Understanding Jalauka in Detail for Ayurvedic Practitioner’s | LEECH THERAPY in Depth by Ayurveda Siddhi

Definition of Jalauka:

As water is its life, it is called jalayuka OR as it was got
habituated to water, it is called jaluka.’

 (toc)

TYPES:

(I) According to Acharya Shusruta

1. Krishna 
2. Karbura 
3. Algarda 
4. Indrayudhdha 
5. Samudrika 
6. Gochandana 

 

1. Kapila 
2. Pingala 
3. Shankumukhi 
4. Mushika
5. Pundarikamukhi 
6. Savarik

 

SAVISHAJALAUKA:

(1)Krishna: The leech has the colour of powdered anjana and
has a broad anterior end .

(2)Karbura: The leech has shape and dimension like
varmimatsya, The abdomen of it is rised and fissured or segmented.

(3)Alagarda: The leech is hairy , flanks are larger and the
front and is blackish.

(4)Indrayudhdha: The leeches are stripped on their backs.

(5)Samudrika: The leeches are slightly blackish-yellow in
colour, have numerous marks on the body resembling flowers.

(6)Gochandana: The leeches have their lower end devided into
two halves like the scrotum of bull and have a narrow tip.

Savisha jaluka dansha lakshana:

•  Shotha 
•  Kandu 
•  Murchchha
•  Jwara
•  Daha 
•  Chhardi 
•  Mada 
•  Sadana 

 

CHIKITSA:

•  Indrayudhdhajalaukadansha
  is Asadhya.
•  Mahagada
  prayoga for pana , lepana and nasya.

 

NIRVISHAJALAUKA: 

(1)Kapila: Flanks have reddish colour like manashila, where
as the back is oily and greenish like mudga.

(2)Pingala: Are slightly red coloured or reddish brown, have
rounded, body and move quickly.

(3)Shankumukhi: Coloured brownish, like the colour of liver,
sucker are long and penetrate deep and thus sucks blood fast.

(4)Mushika: Have a shape and colour like mouse and are foul
odered.

(5)Pundarikamukhi: Coloured like mudga, tip is broad (like
the flower of lotous).

(6)Savarika: Are unctuous, coloured like lotous leaves and
are 18 angula long. 

 

These are used for only animals.

(II)According to Acharya Vagbhatta, On the based on the sex
characters,

(1)Purusha Jalauka:

–  Hard skin,big head
along with being semilunar in look with large front portion are male. 

–  It is indicated in
highly vitiated dosha and chronic disease.

(2) Stree Jalauka:

–  Delicate, having
thin skin, small sized head, the lower body being large.

–  It is indicated in
alpadosha and acute disorder.

 

NIRVISHA JALAUKA KSHETRA

Yavana- Arab countries

Pandya- South india

Sahya- Central india

Pautana- Region in and around Uttarapradesh

 

JALAUKA UTPATTI STHANA

 (I) Savisha Jalauka:

–  Jalauka originating
from putrifying urine and faeces of poisonous fishes, insects and frogs
and inhabiting dirty contaminated water are of the poisonous variety.

 

(II) Nirvisha Jalauka:

–  Those owing their
origin to putrifying lotuses such as utpala, nalina, kumuda, sauganghika,
kuvalaya and pundrika or to moss and inhabiting clear water are nirvisha.

–  Nirvisha Jalauka
dwell in places with plenty of water and fragrance and they do not eat
dirty material and do not lie in mud.

 

JALAUKA GRAHANA AND RAKSHANA VIDHI (Collection and
Preservation of leech)

They should be caught hold of by adracharma Or with the help
of other means. They should be stored in a new and big pot after filling it
with tank water and mud. Powder of moss, dried meat and aquatic tubers
should be given for feeding them. Straw and leaves of aquatic plants for
making their bed, after every 3 day they should be given fresh water and
food, after every week they should be transferred to another pot.

 

PRASHASTA JALAUKA

–  Mahasharira 

–  Balavana 

–  Shighrapayini 

–  Mahashana 

–  Nirvisha

 

APRASHASTA JALAUKA

–  Sthulamadhya 

–  Pariklishta 

–  Pruthu

–  Mandavicheshtita 

–  Agrahini 

–  Alpapayini 

–  Savisha

 

INDICATION

According to Acharya Shusruta, Nrupa, bala, aadhya,
sthavira, bhiru, durbala, nari, sukumar.

 

According to Acharya Vagbhatta,

–  Gulma 

–  Arsha 

–  Vidradhi 

–  Kushtha 

–  Vatarakta 

–  Galaroga 

–  Netraroga 

–  Vishadansha

–  Visharpa

CONTRAINDICATION

–  Sarvangashopha

–  Amlabhojananimita
kshinata 

–  Pandu

–  Arsha 

–  Udara

–  Shoshi 

–  Garbhini 

–  Ekangashotha
(According to Acharya Dalhana)

 

 JALAUKA AVACHARANA VIDHI

Poorvakarma :

•  Pt.
  is examined to see if he/she is fit for jalaukavacharana. 
•  Jalauka
  should be taken out of pot and smeared with sarshapakalka and haridra.
  Then about one muhurta(48 min.) they should be kept in pot full of 
• haridra
  jala till they regain the natural cheerfulness and freshness(vigata
  klama).
• Other
  materials like gauze, bandage, emergency medicine kept ready.

Pradhanakarma: 

 Pt. is made to sit/lie in a comfortable posture.

–  The selected area
is make ruksha(rough) by rubbing the area with gomaya churna or mud
without causing much pain.

–  Thenafter they made
to stick at the site of the lesion. If jalauka is not able to stick &
bite to the desired area, then a drop of milk, blood, ghee or honey should
be dropped on the affected part. If jalauka does not bite by doing so,
slight incision should be made over the lesion. After above said efforts,
if jalauka does not hold at the desired site, the jalauka should be discarded
& other fresh jalaoka should be applied. 

–  When jalauka mouth
gets stuck to the site and middle portion gets elevated assuming the shape
of horseshoe (Ashwakhuravat ananam). The neck of jalauka looks like a breathing
rhythm of little child and continuous pulsation like peristalsis movement
over the body. It should be known that it is sucking well.

–  Then jalauka body
should be covered with a piece of thin and wet cloth or cotton and cool
water should be dropped on the covering part continuously to provide
cooling effect.

 

MODE OF ACTION:

–  Vitiated blood
flows out first, just like the yellow juice from the seeds of the kusumbha
before its oil flows out. 

 

JALAUKA  APANAYANA:

–  When toda or kandu
is occure at the site of application if should be inferred that the
jalauka is now sucking sudhdharakta. When jalauka sucking pure blood
should be removed if it does not withdraw due to the smell of rakta,
common saindhava churna should be sprinkled upon its mouth. According to
Ashtanga Hridaya use saindhava with madhu for jalauka apanayana.

PASCHATAKARMA:

(I)Jalaulaupachara:

–  Tandulakandana is
sprinkled and do tailalavana abhyanga on mukha of patita jalauka.

–  Then to its sucker
little salt is touched. The presence of salt makes the jalauka vomit out
the sucked blood.

–  When this does not
happen, jalauka is pressed from behind to forward with thumb and index
finger carefully, such that the jalauka brings out the sucked blood.

SAMYAGVANTA:

–  The jalauka is
dropped in a bottle of water, if it actively moves around in search of
food, it means sucked blood has been completely removed.

DURVANTA:

–  If jalauka sinks in
water, it indicates that the sucked blood has not been completely removed
and hense the jalauka is heavy and inactive. The jalauka has to again be
squeezed to remove the remanant blood. If remanant blood not remove
compeletely, the jalauka suffers from a incurable disease termed
‘INDRAMADA OR RAKTAMADA (A.H.). Which makes stabdhta and mada in
jalauka.(A.H.)

–  Due to Ativamana of
rakta, jalauka may suffers from klama or even mrutyu.(A.H.)

(II) Aturaupachara:

–  Once proper
quantity of blood has been removed, the area is cleaned and in case of
Samyaka yoga, do the abhyanga of Shatadhauta Ghrita.

–  In case of Ayoga,
wound should be rubbed with madhu.

–  In case of Atiyoga,
drugs which are shita and madhura in nature can be used in the form of
irrigation, external application. Then if bleeding persists, it has to be
tightly bandaged. According to Acharya Vagbhatta, in case of Atiyoga if
cold smearing and all other cold application do the Vataprakopa, such
person should be relieved by the sprinkling or pouring warm Ghrita over
the wound area.

–  In case of
Mithyayoga(Absence of any bleeding at all), application of pradeha made
from madhra, kashaya and snigdha dravya. (A.H.Su.20/45-46)

 

JALAUKA AHARA & VIHARA:

–  Natishita

–  Natiushna

–  Dipaniya

–  Laghu

 

LEECH THERAPY

 Action and Uses: K.M. Nadakarni in his work “Indian
Materia Medica” has dealt the action and uses of leeches in great details.
According to him Leeches are antiphlogistic, used for the local
abstraction of blood and are also anticoagulants. Depletion by leeches is
analogous to the abstraction of blood y Venesection, by lancing or by
moist cupping. The quantity of blood drawn off by each Indian leech is
about 1 to 1 drachms. The quantity of blood drawn off by each Indian leech
is gradual local impression. They are used in acute inflammation of the
glands, as mammary, parotid etc; also in incipient abscesses boils, in
bruises, sprains and blows, in inflammations of the serous membranes and
in inflammation affecting the skin or bones. This is generally followed by
hot fomentations to relieve pain and the inflammation.

–  To stop the
bleeding continuing after the removal of the leeches, various haemostatics
are used, such as burnt cotton, desiccated alum, copper sulphate, tannin,
turmeric, burnt rags, cobweb, scrapped lint etc. pressure with the finger
over the bite may be useful. In obstinate cases, solution of the
per-chloride of iron is used withbenefit. Even a very fine point of
caustic nitrate of silver is inserted into the wound with benefit.
Touching the bite with the point of a red-hot needle or applying a
ligature or pressure by lint and bandage has also been tried with success.
For application, morning is the best time. It should not be put on in the
evening, lest there be serious consequences from hemorrhage and want
of proper attendance.

 

Specific indications of leeches:

·
Manifestations of ear and nose.

·
Headache.

· Whooping
cough, thrombosis, clotting

·
Brain tumor

·
Piles venous congestion

·
Tonsillitis

·
Tumors

· Skin
diseases

·
Swelling and local inflammations

·
Bruises

·
Acute abdominal pain.

 

–  In fact, the
leeches were employed for the partial exsanguinations of patients
suffering from every variety of ailments blood common cold to cancer.
Failure of adequate venous return from a graft reduces blood supply,
causing tissue necrosis. Placing a leech on the congested skin flap, finger
or other compromised area removes the congested blood and enables the
graft to be salvaged. Leeches are currently used during post[1]operative care of re-implanted
fingers, skin grafts and breast reconstructions.

–  Each leech will
feed for 30 minutes to an hours, removing around 20 ml of blood before
falling off, although blooding form the wound afterwards can result in a
blood loss of ten times this amount. Fresh leeches are applied as require
for several days or weeks until the venous congestion is relieved and
normal venous drainage of the graft has had time to develop.The Leech therapy
is mainly practiced in case of: Venous illness, acute phlebitis and
varicose veins (thrombophlebitis, varicose syndrome, post thrombotic
syndrome, phlebo thrombosis), acute gout attacks, infections, facial boil
and infected insect bites.

Further indications: Acute and chronic inflammation of the
middle ear (Otitis media), mastoiditis, glaucoma, angina pectoris with
pure-bred patients, acute inflammation of the gall bladder and infections
of the bile ducts and condition after removal of the gall bladder, high
blood pressure. Hemorrhoids and disorders within the wound healing process
in case of a post operational lymph build-up (hand surgery) or infected
wounds, acute and chronic periostitis and much more.

 

Effects of the therapy with leeches: The loss of blood by
sucking of the leech (approx, 10 ml) and the secondary hemorrhage (approx,
20-40 ml) correspond to a very gentle and slow blood-letting with a
reduction of the red blood hemoglobin according to the loss of proteins
and a local endodemisation. This loss of blood is replaced by a
breakthrough lymph whereby it comes to a clear reduction of the viscosity
and improvement of the flow characteristics of the blood (blood dilution)
especially in the final path. This effect is strengthened by the emitted
anticoagulants hirudin of the leech. It comes to a local effect due to several
active leech substances, which the leech emits, into the wound.

 

Therapeutic properties of Hirudotherapy

·
General Reflexogenic, hypotensive

·
Bloodletting immunopotentiating

·
Internal decongestion, bacteriostatic

·
Anticoagulant, anti-inflammatory

·
Protective antithrombotic, local anti-edematous

·
Thrombolytic, analgesic

·
Removal of microcirculation disorders, antiatherosclerotic

·
Anti-ischemic removal of abnormal infarctions

 

Wonder-doctor called leech

–  Hirudotherapy (from
Latin Hirudo-Leech) is known since ancient time. Along with the general
bloodletting, it has been considered as a necessary remedy in treatment
for different diseases.

 

–  Secret of salivary glands
of medical leech contains more than 100 bioactive substances and has
anti-edematous, bacteriostatic, analgesic, resolving actions, it
eliminates microcirculation disorders, restores damaged vascular
permeability of tissues and organs, eliminates hypoxia (oxygen
starvation), reduces blood pressure, increases immune system activity,
detoxifies the organism, releases it from the threatening complications,
such as infract, stroke, improves bioenergetic status of the
organism. 

–  The way to leech secret
injection is very simple: being placed on the skin it bites the skin, then
the secret of the leech saliva falls into the blood channel and goes to
the disease focus through vessels. In the treatment we use irudoreflexotherapy
placing the leeches on the Reflexogenic points as a “Life needle”.

 

Indications for treatment with medicinal leeches:

cardiovascular diseases, including essential
hypertension and ischemia disease, phlebogene diseases of the lower
extremities; chronic bronchitis, pneumonia, bronchial asthma; gastrointestinal
tract diseases (hepatitis, cholecystitis, pancreatitis, stomach ulcer);
ENT diseases; paradontosis and other teeth diseases; urological diseases; male
sterility; skin diseases (neurodermatitis, psoriasis, eczema, herpes); gynecological
disorders (commissural processes in the small pelvis, female sterility,
chronic adenitis, parametritis, endometriosis, fibromastopathy); systemic diseases
(rheumatic arthritis, systemic lupus erythematosus, scleroderma); osteochondrosis
and radiculitis; eyes diseases, including glaucoma; Infantilecerebral
paralysis (ICP) and other diseases.

 

Pharmacodynamic of Bioactive substances present in medicinal
leech

·
Hirudin-Inhibits blood coagulation by binding to thrombin.

·
Calin-Inhibits blood coagulation by blocking the binding of von Willebrand
factor to collagen. Inhibits collagen-mediated platelet aggregation.

·
Hirustasin-Inhibits kallikrein, trypsin, chymotrypsin, neutropholic cathepsin
G.

·
Bdellins-Anti-inflammatory. Inhibits trypsin, plasmin, acrosin.

·
Hyaluronidase-Anti-inflammatory. Inhibits trypsin, plasmin, acrosin.

·
Tryptase inhibitor-Inhibits proteolytic enzymes of host mast cells. 

·
Eglins-Anti-inflammatory. Inhibit the activity of alphachymotrypsin, chymase,
substilisin, elastate. 

·
Factor Xth inhibitor-Inhibits the activity of coagulation factor Xth by forming
equimolar complexes.

· Complement
inhibitors-May possibly replace natural complement inhibitors if they are
deficient.

·
Carboxypeptidase A inhibitors-Increases the inflow of blood at the bite
site.

·
Histamine like substances-Vasodilator. Increases the inflow of blood at
the bite site.

·
Acetylcholine-Vasodilator

·
Anesthetics substance-Anesthetic effects

–  The active leech
substances totally block the enzymic processes activated the often
exceeding within inflammation and trauma.

–  The salivary glands
of leeches also produce a cornucopia of other pharmacologically active
substances, including an antihistaminic, proteases and possibly an
anesthetic and an antibiotic.

–  The therapeutic
effect is not only released by a loss of blood but also by the secretions,
which the leech emits into the wound. 

–  Tourists are
advised to avoid bathing in lakes and creeks in Africa, since the HIV
infection is also transmissible by leeches, the blood that they suck from
their human hosts (often unnoticed) lands in the intestines of the worm,
and it is stored in reservoir unchanged because of the lack of digestive
enzymes. In this manner, the blood meal provides ideal grounds for
breeding of the disease-causing microorganisms that live there, such as
Toxoplasma gondii, Escherichia coli or HIV. The greatest danger of
transmitting an infection from the intestine of the leech occurs during
any attempt to remove the parasite by force. During this manipulation, the infectious
blood is emitted from the intestine of the worm, and thus it can
immediately infect a new victim at the site of the site. If the leach has
sucked the blood on an HIV-infected person, it operates as a can of
conserved infectious blood for the next victim. It is less risky to wait
until the worm has fed itself fully, then it releases itself and falls
off. In this manner, the infectious bloodto-blood contact is avoided, and
the causative microorganisms perish before they can infect anybody.

 

–  Leech therapy may
be an effective therapy for rapid reduction of pain associated with
osteo-arthritis of the knee.

–  Leeches are
anti-phlogistic, used for the local obstruction of the blood. They are
used in acute inflammation, abscess, boils, in bruises, sprains and blows.
The leech saliva has helped in countless tricky re[1]attachment
as well as being effective against various inflammatory conditions and
skin diseases such as eczema, psoriasis.

–  A medicinal leech
can once bite, victims can bleed for hours, allowing oxygenated blood to
enter the wound area until vein re-grows and regain circulation.

–  The leech saliva
has helped in degradation of fibrinogen, inhibition of factor XIIIa and
lyses of fibrin clots.

–  As the benefits of
judicious treatment with leeches are recognized, the range of conditions
that can be treated extends. There are case reports of effective leech
treatment for hematomas, purpuri fulminans, paronychia and even vascular
congestion in the penis.

–  Leeches extracts
the blood of their victims in a painless manner. Thus, leeches were
broadly used in surgery for phlebotomy under the mistaken belief that
removal psoriasis.

 

Limitations and solutions in leech therapy

Leeches gave a miraculous effect in all field but some
limitations or side effects are also there which are summarized below. The
leeches are very useful in micro-surgical practice i.e. plastic and graft
surgery. But there is significant risk of infection.

 

· The
leech’s natural anticoagulant, hirudin, keeps blood flowing for the 20 to
40 minutes it takes to feed. Particularly in those procedures were the
vascularity of the tissues are compromised.

·
Hirudo medicinalis has endosymbiotic bacteria, almost 20% of infectious
complications seen after leech therapy, So appropriate antibiotic
prophylaxis should be administered to the patient who 

need leech therapy.

·
Aeromonas infections are reported after medicinal leech therapy.

·
Pseudo lymphomas are rare but not worthy side effect of medicinal 

leech therapy.

 

There are two problems with leech therapy.

· The
squeamishness factor

· The
possibility of bacterial infection As leeches cannot be sterilized,
Historical account warns of the transmission of syphilis, AIDS, hepatitis,
after the re-application of leeches used on infected patients. So leeches
should be used single time then they should be disposed away.

· More
recently, Acromonas hydrophilia, the leech’s Natural gut flora has been
isolated from wound infections after leech treatment. So, properly
prophylactic antibiotic should be provided before the leech application.

· The
leech therapy may not be used in case of-

·
Hemorrhagic diathesis(hemophilia)

· Many
leeches are held under suspicion to act as vectors for pathogenic organism
i.e. Hirudinaria manilenses of the Philippines is play the role of carrier
of the pathogenic organism of rinderpest disease. The lands of leeches
JAVA are believed to transmit the flagellate herpentomonas causing
gangrenous ulcers.

–  The perfect 19th
century solution for many surgical conditions is leeches says Ruth Sordle,
in his special report on leeches in surgery published in the science and
medicine section of Houston Chromide quoting the miraculous events
that attracted the Huston plastic surgery. He is hopeful of getting solutions
for many modern medical problems from them.

–  The long history of
the medical utilities of leeches has revealed its much applauded
therapeutic effects and even its risks. It is also said that leeches grow
bacteria in their gut. In the April 1987 issue of British Medical Journal,
researchers at Frenchay Hospital in Bristol, England noted that they had
diagnosed six cases of infections caused by Aeromonas hydrophillia.
Despite these findings, leeches will remain useful in plastic and reconstructive
surgery to treat venous congestion according to latest reports from the
west.

 

 CONCLUSION

 –  Jalaukavacharana if
used after proper diagnosis and evaluation gives instant result compare to
other palliative or conservative treatment.

–  It is a very much
economical and cost effective.

–  No much man power
is required unlike other panchakarma procedure.

–  If not used
cautiously then may even prove fatal.