LEECH THERAPY

LEECH THERAPY

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

·         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

·         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 and blood letting was the treatment of choice. 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

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.

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.

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

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

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
• 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

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.
• ·         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 diseases – 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
• ·         Reattachment of the ear lobes

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)
• ·         All leeches used must be destroyed with 70% Alcohol and supplier must be notified
• ·         Fresh, unused leeches should be used
• ·         Should not reuse