Leech therapy / Hirudino therapy / Jalokavcharana (JA) can be traced from ancient civilization when the Ayurveda was in the scripting phase. The novel Ayurveda text Sushruta Samhita devoted a complete chapter on hirudin/leech therapy. Earlier leech was widely used in practice but by time in the early 20th century, this therapy had a major setback due to the origin and evolution of antibiotics. But later on, it again regains its value for action along with a part of reconstructive surgeries. During this period, many research works were conducted in various medical conditions. This article emphasizes a brief review of leech therapy / JA described in Sushruta Samhita.
In Ayurvedic classics, Raktmokshana (bloodletting) is a major reform indicated in the management of Rakta and Pitta Dosha disorders. Bloodletting has two media depending on the equipment or utility used to perform that. It can either be done with the help of Shastra (sharp instrument) or Without Shastra.
Jaloka/Leech is described under Ashastrakrit Raktmokshana and is classified into two specified categories based on their toxicity created by their bite and their habitat, the Savisha (poisonous), and Nirvisha (non-poisonous). Savisha is not fit for therapeutic use while Nirvisha is fit for therapeutic use. Further, these are subdivided into six types, each based on their morphological character or phenotypic properties.
Non- Poisonous Leech /Nirvisha Jalokas
They are obtained from freshwater sources. Large in size, quick in sucking the blood. They live in deep water and don’t feed on rotten or dumpy food material.
- Kapila (Body is slightly yellowish like Reaglar and texture is like Moonga)
- Pingala (Slightly reddish in color, round in shape and quick in movement)
- Sankumukhi (slightly blackish or brownish in color like liver, lengthy, quick in sucking)
- Musika (look and smell like a rat)
- Pundarikamukhi (Colour like Moonga and mouth is like the lotus)
- Savarika (slimy, look like a lotus leaf, 27 cm long and can be used in the animal also).
They are dependent on rotten, turbid, contaminated water, and dead marine cadavers for their food. Their accidental bite can make an individual suffer localized complaints like were inflammation, excessive itching, burning sensation, and systemic complaints such as vomiting, febrile state, unconsciousness, confusion, and lethargy. To treat such conditions, it should be treated as Visha (Poisoning) or like disorders of Pitta and Rakta Dosha.
- Krishna (black colored with a big head)
- Karbura (like an earthworm and lined stomach)
- Algarda (haired body, big sides, and black mouth)
- Indrayudha (varied in color like a rainbow)
- Samudrika (like a flower and black and yellow dots on the body)
- Gochandana (divided into two like testis of an Ox and small upper body)
Acharya Sushruta mentioned their general property as Sheeta Virya (cold potency), Madhura Rasa (sweet), and aquatic habitat.
Collection and Breeding of Leeches
Acharya mentioned that they can be captured or collected with the help of wet leather or to attract them butter or some drops of milk can be poured over a piece of meat.
- After collection, they are stored in the earthen pot and filled with some amount of mud and freshwater.
- Dried meat, chestnut, some algae, or pieces of lotus stem should be poured in a pot as a food for them. Nowadays many aquariums use flour to feed them.
- Some kind of animal fodder can be used to provide as a source for resting or sleeping in the aquarium.
- Every 3 days, water should be replaced with a fresh one.
- After every 7 days, the earthen pot should be replaced with a new one and keep them away with some sought of contamination.
The classic methodology of JA/Leech therapy
They are applied in various disorders with a specified protocol mentioned in Classics To obtain the best-desired outcome it is to be performed under the observation of experts as to some patients they can cause anaphylactic shock or some local allergic reaction.
JA is a supreme treatment modality indicated in many diseases such as skin conditions like psoriasis, eczema, acne, facial melanosis, alopecia, herpes zoster shingles, varicose vein, some other leprotic conditions, and cellulitis and reported efficacy in disorders like rheumatoid arthritis, diabetic foot, a non-healing or venous ulcer, filariasis, osteoarthritis of knee joints, thrombosed pile mass. However, in the current era, their scope of application has boosted up so other than these conditions they are also used as a primary or secondary mode of treatment.
JA is, however, there is no clear literature available regarding contraindication but contraindication for bloodletting is well mentioned in various diseases like generalized edema over the whole body, a person who got emaciated due to intake of sour dietic intake, anemic patient, a person suffering from piles-in-ano, any disease associated with abdominal organ, individual suffering from TB, pregnant ladies and if there is any inflammatory condition present in the body.
Bloodletting is also contraindicated in rainy times, when there is a flow of cold breeze, just after intake of a meal or if an individual has not properly undergone therapeutic heating of that particular part of the body.
Further, there is also the exclusion of the individuals who are suffering from psychological conditions like delirium, unconsciousness, physically exhausted patient, sleepy or scared person. So, it can be assumed that JA should also be not be performed in all these conditions.
- Initially, it is mandatory to assess the patient and his disorder regarding the fitness for JA
- Necessary blood investigations are carried out such as Hb%, CT/BT, and some serological investigations like VDRL/HIV/HCV, etc.
- After the fitness of the patient, a thick paste of mustard seed and turmeric is applied on Jaloka and then transferred to turmeric water for approximately 10-15 min till they get active and regain their motility.
- Then the site to which it is applied is rubbed with cow dung powder or with a broken part of earthen pot to make the surface rough to some extent. As on a smooth surface, Jaloka may slip due to their slimy touch. Leech is being made still on that particular part so that they catch the skin with their Jaws and start sucking the blood.
- If they don’t then a few drops of milk or blood are poured on that part or some south of pricking is made to facilitate the action.
Procedure of JA
- On catch some sought of the bite is felt by the patient as if some prick by ant or needle
- During sucking Jaloka assumes the shape of a horseshoe in the raised and arched position and also during this moment it is covered with a piece of a thin and wet piece of white cotton or gauge that provides a cooling effect and favorable habitat to them.
- It gets detaches after completing its feed. If it doesn’t get detaches off automatically then some pinches of turmeric are poured on their mouth.
Post-Procedure of JA
- After detachment of Jaloka, it is transferred to a kidney tray, and efforts are made to regurgitate the ingested blood by them by pouring turmeric powder on them and by squeezing them from tail to their mouth to get the whole amount of blood out which was sucked by them.
- They are transferred back to the pot from which they are taken out.
- Reduction in signs and symptoms of the disease is a sign of proper JA. Shatdhautama Ghritama (prepared by the washing of ghee with cold water by 100 times) or honey is applied on the tiny wound made by them and proper bandaging is done.
- On excessive bleeding high pressure, elevating the site in anti-gravity direction, Yavkshara application (Caustic medicated powder), or some other anti-haemorrhagic measures can be taken.
- It should always be performed under an expert/skilled person.
- They should be used only after 7 days of their prior use
- One Jaloka shouldn’t be used on the other patient as it may transfer some diseases.
- Ingested blood should be made out immediately after their detachment as ingested blood can hamper their normal body function and they may undergo some other abnormality and will be of no use from next time.