JALAUKAVACHARANA (LEECH THERAPY) IN VENOUS ULCERS AND VARICOSE VEINS: CLASSICAL BASIS, MECHANISMS AND CLINICAL EVIDENCE
Background: Chronic venous insufficiency, varicose veins and venous leg ulcers are common, disabling and costly. Compression therapy is the mainstay of treatment, but healing is slow and recurrence is frequent. Jalaukavacharana, the application of medicinal leeches, is one of the classical methods of Raktamokshana (bloodletting) described in detail by Sushruta and is widely used in Ayurvedic surgery for venous disease. Objective: To review the classical basis of Jalaukavacharana, the bioactive constituents of leech saliva, and the clinical evidence for leech therapy in varicose veins and venous ulcers. Methods: Narrative review of Sushruta Samhita and of experimental, clinical and review literature on medicinal leech therapy. Results: Sushruta classifies leeches into poisonous and non-poisonous types, describes their collection, storage, application and removal, and recommends them especially for Pitta-dominant blood disorders and for delicate patients. Leech saliva contains hirudin and other anticoagulant, antiplatelet, anti-inflammatory, vasodilatory and anaesthetic substances. In a prospective study of 20 patients with complicated varicose veins, leech application around ulcers was followed by healing of all ulcers and reductions in oedema and pigmentation. A randomised trial in knee osteoarthritis showed that leech therapy reduced pain more than topical diclofenac. Leeches have regulatory clearance as a medical device in reconstructive surgery. Infection with Aeromonas species is the main recognised risk. Conclusion: Leech therapy has a strong classical basis and plausible mechanisms in venous disease, and early clinical studies are encouraging. Controlled trials in venous ulcers, combined with standard compression therapy, are needed.
KEYWORDS: Jalaukavacharana; leech therapy; hirudotherapy; Raktamokshana; varicose veins; Siraja Granthi; venous ulcer; hirudin