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HIRUDOTHERAPY - LEECH THERAPY

History of Hirudotherapy is accepted as old as the pyramids. There is information about leech pictures on the tombs of the Pharaohs and the use of leeches in medicine for the purpose of Roman and Greek texts. Hippocrates (460 BC Kos -MON 370, Larissa) is a Greek physician considered as the “father of medicine” in western medicine who is the first to express that diseases develop as a specific logic. Aelius Galenus (AD 200 – AD 129) is a medical scientist who lived during the Roman period and influenced the modern medical world with his theories for 1000 years. From these doctors Hirudotherapy has been used. The physiological mechanisms underlying the Hirudotherapy has emerged after examination of the animal’s saliva in recent years. In the United States in the 17th, Dr. Benjamin Rush has found that Hirudotherapy has more benefits in the blood circulation and the treatment of vascular diseases than ever known. Dr. Henry Clutterbuck has described the ‘Hirudo Medicinalis’ in 1840 as “When leech is used sensibly, it is a perfect drug that we know as highly beneficial.”

Hirudotherapy has gained popularity in Europe in the 18th and 19th centuries. Around the world throughout the centuries it has been an important factor in the treatment of disease. In Europe, especially Germany, France and Britain have discovered the wonders of leeches and imported millions of leech every year. Not only in Europe, Asia and Far East countries also intensively used leech and continues to use it. Russia is in the top among the countries exporting leeches in the world. Although its popularity has declined in the medical world in Europe with the discovery of antibiotics in the 20th century, in 1928, ‘Hirudo medicinalis enzymes have been studied scientifically by Richard Ruszkows. With the spread of plastic surgery and orthopedic surgeon implants, miraculous effects in the animal’s saliva has been discovered and used again. ‘Hirudo Medicinalis’ use in our country after many successful surgeries on plastic surgery for the past 30 years became widespread as we are affected by European medicine. In fact, Hirudotherapy was used in our country for several years in Anatolia traditionally, it was seen as old wives’ treatment by physicians and wasn’t interested. These creatures have been humiliated in our subconscious by society using phrases like ‘suck like a leech’. It beneficial to humanity in such a way that it does not deserve to be humiliated is a known fact for centuries. As with all our applications, the use of Hirudotherapy has also started to rise in the medical world as its use became widespread in Europe. In fact, these kinds of treatments should be used by being evaluated in integrative way and blended with modern medical information for the treatment of humanity. Just as breast milk is still number one, and will continue to do so with its content and effects on children’s development despite all the sophistication, Hirudo medicinal use in treatment is also excellent in terms of effectiveness and will continue to be excellent. As in Hirudotherapy, the degree of healing in phytotherapy is also higher than synthetic as the source is natural. Hirudotherapy and phytotherapy (herbal medicine) deserve much more attention to be a source of healing for the diseases.

Mechanism of Action of Hirudotherapy

This creature’s oral secretions, contains over 100 bioactive substances which may be easily integrated with the substances in human physiology. The main principle is that they leave oral secretions to our bodies while sucking blood like mosquitoes. These secretions facilitates the blood-sucking of the leech. While the leech is doing this process, it becomes the source of healing for our diseased regions thanks to the enzymes that it gives our blood vessels and lymph system. The oral secretions have the feature of an elaborated medicinal due to the content. With the bioactive substances it secretes, Hirudo Medicinalis has the feature of a small factory.

These substances:

Hirudin: prevents blood clotting (connected to thrombin)

Hyaluronidase: lowers the viscosity increasing tissue permeability

Apiraz: Inhibits Host platelet aggregation.

Collagenase: decompose collagen peptide fragments

Protease: decomposes protein fragments. It cleans damaged areas on the wounds and burns.

Lipolytic enzymes: distribution of lipids; It involves hydrolysis of triglycerides.

Destabilase: melts fibrin (thrombolytic effects)

Bdellines: anti-inflammatory trypsin, plasmin, inhibits the acrosin.

Eglines: inhibits activity of anti-inflammatory alpha-chymotrypsin, chymase, subtilisin, elastase, cathepsin G

Calin: It inhibits blood clotting binding to collagen and Van Willebrand factor. It inhibits the collagen-induced platelet aggregation,

Tryptase inhibitor: inhibits the proteolytic enzymes of host mast cells.

Acetylcholine: vasodilator effect

Carboxypeptidase inhibitors: Increases blood flow

Factor Xa inhibitors: inhibits coagulation factor Xa activity creating complexes.

It produces the following effects in our body thanks to the bioactive substances

– Reduces Blood coagulation

– Thrombolytic (Clot massacre) effect

– Increasing the blood flow and organ

– Antihypertensive Effect (normotensive)

– The drainage of toxins and blood clots to blood and lymphatic system

– Inducing neuromuscular system

– Vascular disorders restoration

– Bacteriostatic Effect (stopping the growth of microorganisms and provide them die)

– Immune System Stimulant

– Help stabilize the body physiology by applying on the acupuncture points.

-And most important effect is the prevention of ischemia in end organs by increasing the microcirculation which is still not achievable with current medical therapy.

Application Area of Hirudotherapy

Its usage is common on many disease groups and systematic disorders. By means of the increased blood flow produced with the secretion of the leech, oxygenation in organic structure will increase, the clots will be dissolved, and the nutrition of tissues will increase as the permeability in tissues increases. Four key mechanisms of action is essential in the formation of disease. These include: TOXINS / INFLAMMATION / Hypoxia / Acidosis. Process starting with this mechanism can go up to the formation of cancerous cells. If this logic framework for the treatment of diseases are neglected, the basis of the problem cannot be solved, it is not possible to find a permanent solution of the treatment. For example, there may be pain in the ankle for several months as a result of sprains without having a fracture. Splint application, pain relief creams and pills are given in our understanding of modern medicine. Often the pain continues even after treatment and disappears in 6 to 12 months. Sometimes it can take a long time. Signs and symptoms of ankle sprains are lost with 1- 2 sessions of Hirudotherapy as the leech eliminates the edema-related pain that occurs in the ankle with four mechanism; educes edema, facilitates movement destroys subcutaneous bleeding and clotting in the area, reduces the pressure on the nerves and acts as a local painkiller. The most important condition for treatment is the circulation as in ankle sprain. It is the transmission of nutrients and oxygen together with blood to the diseased area. Just as grass does not vegetate and beings cannot live in the barren land, there is inflammation, edema in the regions where blood cannot reach. Another example; on swellings occurred in leg veins due to varicose, there is edema, pain, difficulty in walking, aesthetic problems and circulatory disorders. In our understanding of modern medicine, compression stockings, pills to increase venous tone and blood thinners are given or if it is advanced, surgery on deep veins; if it is enough, surgery on superficial veins is recommended. In Hirudo medicinalis application the insufficient circulation related edema around varicose is absorbed, pain is killed with oral secretions, stasis (stagnation) blood is excreted, the blood circulation is facilitated by increasing the fluidity, thrombi (clots) is melted if present, clot formation is prevented sticking clot blood elements (platelets) together, bacteria around the diseased area are destroyed and the fibrin around thrombi is melted. To be able to do it with the understanding of modern medicine is sometimes very difficult, and sometimes impossible, sometimes very expensive. But the saliva of leeches as natural resources can easily make them at all without difficulty. As in the example of these diseases, the ones below can be evaluated in this logic of framework.

Hirudotherapy in the Treatment of Migraine

Leeches carefully placed in selected areas, creates a powerful reflex acting as a muscle relaxant in tendons, ligaments, and paraspinal muscles without damaging. It prevents edema by providing blood flow to the painful area and creates analgesic effect. As the application areas are acupuncture locations, the therapy mechanism is evaluated in combination.

Apart from migraine, it is useful on trigeminal neuralgia, polyneuropathy and for the patients with acute stroke and peripheral nervous system disorders.

Hirudotherapy in hypertension and varicose veins

It is said that 95% of causes of hypertension is known but in our treatment approach there is no result without reason. Especially in the pathophysiology of hypertension, we believe there is vasoconstriction (narrowing of arteries) in end organs as a result of lack of healthy circulation and stress. We help hypertension to come to normal without drugs by ensuring a healthy circulation with expansion in vein and teaching patients to cope with stress in our additional treatment with Hirudotherapy.

Varicose is a structural disorder of the venous system in the legs. Treatment of surgery or medication is recommended. However, these treatments is often not sufficient, compression stockings are recommended but they are not used by patients as the usage is painful. The most serious complication of venous (varicose veins) insufficiency is that it sets the ground for chronic heart disease by creating defects in the circulatory system that increases the burden on the heart and lungs. Also in these patients the second most common case is hypertension. If these patients are treated, they are candidates to hypertension and chronic heart disease in the long term. What is aimed to be done in Hirudotherapy is to help circulation by preventing the stasis associated with circulatory disorders of the lower extremities (blood collection). As the blood will flow to the muscles more easily with the disappearance of stasis, acidosis table will be lost and the pain will decrease. However, this disease is structural damage, Hirudotherapy must be done regularly under the PERSONAL PROGRAM determined by doctor, otherwise, application done only once can be considered as symptomatic treatments.

Hirudotherapy for Joint Diseases

There are a variety of joint diseases. Hirudotherapy is beneficial in the treatment of acute or chronic edema, infective (inflammatory / infectious) non-healing wounds and soft tissue trauma. FDA approved the Hirudotherapy to these patients in 2004. Especially in joint pains in the chronic phase, Hirudo medicinalis increases the circulation by taking edema in the painful area and creating vasodilation and analgesic effect with saliva. In this way, circulation increases with the reduction of edema; the pressure on the nerves and edema decreases with healthy work of system. Arthritis Patients state that they relaxed much with a good sleep after the treatment. Also in degenerative joint diseases the pain would be severely reduced if it is applied periodically. When the degenerative joint disease is characterized as structural disorder, the treatment need to start early in order the results to be good. Otherwise, it will be difficult for the patient to take response from the treatment.

Hirudotherapy is made with small leeches in joint practice. It takes about an hour and is painless. For non-degenerative joint diseases, a long-term relief is often provided with a single leech therapy sessions. At the earliest 6 months after cure is completed, patients whose complaints remain are called to treatment again.

Hirudotherapy in Gynecological Diseases

Synthetic hormone drugs and antibiotics which are widely used in the last century, hasn’t healed the women illnesses as well as increasing the number and the kind of diseases.

Hirudotherapy creates a triple effect by reducing the weight on the pelvic organs, preventing inflammation, ensuring the healthy functioning of the hormonal system. Furthermore it also has an immune modulating effect. Genital itching and pain in the abdominal area often disappears after the first session, improvement on menstruation is seen after 3-4 months in. In infertile patient pregnancy have been reported after treatment. Diseases that we thought might be useful with Hirudotherapy include: endometrial hyperplasia, chronic pelvic inflammatory disease, menstrual irregularities, adenomyosis, functional ovarian cysts, and uterine fibroids, some forms of infertility, menopausal syndrome, viral and bacterial infections including diseases of the Pelvic (pelvis) organs.

Contraindications (situations that Hirudotherapy cannot be used)

  The exact contraindication conditions

 

HemophiliaLeukemiaMultiple MyelomalymphomaHypotension (low blood pressure)AnemiaHIV infection, AIDS ChemotherapyLiver cancerPace makerPregnancyMenstrual periodDialysis patients

 

The use of the following drugs should necessarily be reported (Hirudotherapy for the patients with chronic use is not possible).

Coumadin

Plavix and similar

Aspirin and similar

Dabigatran and similar

Drugs should be left for 2-3 days before the operation

Fish oil

Ginkgo biloba products

Acetylsalicylic acid

Sildenafil

Don’ts before operation

Powerful painkillers

Herbal treatments

Vegetable-based creams

Homeopathic remedies

Don’ts after operation

Physiotherapy

Intensive massage

Deep tissue massage

Reflexo therapy

Aromatherapy

Acupressure

Jogging

Bicycle

Intensive swimming

Weight lifting

Hard working

 

FREQUENTLY ASKED QUESTIONS?

Is Hirudotherapy safe?

The process is safe in safe hands in sterile environments. However, it must be remembered that for centuries have come to use safely and complications are extremely rare.

Is Hirudotherapy painful?

Pain levels vary depending on the person. Pain that leeches create can be said as much as a bee bite but with a difference; 1 and 5 minutes after leech bites, substances in the oral secretions relieves pain, showing the effect of anesthesia. However in bee bite secretions increase the severity of the pain by creating allergic reactions.

IS IT ITCHY AFTER THE PROCESS?

The most common side effect after the procedure is itching. This is not an allergic reaction. It is an effect produced by the oral secretions, disappears in 2-3 days. Our proposal for this is vinegar water, cold compresses. To protect application areas from scratches and bumps can prevent adventitious non leech related complications that occur later.

WILL THERE BE TOO MUCH BLOOD LOSS?

No there won’t. The blood a leech can suck cannot exceed a maximum of 10 cc. Losses that could occur in the total don’t exceed a tea cup (about 100 cc). It is much less loss than cupping.

What is the risk of infection?

There is always the risk in unsafe hands. The most significant risk of the leeches that are used on many patients repeatedly is the infectious diseases (Hepatitis B and C, HIV). Aeromonas spp. bacteria that can be found in the intestines of Hirudo medicinalis have the risk of developing infections. We can get rid of this situation by having operations in safe hands.

Fields of Application

Leech (Hirudo medicinalis) therapy has anticoagulant (blocking clot formation), vasodilatation, bacteriostatic and anesthetic effect. With this mechanism of actions, it can be used to treat many diseases. In this way, it ensures healthy circulation in diseased organs allowing movement of the expansion of blood vessels leading to damaged organs, melting the clots if present, stopping the proliferation of bacteria in the area if present. It can be applied for healthy circulation after all kinds of microsurgical operation. The secretions of Hirudo medicinalis are is still the most magnificent method for opening blockage in the arteries that feed the internal organs despite today’s technology. It is also used in the prevention of venous congestion and internships depending on compression. It can be used for Gynecology, Urological Diseases, Joint Diseases, Migraine and Tension Headaches, Hypertension, abdominal pain, body aches. We must not forget also that this treatment method can also be used for the purpose of getting rid of toxins, stimulating the circulation (prophylactic).

The mankind’s share is to investigate saying ‘if there is disease then there must be its treatment’, to use common methods and deal with the treatment without losing our hope. The God who puts bioactive substances on the animal’s saliva that will create great impacts, also put active ingredients in many creatures and plants we don’t know yet that could help towards healing. What we should do is to search persistently. Under this logic, we need to use our treatment methods, which has been used for centuries in our modern age, in a logical manner by improving, consulting with the physicians. In recent years, these methods have been exposed to treatments they do not deserve. A segment of society misuse these applications in unsanitary conditions and with the lack of information under the counter offering them as a panacea like a miracle. On the other hand, another segment of society considers it as old wives’ treatment by showing no interest in them. We think, this method deserves attention, however, it is not the right to deceive people serving them as a panacea. Whether we admit it or not, the physicians Hippocrates and Galen, which our understanding of modern medicine is affected by, dealt with these methods and used in their therapy. Using these methods by blending our understanding of modern medicine is the most accurate way. Only physicians can make it.

Unfortunately preventive medicine is not well understood in our country. We don’t have the habit of seeing the doctor before illness. We don’t remember the principle Luqman the Wise said centuries ago “CALL FOR THE DOCTOR BEFORE ILLNESS, SHOW RESPECT TO THE DOCTOR BEFORE ILLNESS” In fact, the way is clear for not being ill. Just as we take our car every year before breakdown, we should go to the doctor at least 2 times per year and the rehabilitation of the body should be provided likewise.

In fact all diseases/complaints begins with the failure to meet the blood, oxygen, water, minerals and other vital substances that a single cell needs and remove the waste materials(allergens, toxins) resulting from functioning of the cell. A number of signals are emitted from the body as a result of the errors that occur in metabolism (E.g. fever, excessive sweating, fetor oris, nausea, constant fatigue, bowel problems etc.). Misguidance starts here.  We suppress these distress calls with pain killers, antifebriles, antiallergens etc. assuming them as illnesses. However, what needs to be done is to help the body through healing by activating its inner mechanisms. We believe the patient attains healing as a result of treating the body, emotions, mind/subconscious and soul as a whole. Hirudotherapy has a very important place this understanding of approach and in our clinic we aim for success as a result of action by various treatment methods not only a single form of therapy.

Dr. Ceyhun NURİ

suluktedavi