शिरस्कस्योपविष्टस्य विस्फूर्जितपृष्ठस्यविध्येत् ।
उदरोरसोः प्रसारितोरस्कस्योन्नामितशिरस्कस्य विस्फूर्जितदेहस्य।
बाहुभ्यामवलम्बमानदेहस्यपार्श्वयोःअनामितमेढ्रस्यमेढ्रे।
उन्नमितविदष्टजिह्वाग्रस्याधोजिह्वायाम् ।
अतिव्यात्ताननस्यतालुनिदन्तमूलेषुच ।
एवंयन्त्रोपायानन्यांश्चसिरोत्थापनहेतूनबुद्धचाऽवेक्ष्यशरीरवशेनव्याधिवशेनचविदध्यात् ॥८॥

Controlling / manipulating the veins of the top –

Positioning the affected person – The one that is chosen for siravyadha is made to sit down on a chair going through east. The chair will have to be of the peak of his forearm. The particular person will have to sit down at the chair flexing his legs on the knees. He will have to stay his elbows on his knees and clench his fists.

Applying pressure – The affected person is now requested to stay his clenched fists at the nape of his neck on all sides and press at the nape.

Binding – Now a binder is taken and is handed above his neck and fists. The particular person status at the back of the chair on which the individual is seated will grasp the 2 ends of the binder. Raising his left hand fairly he ties a knot. The knot isn’t very tight however enough sufficient to lift the veins. Then, he tightens the binder on the center of the affected person’s again.

Instruction to the affected person – Now, the affected person is requested to inflate his mouth with air.

This is the process of controlling or manipulating the veins of the top which aren’t spreading inwards, for puncturing.

Controlling / manipulating the veins of the legs (decrease limbs) –

Positioning the affected person – To habits siravedha within the legs i.e. to puncture the leg veins, the affected person will have to position his one leg firmly on a fair position like sofa / cot. He will have to fairly flex and upward push the opposite leg above.

Binder – After positioning the affected person as mentioned above, a binder will have to be wrapped underneath the knee of the leg during which siravyadha is to be carried out.

Conducting vein puncture – Now, the doctor will have to knead the ankle of the affected person with the assistance of his arms after tying a band of material or the sort of subject material about 4 angula (8 cm) above the web page of puncture. After this, he will have to puncture the vein of the leg.

Controlling / manipulating the veins of the arms (higher limbs) –

Positioning of the affected person – The siras of the arm – higher limb will likely be punctured after the affected person assists in keeping his arms as defined previous – with tightly clenched fists with thumb within the fists, with different palms wrapping it and through making the affected person to sit down with ease. He will have to be manipulated as described previous following which the veins will have to be punctured.

Manipulation and puncturing the opposite veins

Veins to be punctured	Position during which vein will have to be punctured
In Gridhrasi – sciatica and Visvaci – painful situation of the arm	With knee (in gridhrasi) and elbows (in visvaci) flexed
Veins of the pelvis, again and shoulders	By increasing the again of the affected person through making the him sit down, elevating his again and decreasing his head
Veins of the stomach and chest	With the affected person increasing his chest, elevating his head and stretching (increasing) his frame
Veins of the flanks	When the frame is resting at the fingers
Veins of the penis	When the penis is erect
Veins of the tongue	Below the tongue whilst the tongue is stored lifted up and biting its tip
Veins of the palate and root of the enamel	When the individual assists in keeping his mouth very vast open

Thus, even in puts of frame in which siravyadha has no longer been indicated, the vein puncture will have to be carried out through binding where with appropriate yantra or anuyantra and through adopting efficient strategies of keep watch over or manipulation which reasons the vein to upward push, in order that it may be simply punctured. Puncturing of the vein will have to be carried out according to the character of the frame of the affected person and the character of the illness.

Vyadhapramana- measurement of the puncture

मांसलेष्ववकाशेषुयवमात्रंशस्त्रंनिदध्यात्,अतोऽन्यथाऽर्धयवमात्रंव्रीहिमात्रंवाव्रीहिमुखेन, अस्थ्नामुपरिकुठारिकयाविध्येदर्धयवमात्रम् ॥९॥

Region of the frame in which puncturing must be carried out	Size of the puncture
Muscular areas of the frame	Size of yava – barley grain
In different spaces i.e. spaces rather then muscular spaces of the frame	Size of Half Yava or one vrihi (paddy) Puncturing will have to be carried out the use of Vrihimukha Sastra – Trocar or Puncturing needle
Veins at the bones	Size of Half Yava Puncturing will have to be carried out the use of Kutharika – small surgical awl

Vyadhana Kala- appropriate time

व्यभ्रेवर्षासुविध्येत्तुग्रीष्मकालेतुशीतले ॥
हेमन्तकाले मध्याह्रेशस्त्रकालस्त्रयः स्मृताः ॥१०॥

Time of instrumentation for siravyadha are 3, relying at the seasons.

Season during which puncturing of vein will have to be carried out	Conditions
Varsa Rtu – wet season	On days which aren’t cloudy
Grisma Rtu – summer season	At a time when it’s cool
Hemanta Rtu – iciness	At noon

Samyak Viddha Laksana – correct puncture

सम्यक्शस्त्रनिपातेनधारयायास्रवेदसृक्॥
मुहर्तं रुद्धा तिष्ठेच्चसुविद्धांतांविनिर्दिशेत् ॥११॥
यथाकुसुम्भपुष्पेभ्यःपूर्वंस्रवतिपीतिका॥
तथासिरासुविद्धासु दुष्टमग्रे प्रवर्तते॥१२॥

When the instrumentation against siravyadha – puncturing of vein has been carried out in a correct approach and the blood let loose correctly, the underneath discussed indicators may also be noticed –

–        blood flows out in circulate, for a time frame of 1 muhurta – 28 mins and

–        later, the bleeding stops by itself accord

Simily – Giving an analogy to give an explanation for bleeding after siravedha, Acharya says that handiest vitiated blood flows out first after the siras were punctured similar to a yellow-colored liquid flows out from the Kusumbha plant life, when those plant life are beaten.

Asrava – absence of waft

मूर्च्छितस्यातिभीतस्य श्रान्तस्यतृषितस्यच ॥
नवहन्तिसिराविद्द्धास्तथाऽनुत्थितयन्त्रिताः ॥१३॥

Below discussed are the prerequisites during which the blood does no longer simply waft out when the siras are punctured –

–        in those that have fainted,

–        in those that are very much afraid,

–        in the ones exhausted

–        in those that are thirsty,

–        in prerequisites when the veins aren’t correctly raised for puncturing thru manipulations

Conditions in which puncturing will have to be carried out within the midday

क्षीणस्यबहुदोषस्यमूर्च्छयाऽभिहतस्यच ॥
भूयोऽपराह्वविस्राव्यासाऽपरेद्युस्त्र्यहेऽपिवा॥ १४॥

Puncturing will have to be carried out within the afternoon or at the subsequent or 3rd day the underneath discussed forms of individuals –

–        those that are debilitated,

–        those that have nice accumulation of doshas,

–        those that are troubled through murcha – fainting

Samshamana

रक्तंसशेषदोषंतुकुयोदपिविचक्षणः ॥
नचातिनिःस्त्रुतंकुर्याच्छेषंसंशमनैर्जयेत् ॥१५॥

The doctor / surgeon who’s accomplishing siravyadha – bloodletting thru vein puncture, would possibly every now and then permit little amount of vitiated blood within the frame after having let majority of vitiated blood out of the frame, however will have to by no means permit blood to waft out in extra. The doshas which were left over within the frame after bloodletting will have to be later mitigated with appropriate palliative remedies.

Sravapramana- amount offlow

बलिनोबहुदोषस्यवयःस्थस्यशरीरिणः ॥
परंप्रमाणमिच्छन्तिप्रस्थंशोणितमोक्षणे ॥१६॥

According to the opinion of mavens, 1 prastha – 640ml roughly – of blood will have to be allowed to waft out after puncturing the vein whilst accomplishing siravyadha in –

–        robust individuals

–        individuals having nice accumulation of doshas and

–        individuals who’re of appropriate age i.e. center age

Vyadhasthana – position of puncturing

तत्र पाददाहपादहर्षचिप्पविसर्पवातशोणितवातकण्टकविचर्चिकापाददारी प्रभृतिवुक्षीप्रमर्मण‌उपारिष्ठाद् द्यङ्गुल्लेव्रीहिमुखेनसिरांविध्येत्,  शेलीपदेतच्चिकिस्तितेयथावक्ष्यते,  कोष्ट्तकशिरः, खञ्जपङ्गुलवातवेदनासुजङ्घायां, ऊरुमूलसश्रीतांगलगण्डे,  एतेनेतरसक्थिबाहूचव्याख्यातौ; विशेषतस्तुवामबाहौकूर्परसन्धेरभ्यन्तरतोबाहुमध्ये प्लीह्रि कनिष्ठिका-नामिकयोर्मध्येवा, एवंदक्षिणबाहौयकृद्दल्ये(कफोदरेच), एतामेवचकासश्वासयोरप्यादिशन्ति, गृध्रस्यमिवविश्र्वाच्यां, श्रोणिंप्रतिसमन्ताद् ह्यङ्गुलेप्रवाहिकायांशूलिन्यां, परिवर्तिकोपदंशशूकदोषशुक्रव्यापत्सुमेढ्रमध्ये, वृषणयोःपार्श्वेमूत्रवृध्द्यांनाभेरधश्चतुरङ्गुलेसेवन्यादकोदरे, वामपार्श्वेकक्षास्तनयोरन्तरेऽन्तर्विद्रधौपार्श्वशूलेच,  बाहुशोषावबाहुकयोरप्येके, वदन्त्यंसयोरन्तरे, त्रिकस्सन्धिमध्यगतांतृतीयके, अधःस्कन्धसन्धिगतामन्यतरपार्श्वसंस्थितांचतुर्थके, हनुसन्धिमध्यगरामपस्मारे,  शङ्खकेशान्तगतामुरोऽपाङ्गललाटेषुचोन्मदे, जिह्वारेगेष्वधोजिह्वायांदन्तव्याधिषुच,  तालुनितालुनितालव्येषुकर्णयोरुपरिसमन्ताम्‌कर्णशूल‌एतद्रोगेषुच,  गध्राग्रहणेनासारोगेषुचनासाग्रे, तिमिराक्षिपाकप्रभृतिष्वक्ष्यामयेषूपनासिकेलालट्चामपाङ्ग्चांवा, एता‌एवशिरोरोगाधिमन्थप्रभृतिषुरोगेष्विति ॥१७॥

Conditions / sicknesses during which siravedha – vein puncture is to be carried out	Site / Vein for accomplishing vein puncture
Pada daha – burning sensation of toes / soles Pada harsa – tingling or tenderness within the toes / soles Cippa – whitlow Visarpa – erysipelas, herpes Vatasonita – gout Vatakantaka – ankle joint sprain Vicarcika – pores and skin illness, eczema Padadari – fissures within the soles and many others.	Sira located 2 angula – 4 cm above the Ksipra Marma (important spot found in between giant toe and the following toe)   Instrument used – Vrihimukha Sastra – trocar, thick needle
Slipada – filariasis	The approach of puncturing the vein will likely be described within the bankruptcy coping with its remedy (Chikitsa Sthana, bankruptcy 19)
Krostukasirsa – irritation of knee joint Khanja – limping Pangu – lameness Vata Vedana – pains brought about through annoyed vata	In janghas – calves,   Location – 4 angula – 8 cm above the ankle joint
Apaci – tumor happening within the neck, lymphadenitis of the neck	2 angula – 4 cm underneath the Indrabasti Marma (an important spot situated on the middle of the calf muscle)
Gridhrasi – sciatica	4 angula – 8 cm – both above or underneath the knee joint
Galaganda – tumor happening within the neck, Thyroid swelling, Goiter	Vein provide on the root / base of the thigh
Pliha – sicknesses / growth of spleen	In the left arm, both on the inside aspect of the elbow joint or on the middle of the arm or within the house between little and ring palms
Yakriddalyodara – belly growth brought about because of build up in measurement of liver – hepatomegaly and Kaphodara – belly growth brought about through higher kapha	In the correct arm, on the similar puts discussed for vein puncture in case of growth of spleen above (no 7)
Kasa – cough Swasa – dyspnea, respiring issues	In the similar puts discussed above (in pliha and yakriddalyodara)
Visvaci – ache within the fingers	As defined in Gridhrasi – sciatica
Pravahika – dysentery Sula – ache within the stomach, colic	2 angula – 4 cm in entrance of the pelvis – pubic symphysis
Parivartika, Upadamsa, Suka Dosa – all are sicknesses of penis Diseases of semen	In the center of the penis
Mutra vriddhi – hydrocele	On the edges of the scrotum
Dakodara / Jalodara – ascites	Below the umbilicus, 4 angula – 8 cm on the left aspect of the raphae of the stomach
Antar-vidradhi – interior abscess Parsva-sula – ache within the flanks	In between the axilla and breasts, at the left flank
Bahusosa – losing of fingers Apabahuka – lack of motion of arm	Between two shoulders
Tritiyaka Jwara – tertian fever	Middle of trika – higher again
Chaturthaka Jwara – quartan fever	Below the shoulder joint of decrease jaw, close to the ear
Apasmara – epilepsy, reminiscence issues	Vein located in the course of the joint of the decrease jaw, close to the ear
Unmada – madness, psychoses	In the temple and border of hairs within the head, on the outer perspective of the attention and brow
Jihva danta roga – sicknesses of the tongue and enamel	Above the ears
Loss of odor belief and sicknesses of the nostril	Tip of the nostril
Timira – partial blindness Aksi-paka – ulceration of the attention Diseases of the attention	At upanasika – base of the nostril or Forehead or Outer perspective of the attention
Shiroroga – Diseases of the top Adhimantha – illness of the attention, glaucoma Other such sicknesses	Base of the nostril, brow and outer perspective of the eyes

Dusta Vyadha – Improper puncturing

दुष्टव्यधा विंशति:-दुर्विद्धाऽतिविद्वा कुञ्चितापिच्चिताकुटिताऽप्रस्रुताऽत्युदीर्णाऽन्तेविद्धापरिशुष्काकूणितावेपिताऽनुत्थितविद्धाशस्त्रहतातिर्यग्विद्धाविद्धाऽव्यध्याविद्रुताधेनुकापुनःपुनर्विद्धासिरास्नाय्वस्थिसन्धिमर्मसुचेति ॥१८॥

DustaVyadha or fallacious puncturing of vein is of twenty sorts. They are as underneath discussed –

–        Durviddha,

–        Atividdha,

–        Kuncita,

–        Piccita,

–        Kuttita,

–        Aprasrta,

–        Atyudirna,

–        Anteviddha,

–        Parisuka,

–        Kunita,

–        Vepita,

–        AnuthitaViddha,

–        Sastrahata,

–        Triyakviddha,

–        Aviddha,

–        Avyadhya,

–        Vidruat,

–        Dhenuka,

–        Punahpunar viddha and

–        Mamsa Siran Snayu- AsthiSandhi Marma viddha

तत्रयासूक्ष्मशस्त्रविद्धाऽव्यक्तमसृक्‌स्रवतिरुजाशोफवतीचसादुर्विद्धा, प्रमाणातिरिक्तविद्धायामन्तःप्रविशतिशोणितंशोणितातिप्रवृत्तिर्वासाऽतिविद्धा, कुण्ठश्स्त्रप्रमथिता पृथुलीभावमापन्ना पिच्चिता, अनासादितापुनःपुरन्तयोश्चबहुशःशस्त्राभिहताकुटिता, शीतभयमूर्च्छाभिरप्रवृत्तशोणिता‌अप्रस्रुता, तीक्ष्ण्महामुखशस्त्रविद्धाऽत्युदीर्णा, अल्परक्तस्राविण्यन्तेविद्धा, क्षीणशोणितस्यानिलपूर्णापरिशुष्का,  चतुर्भागादादिताकिंचित्प्रवृत्तशोणिताकूणिता, दुःस्थानबन्धनाद्वेपमानायाः  शोणितसंमोहोभवतिसावोपिता,  अनुत्थिरविद्धायाम छीन्नातिप्रवृत्तशोणिताक्रियासङ्गकरीशस्रहता, तिर्यक्प्रणिहितशस्त्राकिंचिच्छेषातिर्यग्विद्धा, बहुशः क्षताहीनशस्त्रप्रणिधानेनाविद्धा, अशस्त्रकृत्या‌अव्यध्या,  अनवस्थितविद्धा, विद्रुता, प्रदेशस्यबहुशोऽवघटनादारोहद्व्यधामुहुर्मुहुःशोणितस्त्रावाधेनुका, सूक्ष्मश्स्त्रव्यधनाद्वहुशो बिन्ना पुनःपुनर्विद्धा, स्नाय्वस्थिरासन्धिमर्मसुविद्धा,  स्नाय्वस्थिसिरासन्धिमर्मसुविद्धारुजांशोफंवैकल्यंमरणंचापादयति॥२९॥

Durviddha–

It is the puncture of the vein made through a minute sharp software.

Features –

–        Invisible blood waft

–        Pain

–        Swelling

Atividha–

Inn this kind, the dimension of the puncture carried out at the vein is greater than what is needed.

Features –

–        bleeding takes position within the frame i.e. blood waft is going into the frame or

–        the blood flows out in massive amount i.e. over the top bleeding takes position

Kuncita– is very similar to atividha.

Piccita–

It is a puncture carried out with a blunt software.

Features – the vein which has been beaten through any such blunt software attains extra breadth or thickness.

Kuttita–

This occurs because of repeated puncture carried out within the web page of the vein in which the vein isn’t simply to be had for puncture (repeated makes an attempt on an unclear vein).

Features – Damage of even the opposite veins within the neighborhood of the vein over which the puncture used to be tried.

Aprasrta–

In this situation, blood isn’t let loose from the vein which has been punctured. This occurs because of the impact of coldness, concern or fainting.

Atyudirna–

In this kind, the puncture of the vein is made through a pointy and thick software.

Antebhihata–

In this sort of puncturing, there’s scanty waft of blood from the sira.

Parisuska–

It is a situation in which there’s much less blood within the sira but it surely is stuffed with air.

Kunita–

It is a situation which happens because of a puncture carried out on 1 / 4 portion of the vein.

Features – much less bleeding happens.

Vepita–

In this, the binding is made at an fallacious position.

Features – Blood does no longer pop out because of the trembling of siras or because of siravyadha carried out with trembling arms of the surgeon.

AnuthitaViddha –

It items with the similar signs as the ones of vepita defined above.

Sastrahata–

In this, there’s over the top reducing of the vein all through the process.

Features – Copious waft of blood and stoppage of purposes of the vein and the comparable frame section / portions.

Tiryakviddha–

This occurs when the software used for siravyadha is driven into the sira thru its aspect and likewise fairly and as a result, the sira isn’t lower or punctured totally, because it will have to.

Apaviddha–

It is a situation during which a couple of wounds are brought about because of insufficient utilization of the software (for puncturing the vein).

Avyadhya–

This situation happens when

–        the puncture isn’t carried out through the software or

–        when the siras which can be undeserving / contraindicated for puncturing are punctured through the software

Vidruta–

It is punctured when the veins are unsteady (or when the doctor is unsteady in his thoughts).

Dhenuka –

It is that situation during which the frame section is time and again hit with the aim of elevating the sira for siravyadha.

Features – repeated bleeding.

Punah Punar viddha–

In this, the sira is punctured a couple of instances as a result of the pointy software used for the process being small (minute).

Mamsa sira snayu asthi sandhi marma viddha – Puncture carried out at the important spots situated in / on muscle groups, veins, ligaments, bones, and joints offers upward push to ache, swelling, deformity or dying.

Complications of Sira Vedha (vein puncture) and their treatments

सिरासुशिक्षितोनास्तिचला ह्येताः स्वभावतः॥
मत्स्यवत्‌परिवर्तन्तेतस्माद्यत्नेनताडयेत् ॥२०॥
अजानतागृहीतेतुशस्त्रेकायनिपातिते ॥
भवन्तिव्यापदश्चैताबहवश्चाप्युपद्रवाः ॥२१॥
स्नेहादिभिःक्रियायोगैर्नतथालेपनैरपि ॥
यान्त्याशुव्याधयःशान्तिंयथासम्यक्‌सिराव्यधात् ॥२२॥
सिराव्यधश्चिकित्सार्धंशल्यतन्त्रेप्रकीर्तितः ॥
यथाप्रणिहितःस्म्यग्बस्तिःकायचिकित्सिते ॥२३॥

Some verse right here:-

The sira wish to be punctured with nice efforts and talent as a result of –

–        there is not any one that is specifically or exactly educated in puncturing the sira and

–        the sira is through nature slippery and it turns just like the fish

If the doctor / surgeon conducts instrumentation for puncturing the veins at the frame with no need entire wisdom of the process, he would indubitably give upward push to many sicknesses and headaches.

The sicknesses and headaches which can be produced because of fallacious puncturing of siras don’t subside briefly through snehana and different remedies and likewise through exterior software of medicaments and many others. not like the ones brought about through correct puncturing of siras.

Just like vasti chikitsa i.e. enema remedy is thought of as as part remedy within the box of Kaya-Chikitsa (inside or common drugs), Siravyadha – vein puncture or venesection is thought of as as part remedy in Salya-tantra (surgical faculty).

Varjya-avoidable

तत्र स्निग्धस्विन्नवान्तविरिक्तास्थापितानुवसितानुवसितसिराविद्धैः परिहर्तव्यानि क्रोधायासमैथुनदिवास्वप्नवाग्व्यायामयानाध्ययनस्थानासनचङ्क्रमणशीतवातातपविरुद्धासात्म्या जीर्णान्याबललाभात्, मासमेके, मन्यन्ते । एतेषां विस्तरमुपरिष्ठाद्वक्ष्यामः ॥२४॥

The individuals who’ve passed through remedies like snehana, swedana, vamana, virecana, asthapana vasti, anuvasana vasti and siravyadha will have to keep away from the underneath mentioned till they download power or for a duration of 1 month after those remedies (as in step with some government) –

–        krodha – anger,

–        ayasa – exertion,

–        maithuna – copulation,

–        divasvapna – day sleep,

–        vak – talking loudly,

–        vyayama – bodily workout routines,

–        yana – driving,

–        adhyayana – learn about(in prime pitch),

–        sthana asana – sitting for very long time,

–        chankramana – strolling an excessive amount of,

–        shitavata – chilly breeze,

–        atapa – daylight,

–        viruddha, asatmya, ajirna ahara – meals which can be incomputable and unaccustomed and likewise indigestion

Rakta Moksana Krama – strategies of blood

सिराविषाणतुम्बैस्तुजलौकाभिःपदैस्तथा॥
अवगाढं यथापूर्वंनिर्हरेद्दुष्टशोणितम् ॥२५॥
अवगाढेजलौकास्यात् प्रच्छन्नं पिण्डितेहितम् ॥
सिराऽङ्गव्यापकेरक्तेशृङ्गालाबूत्वचिस्थिते ॥२६॥

Below discussed are the other strategies of taking out the vitiated blood from the frame. Raktamoksana – bloodletting or elimination of vitiated blood will have to be carried out the use of one of the crucial underneath discussed procedures –

–        siravyadha – puncturing the vein, venipuncture, venesection,

–        visana – sucking thru a horn,

–        tumbi – sucking thru a tumbler gourd,

–        jalauka – software of leech or

–        prachana – incising or scraping

Each previous one (opposite of given chronology) being mentioned to be the most productive approach for deeper tissues (vitiated blood situated within the deeper tissues).

When the vitiated blood is deep seated, jalauka (leeches) will have to be administered.

When the blood is clotted, pracchana i.e. incising / scraping the outside is advisable.

When the vitiated blood has unfold in all of the frame, siravyadha i.e. venesection is perfect.

When the vitiated blood is provide handiest within the pores and skin, visana / srnga or alabu i.e. horn or pitcher gourd will likely be used to suck the vitiated blood and they are going to be advisable.

इति श्रीसुश्रृतसंहितायांशारीरस्थानेसिराव्यधविधिशारिरं नामाष्टमोऽध्यायः ॥८॥
Thus ends the 8th bankruptcy through title Siravyadha Vidhi in Sarira Sthana of Susruta Samhhita.