Ayurveda Panchakarma: Raktamokshana – Therapeutic Withdrawal of Blood

Thousands of years ago, Charaka wrote the oldest and most extensive text of Ayurveda, thoroughly explaining the science of Ayurveda. In this treatise, he also delineated the five karmas or major procedures of vamana, nasya, virechana, cleansing and nourishing bastis for purifying and rejuvenating the body. He is consequently considered to be the father of Ayurvedic internal medicine.


After Charaka, Sushruta is perhaps the most important commentator on the “science of life.” Sushruta is known as the father of Ayurvedic surgery because his focus was more narrowly defined by treatment methodologies used in critical disease situations. Many of the surgical procedures and instruments which he describes in his scholarly writings thousands of years ago have been rediscovered in the last 150 years by Western medical science.

Although Ayurveda favors prevention wherever possible, traumatic invasive surgery is advised in certain acute cases. Sushruta extensive experience in the examination of blood during the course of surgery enabled him to gain a deep understanding of the relationship of the blood to rakta dhatu, pitta dosha and diseases associated with their toxicity and malfunction. He subsequently combined the two main types of basti discussed by Charaka into one category and added raktamokshana — the therapeutic withdrawal of blood from the body — as the fifth major procedure used in Panchakarma therapy.

Sushruta attributed particular importance to the blood because it performed the important job of providing transportation within the body. He noted that when ama or toxins collected, they were circulated throughout the body with the blood. Through extensive observation oi the blood, he identified several different types of blood toxemia based on doshic imbalance. He devised raktamokshana as a purification treatment to be used when excess toxins are being carried in the blood to the periphery of the body.

Although raktamokshana is the most limited of the five major procedures, it provides a rapid and sometimes dramatic reduction of symptoms in certain acute disorders, especially where time is a critical factor, The other procedures are much more comprehensive in their scope and are applied after raktamokshana is completed in order to provide deep cleansing of ama from the tissues and thereby eliminate the actual disease process.

Rakta dhatu and pitta dosha are closely associated and their functions interrelated. The blood, which represents rakta dhatu, is formed and regulated by the liver, spleen and bone marrow, which perform pitta-related work. For this reason, when toxins appear due to excess pitta, they concentrate in the blood. Examination of the blood can then provide significant diagnostic information about the condition of pitta and its associated organs.

When excessive pitta-related ama exists in the blood, it gets transported to the body’s periphery, where it often produces characteristic symptoms like skin inflammation or skin hypersensitivity. Acute symptoms can usually be relieved within a few hours by simply removing a small amount of toxic blood from the affected area. Once ama is gone, rakta metabolism improves, and the blood can perform its job efficiently. When toxins associated with pitta are eliminated, pitta function regains balance.

Raktamokshana successfully treats blood-related diseases, including many types of skin disorders: chronic itching, eczema, urticaria, rashes, and leukoderma. It is also indicated for enlarged liver or spleen, gout and some types of headaches and hypertension. Raktamokshana is most often prescribed rowards the end of summer and during autumn, when pitta tends to become aggravated due to agni bhuta’s dominance in the environment. It is con-traindicated for infants, pregnant or menstruating women, the aged, and those with anemia, edema, leukemia, cirrhosis of the liver, and any bleeding in the body.

Administration of Raktamokshana

Snehana and swedana do not have to precede raktamokshana. On the day of treatment, the patient simply lies on a table and a small amount of blood is withdrawn intravenously. In ancient times, several different methods were used, depending on the patient’s doshic constitution. Today, we use a sterile syringe. This procedure should always be performed under qualified medical supervision. The venipuncture is sealed by medicated gauze and a pressure bandage is applied for a short time. After approximately one hour, the patient can get up and leave.

The blood is examined for color, smell, consistency, viscosity and clotting characteristics. The specific characteristics of the blood will indicate the quality of funcrion in the pitta zone.

In my clinical practice I have seen some remarkable results from the use of this procedure. A patient once came to me with oozing eczema on his whole body and an extremely swollen face. Because he had unusually high blood pressure, I could not immediately use the other cleansing procedures. Instead I performed raktamokshana, removing 80 cc. of blood from his body. Within six hours the oozing and itching stopped; his skin, which had previously been a darkish gray, returned to a more normal color and all the swelling disappeared from his face and body.

Because the toxins in his peripheral circulation were quickly removed, all his symptoms were reduced within a short period of time. After this, he was put on a Purvakarma regimen, followed by the major k.armas of vamana, virechana, and bastis, and he recovered completely. With this thorough cleansing, as well as diet and lifestyle changes to avoid future toxicity, he has remained free from these unpleasant skin disorders.

In another case, a patient who suffered from migraines came to my clinic with a severe headache. Fifteen minutes after performing raktamokshana on a point called the shankha marma in the temporal-occipital region of his head, the headache was gone and he did not have to take pain medication.

I offer you these anecdotal experiences to demonstrate the effectiveness of removing toxins directly from the bloodstream by withdrawing blood. It can be used in most situations where symptoms must be reduced quickly, and where the cause of symptoms lies in a derangement in the function of rakta dhatu.

When raktamokshana is contraindicated but symptoms indicate that the blood is toxic and needs to be cleansed, Ayurveda employs shamana or palliative therapies. These include adjustments in diet, and the use of specific herbs to cleanse the blood. In Ayurveda, the blood is said to be the carrier of ayu, or life, so its condition directly influences the four parts of life: atma (soul), manas (mind), indriyas (senses) and sharira (body). Good blood, free from toxins and waste products, sustains life and helps maintain the physiological equilibrium necessary for health.

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