Leech Therapy

LEECH THERAPY Dr. Mohammed Shiffa MD, BUMS

Historical Historical Background •

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The use of leeches (Hirudo medicinalis) has been popular throughout the ages, and still has a place in modern medicine—especially in reconstructive reconstructive and micro vascular surgery First written 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

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Broussais (1772 –1838), France Student of Marie Francois Francois Xavier Bichat (1771 ( 1771 –1802), the founder of modern histopathology Napoleon’s physicians and Broussais served as one of Napoleon’s became professor of general pathology in Paris Broussais applied 10 to 50 leeches at one time to any patient, thereby 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

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Von Ronsenstein, in the first printed textbook on diseases of children, advocated advocated leeching for difficult difficult dentition, tooth abscess, convulsion, convulsion , scarlet scarlet fever fever,, pleurisy pleurisy,, or inflamed inflamed eyes. The English edition was published in 1776 Gross’ System of Surgery in 1859 advocated leeching as a minor surgical procedure

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Charles de Nancrede, (Professor of Surgery) in Ann Arbor, mentioned leeches in his textbook, “Lectures on the Principles of Surgery”. 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.

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Bloodletting is an ancient therapy with origins that are suspected to go back as far as the Stone Age. Healers attributed 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. advantages. slower, less painful; more quantitatively dependable extraction of blood

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Avicenna (d. 1037), believed that leeches drew blood from deeper sources than did wet cupping. Galen prescribed p rescribed phlebotomy for diverse infirmities including epilepsy, epilepsy, liver disease, melancholy, melancholy, and pleurisy and he used leeches

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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 better than  fasad or ishal .

Leeches •

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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 Threatened Relatives: Earthworm, lugworm

Cont… Description: •

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Leeches have segmented bodies like an earthworm, but unlike earthworms they are slightly flattened rather than round. Sucker 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 pool s 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. •

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Cont… Family Family & friends •

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Like slugs, leeches are hermaphrodite, having both male and female parts, but they still need to come together to mate with wit h each other. 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

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Leeches having soft hairs, resembling eels (snake fish)

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Those having azure lines

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Those which can change their colours

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Those having red bellies and green back especially if they are found in running water

all the above being poisonous produce swelling syncope, heamorrage, heamorrage, fever, fever, paralysis and malignant ulcers

Cont… Following types can be used for the medicinal purpose •

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Leeches which are thin and a nd have tiny head Emerald green leeches predominantly green and having yellow stripes or leeches which resemble liver colour

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Brown leeches with round sides

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Leeches which looks like like mouse tails

Uses •

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Relieves vascular congestion - effectively used in conditions like long standing Varicose ulcers, Filariasis, post-op. skin grafting g rafting lesions. Arthritis, Sprain or spasm to relieve relieve the pain, inflammation & discomfort symptomatically. Abscess, Cellulites, Thrombophlebitis and Varicose Veins Atherosclerosis Atherosclerosis of the limb - improves circulation.

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Management of non- healing ulcerative ulcerative lesions like Diabetic ulcer, Leprotic wound etc. it helps to improve the local blood circulation & healing is i s promoted. Cardiovascular Cardiovascular diseases  – hypertension and ischaemic disease Respiratory – pneumonia, bronchial asthma Paradontosis Paradontosis and other teeth diseases Skin diseased – neurodermatitis, psoriasis, herpes, eczema

Indications for leech therapy in micro vascular surgery •

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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 microsurgical anastomosis of the hair thin blood vessels of the ear is extremely challenging Venous insufficiency sometimes occur

Contraindications •

Anaemia

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In extreme ages i.e. in children and old age

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Weak patients

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Allergic patients

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Extreme hot or cold climate

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Bleeding disorder dis orderss like haemophilia

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Pregnancy

Application Application guidelines guidelines •

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Clean patient’ patient ’s skin thoroughly with hot water to remove odour odo ur,, dirts.

Application site- rubbed till red. Caught one day before, If possible squeeze till the contain of the stomach comes out.

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Pick leech with gloved hand, wipe it

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Hold the leech’s head to the application site

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If did not bite make prick and smear a blood drop

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Leeches will remain until they become full then removed spontaneously When the leeches get distended and their removal 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.

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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 leave small blood spots (ecchymoses) which sometimes develop into keloids in some individuals. Most of these spots disappear within 2-3 weeks weeks To remove the leech, absolute absolute care is is required  – Forcible removal of the leech may rupture gut contents (Aeromonas hydrophilia) Prophylactic Antibiotics- Ciprofloxacin / Ceftriazone

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All leeches used must m ust be destroyed destroyed with 70% Alcohol and supplier must be notified

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Fresh, unused leeches should be used

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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 disorders Bacteriostatic Restores Restores permeability of tissues and org o rgans ans Eliminates hypoxia Reduces BP Detoxifies Detoxifies the organism

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Benefits of Leech Saliva •

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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 facilitates the penetration and diffusion of these pharmacologically active substances into the tissues- especially in joint pain and has antibiotic properties

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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 •

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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 w idely.. It is our duty to reveal its value scientifically.

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Lineaweaver Lineaweaver WC, Hill MK, Buncke GM, et al. Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery. surgery. Ann Plast Surg. 1992; 29: 234- 244 Michalsen A, Klotz, K lotz, Ludtke R, et al.: Effectiveness Effectiveness of leech therapy in osteoarthritis of the knee: a randomized controlled controlled trial. Ann Rheum Dis. 2001:60:986 Michalsen A, Moebus S, Spahn G, Esch T, T, Langhorst J, Dobos GJ. Leech therapy for symptomatic symptomatic treatment of knee osteoarthritis: results and implications of a pilot study. study. Altern Ther Health Med. 2002 Sep-Oct;8(5):848. Michalsen A, Lüdtke R, Cesur O, Afra D, Musial F, Baecker M, Fink M, Dobos GJ. Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: a randomized randomized controlled trial. Pain. 2008 Sep 30;139(1):237-8. Pain. Pain. 2008 Jul 15;137(2):235-6. 15;137(2):235-6 . S.M Abbas Zaidi, SS Jamil, Jamil, A Sultana, F Zaman & M Fuzail, Safety Safety and efficacy efficacy of leeching therapy for symptomatic symptomatic knee osteoarthritis using Indian medicinal leech, Indian Journal of Traditional Knowledge Vol.8 Vol.8 (3), July 2009,pp.437-442 Utley DS, Koch RJ, Goode RL. The failing flap in plastic and reconstructive surgery: role of the medicinal leech. Laryngoscpoe. 1998; 1129-1135. Utley DS, Koch RJ, Goode RL. The failing flap in plastic and reconstructive surgery: role of the medicinal leech. Laryngoscpoe. 1998; 1129-1135.

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