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Introduction

Jalaukavacharana is claimed to be the supreme therapy because of its safety and high efficacy in the disorders involving the vitiation of blood. It is safely indicated even for the king, rich, old, fearful, weak, women and the people of tender nature. The word Jalauka is a compound word with two components Jala + Ayu; i.e. the animals having water as the life. The term Jalauka can be split into Jala + Oka; i.e. water dwelling animals.[1]

Synonyms: Jalauka is called by different names, which are as below – Jalayuka, Jalaua, Jaluka, Jalaluka, Jaalalauka, Jalita, Jaloka, Jalauga, Jalatani, Jalauka, Jalasuchi, Jalaukasu, Jalasarpini, Raktapata, Ruktapa, Raktapayini, Vanini, Vedhini, Venika.

Types of Jalauka:-

 There are two types of Jalaukas are described in Ayurveda. [2]

               1. Savisha Jalauka

               2. Nirvisha Jalauka                  

Nirvisha Jalauka- Nirvisha Jalauka originates in decomposed vegetable matter, as the purified stems of the several aquatic plants known as-

 

Habitat:- According to Sushruta, the Jalaukas are found in Yavana, Pandya, Sahya, Patuna etc.                                                                          

General characters of Nirvisha Jalauka- Strong and large bodied, Ready sucked and Greedy. [4]

Collection and preservation of Jalauka. [6]

Acharya Sushruta has told that the Jalauka can be caught with a piece of wet leather. In ponds, streams and when there are lotuses .There is another method to collect the Jalauka ie. The fresh meat of dead animals, fish or milk must be applied on the thigh of an animal or the human being himself, may apply on his thigh and keep the Jangha in the water for some time. Due to attraction of their diets, Jalauka will come and start biting. Then they are made to leave the skin of the person with application of Saindhava lavana (Rock salt) and collected.

Preservation of Jalauka:- After collecting the Jalauka they should be kept in wide and new pot. The pure water of tank with lotus is put in the pot. Feed it with Shaivala, the meat of pig and other animals, which are living in water and marshy area, and powder of stem of small plants, in order to make Jalauka to move and the grass and leaves of plants must be kept inside water in the pot. Only every third day the water should be dropped inside the pot. After seven days the pot should be changed. [7]

Indication of Jalaukavacharana:-

 Only Vagbhatta has mentioned the diseases where Jalauka application is indicated, they are –Gulma, Arsha, Vidradhi, Kustha, Vatarakta, Galaroga, Netro roga, Visarpa.123 In other condition if Vrana is Kathina Vivarana and Vedana yukta then only Bloodletting should done with Jalauka. [8]

Other indications

Venous disease, varicose veins: Jalauka is effective in the complicated varicose veins, decreases the oedema and hyperpigmentation.

Peripheral vascular diseases: Jalauka is effective in treatment of Burger’s disease as it relieves the inflammation and thrombosis. It is also effective in other peripheral vascular diseases.

Hemorrhoids: leach is a very effective in the treatment of thrombosed hemorrhoids. the saliva of leech acts as anti- inflammatory agent hence reduce inflammation and maintains normal circulation which in turn recovers bluish - black discoloration.

Osteoarthritis : Jalauka helps rapid reduction of pain associated with osteoarthritis of knee and is an effective and safe treatment in symptomatic treatment of degenerative knee.

Gout (Vatarakta): jalauka is effective in relieving pain, swelling, erythema present in acute gout.

Non healing ulcer: jalauka therapy is effective in the treatment of pain in the treatment of non -healing ulcers.

Diabetic foot ulcer: jalauka application is significantly effective in the treatment of diabetic foot ulcer.

Eczema:(Vicharchika): Jalaukavacharan in Vicharchika is effective and is proved statistically significant.

Application of Jalauka[9]:-

It is divided in 3 procedures-

1. Poorva karma

2. Pradhana karma

3. Paschata karma

1.Poorva karma:- [10]

A. Examination of the patient who is fit to undergo Jalaukavacharana.

B. Shodhana of Jalauka-Before the application of Jalauka, It should be kept in the Haridra mixed water for one minute and cleaned with the help of pure water.

C. Preparation of the Patient-The part of the application should be cleaned and if there is oil on the skin than that oil should be removed properly because it’s difficult for Jalauka to catch on oily surface. If Jalaukavacharana is going to be applied on Vrana then only surface should be cleaned with pure water.

2. Pradhan karma[11]:-

Jalaukavacharana- The patient must be prepared as stated above .The Jalauka will be too much unctuous and picchila and soft and as a result it slips off from the hand. It is better to catch Jalauka either with the gauze or after wearing the rubber gloves. Then the Jalauka should be taken out of their receptacles and sprinkled over the cater. Jalauka attach to the skin by two muscular suckers before biting with three teeth inside their anterior suckers. Blood is sucked into the stomach by peristalsis. Each Jalauka will ingest nearly ten times its body weight before falling off. The middle portion of Jalauka is swollen, as soon as it starts sucking the blood. It sucks only impure blood first. If the patient notices the pain at the time of sucking the blood by Jalauka, it should be noted that the Jalauka is sucking the pure blood. It should be removed instantaneously by pouring Saindhava Lavana at its mouth. If they slightly refuse to stick to the desired spot, then the affected part should be sprinkled over with drops of milk or blood. Otherwise other Jalauka should be applied. Even when the preceding measuring should prove ineffective.      

Inference of Sucking[12]:- The Jalauka having stuck to the affected part may be inferred from the mouths of the Jalauka assuming the shape of horse claw and raised and arched position of their neck after they had attached to the seat of the disease. While sucking is started, the Jalauka should be constantly sprayed over with cold water.              

Clinical finding of fresh sucking[13]:- Some Jalauka suck the fresh even after the vitiated blood is completed from the seat .In order to save the fresh blood and to know the same Sushruta has given some notable findings which can be ascertained from the patient only , which are given below-

? Itching sensation on the seat of application.

? Pain at the seat of application.

This would give rise to the presumption that fresh blood is being sucked and the Jalauka forth with removed. Vagbhata has stated regarding the role of sucking of Jalauka giving an ideal example that the Swan only drinks the milk from the pot of milk mixed with water. The water is only left in the pot while the milk is received. It is its natural action. Similarly the Jalauka have some power to suck the vitiated blood only, from the body.

Direction to remove the Jalauka:-

 Some Jalauka refuse to fall off even after the appearance of the disease sign, sticking to affected part, out of their fondness for the smell of blood. They should be sprinkled with the dust of powdered Saindhava. Then they would give up the sucking within a while, after that the post operative care should be taken for the Jalaukas.

Paschat karma:-

It consists of two things-

1. Treatment of Jalaukas.

2. Treatment of Patients.

1. Treatment of Jalaukas:-

Treatment means for Jalauka means to expel out the sucked blood. Hence the following methods should be applied.

Method of emesis of sucked blood[14]:- After falling off the Jalauka should be dusted over with rice powder and their mouth should be lubricated with a composition of oil, common salt. Then they should be caught by the tail end with the thumb and the fore finger of left hand and their back should be gently rubbed with the same finger of the right hand from tail upwards to the mouth with a view to make them eject the full quantity of blood, they had sucked from the seat of disease. This process should be repeated until they manifest the fullest symptoms engorging. Then Jalauka should be kept in a separate pot containing pure water.

2. Treatment of Patient[15]:-

Usually, the blood will not clot due to the property of anticoagulant “Hirudin”. As soon as the Jalauka is removed from the body of patient an application of Shatadhauta Ghrita should be applied on the wound, or pichu dipped Shatadhauta Ghrita should be kept on it. In case of improper letting by a Jalauka, the wound must rubbed with honey, and cold water or else it should be bandaged or astringent sweet, greasy and cold paste should be applied over the wound.

table 1,2

Discussion

Components of Leech Saliva:- [16]

• Hirudin inhibits - Blood coagulation by binding to thrombin.

• Fibrin          -Thrombolytic effect.

• Hirustasin - Inhibits kallikerin, trypsin, chymotrupsin.

• Bdellins - Anti-inflammatory, inhibits, trypsin, plasmin,        acrosin.

• Hyaluronidase - Increase interstitial viscosity, antibiotic.

• Tryptase inhibitor - Inhibits proteolytic enzymes of host mast cells.

• Eglins          Anti-inflammatory- Inhibits the activity of alpha chymotrypsin, chymase, substilinsin, elastase.

• Factors Xa inhibitor -         Inhibits the activity of coagulation factor Xa by forming equimolar complexes.

• Carboxypeptidase A –inhibitors - Increase the inflow of blood at the site of bite.

• Histamin like substances - Vasodilator, Increase the inflow of blood at the bite site.

• Acetylcholine -      Vasodilator.

Role of jalauka in Indralupta

The main aim of the therapy (Jalaukavacharana) is removal of vitiated Pitta and Rakta, impurities, toxin from body through blood. Pitta and Rakta have ushna guna, leech described by Acharya Sushruta have Sheeta guna because they live in cold water. Leech (Hirudo medicinalis) has property of discrimination of impure blood and pure blood; it sucks the impure one and left the site. Leech has Hirudin in saliva which inhibits blood coagulation by binding to thrombin, Hyaluronidase which increases interstitial viscosity, B-dellins which is anti-inflammatory, Acetylcholine which is vasodilator. In all leech increase the blood flow of the affected site, helps in infection and inflammation. In Indralupta, mainly Pitta and Rakta dosha are vitiated with Vata dosha, Jalaukavcharana helps in removal of Pitta and Rakta dosha and obstruction caused by Vata and Kapha dosha due to which pure blood circulation over affected site is occurring.

Conclusion

Leach application is best and safe alternative therapy which can be used to treat Indralupta with shaman therapy. Jalaukavcharana is easy to do and relatively speedily and can reduce the complication arising from the excessive use of modern drug, it is also cost-effective therapy for this common aliment with no short-term side effects.