Introduction

In the fast developing technical era; the changes in lifestyle, food habits, stress & strenuous work and busy agenda have led people to suffer from various diseases. While seeking the treatment for the same, even though the people are usually motivated towards new advanced medical science and technology, the most component science to the former, the oldest traditional discipline, Ayurveda, the science of Life; offers a better cure without side-effects.

Same is the case with surgery; surgeons are constantly looking out for more & more safe and less time consuming and giving better results. But time comes when these modern techniques fail to give results even by using latest type of surgery. At such time one has to look back and see what methods were used by our ancient physicians & surgeons to treat such diseases.

Leech application is one of the methods of bloodletting used by them and recently in foreign countries leech is becoming more popular for bloodletting & medicinal purpose. Leech is widely used in post operative complications where blackish & bluish discoloration of skin occurs due to impairment of blood circulation. When the leech being feed they injects salivary component that inhibit both the platelet aggregation and the coagulation escalade thus releasing the venous congestion and induces neo-vascularization. Due to this property leeches are being widely used in post operative complications after skin grafts. Leeches sucks the surplus blood free of veins to reconnect naturally so that, the circulation is restored.

Leeches secrete Hirudin (hementin) in its saliva which has anti-coagulant property and prevents blood clotting. Due to this property it improves macro & micro circulation and clearing blockage. Leech injects powerful anesthetic & anti-inflammatory enzymes while sucking the blood so that, patient feels no pain. Hirudin has a powerful blood thinner which break-up pooled blood for better extraction from the affected part.

Materials and methods

 Clinical study was carried out over a period of 3 months on 20 pts in M.A. Podar Ayurved Medical College, Mumbai-18. Patients of both the sexes between the age of 12-60 years with perianal haematoma. At the time of baseline assessment, a profile of haemogram, biochemical investigations and serological tests for HIV, HBsAg, VDRL was obtained. Patients with HIV I/II, HBsAg, VDRL infections were rejected. Hirudo Medicinalis (medicinal leech) was obtained from the storage tank at surgical ward of M. A. Podar Hospital. Leeches are kept starved for five days. Turmeric powder was applied to the mouth of leech to make them active.

The leeches were applied to the area affected. The number of leeches applied depends on the area of the affected part. The leeches were applied once in a week or earlier as per need. The duration of application of leech depend on size of leech and the speed of sucking the blood which varies from 10 min to 45 min. Each leech sucked averagely 20-30 ml of blood, with a further mild oozing occurring for 3-4 hours after the leech fells off.

Assessment criteria

Clinical Parameters –
1.  Pain: Internationally accepted pain Mobility Gradation Chart (Based on V.A.S)

2.  Swelling
           Grade 0 – No swelling
           Grade 1 - mild
           Grade 2 - moderate
           Grade 3 – Severe
 
3. Tenderness
           Grade 0 - No tenderness
           Grade 1 - mild
           Grade 2 - moderate
           Grade 3 – Severe
          
4. Kandu (Itching):
          Grade 0- No Kandu
          Grade 1 -Mild or occasional Kandu
          Grade 2- Kandu on and off
          Grade 3- Continuous Kandu without medication
          Grade 4- Continuous Kandu with medication

 The patients were assessed parameter wise and the score was recorded on the efficiently designed case record form according to the standard degrees of respective parameter. The results were analysed using Wilcoxan sign rank test.

Result

The number of leeches applied during each session ranged from 1-4 and the number sessions required per patient ranged from 2-8, depending on the extent of disease, severity and the site of disease. The applications were carried out until the patient gets significant relief in major symptoms.

Study population consists of 20 patients. All patients having varying degrees of pain, tenderness, swelling and Kandu. Sevarity of pain significantly decreasese from 1.9+_0.7 to 0.17+_0.44 with p=0.006.  Tenderness decreases significantly from 1.97+_0.57 to 0.12+_0.4. Also swelling decreases significantly from 2.27+_0.55 to 0.55+_0.55. Tenderness decreases significantly (p=0.0004) from 1.05+_0.91 to 0.31+_ 0.47. Leech sucks clotted blood collected in the saccules of haematoma. It also secretes Hirudin in the clot which results in degradation of clots and reduction in pain, size of haematoma.

Discussion

Leech therapy was an established treatment for haematomas, boils, abscesses etc. in the old Indian medicine. The pioneer of this therapy is Acharya Sushruta (2000 BC). He has elaborated leech application (Jalaukavacharana) under the topic of bloodletting (Raktamokshana).

We focused on analgesic, anti inflammatory and improvement in venous circulation, were the important goals to concentrate. The complications may occur in leech therapy such as wound infection by gut flora of leech, excessive bleeding, etc. These may be avoided by proper knowledge and good skills of applying the leeches.

Conclusion

1. It may produce better result a singly & as an adjuvant therapy with drugs.
2. It can be used in Rural area & in OPD basis.
3. It is very effective in the patient who are not fit for surgery, even though we can apply in pediatric patients.
4. There is no pain in Leech application as compared to surgical incision. The other symptoms of inflammation like redness, tenderness were reduced & local temperature came to normal.

References
1) Sushruta, Raktavistaran; In Atridev (translator) ; Sushruta  Samhita, 5th edition, Chapter 25, New Delhi, Narendra Prakashan, 1981, Shloka 12-5.