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    1 : CONCEPT OF LEECH FOR THERAPEUTICAL MANAGEMENT Dr.M.L.Naidu. Dr.M.Srinivas Naik Dr.N.R.S.Govt Ayurvedic College Vijayawada- 10
    2 : RAKTA MOKSHANA: Extraction of vitiated blood from the body by means of sastra and anusastra is known as raktamokshana.   Sastra prayoga: It can be done by 1) Pracchana 2) Sira vedana   Anusastra prayoga: It can be done by 1) Jalauka 2) Sringa 3) Alabu 4) Ghati yantra
    3 : JALAUKA VIDHI DEFINITION OF JALAUKA: The Jalaukas are also known as ‘JOKA’. They are given the name Jalauka because the very basis of their life, the site of their dwelling, and the source of their nutrition is Jala or water.
    5 : INDICATIONS OF BLOOD LETTING Chronic skin diseases Eye diseases Headache Chronic anger Excessive sweating Tumours Eczema Spleenomegaly Skin pigmentations Mental confusion Bodyache Psoriasis Hepatomegaly Pruritus Vitiligo Acne Gingivitis Jaundice Tremors Acid reflux Urticaria Anxiety Gout Alcoholism Metrorrhagia Boils Stomatitis Snake bite Foul body odour Erysipelas Haemorrhoids Anorexia Allergies Neurasthenia Pitta born diseases
    6 : CONTRA INDICATIONS OF BLOOD LETTING Pregnancy Angina Impotency General anasarca Chest injury Severe cachexia Dehydration Anaemia Fear of the procedure Acute asthma Immediately after vamana, virechana, basti.  
    7 : MODE OF APPLICATION OF LEECHES (JALAUKAVACHARANA VIDHI) This consists of 3 phases namely 1.Poorvakarma 2.Pradhana karma, and 3. Paschat karma
    8 : POORVA KARMA: In poorva karma, following things are considered. Collection of Leeches Preservation of Leeches and Nutrition of Leeches Purification of Leeches
    9 : COLLECTION OF LEECHES: Ideal time or season for the collection: - Sarad ritu / autumn season or Varsha ritu
    10 : Collection of leeches is a very simple method. A river or stream with fresh flowing water is selected. The leg is anointed by applying flesh all around the leg and calf muscles. This is draped with freshly slaughtered leather piece with its inner surface exposed for leeches. Then one should stand in the water for a while, after few minutes. Leeches will automatically come to suck blood from the leather and get stuck up to the leather. Then one should come out of the water and collect the leeches and preserve them in pure water.
    11 : Another easier method is to get them caught with the help of fishermen net from fishermen. There are professional leech collectors wherever there is Zoology sections in colleges and one can get any number of leeches on request from them.
    12 : PRESERVATION OF LEECHES After collecting the required number of leeches, the individual leeches are kept in separate glass bottles. They are provided with food in the form of algae, fungi, small leaves likely Bhumyamalaki, cooled rice, fine pieces of mutton, etc., The water is changed once in two days, and feeding once in seven days. The water must be cool and the container transparent for light rays. The container should not be kept in hot weather nor exposed directly to sun. The container should be sufficiently big enough and is filled up with water up to 3/4th of its capacity, allowing enough space for the movement of the leech. The lid of the container must contain fine holes for exchange of air.  
    13 : PURIFICATION OF THE LEECH ( Jalauka - sodhana) The purification is carried out by putting the leech in water containing sarshapa (Brassica nigra/alba) and Turmeric (Curcuma longa). It should be kept in this water for one muhurta i.e for a period of 48 minutes with this the activity, appetite, and blood-sucking power are increased.
    14 : PREPARATION OF THE PATIENT The patient must be subjected to oleation and sudation before the actual leech is applied. The oleation and sudation are carried out a day before. The part, which is to be leeched, is made to dry with the help of mud or cow dung. When there is an ulcer or pain at the site of leeching the mud or cow dung should not be applied, as there is chance of Tetanus.
    15 : PRADHANA KARMA (APPLICATION OF LEECH) After satisfying all the requrirements of poorvakarma, the physician must now resort to jalaukavacharana The patient is asked to lie down or sit comfortably and the part to be leeched is cleaned. A small incision is given on the skin or a drop of milk or honey is placed. The leech is caught with gloved hand (to prevent slipping) and its mouth is brought to the point of bleeding or to the milk or honey drop at the site of lesion. With three to four attempts and efforts, the leech will stick to the point. The leech when once starts sucking blood, elevates its neck and fixes its head to the supporting point of skin.
    16 : A gradual distension in the central portion of the Jalauka is observed, during the process of sucking wavy movements or pulsations on jalauka are visible. At this stage the neck and body of the leech are covered with a layer of wet cotton, which is to be moistened regularly throughout the process. The patient will not experience any discomfort during sucking as long as the leech sucks the impure blood. After few minutes either the leech becomes fully satisfied with its food and leaves the skin and drops itself down or the patient may feel itching sensation or burning sensation at the point of sucking, which indicates that impure blood is no more available to the leech and hence it is sucking pure blood. In such a case a little quantity of Haridra churna or Rock salt is sprinkled over the sucking point and immediately leech take away its mouth from that point
    17 : PASCHAT KARMA This phase consists of : 1. Treatment of the Leech 2. Treatment of the Patient.
    18 : TREATMENT OF THE LEECH As soon as the leech is removed from the skin,Taila mixed with rock salt is poured on its mouth and on its body,the powder of paddy husk is applied. By this process,it will be easy for the physician to hold it properly. With the help of left hand the leech is held at its tail cord and is gently squeezed towards head with the right hand. This will make the leech vomit the blood. The easier way it to place leech in a tray and turmeric powder is sprinkled repeatedly over its mouth. With this the leech vomits the dark colored blood actively. If it is lethargic, it should be presumed that it has not yet vomited properly. When the leech is not made to vomit completely, it may get a disease called ‘Indramada’. It should not be re-applied till seven days and it should be kept in a pot containing pure water.
    19 : TREATMENT OF THE PATIENTS As soon as the leech is removed the bite is to be smeared with honey, cold water and Satadhauta Ghrita. Even astringent substances or poultices may also be applied and the wound is bandaged and tied properly. In case of Samyak yoga, abhyanga or pichu with Satadhauta Ghrita is applied. In case of ayoga, the wound is rubbed with honey so as to make the wound bleed freely. Incase of atiyoga, application of cold packing and tight bandage is done. In case of Nityayoga a pradeha with astringent, sweet and cold medicine should be applied. This will facilitate the bleeding or else the rock salt is applied. The wound is cleaned with Kashaya rasa or astringent drugs or any one of jatyadi or padmakadi taila is applied and bandaged.
    20 : PRECAUTIONS TO BE TAKEN DURING JALAUKAVACHARANA Leeches are not to be applied to young children because there is a fear of hemorrhage after the removal of leech. Leeches are not to be applied to major veins like femoral, jugular, Anterior tibial,temporal veins etc. It must be applied very carefully to eyelids, breasts, penis and scrotum etc. Leeches should be held carefully especially if they are applied in the regions near to anus, penis, vagina, the ears, nostrils etc. Otherwise they may try to enter into the orifices.
    21 : SIGNS AND SYMPTOMS OF POISONOUS LEECHING AND THEIR TREATMENT:   If poisonous leech is applied by ignorance or by mistake. There will be Sodha (oedema) Kandu(Pruritus) Moorcha(Coma) Jwara (fever) Daha (Burning sensation) Vamana (Vomiting) Mada(intoxication) and Angasada(Myalgia)
    22 : This type of complications are to be treated with a drug called ‘MAHA-GADA’, in the form of pana, (Drink), Lepana (local application) and Nasya (errhine therapy).
    23 : MAHA-GADA consists of:   Trivrit (Operculina turpetum) Ati-madhura (Glycyrrhiza glabra) Haridra (curcuma longa) Daru haridra (Berberis aristata) Manjishta (Rubia cordifolia) Sunti (Zingiber officinale) Pippali(Piper longum) Maricha (Piper nigrum) and Five salts etc. All these are taken and finely powdered and preserved after mixing with honey.
    24 : SPECIALITY OF JALAUKAVACHARANA: Leech has got anti-coagulation chemical called Hirudin. Thus the leech while sucking blood sends out this Hirudin, which prevents patient’s blood from coagulation. Thus the leech can suck large amounts of impure blood without any problem. It is very difficult to clarify the meanings of pure and impure blood in modern terms. It is also difficult to take into consideration the toxaemic and Septicaemic conditions as impure blood. It cannot be said whether a leech can separate or filter toxins of bacterias from the circulation. Anyhow Ayurveda believes that a leech can definitely suck out only impure part of the blood of the patient. Accordingly Ayurvedists achieve excellent results in several diseases through this Jalaukavacharana.
    25 : ENZYMES IN LEECH’S SALIVA 1. Hirudin 2. Hyloronidase 3. Eglin ACTION OF ENZYMES Anticoagulant Local anesthetic Vasodilator Antithronbotic Thrombolytic Antiischemic Hypotensive Immunostimulent Antiinflamatory Analgesic Anti atherosclerotic
    26 : THANK YOU

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