MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Hirudotherapy, also known as leech therapy, has been used to treat a wide range of disorders for thousands of years. It is also mentioned as a minimal invasive technique called Jalaukavacharana in the Sushruta Samhita, an ancient Sanskrit text of Ayurvedic medicine.

But a long history is a fallacious argument (appeal to tradition) when used to imply efficacy. So, does this treatment work?

A review located a total of 834 articles were found of which 89.8% were original articles. USA was the leading country with 280 publications, followed by UK, Germany and France (128, 101 and 41 items, respectively). The most productive countries regarding hirudotherapy were the UK (1.93), Slovenia (1.44), and Israel (1.32). The peak publication year for hirudotherapy literature was 2011 with 41 papers.

What does that tell us about the efficacy of leech therapy?

Nothing!

The authors of another review concluded that reached the following conclusion: ” Given the low number of reported adverse events, leech therapy may be a useful approach in treating this condition. Further high-quality RCTs are required for the conclusive judgment of its effectiveness and safety.”

Sounds good?

Not really!

The few clinical trials that were reviewed are mostly by one research group – and yes, you guessed it: it was also this group who published the review.

And anyway: why do they conclude that there is a low number of adverse events? Firstly, there is no reporting system for such events; so, a low number is next to meaningless. Secondly, there are several reports of adverse events. Here are three recent cases:

1st case report

A 59-year-old woman was admitted to the emergency department with complaints of redness and swelling in both eyes and face. She had a long history of headache, therefore applied leech treatment occasionally. Swelling began on the face after the treatment of leech therapy. Vital signs were as follows; fever: 36.5°C, BP: 126/81 mmHg, heart rate: 84/min and sO2: 98%; respiratory rate: 12/min. In physical examination, GCS was 15, conscious, oriented cooperative. There was no lymphadenopathy in the palpation of the head and neck examination. Oropharynx was in natural appearance and no uvula edema. Facial palpation revealed redness, pain and heat rise. Other systemic findings were normal. Laboratory tests showed leukocytes: 11,000/mm3 (4,000-10,000/mm3), haemoglobin: 12.8 g/dL (12,00-14,00 g/dL) platelet: 271,000 (100,000-400,000/mm3) CRP: 3.45 mg/L (0-0.5mg/L). Other parameters were within normal limits. Computed tomography (CT) showed bilateral periorbital, frontal subcutaneous soft tissue oedema and lymphatic dilatations. She was hospitalized with the diagnosis of orbital cellulite due to leech therapy.

2nd case report

Anorectal sepsis usually presents with anal abscesses, which may evolve to become anorectal fistulas. Most of these cases are either of cryptoglandular origin, or they develop secondary to inflammatory bowel diseases. A 32-year-old male patient applied to our Proctology Unit with severe anal pain and swelling. Three days before admission, leeches were applied to the hemorrhoidal swellings in a medical center. The abscess was drained with appropriate unroofing and search for any compartments. The patient recovered rapidly. The abscess culture and microscopy revealed mix flora with predominant Escherichia coli. After 6 months, he has been symptom-free with perfect healing of the surgical site. We need to check up on possible handicaps in our modern patient care policies that divert people to such methods. Nevertheless, such alternative methods should be regarded as nonscientific and out of context unless their efficacy and safety are documented.

3rd case report

Pseudolymphoma, also known as Jessner’s lymphocytic infiltration, is a benign but usually chronic, T-cell infiltrating disease with erythematous papules and plaques usually seen on the skin of the face, neck, and back. The use of leech therapy also known as hirudotherapy has increased in recent years. Here, we report a 52-year-old male patient who had undergone hirudotherapy in his neck and developed infiltrating plaques after four months. A skin biopsy confirmed the diagnosis of Jessner’s lymphocytic infiltration. In parallel with the increasing use of hirudotherapy in recent years, the side-effect reports will likely to increase. Indications and contraindications of hirudotherapy, which is being used officially in hospitals, should be taken into consideration.

So, what do we make of this evidence?

I don’t know about you, but I am not likely to try or recommend leech therapy in a hurry.

14 Responses to Leech therapy, if you ask me, it sucks!

  • It is just like most of the rest of allopathic treatment: suppress/palliate the symptoms. Using leeches instead of drugs or surgery. Why do you have a problem with it? Its allopathy going back to its roots!

    • I think you should reserve your contributions to subjects that you know something about, Roger. Leeches are not a substitute for drugs or surgery.

      Leech therapy has one very special indication and that is saving replanted body parts. Leeches for that purpose are not fished out of ponds, they are bred under controlled and aseptic conditions and shipped all over the world for these special cases.
      Idiots who think they can play doctor are responsible for the serious complications described in the Professor’s post.

  • Correct me if I’m wrong, but I recall that leech therapy could be helpful for hemachromatosis and some other blood disorders where phlebotomy (blood-letting) is also indicated.

    Then again, some 15 ml of blood apparently is enough for one leech to survive a full year, with another 50 or so millilitres lost until the anticoagulant is washed out and the wound closes over.
    So you’ll need literally many dozens of the creepy suckers every month for ongoing treatment – something that is achieved far more safely, easily and better-controlled with periodical blood-letting.

    As for the leeches in human form … ah well, let’s not unduly wake up the Rogers, RG’s etcetera among us …

  • I believe in the benefits of blood-letting, I give blood donations regularly.

    • There are some situations where blood-letting will give immediate and dramatic relief. One fairly common example is acute laft ventricular failure, which is characterised by desperate shortness of breath, often coming on in the middle of the night. The reduction in blood volume takes some of the strain off the heart which in turn reduces venous pressure and therefore swelling in the lungs, allowing oxygen to transfer into the blood more easily. Unfortunately the benefit is short-lived, as the consequent anaemia reduces the oxygen-carrying capacity of the blood, and so struggling heart has to work harder.

      Nowadays we have much safer ways of reducing blood volume (a simple one is the use of intravenous diuretics). However, seeing someone with LVF improve after blood-letting must seem a very convincing demonstration of its effectiveness to those without a modern knowledge of physiology.

      • Dr. J

        Your thinking is way beyond mine.

        Mine is simple;
        The solution – for pollution – is dilution.

        • @RG said:

          Your thinking is way beyond mine.

          The way beyond reach of your thinking is not long.

          Whatever your point is RG, by quoting this well known and widely used proverb I am not going to try to guess. But I can tell you out of general interest, that it is frequently quoted at the operating table by old surgeons like me when teaching the young and aspiring to be thorough when lavaging (rinsing) the abdomen in situations of infection and soiling.

          @Julian M-K
          Another obsolete but interesting way of relieving the burden of a failing heart was that of ‘rotating tourniquets’. I have actually seen that attempted once by a surgeon who was convinced diuretics would destroy the kidneys. Said surgeon did not altogether harmonise with the normal, so to speak.
          The idea behind this method was not altogether implausible but research has long since taught medicine that there are better and many times more effective methods to treat congestive heart failure.
          https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.50.2.366

          • Bjorn,

            Another obsolete but interesting way of relieving the burden of a failing heart was that of ‘rotating tourniquets’.

            Yes, I’ve heard of that. I also like the idea of CPAP, which squeezes the fluid out of the lungs and back into the circulation (though this doesn’t address the heart failure itself). Of course as an oncologist it is many years since I have had to treat acute LVF myself. Even though I have a solid grounding in general medicine (I think more than most oncologists), management changes so quickly as new evidence emerges that I am quite out of date when it comes to cardiology. I am getting fairly out of date with oncology, too, now that I have been away from it for nearly three years.

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