What is hirudotherapy and what can it help with?

Hirudotherapy, also known as leech therapy, is a unique approach to healing in the realm of alternative medicine.

In alternative medicine, treatments often lack the rigorous clinical evidence seen in conventional medicine. While some of these methods have been explored by researchers for quite some time, they haven’t always demonstrated clear-cut effectiveness. For instance, studies on hirudotherapy, as well as practices like homeopathy, date back to the 1940s, with approximately 500 scientific articles published on the subject to this day. While no groundbreaking curative effects have been conclusively documented with leeches, there are still some potential health benefits to this method.

Hirudotherapy is actually one of the oldest medical traditions, with its roots in ancient civilizations such as Mesopotamia, Byzantium, Ancient China, Greece, and Rome. These cultures utilized leech therapy to treat a wide range of ailments. Interestingly, even today, you can find clinics in major cities that offer this service.

What exactly is leech therapy, and how does it impact a person?

Medicinal leeches, scientifically known as Hirudo medicinalis, are parasitic segmented worms that subsist on the blood of warm-blooded creatures, including humans. They dwell in freshwater environments and exhibit sensitivity to factors like sound, light, temperature, and certain chemical substances.

At the front of the leech, you’ll find three jaws equipped with teeth. When it bites, it creates a distinctive Y-shaped wound and, through rhythmic motions, draws blood. In a single feeding, a leech can acquire approximately 10-15 milliliters of blood, which is roughly equivalent to the amount typically drawn for complete blood count or biochemical analysis in a laboratory using two test tubes.

When a leech bites, it injects a mixture of active compounds from its salivary glands into the wound. This is its way of ensuring a successful meal and survival. If the bite were painful, the leech’s target might get upset and attempt to kill it. The leech certainly doesn’t want that, so it cleverly numbs the area with an anesthetic.

Furthermore, researchers have identified more than two dozen biologically active molecules in leech secretions, which could potentially have health benefits for humans.

One of the most famous substances produced by leeches is hirudin, a powerful natural anticoagulant. In the 1950s, scientists isolated hirudin from leech saliva, but its use was limited because it sometimes caused severe symptoms in patients. By the end of the 20th century, genetically modified versions of hirudin had been developed, but by then, a hirudin alternative known as heparin was already widely used in medicine due to its easier dosing and reduced side effects.

What does the leech’s secretion contain?

Characteristic	Substances
Analgesic and anti-inflammatory action	Antistasin, gyrustasin, gilantens, eglin C, leech tryptase inhibitor, complement C1 inhibitor, guamerin and piguamerin, carboxypeptidase inhibitor, bdellins and bellastazin
Increased blood flow	Acetylcholine, histamine-like molecules
Extracellular matrix degradation	Hyaluronidase and collagenase
Anti-aggregant effect	Saratin, kalin, apyrase, decorcin
Anticoagulant effect	Hirudin, hirudin, factor Xa inhibitor, destabilase, new leech protein 1, vitid, and vitmamin
Antimicrobial effect	Destabilase, chloromycetin, theromycin, theromycin, and peptide B

What advantages can leeches offer from the perspective of a hirudotherapist?

Leeches, when they attach themselves to the skin of warm-blooded creatures, such as humans, serve a unique purpose. They start by drawing a small amount of skin and making a tiny incision, followed by the injection of their saliva. This initial saliva contains special enzymes that help the leech reach the tiniest blood vessels in the area. This enzymatic action removes harmful compounds that may have built up due to poor venous circulation.

Following this, the leech introduces substances that relieve pain and thin the blood within the wound, creating a soothing effect. Should it encounter any issues, such as thickening blood, the leech introduces additional bioactive compounds.

In essence, throughout this entire process, the leech effectively assesses the patient’s blood and tailors its actions accordingly. Its impact is therefore highly individualized. Upon concluding its feeding, the leech injects disinfecting substances into the wound and then detaches itself.

It’s essential to note that leeches have a vested interest in ensuring their host doesn’t suffer. Evolutionarily speaking, they’ve evolved not to harm the creatures they feed on. Quite the opposite, leeches aim to support the well-being and longevity of warm-blooded animals. These animals often visit water sources to drink and provide nourishment for leeches and their offspring. These segmented worms are typically found in clean, flowing freshwater frequented by larger mammals rather than in swamps, as one might assume.

Evolution has forged a mutually beneficial partnership: warm-blooded animals supply leeches with a small amount of blood, and in return, leeches offer them valuable bioactive substances.

What doctors believe leech therapists often misunderstand.

Leeches don’t analyze food; they process it using their own enzymes to extract the energy necessary for their growth, development, and reproduction. While the composition of a living creature’s saliva may vary, the changes are usually insignificant.

The bioactive compounds in leech saliva can indeed influence the composition of blood, but this process isn’t selective. It’s unclear exactly what enters a person’s body with leech saliva and whether it will have a beneficial or harmful effect.

In any case, leeches can’t address the underlying cause of a disease. After undergoing hirudotherapy, there may be a short-term reduction in specific blood test values. This occurs because the blood extracted is replaced by fluids from tissues and cells waiting their turn in the liver, spleen, and bone marrow. Initially, various biochemical parameters in the blood may decrease, but this isn’t a solution to the problem—it’s merely a temporary masking.

There’s one condition in which hirudotherapy can provide some relief by reducing blood volume: true polycythemia, an oncological hematological disease that occasionally requires bloodletting as a treatment method. However, the unpredictable nature of hirudotherapy’s effects and the risk of infectious complications make it highly undesirable in most cases.

If we consider the beneficial compounds in leech secretions, heparin preparations are a medicinal alternative to hirudin. Different types of heparins allow for precise and careful treatment planning, including selecting the right dose, speed, and method of administration. In contrast, hirudotherapy lacks these advantages for patient care.

Do clinical studies support the effectiveness of hirudotherapy?

In modern clinical research, it’s standard practice to conduct studies on medications or treatments in a way that keeps both the participants and the doctors “in the dark” about which treatment they’re receiving. This is known as a “blind” method, with double-blind studies being the most trusted. However, hirudotherapy, the use of leeches for therapeutic purposes, can’t be examined using this approach. In hirudotherapy, both the patients and the doctors are aware of the treatment method, making it impossible to blind the study. Additionally, the psychological aspect of hirudotherapy is quite distinct from taking a conventional pill, and a patient’s psychological state can play a significant role in the treatment’s effectiveness.

As a result of these unique challenges, there have been relatively few high-quality clinical trials on hirudotherapy. When these trials do occur, they typically compare the effects of leeches to well-established and proven treatments.

The most compelling evidence for the benefits of hirudotherapy comes from its use in plastic and reconstructive surgery. After such surgeries, complications often arise from tissue rejection due to venous congestion. Leeches have been successfully employed in cases of transplantation and reshaping procedures involving various body parts. This application of leeches is even approved by regulatory bodies like the Food and Drug Administration (FDA) in the United States.

Researchers are also actively investigating the analgesic (pain-relieving) effects of leeches in chronic pain syndromes, with knee osteoarthritis being a particular focus. One study aimed to provide clarity on the method’s effectiveness through a meta-analysis. Out of 121 articles on hirudotherapy for knee osteoarthritis, only three were considered of high quality, involving a total of 237 participants. These studies indicated that leech therapy can indeed reduce pain and improve joint mobility. However, not all studies consistently showed these effects and sometimes reported side effects.

Individual studies suggest that leech therapy may be beneficial for various conditions, such as chronic lower back pain, hypertension, headaches, thrombophlebitis, hemorrhoids, otitis, glaucoma, and ovarian cysts. However, the participant numbers in these experiments were often too limited to confidently claim that hirudotherapy is safe and effective for conditions unrelated to surgical interventions.

It’s also important to note that in all the mentioned studies, leeches were used in addition to conventional treatments. This implies that the primary advantage of hirudotherapy might be its ability to reduce the need for medications with potential side effects.

The general consensus is that more high-quality research is needed to ascertain whether hirudotherapy offers significant advantages over other treatment options. These future studies could determine if hirudotherapy stands as a reliable and superior form of therapy.

Does leech therapy help with coronavirus disease, the opinion of a hirudotherapist?

Another noteworthy benefit of leeches that I’ve recently come across is their role in addressing the aftermath of COVID-19.

I specialize in post-COVID rehabilitation. COVID-19 can lead to the formation of tiny blood clots in various organs, including the lungs, heart, kidneys, and the brain. As a result, patients are often prescribed blood-thinning medications to prevent clot formation. Leeches, however, have shown promise in assisting patients who have already developed clots following a COVID-19 infection. While they don’t completely dissolve these clots, they do improve blood circulation.

We frequently receive patients who have developed encephalopathy due to blood clots after COVID, which leads to symptoms like emotional sluggishness and cognitive issues. After a course of hirudotherapy, we observe that these patients become more energetic and re-engage with the world around them.

It’s important to note that we incorporate hirudotherapy as part of a comprehensive treatment plan. It’s nearly always just one component of our holistic approach, designed to expedite rehabilitation and reduce the reliance on medications.

Can leech therapy genuinely assist in combating microthrombosis, according to a perspective of physician?

The idea seems reasonable, but the actual efficacy is limited.

To prevent and manage clot formation, healthcare providers primarily employ anticoagulant medications. These include heparins, which bear structural and functional similarities to hirudin, a substance found in leech saliva. The dosages of heparins for thrombosis prevention and treatment are well-established through rigorous scientific research, ensuring precise administration to patients. This precise dosing method maximizes the effectiveness of the treatment while minimizing the risk of complications.

However, it remains uncertain how much hirudin from a leech’s bite site effectively enters the bloodstream and exerts an impact. Consequently, the outcome of leech therapy is highly unpredictable.

What potential issues can arise from leech therapy?

1. Infection: The most frequent problem associated with leech therapy occurs when leeches are used in plastic and reconstructive surgery. In these cases, infections can affect up to 20% of surgical patients. To minimize the risk of complications, surgeons typically administer antibiotics to patients before employing leeches. However, some experts question whether the postoperative infection risk is too high for leech therapy to be a viable option.
2. Bleeding: When leech therapy is applied for non-surgical conditions, the most common complication is excessive bleeding. This usually happens when hirudotherapy is performed on individuals with certain contraindications, such as those taking blood-thinning medications.
3. Allergic Reactions: Some individuals may experience local allergic reactions after leech therapy, resulting in redness and swelling at the bite site. In more severe cases, patients have even developed cutaneous pseudolymphoma, characterized by the growth of lymphoid tissue at the site of the leech bite.

Which types of leeches are used in therapy, and how safe is the practice?

Hospitals and pharmacies source leeches from certified biofactories that adhere to strict breeding guidelines. These leeches are carefully nurtured, undergoing a fasting period for several months before being offered for sale, with their last meal being sterile bovine blood.

These biofactories offer leeches in various sizes, with medium-sized ones being the preferred choice for leech therapists. However, in some cases, particularly in pediatric treatments, smaller leeches may be utilized, while larger leeches are reserved for addressing significant hematomas.

Following a leech therapy session, the used leeches are immediately disposed of, eliminating any risk of infection through blood. Medical facilities closely monitor the proper disposal of leeches. Nevertheless, even without strict controls, reusing leeches is not considered a viable option. Once a leech has fed, it won’t attach itself again, and it would require several months of care before it could be used again. The logistical challenges make it more convenient to acquire new leeches.

Who practices hirudotherapy?

In essence, a hirudotherapist is a specialist with advanced medical training who possesses expertise in leech-based treatments. However, in practice, there are many individuals who lack the credentials to practice medicine but still refer to themselves as hirudotherapists.

Currently, hirudotherapy is offered by a multitude of commercial and non-profit organizations. Training can be undertaken through in-person courses or via distance learning. Some medical universities exclusively teach hirudotherapy to licensed physicians, who receive a qualification certificate upon completing the course. Additionally, numerous educational institutions provide hirudotherapy training to anyone interested in the practice, regardless of their educational background, and these individuals receive a certificate of additional education.

How Leech Therapy Works

Preparing for Hirudotherapy

Before beginning hirudotherapy treatment, a patient may undergo several medical assessments, including clinical blood analysis, coagulation time analysis, and tests for infectious diseases such as HIV and hepatitis B, among others. In some cases, treatment can commence based on prior test results documented in the patient’s medical history.

Application of Leeches

Leeches are strategically placed on various areas of the body to facilitate the healing process. For instance, after plastic surgery, leeches are applied near the surgical incision site to enhance tissue recovery.

In the treatment of somatic diseases, leech placement is sometimes guided by the concept of Zakharin-Ged zones. This pseudoscientific notion suggests that specific skin areas correspond to internal organs, and by influencing the skin in these regions, various ailments can be addressed. For example, it’s believed that applying a leech to the interscapular zone can impact blood circulation in the heart area.

Typically, a hirudotherapy session begins with the coccyx area, as practitioners suggest it plays a role in venous outflow from the legs, the pelvic region, and fluid circulation within the spinal canal. Some hirudotherapists claim that applying a leech to the coccyx can help reduce swelling in the intervertebral discs, although there is no scientific evidence to support this claim.

In addition to the coccyx, leeches are often placed on the lumbar, interscapular, and neck-collar zones. In unique cases, they may be applied to the nape, behind the ears, the liver area, or around the navel. For knee osteoarthritis, leeches are applied to the knee area, and in ophthalmology, they are used in proximity to the eyes.

Typically, a session involves the use of up to five leeches. In specific cases, up to ten leeches may be used, although this is infrequent.

Duration of a Session

Hirudotherapy sessions can be conducted using one of two methods. In the first approach, leeches remain on the skin for no more than 15 minutes, as it is believed they can inject all their therapeutic compounds within this timeframe.

However, most hirudotherapists favor an alternative method. According to this approach, leeches are left in place on the skin until they detach on their own, which may take anywhere from 20 to 60 minutes. As leeches inject an additional dose of bioactive compounds before detaching, this method results in reduced bleeding and a greater influx of beneficial enzymes into the patient’s system.

How to properly care for the bite area following a session: After the procedure, a sterile dressing is placed over the wound, and it’s recommended not to remove it for approximately a day. It’s also best to avoid exposing the wound to water, including taking showers during this time.

Usually, the wound may release small amounts of blood for around three to four hours, and this blood is absorbed by the dressing. Engaging in physical activity or consuming alcohol, particularly strong alcoholic beverages, can significantly increase bleeding at the site of the bite. The use of blood clotting agents is usually unnecessary. If bleeding persists for over a day, necessitating frequent dressing changes, and you encounter pain, swelling, or a rise in temperature at the bite site, it’s crucial to promptly seek medical assistance.

Can leeches be self-applied? Medicinal leeches can be obtained from pharmacies without a prescription, and they are available for purchase by both medical institutions and private individuals from leech farms. Therefore, there are no legal restrictions on using leeches at home. However, experts in leech therapy strongly discourage attempting leech therapy independently. In the event of bleeding or an allergic reaction, there may be no one available to provide medical assistance.

Summary

• Hirudotherapy is a form of alternative medicine, lacks substantial scientific backing for its effectiveness. While the use of leeches has been proven to prevent complications in plastic and reconstructive surgery, its efficacy for other medical purposes remains poorly understood.
• Hirudotherapy is primarily used as a complementary treatment option. Hematologists generally advise using heparin-based medications in precise doses for similar purposes, as they are considered safer. Unlike some other nations, the United States, for example, does not have a recognized medical specialty known as “hirudotherapist.” In countries where hirudotherapy is practiced, individuals applying leeches must have a different medical specialty, such as cardiology or pediatrics. Furthermore, even non-medical practitioners can obtain additional education in hirudotherapy but require permission from local authorities to practice traditional medicine. Therefore, when seeking hirudotherapy, exercise caution and consider treatment only from officially registered private clinics and state medical institutions.
• Medical leeches are available for purchase at pharmacies and can be self-administered. However, this is risky, as leeches may trigger allergies, excessive bleeding, or infections. It is crucial to note that hirudotherapy is not recommended for individuals with blood clotting disorders, anemia, weakened immune systems, or those undergoing chemotherapy. Using leeches for treatment is also discouraged for individuals with low blood pressure, liver cirrhosis, or during pregnancy.
• Following a leech bite, the wound may bleed for up to 24 hours. During this period, it is vital not to remove or moisten the bandage. If bleeding persists beyond a day, it is essential to seek medical attention.
• If a healthcare provider suggests hirudotherapy, even as a supplementary treatment, it is advisable to seek a second opinion from a healthcare professional practicing evidence-based medicine in Western countries.