Michalsen / Dobos / Roth Medicinal Leech Therapy

1. Auflage 2007
ISBN: 978-3-13-257846-3
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 200 Seiten, ePub

Medicinal leech therapy has undergone a renaissance in recent years, both in terms of how well the effects of using leeches are understood,and in the discovery of new clinical applications that have resulted in remarkable outcomes. This timely book introduces the basic principles of using leeches in clinical practice, and clearly sets out the methodology and potential applications. Emphasis is given to those areas of medicine where scientific studies have already provided firm evidence of success -- treatment of arthrosis and pain is already benefiting from this highly effective therapy. Excellent instructions for the use of leeches cover the full spectrum of possible applications, while the encouraging new developments in research are also addressed. This valuable guide for physicians to this important therapy comes from the acknowledged experts in the field.

Michalsen, Roth, Dobos

Zielgruppe

Ärzte

Autoren/Hrsg.

Michalsen, Andreas

Dobos, Gustav

Roth, Manfred

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Komplementäre Medizin, Asiatische Medizin (TCM), Heilpraktiker

Inhaltsverzeichnis

1 Introduction
2 History of Leech Therapy
3 The Biology of Leeches
4 The Technique of Leech Therapy
5 Indications for Leech Therapy
6 Leech Therapy in Rheumatic Disorders
7 Leech Therapy in Plastic Surgery
8 Contraindications
9 Safety and Adverse Effects of Leech Therapy
10 The Scientific Basis of Leech Therapy
11 The Biochemistry of Leech Saliva
12 Bacterial Flora of the Medicinal Leech ()
13 Medicinal Leeches in Integrative Medicine
14 Legal Aspects of Leech Therapy in the EU and USA
Appendix

Leseproben

2 The History of Leech Therapy

Leeching is one of the most ancient healing methods documented in the history of medicine. The first clearly identifiable account of leeching appears in ancient Sanskrit writings from India. According to Hindu mythology, Dhavantari, the physician who revealed the secrets of traditional Indian medicine to the world, held nectar in one hand and a leech in the other. The most extensive descriptions of leeching in the Indian literature appear in the writings of the physician Sushruta (100–600 B.C.E.). Leeching was also an ever-present force in traditional Chinese medicine (TCM), but was of lesser significance than in Indian medicine.

In Europe, medicinal leeching was viewed as a science-based therapeutic method right from the beginning. Leeching was an integral part of conventional and folk medicine from antiquity to the 19th century. Medicinal leeching initially remained primarily the domain of empirically minded physicians. Then, most proponents of medicinal leeching deduced its therapeutic efficacy within the framework of the prevailing scientific paradigms of their respective school of medicine. Leeching remained part of various systems of medicine through the centuries. The underlying basis for its use was the widespread belief in the concept of body humors (humoral pathology). This broad concept of disease was based on the notion that all illnesses are caused by an imbalance of one of the four body fluids, or humors (blood, phlegm, yellow bile, and black bile).

Leeching had a fixed and relatively modest range of indications in humoral pathology, the dominant paradigm in ancient European and Arabic medicine until the 17th century. Like bloodletting, leeching was mainly conceived as a means of eliminating the superabundance of blood, or plethora. The other main indications for leeching in early medicine were acute infection, local inflammation, heart problems, and circulatory disorders. Following the decline of humoral pathology, an age of misuse of leeching (“the age of vampirism”) began in the 18th and 19th centuries. Mainly influenced by the teachings of the French physician F. J. V. Broussais (1772–1838), the indications for leech application were extended for no rationally justifiable reason, and leeching was performed at an intensity of hitherto unknown proportions.

In most cases, it is not possible to reliably and accurately translate the historical classification of diseases, their underlying causes within the body, and the corresponding indications for treatment as defined by humoral pathology into the language of modern medicine. Basically, the historical definitions of disease types, constitutional causes, and treatments established based on the humoral concept of disease should be taken metaphorically, similar to the concepts of TCM and Indian medicine that are still present today.

Leeching in Ancient European Medicine

The first detailed description of the therapeutic use of leeches in ancient Greek medicine, which was influenced by Indian medicine, can be found in the poem by Nicandros of Colophon (200–130 B.C.E.). However, medicinal leeching first gained true significance in the Methodist School, which differentiated two main causes of disease, e. g. “constriction” and “dilation.” Chronic headache, general febrile conditions, psychoses, epilepsy, ear ailments, liver disease, splenic and intestinal disorders, ischialgia, arthritis, and gout were the main indications for medicinal leeching; general diseases causing symptoms of hardening, heaviness, rigidity, tension, swelling, pain, and cramps (referred to as “” in the ancient nomenclature) were additional indications. Leeches were regarded primarily as tools for alleviating the tension associated with .

Advocates of the pneumatic theory of medicine valued leeches as a useful cure for “putrefaction” and “plethora” of blood. The object was to replace “bad blood” with “good blood.” The therapeutic use of leeches became fashio nable and had its first heyday around the middle of the 1st century C.E. An ancient writing credited to the school of the Roman physician Galen (129–199 C.E.) classified leeching as part of the system of elements (fire, earth, air, and water) and temperaments (sanguine, phlegmatic, choleric, and melancholic), the healthy balance of which required the drainage of excess corporal substances. Distinctions were made between plethora (superabundance) and putrefaction of body fluids, as well as between qualitative and quantitative fluid excesses. Plethoric changes were treated by draining blood from the body, which was chiefly achieved by leeching and bloodletting. Disease management strategies were governed by popular beliefs regarding the movement of body fluids. According to the humoral concept of disease, organs or organ systems are not at risk of damage as long as the body fluids remain in motion and are excreted by the natural routes. However, if one part of the body is directly afflicted and the process becomes chronic, it should be treated locally in order to restore the healthy flow of humors. Ancient physicians therefore applied leeches for symptomatic local treatment of febrile and inflammatory diseases. Roman military physicians also used leeches to treat battle wounds.

Leeching in the Middle and Modern Ages

Leeching played a less important role than venesection and cupping in medieval Arabic medicine, where leeches were typically used to treat a variety of skin diseases and illnesses associated with the melancholic temperament (black bile). In Italy, on the other hand, physicians from the school of Salerno used leeches to remove excess body fluids in numerous indications. The teachings of Salernitan physicians gradually spread from Italy across all of Europe.

In the late age of Galenism, medieval physicians also used leeches primarily for “derivation” and removal of harmful fluids directly from an afflicted body part. They believed that the elimination of fluids by leeches promoted “internal combustion” (complete combustion of a body substance by natural organ heat) of residual disease material, thereby promoting natural healing. Leeching, as a simple systemic method for eliminating fluids, was indicated for treating conditions characterized by a general overabundance of fluids (e.g., fever) and could be used instead of venesection. The most important late-Galenic proponent of leeching was Abraham Zacuto (1575–1642), who expanded the range of indications for leeching and established the empirical basis for many physicians of the following years.

In the 17th century, the concept of humoral medicine put forward by Galen had to compete with new medical movements that arose from different streams of reasoning and that had different views on the practice of bloodletting. Proponents of the school of iatrochemistry tended to reject all forms of bloodletting. They believed that any type of blood withdrawal could shorten one's lifetime and that, according to the Holy Scriptures, blood was the locus of the soul and the source of life energy. Since they believed that illnesses developed because the Archeus (the active principle of the body and mediator between body and soul) was infected with an , they reasoned that blood withdrawal would not cure the morbid thought underlying the disease. Still, the majority of iatrochemists continued the different practices of bloodletting with moderate restrictions.

The proponents of iatrophysics had a completely different opinion of medicinal leeching. Influenced by the discovery of the blood circulation, they believed that leeching was practically indispensable. Based on the laws of mechanics, iatrophysicists explained the effects of blood withdrawal in terms of changes in blood pressure, resistance, and velocity in response to bloodletting, resulting in a temporary redistribution of blood within the body with associated effects on the blood vessels, heart, and blood composition. A combination of iatromechanic theories and Galen's humoral concept of disease predominated in 18th century medicine. According to these paradigms, blood is a labile mixture of different substances and is therefore subject to putrefaction. Their proponents believed it was imperative to keep the blood in motion to prevent it from “thickening.” Plethora, which they identified as the major cause of disease, was attributed to an imbalance of food input to blood consumption. Restoration of this balance, they believed, required fasting and physical exercise which, for practical rea sons, frequently could not be performed rigorously and intensively enough to achieve adequate results. Therefore, they had to resort to an imitation of spontaneous bleeding, nature's remedy. The advantage of leeching was that it did not cause asthenia, a frequent complication of venesection and wet cupping. Furthermore, they reasoned that venesection did not eliminate blood effectively from individuals with a sanguine temperament (plethora) or a spongy, fleshy constitution because their blood accumulated mainly in the capillaries. If the superabun-dance of blood was predominantly located in the major blood vessels, as in patients with a choleric temperament, they believed that cupping was inadequate and that leeching was more effective. A special advantage of leeches was that they could be applied to parts of the body that were not amenable to cupping, for example the frontal vein, jugular vein, vessels behind the ears, temporal arteries, and hemorrhoidal veins....

Über Autor(innen)

Michalsen, Roth, Dobos