The variables that shape the session plan in medicinal leech therapy: examination findings, the treatment area and follow-up, from a physician perspective.
Hirudotherapy — one of the oldest treatment methods known in medicine, encountered frequently in the practice of Hippocrates, in ancient Egyptian documents and in the works of Ibn Sina — is a form of treatment using the creature known as the leech, Hirudo medicinalis.
Broussais (1772-1838), one of Napoleon's surgeons, believed that the accumulation of blood in the body caused inflammation and that inflammation in turn caused illness. He therefore recommended removing blood using leeches, importing millions of leeches from Hungary and applying leech therapy to all of his sick soldiers.
Medical leech therapy is a form of integrative and complementary treatment applied with the help of blood-sucking leeches, and is one of the first examples that come to mind of using invertebrates in the treatment of disease. Although there are hundreds of leech species in nature, only 15 are classified as medicinal leeches.
What Is a Leech?
Leeches, whose average weight does not exceed 2.5 grams, are worms that live freely or as parasites in temperate streams and warm lakes and range from 8 mm to 76 cm in length.
Their bodies are segmented like the earthworms we are familiar with, but slightly flattened. The head is pointed and much narrower than the rear end. There is a sucker at each end; the rear sucker helps with movement and attachment on dry surfaces.
Those used for treatment have different characteristics; they are generally brown, dark brown, dark green, green or red-brown. Among the leeches used in medicine, Hirudo medicinalis is the best known. Its body is slightly flattened and its length does not exceed 15 cm.
What Is Hirudotherapy?
In hirudotherapy, practised for thousands of years, leeches are attached to points determined by the physician. As the creature feeds, the aim is for the bioactive molecules it carries to be released into the area.
These bioactive substances, which can even be used in veterinary medicine, have blood-thinning, muscle-relaxing, immune-regulating and microcirculation-regulating properties.
Leech therapy, which appears frequently in complementary medicine today, was approved by the FDA in 2004.
What Kind of Creature Is the Leech?
Annelids, of which there are more than 800 species, have flat bodies and three jaws, and are known for attaching firmly to the area they grip. Each jaw has 100 teeth. The leech's secretion contains more than a hundred bioactive compounds.
How Is the Treatment Applied?
Apart from cleaning the surface in a sterile manner, no detailed preparation is required. Because leeches can be sensitive to chemical odours, detergents and perfumes are not recommended. A sweaty surface also makes attachment difficult, so this needs attention too.
The leech or leeches are brought into contact with the treatment point so that they attach. The bite may be felt faintly at first; throughout the procedure the local anaesthetic component secreted by the leech means no pain or soreness is felt.
At the end of the procedure, which can take 20 to 60 minutes, the leech releases its grip on its own. In some cases it may need to be encouraged to let go.
Hirudotherapy requires a separate approach for each patient. The approach is arranged according to the person's complaints, weight, age, general condition and many other variables assessed by the physician.
If leeches do not bite for no apparent reason, piercing the skin with a needle or lancet to draw a few drops of blood helps encourage the bite. If a leech comes into contact with blood and still does not bite, it must not be used on another patient under any circumstances and must be destroyed rather than returned to the jar of fresh leeches.
At the end of the procedure a clean, firm dressing is used to stop the low-level bleeding. Bleeding can continue for 4 to 24 hours, though this is rare.
Which Conditions Can Leech Therapy Be Used For?
Leeches may be of benefit in reducing pain in varicose venous disease, in joint degeneration and in tendon inflammation such as tennis elbow.
What Does Leech Therapy Help With?
- Migraine and tension-type headaches
- Eye conditions
- Chronic hepatitis and liver conditions
- Dizziness, tinnitus and Ménière's syndrome
- Anxiety and panic attacks
- Arthrosis and joint degeneration
- Chronic fatigue syndrome and immune system disorders
- Rheumatoid arthritis and other rheumatic conditions
- Varicose veins and venous problems
- Muscle pain, fibromyalgia and restless legs syndrome
- Eczema, urticaria, psoriasis and acne
- Degenerative nervous system conditions and paralysis
Does Leech Therapy Have Side Effects?
An allergic lesion may rarely be seen at the site of application. Itching lasting 1-2 weeks and marks that may fade within a few months can occur.
How Quickly Does It Help?
It is normal for bleeding to continue for 1-2 hours after the leech detaches. The leeches' effect continues over 5 days in the areas where blood has accumulated, and a reduction of roughly 1-2 grams in haemoglobin may occur.
Who Should Not Have Leech Therapy?
Leech therapy is not recommended for pregnant women, breastfeeding mothers, or people with heart failure or uncontrolled diabetes.
Are Leeches Sold in Pharmacies?
In 2004 the US Food and Drug Administration (FDA) approved leech therapy and permitted their sale in pharmacies. National regulations vary; in Turkey it is safest to proceed with sources approved by the Ministry of Agriculture.
How Many Times Can a Leech Be Used?
A leech that has been used once must not be used again. The part of the leech that actually benefits the treatment is the secretion in its mouth, and a certain amount of time must pass for the bioactive substances in that secretion to form again.
What Determines the Cost of Treatment?
Because the number of sessions, the area to be treated and the number of leeches to be used differ from person to person, the treatment plan and its cost only become clear after a physician's assessment.
