Bloodletting is an ancient art which archaeologists have now dated to
the Stone Age after recent discovery of bloodletting tools in that culture
(Glasscheib, 1964). The first records concerning bloodletting by cutting
vein, or venesection, were found in the Hippocratic collection in the
5th century BC. Early practitioners let blood to eliminate the peccant
humors in an attempt to restore health. Plethora or an overabundance of
body humors is considered ass unhealthy in Unani System of Medicine also.
The idea laid down by renowned physicians of the past like Hippocrates,
Galen, Avicenna, Razzes etc. Leeches are being instrumental in helping
to rid the body of plethora painlessly. Leeches and the medical practitioners
have been closely associated for centuries. Five thousand years ago, Egyptian
medics believed that letting a leech sip a sick patient`s blood could
help cure everything from fevers to flatulence. In medieval Europe, leeches
were so closely associated with doctors that physicians were called “leeches”
and they used millions of the parasites annually to treat patients. The
earliest clearly documented record of leeches being used for remedial
purpose appears in a painting in an Egyptian tomb of around 1500 BC. The
term leech was used to designate English Physician.
It has been reported that the first person to use leeches medicinally
may have been Nicandros of Colophon (200-130 BC) and soon thereafter,
Thmison of Laodicea (123-43 BC a pupil of Aesculipius (Major, 1954).
During the Roman Era, Galen (129-189 AD) promoted leeching because he
believed that bloodletting would rid the body of noxious substances produced
by disease. By doing so it ould restore the four humors to proper balance.
Avicenna (978-1037 AD), the great Arab Physician, believed that leeches
drew blood from deeper sources than did wet cupping. In his world famous
book The Canon of Medicine (Alqanoon-fi-Tibb) he has devoted several pages
for instructions on leeching and description of leeches to be used medicinally
The description of leech is also found in Kitabul Umda Fi Jarahat written
by Ibne Maseehi (1233- 1286 AD), where he has mentioned the characteristics
of poisonous leeches. The leeches described for the medicinal use include
mash colour leeches, blackish red leeches, liver colour leeches, yellow
colour leeches, thin leeches resembling to mice tail etc. (Maseehi, 1986).
The leeches became popular mode of bloodletting in 18th and 19th century
AD. Their use peaked in 1830 in France when Brousias, the most sanguinary
physician in history was practising (Castiglioni, 1948). He believed that
every disease could be traced to an inflammation, that is, excessive accumulation
of blood in one part of the body.
Numerous indications for leeching include acute laryngitis, nephritis,
nephralgia, subacute ovaritis, epistaxis, swollen testicles, ophthalmia
and brain congestion (Adams, 1988).
In acute gastritis, application of 20 to 40 leeches was recommended.
Even leeches were applied over the spermatic cord in epididymitis, on
the temple in ocular inflammation.
Between 1829 and 1836 AD the use of leeches became more popular and approximately
5 to 6 million leeches were used yearly.
In 1870 edition of American Dispensatory, the authors described the regimen
necessary for maintenance of the leeches and how to prevent the putrification
of water containing leeches (Adams, 1988).
The leeches can ingest an amount of blood almost 10 times its own weight
and may digest the bout of blood for as long as 12 to 18 months during
which time the leech will not bite (Lent, 1985). Leech could suck 5 to
15 mL of blood which would then be broken down by the flora of the gut
of the parasite (Busing et al., 1953).
One reference from Medieval England refers to bloodletting by leeches
in a Latin written by Aldhelm of Malmsburh (7th or 8th century AD) and
may be translated as I bite unfortunate bodies with three-furrowed wounds
and bestow a cure from my healing lips (Cameron, 1993).
Von Rosenstein, in the first printed text book on diseases of children
advocated leeching for difficult dentition, tooth abscess, convulsion,
scarlet fever, pleurisy, or inflamed eyes. Regarding diseases of the throat
he wrote. “We know very well what an incomparable effect blistering
has in a rheumatism, toothache, in common sore throat and in all colds
or rheumatisms in what place so eve; so that there is reason to expect
a good effect in this disease likewise. But bleeding and leeches ought,
without dispute, to have been used beforehand (Von Rosenstein, 1776)”.
Thomas treatise on domestic medicine, written in 1822, advocated leeching:
Topical bleeding may be performed in two ways, viz., wither by application
of leeches or cupping. Leeches are highly useful and can be applied to
the most delicate parts as eyes, gums, breasts and testicles etc. where
cupping can not be employed. He also mentioned continued bleeding after
the leech drops off should be encouraged. Mention of medicinal leeches
in Australia dates back to 1824 AD (Thearle, 1998). Although, the same
thing has been mentioned in Avicenna`s Cannon of Medicine way back in
The leeches belong to the phylum Annelida and there are about 650 species
of leeches in the class Hirudinea. The leeches in use medicinally are
Hirudinaria medicinalis, Hirudinaria asiatica and
Hirudinaria manellensis. The name Heridunaria medicinalis was
given to the leeches used medicinally by Linnaeue in 1758 AD.
METHODS OF APPLICATION
The techniques of application of leeches today are not much different
from Avicenna`s prescribed methods. His precise description and logical
methods 1000 years ago should humble modern healers, who forget that they
stand on the shoulders of a number of giants. Avicenna`s insistence on
cleaning not only the leeches but also the application site and the applicator`s
hands is common antiseptic sense that Holmes, Semmelweisand Lister rediscovered
for themselves 800 years latter and struggled to prove to resistant colleagues
(Robert et al., 2000).
The leeches once used should never and never be reused, but should be
destroyed in 70% alcohol where it gets killed. The part should be prepped
well and nothing should be applied to the part having pungent smell as
it repels the leeches. If the leech do not stick to the part well then
a drop of sugar water should be applied to the part and in certain cases
some blood is being oozed by pricking the part so that the leech sticks
it. The leeches should be kept hungry for the overnight. The temperature
should be maintained between 5 and 15 degree centigrade as leeches do
not stick in severe cold and extreme hot seasons. The lean leech should
be selected for the purpose. The saline or alcohol swab encourages the
leech to drop.
PRESERVATION OF LEECHES
The leeches are to be preserved in the pharmacy in fresh spring water.
The water needs to be changed every day or twice daily depending on the
temperature. Traditionally the leeches are being kept in earthen pots
as the pores present in the pot keeps the atmosphere for the leeches cool.
The temperature should be maintained between 5 and 15 degree centigrade.
Do not use distilled water for the storage purpose as it leads to the
ion depletion of the leeches. If distilled water is to be used then the
commercially available salt (Hirudosalt) should be added to it. Otherwise
the fresh spring water or the dechlorinated water can be used.
Although, Haycraft in 1884 discovered that a substance from leech saliva
was powerful anticoagulant (Haycraft, 1884) but the use of leech for the
medicinal purposes dates back to 1500 BC. It was believed that the leeches
suck the bad blood which later on proved to be wrong notion, instead the
leech is a blood sucking animal which sucks every type of blood. The leeches
were used for almost every ailment and in the past if the physician could
not get the time to see the patients on the same day he used to say to
the attendants to subject the patients for leeching till he would visit
in the morning. The leeches were also used after the patient gets cured
so as to remove the paccant humors which get accumulated in the body.
In Unani System of Medicine the bad humor`s which get accumulated in the
body need to be removed (Istefragh) by various methods like vanesection,
purging, emesis, diaphoresis, leeching etc. especially after the winter
season due to less work and exercise the bad humor (Ikhlate-fasida) get
accumulated in the body and need to be removed. In the valley of Kashmir
since centuries the people opt for leeching on 21st of March every year
as this date marks the end of the winter. Though the people with different
diseases throng the leech vendors but it has been observed that healthy
people also opt for leeching on that day (Younis, 2002).
The advances in medical sciences have proved that the leeches can work
wonders. Recent studies have proved that efficacy of leech extract in
cosmetics. The leeching has proved very beneficial in microsurgeries (Derganc
and Zdravic, 1960), in ailments like frostbite (Younis, 2005), essential
hypertension and different types of arthritis. In a study conducted in
Germany, the effectiveness of leech therapy in osteoarthritis of knee
was established. The patients (n = 51) received a single sting of leeches
(4 to 6 in number). The primary end point pain at day 7 was reduced from
53.5±13.7 to 19.3±12.2 in leeching group compared to the
control group where the pain was reduced from 51.5±16.8 to 42.4±19.7
with topical diclofenac application (Michalsen et al., 2003). In
this study, the outcome was measured with WOMAC criteria which is subjective
one, so we at RRIUM, Srinagar which is a unit of CCRUM, New Delhi started
the work in this direction and the outcome is being measured on basis
of reduction in joint swelling which is the only objective parameter.
The study is going on in a positive direction and the results seem to
In another study, the hirudin was tested for thrombin inhibition in synovial
inflammation in Antigen Induced Arthritis (AIA). The study was conducted
on animal models where experiments showed hirudin did indeed significantly
attenuate the severity of AIA as measured by both 99mTC uptake
and synovial histology. The intra-articular fibrin staining was reduced
by hirudin treatment. There was a clear reduction seen in synovial inflammation
by hirudin (Vrisco et al., 2000). The hirudin as a potential therapeutic
agent for arthritis has also been advocated by K Scott, Professor in University
of Auckland, New Zealand (Scott, 2002) and synovial stimulatory protein
(SSP) acting as auto-antigen to which T-Lymphocytes from patients with
rheumatoid arthritis respond identified in synovial fluid has been found
to bind to a hirudin-agarose affinity chromatography matrix (Bush et
The major enzymes of leech saliva having different functions are as under:
||The most well known enzyme, a powerful anticoagulant
in existence, than heparin.
||A protease inhibitor thus acts as anti-inflammatory.
||A powerful platelet anti-aggregate factor thus making blood flow
||It is also an inhibitor of inflammation but at the same time it
||This enzyme has very powerful platelet anti-aggregating activity
which acts by dissolving the blood clots, thus opening up very exciting
||It acts both as a factor for diffusion and as an antibiotic.
||Used for hyperlipidemia.
||This substance acts by limiting the action of Elastases which degrade
cutainous elastin particularly at the level of skin.
||These substances have not yet been
||identified but it is very similar to histamine.
There are other important enzymes in the bio-energetic processes such
as neurotransmitters which are secreted by the 34 cerebral nodes distributed
along the body of leeches.
The leeches also produce catacholamines which act on the nerve terminators,
particularly at the level of the skin which are Dopamine, Serotonin and
Acetylcholine, which is so important in leeches that the official method
for assaying acetylcholine in tissue is based on a biological method involving
the contractility of the leech`s dorsal region.
So on and so forth the leech has been termed as pharmaceutical manufactory
by the scientists and it was on these observations that in 2004 the FDA
of USA allowed the marketing and growing the leeches for the medicinal
There is a good scope for the study on the efficacy of leeching in different
diseases and RRIUM, Srinagar has been successfully doing the work in this
direction from 1998 onwards. We are also in the process of establishing
a leech bank so that the laboratory propagation of leeches can be done,