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Introduction: Raktamokshana, or therapeutic bloodletting, is one of the five purification therapies (Shodhana Chikitsa) described in Ayurveda for the elimination of vitiated blood (Dushta Rakta). Traditionally applied in various disorders such as skin diseases, inflammatory conditions, and vascular ailments, it remains a topic of growing interest for integrative medicine. Methods: A comprehensive review of Ayurvedic classical texts, modern medical literature, and scientific databases (PubMed, Scopus, Web of Science, and AYUSH research portals) was undertaken. Studies including randomized controlled trials, observational studies, case reports, and preclinical experiments were included, along with references from Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya. The focus was on identifying evidence for Raktamokshana’s role in surgical and systemic conditions. Results: Classical sources emphasize Raktamokshana for conditions involving Pitta and Rakta vitiation, including skin disorders, varicose veins, abscesses, and gout. Modern studies suggest its therapeutic benefits in psoriasis, hypertension, migraine, localized infections, and metabolic syndromes. Techniques such as Siravyadha (venesection), Jalaukavacharana (leech therapy), Shringa (horn application), and Alabu (gourd application) are reported to offer localized anti-inflammatory, detoxifying, and immunomodulatory effects. Clinical trials on leech therapy have shown promising outcomes in reconstructive surgery, osteoarthritis, and chronic venous diseases. Discussion: Evidence suggests Raktamokshana has both systemic and localized effects, mediated through improved circulation, removal of inflammatory mediators, and neuroimmune modulation. However, scientific validation is limited by small sample sizes, lack of standardized protocols, and insufficient mechanistic studies. Conclusion: Raktamokshana, though rooted in traditional Ayurvedic wisdom, demonstrates potential in modern integrative care for surgical and systemic conditions. Rigorous clinical studies and translational research are warranted to establish its evidence-based role in current medical practice.

KEYWORDS: Ayurveda, bloodletting, leech therapy, Raktamokshana, systemic diseases