A person afflicted with an oedematous swelling extending all over the body should be deemed unfit for bleeding. An intumescence occurring in a weak and enfeebled patient owing to an excessive use of acid food or in a person suffering from jaundice or laid up with haemorrhoids or abdominal dropsy, as well as in an enceinte, or in a person suffering from Pulmonary consumption (Shosha), should not be bled.
Blood-letting, with the help of a surgical instrument, may be grouped under two distinct heads, according as scarification (Prachchhanam) or venesection (Sira-Vyadhanam) is resorted to for the purpose. In such a case the knife or the instrument (Shastram) should be driven straight and speedily so as to make the incision straight, narrow, unextended, and of equal and slight depth throughout, (so as to reach only the surface layer of the flesh and blood), and not to injure in any way the local veins, nerves, joints, and other vital parts.
Bleeding performed on a cloudy day or done with a
Later on we shall have occasion to speak of the principles known as the life-blood (essential conditions of vitality - Sk. Jiva-Shonila) and of the process of blood-letting, wrong incision, or with full exposure to cold and wind, or performed on a patient not previously diaphorised, or on a patient with an empty stomach, is attended with little or no outflow of blood owing to the thickened condition of the blood.
Blood-letting surgically performed on a fatigued or exhausted subject, or on a person in a swoon, or anyway poisoned or intoxicated, or on a person suffering from extreme constipation of the bowels accompanied by suppression of the flatus (Vayu) and urine, or on a person of timid disposition, or on one overcome with sleep, is marked by the absence of any outflow of blood.
The vitiated blood, failing to find out an outlet, gives rise to itching, swelling, redness, burning, suppuration and pain in the part (to which it is confined). On the contrary, blood-letting performed on the body of a person excessively diaphorised or heated, or by an ignorant or inexperienced surgeon, or with an injudiciously deep incision, is attended with haemorrhage, which may be followed by such dreadful results as Shirobhitapa or violent headache, blindness or loss of sight (Timria), Adhimantham (ophthalmia), loss of vital principles of the body (Dhatu-Kshaya), convulsions, paralysis (Ekanga Vikara), Hemiplegia (Pakshaghata), thirst, a burning sensation, hic-cough, cough, asthma, jaundice and even death.
Therefore blood-Jetting should be performed on a patient not in an extremly hot or cold season, neither on one who is too much heated or improperly diaphorised (before the act). The patient should be given gruel (Yavagu) before the operation. A spontaneous cessation of red flow would indicate that there has been a free discharge of blood.
An act of complete and successful blood-letting is followed by a feeling of lightness and alleviation of pain in the affected part, by an abatement of the disease, and a general sense of cheerfulness.
A person, accustomed to blood letting, enjoys a kind of immunity from all types of skin diseases, sarcomata, aneurism, oedema, and diseases brought about by a vitiated condition of the blood such as, Ovarian tumour, Carbuncle, Erysipelas, etc.
A plaster composed of Ela, Shitashiva, Kustha, Tagara, Patha, Agaradhuma, Bhadradaru, Vidanga, Chitraka, Trikatus, Ankura, Haridra, Arka, and Nakta-mala, or three, or four, or as many of them as are available, pasted together and soaked in mustard oil saturated with common salt, should be rubbed over the mouth of the incision. By this means the blood will fully come out. In a case of excessive flow or haemorrhage, the mouth of the incision should be gently rubbed with a composition consisting of the powders of Lodhra, Priyangu, Madhuka, Pattanga, Gairika, Sarjarasa, Rasanjana, Shalmali flowers, Shankha, Shukti, Masha, Yava and Godhuma, and firmly pressed with the tips of the fingers. As an alternative, the mouth of the incision should be gently rubbed with the powdered barks of Sala, Sarja, Arjuna, Arimeda, Mesha-shringi, and Dhanvana, or the edges of the wound should be lightly dusted with the burnt ashes of a silk cord (a piece of silk rolled up in the form of a cord), and firmly pressed with the tips of the fingers; or the mouth of the wound should be lightly touched with the powders of Laksha and Samudra-phena, and its edges should be similarly pressed together as above. Then the wound should be firmly tied up (with a piece of silk or linen) plastered over with a paste of the substances mentioned in connection with the bandaging of ulcers (Vrana). The patient should be kept in a cool room, covered over with a wet sheet and constantly soothed with sprays of cold water. A medicinal plaster of a cooling virtue and a course of cooling diet should be prescribed for him. The wound should be cauterised with fire or an alkali, or the vein should be again opened at a point a little below the seat of the first incision in case where the abovesaid measures should have failed to check the flow of blood. The patient should be made to drink a decoction compound of drugs of the Kakolyadi group, sweetened with sugar or honey; and his ordinary drink should consist of the blood of the Ena or common deer, or of a sheep, hare, or buffalo. A diet composed of boiled rice, soaked in or saturated with clarified butter, should be prescribed, and the complications should be subdued according to the nature of the deranged bodily humours respectively involved therein.
Excessive blood-letting is followed by impaired appetite and an agitated condition of the vital Vayu owing to the loss of the fundamental principles of the body, and, accordingly, to recoup the health of the the patient a course of diet should be prescribed which is light and not excessively heat-making, and which contains a fair amount of emollient and blood-making matter, and is marked by little or no acid taste.
The four measures indicated for the stoppage of bleeding are known; as the Sandhanam (process by contracting the affected part), the Skandanam (thickening or congealing the local blood), the Pachanam (process of setting up suppuration in the wound) and the Dahanam (process of cauterisation).
Drugs of astringent tastes are possessed of the property of bringing about an adhesion (contraction) of the wound. Cooling measures such as, applications of ice etc, tend to thicken the local blood; alkalis and alkaline preparations produce suppuration in such a wound or ulcer, whereas cauterisation has the property of contracting a vein.
Remedies and appliances possessed of the virtue of bringing about an adhesion of such a wound should be used where applications for thickening or congealing the local blood would fail; whereas the suppurating measures should be adopted in the event of the former (Sandhanam) proving ineffectual. With any of the three of these preceding measures a physician should try to check the outflow of blood incidental to an operation of bleeding, and lastly the process of cauterisation should be resorted to in the event of the preceding ones having proved unavailing, as it is pre-eminently the best means of checking the bleeding.
The least residue of the vitiated blood continuing in the affected part may not aggravate the disease but prevent its perfect healing. In such a case bleeding should not be again resorted to, but the deranged residue should be subdued by means of pacifying or absorbing remedies.
Blood is the origin of the body. It is blood that maintains vitality. Blood is life. Hence it should be preserved with the greatest care.
The Vayu of a person who has been bled, and which has been aggravated by constant cold applications may give rise to a swelling of the incised part characterised by a piercing pain, which should be treated with an unguent of tepid clarified butter.