Sushruta Samhita Chapter 13 Jalaukavacharaniya Adhyaya

This article explains Sushruta Samhita Sutrasthana Chapter 13 “ Jalaukavacharaniya Adhyaya”- Application of Leeches.
We will now expound the chapter by name Jalaukavacharaniya – application of leeches on body; as revealed by the venerable Dhanvantari.

Table of Contents

Jalaukavacharana

Best and easy method for bloodletting
Jalaukavacharana means administration of leeches for removing the contaminated (vitiated) blood (bloodletting). It is best suited to the kings, wealthy persons, children, old people, those who are scared (frightful), debilitated persons, women and those of tender constitution. This method is also considered to be the most easy and convenient method of bloodletting.
Read – Raktamokshana Benefits, Types, Procedure, Indications

Raktavasechana

Methods of removing blood
The blood vitiated by vata, pitta and kapha should be removed from the body by using shrunga (animal horn), jalauka (leeches) and alabu (pitcher gourd) respectively. This is because shrunga is unctuous in nature and pacifies vata, jalauka is cold in nature and mitigates pitta and alabu is dry in nature and hence subsides kapha.
The blood vitiated by all the doshas is eliminated by using all these things (horn, leech and pitcher gourd).
For removal of more blood using horn, leeches or pitcher guard is especially suitable.

Qualities and doshic action of Shrunga, Jalauka and Alabu
shrunga (cow’s horn) is hot in potency, sweet in taste and unctuous. Hence it is ideal to remove blood vitiated by Vata. (Heat, sweet taste and unctuous quality – are antagonistic to vata).
Jalauka (leech) dwells in the cold, are sweet and born in water. Hence it is ideal to remove blood vitiated by Pitta. (Coldness and sweet taste are antagonistic to pitta).
Alabu (pitcher gourd) is considered bitter, dry and penetrating in nature. Hence it is ideal to remove blood vitiated by Kapha. (Bitter taste, dry and penetrating qualities are antagonistic to kapha).

Shrunga- Alabu upayoga

Method of using horn and gourd
First of all, the site selected for drawing the blood (bloodletting) should be scratched or incised (by using a sharp instrument). Now the horn whose narrow orifice has been covered by a thin layer of cloth should be used for sucking and removing the blood (from that site). After scratching or incising (by sharp instrument) the place (site selected for drawing blood) and covering the horn (narrow orifice of the horn) with a thin layer of cloth, the blood should be removed by sucking. Similarly, a pitcher gourd shall be used to remove the blood by keeping a burning lamp inside it. The method of using leeches will be described next.
Read – Alabu Avacharana – Bloodletting Method Using Bottle gourd

Note:
It is strange to note that Sushruta Samhita has mentioned the use of cow horn and pitcher gourd for bloodletting but has not furnished the details of how to use them. On the other hand, we can get some details of the same being described by Master Vagbhata. The details are given below –

“Shrunga (cow’s horn) shall be slender and strong, eighteen angula (36 cm) in length, twelve Angula (24 cm) in circumference in middle; have an orifice of three angula (6 cm) (in diameter) at its base and another orifice of the size of mustard at its tip; which resembles the nipple and covered with a layer of thin leather. Alabu (pitcher gourd) shall be twelve angula (24 cm) long, eighteen Angula (36gms) in circumference, its mouth (orifice) being three or four angula (6 or 8 cm) wide, with a burning lamp kept inside. (Ref – Astanga Sangraha, Sutrasthana, chapter 34 and Ashtanga Hridaya, Sutrasthana, chapter 25).

Jalauka Nirukti

Leeches
Since Jala (water) itself is their ayu (life), they are called Jalauka or since the jala (water) is oka (residing place, habitat) to these (they are accustomed / habituated to water), they are called Jalauka.
Read – Leech Therapy Procedure, Benefits, Side Effects, Treatment

Jalauka Vidha

Kinds of Jalauka
Jalauka are of twelve kinds. Six among these are Savisha – poisonous varieties. The same number of jalaukas (the other 6 among them) is Nirvisha – non-poisonous variety.

1. Savisha Jalauka – Poisonous leeches, symptoms of their bite and treatment

Poisonous leeches are Krishna (black), Karbura (gray), Alagarda, Indrayudha Samudraka and Go Chandana. Among these,

Krishna Jalauka – have the colour similar to that of the powder of Anjana (antimony) and big head;
Karbura Jalauka – are broad like Varmi Matsya (a kind of fish), their abdomen, segmented and bulging.
Alagarda Jalauka – are hairy (covered with hairs all over the body) with big flanks (sides) and black mouth.
Indrayudha Jalauka – has varieties of stripes on its back resembling the colours of a rainbow.
Samudrika Jalauka – are slightly blackish yellow (have black- and yellow-coloured spots) in colour, and will have marks resembling many flowers on their body.
Gocandana Jalauka – are those whose lower part is divided into two halves (attached to a common root) resembling the scrotum of a bull and will have a very small mouth.

Symptoms of bite by poisonous leeches – If bitten by the above mentioned six kinds of leeches, there will be –

Profound swelling,
Excessive itching,
Fainting,
Burning sensation,
Vomiting,
Intoxication, and
Debility

Remedy – For those bitten by poisonous leeches and when they exhibit the above said symptoms caused due to their bite, Mahagada (anti-poisonous recipe mentioned in 5^th chapter of kalpa sthana should be used for drinking and also for external application and nasal instillation.
The bite by Indrayudha leech is incurable.
Thus, are described the poisonous leeches and their treatments.
Read – Siravyadha Method Of Bloodletting: Procedure, Precautions, Benefits

2. Nirvisha Jalauka – Non-poisonous leeches, symptoms of their bite and treatment

Non-Poisonous leeches are – Kapila, Pingala, Shankumukhi, Mushika,Pundarikamukhi and Savarika. Among these,

Kapila Jalauka – are those whose flanks are yellow in colour resembling the colour of Manashila, whose back is unctuous (oily) and has colour of mudga (green gram).
Pingula Jalauka – are slightly red and have a round body. They are brown in colour and move quickly.
Shankkumukhi Jalauka – has the colour of liver (brown), drinks the blood quickly (sucks blood quickly), has long and penetrating (sharp) mouth.
Mushika Jalauka – is similar to mice in shape and colour. These leeches emit unpleasant (foul) odours.
Pundarika Mukhi Jalauka – has the colour of mudga – green gram and its mouth resembles the shape of a lotus.
Savarika Jalauka – is oily / unctuous, has the colour similar to that of lotus petal and is eighteen angulas (approximately 36 cm) in length. It is used for bloodletting in cattle.
Thus, were described the non-poisonous leeches.

Regions in which the non-poisonous leeches are found
The nirvisha jalauka i.e., non-poisonous leeches are found in provinces like Yavana (Arab countries), Pandya (South India), Sahya (Central India) and Pautana (region around Mathura in Uttar Pradesh). Among these leeches, those which have large bodies, which are strong, drink (suck) blood quickly and are voracious should be considered as non-poisonous especially.

Deciding the type of leeches from their origin
Origin of Savisha Jalauka (poisonous leeches) – The leeches which are born out of urine, excreta and putrefied (decayed) dead bodies of poisonous fishes, insects, worms and frogs and those which live in poisonous water are poisonous in nature.

Origin of Nirvisha Jalauka (non-poisonous leeches) – The leeches which are born from the putrefied / decayed Padma (Lotus), Utpala (white lotus), Nalina (slight red lotus), Kumuda (lily), Saugandhika (another kind of lily highly fragrant), Kuvalaya (red lily) Pundarika (very white lotus) and Saivala (Algae) and which live in clean water are non-poisonous.

These (non- poisonous leeches) live in places where more fragrant water is found, do not feed on dirty foods nor live in slush.

Jalauka Poshana

Rearing of leeches
The leeches should be collected (caught) with moist leather or by any other method. Then they should be placed in a new big pot containing water from ponds or tanks along with their silt. (Food should be provided to the leeches.) For this, algae, dried meat of aquatic animals and tubers should be powdered and put into the water pot in which the leeches are placed. This serves as the food for the leeches. For bedding, for leeches to sleep, straw, leaves of aquatic plants should be placed in the pot. Every three days the water in the pot and food materials should be changed. Every seven days once, the leeches should be transferred to another pot (with similar arrangement).
Read – Sushruta Samhita Chapter 8 Shastravacharaniya Adhyaya

Sanskrit Verses

Ayogya Jalauka

Leeches unfit for use

The leeches which have the below mentioned features are unfit for use (in bloodletting) –

big in their middle (abdomen),
ugly in appearance,
very broad / flat
slow in their activities (movement),
which do not bite the site when applied,
drink (suck) very little quantity of blood and
which are poisonous
Read – Sushruta Samhita Chapter 7 Yantra Vidhi Adhyaya

Jalauka Avacharana

Method of applying leeches on the body
The patient suffering from a disease which is curable by jalaukavacharana (leech therapy), should be either made to sit down or lie down. Now the site / area selected for application of leech should be made rough by rubbing the site with either mud or fine cow dung powder, without causing any pain or discomfort. The body of the leeches should be smeared with a solution of mustard and turmeric mixed together. The leeches should now be kept in a water pot for a period of one muhurta i.e., 28 minutes approximately. After having learnt that the leeches have become fatigue-free one of them should be selected for the therapy. The selected leech is applied to the site selected (diseased site) for bloodletting and the leech made to bite (catch) the place. Later a smooth, white and wet (moist) cotton wool, swab, piece of cotton or cloth should be put on the leech, except its mouth. If the leech is not holding / biting the site or not sucking the blood, a few drops of milk or blood should be put at its mouth or a small incision may be made at that site. In spite of all these, if the leech does not bite the site, then another leech should be applied at the site while discarding the earlier one.

When the leech makes its mouth in the shape of a horse’s loof and lifts its neck the physician / surgeon should understand that ‘the leech has caught or bitten the site selected for its application’. It should also be understood that the leech is now sucking the blood. At this moment the body of the leech should be covered with a moist cloth and retained in place. The cloth should be constantly sprinkled with water.
When the patient experiences pricking pain and itching at the site of the bite (by leech) it should be understood that the leech is sucking pure blood. Such a leech which has started drinking pure blood should be removed. If the leech does not leave the site being attracted by the smell of blood (greed to drink more blood), powder of saindhava lavana – rock salt shall be sprinkled over its mouth.

When the leech falls off after having sucked (drunken) impure blood from the diseased site (where it was applied) its body should be sprinkled with rice flour. Its mouth should be rubbed with a mixture of oil and salt. Now the physician / surgeon should hold the leech up, held at its tail end with the thumb and fingers of his left hand and its body should be kneaded slowly in the downward direction with the thumb and fingers of his right hand. In this way the leech is made to vomit all the blood it has consumed until the signs of satisfactory and complete vomiting appear. When the leech has vomited properly and is placed in a pot / vessel of water, it moves to and fro frantically in search of some food (this is also the sign of satisfactory vomiting). If the leech sinks in the water and does not make any movements it should be understood that the leech has incompletely / improperly vomited the contaminated blood. This leech should be made to vomit properly once again. If the leech does not vomit the blood completely it develops an incurable disease known as indramada. After the leech vomits completely it should be put into the water pot described earlier.

After noticing the proper and improper sucking of blood by the leech the area of bite should be anointed with Satadhatuta Ghrta (ghee washed many times in water or decoction of drugs of cold potency) or a swab dipped in shatadhauta ghrta should be placed on the site. The wound caused by the leech should be massaged with honey and bathed / sprinkled with cold water or the site should be bandaged. Alternatively, the site should be applied with paste prepared from drugs having an astringent and sweet taste, and having unctuous and cold potency (and bandaged).

Notes: Dalhana in his commentary assigns the above methods to be administered in the three kinds of bouts as mentioned below –

in samyak yoga( proper bleeding) – the site should be anointed with shatadhauta ghrta
in hina yoga (inadequate bleeding) – the wound created by the leech should be squeezed to promote more flow of blood,
in atiyoga (excess bleeding) – bathing with cold water and binding with cloth are to be done to stop the bleeding;
in mithya yoga (improper bleeding) – application of cold poultice and banding are indicated

He (physician) who knows well the habitat, methods of catching, varieties of rearing and mode of application of leeches, will be able to cure diseases which are curable by the use of leeches.
Thus ends the Thirteenth chapter by name Jalaukavacarana, in Sutra Sthana of Susruta Samhita.