Introduction:-

Leech therapy has been used in Ayurveda since centuries for the purpose to drains impure blood. It is considered a unique and effective method of bloodletting. Leech therapy works on the principles of evacuation of morbid humors and diversion of humors, means the resolution and excretion of morbid humors and excess fluids from the body. The effectiveness of this therapy may be attributed mainly to the sedative  and anti-inflammatory actions of saliva of leeches.

Leeches’ Modes of Action:-

Leeches act by secreting biologically active substances in their saliva. This saliva, which contains a hundred or so different substances, includes an antiplatelet aggregation factor, anesthetic, and anti-inflammatory and antibiotic agents. Leech saliva also contains an anticoagulant, hirudin, which stops blood clotting and dissolves thrombi, clearing partial and complete blockages in distal arteries. When leeches bite, chemicals in their saliva dilate hosts’ blood vessels and thin their blood. Simultaneously secreting a local anesthetic masks any pain from the bite, rendering hosts unaware of leeches’ presence. By ingesting excess blood, leeches reduce tissue swelling and promote healing. These microcirculatory actions enable fresh oxygenated blood to reach hosts’ affected areas prior to the restoration of the normal circulation.

Composition of Leech Saliva:-

1-Hirudin-Inhibits blood coagulation by binding to thrombin 

2-Calin-Inhibits blood coagulation by blocking the binding of Von Willebrand factor to collagen; inhibits collagen mediated platelet aggregation 

3-Destabilase-Monomerizing activity; dissolves fibrin 

4-Hirustatin-Inhibits kallikrein, tryptin, chymotryptin, and neuropholic cathepsin G 

5-Bdellins -Anti-inflammatory, inhibits plasmin, trystin, and acrosin 

6-Hyaluronidase-Increases intestinal viscosity and antibiotic action 

7-Tryptase- inhibitor Inhibits proteolytic enzymes of host mast cells

8-Eglins-Anti-inflammatory; inhibits the activity of α-chymotrypsin chymase, substilisin, elastase, and cathepsin G

9-Factor Xa inhibitor -Inhibits the activity of coagulation factor Xa by forming equimolar complexes

10-Carboxypeptidase-A-Increase the inflow of blood at the bite site of inhibitors 

11-Acetylcholine-Vasodilator

12-Histamine-like Vasodilator

Indications for Leech Therapy:- Pita ,Deep located Granthita rakta (blood clots),kusta, piles.

Benign tumors•Hemorrhoids•Abscesses and boils•Skin disorders—such as dermatitis, psoriasis, vitiligo, alopecia, ulcers•Gout•Diseases of the throat•Diseases of the eye•Cysts•Headaches•Herpes zoster•Thrombosis•Wound management—such as diabetic, pyogenic wounds.

Contraindications in Leech Therapy:-

Leeches should not be applied directly over large, prominent veins or to the eyelids, breasts, or genital organs. Care should be taken in using leeches with children, as bleeding can be severe (intense) or prolonged. Applying leeches at midday or during the evening or night is also inadvisable, as this can lead to complications such as hemorrhage.

 patients who are immunocompromised or taking anticoagulants; those who have endoprostheses, anemia, diabetes, or an allergy to leeches; as well as those with bleeding disorders such as hemophilia and arterial insufficiency. It is also inadvisable to apply them during pregnancy.

Leech therapy in CAD:- Leech therapy is sometimes used for Coronary Heart disease, where atheromatous plaques accumulate(Vyan vata gets occluded by Shadak pitta and Avalambhak kapha) within the walls of the arteries that provide the blood supply for the myocardium.It is also used for ischemic heart disease, where the blood supply to the heart is reduced. Para Ojas get polluted which is situated in the heart give leads to many Hrudya roga (Heart Disease).The para ojas is extremely vital and its loss leads to immediate death. The exact correlate of ojas in modern medical science is yet to be identified or discovered. The ojas predominantly contains the water element-it is greasy, white, cool, steady, expansile, clear, soft and moist and is the important seat of life. leech sucks the Deoxygenated blood and does pitta nirharan ( According to Ashrya-Ashryee bhav if pitta is pure Rakta automatically becomes pure ) Drains out the toxic which are present in Hrudya predesh.

Action on Doshas – Pittahara and Rakta sodhaka.

Identification of Jaloukagrahana:-

When Jalouka starts sucking the blood it attains shape of Ashva khuravadanana i.e. its mouth end becomes the hoof of horse by raising its neck region 

Identification of Shuddha rakta (pure blood sucking)Pana by Jalouka At the site of Jalouka bite if the person gets pain and itching sensation then it should be understood that it is sucking pure blood then it should be removed.

By:- Dr. Nitin Dhruv.

MD in Medicine, BAMS, PGDEMS,DIHM,CCPT.

Assistant Prof. and Consultant @ GGIMS , Gorakhpur.