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Introduction: Raktamokshana, or therapeutic bloodletting, is one of the five Shodhana procedures of Panchakarma described in Ayurveda for the elimination of vitiated blood (Dushta Rakta). Ancient texts emphasize its role in skin diseases, inflammatory conditions, and systemic disorders. Despite historical parallels with bloodletting in Western medicine, Raktamokshana in Ayurveda is a refined, dosha-specific intervention. Methods: A narrative review was conducted using Ayurvedic classical texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya), commentaries, and modern research articles. Databases including PubMed, Scopus, Web of Science, AYUSH Research Portal, and Google Scholar were searched with terms such as “Raktamokshana,” “bloodletting Ayurveda,” “Jalaukavacharana,” and “leech therapy.” Inclusion criteria encompassed clinical studies, experimental work, and conceptual reviews published between 2000–2024. Non-English and irrelevant studies were excluded. Results: Classical texts classify Raktamokshana into Shastra/Anushastra methods (surgical/phlebotomy) and Ashastra methods (leech application, cupping). Among them, Jalaukavacharana (leech therapy) remains the most widely practiced today. Evidence supports its role in conditions such as eczema, psoriasis, varicose veins, arthritis, and ischemic disorders. Mechanisms include anticoagulant, anti-inflammatory, analgesic, and antimicrobial actions of leech saliva. Modern parallels with phlebotomy and hirudotherapy highlight its physiological relevance, particularly in reducing venous congestion and modulating immune responses. Discussion: Ayurveda’s holistic framework views Raktamokshana as eliminating morbid Rakta and pacifying Pitta. Contemporary evidence affirms its biochemical and pharmacological efficacy. However, limitations include lack of standardized protocols, ethical issues in leech use, and insufficient large-scale randomized controlled trials. Conclusion: Raktamokshana bridges ancient Ayurvedic wisdom with modern therapeutic strategies. With validated protocols, integration into dermatology, vascular medicine, and pain management could enhance its global recognition as a safe and effective adjunctive therapy.

Keywords: Ayurveda, Bloodletting, Jalaukavacharana, Panchakarma, Raktamokshana