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LEECHING: THE ANCIENT ART OF HEALING

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Alam et al. WORLD JOURNAL OF ADVANCE ISSN: 2457-0400

Page 1 of 286
Volume: 4.
HEALTHCARE RESEARCH Issue: 2.
Page N. 281-286
Year: 2020

Review Article www.wjahr.com

LEECHING: THE ANCIENT ART OF HEALING

Md. Anwer Alam1, Zarnigar2 and Md. Tanwir Alam3*
1
Medical Officer, Under RBSK, Purnea, Govt. of Bihar.
2
Assistant Professor, Dept. of Tahaffuzi wa Samaji Tib, NIUM, Bangalore, Karnataka.
3
Assistant Professor, Dept. of Tahaffuzi wa Samaji Tib, Govt. Tibbi College & Hospital, Patna.

Received date: 21 February 2020 Revised date: 11 March 2020 Accepted date: 31 March 2020

*Corresponding author: Dr. Md Tanwir Alam

Medical Officer, Under RBSK, Purnea, Govt. of Bihar.

ABSTRACT
Ibne Sina, Akbar Arzani, Ibn Baitar and Ambroise (1510-90) recommended leeches for bloodletting in
cases where cupping glasses could not be used, "to those leeches may for the most part be put to open the
coat of the haemorrhoid veins, to the mouth of the womb, the gums, lips, nose, fingers and calf.”.[1,2,3,4]
Harvey defended venesection as a major therapeutic tool for the relief of diseases caused by plethora.
Long after accepting Harvey’s theory, physicians praised the health promoting virtues of bloodletting with
as much (if not more) enthusiasm as Galen.[5] For hundreds of years after the death of Galen, physicians
warned their patients about the dangers posed by a plethora of blood. If a plethora of blood caused
diseases, venesection was the obvious remedy; thus, spontaneous haemorrhage and venesection were as
natural and helpful to the maintenance of life as the menstrual purgation was in healthy women. Bleeding
was a perfectly rational means of treatment within this theoretical framework. [5] Leeching had a fixed &
relatively modest range of indication in humoral pathology. The dominant paradigm in ancient European
and Arabic medicine until the 17th century like bloodletting, leeching as mainly conceived as a means of
eliminating the superabundance of blood, or plethora. [5] Roman physician Galen (129-199 C.E) classified
leeching as part of the system of elements & temperaments, the healthy balance of which required the
drainage of excess corporal substances. Plethoric changes were treated by draining blood from the body,
which was achieved by leeching & bloodletting.[6] Leeches have been used medicinally for phlebotomy.
They were once used in India and elsewhere for the abstraction of blood from foul ulcers and other
congested parts of the body.[7]

KEYWORDS: Leeching; Alqa; Irsale Alaq; Leech Therapy; Jaluka; Hirudo medicinalis.

INTRODUCTION have a very positive effect on the patient's general

[8] condition. Leeching was therefore a permanent
The use of medicinal leeches (Hirudo medicinalis) for
institution at many hospitals for many years and was
the salvage of tissues with venous congestion has been
readily performed even though it was relatively time-
intermittent over the last two centuries. During the last
consuming in terms of changing the dressing and caring
decade venous disease is one of the best-established
for the animals.[6,10]
traditional indications for leech therapy.[9] There is a
plethora of case reports and empirical studies on the
Leeches
subject, including clinical investigations of the efficacy
Leeches are carnivorous or blood sucking annelid worms
of leeching for postoperative prevention of thrombosis
with pronounced ability to extend or contract their
before the advent of heparin, which is now the standard
bodies. They are hermaphrodites. They are distributed all
prophylactic agent. The postoperative use of leeches for
over the world, except the polar zones, deserts and
prevention of thrombosis was proposed by the French
altitudes exceeding 3,700 m. About 45 species belonging
surgeon Termier as far back as the 1920s. His
to 22 genera occur in India.[7]
recommendation was first adopted in France and was
later implemented successfully in numerous hospitals
Vernacular Names of leech (or Synonyms)
around the world. In addition to its fibrinolytic and
Arabic: Alaq.[3,11,12,13,14]
viscosity-enhancing effects in the blood, leeching also
Persian: Zalu, Deucha, Shalak, Shalka, Shalook.[3,12,13,14]
has bactericidal and some spasmolytic activity that may
Urdu: Jonk[12,15,16]

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Alam et al. Page 282 of 286

Khurasani: Zalucha.[16] Genus: Hirudo

Turkish: Salook.[3,13] Species: medicinalis.[22]
English: Leech[3,15]
Latin: Hirudo Hirudinaria grnulosa (the common Indian leech)
Greek: Bdella Kingdom: Animalia
Sanskrit: Raktapa, Jaluka, Jala- Sarpni.[7] Phylum: Annelida
Hindi: Jalu, Jok, Jonk.[3,7,13] Class: Hirudinea
Bengali: Jonk.[7] Order: Gnathobdellida
Guajarati: Jala.[7] Family: Hirudidae
Telgu: Jalagalu, Attalu, Jeriku.[7] Genus: Hirudinaria
Tamil: Attai.[7] Species: granulosa.[20]
Kannada: Jiganey.[7]
Malayalam: Atta.[7] Identification of leech
Kashmiri:Dirk.[3,7,11,12,13,14,15,16,17,18,19] Identification of poisonous leech: Ibn Sina describes
the characteristic features of poisonous leech with
The common Indian species are Hirudinaria granulosa, reference to the Indian physicians, and said one should
H. viridis. H. javanica, and H. manillensis. These species beware of using:
are also common in Burma, Pakistan, Bangladesh and Sri  Those with Large heads of antimonial, black colour,
Lanka. H. medicinalis, and H. australis are the common or Green colour; those with down on them,
leeches of Britain and Australia respectively.  Like eels (snakefish),
Haemadipsa is a land leech of the hills of Southern  Those upon which are fine streaks of bright colour,
India.[20] Leeches are of two types medicinal and or chameleon-like in colour.
poisonous. The medicinal leech, Hirudo medicinalis, is a  Leeches from unhealthy water or those whose
European species which has been introduced into certain excrement is black & muddy, and whose movement
ponds and streams of the eastern portion of the United immediately darkens water, and renders it offensive
States. It is relatively large leech often growing to 10 or in smell.
more centimeters in length. It feeds upon blood of a  Those with red bellies & green backs, especially if
vertebrate to which it periodically attaches itself.[21] In they were collected from running water.
Indian leeches H. granulosa has medicinal properties.[22]  They would give rise to inflammations,
Hirudinaria granulosa is a common Indian leech found in haemorrhage, fever, syncope, paresis of the limbs,
freshwater tanks, ponds lakes, swamps, and slow and intractable ulcers.[12,23,24,25,26,27]
streams. It prefers shallow water and remains concealed
under weeds, logs and stones. It is sanguivorous (blood- Identification of medicinal /non-poisonous Leeches
sucking), sucking the blood of fishes and frogs, and also
 Take leeches from water whose surface is covered
of cattle or human beings when they enter the pond. [20]
over with duckweed and in which frogs live.
 The colour should be greenish (like duckweed),
Classification
 There should be 2 longitudinal lines having the
Hirudo medicinalis
colour of orpiment & ruddy; they should be rounded
Kingdom: Animalia
and liver-coloured.
Phylum: Annelida
Class: Hirudinea  Leeches which look like little locusts, or like mouse-
Order: Gnathobdellida tails, with very small heads.[23,24,28,29]
Family: Hirudidae

Poisonous Leech Medicinal Leech

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Alam et al. Page 283 of 286

Identification of Hirudinaria granulosa anterior end. It also possesses a ventrally directed cup-
It is a common Indian leech found in freshwater tanks, like hollow structure, the pre-oral chamber, which leads
ponds lakes, swamps, and slow streams. It prefers into the mouth. The posterior sucker or anal sucker is
shallow water and remains concealed under weeds, logs circular in outline and forms the highly muscular disc at
and stones. It is sanguivorous (blood-sucking), sucking the posterior end of the body of leech. It is formed by the
the blood of fishes and frogs, and also of cattle or human fusion of last 7 segments. It is much better developed and
beings when they enter the pond.[20] larger in size than the anterior sucker. Both suckers are
directed ventrally, the leech can firmly grip the
Morphology substratum by its suckers. The two suckers are primarily
Shape and size: the body of Hirudinaria is soft, meant for adhesion and locomotion.
vermiform, elongated, bilaterally symmetrical and
metamerically segmented. In a state of extension, the Clitellum: During breeding season a girdle-like clitellum
body is dorsoventrally flattened and appears almost is formed around segments 9 th to 11th, rest of the year
starp-shaped but in a state of contraction, the body there is no clitellum.
becomes more or less cylindrical. The body is broadest
near the posterior end, while narrowest near the anterior Eye: On the dorsal side are five pairs of eyes, one pair on
end. It has great power of contraction and expansion. A each of the first and second segments, and one pair on
full-grown specimen may attain the length of 30 to 35 the first annulus of the segments third, fourth and fifth.
cm.
External apertures: external apertures in the body are
Colour: the body is beautifully coloured with as follows:
characteristic markings. The dorsal surface is generally  Mouth: It is a narrow triradiate aperture situated in
olive-green and the ventral surface is orange-yellow or the center of the funnel-like pre-oral chamber.
orange-red and the two sides bear distinct stripes of  Anus: it is a very small aperture situated mid-
orange or yellow and black. On the dorsal side is a dorsally on the 26th segment at the root of the
median longitudinal black stripe. posterior sucker.
 Nephridiopores: there are 17 pairs of
Segmentation: the body of leech is divided nephridiopores lying on the ventral surface of the
metamerically into segments or sometimes but body, of which one pair lies on the last annulus of
metamerism is much reduced and the number of each of the segments from 6th to 22nd.
segments unlike other annelids is fixed in leeches. They  Male generative aperture: it is situated in a groove
always have 33 segments or somites. In case of leech the between the 2nd and 3rd annuli of the 10th somite on
external segmentation does not correspond with the the mid-ventral line of body. A filamentous penis is
internal segmentation. But the original segmentation is sometimes seen protruding through this aperture.
obscured by secondary external annulations. Each  Female generative aperture: it is usually smaller
segment is broken up externally by grooves into rings and less conspicuous than the male aperture. It is
called annuli. The first and second segments have one situated mid-ventrally in a groove between the 2nd
annulus each. The third has two annuli; segments 4 th to and 3rd annuli of the 11th somite of the body.
6th have 3 annuli each. Segments 7th to 22nd are broad  Divisions of body: the body of leech is composed of
having five annuli each. Segments 23 rd to 26th have two 33 somites and is divisible into the 6 regions,
annuli each. Segments 27th to 33rd have one annulus namely cephalic or head region, preclitellar region,
each, they form the posterior sucker. However, segments clitellar region, middle region, caudal region,
with less than five annuli are referred to as incomplete, posterior sucker.
while those with five annuli are called complete
 Posterior sucker: it is composed of 7 segments
segments. Each annulus of a segment is divided into
(27th to 33rd) arranged in concentric rings and each
small rectangular areas by longitudinal wrinkles. Each
represented by a single annulus. These 7 segments
such area has a sort of papilla-like structure bearing
are completely fused and their intersegmental
sensory organ called annular receptor; there are 18 such
furrows are greatly suppressed.[20,30,31,32,33,34]
receptors both on the dorsal and ventral surfaces of each
 Buccal cavity: the triradiate mouth leads into very
annulus. Besides these, the first annulus of each segment
short chamber, the buccal cavity. In the mucous
bears larger sensory organs called sensillae or segmental
membrane of buccal cavity are embedded 3
receptors; there are four pairs on the dorsal side and three
crescentic jaws, 1 mid-dorsal and the other 2 are
on the ventral side. Due to this the first annulus of each
ventro-lateral in position. Each jaw is a laterally
segment is called sensory annulus.
compressed cushion, covered with a fine cuticle
which is thickened at the free edge to form a
Suckers: each of the body of leech bears a hollow
dentigerous ridge bearing a row of minute teeth
muscular organ, the sucker. The anterior sucker or
(denticles). As these teeth form a single series on
cephalic or oral sucker is formed by the fusion of the
each jaw, the jaw is termed as monostichodont. The
prostomium with a few somites of anterior region. It is
median jaw bears 103-128 teeth, while the lateral
oval in outline and is placed on the ventral surface of
jaws bear 85-115 teeth each. On both the sides of a

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Alam et al. Page 284 of 286

jaw are small button-shaped salivary papillae, each Removal

bearing a number of openings of salivary glands the When the leeches are full, and wish to let them come off,
number of papillae is 42-45 on each side of a jaw. sprinkle a little salt over them, or peeper, or snuff, or
However, the jaws are moved in such a way that ashes or nitre, or burnt bristles, or flax, or burnt sponge
they make Y-shaped wound on the body of its or burnt wool. They will then fall off. Don’t detach
victim through which blood is sucked.[20] leeches forcibly, or else there may be violent
 Pharynx: The buccal cavity leads into thick-walled haemorrhage.
muscular pharynx, which is an oval sac running
from the 5th to 8th segments. The lumen of the After-treatment
pharynx varies in outline in different regions. The After the leeches have fallen off, the place should be
muscles of the pharynx are circular and radial which sucked by cupping it, in order to extract some of the
join the pharyngeal wall to the body wall; radial blood at the spot and thereby get rid of the toxic
muscles dilate the pharynx producing a pump-like substances left in the wound. If one wishes to keep the
action for sucking blood. Large masses of blood flowing anyway, one applies warm, dry cloths to
unicellular pyriform salivary glands surround the the part, or a warm poultice, or a sponge soaked in warm
pharynx, their ducts open between the teeth of jaws. water. After the bleeding has stopped, apply a soft, dry
The secretion of salivary glands contains a substance compress.
called hirudin or anticoagulin which prevents the
coagulation of blood of the host when the leech is If the blood will not stop flowing, dust the spot with
sucking.[20,35,36] finely powdered burnt galls, quicklime, ashes, ground-up
earthenware and similar styptics.
Leech bite  Alum, cobwebs, pitch, gunpowder, hydrates,
When a leech bites it holds the sucker in place by making sesquioxide of iron, or pressing the skin into the
its body rigid. Using its semicircular and many toothed folds have been advocated. The cautery has been
jaws like minute saws, it then makes an incision in the necessary as a last resource. All such remedies
skin and excretes mucous from the nephropores (external should be at hand.
openings form the kidney-like organs). This helps the  Don’t leave the patient till the bleeding has stopped,
sucker to adhere. A salivary secretion containing the and if it is a child, watch it the following night as
anticoagulant and histamine floods the wound and the well.
leech relaxes its body to allow the blood to be ingested.  Don’t use leeches again if they have been applied to
This mixture allows the blood to flow and also prevents a case of typhoid fever, cholera, smallpox, or
clotting once inside the leech.[37] syphilis.[23,38]

Procedure of application Components of saliva

Leeches should be kept a day before applying them, and During the process of feeding, leeches secrete a complex
they should be squeezed (or have their heads bent down) mixture of different biologically and pharmacologically
to make them eject the contents of their stomachs. If active substances into the wound. Hirudin is the best-
feasible, they should be given a little lamb’s blood by known component of leech saliva. Hirudin is sometimes
way of nourishment. The slime & debris from their used to describe all active substances in leech saliva. In
bodies should be cleansed off, with a sponge. reality, Hirudin refers only to one specific active
substance in leech saliva. Components of medicinal
The site of application leech saliva that exert effects in the host's body are:
The place where the leeches are to be applied must be  Hirudin [30] - Inhibits blood coagulation by binding
(shaved if necessary) well laved with nitre-water and to thrombin.
rubbed till red. Dry carefully. Dip the leeches in fresh  Calin- Inhibits blood coagulation by blocking the
tepid water (a few drops of white wine being added if binding of von Willeband factor to collagen-
they are sluggish), cleanse and apply (with one’s freshly- mediated platelet aggregation.
washed hand, or with a soft towel, or in a test-tube called  Destabilase- monomerizing activity. Dissolves
a “leech glass” –especially if the place in question is the fibrin. Thrombolytic effects
palate or gums). The point of application may be  Hirustasin- Inhibits kallikrein, trypsin,
smeared with clay (or moistened with sugar-water or chymotrypsin, neutropholic cathepsin G.
milk) or scratched with a needle till blood appears, in
 Bdellins- anti-inflammatory, inhibits trypsin,
order to coax them to take hold.
plasmin, acrosin
 Hyaluronidase- increases interstitial viscosity.
The leech must not be let go until it has taken proper
Antibiotic.
hold, as one can tell by the sinuous movements of the
 Tryptase inhibitor- inhibits proteolytic enzymes of
neck and from the circumstance that the head forms a
host mast cells.
right angle to the body.

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Alam et al. Page 285 of 286

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