An incision to the depth of a barley-corn should be made with a Vrihimukha instrument (into a vein situated) in the muscular parts of the body, whereas the instrument should be thrust only half that depth or to the depth of a Vrihi seed in other places (Vrihi here signifies S'ukadhdnya as well as Rakta-sáliy. An incision over a bone should be made with the Kutháriká (small surgical axe) to the half depth of a barleycorn. 18-19.
An opening should be effected in such a day in the rainy season as would be devoid of the rumblings of a thunder-cloud, during the cold (i.e., in the fourth) part of the day in summer, and at noon in the winter season (Hemanta). These are the only three times of opening a vein. A well and successfully pierced vein bleeds in streams (almost simultaneously with the thrusting of the knife) and spontaneously stops after a Muhurta (a little while). The vitiated blood is seen first to flow out of an opened vein, like the drop of yellow pigment first coming out of a Kusumbha flower. Blood does not flow out from an incision made into a vein of an unconscious (Murchchhita), much frightened, or a thirsty patient. An incision of a vein without proper bandaging and raising up is attended with a similar result. 20-23.
A weak person, or one affected with the unusual derangement of the bodily Doshas etc., or one fainted (under operation), should not be subjected to a measure of continuous blood-letting at a time; instead of that, the vein should be opened afresh in the same afternoon or on the following day, or on the third day (as the exigency requires). An intelligent surgeon should not allow the flow of blood to an excess but should stop the flow even with a remnant of the diseased blood in the system and administer soothing internal remedies (Sams'amana) for the purification of the diseased remnant. Bleeding to the quantity of a Prastha * measure should be deemed sufficient for a strong and adult patient, stuffed with a large quantity of the deranged Doshas (in the body). 24-26.
The vein should be incised with a Vrihimukha instrument at a distance of two fingers above the seat of the Kshipra-marma in such diseases as Pádadáha, Páda-harsha, Ava-váhuka, Chippa, Visarpa, Váta-rakta, Váta-kantaka, Vicharchiká, Pádadári etc. The mode of opening a vein in the case of Slipada (Elephantiasis)
* In medicinal preparations, a Prastha measure is understood to be four seers in the case of liquids, but in cases of excreta due to emetic and putative measures and of blood-letting. a Prastha is meant to be thirteen Palas and a half only.
would be described under the treatment of that disease. In Váta-rogas, such as Kroshtuka-s'irah (Synovites), maimedness (Pangu) and lameness (Khanja) the Sirá (vein) of the Janghá (lower leg-calf), four fingers above the Gulpha, should be opened. In cases of Apachi (scrofula), the vein should be opened simultaneously with the appearance of the disease two fingers below the Indravasti-marma. In a case of Gridhrasi (sciatica), the vein should be opened four fingers above or below the Jánu (knee-joint). In a case of goitre, the veins attached to the roots of the Uru (thighs) should be opened. The instructions regarding the opening of a vein in one leg shall hold good in the case of that in the other, as well as in cases of those situated in the two upper extremities (hands), but the speciality is that in a case of enlarged spleen, the vein near the Kurpara-sandhi (elbow-joint) of the left hand or that inside the fourth and the fifth fingers should be opened. Similarly in a case of Yakriddályodara or Kaphodara, the corresponding vein in the right hand should be opened. Several authorities advise the opening of the same vein in cases of cough and asthma * due to the action of the deranged Kapha. 27-35.
In a case of Vis'vachi, the same argument holds good dour fingers above or below the Kurpara-sandhi) as in a case of Gridhrasi. In a case of Praváhiká (diarrhoea) attended with Sula (colic), the vein within two fingers width around of the Pelvis (Sroni) should be opened. The vein of the penis should be opened in a case of Parikartiká. (D.R.-Parivartiká), Upadansa, Suka-dosha and seminal disorders. The vein on either side of the scrotum should be. opened in a case of hydrocele (Mutra-Vriddhi). 36-39.
* Gayi holds that in cases of asthma and cough venesection should be had recourse to only when they are in a mild form.
The vein four fingers below the navel and on the left side of the Sevani (suture) should be opened in a case of Dakodara (ascites). In a case of internal abscess and colic in the sides (Pleurodynia), the vein in the region between the breast and the left armpit should be opened. Several authorities assert that in a case of Avaváhuka and Váhus'osha (atrophy of the hand), the vein between the Amsas (shoulders) should be opened. In a case of Tritiyaka (Tertian) fever, the vein inside the Trika-Sandhi should be opened. In a case of Chaturtliaka fever, a vein joined with either side of and below the shoulder-joint should be opened. In a case of Apasmára, the middle vein adjacent to the joint of the jaw-bones (Hanu-Sandhi) should be opened. In a case of insanity and hysteria * (Apasmára), the vein between the temple and the edge of the sculp or those in the Apánga (tips of the eyes), the forehead or the chest should be opened. In cases of the diseases of the tongue and the teeth, the veins on the under-surface (Adho-Jihvá) of the tongue should be opened. In the case of a disease of the palate, the local vein should be opened. In diseases of the ears and specially in a case of inflammatory ear-ache (Karna-Sula), the vein along the region above the ears should be opened. In diseases of the nose and specially in a case of the loss of the smelling faculty, the vein at the tip of the nose should be opened. In cases of eye-diseases, such as Timira (blindness), Akshipáka (ophthalmia) etc., as well as in diseases of the head and in Adhimantha, the veins about the nose, the forehead and the Apánga (the outer canthus of the eyes), should be opened. 40-51.
* Dallana, however, differs here from the text. He says, on the authority of Vágbhata, that the opening of a vein between the temple and the edge of the sculp or those in the Apánga, the forehead and the chest should be recommended in cases of insanity only, and not in the case of of Apasmára as well (as in the text).