Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study

M Rakhy; PS Sreenath

doi:http://dx.doi.org/10.21760/jaims.8.7.48

Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study

Rakhy M.^1*, Sreenath P.²

DOI: http://dx.doi.org/10.21760/jaims.8.7.48

^1* M Rakhy, Assistant Professor, Department of Shalya Tantra, Ahalia Ayurveda Medical College & Hospital, Palakkad, Kerala, India.

² PS Sreenath, Assistant Professor, Department of Shalya Tantra, Ahalia Ayurveda Medical College & Hospital, Palakkad, Kerala, India.

Jalaukavacharana or Leech therapy is medicinal leech therapy which is used in a variety of inflammatory conditions. It is indicated in Raktaja and Pittaja Vikaras. Its mode of action depends on the injection of leech saliva into patient's tissues during the process of blood sucking. Leech’s saliva contains numerous bioactive constituent which possesses anti-inflammatory, analgesic, thrombolytic, anti-coagulant and blood circulation enhancing properties. Thrombosed hemorrhoid is an emergency condition that occurs due to high venous pressure associated with severe pain in the anus. In the present study a thrombosed external haemorrhoids is managed with Jaloukavacharana and its efficacy was observed.

Keywords: Jaloukavacharana, Thrombosed External Haemorrhoids, Thrombolytic

Corresponding Author	How to Cite this Article	To Browse
M Rakhy, Assistant Professor, Department of Shalya Tantra, Ahalia Ayurveda Medical College & Hospital, Palakkad, Kerala, India. Email:	M Rakhy, PS Sreenath, Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study. J Ayu Int Med Sci. 2023;8(7):263-266. Available From https://jaims.in/jaims/article/view/2626

Introduction

A thrombosed hemorrhoid is a variety of external haemorrhoid where a clot is formed in one or more veins situated in the anal skin resulting in painful swelling in the anal tissues. Venous return in such cases will be very low and severe edema takes place along with serious pain. The swollen tissues often have a characteristic bluish color, because of the underlying clot. It becomes an emergency condition when the pile mass gets strangulated. Urgent surgical intervention is required in all such cases.

Jaloukavachrana is known to be effective in thrombosed hemorrhoid as it relieves venous pooling of blood in that area by dissolving the clotted blood.

Jaloukavacharana is comparatively safe and economical OPD procedure, hence in this study leech has been applied in thrombosed external pile mass and efficacy was evaluated.

Case Study

Presenting complaint

A female patient of 65 years old came to our OPD with complaints of pain and mass per rectum since 2 weeks.

History of presenting complaint

Patient was apparently normal before 2 weeks, then she developed pain over anal region with an associated mass per rectum. Pain gets aggravated while sitting and lying down in supine position. Pain is of excruciating nature while defecation. She is having habitual constipation. For the same she got admitted in our hospital for further management.

Past history

No H/O - HTN, DM

Personal history

Appetite - Good

Sleep - Disturbed

Bowel - Constipated

Micturition - Normal

Habits

Non smoker

Non alcoholic

Examinations

BP - 130/80 mm of Hg on supine position

Pulse - 78/min regular

Temp - 98.6°F

Systemic

CNS - conscious oriented GCS 15/15

RS - NVBS

CVS - S1, S2 normal, No added sounds

P/A - Soft & normal

Local examination

Ano rectal examination

Inspection: reddish black globular mass at 7 ‘o’ clock.

Sentinel tag present at anterior midline.

Palpation: mass is tender

Digital rectal examination: hyper tonicity

Proctoscopy: not done due to pain

Blood investigations

Hb - 13.8gm/dl

TLC - 7100/cumm

RBC count - 4.43 millions/cmm

PCV/Hematocrit - 34.7%

MCV - 79.8fL

MCHC - 33.6 gm/dl

MCH - 26.9 picogram

Platelet Count - 2.91 Lakh/cmm

Bleeding Time - 02 min 05 sec

Clotting Time - 05 min 20 sec

Blood Sugar Random - 98 mg/dl

HbsAg - Non reactive

HIV 1 (Antibodies) - Non Reactive

HIV 2 (Antibodies) - Non Reactive

Covid 19 - (RT-PCR) report -ve

Methodology

After proper investigation, leech therapy was planned as a first line treatment.

Written consent was taken.

Preparation of the leech: An unused leech of medium size was taken and activated using turmeric water.

Activated leech is made to bite over the thrombosed external haemorrhoid at 7 ‘o’ clock After 45 minutes leeches were removed using turmeric powder.

Bite site was applied with turmeric and tightly covered with gauze piece to prevent further bleeding.

Observations

Before treatment
Treatment day 1
Treatment day 3

Treatment day 5

Treatment day 7

Total 6 sittings done on consecutive days.

Observations

Symptoms were taken into consideration under grading system according to their severity.

After the first sitting of Jaloukavacharana 30% reduction in the reddish discolouration over thrombosed haemorrhoids was noted; about 50% reduction in pain and moderate reduction of oedema attained.

After third sitting almost 70 % reduction in the reddish discolouration, pain and oedema was noted

After 6^th sitting 90% reduction in the reddish discolouration, pain and oedema was noted

On the 7^th day, reddish discolouration, pain and oedema resolved completely.

Result

Variables	BT	Day 1	Day 3	Day 6	Day 7
Reddish discolouraion	+++	++	++	+	-
Pain	+++	++	+	+	-
Oedema	+++	++	++	+	-

Before treatment: BT, Mild: +, Moderate: ++, Severe: +++ No symptom: -

As soon as the leech application was commenced patient got relieved of pain over the thrombosed haemorrhoids.

Her discomfort level got reduced.
After second sitting, marked reduction in redness was also reduced.
After sixth sitting of Jalaukavacharana, patient got 90% relief of all symptoms.
On 7^th day, patient was completely relieved of all symptoms and is fully satisfied with the treatment.

Discussion

Due to the qualities of its anticoagulant, vasodilator, thrombolytic, anti-inflammatory substances, leeches has been proved as medically effective.^[1]

Through their sucking effect, leeches stimulate circulation of cells at risk of necrosis and maintain oxygenation of the tissue.^[2]

They therefore promote restoration of capillary anastomosis.^[3]

They accelerate the thrombolytic activity in the thrombosed haemorrhoids and thereby decongestion occurs.

Conclusion

The present study proves the effectiveness of Jalaukavacharana in the treatment of thrombosed external haemorrhoids.

Reference

1. https://s3.amazonaws.com/academia.edu.documents/ 36092240/IRJPS_11_3345.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1530014300&Signature=BMlGWJ3wsksKsvIU%2Bcee0CTeO1Y%3D&responsecontentdisposition= inline%3B%20filename%3DAn_Overview_on_Hirudotherapy_Leech_thera.pdf

2. Dr. Sinjid R, Dr. Gopikrishna BJ. Clinical efficacy of Jalaukavacharana (leech application) in Gluteal Hematoma - A Case Study. J Ayurveda Integr Med Sci 2018;4:187-190. http://dx.doi.org/10.21760/jaims.v3i4.13309

3. K.R. Srikantha Murthy, Illustrated Susruta Samhita, Vol 1, Chaukamba Orientalia, Varanasi, 2001;p78.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-05-27	2023-05-29	2023-06-05	2023-06-12	2023-06-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Case Report

Jaloukavacharana

Journal of Ayurveda and Integrated Medical Sciences

Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study

Rakhy M.^1*, Sreenath P.²

Introduction

Case Study

Methodology

Observations

Result

Discussion

Conclusion

Reference

Case Report

Jaloukavacharana

Journal of Ayurveda and Integrated Medical Sciences

Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study

Rakhy M.1*, Sreenath P.2

Introduction

Case Study

Methodology

Observations

Result

Discussion

Conclusion

Reference

Rakhy M.^1*, Sreenath P.²