Introduction to ArtificiaI Intelligence in Higher Education
Zoheb leech therapy
1.
2. Irsal-e-Alaq therapy and its mechanism
of action with scientific interpretation
Presented by:
Zoheb Alam Khan
P.G Scholar,Dept of IBT
NIUM
3. Ilaj Bit Tadbeer
There are three modalities of treatment available in Unani system of
medicine viz.
Ilaj bit Tadbeer (Regimenal therapy - including Dieto-therapy),
Ilaj bid Dawa (Pharmacotherapy) and
Ilaj bil Yad (Surgery).
Definition:
Ilaj bit Tadbeer is made from two words Ilaj meaning
treatment & tadbeer meaning regimen . Any favourable modification in
Asbabe Sitta Zarooriya, aimed at treatment of the diseases is known as
Ilaj bit tadbeer. Ibn e sina
4. Leech Therapy
• Application of leeches with certain intended medical
benefits.
• Hirudotherapy
• Irsal-e- Alaq /Taleeq
• A Tadbeer for Istefraghe Dam (Bloodletting)
The word ‘leech’ is supposed to be derived from an
old English word for physician, ‘laece’. Leeches are
known as ‘Alaq in Arabic language
6. Morphologically
• An elongated, flatten
body, tapering toward
each end, and
terminating in circular
flatten suckers the
hinder one being the
larger of the two
• Length ranges from <1 -
>12 inch (2.5 - 30cms)
• Hermaphrodites
• Oviparous
7. • 3 jaws arranged in a Y-shaped
pattern, and are lined at edges
with fine sharp 100 teeth's,
• Leeches have a proboscis that
is inserted for sucking out
fluids
8.
9. Historical Background
• Taleeq (Hirudotherapy /Leech
therapy) is known from the time of
extreme antiquity and is still alive
• Leeches can be seen in wall
paintings found in sepulchre of the
18th dynasty pharaohs (1567–
1308 B.C.). Leech therapy was
documented in Sanskrit writings
from 1300 BC.
• The first written record of their
medicinal use has been attributed to
Nicader of Colophain (200–
130 B.C.)
• Galen (130–201 A.D.), physician to
Marcus Aurelius, further advanced
the practice of blood letting through
the development of his humoral
concept of disease
10. Contd…
• Abu Al Qasim Zaharawi quoted when & how to use the leech,
Zakariya Razi (10th century A.D)advocated use of leech in different
skin diseases.
• Avicenna (980–1037 A.D.), believed that leeches drew blood from
deeper sources than wet cupping.
• In 11th century A.D Ahmed Hasan Jurjani & Ibn Hebal Baghdadi
instructs about application of leech & their removal procedure.
• Ameen Ud Daula Abu Farz speaks about the types of leech,
poisonous & non poisonous leeches, their habitat & characteristics
of good leeches.
• Hakim Mohd Akbar Arzani advocates the use of leeches in various
ailments.
• Leeches were named Hirudo medicinalis by Linnaeus in 1758
11. Contd..
• In France, under Broussais (1772–1832),the use of leeches spread
rapidly. Broussais has been referred to as ‘the most sanguinary
physician in history’.
• Artificial Leeches were made by Frederick Wolf in 1866
• The major event in the history of leech therapy was the discovery by
J.B. Haycraft, that the throat and mouth of the leech contained a
substance that prevented the blood from coagulating in 1884. This
compound was later isolated from leech saliva by Jacoby and was
named hirudin around 1904
• In 1976 a law allowed companies growing medicinal leeches
• With the advent of antibiotics in the 20th century, however, the
practice of leech therapy gradually lost favour
• Since the 1980s, leech therapy has regained recognition
12. Contd..
• In 2003 CSIR published a book Wealth of India which states that
there are around 52 different species of leech found in India.
• In July 2004, the FDA approved leeches as a medical device in the
area of plastic and reconstructive surgery
13. Poisonous leeches
Leeches with
• Large heads of antimonial
(surmayi), Black (siyah) / green
(sabz) colored one,
• Like eels i.e., snakefish (Bam
Machli), and
• Fine streaks of bright color (La
juvardi), and
• Color resembles like chameleon
(Bu qalmoon).
• Leeches which have been caught
from the water from bad type of
mud i.e., Miyah e Humayia.
14. Non - Poisonous leeches
• Water contains algae i.e., Mai’ah
e Tahalbiya,
• Water containing the habitat of
frogs
• The greenish colored i.e.,
“Mashi al Lavun”,
• Greenish colored and bodies are
covered with yellow (orpiment)
colored two longitudinal lines,
• Yellowish red, or brown, and
• Their heads are rounded,
• Those one when after shrinks its
resembles little locusts,
• Those which resembles like the
tail of mouse (round and thin)
• Those whose heads are smaller
and thin one.
15. It is further divided into 3 parts:
• Pre procedure
I. Prepartion of patient
II. Preparation of leech
• Procedure
• Post procedure
I. Control of bleed
II. Care of leech
Leech therapy
16.
17. PRE PROCEDURE:Preparation of patient
The skin of the area to which leech applying should be made rough by rubbing / just cleaned by a
cotton swab gently.
Specify localized area to be treated & frequency of application
If all investigations are normal or WNL,then go further to next step
Order baseline haemoglobin & haematocrit,BT,CT,VDRL,HIV,HbsAg
Obtain informed patient consent
Educate the patient
18. PRE PROCEDURE:Preparation of leech
Specify localized area to be treated & frequency of application
Specify how many leeches are required
Then they are put in tray containing water
After selection they are put in tray containing water and turmeric
Non poisonous leeches are collected and identified
19. PROCEDURE
When the leech lies over the skin with its mouth protruded like the hoof of a horse and its neck is swollen,
then it should be determined that the leech has started sucking blood.
If it does not suck blood, then in that part of the skin, a drop of milk or blood should be dropped or it should
be slightly scratched.
Hold the leech in the cup & steer towards area to be treated
Clean the site of application & localize the area of application with barrier of gauze dampened with sterile
water
Place in a cup or a syringe with the plunger removed
Remove leech with a non-toothed forceps
Physician initiates application of leech to determine desired site of application
20. POST PROCEDURE
We use habis ud dam powder and tightly bandage the wound area
Once sufficient amount of blood is removed, wipe the wound with
antiseptic and cover till bleeding stops
Sometimes we use dry cupping to remove out the blood
The local site should be wash with water and the wound should be pressed
for 5 minutes
After leech detaches drop it in tray with turmeric powder and water
21.
22. POST PROCEDURE
The jar in which leeches have been kept should be areated and labelled
properly
Never place used leech with unused leech
After proper emesis, the leech should be kept in a vessel containing water
It should be caught at its tail with the left hand and with the finger of the
right hand, it should be gradually squeezes with pressure downwards
towards the mouth.
After leech detaches drop it in tray with turmeric powder and water
23. Bio active substance and their beneficial
effects of leech saliva
1. Hirudin
2. Platelet aggregation
inhibitors
3. Calin - platelet adhesion
4. Apyrase- anti-platelet
aggregant
5. Histamine,
6. Hyluronidase,
7. Eglins,
8. Elastase,
9. Cathepsin,
10. Collagenase,
11. Fibrinases,
12. Inhibitor of Kellikerin,
13. Tryptase inhibitor,
14. Antibacterial
15. Hementin,
16. Anesthetics,
17. Bdellin,
18. Proteinase
19. Destabilase
20. Lipase and Easterase
24. • Hirudin:Most potent known inhibitor of thrombin. It inhibits blood
coagulation by binding to thrombin
• Hyaluronidase :It is a spreading or diffusing substance that modifies the
permeability of connective tissue through the hydrolysis of
endoglucoronidic linkages of hyaluronic acid –found in the intercellular
ground substance of connective. It reduces the viscosity and renders the
tissues more readily permeable to injected fluids, increasing the speed of
absorption. This promotes resorption of excess fluids and extravasated
blood in the tissues and increases the effectiveness of local anesthesia.
Hence, hyaluronidase from leech saliva helps increase the spread of all
salivary secretions.
• Calin Calin has a rapid (1-10 min.) effect on collagen that is reflected in its
ability to suppress collagen induced platelet aggregation as well as adhesion
of platelets to collagen coated micro-carrier beads. Besides inhibition of the
direct platelet collagen interaction, Calin also interferes with von-
Willebrand factor collagen binding, which is believed to be one of the
initiative events for thrombus formation at sites of damaged endothelium.
Interference with this mechanism may provide an antithrombotic potential
25. MECHANISM OF ACTION OF HIRUDIN AND BIVALIRUDIN
EXOSITE 1
EXOSITE 2 ACTIVE SITE
26. • Destabilase Destabilase possesses glycosidase activity. Destabilase lysozyme is the
first invertebrate lysozyme with combined enzymatic and non-enzymatic
antibacterial action, and it also dissolves blood clots
• Apyrase (adenosine 5’- diphosphate diphosphohydrolase) is a nonspecific inhibitor
of platelet aggregation by virtue of its action on adenosine 5’ diphosphate,
arachidonic acid, platelet-activating factor (PAF), and epinephrine.
• Eglins (elastase-cathepsin G leech inhibitors) are small proteins,It is an inhibitor of
alpha-chymotrypsin, subtilisin, chymosin, granulocyte proteinases, elastase, and
cathepsin G. Eglin c is a potential therapeutic agent for the treatment of diseases
associated with inflammation and has been proven effective for the treatment of
shock . Considering the role played by elastase in the process of leucocyte
infiltration and accumulation in inflamed microvessels, eglin c could be used to
prevent neutrophil infiltration (adhesion, penetration, and migration) into inflamed
vessels and neutrophilmediated injury to the microvascular endothelium
.
• Bdellins – inhibitors of trypsin, plasmin, and sperm acrosin – were first discovered
in 1969. A similar proteinase inhibitor, Bdellins, especially bdellin A, could be used
as a plasmin inhibitor to control bleeding. Administered systemically, they are
rapidly excreted into the urine.
27. • Decorsin is a protein .It acts as an antagonist of platelet glycoprotein II b-III a and
is a potent inhibitor of platelet aggregation
• Hirustasin binds specifically to tissue kallikrein. Antistasin and ghilanten are
potent specific inhibitors of the blood coagulation Factor Xa. In this respect,
selective Factor Xa inhibition by recombinant antistasin: (1) prevents vascular graft
thrombosis in baboons and rabbits, (2) accelerates reperfusion and prevents re-
occlusion in a canine model of femoral arterial thrombosis, (3) reduces restenosis
after balloon angioplasty of atherosclerotic femoral arteries in rabbits, and (4)
affects the mitosis of cultured aortic smooth muscle cells.
• Piguamerin is a serine protease inhibitor of plasma kallikrein . The peptide
potently inhibits plasma and tissue kallikrein and trypsin.
• Platelet Activating Factor Antagonist (PAFA) and an Ornithine-Rich Peptide
PAFA has been isolated from lyophilized dilute leech saliva. It is identified as a
phosphoglyceride, which may prove to be an important compound for the treatment
of thromboembolic disorders and inflammation. In addition, two specific Factor Χa
inhibitors from diluted leech saliva have been isolated. Although PAFA is a more
effective antithrombotic agent than heparin, its effect on bleeding time in
experimental animals did not differ from that of heparin.
28. • Chloromycetyn: Potent antibiotic (USA, 2011).
• Tryptase inhibitor: Inhibits proteolytic enzymes of host mast cells
• Anesthetic-like substances: Reduce pain during biting by a leech (Electricwala et
al., 1991; Cherniack, 2011).
• Histamine-like substances: A vasodilator increases the inflow of blood at the bite
site (Sawyer, 1986; Gasic et al., 1983; Walsmann and Markwardt, 1985).
• Complement inhibitors: Replace natural complement inhibitors if they are
deficient. 14. Carboxypeptidase-A inhibitors: Increase the inflow of blood
(Markwardt, 2002; Strube et al., 1993).
• Acetylcholine: Vasodilator
• Carboxypeptidase-A inhibitors: Increase the inflow of blood
29. As Analgesia
1. Pain-killing effects through the components of the leech saliva.
Platelet-derived growth factor (PGF) is assumed to play an
important role in producing the signals of neuropathic pain in
spinal cord and inhibition of its release by intrathecal injection of
Hirudin has been reported to suppress thermal hyperalgesia and
tactile allodynia in mice.
2. Analgesic effect provided by leeches is due to the attraction of
human brain to the neuropeptides of a leech. These neuropeptides
from a leech contain endorphins (Morphine - like substances, also
commonly known as "Hormones of happiness"). The effects of
endorphins as opiod agonists are many and they are very positive,
among them effective analgesia. Relief of anxiety ,Euphoria
,Sedation and etc..
30. • Also the leech‟s neuropeptides contain encephalin, which are a
smaller peptide naturally found throughout the brain of a human &
his dorsal horn of a spinal cord. Encephalin is considered to be
neurotransmitter that modulates pain.
• Encephalin are responsible for pain relief due to the inhibition of
substance-P (a chemical responsible for sensation of pain).
As Anaesthetic
• The anaesthetic effect produced by leeches is also due to the
injection of Serotonin - which facilitates pain in Peripheral
Nociceptors and also acts as one of the transmitters in descending
pain inhibition system.
• Newer studies on leech saliva have revealed the presence of
histamine, serotonin and also certain steroid hormones including
cortisol, progesterone, testosterone, estradiol, and
dehydroepiandrosterone. Certain kininases have also been isolated
from the leech saliva, which are possibly responsible for the
anaesthetic action
31. As Thrombolytic:
• Destabilase, which in nature can be found only in leeches Medicinalis.
With the help of this enzyme the mechanism of the fibrinolysis is being
exercised which has not been known to the science before. In practical
terms of medicine it means that through the Destabilase a leech provides
the dissolution of the old stabilized thrombs. DC provides fast penetration
of the enzymes through the cell membrane. Thrombolysis occurs by the
selective hydrolysis of isopeptide bonds of stabilized fibrin
As anti platelet aggregation:
Leeches also contain inhibitors of platelet aggregation. One such
compound, apyrase, is a substance which hydrolyzes ATP and ADP to AMP
and strongly inhibits ADP-induced platelet aggregation. Apyrase is not a
specific inhibitor, since different agonists release endogenous ADP from
platelets before aggregation .Other than that, Calin, a protein, this
compound binds specifically to collagen, thus, inhibiting collagen induced
platelet aggregation and adhesion as well as collagen-mediated thrombin
formation
32. Maintenance of local blood circulation
Increased local blood perfusion
Vasodilatation of local blood vessels
(Histamine like substances)
Dissolution of vascular thrombi
(Such as carboxypeptidase-A,Histamine)
Maintenance of local blood circulation
33. Reduce venous congestion
• Calin inhibits Collagen mediated platelet aggregation and Hirustasin that
inhibits Kallikerin,trypsin, Chymotrypsin,neutrophilic cathepsin –g ,hence
acting as anti inflammatory agents
• Application of medical leech reportedly increases blood flow within
congested tissue via active feeding and indirectly by passive bleeding
from the leech bite after detachment.
• Active & Passive bleeding are both facilitated by the actions of
different salivary secretions of the leech such as hirudin – an
anticoagulant.
35. Indications with their studies
Inflammatory Reactions (Moore and Professor, 1952; Walsmann and
Markwardt, 1985). •
Passive congestions and spastic conditions (Moore and Professor, 1952;
White et al., 2007; Katzung et al., 2009). •
Plastic and reconstructive surgery (Upshaw and O’Leary, 2000; Srivastava
and Sharma, 2010; Katzung et al., 2009; Brankamp et al., 1991; Chopin et
al., 2000; Murray et al., 2009; Swadesh et al., 1990). •
Cardiovascular diseases (Moore and Professor , 1952; Yule and Yong ,
2004; Murray et al., 2009; Whitaker et al., 2005; Green and Shafritz, 2010;
Koch et al., 2012; Henderson et al., 1983; Batchelor et al., 1984). •
Hypertension (Batchelor et al., 1984). •
Varicose Veins. (Batchelor et al., 1984; Mutimer and Banis, 1987). •
Hemorrhoids (Chudzinski-Tavassi et al., 1998). • Arthrosis, osteoarthritis,
periarthritis and rheumatoid arthritis (Sawyer, 1986; Mutimer et al., 1987).
Thrombophlebitis, thrombosis and embolism (Jeng et al., 1994).
Hematomas (Swadesh et al., 1990).
External ear and chronic ear infections (Mutimer et al., 1987). •
36. • Eye diseases, including cataracts, glaucoma,traumatic injuries and
inflammation (Sawyer, 1986). •
• Dental problems, like gingivitis, paradontitis, gingival edema and
stomatorrhagia (Sawyer, 1986; Mutimer et al., 1987). •
• Vertebrogenic Pain Syndromes (Sawyer, 1986). • GI tract – hepatitis,
cholecystitis, pancreatitis, stomach ulcers (Rouse et al., 2006; Mutimer et
al., 1987). •
• Chronic skin diseases, like scabies, psoriasis, eczematous dermatitis, and
chronic ulcers (Koh and Kini , 2008; Sawyer, 1986; Mutimer et al., 1987).
•
• Respiratory disorders - Asthma, acute rhinopharyngitisand spasmodic
coryza (Yule and Yong , 2004; Porshinsky et al., 2011; Mutimer et al.,
1987). •
• Gynecological disorders - male and female sterility, endometriosis.
37. Contraindications
• Absolute hemophilia
• Anemia
• Leukemia
• Hypotonia
• Pregnancy
• Multiple Myeloma
• Lymphoma
• Low blood pressure
• Chemotherapy
• Liver Cancer
• Pacemaker
• Pregnancy
• Menstrual period
We do not apply leeches if is on
the following medication:
• Coumadin
• Plavix
• Lovenox
• Marcumar or similar are in use
• Anti-inflammatory and
antidepressant medication
38. Complications
• Infection
• Local hypersensitivity conditions including itching,
blister forming, ulcerative necrosis and even local
tissue damage (flap death),
• Blood loss
• Skin marks (scars) left by impaired healing of leech
bites are also reported as postleeching complications
• Hypotension and vasovagal attacks
• Local pain
39. Refrences
• Mohamed Shiffa, Mohammed Akhtar Siddiqui, Asia Sultana, Fasihuzzaman,
Nazeem Fahamiya LEECH THERAPY IN KNEE OSTEOARTHRITIS:
MECHANISM AND EFFECS ,International Journal of Universal Pharmacy and
Life Sciences 2(3): May-June 2012
• Abbas Zaidi S.M., Jamil S.S., Sultana A., Zaman F., Fuzail M., Safety and efficacy
ofleeching therapy for symptomatic knee osteoarthritis using Indian medicinal
leech, Indian Journal of Traditional Knowledge, 2009;
• Abbas Zaidi, Clinical study on Taleeq(leeching), its utility in the treatment of
osteoarthrosis.MD Thesis, Faculty of Medicine (U). Jamia Hamdard. New Delhi,
India, 2007.
• Ashok Kumar Panda* and Saroj Kumar Debnath Effectiveness of Leech Therapy in
Gambhira Vata-Rakta (Acute Gout): A Pilot Study;2012
• Abdelgabar AM, Bhowmick BK (2003) The return of the leech. Int J Clin Pract57:
103-105.
• Eldor A, Orevi M, Rigbi M (1996) The role of the leech in medical
therapeutics.Blood Rev 10: 201-209.
• S.M. Abbas Zaidi, MD; S.S. Jameel, MD; F. Zaman, MD; Shazia Jilani, MD;
A. Sultana, MD;Shariq A. Khan, MD A Systematic Overview of the
Medicinal Importance of Sanguivorous Leeches
40. • Bichler J, Fritz H. Hirudin, a new therapeutic tool? Ann Hematol 1991;63:67-76,Walsmann P,
Markwardt F. Biochemicaland pharmacological aspects of the thrombin inhibitor hirudin.
Pharmazie 1981;36:653-660. [Article in German]
• Markwardt F. Studies on the mechanism of the anticoagulant effect of hirudin.
NaunynSchmiedebergs Arch Exp Pathol Pharmakol1956;229:389-399. [Article in German]
• Ahmad, T., Anwar, M.; Clinical importance of leech therapy; IndianJournal of Traditional
Knowledge, (2009); 8(3): 443–445.
• Shastri, A.D., (ed). Sushruta Samhita, Sutra Sthana 13(Jalaukavcharaniya Adhyaya).
Chaukhambha Sanskrit Sansthan,Varanasi, 2007, .
• Haycox CL, Odland PB, Coltrera MD, Raugi GJ. Indications and complications of medicinal
leech therapy. J Am Acad Dermatol 1995;33:1053-1055.
• Eldor A, Orevi M, Rigbi M. The role of the leech in medical therapeutics. Blood Rev
1996;10:201- 209
• Ibn sina,Al Qanoon Fil Tib,2nd Edition English translated by Mazhar H Pasha(Inter services
Press Karachi,Pakistan,1998
• Ali bin RabbanTabri,Firdous ul Hikmat Urdu Transalation by Mohd.Adil Shah(Faisal
publications Deoband) 2002
• Hakeem mohd.kabeer ud din,Kulliyat e Qanoon,
• Ahmed Jurjani,Zakhira Khwar Zam Shahi,Idara Kitab Us Shifa,New Delhi,2010
• Hakeem Mohd.Hasan Qurshi,Jam ul Hikmat, Idara Kitab Us Shifa,New Delhi,2011
•
