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Role of Leech therapy in the management of Burger's disease

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Abstract

The scientific basis of application of leech in burger's disease is established. There is presentation of paper in a national conference.
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CASE REPORT
LEECH THERAPY IN THROMBOANGIITIS OBLITERANS BUERGER’S DISEASE
PRAVEEN KUMAR CHOUDHARY1
Summary
Leech therapy or hirudotherapy has been in use in various disciplines of medicine ranges from reconstructive
and plastic surgery to vascular and general surgery. Leech inflicts a painless bite from a sucking disk at each
ends of its body. The leech saliva injected in to the wound possesses various metabolically active substances
causing beneficial effects locally and systematically. Leech therapy in the patients of Buergers disease as
performed and the therapeutic benefits were evaluated.
Buergers disease is also ko as throoagiitis obliterans is a disorder of peripheral arteries affecting
commonly the lower limb. Extensive thrombosis leads to reduced blood supply. Initial claudication follows
severe pain and disability to walk. Leech therapy has been found very useful in cure of the diseases as well as
in improvement of quality of life.
Keywords: Leech therapy, Hirudotherapy, thromboangiitis oliteras, Buergers disease
1Associate professor, Department of Shalya Tantra, A & U Tibbia College, Karol Bagh, NEW DELHI, INDIA
Corresponding author email: praveensurgeon9@gmail.com
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Published by Atreya Ayurveda Publications under the license CC-by-NC
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INTRODUCTION
Sushruta has clearly advocated the use of
leech in two clinical conditions, first in vitiation
of pitta and second in coagulated stage of
blood. [1] Sushruta has mentioned various tools
for bloodletting in different clinical conditions.
[2] Jalaukavacharana or leech application for
bloodletting is the painless and minimally
invasive method. [3] Leech contains anaesthetic
agent in its saliva along with hirudin, the
anticoagulant. [4] Since both ancient and
modern views suggest the anticoagulant
property of leech bite; therefore, I chose
therapeuti loodlettig i Buergers disease.
Buergers disease or throoagiitis
obliterans is a disease of medium and small
sized arteries particularly involving lower
extremity. [5] Male patients with history of
chronic smoking in age group of 30-40 years
suffer more. [6] As the name suggests,
thromboangiitis obliterans, there is
inflammation in vessels wall leading to
thrombosis and obliteration of caliber. [7] It is
characterized by claudication in the initial
stage which becomes continuous and
excruciating with the advance in the disease
process. Pain is due to ischaemia,
inflammation in wall and neuritis. [8]
For the therapy, medicinal leech was selected
and the medicinal leech is a non-poisonous
leech. Remarkable clinical improvement was
noticed. Long term follow up confirmed non
recurrence of the symptoms of the disease
treated by leech therapy.
CASE REPORT
The patient named xxx aged 45 years came
with the complaint of severe pain not relieved
by conventional opioid and non opioid
analgesics. He could not even able to put the
foot on earth and came with the help of a
stick. On examination, the affected foot was
colder than opposite one and there was
discoloration on the tip of great toe. The toe
was severely tender, blackish in colour with
sign of dry gangrene. The edges were
demarcated and there was ulcer below the
edge of gangrene.
Fig. 1 Buerger’s disease with sign of dry gangrene
The careful history revealed that he was a
chronic smoker. He was taking allopathic
treatment for about a year but no relief was
noticed in the symptoms. There was not any
co-morbidity such as diabetes mellitus,
hypertension etc. The patient was advised
colour Doppler arterial study of the lower
limb.
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Fig.2 Colour Doppler study of lower limb
(arterial)
Fig. 3 Report of the arterial colour Doppler
According to the report, there was diffuse
atherosclerosis starting just above popliteal
artery and increasing in posterior tibial artery
and deep femoral artery. The patient was
advised routine blood investigation such as
complete blood count, HIV and Hepatitis B, C
and liver and kidney function test. Coagulation
profile was also performed. A pre-procedural
counseling was given to the patient. He was
instructed to quit smoking forever. The
consent for performing the procedure was
taken prior to the leech therapy.
Leech therapy was carried out twice a week
and in each sitting 3 to 4 leeches were applied
around the affected area. Sushruta principles
were followed in application of leech. [9]
Vamana of leeches was carried out prior to
application. [10] The leeches were allowed to
suck till they detached there selves. After the
completion of procedure, the wound was
inspected and dressed with haridra powder.
The patient was kept under observation for
few hours before discharge. The condition of
wound and complications were checked every
time patient came for leech therapy. A total of
10 sittings were performed and after 10
sittigs, the patiets liial oditio as
evaluated. Colour Doppler arterial study was
also performed to see the changes.
The pain was managed by giving trayodashang
guggulu 3 tablets thrice a day. No other
medication was given to the patient.
Patient showed marked improvement in
clinical conditions. Pain was very much less,
swelling was reduced; the patient could be
able to walk without stick. The wound became
healthy and healing started. The patient was
advised to come for follow ups monthly and
then yearly.
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Fig 4 Condition of wound after application of
leech
The patient came for follow up after 6 months
and then after 2 years. He was advised a color
Doppler arterial study to rule out any
recurrence; however, he was completely free
of symptoms of Buergers disease.
Fig 5 Colour Doppler study after 2 yrs of
therapy
Fig 6 Report of the patient after treatment
‘eport said, oo feoral artery CFA is
normally seen and it is dividing in to superficial
femoral artery (SFA) and deep femoral artery
(DFA). Normal flow and flow velocity is seen in
these arteries which is also normal in popliteal
artery (PA).
DISCUSSION
Leech possesses various metabolically active
substances in its saliva. [11] It has hirudin, the
anticoagulant and an anesthetic also. Its bite is
totally painless. It is also having proteolytic
substances such as hyaluronidase and bdellin
along with several others. [12] When a leech
bites, it causes prolong bleeding and reduction
in clotting capacity of body. The effects are not
only localized but generalized in the body. It is
the base of effects of leech bite in the patient.
Keeping in view the above benefits of leech
and on the basis of ancient literature, I started
using leeches in thrombotic disorders. It
started i Buergers disease. It was evident
from the initial sitting of the leech therapy,
that the severe excruciating rest pain was
relieved very much in the patient. He was
feeling good after each session of leech
therapy. The symptoms were vanished in a
few sittings and the patient had claudication
only. The wound was healed gradually and the
patient was able to move freely without the
help of stick.
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I planned long term follow ups and I instructed
the patient to come for follow ups in
December each year. His family members
were asked to monitor the addiction of
smoking and every time he visited the
hospital, the counseling was given to him. The
colour Doppler was carried out again after a
gap of 2 years, which showed considerable
and permanent improvement.
Based on the above observation, it is
concluded that jalaukavacharan or leech
therapy is a very good procedure for dealing
ith the Buergers disease. The iproeet
in symptoms is permanent and recurrence in
symptoms is negligible. The blood flow speed
in artery improves and patients remain
symptom free for year.
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11. Bates M., Kneer K., Logan C. Medicinal leech
therapy: an overview, Orthop Nurs, 1989, 8:12-17
12. Baskova IP, Kostrjukova ES, Proteins and Peptides in
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Biochemistry (Mosc), 2008, 73:315-320
Cite as: Praveen Kumar Choudhary. Leech therapy
i Throoagiitis Oliteras Buergers Disease, J
of Ayurveda and Hol Med (JAHM).2015;3(6):130-
134
Source of support: Nil, Conflict of interest: None
Declared
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Article
Full-text available
The protein and peptide composition of medicinal leech salivary gland secretion (SGS) was analyzed in preparations obtained in July from three species--Hirudo verbana, H. medicinalis, and H. orientalis. Two-dimensional electrophoresis (molecular mass 10-150 kD and pI 3-10) revealed no distinctions in the distribution of over 100 silver-stained proteins. Differences were noted only in intensity of 10 protein spots at 30-90 kD and pI 4.7-7.5. Mass spectrometric profiling of SGS of the three leech species using the Zip-Tip/golden chip scheme and cation-exchanging chips CM-10 revealed over 50 components in SGS of each of the three leech species. It was noted that 30-40% of the individual masses of the SGS of each leech species fall within the masses present in SGS of at least one of the two other species. This rather small part of the total mass may be indicative of a high polymorphism of amino acid sequences or a high frequency of posttranslational modifications of the SGS proteins and peptides. Calculation of Jacquard's coefficient showed that H. medicinalis and H. orientalis are closest to each other in SGS composition, which is consistent with data in the literature on the phylogenetic relationship between these two species of medicinal leech. Comparison of detected molecular masses with those of six known biologically active compounds produced by medicinal leeches revealed their uneven distribution in SGS of each of the three medicinal leech species. This opens prospects for using certain species of medicinal leech for targeted therapy of various pathologies.
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Leech therapy has made a comeback as a legitimate form of therapy for treating venous congestion following grafts and replants. Complications caused directly by leech therapy are minimal, as are the risks, while the benefits can be revascularization of replanted tissue. Nurses are integral in preparing patients for leech therapy.
Cite as: Praveen Kumar Choudhary Leech therapy i Throoaagiitis OOliteras Buergerrs Disease
Cite as: Praveen Kumar Choudhary. Leech therapy i Throoaagiitis OOliteras Buergerrs Disease, J of Ayurveda and Hol Med (JAHM).2015;3(6):130- 134
Manipal manual of Surgery, CBS Publishers and Distributors
  • Kr Shenoy
  • A Shenoy
Shenoy KR, Shenoy A, Manipal manual of Surgery, CBS Publishers and Distributors, 4 th edition 2014; 82
Diseases of artery, Short Practice of Surgery
  • Love Bailey
Bailey and Love, Diseases of artery, Short Practice of Surgery, 6 th edition; 599-604
A manual of clinical surgery
  • S Das
  • Diseases
Das S, Diseases of artery, A manual of clinical surgery, 6 th edition, Calcutta; 12; 55
Diseases of artery, A manual of clinical surgery
  • S Das
Das S, Diseases of artery, A manual of clinical surgery, 6 th edition, Calcutta; 12; 55