Charka samhita, susruta samhita, Ashtanga Hridaya are the Brihat samhita of ayurveda while madhav nidana, sharangdhara samhita, bhava prakasha , Yogratnakar etc. are the Laghutrayi.  These all Samhita mentioned Panchakarma to Purify whole body and not to have a recurrence of disease. Raktamokshana (blood letting) is one of these panchakarma mainly described by Acharya Sushrut. Sushrut mentioned Raktamokshana as one of the important means of treatment of different types of Urdhwajatrugata vyadhi.

About Raktamokshana by Jalauka:

Rakta dushtijanya vyadhi demarcates the resistant nature of the disease to respond to general line s of treatment i.e either vyadhi pratyanika or dosha pratyanika chikitsa. According to classics, the properties of Jalauka are Sheeta, Madhura and Pittahara as well as efficacy has been emphasized in the Raktadushtijanya vyadhi. So Jalauka (leech) application will be useful in diseases of Netra (Eye), since eye is pitta dosha pradhan vyadhi. Also In Shirorogas (Headache) since Rakta is main dushya (etiological factor) in Shiroroga. In Mukhroga where Kapha Rakta Dushti present.

A local effect is due to several active leech substances, which the leech introduces into the site of application, like Hirudin, Calin, Hyaluronidase, eglin, Haematin. Hirudin is anti coagulant which inhibits conversion of firbrinogen to fibrin, thus preventing blood clotting.

Jalukacharana Procedure:

Purvakarma (before procedure)
Proper snehana (oleation) and swedana (sudation) of the patient
Purification of leech by pouring the leech in haridra (turmeric powder) and water
Part preparation – cleaning of place by turmeric water

Pradhana karma (main procedure)
Application of honey or blood or butter or by prachchan (making scar) at the desired site
Application of leech through its front end
Cover the leech by wet cotton
Removal of leech by dusting haridra churna (turmeric powder) after completion of blood letting

Paschata karma (after procedure)
Induction of emesis to the leech by dusting of haridra churna (turmeric powder) on its mouth
Sometimes pressing the leech from caudal to front end is required for proper emesis
Leech should be freed in fresh water, where it swims swiftly and then settles down.
Replace the leech in a clean jar or aquarium
Dusting of  Lodhra churna and bandaging over the bite site

Uses of Jalauka in Urdhwajatugata vyadhis:-
In our OPD we are applying jalauka successfully since many years on following diseases  percentwise:
1.Migrain( Suryavarta or Ardhavbhedaka)      30%
2.Glaucoma(Adhimantha)                                30%   
3.Deafness(Karnabadhirya)                             10%
4.Subconjnctival hemorrhage. (Arjuna)             5%
5.Periorbital hematoma (Shyav vartma)            5%
6. Alopecia areata (Indralupta)                          5%
7.Herpiz zoster opthalmaticus. (Netra visarp)   5%
8.Frozen shoulder (Skandha graha)                    2.5%
9. Mukhpak, Jivapaka (Stomatitis)                     5%
10. Dacrocystitis (puyalasa)                              2.5%

Frequency of leech application is varied in each case depending upon severity of disease.
In cases like Glaucoma, Herpiz Ophthalmaticus We Applied weekly twice for 4-5 sittings.

This article is published under guidance of Dr.M.A.Lahankar , HOD and Asso. Proff. Shalakyatantra department, R.A.Podar (Ayu) college, Mumbai.