Hirudotherapy

The medicinal properties of the medicinal leech are known to people for thousands of years. Description of the methods of treatment of various diseases with the help of leeches can be found in the medical collections of most ancient civilizations: Ancient Egypt , India , Greece . The use of leeches was described by Hippocrates ( IV - V century BC) and Avicenna (Ibn Sina, 980 - 1037 ) ^[1] .

Medical leeches were most widely used in Europe in the 17th and 18th centuries for bloodletting in connection with the concept of "bad blood", which then dominated medicine. In order to release bad blood, doctors sometimes assigned up to 40 leeches to one patient at a time. Preference to veinous bloodletting was given to them in case of need for bloodletting from hard-to-reach or tender places (for example, gums). In the period from 1829 to 1836 in France , 33 million leeches a year were used to treat, in London - up to 7 million with a population of 2.3 million ^[2] . Russia supplied about 70 million leeches a year to Europe ^[3] .

After the paradigm shift in the middle of the XIX century, bloodletting was refused, and the use of leeches in Europe practically ceased.

Scientific studies on the mechanisms of action of the leech on humans began in the late XIX - early XX century with the work of , who discovered the anticoagulant effect of leech extract. In 1884, he discovered the enzyme from the leech’s saliva, hirudin , and in 1902 preparations were obtained from hirudin. These studies initiated the scientific application of leeches in medicine ^[4] .

Live leeches are attached directly to the human body according to specially designed schemes. The choice of the place of attachment is determined by many factors: the disease, the severity of the process, the patient's condition. The process of sucking lasts from 10-15 minutes to an hour, after which the leeches are removed with the help of alcohol, iodine or, in the case of feeding their fill, they release themselves. Fed leeches are subject to destruction by placing in the solution of chloramine , their repeated use is not allowed. The therapeutic effect of living leeches is due to several factors:

• Dosed bleeding (from 5 to 15 ml of blood for each leech depending on the weight of the leech and the duration of the prefix). It is used to treat hypertension , glaucoma , liver congestion, general intoxication of the body.
• The action of biologically active substances is leech saliva, the main of which is hirudin anticoagulant, which reduces blood clotting. Used to treat angina and myocardial infarction , thrombophlebitis , vein thrombosis, hemorrhoids ^[5] .
• The complex response of the body to the bite, biologically active substances of leech saliva and subsequent blood loss.

The possibility of transmission through a leech is practically excluded if more than 4 months have passed since the last feeding. By this time, a small amount of blood remains in the leech's stomach, and the possible growth of pathogenic bacteria manages to choke on the symbiotic bacteria A. hydrophila . Her titer falls, and when sucking, it does not fall into the wound. However, in weakened patients with reduced immunity or on grafts of transplanted tissue (due to a decrease in local defense mechanisms), infection with Aeromonas may still occur. To prevent the development of this infection after plastic surgery in the USA, it is recommended to conduct courses of antibiotic therapy with fluoroquinolone ( ciprofloxacin ) ^[6] .

A reliable guarantee of protection against the transfer of leech infectious agents is the use of artificially grown and sufficiently starving animals in the intestines of which there is no pathogenic flora ^[7] . The use of leeches in therapy was revived in the 1970s: in microsurgery, they are used to stimulate blood circulation, to save transplanted skin and other tissues from postoperative venous stasis. Other clinical applications of medical leeches include the treatment of varicose veins, muscle spasms, thrombophlebitis and arthrosis. The therapeutic effect comes not only from the flow of blood through the tissues during feeding with leeches, but from further and steady bleeding from the wound left after the leeches detach. Leech saliva has analgesic, anti-inflammatory and vasodilator properties.

Bite process

The leech sucks, after which it bites the skin to a depth of 1.5–2 mm, and injects saliva into the wound, which also contains the hirudin enzyme, which prevents blood from clotting . At one time, the leech is able to suck about 5 ml of blood. A session lasts from 20 to 60 minutes depending on the disease. After the bite, there is a wound that normally secretes blood and lymph from 6 to 16 hours. The amount of blood flowing from 5 to 30 ml. It is not recommended to smear the bite site with iodine or brilliant green , since the permeability of tissues is increased, and they can cause severe burns .

Stop Bloodsucking

In most cases, leeches are placed before self-discharge after they are fully saturated. To prematurely remove the leech sucked, it is enough to attach a tampon slightly moistened with iodine or alcohol to its front suction cup ^{[8] [9]} , after which it instantly disappears ^[10] . You can also sprinkle it with salt, snuff, wood ash, you can moisten with vinegar, wine, lemon juice, it is possible to put a stream of tobacco smoke on it. If these methods do not help, then it is necessary to unfasten the front suction cup with a scalpel, letting in air under it. Cutting the leech's body is useless, as it continues with bloodsucking while doing this ^[11] . After using leeches, as a rule, they are destroyed ^[12] and their repeated use is unacceptable.

It should be noted the growing interest in hirudotherapy in the field of cosmetology. A noticeable lymphatic drainage effect together with the action of biologically active substances (there are more than 100) of leech secretion promotes healing of the skin and improvement of its appearance. It should be emphasized that the rehabilitation period after the session can last 4–5 days. On the second or third day, redness and swelling of the soft tissues at the site of the bite may increase, and in the following days the swelling will gradually subside and reject a small crust at the site of barely noticeable damage to the skin. The expected effect is a reduction in the mesh of fine wrinkles, improvement of the skin condition, color smoothing due to a decrease in the intensity of coloring of pigment spots. The effect may increase over several weeks.

Hyaluronidase improves tissue permeability for other components of leech saliva. This effect is used to enhance the action of medicinal substances administered subcutaneously or cutaneous. Hirudin selectively blocks thrombin and slows blood clotting.

Histamine-like substance causes a local inflammatory reaction. Perhaps this provides improved blood flow to the leech landing site.

Psevdogirudin: the role is not yet known.

Bdellins, eglins are inhibitors of proteolytic enzymes (the content of which in the blood increases with certain pathological processes), thus reducing the overall inflammatory response of the body.

Destabilase complex has a powerful antithrombotic effect by blocking platelet aggregation. And it works as a hydrophilic , and as a hydrophobic formation, depending on the environment. The bacterium Aeromonas hydrophila is believed to produce destabilase. This complex is interesting for the treatment of encephalopathy .

Neurotrophic factors are interesting from the point of view of effective use in children with cerebral palsy and rehabilitation of patients after a stroke. These factors contribute to the growth of nerve cell processes.

Contraindications are ^[13] :

• diseases associated with bleeding due to low blood clotting
• hemolysis
• anemia ( anemia ) ^[14]
• weakening or exhaustion of the body
• leech enzyme intolerance (allergic reactions)
• tuberculosis of various locations
• oncological diseases

• Savinov V. A. Hirudotherapy. - Medicine, 2004. ISBN 5-225-04793-9
• Kamenev Yu., Kamenev O. leech will help you. A practical guide to hirudotherapy. - SPb: All, 2014. - 192 p. - ISBN 978-5-9573-0271-1 .
• Kamenev O. Yu., Baranovsky A. Yu. Treatment with leeches. Theory and practice of hirudotherapy. - Publishing House "All", 2008. ISBN 978-5-9573-0790-7 , ISBN 5-9573-0790-4
• Kostikova L.I. Hirudotherapy. Treatment of complex chronic and neglected diseases. - Phoenix 2014 ISBN 978-5-222-21757-3
• Gerashchenko L., Nikonov G. The medical leech will help you. Encyclopedia of hirudotherapy. - AST, Astrel, Transit, 2005. ISBN 5-17-020644-5 , ISBN 5-271-09521-5 , ISBN 5-9578-0516-5
• Stoyanovskiy D.N. Medical leech. Bloodletting - AST, Stalker, 2006. ISBN 5-17-014983-2 , ISBN 966-596-883-1