Cupping Therapy

Futuristic Considerations on Rakthamoksha, A Paradoxically Placed Shodhana Karma Type or a Principal Sastra Karma Type

Blood-letting:
Is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fluids were regarded as “humours” that had to remain in proper balance to maintain health. It is claimed to have been the most common medical practice performed by surgeons from antiquity until the late 19th century, a span of over 2,000 years. In Europe the practice continued to be relatively common until the end of the 18th century. The practice has now been abandoned by modern-style medicine for all except a few very specific medical conditions.

It is conceivable that historically, in the absence of other treatments for hypertension, bloodletting sometimes had a beneficial effect in temporarily reducing blood pressure by reducing blood volume.

Today, the term phlebotomy refers to the drawing of blood for laboratory analysis or blood transfusion. Therapeutic phlebotomy refers to the drawing of a unit of blood in specific cases like hemochromatosis, polycythemia vera, etc., to reduce the number of red blood cells.

History
Passages from the Ebers Papyrus may indicate that bloodletting by scarification was an accepted practice in Ancient Egypt. Egyptian burials have been reported to contain bloodletting instruments.

In Greece, bloodletting was in use in the fifth century BC during the lifetime of Hippocrates, who mentions this practice but generally relied on dietary techniques. Erasistratus, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood and advised that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and vomiting. Herophilus advocated bloodletting.

Archagathus, one of the first Greek physicians to practice in Rome, also believed in the value of bloodletting “Bleeding” a patient to health was modelled on the process of menstruation.

Hippocrates believed that menstruation functioned to “purge women of bad humours”.

During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting.

The Talmud recommended a specific day of the week and days of the month for bloodletting, and similar rules, though less codified, can be found among Christian writings advising which saints’ days were favourable for bloodletting. During medieval times bleeding charts were common, showing specific bleeding sites on the body in alignment with the planets and zodiacs.

Islamic medical authors also advised bloodletting. It was practised according to seasons and certain phases of the Moon in the lunar calendar. The practice was probably passed by the Greeks with the translation of ancient texts to Arabic and is different than bloodletting by cupping mentioned in the traditions of Prophet Muhammad.

When Muslim theories became known in the Latin-speaking countries of Europe, bloodletting became more widespread. Together with cautery, it was central to Arabic surgery; the key texts Kitab al-Qanun and especially Al-Tasrif li-man ‘ajaza ‘an al-ta’lif both recommended it.

Even after the humoral system fell into disuse, the practice was continued by surgeons and barber-surgeons. Though the bloodletting was often recommended by physicians, it was carried out by barbers. This led to the distinction between physicians and surgeons. The red-and-white-striped pole of the barbershop, still in use today, is derived from this practice: the red symbolizes blood while the white symbolizes the bandages.

A number of different methods were employed. The most common was phlebotomy, or venesection (often called “breathing a vein”), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck.

In arteriotomy, an artery was punctured, although generally only in the temples. In scarification, the “superficial” vessels were attacked, often using a syringe, a spring-loaded lancet, or a glass cup that contained heated air, producing a vacuum within.

There was also a specific bloodletting tool called a scarificator, used primarily in 19th century medicine. It has a spring-loaded mechanism with gears that snaps the blades out through slits in the front cover and back in, in a circular motion. The case is cast brass, and the mechanism and blades steel. One knife bar gear has slipped teeth, turning the blades in a different direction than those on the other bars.

Leeches could also be used. The withdrawal of so much blood as to induce syncope (fainting) was considered beneficial, and many sessions would only end when the patient began to swoon.

Bloodletting was used to treat almost every disease. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmic problems, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases.

Bloodletting was even used to treat most forms of haemorrhaging such as nosebleed, excessive menstruation, or haemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation.

Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed.

Leeches became especially popular in the early nineteenth century. In the 1830s, the French imported about forty million leeches a year for medical purposes, and in the next decade, England imported six million leeches a year from France alone. Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe.

Controversy
Bloodletting gradually declined in popularity over the course of the 19th century, becoming rather uncommon in most places, before its validity was thoroughly debated. In the medical community of Edinburgh, bloodletting was abandoned in practice before it was challenged in theory, a contradiction highlighted by physician-physiologist John Hughes Bennett Authorities such as Austin Flint I, Hiram Corson, and William Osler became prominent supporters of bloodletting in the 1880s and
onwards, disputing Bennett’s premise that bloodletting had fallen into disuse because it did not work.

These advocates framed bloodletting as an orthodox medical practice, to be used in spite of its general unpopularity. Some physicians considered bloodletting useful for a more limited range of purposes, such as to “clear out” infected or weakened blood or its ability to “cause haemorrhages to cease”—as evidenced in a call for a “fair trial for blood-letting as a remedy” in 1871.

Phlebotomy
Bloodletting is used today in the treatment of a few diseases, including haemochromatosis and polycythemia; however, these rare diseases were unknown and undiagnosable before the advent of scientific medicine. It is practiced by specifically trained practitioners in hospitals, using modern techniques, and is also known as a therapeutic phlebotomy.

In most cases, phlebotomy now refers to the removal of small quantities of blood for diagnostic purposes. However, in the case of hemochromatosis, bloodletting (by venipuncture) has become the mainstay treatment option. In the U.S., according to an academic article posted in the Journal of Infusion Nursing with data published in 2010, the primary use of phlebotomy was to take blood that would one day be reinfused back into a person.

In Alternative Medicine.
Though bloodletting as a general health measure has been shown to be ‘pseudoscience’, it is still commonly indicated for a wide variety of conditions in the Ayurvedic, Unani, and traditional Chinese systems of alternative medicine.

Unani is based on a form of humorism, and so in that system, bloodletting is used to correct supposed humoral imbalance

Cupping therapy.

Cupping therapy is a form of alternative medicine in which a local suction is created on the skin with the application of heated cups. Its practice mainly occurs in Asia but also in Eastern Europe, the Middle East, and Latin America.

Cupping practitioners attempt to use cupping therapy for a wide array of medical conditions including fevers, chronic low back pain, poor appetite, indigestion, high blood pressure, acne, atopic dermatitis, psoriasis, anaemia, stroke rehabilitation, nasal congestion, infertility, and menstrual period cramping.

Scientific Evaluation
The American Cancer Society notes that “available scientific evidence does not support claims that cupping has any health benefits” and also that the treatment carries a small risk of burns. Cupping is often practiced along with other acupuncture therapies and therefore cannot exclusively account for resultant positive benefits.

Method
Cupping therapy types can be classified using four distinct methods of categorization. The first system of categorization relates to “technical types” including: dry, wet, massage, and flash cupping therapy.

The second categorization relates to “the power of suction related types” including: light, medium, and strong cupping therapy.

The third categorization relates to “the method of suction related types” including: fire, manualsuction, and electrical suction cupping therapy.

The fourth categorization relates to “materials inside cups” including: herbal products, water, ozone, moxa, needle, and magnetic cupping therapy.

Safety
In 2016, the Cambodian Ministry of Health warned that cupping could be a health risk and particularly dangerous for people with high blood pressure or heart problems. According to the NCCIH “Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis”.

Cupping may cause breaks in the capillaries in the papillary dermis layer of the skin, resulting in the appearance of petechiae and purpura.

These marks are sometimes mistaken for signs of child abuse when cupping is performed on children.

Cupping therapy adverse events can be divided into local and systemic adverse events. The local adverse events may include scar formation, burns, linear bruising or streaks (wet cupping), skin ulcers, undesired darkening of the skin, induction of the Koebner phenomenon in susceptible individuals with psoriasis, and pain at the cupping site. A theoretical risk of infection exists but there are no reports of this as of 2012.

Dry cupping
Dry cupping involves the application of a heated cup on the skin of the back, chest, abdomen, or buttocks. The cooling of the air is then thought to create a suction effect. Bamboo and other materials are some times used as alternatives to glass cups.

Fire cupping

Fire cupping involves soaking a cotton ball in almost pure alcohol. The cotton is clamped by a pair of forceps and lit via match or lighter, and, in one motion, placed into the cup and quickly removed, while the cup is placed on the skin. The fire uses up all the oxygen in the cup which creates a negative pressure inside the cup.

The cup is then quickly placed onto the body and the negative pressure “sucks” the skin up. Massage oil may be applied to create a better seal as well as allow the cups to glide over muscle groups (e.g. trapezius, erectors, latissimus dorsi, etc.) in an act called “gliding cupping” or “sliding cupping”. Dark circles may appear where the cups were placed because of capillary rupture just under the skin. There are documented cases of burns caused by fire cupping.

Wet Cupping Hijama (Arabic)

Wet cupping is also known as Hijama (Arabic: حجامة lit. “sucking”) or medicinal bleeding, where blood is drawn by local suction from a small skin incision.

The first reported usages are found in the Islamic hadith, sayings attributed to or describing the actions of the Islamic Prophet Muhammad.

As a result, wet cupping has remained a popular remedy practiced in many parts of the Muslim world.

In Finland, wet cupping has been done at least since the 15th century, and it is done traditionally in saunas. The cupping cups were made of cattle horns with a valve mechanism in it to create a partial vacuum by sucking the air out.

Cupping is still practiced in Finland as part of relaxing and/or health regimens.

Traditional Chinese Medicine

In Chinese, cupping is known as “pulling-up jars” . According to traditional Chinese medicine (TCM), cupping is done to dispel stagnation (stagnant blood and lymph), thereby improving qi flow , in order to treat respiratory diseases such as the common cold, pneumonia and bronchitis.

Cupping also is used on back, neck, shoulder and other musculoskeletal conditions.

Its advocates claim it has other applications as well. Cupping is not advised, in TCM, over skin ulcers or to the abdominal or sacral regions of pregnant women.

Society and Culture
Cupping has gained publicity in modern times due to its use by American sport celebrities including National Football League player DeMarcus Ware and Olympians Alexander Naddour, Natalie Coughlin, and Michael Phelps.

Professional swimmer Michael Phelps received publicity during the 2016 Olympics for the purple bruises evident on his back resulting from cupping. He has been known to “do it before every meet he goes to” in order to “speed up recovery” . Celebrity endorsements similar to Michael Phelps may create biases in individuals who report the benefits or their experiences with therapies such as cupping.

RAKTA MOKSHA AYURVEDIC THERAPY FOR BLOOD PURIFICATION, CLEANSING

Rakta Moksha , also called bloodletting, is a traditional Ayurvedic treatment method for the removal or displacement of impure blood from the affected body part. Rakta Moksha therapy is also regarded as one of the five detoxification procedures in Panchakarma.

Rakta dhatu is one of the seven dhatus or bodily tissues. When the Rakta dhatu is healthy, it enhances the individual’s complexion and enables the proper nourishment of the muscles and other tissues.

In its vitiated state, it leads to several diseases like mukhapaka (oral ulcers), raktapitta (epistaxis), vaivarnya (discolouration of skin), kushta (skin diseases), gulma (tumour), etc. Acharya susrutha and vagbata included it under pancha shodhana procedure , but charaka does not included it under shodhana

Some of the factors that produce toxins in blood, according to Ayurveda, are:

• Excessive consumption of salt, sour, unctuous, and heavy foods
• Alcohol intake
• Overeating
• Sleeping immediately after meals
• Excessive exposure to sun or heat
• Stress

By letting out the blood through Rakta Moksha therapy, all the problems caused due to vitiated blood can be eliminated. It can be performed along with other therapies like Virechana, Vamana, Nasya, and Vasti to balance the doshas as well as the energies that control the biological functions in the body.

Rakta Moksha Procedure
There are two categories in the way the Rakta Moksha treatment is performed.

1 – Shastra Visravana
Shastra Visravana therapy is performed using metal instruments. In this therapy, the blood is let out through two procedures:

1. Siravyadha (puncturing the vein)
2. Pracchana (creating several incisions over the skin)

2 – Anushastra Visravana
The therapies in Anushastra Visravana are performed without using metal instruments.

They are of four types:
Jalouka Vacharana: Application of jalauka or leeches are preferred in cases of vitiated Pitta doshas in blood.
Alabu: Due to the bitter, dry, and pungent nature of calabash gourd, it is useful for bloodletting in Kapha dosha vitiation. This procedure involves making multiple incisions on the skin and then extinguishing an ignited wick over the affected area to create a vacuum that drains the blood out.
Shrungavacharana: Here, the Shrunga or horn of a cow is used to bring out blood in Vata dosha vitiation.
Ghati Yantra: The method of extracting blood is similar to Alabu therapy, but it uses a pot instead of the gourd.

Indications

• General indications for Raktmoksana
• Swelling, burning sensation, suppuration, rashes, vatharaktha, skin diseases, elephantiasis, toxic conditions of blood, fibroid, tumor, mastitis, debility, heaviness of body, conjunctivitis, sinusitis, herpes, liver abscess, spleen abscess,
  suppuration and burning sensation in ears, nose, lips, oral cavity, headache, gonorrhoea, bleeding disorders.
• Leukoderma, Psoriasis, leprosy, Eczema, Urticaria, Hives, Varicose veins, Enlarged liver or spleen
• Trigeminal Neuralgia

Contraindications
Anasarca, emaciated person, pregnancy, suffering from diseases such as anemia, hemorrhoids, ascites, consumption and dropsy.
Young children, Old age, Pregnancy, Menstruation, Anaemia, Jaundice, Tuberculosis, Diabetes

Rakta Moksha Benefits

• Expels out disease-causing vitiated blood from the body
• Prevent tumours and oedema
• Helps to balance Pitta dosha aggravation
• Beneficial in bleeding disorders
• Prevents allergies and repeated hives
• Helps to manage high blood pressure and arthritis
• Treats chronic diseases, such as psoriasis

Acharya Sushrutha mentioned Raktamokshana as one among the five purification procedure (Panchakarma). It is the procedure of letting out vitiated blood from the body

Importance of Blood in the body:

Blood maintains and supports the body like roots supporting the tree. So the blood is considered as life (jeeva).
When blood gets vitiated by doshas it causes various diseases. Rakthamokshana is that procedure which expels out vitiated blood from the body.

Person fit for Rakthamokshana
Person not afflicted with excess cold, hot, excess of sweating and exposure to sun. Prior to rakthamokshana person should take barley juice.

Symptoms of proper blood flow
Feeling of lightness of body, subsiding of pain and severity of diseases, cheerfulness of mind.

Cause for excess flow of blood
Rakthamokshana done during excess sweating, hot season and due to deep puncturing.

Treatment for Atiyoga
Treatment for excess blood flow:

Apply the paste prepared of

1. Lodhra (Symplocos racemosa), Sarja (Vateria indica), Rasanjana (aqueous extract of Berberis aristata), Barley, Wheat made paste with Gairika (Red Ochre).
2. Paste of burned particles of snakes skin and silk cloth.
3. Sprinkle cold water over face.
4. If bleeding does not stop by these methods then stopped by Agnikarma (Cauterization) and Ksharakarma (alkali application).

Cause for inadequate blood flow.
Rakthamokshana done for person afflicted with cold, excess sleep, giddiness, unconsciousness, fear, debility, done at empty stomach, when not passed the bowel, urine and flatus.

Importance
Diseases of the skin, tumours, oedema and diseases arising from blood will never occur in persons indulging in blood letting (whenever required). Rakthamokshana is considered as ardha chikitsa and due to asraya asrayi bhava it acts on pitha also Season for Raktamokshana

Season for Rakthamokshana Panchakarma therapy:
Sharat rut (Autumn season).

Blood vitiated by vata, pitta and kapha should be removed from the body using

Shrunga (horn of animals),
Jalauka ( leech therapy) and
Alabu (pitcher gourd) respectively.

For Vata Dosha vitiated blood, Shrunga Horn method is used.
For Pitta vitiated blood, leech therapy is used.
For Kapha vitiated blood, pitcher gourd (Alabu) is used.

Leech therapy
Leech therapy is considered easy and convenient blood letting therapy.

Types, method of application
Types of Leech:
12 types:

6 Poisonous leeches and 6 Non poisonous leeches

Method of application of leech:
Selected leeches are collected, to bite effected area which is washed priorly with antiseptic solution. Once they start sucking the blood, it is covered with moist cloth. Once it completes sucking the vitiated blood, they leave the site to fall off itself. Then the area is rubbed with turmeric powder which helps to stop the bleeding.

Indications
Indications for leech therapy:
Children, old aged, frightful , debilitated, women and persons of tender constitution.

Shrunga
Shrunga (Blood letting using cow’s horn)
Selected cow’s horn is collected which is open at both end. Superficial multiple small incisions are made over the affected area which is cleaned priorly with antiseptic solution. The larger open end is kept over the incised area and blood is sucked through other end.

Alabu
Alabu (Blood letting through pitcher guard)
Medium sized selected pitcher is opened at the top to remove pulp and seed, dried under sun till it is hard. Affected part is cleaned with antiseptic solution, multiple vertical incisions made over the site. An ignited wick is kept straight over the area and closed with the pitcher guard, the fire extinguishes creating the vacuum inside the pitcher which drains out the blood which gets collected at margins of pitcher.

Prachana (Blood letting by puncturing)
A tourniquet is applied slight above the affected area. Using a sharp instrument, multiple incisions are made avoiding vital structures. Incisions are made in upward direction, not very deep nor superficial, not very closely placed, should not be done transversely and made very quickly.

Siravedha (Venepuncture)
Venepuncture is considered superior. Just as bunds of channels in the fields break off, the standing grains are destroyed from its roots completely similarly, this procedure is able to destroy the diseases from its roots completely.

In Shalya Tantra, Venepuncture is considered as half complete therapy for numerous diseases, as blood bieng the pathogenic factor in most of the diseases.

Procedure
A tourniquet is tied above the selected area. The vein is tapped with fingers to make prominent, which is then punctured using sharp instrument. Once the vitiated blood flows out completely, then the area is tightly bandaged to arrest bleeding.

Contraindications for venepuncture.
Who has undergone excess sweating and Panchakarma therapy, pregnant woman, jaundice, indigestion, Convulsions, paralysis, diarrhoea, vomiting, Asthma, cough, bleeding disorders, haemorrhoids, anaemia, Traumatic injury, it should not be done in veins which runs transversely,when tourniquet not been tied above the selected site, when a vein is not engorged with blood, when the weather is extremes.

Blood Donation
How Can Blood Donation Therapy help with hypertension?

As per Ayurveda , every healthy individual has to undergo seasonal detoxification (Panchakarma) to keep the body free from disease causing toxins.
High BP is associated with blood tissue, which in turn, is related with Pitta Dosha. Blood tissue and blood pipes are directly controlled by Pitta Dosha.

Pitta Dosha naturally increases in all of us during Autumn season (September end to November). During this season , Virechana purgation therapy is advised to everyone, to keep Pitta under balance.

Virechana expels toxic Pitta out of the body. Similarly, blood letting is also useful in expelling out Pitta Dosha from the body. Blood tissue related diseases such as hypertension, bleeding disorders, allergies such as repeated hives, chronic skin diseases such as psoriasis are immensely benefited by blood letting therapy.

Autumn Season Healthy Regimen
If you are averse to get blood-letting therapy in an Ayurveda center, you can easily donate your blood once a year, during autumn season. Though blood donation is not exactly equivalent to blood-letting therapy, it is useful to some extent for sure.

For this reason, many healthy people are advised to donate blood by their Ayurvedic doctors. For all healthy people, blood donation, at least once a year is good. It improves your health and also saves someone else,s life. Then why not do it in Autumn season?

Conclusion

Raktamokshana (Bloodletting), a popular para surgical procedure in Ayurvedic system of medicine is time tested. It answers several chronic problems of ill health. It has been practiced in some form by almost all societies and cultures. At various times bloodletting was considered part of the medical treatment for nearly every ailment known to man.

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