HISTORY OF LEECH THERAPY, LEECH THERAPY IN OUR DAY
History of Leech Therapy
Hirudotherapy, in other words Leech Therapy, has been used as a treatment tool by physicians since ancient times. The first sources concerning the leech therapy goes back to the Babylonian physicians who lived in 15th century BC. Still, it is widely known that this treatment was among the fundamental treatment methods of Egyptian physicians in the 3rd century BC. In addition, in the 2nd century BC., Nikandros the physician who lived on the Aegean coast, in the 1st century AC. the Greek physician Pliny and Galen who lived in the 2nd century AC. administered leech therapy. The leech therapy has also taken its place in the books of Ibn Sina. However, the mankind who gave up the nature in the 20th century has forgotten the leech therapy. As the American researcher Roy Sawyer revealed the potential therapeutic effect of leeches and established the world’s first modern leech farms (Biopharm – UK), the medicinal use of leeches has been recalled again today.
Leech Therapy in Our Day
Today, leech therapy is defined as an “unparalleled” method of treatment in terms of its biological effects. In Germany, there are over 300 Hirudotherapy Clinics. Hirudo Medicinalis has been pharmaceutically accepted pursuant to the subparagraph 1 of the Article 2 of the German Act on Pharmaceuticals. Thanks to the subsequently supplemented Article 4, it is defined as a ready-to-use pharmaceutical product. The difference between this and the medicine in the syringe is that “we do not give this medicine by injection but it is directly given from the mouth of a living being called Hirudo Medicinalis”. Only in Europe, 100 millions of leeches are used per year. The association found by the physicians giving leech therapy in America has more than 1000 members and in 2004, the U.S. Food and Drug Administration (FDA) accredited leech therapy and allowed it to be sold in pharmacies like in Europe.
Anatomy and Other Properties of Leech
Leeches are from phylum Annelida which has more than 15.000 species. Most of them are ectoparasites and they feed by sucking blood. About more than 650 species of them belongs to the class Hirudinea. This class generally involves marine, freshwater and land leeches. Not all leeches are bloodsuckers. Some leech species eat invertebrates, individuals of other classes of Annelida, snails and insect larvae. Those bloodsucking ones live as ectoparasites on fishes, frogs, turtles, snails and aquatic crustaceans as well as vertebrates. Although almost all groups of the vertebrates are hosts, fishes are the group which is mostly attacked by them. In analogy to mosquitoes, they begin to suck blood by incising the skin with their three sharp teeth on the maxilla without creating pain and they release various mediators in their saliva (local anesthetic, histamine-like vasodilators, anticoagulant agents, spreading factors, antibiotics etc.) to this region.
These leaches with therapeutical properties have a few species and H. medicinalis and Hirudo verbena are among them. These leeches are called “medical leeches”. They have several types and H. medicinalis and H. verbana are known to exist in Turkey. Anatomy of leeches is a remarkably single sample. Their bodies are typically dorsoventrally flattened. Their segments was transformed into anterior and posterior suckers. Anterior sucker is generally smaller than the posterior sucker and the three-jaw mouth is surrounded by sucker. In their jaws, there are 50-100 teeth aligned in a row. The posterior sucker is disc-shaped and formed by the merger of eight segments and is towards the ventral side; the suckers help sticking and movement. Their bodies are always composed of a fixed number of 34 segments. The mouths of the leech are at the front end, at the bottom of either a sucker or a spoon-shaped upper lip.
A leech’s body is surrounded by a thin and flat blanket that can appear in various colors. H. medicinalis’s back is in a spoiled olive color and has six longitudinally-extending lessly-clear reddish-yellow strips. The sides of its body is in a light olive color. There are a flat black stripe in each sides of the abdomen. Aeromonas hydrophila, a genus of bacteria, is found in the flora of the digestive tract of H. medicinalis. It is reported that this extracellular symbionts helps digestion of the blood sucked, kills other bacteria with the antibiotics it produces and has some other benefits. Lenght of H. medicinalis is 10-15 cm and it is comprised of 34 segments. It weights 3-6.5 g. It is able to suck blood 3-10 times more than its body weight and the amount of the blood it sucks increases as its body weight increases. In addition, it is can survive up to one year without feeding.
While, in a study conducted, its blood suction time from a person is found as an average of 68 ± 26 minutes, its body weight increasing with the blood sucked is found to be 460%. It has been reported that this species contain much more antitrombik unit hirudin from extracts of crude compared to the some other species of leech (e.g. Macrobdella decora). Most of the hermaphrodite leeches live for about a year. Those leeches hatched in the spring grow mature in the following year. Their life cycle depends on their eating habits and environment. H. medicinalis lives longer than other leech types. Even if some leech types are found in seas, most of the aquatic species live in fresh waters such as the edges of ponds, lakes and gentle flowing streams which consist of superficial plants. Although leeches could be seen all over the world (from polar oceans to water resources in the deserts), they are mostly found temperate waters of lakes and pools. Most of the leech fauna of North America is similar to those in Europe. Our country is one of the richest regions over the world in terms of the types of leeches. H. medicinalis and H. verbana are the very common types in our country and region. Leeches have the senses of smell and taste. However, they have no organs of sight and hearing. They have termoresept and baroreceptor systems as well as a sonar equipment.
Medical Effects of Leeches
Hirudo Medicinalis and Hirudo Verbena species of the leeches with therapeutical properties, are called as “Medical Leeches”.
We can divide the medical effects of the leeches into 3 main groups:
- Phlebotomy (intervention to a vein in order to remove the clot inside it)
- Reflex Stimulation
- Bioactive Secretion Content
Leeches lets the secretions produce by themselves into the body while sucking blood. This secretion comprises almost 100 bioactive agents as far as can be isolated so far. Some of these substances prevents blood clotting and some of them dissolve the clots already formed while some of them exhibit some analgesic properties and others moderate the blood pressure. In addition, the antidepressant, antibacterial, antioxidant effects of the leech therapy are also demonstrated by the studies.
We can list the medical effects of leeches as follows:
- Antihypertensive (anti-high blood pressure)
- Myorelaxant (muscle relaxants)
- Neurotrophic (regenerating nerve cells)
Bioactive Secretion Content of Leeches:
- Hirudin: Anticoagulant
- Hementin: Fibrinolytic
- Hementerin: Fibrinolytic
- Ghilanten: Prothrombinase İnh.
- Anti-statin: Prothrombinase İnh.
- Piyatin: Prothrombinase
- Calin: Tr. Agg. İnh.
- Decorsin: Tr. Agg. İnh.
- Destabilase: F XIII İnh.
To which diseases Leech Therapy applies?
Thanks to these properties of it, the leeches therapy applies successfully, in our clinic, to; the vascular problems such as varicose veins, hemorrhoids, deep vein thrombosis and peripheral arterial occlusion, skeletal system diseases such as arthrosis and arthritis, various skin diseases particularly in eczema and psoriasis and eye diseases almost impossible to treat such as glaucoma and retinal artery occlusion.
We can list the diseases for which leech therapy is effectively used, as follows:
- Some Eye Disease (Behcet’s disease, Uveitis, Glaucoma, Maculopathy, Yellow spot disease, Diabetic retinopathies, Hypertensive retinopathies, Retinitis pigmentosa, problems of the Optic nerve and vascular, neural, macular and retinal diseases of eyes such as Optic atrophy)
- Varicose veins and venous vascular problems
- Rheumatoid arthritis and other rheumatic diseases
- Arthrosis and arthroliths
- Migraine and tension headaches
- Dizziness, tinnitus and Meniere’s syndrome
- All kinds of muscle pain, fibromyalgia, restless leg syndrome
- Cervical disc herniation, spinal disc herniation, tendonitis -tenosivonit-, bursitis inflammation and pain
- Degenerative diseases of the nervous system and paralysis (such as MS,ALS, PARKINSON’S DISEASE…)
- Eczema, urticaria, chronic skin diseases, psoriasis and acne
- Chronic hepatitis and liver diseases
- Depression and phobias
- All immune system disorders and chronic fatigue syndrome
The cases on which Leech Therapy is not recommended
Leech Therapy is not recommended especially for the patients:
- with anemia (anemia) problems
- using blood thinners
- with any disorder preventing clotting
- with an active source of bleeding.
In addition, the leech therapy does not apply to pregnant and nursing mothers as well as those with uncontrolled diabetes or heart failure.
- Bleeding diathesis (such as hemophilia)
- Presence of an Active Bleeding Focus
- Severe Anemia (Hb < 10)
- Pre-Surgery period
- Use of Blood Thinners
- Pregnancy and lactation
are the cases in which Leech Therapy is not administered.
To which parts of the body can the Leech Therapy apply?
Every part of the body except the following regions is suitable for the Leech Therapy. However, applying Leech Therapy to the following parts of the body, is very inconvenient.
Leech Therapy can apply to any region other than the following:
- Soft Skin Regions (such as on or around the eyelid)
- Keratinized Regions (such as palms and soles)
- Over important veins (such as neck, gill, underarms, groin).
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