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A CONCEPTUAL REVIEW OF
JALOUKAVACHARANA
Dr. Beatrice Synnah1, Dr. Rakesh R.N2, Dr. Aswin Haridas3
ABSTRACT
Jaloukavachara or leech therapy is an ancient method of bloodletting where impure blood is being removed
from the body using medicinal leech that has the great potential in managing many inflammatory, ischemic,
and infectious diseases. It is considered as the most easy and convenient method of bloodletting therapy and
most effective in ayurveda. There are two basic principles in Ayurvedic treatment viz. Shodhan chikitsa
(elimination Therapy) and Shamana chikitsa (internal medicine). Shodhan Chikitsa deals with five
purificatory procedures popularly known as Panchakarma. Acharya Susruta included Raktamokshana in
Panchakarma and described it as the best procedure because it eliminates all three vitiated Doshas viz. Vata,
Pitta & Kapha. Leech’s saliva contains many biologically and pharmacologically active compounds that
exert anticoagulant, antiplatelet, anti-inflammatory, and anti-oedema effects in the host’s body. Arthritis,
venous congestion, vascular diseases, abscess, ischemic heart disease, etc. can be successfully managed by
leech therapy. The main objective of the present article is to explore the basic concepts of leech therapy and
the method of using leech for Raktamokshana procedures and the application of leech therapy in different
medico-surgical diseases.
INTRODUCTION
The importance of Panchakarma is being widely known globally as one of the main treatment protocols in
Ayurveda where correction of disequilibrium of the tridoshas which is the cause of diseases is done.
According to Acharya Sushruta, Raktamokshana is a para surgical procedure in the surgical stream of
Ayurveda and also one of the panchakarma which involves the removal and renewal of dushta Rakta. He
propounds practical guidelines for bloodletting and claims it as most effective therapy in half of the body
ailments.[1] Jalaukavacharana is one of the procedures of Raktmokshana which is an ancient bio surgical
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Jalaukavacharana forms by the addition of two words: Jalauka and Avacharana which means application
of jalouka (leech) in which the basis of jalouka life, the site of their dwelling, and the source of their nutrition
is Jala (water) hence the name.[2] The word leech comes from an old English word ‘laece’ meaning
‘physician’. In medieval England, leeches were linked with healing because of the etymology of the word.[3]
There are a total of twelve types of Jalauka described in Ayurvedic text, these twelve types are categorized
into two main types based on their therapeutic use. Jalauka which are fit for therapeutic purposes are called
Nirvisha Jalauka, these were further subclassified into six types each. The Nirvisha Jalauka are Pingla,
Shankhamukhi, Mushika, Pundarikamukhi and Savarika. Jalauka which are not fit for therapeutic purposes
are called Savisha Jalauka, these were further subclassified into six types each. The Savisha Jalauka are
Krishna, Karbura, Algarda, Indrayudha, Samudrika and Gochandana. Nirvisha Jalauka should be properly
identify on the basis of their breeding grounds, their characteristic appearance and behaviour, which are
described in Ayurveda text as it is very essential to avoid the use of Savisha Jalauka.[4] are used to treat
arthritis, vascular and venous diseases, varicose vein ulcers heart and lungs problems, Skin conditions like
psoriasis, eczema and hypo pigmented patches.
Leeches have segmented bodies like that of an earthworm and have two suckers, one at each end, caudal
(back end) and rostral (front end). The mouth (front end) contains three jaws which can break the skin of the
hosts to suck their blood and leave a `Y` shaped bite mark. There are two species of therapeutic medicinal
leeches- Hirudo medicinalis and Hirudo mychaelseni. In India, Hirudo medicinalis of Phylum-Annelida,
class-Hirudinea, are used for bloodletting. These leeches are dark brown in colour and have 6 longitudinal
stripes running along the body. Their bodies are 2 to 3 inches long, convex and wrinkled transversely,
tapering at each end.[5] During feeding it can suck around 5to 15 ml. of blood. Its saliva contains several bio-
active substances and pharmacologically active compounds that exert anticoagulant, antiplatelet, anti-
inflammatory, anaesthetics, vasodilators, prostaglandins and anti-oedema effects in the host’s body. Hirudin
present in leech’s saliva is a potent anticoagulant inhibits conversion of fibrinogen to fibrin, thus prevents
blood clotting.
The main aim of this article is to give a brief review on the indication, contraindication and methods of
application of jaloukavacharana.
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All the literature related to Jaloukavacharana is collected from classical texts of Ayurveda along with various
research publications and books which are related to leech therapy was compiled and critically analysed in
this study.
LEECH
There about 650 leech species, the most frequently used leech is Hirudo-medicinalis which is collected from
freshwater bodies. Therapeutic effect of leech is due to presence of different biological substance in leech
saliva. This saliva contains more than hundreds of these bioactive substances, which includes an anti-platelet
aggregation factor, thrombolytic, anaesthetics, vasodilators, antimicrobial effects, anti-inflammatory and
antibiotic agents.Some major constituents are Hirudin, Hyaluronidase, Calin, Destabilase, Apyrase, Eglines,
Bdellins, Decorsin, Hirustatin, Lipase, Esterases and Catecholamine like Acetylcholine, Serotonin,
Dopamine etc. During the bite taken by the leeches the patient experience as a painless procedure this is due
to the anaesthetize agent present in the saliva and it also dilates the blood vessels to increase blood flow to
the effected site [6]
INDICATION
There have been many study carried out to evaluate the effect of leech therapy in different diseases but the
classical indications mentioned in Ayurveda is Gulma (abdominal lump), Arsha (piles), Vidradhi (abscess),
Kustha (skin diseases), Vatarakta (gouty arthritis), Netraroga (eye disorders), Visarpa (erysipelas),
Koshtuka-Shirsha (Infective Arthritis), Sandhigata Roga (Osteo-Arthritis), Kantharoga (goiter), Granthi
(Nodular Swelling), Arbuda (Cancer), Shlipada (Filaria), Vidarika (Cracks), Vishadamsha (Insect
Bite),Shiroroga (disease of scalp), Dantaveshta (pyorrhea), etc.[7] Jaloukavacharana is also indicated in
Rakta pradoshaja vikara as jalouka is indicated in treating the vitiated rakta. Some of the other indications
were research work has been done and results have been seen are:
Venous disease, varicose veins (sira granthi): Leech therapy is seen effective in the management of
complicated varicose veins, decreases the oedema and hyperpigmentation on a study did on 20
patients diagnosed with varicose ulcer. This study also reveals that the medicinal leech sucks venous
blood and aids ulcer healing.[8] Leeches are also used after breast surgery to relieve venous congestion
at the nipple.[9] It treats post phlebitis syndrome in which venous valves are obliterated by deep vein
thrombosis.[10]
Peripheral vascular diseases: Leech therapy is effective in management of Burger’s disease as it
relieves the inflammation and thrombosis. It is also effective in other peripheral vascular diseases.
[11]
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maintains normal circulation which in turn recovers bluish-black discoloration. Anaesthetic agent
present in saliva of leech reduces pain, burning sensation and tenderness giving symptomatic relief.[12]
Osteoarthritis: A pilot study was done where application of jalouka was done once a week for 6
weeks on the affected knee and the patient experiences rapid reduction of pain, stiffness and
tenderness.[13]
Gout (Vatarakta): Leech therapy is seen effective in relieving pain, swelling, erythema present in
acute gout.[14]A study was done on 10 patients and jalouka application done once a week for 3weeks
It shows reduces characteristic symptoms like Sandhisoola (joint pain), Sandhishopha (joint
swelling), Sandhivaivarna (erythema), and Sandhidaha (burning sensation at joint).[15]
Non healing ulcer: Leech therapy is effective in the management of pain in the treatment of non-
healing ulcers.[16]
Diabetic foot ulcer: Leech application is significantly effective in the management of diabetic foot
ulcer.[17]
Reconstructive surgery: Reconstructive surgeons are now using leeches remove stagnant blood from
a flap or reattached limb. Medicinal leeches were used successfully to reattach the ear of a five-year-
old boy, in the year 1995. Since then, leeches have been widely used to reduce venous congestion in
fingers, toes, ears, scalp, limbs or other body part reattachments and replants after traumatic
amputation. [18,19]
Eczema (Vicharchika): A study has been carried out on 34 patients of Vicharchika where
Raktmokshana was done by Jalouka shows significant result without any adverse effects and
recurrence. [20]
Khalitya: A case study of a 28 years old woman of Khalitya shows significant results after
Jaloukavacharana with oral medication for regular 2 months.[21]
Indralupta: A case study on a patient of Indralupta with local Jaloukavacharana and application of
Gunja Beeja lepa shows significant results.[22]
Shlipada: A study was carried out on 13 patients of Shlipada with the help of leech application.
Jalauka was applied according to the involvement of the part of the body once in a week for 6 weeks.
It was found that the results are symptomatically positive and significant without any side effect.[23]
Keloids: In a case study a 15 years old girl having Keloid on chest was treated with Jaloukavacharana
with significant results.[24]
Visarpa: A study was carried out on 40 patients suffering from Visarpa (Herpes Zoster). Patients
were treated with Jalauka every alternate day for 2 weeks, showing significant improvement in the
condition of the patient. [25]
CONTRAINDICATIONS [26,27]
Leech Therapy is not recommended under the following medical conditions and diseases:
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Absolute Hemophilia
Anticoagulant medication eg. Warfarin, Heparin, Marcumar. (Aspirin and Clopidogrel are not
contraindicated)
Severe Anaemia
Erosive gastritis and potential gastrointestinal bleeding
During chemotherapy (or people who are on immunosuppressive medication)
Individuals with HIV infection
Severe allergic diathesis (allergy to foreign proteins)
Hypotension
Active tuberculosis
Pregnancy
Mental disorders during acute episodes
Severely ill and bed ridden patients
Extremely fearful patient
Preparation of the patient: patient which is fit for jaloukavacharana is to be selected rulling out all the
contraindicated conditions. Certain biochemical parameters should be observed prior to leech application in
order to prevent any problems and side effects. Hb percent, TLC, DLC, ESR, LFT, blood urea, Sr. creatinine,
bleeding duration, coagulation duration, prothrombin time, blood sugar level, HIV, and HbsAg are certain
parameters. The patient to be under gone proper snehana (oleation) and swedana (sudation) on the previous
day and not just before application of leech. However mild Swedana (half hour before) to the site of
bloodletting can be given. The desired site is properly washed with cold water
Preparation of Leech: A paste of mixture of water, mustard and turmeric powder to be smeared on the leeches,
this will disinfect the leech and also increase their appetite and blood sucking ability. The disinfected leeches
are kept in a fresh jar of water for half an hour prior to use and use of disinfectant or soap should be avoided
Mornings are the preferred time to apply leeches. The leech should be taken out from its jar and is held at its
neck with fingers. The leeches are applied with patients sitting or supine, in a way that exposes the affected
part comfortably. The desired site is cleaned with wet gauze. Its mouth is placed precisely over the affected
part. The leech’s tail should be held until it begins to draw blood, at which time it can be gently released.
When it starts sucking the blood, elevates its neck assuming the shape of a horse shoe 5- 10 Leeches are
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applied at a time depending upon the necessity. Once Leeches start sucking the blood, they are covered with
wet gauze & cold water is poured on them from above time to time, so as to make Leech comfortable during
sucking. If a leech refuses to bite by its own, in such condition a drop of milk or ghee or prick induced
bleeding may be required so as to facilitate the sucking procedure in which the skin is prick with a sharp and
sterile needle, so the drop of blood comes out. If the leech still refused then changed the jalouka.
Removal of leech: When Leech becomes fully satisfied, it leaves off the skin of the patient & drops itself
down. The jalauka first sucks only the vitiated blood. Itching or pricking pain at the site of application
indicates that the leech is now sucking the pure blood. When sucking pure blood leech should be removed.
If it does not withdraw, a little turmeric powder or common salt powder should be sprinkled on the sucking
part of the leech. Leeches normally absorb about 5 -10 ml of blood.
Wound treatment: After leech detachment, blood should be allowed to flow from the wound for a few
minutes. The area is then clean with saline and wound treatment to be done as there is a triangular wound
caused by the mouth of the leech. Turmeric powder or Satadhauta ghritha, a classical Ayurvedic herbal ghee
preparation can then be applied to promote healing. The wound is then lightly bandaged for 6 to 12 hours to
arrest the bleeding (if the oozing from the wound is not stopped, it can be sealed with the help of tincture
benzene) sips of lime water, soup or glucose water can be offered to the patient
Emesis of suck blood: Emesis induction is then initiated after falling off so that the same leech can be applied
to the same patient next time. This is done by applying turmeric to their mouth and vamana of the leech is
done. To get purified, the leech vomits out all the blood sucked by it. For proper emesis, often pressing of
Leech from the caudal to the front end is needed. Leech should be placed in fresh water, after proper vamana,
where it swims quickly and then settles down. Replace the leech in a clean jar labelled with the details of the
patient.
Leech therapy is a very safe treatment, but local discomfort, itching, hypotension, vasovagal assa ult,
haemorrhage, infection, allergic reactions, ulcerative necrosis and transmission of infectious diseases are
some of the adverse effects recorded by scientists.
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According to disease and severity, the frequency of leech application can vary. Leech can usually be used
for up to six sessions once a week. To prevent cross infection, one Leech should be reserved for a specific
patient.
DISCUSSION
Jalukavacharana is one of the oldest methods used to extract deeply rooted contaminants which was first
documented in 200 BC which help in pacify vitiated dosha to cleanse the body. Dosha gets vitiated and
accumulated in srotas (channels) causing srotoavarodha (channel block) and leading to many illnesses
Jalaukavacharana has important role as thrombolytic and anti-inflammatory activity by removing the local
blood impurities and toxins. Leeches are indicated in surgery whenever there is venous stasis. The saliva
jalauka contains more than 100 bioactive substances which have analgesic anti-inflammatory properties and
lead to elimination of microcirculatory disorders. Also, leech therapy is less expensive and one of effective
treatment in Ayurveda. Ancient history suggests that lord Dhanwatari evolved in this world after Samudra
manthan with Jalauka along with a pitcher filled with nectar in its hand. This shows the importance of
Jalauka in Indian system of medicine. Leech Therapy has been practiced by Ayurvedic Physicians since
vedic times where as Jalauka's anticoagulant property was discovered by modern scientists in 1980 which
later began to be less prevalent due to discontinuity in flow of knowledge. At the end of the 19th century,
leech therapy again emerged, due to its role as constructive surgery.
CONCLUSION
Jalaukavacharana (Leech therapy) is an ancient technique of ayurvedic bloodletting that has the enormous
ability to treat many acute and chronic disorders which include conditions of inflammatory, ischemic and
infectious diseases. Saliva leech contains a variety of bioactive components that have anti-inflammatory,
anticoagulant, anaesthetic, vasodilator, anaesthetic, antibiotic and antioxidant properties that function in
various conditions of illness via multiple mechanisms. Sadly, most bioactive ingredients are still unexplored
and knowledge of the mechanisms of action of bioactive compounds found in Leech Saliva is limited. It is
seen that over the years the use of leeches has evolved from a simple bloodletting procedure into a
scientifically based physiologic process with rational defined clinical applications. Extensive studies needed
to find out the precise mechanisms of different bioactive factor in order to restore conventional therapeutic
ability on a scientific basis.
REFERENCE
1. Aacharya Vaidya Jadavaji Trikamji, Acharya Narayana Ram., editors. 2nd ed. Vol. 8. Varanasi:
Chaukhamba Surbharti Prakashan; 1990. Susruta, Susrutasamhita, Sutrasthana, Shastravacharniya
Adhyaya; p. 23.
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21. Yadav C.R. Gugulothu R., A Case Study of Leech Therapy in Khalitya w.s.r. Alopecia. International
journal of Pharmacognosy and Chinese medicine. 2017:5(10); 3970-74.
22. Vasundhara R. Borakhade, International Journal of Herbal Medicine, 2005: 3(3); 24-25.
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A pilot study. Indian Journal of Ancient Medicine and Yoga, 2012;5 (3):15-21.
24. Shivmangal Prasad, Bijendra Shah. Role of Leech Therapy in Management of Keloids- A Case
Report, International Journal of Scientific Research, August 2018 Vol. 7 (8):12-13.
25. P.N Shilpa, T.T Shirsagar. Efficacy of Jalaukavacharan in Visarpa w.s.r to Herpes Zoster- An
Observational Study. World Journal of Pharmaceutical Research, 2018;7(14):800-813.
26. . Andreas Michalsen, Manfred Roth, Gustav Dobos; Medicinal Leech Therapy, New York 2007; 132-
138.
27. Lone AH, Ahmad T, Anwar M, Habib S, Sofi G, Imam H. Leech therapy-A holistic approach of
treatment in Unani (Greeko-Arab) medicine. Ancient Science of Life 2011;31(1):31-35.
28. Kaviraj Ambikadutta Shastri: Part 1, Sutrasthana, Jalaukavacharaniyaadhyaya of Sushruta Samhita
of Maharishi Sushruta Edited with Ayurveda tatvasandipika, Hindi commentary published by
Chaukambha Sanskrit Sansthan, Varanasi, 13th edition. 13/19-21 P.45.
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