Leech Therapy (Hirudotherapy)

Hirudotherapy — treatment with the medical leech (Hirudo medicinalis) — is one of the modalities recognised in Türkiye's Traditional and Complementary Medicine framework. Modern science is mapping the more than 100 bioactive molecules in leech saliva at the molecular level, showing that hirudotherapy is not merely "traditional" but a biologically active therapy. The FDA classified the medical leech as a medical device in 2004 for treating venous congestion after reimplantation surgery.

Biochemistry of Leech Saliva

The medical leech releases over 100 bioactive substances through its saliva. The best-characterised include hirudin (potent specific thrombin inhibitor — anticoagulant), calin (blocks collagen-mediated platelet aggregation), destabilase (fibrin-degrading thrombolytic enzyme), hyaluronidase ("spreading factor"), orgelase (angiogenic), bdellins and eglins (anti-inflammatory protease inhibitors), acetylcholine and histamine-like vasodilators, and natural anaesthetic components.

The combined effect: improved local microcirculation, dissolution of microthrombi, increased lymphatic drainage and a local anti-inflammatory environment. The leech is not a parasite — it is a biological pharmaceutical factory.

Indications

Vascular: varicose veins, superficial thrombophlebitis, chronic venous insufficiency, haemorrhoids, post-thrombosis syndrome — gold-standard uses.

Musculoskeletal: knee osteoarthritis (supported by clinical trials), back and neck pain, epicondylitis (tennis/golfer's elbow), tendinopathy, myofascial pain, fibromyalgia support.

Neurology: migraine and tension-type headache, tinnitus, post-herpetic neuralgia, early carpal tunnel.

Dermatology: acne, localised psoriasis lesions, alopecia areata, eczema, chronic ulcers, keloid sequelae.

Internal medicine and metabolic: hypertension (adjunct), microcirculatory support in ischaemic heart disease, diabetic complications, chronic prostatitis, gynaecological congestive complaints.

Post-surgical: venous drainage in reimplantation and free-flap surgery (FDA-approved indication), haematoma resolution.

Procedure

Each leech is used for one patient and one session only, then disposed of as biological medical waste — zero cross-contamination risk. After skin antisepsis, the leech is placed on complaint-specific anatomical points. It typically detaches itself after 30–60 minutes, having ingested 5–15 mL of blood; the patient feels only mild stinging at the start (the leech's natural anaesthetic effect).

After detachment, the site oozes for 8–24 hours — a natural extension of hirudin's anticoagulant effect and an important therapeutic component. Sterile dressing follows. A treatment series is 3–10 sessions at 1–2 per week, tailored to the complaint.

Safety and Contraindications

Safe with proper patient selection. Contraindications: active bleeding disorders (haemophilia, von Willebrand), anticoagulant therapy, severe anaemia (Hb < 10 g/dL), pregnancy and breastfeeding, immunosuppression, allergy to leech proteins, uncontrolled hypertension. In diabetics — especially with peripheral neuropathy — wound-healing risk is monitored.

Common minor effects: transient itching, mild redness, rarely small local infection. Allergic reactions are rare. CBC, biochemistry and coagulation panel are standard pre-treatment.