Chapter XIII - Usage of leeches

Now we shall discuss the Chapter which treats of leeches and of how and which to use (Jalauka-vacaraniya-adhyaya).

Leeches should be applied where the patient would be found to be old or imbecile, or a woman, or an infant, or a person of an extremely timid disposition, or a person of a delicate constitution, and as such is not fit to be surgically operated upon, since this mode of bleeding is the gentlest that can be possibly devised. The blood vitiated by the deranged wind (Vayu), bile (Pitta), and phlegm (Kapha) should be respectively sucked through a horn, by leeches and a gourd appliance (Alavu-Yantra) or with whichsoever of them is available at the time, irrespective of the cause of such vitiation, whenever such bleeding or sucking would be found to be imperatively necessary.

Authoritative verses on the subject:—

A cowhorn is described in the Shastras as of a hot or heat making potency, and as possessed of a slightly cooling (Snigdha) or soothing (Madhura) property. Accordingly it should be used in sucking the blood vitiated through the action of the deranged bodily wind. Leeches, which are born in water, are possessed of Madhura (sweet or soothing) properties, and hence they should be used in sucking the blood vitiated through a deranged condition of the bile (Pitta). The gourd (Alavu) is pungent, parching and irritating in its potency and should be therefore used in sucking the blood vitiated through the action of the deranged phlegm (Kapha).

Mode of application:—

The part from which the blood is to be sucked should be first scarified or slightly cut in two or three places, and then the mouth or the open end, of the horn, covered with a thin piece of muslin tied round its edges should be placed over it and sucked with the mouth through the aperture at its tip or top-end, or with a gourd appliance equipped with a lighted lamp placed in its inside.

The term Jalauka (leeches) may be etymologically interpreted to mean creatures whose life (Ayu) or whose longevity is in, or depends upon, water, whereas the derivative meaning of the term Jalauka (leeches) is based upon the fact of their dwelling (“Oka”—dwelling place) in water (Jala). Leeches may be divided into twelve distinct species of which six are venomous, and six non-venomous. The six venomous species are named Krishna, Karvura, Alagarda, Indrayudha, Samudrika and Gochandana. The leeches of the first-named species (Krishna) are marked by thick heads, and of a colour resembling powdered lampblack. The leeches of the Karvura type have extended or elongated bodies like the Varmifishes, and are indented and thick at the waist. The Alagarda leeches are hairy, thick and round at the sides, and black at the mouth. The leeches of the Indrayudha species are marked on the surface with up-pointed rainbow coloured lines. The skins of the Samudrikas are blackish yellow, dotted over with white spots of a variety of shapes. Leeches which are provided with narrow mouths and are marked by bifurcating line at the bottom like the scrotal sac of a buil are called Gochandanas.

A person bitten by any of the abovesaid venomous leeches has an irresistble inclination to scratch the seat of the bite which is marked by a considerable swelling. Fever, with burning, retching, drowsiness and delirium supervenes and ultimately the patient loses all consciousness. The remedy consists in the administration of an anti-toxic medicine known as Mahagada, as snuffs, potions and unguents, etc. A bite by an Indrayudha usually proves fatal. Venomous leeches, as well as cures for their bites, have thus been described.

The non-venomous species include Kapilas, Pingalas, Shankhamukhis, Musikas, Pundarimukhis and Saravikas. The Kapilas are coloured like Manah-Shila (realgar) at the sides, and their backs are tinged with a glossy hue like that of a Mudga pulse. The Pingalas have a reddish colour, are round in shape and capable of speedy locomotion. The Shankhamukhis are marked by a blackish red hue like that of the liver, are provided with sharp elongated mouths, and are capable of sucking blood with the greatest swiftness. The Musikas are coloured like the common blind moles, and emit a fetid smell from their bodies. The Pundarimukhas are coloured like the Mudga pulse and are so called from the fact of the resemblance of their mouths to the full-blown lotus lilies (Pundarikas). The Saravikas have cold bodies marked with impressions like lotus leaves and measure eighteen fingers' width in length, and they should be employed in sucking blood from the affected parts of lower animals. This exhausts the list of non-venomous leeches.

The countries, such as Turkesthan (Yavana), the Deccan (Pandya), the tract of land traversed by the Ghaut mountains (Sahya), and Pautana (modem Mathura), are the natural habitats of these leeches. The leeches, found in the aforesaid countries, are specifically non-venomous, strong, large-bodied, greedy and ready suckers.

The venomous leeches have their origin in the decomposed urine and fecal matter of toads and venomous fishes in pools of stagnant and turbid water. The origin of the non-venomous species is ascribed to such decomposed vegetable matter, as the petrified stems of the several aquatic plants known as Padma, Utpala, Nalina, Kumuda, Pundarika, and the common zoophytes which live in clear waters.

Authoritative verse on the subject:—

The non-venomous leeches swim about in sweet scented waters, live on non-poisonous weeds, lie on the leaves of flowering water plants instead of on the dank and oozy beds of pools, and suck blood from the affected part of a human organism without causing any discomfort.

Leeches should be caught hold of with a piece of wet leather, or by some similar article, and then put in to a large-sized new pitcher filled with the water and ooze or slime of a pool. Pulverised zoophytes and powder of dried meat and aquatic bulbs should be thrown into the pitcher for their food, and blades of grass and leaves of water-plants should be put into it for them to lie upon. The water and the edibles should be changed every second or third day, and the pitchers should be changed each week, (the leeches should be transferred to a new pitcher at the end of every consecutive seven days).

The authoritative verse on the subject:—

Leeches that are venomous, thick about the middle, elongated, of slow locomotion, look fatigued, do not readily take to the part they are applied to, and capable of sucking only a small quantity of blood, should be looked upon as not belonging to the proper or the commendable type.

hen having seated or laid down the patient suffering from a disease which requires the application of leeches, the seat of bleeding, if not previously ulcerated, should be roughened by dusting it over with a composition of loose earth and pulverised cowdung. Then the leeches should be taken out of their receptacles and sprinkled over with water saturated with mustard seed and pasted turmeric. Then for a moment they should be kept in a basin full of water, and after they have regained their natural vivacity and freshness, they should be applied to the affected part. Their bodies should be covered with a piece of thin and wet linen, or with a piece of white cotton. The affected part should be sprinkled over with drops of milk or blood, or slight incisions should be made into it in the event of their refusing to stick to the desired spot. Other fresh leeches should be applied even when the preceding measures should prove ineffectual. That the leeches have taken to the affected part may be inferred from the mouths of the leeches assuming the shape of a horse-shoe, and the raised and arched position of their necks after they had become attached to the seat of the disease. While sucking, the leeches should be covered with a piece of wet linen and should be constantly sprinkled over with cold water.

A sensation of itching and of a drawing pain at the seat of the application would give rise to the presumption that fresh blood was being sucked, and the leeches should be forthwith removed.^[1]

Leeches refusing to fall off even after the production of the desired effect, or sticking to the affected part out of their fondness for the smell of blood, should be sprinkled with the dust of powdered Saindhava (rock salt.)

After falling off, the leeches should be dusted over with rice powder and their mouths should be lubricated with a composition of oil and common salt. Then they should be caught by the tail-end with the thumb and the forefinger of the left hand and their backs should be gently rubbed with the same fingers of the right hand from tail upward to the mouth with a view to make them vomit or eject the full quantity of blood they had sucked from the seat of the disease. The process should be continued until they manifest the fullest symptoms of disgorging. Leeches that, had vomited the entire quantity of blood sucked as above, would briskly move about in quest of food if placed in water, while the contrary should be inferred from their lying dull and inert. These should be made to disgorge again. Leeches not made to emit the entire quantity of the sucked blood stand in danger of being attacked with an incurable disease peculiar to their genus, and which is known as Indramada. The leeches should then be put into a new pitcher, and treated as before laid down, after they had fully emitted the sucked blood.

An ulcer incidental to an application of leeches should be rubbed with honey or washed with sprays of cold water, or bound up with an astringent (kashaya) sweet and cooling plaster, according to the quantity of blood removed from the part.^[2]

Authoritative verse on the subject:—

The physician who is fully conversant with the habitat, mode of catching, preservation and application of leeches, can well aspire to cure the diseases which yield to them or in which their use is indicated.

 

Thus ends the thirteenth Chapter of the Sutrasthana in the Sushruta Samhita which treats of Leeches and of how and which to use.

Footnotes and references:

[1]:

The leeches, though a blissful dispensation of Nature in themselves, instinctively draw off the vitiated blood from a diseased part, attacking the healthy vital fluid (red blood) when the former has been completely tapped or sucked.

[2]:

In case of full and proper bleeding (Yoga) the ulcer should be rubbed with clarified butter technically known as the Shatadhauta (lit: hundred times washed) Ghrita (clarified butter), or a piece of cotton, soaked in the same substance, applied as a compress over the part. The ulcer should be rubbed with honey in a case of insufficient bleeding, while it should be washed with a copious quantity of cold water if excessive bleeding (Ati-Yoga) should set in. Similarly in a case marked by the absence of any bleeding at all (Mithya-Yoga) a sour, sweet and cooling plaster should be applied over the ulcer.