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 medicineespecially in
reconstructive and micro vascular surgery
First written document- medical poem by
Nicander of Colophon (185135 BC), a Greek
poet and physician
The name Hirudo medicinalis, assigned by
Linnaeus in 1758

Cont
Broussais (17721838), France
Student of Marie Francois Xavier Bichat (17711802),
the founder of modern histopathology
Broussais served as one of Napoleons 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 10
th

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


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

Indications for leech therapy in micro
vascular surgery
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 patients 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 leechs 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
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

Actions
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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