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1Traditional Medicine Research  2019, Vol. 4 Issue (3): 118-130    DOI: 10.12032/TMR20190225105
Special Issue on Persian Medicine     
Leech therapy indications: a scoping review
Roshanak Ghods1,2, Mojtaba Abdi3, Matineh Pourrahimi4(), Fataneh Hashem Dabaghian1,2
1Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran.
2School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.
3School of Nursing and Midwifery Branch, Iran University of Medical Sciences, Tehran, Iran.
4Faculty of Allied Medicine Branch, Iran University of Medical Sciences, Tehran, Iran.
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The present scoping review provides evidence for the application of leech therapy in the treatment of plastic and reconstructive surgery, musculoskeletal diseases, osteoarthritis, etc..


The first recorded report of the use of leeches is in a medical poem, Alexipharma, for Nicander of Colophon, born 200 B.C.. There is also evidence of the using leeches by large scholars such as Avicenna in The Canon of Medicine and Abd-el-Latif al-Baghdadi in Al-Mukhtarat fi al-Tibb. Barbers-surgeons in the middle ages used to use leeches to shed blood for treating some kind of diseases. With the development of modern medicine, the first use of medical leeches occurred in the 1960's, for intravenous congestion after reconstructive surgery. In 2004 the FDA approved leech therapy to accelerate tissue transplantation.


After the developments of modern medicine, leeches were not used as before, but in the late nineteenth century, leeches were still being used in many countries around the world. Until now, leeches have been used to treat a wide range of diseases. The present study, is a scoping review of the evidence of the indication of leech therapy. The results of this study are based on English articles and dissertations published in databases from 2000 up to July 10, 2017. The results showed that leech therapy could be used in different conditions including venous congestion in plastic and reconstructive surgery, osteoarthritis, cardiovascular diseases due to blood coagulation disorders, migraine headache, skin disorders, diabetic foot ulcers, macroglossia, priapism, cancer complications, and wounds. More researches are needed in wider areas with more precise methodologies to ensure the potential therapeutic effects of leech therapy.

Key wordsLeeches      Leech therapy      Review      Plastic and reconstructive surgery      Musculoskeletal diseases      Osteoarthritis     
Published: 04 May 2019
Cite this article:

Roshanak Ghods, Mojtaba Abdi, Matineh Pourrahimi, Fataneh Hashem Dabaghian. Leech therapy indications: a scoping review. 1Traditional Medicine Research, 2019, 4(3): 118-130. doi: 10.12032/TMR20190225105

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Figure 1 The papers flow chart
Type of study First author Year published Type of flap Total Survived Failed
Retrospective Studies Cornejo [25] 2017 Free flaps
native tissues
pedicled flaps
and replantation
87 53 34
Butt [26] 2016 Venous congested flaps
congested replanted or revascularized hand digits
20 13 7
Gr?be [27] 2012 Local flaps
pedicled flaps
and microvascular flaps
148 54 94
Koch [28] 2012 Free flaps and replanted tissues 6 6 0
Nguyen [29] 2012 Native skin
local ?aps
regional ?aps
and free ?aps
38 29 9
Agarwal [30] 2010 Thumb replantation 52 48 4
Riede [31] 2010 Various local flaps 23 20 3
Case Reports Banihani [32] 2014 Penile replantation 1 1 0
TarazJamshidi [33] 2014 Finger replantation 3 2 1
Stemann [34] 2012 Nose replantation 1 1 0
Kim [35] 2011 Eyebrow transplantation 1 1 0
Baj [36] 2010 Lip replantation 1 1 0
Kim [37] 2009 Ear replantation 1 1 0
Taylor 38] 2009 Lip replantation 1 1 0
Ward [39] 2008 Pedicled ?aps 1 1 0
O’Toole [40] 2008 Ear replantation 1 1 0
Flores [41] 2007 Nose replantation 1 1 0
Kim [42] 2007 Tongue replantation 1 1 0
Hullett [43] 2007 Replantation 1 1 0
Lazarou [44] 2006 Penile replantation 1 1 0
Heckmann [45] 2005 Haematoma 1 1 0
Yim [46] 2005 Replantation 3 3 0
Frodel [47] 2004 Avulsed soft tissue segments 4 4 0
Tuncali [48] 2004 Ring avulsion injuries 2 2 0
Mineo [49] 2004 Penile replantation 1 1 0
Duroure [50] 2004 Lip replantation 3 2 1
Ribuffo [51] 2004 Free ?ap 1 1 0
Gideroglu [52] 2003 Pedicled ?aps 5 4 1
Sartor [53] 2002 Various 7 2 5
Guven [54] 2002 Ring avulsion injury 1 1 0
Chepeha [55] 2002 Free ?ap 8 8 0
Akyurek [56] 2001 Ear replantation 1 0 1
Talbi [57] 2001 Ear replantation 1 1 0
Guneren [58] 2000 Nipple congestion 1 1 0
Total 428 268 160
Table 1 Plastic and reconstructive surgery
First author Year published Type of study Diagnosis Patients Effect of leech therapy
Michalsen [59] 2002 Non-randomized controlled trial Knee osteoarthritis Leech therapy: 10 patients; control: 6 patients Rapid relief of pain within 24 hours and 10 days later and stable until 4 weeks
Michalsen [60] 2003 Randomized controlled trial Knee osteoarthritis Leech therapy: 24 patients; topical diclofenac therapy: 27 patients Relief of pain within 7 days
Andereya [61] 2008 Randomized controlled trial Knee osteoarthritis Single application: 35 patients; double application: 38 patients and a control group: 40 patients Improvement in stiffness and function in a double application with the leeches until 6 month.
Relief of pain has no different in single and double application but has different with the control group.
Zaidi [62] 2009 Randomized controlled trial Knee osteoarthritis Leech therapy: 20 patients; control: 27 patients Improvement in disease- specific symptoms after six weeks of treatment in patients receiving leech therapy like pain level, stiffness, and functional ability, it was significant in comparison to mean scores but it is statistically non-significant.
Rai [63] 2011 Self-control clinical trial Knee osteoarthritis 32 patients of knee osteoarthritis Reduction of pain, tenderness, swelling, stiffness, restriction of movement and crepitus after leech therapy
Stange [64] 2012 Randomized controlled trial Knee osteoarthritis Leech therapy first: 27 patients; transcutaneous electrical nerve stimulation first: 25 patients Improvement in pain and functional symptoms with single leech therapy
Shiffa [65] 2013 Randomized controlled trial Knee osteoarthritis Leech therapy along with an Unani formulation: 30 patients; Unani formulation only: 30 patients Improvement in the reduction of pain, other symptoms, and physical functions in the test group
Michalsen [66] 2008 Randomized controlled trial Osteoarthritis of the first carpometacarpal joint Leech therapy: 16 patients; Topical diclofenac: 16 patients Improvement in pain, joint function, quality of life, and grip strength in the leech group
B?cker [67] 2011 Randomized controlled trial Chronic lateral epicondylitis Leech therapy: 20 patients; Topical diclofenac: 20 patients Reduction of pain score and functional disability
Konyrtaeva [68] 2002 Randomized controlled trial CHF Leech therapy: 36 patients; control: 34 patients In more than 50%: reduction of dyspnea and peripheral edema and increase of physical stress tolerance.
In hypertensive patients: decreased of diastolic blood pressure and increased of ejection fraction.
Reduce of platelet aggregation and normalizing fibrinogen and SFMC levels.
Hanif [69] 2012 Case report DVT 1 patient with DVT Treated
Nargiza [70] 2010 Randomized controlled trial TIA 55 patients: hypertension;
24 patients: atherosclerosis;
41 patients: atherosclerosis and Hypertension) (leech therapy: 58 patients; control: 62 patients)
The greatest improvement in pain, stiffness, and function in the group treated twice with the leeches
Bakhshi [72] 2015 Non-randomized clinical trial (with individual matching) Migraine headaches 26 Female patients with primary headache which all reported lack of efficacy in past drug treatments (leech therapy: 13 patients
Drug therapy (Propranolol 80 mg/day and Amitriptyline 50 mg/day): 13 patients)
No significant difference in the mean of pain severity and duration between drug therapy and leech therapy until 3-month follow-up after treatment. But reduction in the mean of pain severity and duration in compared with the baseline was significant.
Shankar [73] 2014 Self-control Clinical trial Dermatitis (Vicarcikā) 27 patients with classic symptoms of Eczema
Reduction of erythema, redness, thickness, scratching and lichenification
54.45% reduction in EASI score
55% reduction in SCORAD score
62.36% improve in quality of life
Rastogi [74] 2014 Case report Nevus of Ota 1 patient with nevus of Ota Improvement in the skin color
Ziadi [75] 2016 Case report Diabetic foot ulcer 1 patients with DFUs in left foot Complete Healing in 90-150 days
Na [76] 2003 Case report Diabetic foot ulcer 1 patients with DFU in right foot Complete Healing in 41 days
Ziadi [77] 2016 Case report Diabetic foot ulcer 1 patients with DFUs in left foot Complete Healing in 90-150 days
Ramzan [78] 2010 Case report Macroglossia 1 patients with Macroglossia Complete Healing in 1 days
Bumpous [79] 2001 Case report Macroglossia 1 patients with Macroglossia Complete Healing in 3 days
Asgari [80] 2017 Case report Priapism 1 patient with Priapism After 2 days: reduce of pain
3rd day: discharged from hospital
One month later: loss of pain and perineal swelling
Kalender [81] 2010 Case report Leiomyosarcoma 1 patient with synchronous renal cell carcinoma and leiomyosarcoma was admitted with severe pain in the lumbar region. The pain was refractory to radiotherapy, and systemic and epidural analgesic infusion. After 2 days in a month reduce of pain from 9/10 in visual analog score to 1/10.
Philip [82] 2003 Case report Prostate adenocarcinoma Three men with locally advanced prostate adenocarcinoma presented acutely with penoscrotal edema. After 3 times use of leeches within 15 days: decrease in the edema with near-normal scrotal size and urinary symptomatic relief
Darestani [90] 2014 Randomized control trial Wound 15 male Wistar rats (Rattus norvegicus albinus) with 2 cm liner incision (5 rats: Leech Therapy;
5 rats: treated with Topical phenytoin 1%;
5 rats: no treatment)
Leech therapy improved incisional skin-wound healing in rats significantly.
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