ROLE OF RAKTAMOKSHANA BY JALAUKAVACHARANA IN INFLAMMATORY AND MICROCIRCULATORY DISORDERS: A CLASSICAL AND CONTEMPORARY REVIEW

Abstract

Background: Raktamokshana, one of the principal Shodhana therapies in Ayurveda, is employed for the expulsion of vitiated blood (Dushta Rakta) to alleviate a variety of disorders, particularly those of inflammatory and microcirculatory origin. Jalaukavacharana (leech therapy) is a specialized form of Raktamokshana recognized for its gentle, safe, and effective bloodletting, especially in delicate individuals and in conditions involving Pitta and Rakta vitiation. Modern studies have corroborated its utility in managing chronic inflammatory, vascular, and dermatological disorders by improving microcirculation, reducing inflammation, and modulating immune responses. Aim: To critically review the classical concepts, proposed mechanisms, clinical efficacy, and safety of Raktamokshana by Jalaukavacharana in the management of inflammatory and microcirculatory disorders. Objectives: To explore classical Ayurvedic references and indications of Jalaukavacharana. To examine the physiological and pathological rationale for bloodletting in inflammatory and circulatory disorders. To analyze the proposed mechanisms of action from both Ayurvedic and modern biomedical perspectives. To review clinical evidence and research findings on its efficacy and safety. To suggest future research directions for integrative therapeutic applications. Materials and Methods: A comprehensive literature review was conducted using classical Ayurvedic texts (Sushruta Samhita, Charaka Samhita, Ashtanga Hridaya), modern Ayurvedic treatises, and electronic databases (PubMed, Scopus, AYUSH Research Portal, DHARA, Google Scholar). Relevant clinical trials, case reports, and experimental studies published up to 2025 were analyzed. Results: Classical texts advocate Jalaukavacharana for a wide spectrum of conditions including Vatarakta, Kustha, non-healing ulcers, varicose veins, and localized inflammatory disorders. Modern studies reveal significant improvements in symptoms such as pain, swelling, skin discoloration, and vascular insufficiency. Mechanistically, Jalaukavacharana is proposed to reduce local inflammation, improve microcirculation, modulate cytokine activity, and exert anticoagulant and analgesic effects through bioactive substances present in leech saliva (e.g., hirudin, calin, destabilase). Conclusion: Raktamokshana by Jalaukavacharana remains a clinically effective and safe therapeutic approach for various inflammatory and microcirculatory disorders. Integrative use alongside conventional therapies shows promise, though further high-quality randomized controlled trials and mechanistic studies are warranted to substantiate findings and develop standardized protocols.