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ACADEMY OF HEALTH
INTITUTE OF HOLISTIC MEDICINE
is a precursor of holistic medicine on the Polish market.
In holistic medicine, before initiating a treatment, it is important to identify the cause of the disease, not only to relieve its symptoms or effects, and also to restore the balance of the body, so called homeostasis, by the application of any and all possible methods of health care, starting with conventional medicine, therapies offered by spa centres, psychotherapy and finishing with alternative medical procedures, hirudotherapy (leech therapy), larval therapy (maggot therapy), acupuncture or herbal treatment.
An advocate of holistic medicine was Hippocrates (c. 460 377 BC), a famous Greek doctor, the father of medicine, the most prominent representative of medical school from the Isle of Kos. His fundamental principle was “primum non nocere” – first do no harm. Hippocrates’ medical practice was based on a rational evidence, in-depth observation of the patient and experience, which allowed him to establish a diagnosis and select the best possible methods of treatment. In his profession he cared about the health of his patients as he believed that “salus aegroti suprema est” – the well-being of the patient shall be the most important law”. Hippocrates’ treatment methods involved supporting natural healing processes.
Holistic medicine includes among others two ways of “combating” diseases. They are leech therapy (hirudotherapy), which uses leeches for medical purposes, and larval therapy (maggot therapy), which uses larvae of the common green bottle fly for hard-to-heal wounds.
“Any method is good if it is effective...” Hippocrates
Most important substances produced by salivary glands (SGS) of the medicinal leech
Hirudin – the most known substance produced by medicinal leeches, discovered by Hycraft in 1884. In 1903 Jacobi gave the substance its present name. It is a highly specific thrombin inhibitor, i.e. by deactivating thrombin it prevents the natural process of coagulation
Calin – a thrombocyte adhesion and aggregation inhibitor; it prolongs the time of bleeding after the application of leeches
Bdelins – inhibitors of trypsin, plasmin and acrosin. They are located all over the body of a leech but the greatest number of bdelins is found in the external reproductive organs. Bdelins inhibit the activity of inflammatory factors and prevent them from spreading over tissues. There are two forms of this inhibitor: bdelin A and bdelin B
Hirustasin – serine proteinase which is an inhibitor of kallikrein chains, tripsin, chymotripsin and cathepsin G, i.e. substances needed to keep regular blood pressure
Apyrase – plays an important role in reducing blood viscosity
Antielastase – inhibits the activity of elastases, i.e. the enzymes which destroy skin elastin and effectively slows down the process of skin ageing
Eglins – a strong anti-inflammatory substance (an inhibitor of inflammatory factors) and effective antioxidant. Eglin C is the best known of all eglins produced by leeches.
Destabilase – a substance which has strong antiaggregating properties causing decomposition of clotted blood. Destabilase also contains a unique low molecular substance – prostaglandin, which regenerates blood vessels, the digestive tract and controls the level of blood sugar
Hyaluronidase – a substance which plays two functions. It is a strong antibiotic and facilitates tissue permeability. Due to these properties neighbouring body cells and tissues can easily permeate through the cellular membrane. Another interesting property of this enzyme is the ability to dissolve polisaccharides which are components of endospore walls of many microorganisms.
LDTI – Leech Derived Tryptase Inhibitor is a substance secreted by leeches when they incise the host’s skin. LDTI protects the mouth part of the leech against the proteolytic enzyme (tryptase) produced by the immune system of the host
Factor Xa inhibitor – a substance which is a component of the Xa complex. In the cascade of blood coagulation the substance is responsible for conversion of prothrombin into thrombin. The complex deactivates the Xa factor, which results in the inhibition of the coagulation process
Carboxypeptidase A inhibitor – a substance which increases the blood flow and to some extent, removes clots which appear when the leech feeds on the host
Anaesthetics, neurotransmitters – strong analgesic factors, however not yet really identified. It is supposed that the analgesic properties are connected with neuropeptides produced by leeches. They include endorphins, which are known as happy hormones. Apart from killing pain endorphins eliminate a feeling of anxiety and euphoria, bring calmness, remove physical and mental addictions, negative emotions, nausea, depression and other symptoms observed in drug and alcohol addicts.
Substances dilating blood vessels – very similar to histamine; an organic compound, not yet well identified
Antibiotics – demonstrate strong antibacterial properties. They are produced by bacteria called Aeromonas veronii biotype sobria, which lives in a symbiosis with the medicinal leech
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body parts for application of leeches larval therapy in outline
History of leech therapy
Outline of human anatomy for hirudotherapists
Morphology of peripheral blood – interpretation of laboratory tests
Functional morphology and physiology of the leech
Surgery for medicinal leech therapy – regulations.
Procedure with the use of medicinal leeches
Contraindications and indications for the application of hirudotherapy
Body areas used in leech therapy
Psychology – principles of good contact with patient
Leechtherapy and larval therapy in veterinary medicine
Curiosities from the world
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Hirudotherapy (leech therapy), like any other therapies, can cause complications. Thus, before taking a decision to apply the therapy with leeches it is important to know contraindications for that kind of treatment. The following contraindications and information should be given consideration:
arterial pressure 80/60 or lower
children under the age of 10 (except for reattachment procedures)
cases of allergy should be individually treated
gastric ulcer and erosions
disturbances in wound healing
low level of haemoglobin
blood coagulation disorders
post-chemotherapy and post-radiotherapy complications
administration of acetylsalicylic acid (aspirin) derivatives
patients treated with anticoagulant medicines (antithrombotic drugs) as these partly or completely inhibit the process of blood coagulation. The drugs are applied in the prophylaxis of thrombosis, atherosclerosis and other disorders which might result in the formation of a hazardous or life-threatening thrombus. Antithrombotic drugs include:
Hirudotherapy (leech therapy) can be an effective supplement in treating many diseases and it is helpful in:
urinary system diseases
locomotion-resistance system diseases
Leeches in dermatology
Methods of improving the beauty of a body and inhibiting the process of skin ageing with the application of leeches have been known since the most ancient times. Facial and body masks combined with fragrance oils mixed with the blood of leeches were applied by Japanese geishas, so famous for their beautiful skin. Countess Potocka applied leeches from her own pond to make herself younger. Hirudo compounds circulating around the body have rejuvenating properties because they are strong antioxidants. Moreover, the salivary glands of the leech secrete many other substances which inhibit the process of skin ageing. Lipids, antithrombotic and anti-inflammatory compounds, phosphatidic acid, free fatty acid, proteins, phospholipases, lipases, collagen, serotonin, cortisol, testosterone or progesterone are only some of the substances which improve the skin tension, blood flow and oxidation. Antielastase slows down skin ageing processes, inhibits the enzyme which decomposes elastin and in that way, prevents from degeneration of the elastic tissue. In dermatology leeches are effective in the treatment of discolourations, visible venules, cellulitis, acne, eczema, psoriasis, scleroderma; they prevent sebaceous ducts from being clogged, reduce the excess of sebum, have antibacterial and anti-inflammatory properties, lighten the skin, stimulate epidermal regeneration and moisten the skin.
a facial lifting
The facial mask:
enhances and leaves the skin smooth
improves the skin tone and gives it a nice look
makes wrinkles less visible
improves the face contour
nourishes and enriches the skin with oxygen
stimulates the production of collagen and elastin
actively moisturizes the skin by penetrating its deep layers
Demi Moore admits to bizarre beauty secret: 'I let leeches suck my blood'
"I was in Austria doing a cleanse and part of the treatment was leech therapy. These aren't just swamp leeches though - we are talking about highly trained medical leeches.
of medicinal leeches
Size and body shape
The body size of the leech can range from a few millimetres up to 40 centimetres. The shape can also be different: cylindrical, ribbon-like or leaf-like.
Medicinal leeches are flattened dorsoventrally. Adult leeches can be 10 – 15 centimetres long.
The body of the leech is divided into 34 segments and each is segment is subdivided into annules. The number of annules is different for a different order, family and even genus but ranges between 3 and 14 annules in each segment. Hirudo leeches have segments consisting of 5 annules.
Leeches, similar to other animals, are equipped with pigment-containing cells (chromatophores) which are found in the skin. These cells give an animal its own characteristic colour. The leech exhibits a variety of colours – different shades of green, brown and black.
The medicinal leech Hirudo is characterized with two orange stripes on the dorsal side and a regular patterns of bands on the green-olive background. On the lateral parts of the body there are yellow lines, whereas the ventral side is plain, green-olive and the lateral parts are covered with black lines.
Number and location of eyes
Leeches are equipped with a different number of eyes, between one and five pairs, depending on the family, genus and even species. There are also species of leeches which lack this organ. The medicinal leech of the Hirudo genus has 5 pairs of eyes located in the shape of semicircle, on the anterior part of the body.
Bio-surgery is a kind of treatment which uses biological products, e. g. to perform surgical procedures. Examples of such therapies include the therapy with fly larvae, especially Lucilla ilustris (Meigen), Lucilla sericata (Meigen), Phormia regina (Meigen). The procedure has become common in Western Europe and is used in treating chronic wounds of various origin, e.g. gangrene, decubitus ulcers, diabetic wounds, diabetic foot, infectious and post-operative wounds. This method will probably contribute to a decrease in the number of amputations from diabetes.
A treatment with Lucilla sericata larvae involves:
removing necrotic matter from the wound – larvae release a digestive enzyme which removes the necrotic matter and this liquid matter turns into food for larvae
eliminating bacteria present in the wound
initiating the healing process, larval movements rebuild the granulation tissue and stimulates the production of new epithelium.
The saliva of the leech effectively gets rid of even the most serious infections, e.g. Staphylococcus aureus, methicyllin-resistant bacteria (MRSA), bacteria of the Pseudomonas strain.
leech therapy and larval therapy in veterinary medicine
Indications and contraindications for hirudotherapy and larval therapy are the same as for humans. The leech therapy appears to be equally successful in treating many disorders, both in small and big animals, i.e. in treating thrombosis, varicose veins, furuncles, hematomas, haemorrhoids, oedemas, tenditis, inflammation of the mucosa, gingivitis, inflammations of the reproductive system, endometriosis, in post-surgical rehabilitation, after transplantation of the skin and limbs.
Animals behave differently than people. They are usually calm, they do not demonstrate any anxiety and do not wriggle nervously. They often sleep (e.g. dogs), eat or relax (e.g. horses). They react instinctively. Before the procedure they are not given any anaesthetics. The procedure is similar to the one performed for a man and it takes about 30 – 60 min.
Dr Dave Puerto applies leech therapies in Animal Referral and Emergency Services in Langhorn, Germany in animals which underwent skin grafting surgeries. Larval therapy is becoming more and more common in animals which do not respond positively to antibiotic therapies and in which it is impossible to apply surgeries. The MDT is effective, cleans the wound and has antiseptic properties. Such procedures are usually performed in the US so dogs, cats and rabbits are applied them. They avoid amputations and euthanasia. Doctor Scott Morrisom from Rood & Riddle Equine Hospital in Lenxington used larvae to treat myelitis, abscesses, difficult ulcerations, to clean wounds in more than 100 horses. In the majority of cases he observed a great improvement and the animals avoided euthanasia. Dr Morrison claims that the ability of removing necrotic matter without destroying healthy tissues is an excellent property of leeches. Also dr Donald Walsh from Homestead Veterinary Hospital, Pacific, Mossouri used larval therapy in horses suffering from hooves diseases. Professional; literature gives examples of the MDT applied in a donkey diagnosed with inflammation of the subcutaneous tissue and in an injured lion.
CURIOSITIES FROM THE WORLD - leech therapy
Cosmetics from leeches
The secretion from the saliva of the leech, dry powder made from the leech and an extraction from leech embryos are used as components of cosmetics produced in Russia, in International Medical Leech Center, located close to Moscow. Biologically active substances combined with polysaccharides, starch, chinese rose, milk, vitamins A, B, F, C, olive oil and other components regenerates the skin, eliminates pigmentation disorders, protects the skin against environmental factors, slows down the ageing process and makes the skin more hydrated and elastic. In Poland the medicinal leech is protected by law so manufacturing cosmetics from this species is prohibited. Leeches used for medical purposes include not only hirudop medicinalis but also hirudo verbena and hirudo orientalis.
Taking secretion from leech salivary glands
Giant Amazon leech
The giant Amazon leech is probably the biggest leech that inhabits fresh waters. It is up to 45 cm long and can live up to 20 years. Its habitat is the area between the mouth of the Amazon River and Venezuela and Guyana. It can be found in wetlands along the river banks. The leech attacks amphibians, caimans, anacondas, capybaras and cattle. Anti-thrombotic medicaments are produced from the secretion of the salivary glands of the Amazon leech.
Giant Amazon leech and its proboscis
Horse leech (Haemopis sanguisuga)
The horse leech is the biggest leech found in Poland. It is not a parasitic animal but a predatory species. It feeds on oligochaetes, molluscs insect larvae. It can be 6 – 10 cm long.
The dorsal side of the horse leech is plain dark, not patterned. The ventral side is much lighter than its dorsal side, in most cases – yellow and grey. It inhabits fresh waters, banks of streams, slowly flowing rivers, ponds, wetlands, lakes. It usually stays on land , close to water, especially when the ground is really damp.
Leeches in world museums
In museums all over the world we can find containers for keeping leeches dating back to the times when leeches therapies were most commonly applied.
Vases for leeches – from 1801 – 1834 and 1830 – 1859
Numerous illustrations in books confirm a huge popularity of the worms in the past
In the past leeches were collected by people wading through water reservoirs. Leeches attached to legs, and then they were removed and kept in barrels. The profession of leech collectors was well-paid. Leeches were used in huge numbers, which contributed to a dramatic decrease in their population.
Leech trade in the Far East and Asia Minor
In Far East countries and in Turkey, e.g. Istanbul, leeches are sold by kilograms on local markets, where sellers neglect any and all hygiene requirements or procedures. Such practices are also met in India.
Leech trade in streets
Leech procedures in India
Leech therapy sessions are extremely popular in India. They take place in streets and a lot of people decide for such a therapy. Obviously, there is no hygiene control during such sessions.
Leech application in streets
Indian J Pharm Sci. 2013 Mar-Apr; 75(2): 127–137.
Leech Therapeutic Applications
A. M. Abdualkader,* A. M. Ghawi,1 M. Alaama, M. Awang, and A. Merzouk2
Author information ► Article notes ► Copyright and License information ►
This article has been cited by other articles in PMC.
Hematophagous animals that feed on prey blood have been known to overcome blood clotting by secreting in their salivary gland secretion a multitude of biologically active compounds, especially the anticoagulants. Amongst the blood-sucking organisms, leech is a distinct example of an invertebrate, which possesses a highly-developed mechanism by which they prevents blood clotting. Through centuries, leeches have attracted the attention of therapists who employed leech therapy for a wide range of diseases. For various therapeutic purposes, the European medicinal leech species, Hirudo medicinalis, also known as the healing leech was preferred by the majority of physicians compared to the American species, Hirudo decora, which can suck less blood due to a smaller and superficial incision on its prey skin[3,4,5]. In addition, many other species were also considered as medical tools, such as Hirudinaria manillensis, Hirudo nipponia[7,8], Hirudo verbena, Hirudo orientalis, and Haementeria depressa[2,10].
The current review summarizes the importance of leeches as a complementary source of medical therapy for a large number of ailments, including cardiovascular diseases (CVDs), plastic surgery, cancer and metastasis, diabetes mellitus (DM), and its complication and infectious disorders.
Leech locality and ecology:
Leeches can live in a variety of environments, including aquatic and moist terrestrial regions. Some species live in freshwater, estuaries, rivers, ponds, lakes, and sea. Others are adapted with more mucous glands and larger nephridial vesicles (bladder) that retain and store extra water enabling leeches to tolerate the lack of water on damp land. Moreover, leeches have high physiological flexibility, which makes them able to withstand numerous environmental challenges, such as oxygen shortage and temperature fluctuations. Because moisture is a very essential factor affecting the terrestrial leech's distribution and behavior, they can be found in a large number in the forests and highlands of North America, Europe, and South-East Asia. In permanently humid regions, such as Malaysia, leeches will stay active throughout the year while they go through an active and a dormant phase in territories with wet and dry seasons.
Leech taxonomy and morphology:
Leeches (Euhirudinea) were first named by Linnaeus in 1758 AD. They are related to the phylum Annelida, class Clitellata. In general, early studies classified leeches into 4 subclasses, 3 orders, 10 families, 16 subfamilies, 131 genera and more than 696 species. Recently, taxonomists identified more than 1000 leech species. Leech size varies among families and can reach up to 20 cm in length, in addition to some giant species, such as the Amazonian leech, Haementaria ghilianii, which is about 50 cm in length. A classic leech body consists of many segments divided as two preoral, nonmetameric segments, and 32 postoral metameres (somites). Somites are subdivided into 2-16 external annuli, and the annulation pattern can be considered as a diagnostic feature for leech genus and species. Sensory structures, such as eyes, oculiform spots, papillae and sensilla are also used by taxonomists to identify genus, and species. Typically, a leech has anterior and posterior suckers. Some leeches related to the order Rhynchobdellida have a large anterior sucker with a small jaw-less mouth and protrusible muscular proboscis. Others from the order Arhynchobdellida possess a simple anterior sucker with a wide mouth, which may or may not have jaws such as in hirudinids and erpobdellids, respectively. Suckers are very essential during movement (inchworm-like locomotion) and for attachment to host surface. Leeches breathe through the skin and they are considered as hermaphrodites, but always require another leech for fertilization.
The biology of leech feeding:
Based on feeding habits, leeches are divided into two major groups. The first group includes the predacious leeches, which are predators of many invertebrates. The second group, named the sanguivorous leeches are ectoparasites that feed on the blood of vertebrates including human. With the help of suckers and the biting jaws, leeches are able to absorb prey blood. It is interesting to note that leeches generally suck 2-20 ml of blood within 10-30 min, then drop-off spontaneously after being completely engorged with no immediate desire of more feeding[16,17].
Leeches, both sanguivorous and predacious, digest their food in their intestine. The sanguivorous species only store blood inside their body for months. Actually, the digestion process of blood in hematophagous leeches undergoes many slow stages allowing leeches to store the ingested blood for up to 18 months. Symbiotic bacteria named Aeromonas spp., 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. Furthermore, another presumed role of these enzymes is to prevent B complex deficiency, which often occurs in blood nutrition-depending animals[11,12].
HISTORICAL REVIEW OF LEECHING
The importance of leech in clinical therapy can be simply represented from the Anglo-Saxon word of physician “laece” indicating that both doctors and these annelids were etymologically related to each other since the beginning of civilisation[3,18]. The usage of leech for various medical applications can be traced back thousands of years ago. Before the Christian era (BC), medicinal leeching was mentioned in the 18thdynasty Pharaohs paintings (1500 BC). Talmud, Bible, and other Jewish manuscripts outlined the medical indications of leeching. The Greek poets, Nicader of Colophain (200-130 BC) mentioned leeches in his medical poems.
During the Christian era, the usage of bloodsucking action of leeches became so popular and was utilized in almost every region in the world. Greek physicians used leeches for bloodletting and for treating rheumatic pains, gout, all types of fever and hearing loss. The usage of leeches during that time depended upon the humor concept of Galen (130-201 AD), which was an inspiration from Hippocrates (460-370 BC) hypothesis about body fluids imbalance-related illnesses. Galen believed that illnesses alleviation can be achieved by restoring the balance between the body fluids when a leech withdraws blood from patients[3,19]. Galen would prescribe bloodletting by leech for almost all illnesses such as simple inflammatory conditions, mental disorders and hemorrhoids. Moreover, Themission of Laodice, a Syrian doctor, outlined that removing blood from the patient will evacuate the evil spirits, which can cause diseases.
In addition, leech practice was also documented in Islamic literature. For instance, Avicenna (980-1037 AD) delineated in his book “Canon of Medicine” that leech can suck blood from deep veins which cannot be reached by the conventional wet cupping[3,19] and he recommended leeching for skin diseases. In 12thcentury, Abd-el-latif al-Baghdadi mentioned in his texts the beneficial usage of leech application after surgical operations. Thereafter, Ibn Maseehi (1233-1286 AD) in his book “Umda Fi Jarahat” differentiated the medical leeches from the nonmedical (poisonous) ones according to their shape and colour.
Later, in the middle ages, medics depended more on leech therapy, which was prescribed for a wide range of disorders including nervous system diseases (epilepsy, brain congestion), urinary, and reproductive organs diseases (nephritis, subacute ovaritis, sexually-transmitted diseases), inflammatory diseases (acute gastritis, laryngitis) and eye illnesses[3,19]. Some French physicians prescribed leeches for the patient even before seeing him. Actually, the widespread indications of leeching might be attributed to the concept, which suggested that bloodletting by leech was less painful than using the lancet or the scarifier. Moreover, leech application is more suitable and manageable for hemorrhoids and vaginitis where the blade or the cupping glass is not tolerable by the patients.
After reaching a popular peak in the early nineteenth century, leech trading became a lucrative business which encouraged more people to collect large numbers of leeches, which eventually caused them to become endangered species. Consequently, European and American authorities offered rewards for the invention of a new method to breed leeches. Meanwhile, leeches were employed to treat mental disorders, skin diseases, gout, headache, and whooping cough.
By the end of 19th century, leeching gradually fell into disrepute, and almost stopped by the early twentieth because hirudo therapy did not match the new requirements of the modern medical regulations and the great advancement in all medical fields. During this era, bloodletting by leeches was still common in the treatment of epilepsy along with other traditional remedies, such as cauterisation and baths. Therapists used to apply leeches to the scalp in order to reduce cerebral congestion and brain blood supply, which were thought to be involved in the etiology of epilepsy. Even though, the scientific interest of leech continued as a result of Haycraft's researches that brought leeches back into the medical stream when he outlined for the first time the presence of an anticoagulant agent in leech saliva, which he called hirudin, which was later isolated and identified by Markwardt who demonstrated its antithrombin activity. Another physicia