The accumulation of rakta and vitiation of Vata in Siras leads to Siraakunchana (dilatation of the veins) and vakreekarana (tortuosity). This causes local congestion in that area causing shoola and shotha. Repeated bloodletting by Jalaukavacharana brings down the local shotha by relieving the local congestion (which contains metabolic toxins, debris of the dead tissues) by removing vitiated blood first. So a part of shotha is relived in first phase. Healthy and nourishing blood is supplied to that tissue where the stasis is cleared off. This promotes the regaining the health of surrounding tissue as well as the vessel wall which takes little time i.e. second phase. Thus, by removing the stagnant vitiated blood that had caused Sanga, Jalaukavacharana reduces the localised intravascular pressure and volume hence relieving Shoola and Shotha.
Tortuosity was only partially relieved in the study . The reason might be its a mechanical defect and the tension in the area is only partially relieved.
Kandu (itching sensation) was observed in chronic sufferers of varicose veins in the study. It was seen often associated with shotha due to stagnation of dushta rakta. The same was relieved by applied modality
Daha (burning sensation) gets instantly relieved by this procedure. This may be because daha is the feature of pitha and raktha as per Ayurveda and the modality employed here is Jalaukavacharana which is claimed to have pittahara and raktahara properties.
Vaivarnya (discolouration) occurs due to stasis of blood in the veins. This leads to haemolysis of blood, leading to the deposition of haemosiderin pigment in the skin which manifests as the blackish discolouration noted in patients of varicose veins. By Jalaukavacharana the dushta rakta is drained out, followed by flow of normal blood. Since there is no further stasis of blood, there is no subsequent haemolysis, thereby, reducing vaivarnya and restoring normal pigmentation of skin.
Table showing the constituents of the saliva of leech and its function
|Calin||Inhibits blood coagulation by blocking the binding of Von Wille brand facto.
Inhibits collagen-medicated platelet aggregation.
|Destabilase||Monomerising activity .Dissolves Fibrin .Thrombolytic activity.|
|Hirustasin||Inhibits Kallkrien, Trypsin, Chymotrypsin, neutrophilic Cathepsin -G|
|Bdellins||Anti-inflammatory, inhibits Trypsin, Plasmin, Acrosin.|
|Hyaluronidase||Increases interstitial viscosity. Anti-biotic effect.|
|Tryptase||Tryptase inhibitor- inhibits Proteolytic enzymes of Host Mast cells|
|Eglins||Anti-inflammation .Inhibits the activity of Alpha-Chymotrypsin,
Chymase, Substilisin, Elastase, Cathepsin-G.
|Factor Xa inhibitor||Inhibits the activity of coagulation factor Xa by forming equimolar complexes|
|Complement inhibitors||May possibly replace natural complement inhibitors if they are deficient|
|Carboxy peptidase A Inhibitor||Increases the inflow of blood at the bite site.|
|Histamine like substance||Vasodilator. Increases the inflow of blood at the bite site|