International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Review Article

Historical Aspects of Leech Therapy: A Critical Review

Malik Itrat1*, Zarnigar2, N. Haque3
1
Lecturer, D/o Tahaffuzi Wa Samaji Tib, Allama Iqbal Unani Medical College, Muzaffarnagar, Uttar Pradesh, India.
2
Lecturer, D/o Tahaffuzi Wa Samaji Tib, National Institute of Unani medicine, Bangalore, Karnataka
3
Lecturer, D/o Ilmul advia, Eram Unani Medical College, Muzaffarnagar, Uttar Pradesh
*
Correspondence Email: malik.itrat@gmail.com

Received: 03/05//2013 Revised: 17/06/2013 Accepted: 25/06/2013

ABSTRACT

Bloodletting and the therapeutic use of Hirduo medicinalis dated back to the ancient Egypt and the
beginning of the civilization. Their popularity has varied over the years. Leech therapy is one of the most
important and widely practiced methods of regimental therapy, used for local evacuation of morbid
humour in Unani system of Medicine. With the advent of modern pathology, physiology and
microbiology in the late 19th century bloodletting with leeches fell out of favour. The leech once used by
physicians of emperor and influential academic surgeon enjoyed a renaissance in reconstructive surgery
during the last 15 years. The Leech is no longer ubiquitous, but has warmed its way back into the medical
field. This paper presents a brief review on the history of treatment with leech from its origin to the
present day.

Key words: Leech, Bloodletting, Regimental therapy, Unani Medicine.

INTRODUCTION of leech therapy is that it may be advised on

According to Unani system of those areas of the body where other
Medicine, Bloodletting is based on concept processes of blood-letting like venesection
of humoral imbalance. Their imbalance and cupping are not possible.
causes diseases, where restoration of the
balance leads to health. [1] According to DESCRIPTION OF LEECHES
USM majority of diseases are caused by The leech is an aquatic worm with a
endogenous factors by excessive flattened body, tapering end terminating in
accumulation of blood, foodstuff and morbid circular flattened disc, the hinder one being
humours. [2] Bloodletting in the form of larger of two. It swims with a vertical
venesection; leech therapy and cupping with undulating motion and moves, when out of
scarification is an essential part of water by means of these discs or suckers,
regimental therapy. [3] It has been utilized flattening itself first by one and then by
for preventive as well as therapeutic other and alternately stretching out and
measures for thousands of years by ancient contracting its body. The mouth is placed in
Unani physicians. The important advantage the centre of the anterior disc and furnished
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with 3 cartilaginous lens shaped jaws. These Hirudotherapy has been mentioned in
jaws are lined at their edges with fine sharp Ayurveda by the name of “Jalaukavacharan”
teeth and meet so as to make a triangular („Jalauka‟ meaning leeches and „Avacharan‟
incision in the flesh. The head is furnished meaning application). As per Ayurveda
with small raised points, supposed by some Jalaukavacharan is one of the procedures of
to be eyes. [4] The leech belongs to the Raktamokshana. Raktamokshana is one of
kingdom (Animalia); Phylum (Annelida); the biopurification methods mentioned in
Class (Hirudinea); Order (Gnathobdellida); Ayurveda, in which humours vitiated in
Family (Hirudidae). [5] Leech can ingest an blood are expelled from the body. Ayurveda
amount of blood close to that of eight times mentioned various kind of leeches out of
of their own weight. The leeches can be which 6 varieties of non-poisonous leeches
primarily found in the freshwater lakes, are used for Hirudotherapy. [13] Avicenna in
ponds or rivers ranging from 5cm to nearly the canon of medicine emphasize on the use
25 cm. [6] Leeches are hermaphrodite having of leeches even for skin diseases. Later in
both male and female parts, but they still the 12th century Abdul Latif Baghdadi wrote
need to come together to meet with each that leech could also be used for cleaning the
other. After mating 15-50 eggs are laid in tissues after surgical operations. [14]
one spongy case or coccon above the Leeching reached the height of its popularity
waterline often under stones. The eggs hatch in the middle 19th century, when it was
in 3 to 5 weeks and the young leeches need exposed by the French physicians Francois
two seasons of feeding before they are ready Broussais (1722-1838). Broussis was the
to breed themselves. [7] In India there are head of French physician of the Val De
about 45 species of leeches belonging to 22 Grace Hospital in Paris and a surgeon in
genera. However the species commonly Napoleon‟s grant army. Broussais treated
cultured for medicinal use are Hirudinaria diseases such as typhoid fever, Syphilis,
granulosa and Hirudo medicinalis. H. T.B, and even mental illness by applying
granulosa is abundantly found in the state of leeches to abdomen. Broussais was in fact
Madras, Kerala, M.P, U.P. and Punjab, the biggest consumer in France, ordering 2-3
whereas Hirudo medicinalis is commonly millions leeches in 1824 and his requisition
used in western worl. [8] Leeches are known rose to 42 millions in 1833. A record of 57
by following vernacular names: Alaq ( millions leeches was used in 1854. Between
Arabic); Zalu ( Persian ); Jonk ( Urdu ); the years of 1829 and 1836, five to six
Salook ( Turkish); Leech ( English ); Hirudo millions leeches were used annually in the
(Latin); Bdella (Greek); Jaluka (Sanskrit); hospitals of Paris. [15] In early 19th century
Jalu ( Hindi); Jalagalu ( Telugu); Attai ( American physician from Georgia wrote
Tamil); Jiganey ( Kannada). [9-11] bloodletting is the most important treatment,
whenever there appears mark of local
HISTORICAL BACKGROUND congestion, inflammation or that sluggish or
No one knows exactly when leeches torpid action which makes incapacity in the
began to occupy an important role in circulation vessels. He continue to discuss
medicine. Varying sources date the leech to the use of leeches as treatment for
2500 years ago, when it was used for myocarditis, peritonitis, pleuritis, hepatitis,
bloodletting in ancient Egypt. [12] Leeching gastritis, tonsillitis, nephritis, pneumonia,
is also mentioned in medical encyclopedia whopping cough, dysentery, hemorrhoids,
from India written in Sanskrit completed acne and pimples. [16] The use of leeches was
between 500 BC and 200 AD. discontinued when this practice was
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rumored to transmit some diseases. Several cleansed of, with a sponge. The place where
infectious diseases were thought to be the leeches are to be applied must be
transferred from person to person through (shaved if necessary) well laved with nitre-
their applications- syphilis, puerperal fever water and rubbed till red. Dry carefully. Dip
and erysipelas being a few. With the advent the leeches in fresh tepid water, cleanse and
of modern pathology physiology and apply (with one‟s freshly washed hands, or
microbiology in the late 19th century, with soft towel, or in a test tube called a
bloodletting with leeches fell out of favour. “leech glass” especially if the place in
[17]
The leeches was brought back into the question is the palate or gums). The point of
medical domain in the middle of the 20th application may be smeared with clay (or
century, its use was called as hirudotherapy. moistened with sugar water or milk) or
With the advent of microsurgery including scratched with a needle till blood appears, in
plastic and reconstructive surgeries the order to coax them to take hold. The leech
doctors found a use for the leech in modern must not be let go until it has taken proper
medicine, primarily in the reattachment of hold. The leeches when starts sucking the
fingers, toes, arms, ears and noses and even blood, it elevates its neck and fixes its head
in breast reconstructions. [18] In operation to the supporting point of skin. One can
one of the biggest problems that arise is observe wave like movements indicate
venous congestion, the excess blood from sucking of blood. When leeches become
the injured or reattached tissue needs to be fully satisfied with its food it leaves off the
removed. If the blood is not cleared quickly, skin of the patient & drops itself down. If
the blood begins to clot, the arteries that not then in such a case, a little turmeric
bring the fresh oxygenated blood will powder is placed on the sucking point of the
become clogged and the tissues that were leech and immediately the leech takes away
reattached will decay and die. Venous its mouth from that point. Leech after the
congestion may lead to edema, capillary and use is kept in an empty tray. Turmeric
arterial slowing, arterial thrombosis, flap powder is placed on its mouth to induce
ischemia and eventual necrosis. The main vomiting. Some of the practitioners advocate
reason why leeches are employed in to gently squeezing out the blood with
microsurgeries is to reduce this venous fingers. After this leech again washed in
congestion. After the operation, the use of clean water. [21, 22]
leeches should be withheld as long as
possible. This is due to the anesthetic in CHEMICAL COMPOSITION OF LEECH
patient‟s body. A leech in contact with SALIVA [23- 25]
anesthetic will not feed a phenomenon that The near or total painlessness of
is called as lazy leech syndrome. [19] In leech‟s bite is due to the contents of leech
1983, Handerson et al. reported a case where saliva, which contains a number of different
leeches were used in the post operative chemical compounds .The saliva of leech
treatment of a scalp avulsion case. [20] contains anesthetic, which makes the bite of
the leech painless to its host; an histamine
LEECHING TECHNIQUE like vasodilator which increases the blood
Leeches should be kept a day before flow to the feeding areas by increasing the
applying them and they should be squeezed diameter of the blood vessels; and a
(or have their heads bent down) to make chemical enzyme called hyaluronidase,
them eject the contents of their stomach. The which facilitates the degradation of the
slime and debris from their bodies should be connective tissues around the bite site
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allowing the vasodilator substance, wider operations and has been recommended for
access to the area. There is also an the prevention of phlebitis and post
anticoagulant Hirudin, which is responsible operative pulmonary inflammation. Leech
for inhibiting blood coagulation and is saliva also contains several other bioactive
employed as an anticoagulant in surgical substances are as mentioned in Table.

Hirudin Inhibits blood coagulation by binding to thrombin.

Calin Inhibits blood coagulation by blocking the binding of von willebrand
factor to collagen- mediated platelet aggregation.
Destabilase Monomerizing activity. Dissolves fibrin. Thrombolytic effects.
Hirustasin Inhibits kallikerin, trypsin, chymotrypsin, neutrophilic cathepsin G.
Bdellins Anti- inflammatory, Inhibits trypsin, plasmin, and acrosin.
Tryptase inhibitor Inhibits proteolytic enzymes of host mast cells.
Eglins Anti- inflammatory. Inhibits activity of alpha- chymotrypsin.
Complement inhibitors May possibly replace natural complement inhibitors, if they are deficient.

Indications And Contraindications. [26-30] burning and blister formation and ulcerative
Indications Contraindications
Varicose vein Anemia necrosis due to toxins present in leech saliva
Ringworm Diabetes mellitus have also been reported after leech therapy.
Alopecia Hemophilia
Lymphadenitis Pregnancy Transmission of certain infections from one
Malignant ulcer Hypotonia subject to the other is another probable
Psoriasis
Eczema
Leukemia
Active tuberculosis
complication of leech therapy. [30, 31]
Elephantiasis General fatigue
Gangrenous wound High temperature SCIENTIFIC REPORTS
Osteoarthritis Bleeding disorders
Phlebitis and thrombotic Severely ill patients In recent past years, various clinical
conditions as well as experimental studies have been
Preventing post surgical Bed ridden patients
blood clotting conducted globally to evaluate the efficacy
Odontalgia, periodonitis and Old aged persons of leech therapy in various ailments using
alveolar abscess
Post operative skin Around liver, spleen,
standardized outcome measures. In a study,
grafting lesions stomach & intestine. the hirudin was tested for thrombin
Revascularization of amputated On Buttock
fingers & toes after repalnatation
inhibition in synovial inflammation in
procedure Antigen Induced Arthritis (AIA). The study
was conducted on animal models where
ADVERSE EFFECTS experiments showed hirudin did indeed
The most worrisome complication significantly attenuate the severity of AIA as
other than superficial scaring is aeromonas measured by both 99m TC uptake and
hydrophila. This bacterium is a normal synovial histology. The intra-articular fibrin
inhabitant in the foregut of the leech. The staining was reduced by hirudin treatment.
leech does not contain digestive enzymes to There was a clear reduction seen in synovial
break down red blood cells from the blood inflammation by hirudin. [32] In India also,
so it relies on bacterial enzymes secretions various studies have been conducted to
to digest blood. A. hydrophila can infect the prove the safety and efficacy of leech
bite or surrounding skin during feeding, therapy in musculoskeletal and
such an infection presents itself as a local dermatological disorders on the basis of
abscess. The infection is not reactive to scientific parameters. Another study from
penicillin but to chloramphenicol and amino Bangalore, India, has proved the safety and
glycoside. Other complications are allergic efficacy of leech therapy in the management
reactions such as itching followed by of knee osteoarthritis (OA). In this study, 30
International Journal of Health Sciences & Research (www.ijhsr.org) 81
Vol.3; Issue: 7; July 2013
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How to cite this article: Itrat M, Zarnigar, Haque N. Historical aspects of leech therapy: a
critical review. Int J Health Sci Res. 2013;3(7):78-83.

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