Therapeutic Effects of Leech Therapy - PowerPoint Presentation

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Therapeutic Effects of Leech Therapy

Dr. M. ShoaibD/o Ilaj-bit-TadbeerFaculty of Unani MedicineAligarh Muslim UniversityAligarh-202002

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Leech therapyTa’aleeq

Irsale Alaq BdellotherapyHirudotherapy

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Concept of disease in Unani medicineUnani System, Disease are the result of Humoral inequilibrium.Restoration of huoral equilibrium is achieved by considering

Asbab-e-Sittah Zarooriya (IBT/Regimenal intervention)

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Ilaj bit Tadbeer/Regimenal intervention

Tanqia Umoomi

Tanqiya Maqami

(General evacuation) (Local evacuation)

e.g.

Hammam

&

Riyazat

e.g. Taaleq, DalakRestoration of Humoral equilibrium

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Use of modalities according to the site of Morbid humorsSurface - Hijamah/ wet CuppingDeep - Venesection/ FasdIn between - Leech

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INTRODUCTIONThe word leech comes from old english word Laece (Physician)

Hirudotherapy is considered as a biopurification procedure as help in evacuation of morbid material.

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Scientific name of medicinal leech:Hirudinaria Medicinalis (American species)Hirudinaria granulosa (Indian species)Hirudinaria = Hirudin means Blood thinner

600 species are found, only 15 used for medicinal use

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Leech Therapy:Important mode of therapy of Ilaj bit Tadbeer in Unani Medicine.Old concept: Action depend on the amount of blood sucking by LeechModern concept: Most of the actions depend upon how much saliva is injected into the site/body of patient.

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Cont..Saliva facilitate the free oozing of blood from 2-48 hours after post leech therapy is the strong indication that their saliva contains anticoagulant substances.Anticoagulants, Fibrinolytic, Vasodilator, Anesthetic and Anti-inflammatory substances present in the saliva of Leech.

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Cont..Helps in removal of Morbid humours/ Fasid Madda/ Causative Pathological Substances.Facilitate blood supply lead to increase nutrition and oxygen supply results in increasing healing process of the ulcers.

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Since the inflammations were thought to arises mainly in the capillaries and its territories and leech primarily withdrawn blood from capillaries. Hence leeching was administered as universal cure.Leech therapy experienced a stronger revival in the last 3-4 decads. As the potential of surgery increased thrombus and embolism started to became more and more frequent postoperative complications. Termier a surgeon used the anti-coagulatory effect of leech by direct application on affected part in 1922 called as Hirudinization of Blood. Within a few year all the renowned hospital in Europe had started using leeches again for this medical indication.

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The leech again disappeared from most of the hospital of Europ after the discovery of anticoagulant Heparin (1916). In 1970 leech therapy achieved a remarkable international comeback in the field of plastic and reconstructive surgery for treatment of postoperative venous congestion and graft rejection.Leech saliva consist of 30 individual chemicals and only 8 constituent of leech saliva have so far been characterized in terms of chemical structure and mechanism.

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Live leech is more effective than pure hirudin. Average Leech weight is 3gm. On July 24, 2004 the American FDA, officially approved the leech as medical device based on scientific evidence of efficacy of leech therapy.Recent studies revealed that leech saliva contain nearly 30 bioactive substances such as Hirudin, Calin, Destabilase, Bdellins, Eglins, Hyaluronidase

, Carboxypeptidase-A, Histamine & Acetylcholine.

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These substances are possessing important pharmacological actions like anticoagulant, thrombolytic, Anti-inflammatory, vasodilators & anaesthetics properties. When Leech sucks on the affected part of body, it pours out such substances into the body which either acts locally or systemically.The presence of these pharmacologically active substances provides scientific basis and possible mechanism of action for application of leech therapy in the management of joint diseases, skin diseases, non healing ulcers, varicose vein, haemorrhoids, hematoma, plastic and reconstructive surgery.

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Pre procedure:

Educate the patient

Obtain written informed consent

CT, BT,

Hb

% &

Haematocrit

, BG

Make sure Leech is STERILE

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The part where leech has to be applied should be washed with borax / soap (Fragrance free) to remove any dirt /

odour

/ taste etc

.

Never clean the area with

Betadine

or sprit before the application of Leech

Hyperemia created by rubbing the area/

Hijamah or Dalak

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Smearing of clay / blow also helps stimulating the leech to suck efficiently.

If the area is having poor vascularity the leech may detach prematurely

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Procedures:The leech generally is very sensitive to smell, temperature, noise. Thus the procedure should be perform in peaceful condition. Localize the area of application with barrier of gauze damped with sterile water so as to prevent the wandering of leech especially near

orifices.Grasp with gentle hand and put simple at the site of application. Don’t treat roughly with them. Generally it is attached spontaneously.

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If it is not or reluctant to attached prick the skin with needle, oozing blood make leech entice/ attract to attaché.Sign of attachment: Hook like appearance at the anterior end. With its bite the leech makes an incision (Y-shaped)

in the skin and excrete mucous from the nehropores that helps the sucker to adhere and also make the surface slippery.

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During ingestion the leech body shows peristaltic movement that is also a classical character of sucking.Strictly monitor the patient all through the procedure.

If detachment is required sweep the anterior end of the leech with wet cotton or sprinkle turmeric powder to make the leech detaches.

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Post procedure:After the detachment the wound continue to bleed. Never try to stop that bleeding rather encourage it by removing locally formed clots depending upon the individual condition of patients.The resulting wound from a leech bite is not very large not it is very deep

.Once sufficient amount of blood is removes wipe the wound with antiseptic lotion and cover till bleeding stops.

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Never mix used and unused leeches.Additional re-feeding behavior of leech is achieved by immersion in serotonin (10 micron) solution for 20 mint.

Make the leech to vomit out all the blood by either squeezing or sprinkling turmeric powder over it.Re-use the leech on the same patient if it is required.

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Anti-thrombinHirudinBufrudin TheroninInhibits blood coagulation by binding to thrombin, synthetic analogue of Hirudin are Lepirudin & Desirudin

Bioactive Substances in Leech Saliva

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Anti-plateletCalin SeratinGhilanten TherstatinInhibits blood coagulation by blocking the binding of von Willebrand factor to collagen. Inhibits collagen- mediated platelet aggregation – inhibit coagulation

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ThrombolyticDestabilaseDissolves fibrin lead to dissolution of thrombus.

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Anti-inflammatoryBdellinsEglinst½=2weeksInhibit the activity of Trypsin, Chymotrypsin,, Plasmin, Acrosin – prevent inflammation

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The painkiller effects of leech application were ascertained in many trials on patients with osteoarthritis who claimed that leeching was more relieving than topical diclofenac with no adverse effects. In another study, a group of women with osteoarthritis of the first carpometacarpal joint received a treatment course by 2-3 leeches locally. All treated individuals revealed less pain and disability improvement. The efficacy of leeching was observed after 1 week of therapy and lasted for at least 2 months due to more half life of Bdellin & eglin.Pain decreases due to decongestant effect, as the pooled blood causes tenderness.

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VasodilatorCarboxypeptidase A inhibitorsHistamine like substancesAcetylcholine

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Antibiotic/FibrinolyticHyaluronidaseIncreases interstitial viscosity and act as a Antibiotic Anesthetic substances: leech bit is not painful

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Use of leech therapy:Non Healing Ulcer/ Diabetic footGangrene/ Arterial insufficiency/ diseases/ Burger diseasesVenous insufficiency/ Varicose vein/ Varicose ulcerHematoma/ Post operative Hematoma

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Cont..Reconstructive or Plastic Surgery:Re-attachment of severed body parts such as fingers, hands, toes, legs, ears and noses.Drain blood from swollen faces, limbs and digits (fingers and toes) after reconstructive surgery.

Useful when reattaching small body parts that have many small blood vessels.

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Cont..Prevent the clotting of blood in these small veins.Useful in microsurgery when faced with the difficulties of reattaching minute veins.Saved lives and limbs, reducing severe and dangerous venous engorgement post-surgery in fingers, toes, ear, and scalp reattachments; limb transplants; skin flap surgery; and breast reconstruction.

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Alopecia :By increasing the vascularity, it helps delivery of body’s defensive cells (WBC) that will fight against fungi, thereby promoting healing.Increases conc. and delivery of nutrients, makes hair follicles strong & promotes hair growth.Arthritis: Bedllin and Eglin is an anti-inflammatory chemical having half life 2 weeks thus their anti-inflammatory effects lost for 2-3 weeks. PsoriasisPilesEczema

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SAFETY AND COMPLICATION OF LEECHINGSymbiotic bacteria named Aeromonas hydrophila, located in the leech's gut, secrete enzymes that help not only in breaking down the components of the ingested blood, but also in producing antibiotics to prevent blood putrefaction after a long storage period in leech crop.Infection is the most common complication of leeching and occurs in 2-36% of the patients due to presence of symbiotic bacteria in Leech gut. Thus antibiotic should be given after leeching.

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Cont..Bleeding disorders/ Liver DiseaseAIDS/ HemophiliaAnticoagulant therapy (Heparin/ Aspirin)AnemiaPregnancy

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mechanical leechNadine Connor, a scientist from University of Wisconsin at Madison in 2001 helped to develop the mechanical leech. The device, which looks a little like a small bottle attached to a suction cup, delivers an anti-clotting drug to damaged tissue and then gently sucks out as much blood as needed. And, unlike real leeches, the mechanical version is voracious and can remove as much blood as doctors think is necessary (real leeches drop off when engorged with blood)."But perhaps the mechanical device's biggest advantage is that it is not a leech," says Connor. "People don't want this disgusting organism hanging on their body. This added psychological stress for both patient and family members compounds an already difficult situation.

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Conclusion:Hirudotherapy is a bio-purificatory procedures that are based on the belief that the removal of unclean and impure blood treats the root of all sufferings.leeches might play a special role in certain kinds of surgery, by helping promote blood flow to damaged tissue. That's because when leeches bite a victim, their unique saliva causes blood flow to increase and prevents clotting. As a result, once bitten, victims can bleed for hours, allowing oxygenated blood to enter the wound area until veins re-grow and regain circulation.

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Electron microscopic view of mouth of leech

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Thank you