Panchakarma Treatment – Detoxification of Body

This video is about a short introduction to panchakarma and its constituent procedures like Vaman, Virechana, Basti, and Nasya.

Susruta Ayurveda

Leech Therapy in Ayurveda

Leech therapy / Hirudino therapy / Jalokavcharana (JA) can be traced from ancient civilizations when Ayurveda was in the scripting phase. The novel Ayurveda text Sushruta Samhita devoted a complete chapter on hirudin/leech therapy. Earlier leech was widely used in practice but by time in the early 20th century, this therapy had a major setback due to the origin and evolution of antibiotics. But later on, it again regains its value for action along with a part of reconstructive surgeries. During this period, many research works were conducted on various medical conditions. This article emphasizes a brief review of leech therapy / JA described in Sushruta Samhita.

Leech Therapy

In Ayurvedic classics, Raktmokshana (bloodletting) is a major reform indicated in the management of Rakta and Pitta Dosha disorders. Bloodletting has two media depending on the equipment or utility used to perform that. It can either be done with the help of Shastra (sharp instrument) or Without Shastra.

Jaloka/Leech is described under Ashastrakrit Raktmokshana and is classified into two specified categories based on the toxicity created by their bite and their habitat, the Savisha (poisonous), and Nirvisha (non-poisonous). Savisha is not fit for therapeutic use while Nirvisha is fit for therapeutic use. Further, these are subdivided into six types, each based on their morphological character or phenotypic properties.

Non-Poisonous Leech /Nirvisha Jalokas

They are obtained from freshwater sources. Large in size, quick in sucking the blood. They live in deep water and don’t feed on rotten or dumpy food material.

  • Kapila (Body is slightly yellowish like Reaglar and texture is like Moonga)
  • Pingala (Slightly reddish in color, round in shape, and quick in movement)
  • Sankumukhi (slightly blackish or brownish like liver, lengthy, quick in sucking)
  • Musika (look and smell like a rat)
  • Pundarikamukhi (Colour like Moonga and mouth is like the lotus)
  • Savarika (slimy, looks like a lotus leaf, 27 cm long, and can be used in the animal also).

Savisha Jalokas

They are dependent on rotten, turbid, contaminated water, and dead marine cadavers for their food. Their accidental bite can make an individual suffer localized complaints like inflammation, excessive itching, burning sensation, and systemic complaints such as vomiting, febrile state, unconsciousness, confusion, and lethargy. Treat such conditions, should be treated as Visha (Poisoning) or like disorders of Pitta and Rakta Dosha.

  • Krishna (black colored with a big head)
  • Karbura (like an earthworm and lined stomach)
  • Algarda (haired body, big sides, and black mouth)
  • Indrayudha (varied in color like a rainbow)
  • Samudrika (like a flower and black and yellow dots on the body)
  • Gochandana (divided into two like the testis of an Ox and a small upper body)

Acharya Sushruta mentioned their general property as Sheeta Virya (cold potency), Madhura Rasa (sweet), and aquatic habitat.

Collection and Breeding of Leeches

Acharya mentioned that they can be captured or collected with the help of wet leather or to attract them butter or some drops of milk can be poured over a piece of meat.

  • After collection, they are stored in the earthen pot and filled with some amount of mud and freshwater.
  • Dried meat, chestnut, some algae, or pieces of lotus stem should be poured into a pot as food for them. Nowadays many aquariums use flour to feed them.
  • Some kind of animal fodder can be used to provide as a source for resting or sleeping in the aquarium.
  • Every 3 days, the water should be replaced with fresh one.
  • After every 7 days, the earthen pot should be replaced with a new one and keep them away from some sought of contamination.

The classic methodology of JA/Leech therapy

They are applied in various disorders with a specified protocol mentioned in Classics To obtain the best-desired outcome it is to be performed under the observation of experts as in some patients they can cause anaphylactic shock or some local allergic reaction.


JA is a supreme treatment modality indicated in many diseases such as skin conditions like psoriasis, eczema, acne, facial melanosis, alopecia, herpes zoster shingles, varicose vein, some other leprotic conditions, and cellulitis, and reported efficacy in disorders like rheumatoid arthritis, diabetic foot, a non-healing or venous ulcer, filariasis, osteoarthritis of knee joints, thrombosed pile mass. However, in the current era, their scope of application has been boosted so other than these conditions they are also used as a primary or secondary mode of treatment.


JA is, however, there is no clear literature available regarding contraindication but contraindication for bloodletting is well mentioned in various diseases like generalized edema over the whole body, a person who got emaciated due to intake of sour dietic intake, anemic patients, a person suffering from piles-in-ano, any disease associated with abdominal organ, individual suffering from TB, pregnant ladies and if there is any inflammatory condition present in the body.

Bloodletting is also contraindicated in rainy times, when there is a flow of cold breeze, just after intake of a meal or if an individual has not properly undergone therapeutic heating of that particular part of the body.

Further, there is also the exclusion of individuals who are suffering from psychological conditions like delirium, unconsciousness, physically exhausted patient, sleep or scared person. So, it can be assumed that JA should also not be performed in all these conditions.

Pre-procedure measures-

  • Initially, it is mandatory to assess the patient and his disorder regarding the fitness for JA
  • Necessary blood investigations are carried out such as Hb%, CT/BT, and some serological investigations like VDRL/HIV/HCV, etc.
  • After the fitness of the patient, a thick paste of mustard seed and turmeric is applied on Jaloka and then transferred to turmeric water for approximately 10-15 min till they get active and regain their motility.
  • Then the site to which it is applied is rubbed with cow dung powder or with a broken part of an earthen pot to make the surface rough to some extent. As on a smooth surface, Jaloka may slip due to its slimy touch. Leech is being made still on that particular part so that they catch the skin with their Jaws and start sucking the blood.
  • If they don’t then a few drops of milk or blood are poured on that part or some south of pricking is made to facilitate the action.

Procedure of JA

  • On catch some sought of the bite is felt by the patient as if some prick by ant or needle
  • During sucking Jaloka assumes the shape of a horseshoe in the raised and arched position and also during this moment it is covered with a piece of a thin and wet piece of white cotton or gauge that provides a cooling effect and favorable habitat to them.
  • It gets detached after completing its feed. If it doesn’t get detach automatically then some pinches of turmeric are poured into their mouth.

Post-Procedure of JA

  • After the detachment of Jaloka, it is transferred to a kidney tray, and efforts are made to regurgitate the ingested blood by them pouring turmeric powder on them and by squeezing them from tail to their mouth to get the whole amount of blood out which was sucked by them.
  • They are transferred back to the pot from which they are taken out.
  • A reduction in signs and symptoms of the disease is a sign of proper JA. Shatdhautama Ghritama (prepared by washing ghee with cold water by 100 times) or honey is applied on the tiny wound made by them and proper bandaging is done.
  • On excessive bleeding high pressure, elevating the site in an anti-gravity direction, Yavkshara application (Caustic medicated powder), or some other anti-hemorrhagic measures can be taken.


  • It should always be performed under an expert/skilled person.
  • They should be used only after 7 days of their prior use
  • One Jaloka shouldn’t be used on the other patient as it may transfer some diseases.
  • Ingested blood should be made out immediately after their detachment as ingested blood can hamper their normal body function and they may undergo some other abnormality and will be of no use from next time.

Cupping Therapy In Ayurveda

Cupping or Shringa is mentioned in classics as a Yantra for Raktamokshana which is referred to as the horn of animals. A cupping instrument is a sucking equipment that works on the principle of negative pressure. The broad end of Shringa is applied on the surface of the skin and the other narrow end is used for sucking blood during the procedure of bloodletting. Negative pressure inside the Shringa is generated by sucking (mouth suction or with the help of a syringe) from the narrower end which tends to move blood into Shringa. This act of bloodletting through Shringa is called Sringavacharana.

Shringa Yantra is indicated for Vata Doshjanya Vikara majorly situated in Twak DhatuGau Shringa Yantra is having Ushana(warm), Madhura (sweet), and Snigdha(oily) Guna which is opposite to Vata Dosha, Vagbhattacharya mentioned the Pramana of ideal Shringa that have three Angula Pramana Mukha (broad end), 18 Angula length, tiny Sidhdharthak Pramana distally (narrow end) and having shape similar to the breast of lady.


The use of Shringa is not widely accepted as it is considered unethical in Hindu civilized society as well as according to PETA. Secondly, it is a biodegradable product so can’t be used for a longer duration. It is difficult to properly sterilize it regularly so can act as media to transfer infection from one individual to other. To withstand this problem, it is replaced with modifying Shringa Yantras (Chinese Cups), which are cost-effective, easily available, and can be sterilized easily.

The application of cups is preferred as a substitute for Shringa, the disposable ones are preferable a high-level sterilization or disinfection process is required before reuse, since the pressure exerted may cause extravasation of blood and fluids from the skin. Nowadays, cupping therapy has increasingly been performed with plastic cups. The size of the cups varies according to the place of application, but it is often applied in places with abundant muscles, such as the back

Cupping therapy is being in an application for thousands of years in traditional Chinese medicine to treat many chronic conditions, such as low back pain, chronic arthralgia, radiculopathy, and respiratory disease. This therapy involves the application of an s hollow vessel for suction (generally a cup) to an affected area on the skin, this area is called an Acu-point. There are many types of cupping are practiced in China. The basic suction method of cupping therapy is called retained cupping generally used in common Chinese clinics.


In this method, practitioners utilize the flaming heating power to create a suction (minus pressure) inside the cups at the desired area of the body. Cupping can broadly divide into two subtypes:

  • Dry – Applying Cups on Acu-points for some time
  • Wet cupping (with controlled bleeding)- Bleeding cupping (wet cupping), in which practitioners make some small incisions/pricks before the application of suction cups. Researchers suggest that laceration of the skin and capillaries, promoted by wet cupping, may act as another nociceptive stimulus that activates the descending inhibitory pathways of pain control, thus helping to treat chronic musculoskeletal conditions

Several other subtypes of the Cuppings are-

  1. Cupping with retention (keeping cups on the skin or Acu-puncture points for 10–15 min)
  2. Moving to cup (sliding cups over the skin or acupuncture points with lubricants)
  3. Shaking-cupping (moving cups up and down repeatedly on skin or acupuncture points)
  4. Quick cupping (removing cups immediately when the skin is sucked in)
  5. Balance-cupping (composite manipulation, each dose including cupping with retention 6–8 min, moving cupping four times, shaking-cupping three times, and quick-cupping three times).



Although its exact mechanism is not known. Cupping aims to precipitate the circulation of blood and remove blood stasis and waste from the body. It extracts blood that is believed to be harmful from the body that turn rids the body of potential harm from symptoms leading to a reduction in well-being. Wet cupping has been used as an alternative treatment method throughout the world, especially in Asia, the Middle East, and Europe. Blood flow is the key to healing the damaged area. Bulging discs do not receive good blood flow; as a known fact that blood carries oxygen and nutrients to supply the cells with energy and recovery. Therefore, when blood flow finds it difficult to reach these areas, the patient starts to face these painful problems.

For example, Hijama therapy can be effective in eliminating toxins and promoting good blood flow in a specific area. When negative pressure gets applied to the skin, different endorphins get triggered for recovery. Hijama has so many other benefits and this healing procedure has been practiced for thousands of years.

Wet cupping may act as a nociceptive stimulus, which would trigger diffuse noxious inhibitory control, or by the removal of oxidants, which would decrease oxidative stress. Nitrous oxide release, as shown in acupuncture, maybe also a theoretical mechanism of action. The short- and long-term effects of wet cupping may be explained by a combination of mechanisms, including the affective component of chronic pain

Benefits of Cupping:

  • It is also indicated for an array of respiratory, neurological, gastroenterological, and gynecological disorders.
  • According to Hanaway, Cupping Therapy is indicated for blood disorders, pain relief, inflammatory conditions, mental and physical relaxation, varicose veins, and deep tissue massage and quotes up to 50% improvement in fertility levels.
  • Cupping is an ancient method of treatment that has been used in the treatment of a broad range of conditions.
  • Conditions like blood diseases such as hemophilia and hypertension, rheumatic conditions ranging from arthritis, sciatica, back pain, migraine, anxiety, and general physical and mental well-being.
  • By creating suction and negative pressure, it has been found to affect the body up to four inches into the tissues.
  • So it is used to treat muscle pain and spasms, drain excess fluids and toxins, and loosen adhesions, connective tissue, and stubborn knots in soft tissue.
  • It helps stimulate blood circulation and bring blood flow to nourish stagnant muscles and skin, enhance the flow of energy, stimulate the peripheral nervous system
  • It activates the lymphatic system, clears colon blockages, helps activate and clear the arteries, veins, and capillaries, and improves varicose veins.
  • Cupping draws the inflammation out, yet does not add to it. Due to its stimulating and strengthening effects, it has been used successfully to treat all of the following: bowel conditions (IBS, constipation, and diarrhea), headaches, back pain, arthritis, period pain, injuries, asthma, cellulite, fatigue (ME), anemia, depression and emotional problems, atrophy, sciatica, common cold and flu, skin problems, blood pressure, ladies’ problems, weight loss, and more.
  • In the field of dermatology, it has been used with varying degrees of success for the treatment of skin diseases. Now a day, the use of alternative therapies is rising, and the use of them may undoubtedly become more common.