Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

Introduction

Unani System of Medicine which was founded by Hippocrates (Buqrat) is based on the concept of equilibrium and balance of natural body humours (blood, yellow bile, black bile and phlegm). The imbalance in the quality and quantity of these humours leads to diseases whereas restoration of thiet balance maintains health of a person. Irsaal-e- A’laq (Leech therapy or Hirudo therapy) is one of the most important and widely practised methods of regimental therapy (Ilaaj-bil- Tadbeer) used for local evacuation of morbid humours. It is a method of bloodletting which involves the withdrawl of blood in a considerable quantity from the body with the help of medicinal leeches.

It is one of the most important and widely practised methods of treatment used for local evacuation of morbid humours (Akhlaat-e- faasida). Or in other words it is a procedure of treatment through blood sucking process with the help of medicinal leeches for prevention and treatment of various diseases.This therapy has unique features that are easily recognized. It has been used effectively for the management of various disorders specially skin and musculoskeletal disorders where western medical treatment is of less value.

It may also be used for the restoration of normal heath through its prophylactic and palliative action. It may produce better results either singly or as an adjuvant with drug therapy in diseases like hypertension, thrombosis, atherosclerosis, arthritis, varicose veins, frostbite, skin diseases like dermatophytosis, psoriasis, eczema, vitiligo and in various surgical and traumatic conditions such as re-attachment of severed extremities, fingers, toes and ears.

Advantage of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

The important advantage of leech therapy is that it may be advised on those areas of the body where other processes of blood-letting like cupping (Hijamah) and venesection (Fasd) are not possible.

The therapeutic efficacy of this therapy is known from the very ancient time and is still popular in current health scenario.

Ancient Greeko-Arab physicians were applying medicinal leeches (Hirudo medicinalis) in different diseases. Broadly they were using it in the management of chronic skin diseases, varicose veins, musculoskeletal diseases, thromboembolic diseases, gynaecological disorders, Ear Nose and Throat disorders etc.

Unani Philosophy of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

According to Unani philosophy, the clinical efficacy of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy) is attributed to the resolvent and analgesic activities of medicinal leeches (Hirudo medicinalis). It has been scientifically proven by the modern researchers that the saliva of leech contains about 100 pharmacologically active biological substances like Hirudin, hyaluronidase, fibrinases, collagenase etc. which are antibacterial, anesthetics, vasodilators etc. in nature.

Historical background (Taareekhi Pas-e- Manzar)

The use of medicinal leeches (Hirudo medicinalis) in Unani system of medicine dates as far back as approximately 3,500 years ago, when they were used for bloodletting in ancient Egypt. It is one of the oldest medical therapies, having been practiced among the ancient people, including the Greeks, Egyptians, Mesopotamians, Mayans and the Aztecs.

In Greece, it was initially introduced by a famous Unani physician, Hippocrates (Buqraat). The popularity of this regimental therapy was reinforced by the ideas of Galen (Jalinoos), who classified Leech therapy as a method of treatment and prevention of health. Galen was a Roman philosopher. He believed that blood was the dominant humour. In order to maintain the balance of humours in the body, a physician would either remove excess blood or advise them any other mode of treatment for evacuation of morbid humours.

When Islamic theories became popular in the Latin speaking countries of Europe, Hirudo therapy/ Leech therapy became more widespread.It is mentioned in classical Unani literature; “Alqanoon fil tib” and “Altasreef liman Ajeza Anittalif” that alogwith venesection it was central to Arabic surgery.

The practice of this therapy continued throughout the middle ages but began to be questioned in the 16^thcentury, particularly in northern Europe.

In 1980, medicinal leech therapy got a big boost by plastic surgeons, who used leeches to relieve venous congestion especially after skin grafting in transplant surgery.

Contemporary leech therapy was pioneered by the two surgeons, M Derganc and F Zdravic. They elucidated the use of leeches in tissue flap surgery in which a flap of skin is freed or rotated from an adjacent body area to cover a defect or injury.

Their rationale behind the use of leeches was based on a unique property of the leech bite, namely, the creation of a puncture wound that bleeds for hours.

Now a days medicinal leeches (Leeches) are used in the treatment of various diseases such as thrombophlebitis, hypertension, varicose ulcer and many more skin and musculoskeletal diseases.

Classification of Leeches

Scholars of Unani medicine have classified leeches into two main categories on the basis of specific characteristics

1. Non-poisonous/ Medicinal (useful) leeches: The specific features of these leeches are:

1. They are with thin tiny head
2. Emerald green colour
3. Tiny and rounded like rat's tail
4. These leeches are found in moist rich places where frogs are in abundance.

2. Poisonous leeches: The specific features of these leeches are:

1. Leeches with long head
2. They look black, grey or green colour

Procedure of Leeching/ Leech therapy

The legendary Unani scholar, Ibne Sina in his famous treatise “Canon of Medicine”, an encyclopedia of medicine which served as a standard text book of medicine in Europe till 17^th century A.D, has described the procedure of Leech therapy in a very comprehensive manner and narrated the following steps of the whole procedure:

1. Pre-leeching procedure involving collection of leeches; preservation of leeches and selection of suitable patient.
2. Post-leeching Procedure involving separation of leech; vomiting of leech and control of bleeding.

Proper Leeching Procedure

Ibn-e- Sina narrated in his book “Al Qanoon fil Tib” which is known as Canon of Medicine”, about the proper procedure which is mentioned here stepwise

1. Medicinal leeches should be collected just one day prior to their use
2. Patient is advised to take light semi-solid diet prior to the procedure
3. The affected part to be treated is thoroughly washed with distilled water or with a solution of borax and rubbed until redness appears
4. If the leech is reluctant to attach, a tiny droplet of blood may be smeared on the part to be treated and then leech is applied
5. Usually, one or more leeches are applied to the affected area and left for half an hour.
6. Once the leech is attached, it will likely remain safely in place until fully distended but it is essential to check the site continuously to insure that the leech hasn′t separated
7.  Thereafter, the leeches are detached with a very careful manner by pulling them off or by loosening their grip with table salt, borax or heat but sometimes leeches detach automatically
8. The used leeches are then killed and disposed off

Mechanism of Action

According to the Unani philosophy, leech therapy works on the principles of

1.  Evacuation of morbid humours (Tanqiyae Mawad )
2.  Diversion of humours (Imalae Mawad ). 

1. Evacuation of morbid humours (Tanqiya-e- Mawad): It means the resolution and excretion of morbid humors and excess fluids from the body, thereby maintaining the homeostasis in the quality and quantity of four body humors, which is actually responsible for the maintenance of normal health.
2. Diversion of humours (Imalae Mawad): It refers to the diversion of the morbid fluids from the site of affected organ to the site where from it is easily expelled from the body tissues. Based on this holistic approach, Unani physicians have been widely using this therapeutic regimen for a number of diseases. The effectiveness of this therapy may also be attributed to the Mussakin (sedative) and Muhallil (anti-inflammatory) actions of saliva of leeches.

Indications of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

Medicinal leeches were thought to be able to cure everything from head ache to haemorrhoids.  Ancient physician were using them to treat many diseases and disorders very effectively. For example

1. Chronic skin diseases
2. Eye diseases
3. Musculoskeletal diseases
4. Gynaecological disorders
5. ENT disorders
6. Thromboembolic diseases
7. Local congestive condition, as well as brain congestion
8. Mental illness

The commonest indications of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy) as mentioned in Unani classics are Blephritis (JarabulAjfaan), varicose vein (Dawali), Painful Calf muscle

(Dard-e- pindali), Mania (Malankhoonia), septic wound, non-healing ulcer (Qurooh-e- khabisa), inflammation of organs (Warm-e- aaza), Lymphadenitis (Khanaazeer), Sinusitis (Waram-e- Tajaweef-e- anaf), Pharayngitis (Waram-e- halaq), Piles (Bawaseer), Fistula in ano (Nawaseer), Elephantiasis (Daaul feel) and at the biting site of poisonous animals.

Skin disorders like Ringworm (Qooba), Tinea corporis (Saafa), skin disorders like Chloasma (Namash), Warts (kalaf), Eczema (Narfarsi), Psoriasis (Daul sadaf), Vitiligo (Bars), Osteoarthritis (Wajaul Mafaasil) and hypertension etc.

Nowadays uses of medicinal leeches in coronary artery thrombosis and Ischemic heart diseases (Thromboembolic diseases), plastic surgery, replantation and other reconstructive surgeries is very famous all over world.

Contraindications of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

It is contra indicated in the treatment of certain medical conditions and diseases. These include:

1. Haemorrhagic diseases
2. Absolute haemophilia
3. Pregnancies
4. Severe anaemia
5. Hypotension
6. General fatigue
7. Allergy to leech
8. Active tuberculosis
9. Mental disorders during acute episode
10. High temperature
11. Immuno compromised patients
12. Severely ill and bed ridden
13. In case of extremely fearful patients.

According to some Unani physicians, certain sites of the body are also contra indicated for the leech application such as abdomen especially around the liver, spleen, stomach, intestine and buttock. In tropical areas, leech therapy has been prohibited as the site of leech may become infected.

Adverse effects of Irsaal-e- Alaq (Leech Therapy/ Hirudo therapy)

In spite of all the precautions taken, there is a risk of certain adverse effects and subsequent complications in some cases such as local itching, pain during treatment, vasovagal attacks, hypotension, anaemia, sepsis, allergies, super infections, transmissions of infectious diseases, scarring and slight fever etc.

References

http://www.jbsoweb.com/admin/php/uploads/82_pdf.pdf

http://europepmc.org/articles/PMC3377041/

https://www.scribd.com/document/209144901/Clinical-importance-of-leech-therapy

file:///C:/Users/hp/Downloads/1-3-28-740.pdf

http://www.phytojournal.com/archives/2016/vol5issue3/PartC/6-3-44-145.pdf

http://nopr.niscair.res.in/bitstream/123456789/5069/1/IJTK%208%283%29%20443-445.pdf

https://www.omicsonline.org/open-access/a-comparative-clinical-trial-on-leech-therapy-and-unani-herbal-formulation-on-atopic-eczema-2155-9554.1000232.pdf

http://irjponline.com/admin/php/uploads/2017_pdf.pdf

http://onlinelibrary.wiley.com/doi/10.1111/iwj.12285/abstract

https://www.nium.in/assets/pdf/Details%20of%20Reseach%20Paper%20%20Published.pdf

http://pharmexcil.org/data/conferences_files/conference_file_12.pdf`