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Background: Raktamokshana, therapeutic bloodletting, is one of the main purification procedures in Ayurvedic surgery. Sushruta regarded blood as a Dosha in surgical practice and described several methods of bloodletting using instruments, leeches, horns and gourds. Bloodletting was later discredited in Western medicine for most indications, but phlebotomy remains standard treatment for some disorders and cupping therapy is widely studied. Objective: To review the classical concept and methods of Raktamokshana and the modern evidence for therapeutic phlebotomy, leech therapy and cupping. Methods: Narrative review of Sushruta Samhita and of clinical guidelines, randomised trials, systematic reviews and mechanistic studies on phlebotomy, leeches and cupping. Results: Sushruta classifies Raktamokshana into Shastra Visravana (Siravyadha and Prachchhana) and Anushastra methods (Jalauka, Shringa, Alabu, Ghati), with detailed indications, contraindications and signs of proper and excessive bloodletting. Modern medicine uses therapeutic phlebotomy as first-line treatment for hereditary haemochromatosis and to maintain haematocrit in polycythaemia vera. A randomised trial in metabolic syndrome found that phlebotomy reduced blood pressure. Leech therapy reduced pain in knee osteoarthritis in a randomised trial and is used in reconstructive surgery. A meta-analysis found that cupping reduced chronic pain compared with no treatment. Conclusion: Raktamokshana has modern counterparts with established or emerging evidence. Its use should be limited to indications with reasonable evidence, with careful patient selection, measurement of blood loss and infection control.

KEYWORDS: Raktamokshana; Siravyadha; bloodletting; phlebotomy; cupping; Alabu; Jalaukavacharana; Shalya Tantra