Upashayatmaka Effect of Raktamokshana (Siravyadha) in Shonitadushti / Essential Hypertension: A Clinical Study

Background: Essential hypertension affects an estimated 188.3 million adults in India and is a leading non-communicable disease with significant cardiovascular morbidity. In Ayurveda, its clinical manifestations — Shiroruk, Klama, Bhrama, Tamodarshana, Krodhaprachurata, Akshiraga and Atidaurbalya — correspond closely to Shonitadushti, a Vata–Pitta pradhana Tridoshaja vikara with Rakta as the primary Dushya. Conventional pharmacotherapy carries well-known limitations, including side effects, polypharmacy, resistant hypertension and the need for lifelong medication. Acharya Charaka enumerates Raktamokshana as a principal line of treatment in Shonitadushti, warranting clinical evaluation of its antihypertensive efficacy. Aim and Hypothesis: To evaluate the Upashayatmaka (therapeutic-relief) effect of Siravyadha (therapeutic venesection) in patients presenting with Shonitadushti / Grade 1 essential hypertension. H₀: Raktamokshana has no statistically significant Upashayatmaka effect on blood pressure. H₁: Raktamokshana has a statistically significant Upashayatmaka effect on blood pressure. Methods: A single-arm observational clinical study was conducted at Alva's Ayurveda Medical College, Moodubidire, and other referrals. Twenty patients aged 35–70 years fulfilling diagnostic criteria for Grade 1 essential hypertension (SBP 140–159 mmHg; DBP 90–99 mmHg), with a minimum of three Shonitadushti lakshanas, were enrolled by simple random sampling. Siravyadha was performed on Day 0, withdrawing approximately 300 ml of blood from the saphenous vein following standardised Purvakarma (Snehana and Sthanika Nadi Sweda), Pradhanakarma and Pashchatkarma. Blood pressure and subjective parameters were assessed at baseline (Day 0), Day 8 and Day 16. Results: Most patients were male (80%), aged 35–45 years (55%), of Vata–Pitta prakriti (75%) with Vishama Agni predominant. Disturbed sleep (85%), mixed diet (75%), positive family history (55%) and Akala Bhojana (55%) were the leading Nidaa factors. All seven subjective parameters improved significantly (p < 0.05); six of seven reached p < 0.01. Mean systolic blood pressure fell progressively from 144.30 ± 4.59 mmHg (Day 0) to 132.60 ± 5.70 mmHg (Day 8) and 130.30 ± 5.77 mmHg (Day 16) — a net reduction of 14.00 mmHg (9.7%; p < 0.001). Mean diastolic blood pressure fell from 93.00 ± 3.20 to 82.60 ± 3.44 mmHg, a net reduction of 10.40 mmHg (11.2%; p < 0.001), a proportionally greater fall suggestive of a preferential effect on peripheral vascular resistance. Conclusion: Siravyadha produced a clinically relevant and statistically significant (p < 0.001) progressive reduction in both systolic (14 mmHg) and diastolic (10.4 mmHg) blood pressure over 16 days, with complete or near-complete resolution of Shonitadushti lakshanas. H₀ is rejected and H₁ accepted. Siravyadha shows significant potential as a non-pharmacological Ayurvedic intervention for Grade 1 essential hypertension; randomised controlled trials with larger samples and longer follow-up are recommended.