Abstract
The measurement of viscosity of blood plasma using in vitro techniques only gives us partial information about the characteristics of blood flow however they provide information regarding the rheological properties of blood which is helpful in developing new hemorheological therapeutic modalities. In the past few years the evidence based approaches have given us a better way to understand the clinical role of therapeutic hemapheresis in various diseases for patients which gives better results and information regarding the different uses of therapeutic hemapheresis. Hemapheresis is related to raktamokshana therapy of Ayurveda; it is mainly described by Acharya Shushruta in sushruta samhita. Various indications of hemapheresis were given in ayurveda and modern therapy.
Introduction
Hemapheresis words come from Greek words heme and apheresis.In Greek "Heme"means blood and apheresis means to take away or separate. Hemapheresis treatment is used for different spectrums of illness.In this procedure abnormal cells are removed from blood to treat the hematologic, oncologic and neurological disorders. Replacement of abnormal cells with the normal constituent of blood also help in increasing the immunity, improving the retico endothelial function or increase the responses of conventional therapy. Therapeutic hemapheresis with the use of automated blood processing equipment is very useful in selectively deplete, exchange, replace or atleast manipulation of soluble blood components.
Procedure Of Hemapheresis
Hemapheresis is the procedure which involves removal of blood from a patient or donor. It is done with the help of a centrifuge machine which helps to separate the components of blood after this separation. One which needs to be drawn is withdrawal and rest of the components transfused back in the body of the patient or donor. Blood components which are separating and withdrawn out are:
- Plasma - plasmapheresis
- Platelet - plateletpheresis
- Leukocyte - Leukapheresis
Therapeutic Indication Of Hemapheresis
- Thrombotic thrombocytopenic purpura
- Guillain Barre Syndrome
- Leukaemia Induced Leukocytosis
- Myasthenia Gravis
- Multiple Sclerosis
- Hypertriglyceridemia
- Leukostasis
- Myeloproliferative
- Lymphoma
Contraindication Of Hemapheresis
- Bleeding disorder
- Anaemic patient
- Patient taking medicine like - vitamin e, aspirin, heparin
- Vasovagal reactions
- Discomfort
- Hypovolemia And Hypotension
Ayurvedic Correlation Of Hemapheresis
In ayurveda hemapheresis is related to raktamokshan which is further divided into various raktashodhana techniques which has immense potential to treat blood related disorders. Due to wider studies given in ayurveda it helps in clearing all the misunderstanding, misconceptions related to the therapy and reestablishing our ancient techniques. Raktamokshan is considered to be one of the panchkarma that is why it is considered as ardha chikitsa of shalya tantra.
According to ayurveda, Rakta is considered to be one of the seven dhatu from ras, rakta, mas ,meda, asthi, majja and shukra. These all are body tissues as we know different diseases occured with disruption of these dhatus and to maintain a good health these all should work properly. The word rakta comes from the Sanskrit word "ras ranjane" meaning red colour. As per Acharya sushruta the symptoms of purified blood (Shuddha Rakta) is as follows :-
Blood which looks like indragopa (beetle), it is not thick and discoloured. When the blood is vitiated from its normal property then it is needed to purify. In ayurveda many raktashodhak drugs were given. If someone needed instant results for this then raktamokshan can be done as guided in Ayurvedic medicinal textbooks.
Raktashodhak Drugs
1. Neem (Azadirachta Indica)
Neem Properties
- Rasa - Tikta (bitter), Kashaya (Astringent)
- Guna - Laghu (easily digestible), Ruksha (dry)
- Vipaka (taste conversion after digestion) - Katu (pungent)
- Virya - Potency (Cold)
Neem is considered to be a very useful drug in purifying the blood . Neem is considered to be sheet (it has cooling properties), krimi hur (helps in removing bacteria and other microbes from body) and kushthahara (helpful in many skin diseases) these all properties ultimately help in purifying blood.
2. Manjishtha (Rubia Cordifolia)
Manjishtha Properties
- Rasa - Tikta (bitter), kashaya (astringent), Madhura(sweet)
- Guna - Guru (heavily digestive), Rooksha (Dry)
- Vipaka - Katu (pungent)
- Virya (potency) - Ushna (hot)
This ayurvedic herb is extensively used for skin related disorders like eczema i.e it is useful in purifying the blood. This is categorised under the group of varnya - which means it enhances the skin complexion.
3. Amla (Phyllanthus Emblica)
Amla Properties
- Rasa - It Has Five Taste - Sour, Sweet, Bitter, Astringent And Pungent
- Guna - Guru (heavy to digest), sheeta (coolant)
- Vipaka - Sweet (madhura)
- VIrya - Cold (sheeta)
It has properties like anti ageing (vyavasthapan), removing any fault in dosha (sarvadoshaghan), relieving any burning sensation (dahahara) due to these properties it helps in purification of blood.
4. Haritaki (Terminalia chebula)
Haritaki Properties
- Rasa - Sour, bitter, sweet and astringent
- Guna - Easy to digest (laghu), dry (rooksha)
- Vipaka - Sweet (madhura)
- Virya - Hot potency (usha)
Haritaki has many properties which help in purifying blood like it is said tobe - (dosha ghan) natural detoxifier and (shothanut )relieves information.
5. Bibhitaki (Terminalia Bellerica)
Bibhitaki Properties
- Rasa - Kashaya (astringent)
- Guna - Rooksha (dry), laghu (easy to digest)
- Veepaka - Madhura (sweet)
- Virya - Ushan (hot)
It balances kapha and pitta so if in blood these doshas are imbalanced this will be very helpful.
6. Guduchi (Tinospora Cordifolia)
Guduchi Properties
- Rasa - Kashaya (astringent), tikta (bitter)
- Guna - Laghu (easy to digest), snigdha (oily)
- Vipaka - Madhura (sweet)
- Virya - Ushna (hot)
Guduchi is also known as amrita or giloy. It has many therapeutic properties like antioxidants, antidiabetic, antispasmodic, immunity enhancer, stress etc. these all are helpful in purifying blood components and is also helpful in diseases like gout, arthritis, jaundice, fever.
7. Gambhari (Gmelina Arborea)
Gambhari Properties
- Rasa - Tikata (bitter), kashay (astringent), madhura (sweet)
- Guna - Guru (heavy in digestion)
- Vipaka - Katu
- Virya - Ushna (hot)
It is a fast growing plant with numerous branches. It has many medicinal properties and also grown as ornamental, known as avenue tree.
8. Kackdummer (Ficus Hispida)
Kackdummer Properties
- Rasa - Tikta (bitter), Kashaya (astringent)
- Guna - Laghu (easy to digest), Ruksha (dry)
- Vipaka - Katu (pungent after digestion)
- Virya - Sheeta (cold)
It helps in reducing pitta dosha in the body and is also helpful in treating diseases like eczema. This is also known as the opposite leaf fig. It is very helpful in skin disease, wounds, fever and increases breast milk in lactating women.
Raktamokshana
It is a surgical procedure which is used in ayurveda for different diseases caused due to vitiation of blood. Raktamokshan can be done with different techniques as given in ayurveda like: Siravaid (ShastraVisaravana and Anushastra Visaravan), Jalukavacharana, Shringi avachara, Alabu - avachara, Ghati Yantra avachara. Rakta shodhana procedures can be chosen according to the dosha involved in the particular disease i.e In Vata sringi and Siravedha can be used whereas in pitta jalauka is used and in kapha alabu is used. Let's have a look at them one by one!!
Siravedhana Karma
In this procedure venesection is done on a particular site. It is recommended in many diseases like sandhigata vata , vatakantaka etc it gives results immediately and effectively.
Sringa (Cow Horn)
In this procedure cow horn is used for raktamokshana. Sringa has two ends, one end is kept on the incision site and from the other end blood is sucked. It has Rasa - Madhur (sweet), Guna - Snigdha (oily), Veerya - Ushna (hot) thus used in vata predominance pittaja vyadhi.
Alabu
This is a pitcher gourd which is used for raktamokshana (bloodletting). It has properties which are helpful for vitiation of blood due to kapha dosha. Those properties are as follows: Rasa - katu, Guna - ruksha, Virya - teekshana.
Jalauka Avachara
Jalaukavacharana is known as hirudotherapy or medicinal leechtherapy in modern times. It is not used just as preventive treatment. It is used as a para surgical procedure of rakta mokshana mainly for pitta related blood disorders. In this procedure bloodletting is done by jalauka (leech) . During this procedure jalauka sucks 5-15 ml of blood. Leech saliva contains many bio active substances that are very useful like anticoagulants, anti inflammatory, anaesthetics etc In this procedure bloodletting provides individuals with good health. Leech saliva has many bio active components that's why it is very useful. It has anti inflammatory, antibiotic, anti platelet aggregation factors, analgesic properties. Due to these properties the flow of blood increases which helps in decreasing symptoms of diseases.
Conclusion
Hemapheresis is a technique which helps in treating many medical and surgical diseases and conditions with minimum side effects or complications. Evidence based study shows that this technique is advantageous for the health of individuals. In ayurveda it is considered to be very useful for many diseases since many centuries. Demand of Raktamokshana is increasing day by day. Ayurvedic physicians who have proper knowledge of Raktamokshana are successfully treating many diseases with this procedure.
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