Introduction Rakta, considered the fourth dosha by Acharya Sushruta, plays a vital role in sustaining life. When vitiated, it becomes a causative factor for multiple diseases. Among the methods of Raktamokshana (bloodletting), Siravyadha (venesection) is regarded as Chikitsardha half of all therapeutic measures due to its extensive therapeutic applications. Methods This review critically analyzed classical Ayurvedic texts (Brihattrayi and Laghutrayi) along with contemporary literature to explore the principles, procedure, indications, contraindications, and clinical relevance of Siravyadha. The procedural framework was studied in three stages: Purvakarma (pre-operative), Pradhana karma (operative), and Paschat karma (post-operative). Safety measures, instruments, and complication management strategies were also compiled from both traditional and modern perspectives. Results Siravyadha is indicated in conditions such as Visarpa, Vidradhi, Kushtha, Vatarakta, Raktapitta, and musculoskeletal and vascular disorders. The procedure, when performed systematically, alleviates symptoms of vitiated blood, restores physiological balance, and provides symptomatic relief. Complications like haemorrhage, fainting, and rakta kshaya may occur if performed incorrectly; however, classical measures such as skandana, sandhana, and dahana offer effective management. Conclusion Siravyadha exemplifies a scientifically grounded and clinically useful para-surgical procedure in Ayurveda. Its strong classical foundation, therapeutic outcomes, and similarity with modern venesection highlight its continuing relevance. Integrating Siravyadha into present-day healthcare may enhance management of rakta-prakopaja disorders while preserving a safe, time-tested therapeutic approach.