LEECH THERAPY

Dr. Mohammed Shiffa

MD, BUMS
 Historical Background
• The use of leeches (Hirudo medicinalis) has
been popular throughout the ages, and still
has a place in modern medicine—especially in
reconstructive and micro vascular surgery
• First written document- medical poem by
Nicander of Colophon (185–135 BC), a Greek
poet and physician
• The name Hirudo medicinalis, assigned by
Linnaeus in 1758
 Cont…
• Broussais (1772–1838), France
• Student of Marie Francois Xavier Bichat (1771–1802),
the founder of modern histopathology
• Broussais served as one of Napoleon’s physicians and
became professor of general pathology in Paris
• Broussais applied 10 to 50 leeches at one time to any
patient, thereby utilizing hundreds of worms daily in
his practice
• He treated typhoid fever, syphilis, variola, worms,
tuberculosis, or mental diseases by applying leeches to
the abdomen
 Cont…
• Von Ronsenstein, in the first printed textbook
on diseases of children, advocated leeching
for difficult dentition, tooth abscess,
convulsion, scarlet fever, pleurisy, or inflamed
eyes. The English edition was published in
1776
• Gross’ System of Surgery in 1859 advocated
leeching as a minor surgical procedure
• Charles de Nancrede, (Professor of Surgery) in
Ann Arbor, mentioned leeches in his textbook,
“Lectures on the Principles of Surgery”. The
comment went unchanged from the 1889 to the
1905 edition
• The chinese used leeches as early as the 10th
century, the authority on traditional medicine,
Zhang Zhong Jing found that leeches could
dissolve blood stasis and mentioned it in his
famous book of medicine “Golden chamber of
Jade places channel”
• European medieval medicinal manuscripts
illustrated the use of leeches for the treatment of
variety of disorders.
• Bloodletting is an ancient therapy with origins
that are suspected to go back as far as the
Stone Age. Healers attributed many illnesses
to inappropriate, excessive collections of
blood and its constituents.
• Hippocratic concept - veins can be the site of
pathologic humors.
• Leeching is an alternative to instrumental
bloodletting, with some advantages.
slower, less painful; more quantitatively
dependable extraction of blood
• Avicenna (d. 1037), believed that leeches
drew blood from deeper sources than did wet
cupping.
• Galen prescribed phlebotomy for diverse
infirmities including epilepsy, liver disease,
melancholy, and pleurisy and he used leeches
• Leeching or Irsal e Alaq removes the waste/
harmful and morbid material.
• Jalinoos and Abu Bakr Mohamed Bin Zakariya
Razi used it in quba, saafa, qurooh-e-balkhiya,
waja ul mufasil and describe it better than
fasad or ishal.
 Leeches
• Scientific name:
Hirudo medicinalis (Europian medicinal leech)
Hirudinaria granulosa (Indian medicinal leech)
• The two main species used in medicine are the close
relatives “Hirudo medicinalis” and the “Hirudo
verbana” in europe.
• Diet: Blood of birds, fish, frogs, mammals
• Food & feeding: Carnivore
• Habitats: Freshwater
• Conservation Status: Near Threatened
• Relatives: Earthworm, lugworm
 Cont…
Description:
• Leeches have segmented bodies like an earthworm,
but unlike earthworms they are slightly flattened
rather than round.
• Sucker at the head and the tail end
• Head surrounds the mouth.
• The mouth contains three jaws that can break the skin
of their hosts to suck their blood.
• Medicinal leeches are greenish brown on their backs
with thin red stripes running along the body and paler
below. They grow up to 20 cm in length.
 Cont…
Lifestyle:
• Live in shallow muddy pools and ponds with plenty of
waterweeds.
• When hungry, they attach themselves to a passing
animal, break the skin with their jaws, and inject
special chemicals that prevent the blood from clotting
and reduces any pain.
• They then suck the blood of the host until they are full,
when they withdraw their jaws and drop off into the
water.
• They can consume 15 grams of blood - ten times their
own body weight, before they are full, but they only
need to feed every six months.
 Cont…
Family & friends
• Like slugs, leeches are hermaphrodite, having
both male and female parts, but they still need to
come together to mate with each other.
• Growing up: After mating, 15-50 eggs are laid in a
spongy case or cocoon, above the waterline often
under stones.
• The eggs hatch in 3-5 weeks and the young
leeches need two seasons of feeding before they
are ready to breed themselves
 According to Avicenna
• following leeches should be avoided
– Leeches with large heads
– Leeches having soft hairs, resembling eels (snake fish)
– Those having azure lines
– Those which can change their colours
– Those having red bellies and green back especially if
they are found in running water
• all the above being poisonous produce swelling
syncope, heamorrage, fever, paralysis and
malignant ulcers
 Cont…
Following types can be used for the medicinal
purpose
• Leeches which are thin and have tiny head
• Emerald green leeches predominantly green
and having yellow stripes or leeches which
resemble liver colour
• Brown leeches with round sides
• Leeches which looks like mouse tails
 Uses
• Relieves vascular congestion - effectively used
in conditions like long standing Varicose
ulcers, Filariasis, post-op. skin grafting lesions.
• Arthritis, Sprain or spasm to relieve the pain,
inflammation & discomfort symptomatically.
• Abscess, Cellulites, Thrombophlebitis and
Varicose Veins
• Atherosclerosis of the limb - improves
circulation.
 Cont…
• Management of non- healing ulcerative
lesions like Diabetic ulcer, Leprotic wound etc.
it helps to improve the local blood circulation
& healing is promoted.
• Cardiovascular diseases – hypertension and
ischaemic disease
• Respiratory – pneumonia, bronchial asthma
• Paradontosis and other teeth diseases
• Skin diseased – neurodermatitis, psoriasis,
herpes, eczema
Indications for leech therapy in micro
vascular surgery
• In pedicle flaps, perfusion problems may develop,
but imbalances between arterial and venous
drainage are more common. Deficient venous
return leads to venous congestion (characterized
by blue discoloration and the skin becomes
increasingly mottled), or in extreme cases –
thrombosis
• Following reattachment of the ear post trauma.
• The microsurgical anastomosis of the hair thin
blood vessels of the ear is extremely challenging
• Venous insufficiency sometimes occur
 Contraindications
• Anaemia
• In extreme ages i.e. in children and old age
• Weak patients
• Allergic patients
• Extreme hot or cold climate
• Bleeding disorders like haemophilia
• Pregnancy
 Application guidelines
• Clean patient’s skin thoroughly with hot water to
remove odour, dirts.
• Application site- rubbed till red.
• Caught one day before, If possible squeeze till the
contain of the stomach comes out.
• Pick leech with gloved hand, wipe it
• Hold the leech’s head to the application site
• If did not bite make prick and smear a blood drop
• Leeches will remain until they become full
then removed spontaneously
• When the leeches get distended and their
removal is intended one should sprinkle over
them a little salt or ashes or burnt cloth/wool.
After its fallen suck up that place with cupping
glass, so that some of the blood might get out.
• Following the bite, the area can bleed for up to 48
hours (up to 50 ml of blood), allowing oxygenated
blood to enter the wound area
• If bleeding does not stopped by itself then pack it.
• Leech bites sometimes leave small blood spots
(ecchymoses) which sometimes develop into
keloids in some individuals. Most of these spots
disappear within 2-3 weeks
• To remove the leech, absolute care is required –
Forcible removal of the leech may rupture gut
contents (Aeromonas hydrophilia)
• Prophylactic Antibiotics- Ciprofloxacin /
Ceftriazone
• All leeches used must be destroyed with 70%
Alcohol and supplier must be notified
• Fresh, unused leeches should be used
• Should not reuse
 Actions
Secrets of salivary glands of medical leech Contains more
than 100 bioactive substances. very few are known in
terms of chemical structure and mechanism
• Analgesic
• Resolving actions
• Anti oedematous
• Improves immune system activity
• Eliminates microcirculation disorders
• Bacteriostatic
• Restores permeability of tissues and organs
• Eliminates hypoxia
• Reduces BP
• Detoxifies the organism
 Benefits of Leech Saliva
• Hirudin (a potent anticoagulant) enables the
blood to flow for some time without clotting
• Calin- induce secondary bleeding, which can
last up to 12 hours
• Hyaluronidase – “spreading factor” –
facilitates the penetration and diffusion of
these pharmacologically active substances
into the tissues- especially in joint pain and
has antibiotic properties
 Cont…
• Destabilase - Dissolves fibrin and has
thrombolytic effects
• Bdellins, Eglins – Anti-inflammatory effect and
inhibits trypsin, plasmin and acrocin
• Acetylcholine – vasodilator
• Histamine-like substances – vasodilator,
increases blood inflow at the bite site
 Conclusion
• Leeching is one of good treatment modality
was used by ancient Unani physicians with
great confidence. Now it is practiced widely in
the field of modern science.
• Scope for this treatment is opened widely. It is
our duty to reveal its value scientifically.
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‫جزاكم هللا خيرا‬