COMPARATIVE ASSESSMENT OF ANATOMICAL SITE FOR SIRAVEDHA (VENEPUNCTURE) – ABOVE AND BELOW KNEE JOINT IN THE MANAGEMENT OF GRIDHRASI (SCIATICA): RANDOMISED CONTROLLED TRIAL

Abstract

Raktamokshana is an important Ayurvedic therapeutic procedure, and Siravedha is its principal method of controlled bloodletting. In Gridhrasi, Acharya Sushruta specifically advises Siravedha to be performed four Angula above or below the Janu Sandhi. As Siravedha is an invasive procedure, its clinical effect depends not only on selecting the prescribed level but also on identifying a suitable superficial vein without damaging the adjacent neurovascular structures. The present study was conducted to compare the clinical response to Siravedha performed at four patient-specific Angula above and below the knee joint in patients with Gridhrasi. This single-centre, parallel-group randomised controlled trial enrolled 24 patients aged 25–45 years with clinically diagnosed Gridhrasi/sciatica. Participants were allocated through a computer-generated simple random sequence. Two participants from each group did not complete the study, leaving 20 participants for complete-case analysis. Group A received Siravedha four Angula above the knee joint, whereas Group B received Siravedha four Angula below the knee joint. A single procedure was performed on Day 7 using a sterile 20-G needle or scalp-vein set, with removal of approximately 30–40 mL of blood. Pain, Straight Leg Raise restriction, Ruka, Stambha, Toda, Aruchi, Tandra, Gaurava, and Suptata were assessed up to Day 28. Within-group changes were analysed using the Wilcoxon signed-rank test, while post-treatment comparisons between the groups were performed using the Mann–Whitney U test. Both groups demonstrated statistically significant within-group changes in all nine outcomes. For pain, Straight Leg Raise restriction, and Ruka, the median score changed from 2.00 to 0.50 in Group A and from 2.00 to 0.00 in Group B; the within-group p-value was 0.004 in both groups. None of the post-treatment intergroup comparisons were statistically significant. Group B showed a better descriptive clinical trend in pain, Straight Leg Raise restriction, Ruka, Tandra, and Suptata, but its superiority was not established. Both Sushrutokta levels were associated with clinical improvement in Gridhrasi, while the below-knee level showed only a comparatively favourable descriptive trend. At either level, Siravedha should be performed only after identifying a suitable superficial vein and avoiding deeper arterial and neural structures.