Clinical efficacy of medicinal leech therapy in treating third- and fourth-degree hemorrhoids / Eficácia clínica da hirudoterapia no tratamento de hemorroidas de terceiro e quarto graus

Abstract Objectives Hemorrhoids are characterized by bleeding, mucous discharge, itching, pain, and prolapse. This condition is known as bawaseer in Unani medicine, and Hirudinaria granulosa has been used for its treatment in Irsal-e Alaq, or medicinal leech therapy (MLT), for centuries. Hirudinaria granulosa with antithrombotic and antiinflammatory action is used in the treatment of chronic venous disease and hemorrhoids. The present study was aimed to investigate the efficacy of MLT in third and fourth-degree hemorrhoids. Methods A single-centre prospective, clinical trial with a pre and postanalysis design was conducted at the hospital of the National Institute of UnaniMedicine. Twenty male and female patients, with a mean age of 38 years, presenting moderate symptoms assessed with the colorectal evaluation of clinical therapeutics scale (CORECTS) questionnaire were included in the study. Hirudinaria granulosa were applied around the pile mass for 15 minutes weekly, for 4 weeks. The efficacy of the treatment was measured by an objective and subjective assessment using the CORECTS. Results When analyzed by the clinician, MLT reduced the symptoms' severity score in the following domains: pain (55% improvement; p < 0.001); anorectal itching (30% improvement; p < 0.10); and bleeding (10% improvement; p < 0.7963). Significant improvement (p < 0.001) was reported in the CORECTS score in relation to pain (44.09% improvement; p < 0.001), itching (38.55% improvement; p < 0.001), swelling (44% improvement; p < 0.001), bleeding (17.28% improvement; p < 0.007), discomfort (34.01% improvement; p < 0.001), and wellbeing (32.35 % improvement; p < 0.001), giving an average overall opinion on the therapy of 4/10. Conclusion The results of the study albeit smaller in sample size show that MLT is an effective and safe therapeutic option in reducing the symptoms of 3rd and 4th degree haemorrhoids.

Resumo Objetivos As hemorroidas são caracterizadas por sangramento, secreção mucosa, prurido, dor e prolapso. Esta condição é conhecida como bawaseer namedicina Unani, e a Hirudinaria granulosa tem sido usada para seu tratamento na Irsal-e Alaq, ou hirudoterapia, há séculos. A H. granulosa, devido à sua ação antitrombótica e antiinflamatória, é utilizada no tratamento de doenças venosas crônicas e hemorroidas. O presente estudo teve como objetivo investigar a eficácia da hirudoterapia em hemorroidas de terceiro e quarto graus. Métodos Este ensaio clínico prospectivo e unicêntrico com delineamento pré e pósanálise foi conduzido no hospital do National Institute of Unani Medicine. Foram incluídos no estudo 20 pacientes de ambos os sexos, com média de idade de 38 anos, que apresentavam sintomas moderados avaliados pelo questionário colorectal evaluation of clinical therapeutics scale (CORECTS). Espécimes de H. granulosa foram aplicadas em volta da área afetada por um período de 15 minutos semanais, durante 4 semanas. A eficácia do tratamento foi medida por uma avaliação objetiva e subjetiva usando o questionário CORECTS. Resultados Quando analisada pelo clínico, a hirudoterapia reduziu o escore de gravidade dos sintomas nos seguintes domínios: dor (55% de melhora; p < 0,001); prurido anorretal (melhora de 30%; p < 0,10); e sangramento (melhora de 10%; p < 0,7963). Melhora significativa (p < 0,001) foi relatada no escore CORECTS em relação à dor (44,09% de melhora; p < 0,001), prurido (38,55% de melhora; p < 0,001), inchaço (44% de melhora; p < 0,001), sangramento (17,28 % de melhora; p < 0,007), desconforto (34,01% de melhora; p < 0,001) e bem-estar (32,35% de melhora; p < 0,001), o que resultou em uma opinião geral média sobre a terapia de 4/10. Conclusão Os resultados do estudo, embora com tamanho de amostra pequeno, mostram que a hirudoterapia é uma opção terapêutica eficaz e segura na redução dos sintomas de hemorroidas de terceiro e quarto graus.

Irsale Alaq [leech therapy] everything old is new again

Leeching [Irsale 'Alaq] is one of the oldest methods of treatment to cure the diseases. It has survived for more than 2000 years since the beginning of the scientific medicine. It is nothing but a unique method of removal of Mawaad-e-Fasidah [morbid matters] from the body. It draws blood from deeper tissues thus helping to treat ailments. The best leech should be used in order to get maximum benefits. To fully understand why leech therapy works in such a wide range of applications, one must realize that the therapeutic activity of leech therapy is not based on a single mechanism of action, but on a combination of multiple effects. During the process of feeding, leeches secrete a mixture of different biologically and pharmacologically active substances into the wound that deliver these main therapeutic benefits. It is used effectively in the management of non-healing ulcerative lesions like Diabetic ulcer, leprotic wound etc., as it helps to improve the local blood circulation. Besides these advantages this therapy is also useful in various skin disorders like eczema, pimples, and psoriasis etc. and used to treat abscess, cellulites, thrombophlebitis and varicose veins. Leech therapy rarely ever leads to serious complications. The local pain of treatment and short-term itching are regular side effects. Leech therapy should never be performed in patients suffering from diseases that affect the blood coagulation system, patients on immunosuppressive drugs, the elderly and immune deficient persons. For centuries leeches were the common tool of physicians, who believed that many disease were the result of imbalance in the body that could be stabilized by releasing blood

Determination of biological activity of extract from hirudo by N-benzoyl-L-arginine ethyl ester / 中国中药杂志

As a potent anticoagulant, leech a traditional Chinese medicine, has become increasing topics. Hirudin, which is the primary effective component in leech, is a specific and efficient inhibitor of thrombin, mainly used in prevention and treatment of thrombus on the clinic practice. However, there is still no accurate and convenient method reported about the determination of it's biological activity. This paper reported a method for the determination of the biological activity the of extract from hirudo. The extra thrombin, which was not inhibited by hirudin in the extract from hirudo, reacted with N-benzoyl-L-arginine ethyl ester and was determined. The biological activity of the hirudo extract was determined, indirectly. The linear of calibration curve and accuracy were both perfect, the method was accurate and reliable.

Quality comparison of Hirudo before and after processed by French chalk / 中国中药杂志

<p><b>OBJECTIVE</b>To evaluate the effects of processing methods of Hirudo.</p><p><b>METHOD</b>Both water and alcohol extracts of Hirudo were studied according to Chinese Pharmacopeia (Edition 2005). The content of hypoxanthine in Hirudo was measured by high performance liquid chromatography (HPLC) and Hirudin was determined by thrombin.</p><p><b>RESULT</b>The contents of water, water soluble extraction, ethanol soluble extraction and hirudin in crude Hirudo are higher than those in processed Hirudo. But the contents of hypoxanthine in processed Hirudo is higher than in crude Hirudo.</p><p><b>CONCLUSION</b>Hirudo fried by French chalk can decrease the active components with high intensive drug property, accordingly the toxicity of Hirudo was decreased. As a result, the effects of Hirudo as invigorate the circulation of blood and stimulate the menstrual flow were abated.</p>

Hirudo medicinalis (sanguessuga): eficácia do seu uso no tratamento da insuficiência venosa em retalhos epigástricos de ratos / Hirudo medicinalis (leech): their effective use in venous compromisedd

Objetivo: Demonstrar a eficácia do uso de sanguessugas (Hirudo medicinalis) na insuficiência venosa nos retalhos epigástricos em ilha, utilizando ratos Wistar. Métodos: Em 23 ratos foram realizados retalhos epigástricos bilateralmente, criando uma oclusão venosa de seis horas em ambos. Em um dos retalhos foi aplicado o tratamento com a sanguessuga de maneira randomizada, enquanto o lado contralateral serviu como controle. Foram analisados o número de retalhos sobreviventes e necrosados, o tempo de sucção e de sangramento após a mordida da sanguessuga. Resultados: O número de retalhos que sobreviveram com o uso de sanguessugas foi significativamente superior quando comparado com o grupo de controle, respectivamente, 86,97% e 52,18% (n = 23, p < 0,0134, teste z de proporção). O tempo médio de sucção foi de 92 minutos (mínimo de 14 minutos e máximo de 186 minutos, n = 23) e o tempo de sangramento, em média, de 63 minutos (mínimo de 17 minutos e máximo de 157 minutos), não sendo estatisticamente significante (p < 0,32 pelo teste t de Student). Conclusão: O uso de sanguessugas melhorou a sobrevida de retalhos com isquemia venosa de seis horas em modelo experimental em ratos...

Effect compound decoction on notoginsenosides in Panax notoginseng / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the effect of compound decoction on notoginsenosides in Panax notoginseng.</p><p><b>METHOD</b>Notoginsenoside R1, Rg1, Re, Rb1 and pH were used as the parameters to investigate the changes on the content of notoginsenosides in different compound extractions by heating for two hours and their correlation with pH.</p><p><b>RESULT</b>When the pH values of solution of P. notoginseng with Fructus ligustri, P. notoginseng with Eupolyphaga seu steleophaga, P. notoginseng with Pheretima asiatica, and Zhitangjiang Fang (free of Hirudo) were rept higher than 5.7, the reserved rate (RR) of notoginsenside were higher than 90%; When the pH values of decoetion of P. notoginseng with Salvia miltiorrhiza, P. notoginseng with Paeonia lactiflora, P. notoginseng with Platycodon grandiflorum, P. notoginseng with Arctium lappa were kept 4.5-5.5, their RR of notoginsenside were 60% - 85%; When the pH values of the decotction of P. notoginseng with Hirudo nipponica was decreased to 3.4, its RR of of notoginsenside was 38.4%; When the pH values of Zhitangjiang Fang extraction was regulated by 0.1% NaOH solution to pH 6. 3, and the RR of notoginsenside increased to 97%.</p><p><b>CONCLUSION</b>The pH of other Chinese herbal medicines extraction with P. notoginseng compound is a critical effect on the stability and yields of notoginsensides.</p>