Sushruta Samhita Sutrasthana Chapter 13: Jalaukavacharaniya Adhyaya (Application of Leeches)

The 13th chapter of Sutrasthana of Sushruta Samhita is named as Jalaukavacharaniya Adhyaya. This chapter deals with the Application of Leeches.

अथातो जलौकावचारणीयमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भागवान् धन्वन्तरिः ॥२॥ 

We will now expound the chapter by name Jalauka Vacaraniya – application of leeches on body; as revealed by the venerable Dhanvantari.

Jalaukavacharana: Best and easy method for bloodletting

नृपाढ्चबालस्थविरभिरुदुर्बलनारीसुकुमाराणामनुग्रहार्थं परमसुकुमारोऽयं शोणितावसेचनोपायोऽभिहितो जलौकसः ॥३॥

Jalauka means leeches. Avacharana means administration. Jalaukacharana is a kind of raktamokshana i.e. bloodletting. Herein, Jalaukavacharana i.e. administration of leeches is done for removing the vitiated blood from the blood vessels.

Jalaukacharana is best suited for the below mentioned persons –

–        kings,
–        wealthy persons,
–        children,
–        old aged people,
–        those who are scared / frightful,
–        debilitated persons,
–        women and
–        those of a tender constitution.

Among all other methods of bloodletting, Jaukacharana – bloodletting through leech application is also considered to be the most easy and convenient method of bloodletting.

Raktavasechana: Methods of removing blood

तत्र वातपित्तकफदुष्टशोणितं यथासंख्यं शृङ्गजलौकालाबुभिरवसेचयेत् सर्वाणि सर्वैर्वा(विशेषस्तु  शृङ्गजलौकालाबुभिर्गृह्णीयात् )॥४॥

Srnga (horn of animals) – is used to remove the blood vitiated by vata from the body. This is because shringa is unctuous in nature and pacifies vata.

Jalauka (administration of leech) – is used to remove the blood vitiated by pitta from the body. Jalauka is cold in nature and it mitigates pitta.

Alabu (administration of pitcher gourd) – is used to remove the blood vitiated by kapha from the body. Alabu is dry in nature and hence subsides kapha.

Srnga, Jalauka, Alabu – all these are used to remove the blood vitiated by all the doshas from the body.

Qualities and Doshic Action of Srnga, Jalauka and Alabu

उष्णं समधुरं स्निग्धं गवां श्रृङ्गं प्रकीर्तितम् ।
तस्माद्वातोपसृष्टे तु हितं तदवसेचने ॥५॥
शीताधिवासा मधुरा जलौका वारीसंभवा।
तस्मात् पित्तोपसृष्टे तु हिता सा त्ववसेचने ॥६॥
अलाबु कटुकं रुक्षं तीक्ष्णं च परिकीर्तितम् ॥
तस्माच्छ्लेष्णोपसृष्टे तु हितं तदवसेचने ॥७॥

Some verses here,

Shringa- Alabu Upayoga: Method of using Horn and Gourd

तत्र प्रच्छिते तनुबस्तिपटलावनद्धेन श्रृङ्गेण शोणितमवसेचयेदाचूषणात्, सान्तर्दीप्याऽलाब्वा जलायुका वक्ष्यन्ते॥८॥

First of all, the site for bloodletting should be selected.

This site should be scratched or incised with the help of shastra – sharp instrument.

The narrow opening of the shringa selected for the procedure shall be covered by a thin layer of cloth. This should be used for sucking and removing the blood from the site selected for bloodletting.

After having scratched or incised the site selected for bloodletting / drawing the blood with the help of a sharp instrument, blood should be removed by sucking the blood through the orifice of the shringa which has been covered by a sterile cloth.

Similarly, alabu i.e. pitcher gourd shall be used to remove the blood by keeping a burning lamp inside it. The method of bloodletting through administration of jalauka i.e., leeches shall be explained next.

Jalauka Nirukti: Leeches

 जलमासामायुरिति जलायुका, जलमासामोक इति जलौकसः ॥९॥

Meaning of Jalauka – They are called as Jalauka because Jala i.e. water is itself their ayu i.e. life or source of life. Jalauka lives in water and water is their life. Yet another explanation tells that they are called jalauka since jala is oka i.e. habitat or residing place for them. Jalauka are habituated to live in water.

Jalauka Vidha: Kinds of Jalauka

ता द्वादश; तासां सविषाः षटू, तावत्य इव निर्विषाः ॥१०॥

Jalauka are of twelve kinds. Six among these twelve Jalaukas are Savisa Jalaukas i.e. poisonous variety of leech. The remaining 6 jalaukas are Nirvisha Jalauka i.e. non-poisonous variety of leech.

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

 तत्र सविषा:- कृष्णा, कर्बुरा, अलगर्दा, इन्द्रायुधा, सामुद्रिका, गोचन्दनाचेति। तासु, अञ्जनचूर्णवर्णा पृथुशिराः कॄष्णाः वर्मिमत्स्यवदायता छिन्नोन्नतकुक्षिः कर्बुराः रोमशा महापार्श्वा कृष्णमुखी अलगर्दा; इन्द्रायुधवदूर्ध्वराजिभिश्चित्रा इन्द्रायुधा ; ईषदसितपीतिका विचित्रपुष्पाकृतिचित्रा सामुद्रिका; गोवृषणवदधोभागे द्विधाभूताकृतिरणुमुखी गोचन्दनेति। ताभिर्दष्टेपुरुषे दंशे श्र्वयथुरतिमात्रं कण्डूर्मूर्च्छा ज्वरो दाहश्छर्दिर्मदह् सदनमिति लिङ्गानि भवन्ति। तत्र महागदः पानालेपननस्वकर्मादिषूपयोज्य । इन्द्रायुधादष्टमसाध्यम् । इत्येताः सविषाः सचिकित्सिता व्याख्याताः ॥११॥

Savisha Jalauka i.e. Poisonous leeches are by names Krsna (black), Karbura (gray), Alagarda, Indrayudha Samudraka and Go Candana. Below mentioned are their features.

Symptoms of bite by Savisha Jalauka – 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

Treatment – 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, the poisonous leeches and their treatments are described.

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

अथ- निर्विषा:- कपिला, पिङ्गला, शङ्कुमुखी, मूषिका, पुण्डरीकमुखी, सावरिका चेति। तत्र, मनःशिलारञ्जिताभ्यामिव पार्श्वाभ्यां पृष्ठे स्निन्धा मुद्रवर्णा, कपिला; किंचिद्रक्ता वृत्तकाया पिङ्गाऽऽशुगा च पिङ्गला; यकृद्वर्णा शीघ्रपायिनी दीर्घतीक्ष्णमुखी शङ्कुमुखी शङ्कुमुखी; मूषिकाकृतिवर्णाऽनिष्टगन्धा च मूषिका; मुद्रवर्णा पुण्डरिकतुल्यवक्रा पुण्डरीकमुखी; स्निग्धा पद्मपत्र वर्णाऽष्टादशाङ्गुलप्रमणा सावरिका, सा च पश्वर्थे, इत्येता अविषा व्याख्याताः ।१२॥

Nirvisha Jalauka i.e. Non-Poisonous leeches are of six types by names Kapila, Pingala, Sankumukhi, Musika, Pundarikamukhi and Savarika. Among these,

Thus, the nirvisha jalauka – non-poisonous leeches were described.  

Regions in which the non-poisonous leeches are found

तासां यवनपाण्डचसह्यपौतनादीनि, क्षेत्राणि, तेषु महशरीरा बलवत्यः शीघ्रपायिन्यो महाशना निर्विषाणभवन्ति ॥१३॥

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, mainly the below mentioned leeches shall be considered as non-poisonous –

–        those which have large body,
–        which are strong,
–        drink (suck) blood quickly and
–        are voracious

Deciding the type of leeches from their origin 

तत्र सविषमत्स्यकीटदर्दुमूत्रपुरीषकोथजाताःकलुषेष्वम्भस्सु च सविषाःपद्मोत्पलनलिनकुमुदसौगन्धिककुवलयण्डरीकशैवलकोथजाना वोमलेष्वम्भःसु च निर्विषाः ॥१४॥

Origin of Savisha Jalauka (poisonous leeches) –

–        These leeches are born out of urine, excreta and putrefied (decayed) dead bodies of poisonous fishes, insects, worms and frogs.
–        They live in poisonous water.

Origin of Nirvisha Jalauka (non-poisonous leeches) –

–        These leeches 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)
–        They live in water which is clean and non-poisonous.

भवति चात्र:-

क्षेत्रेषु विचरन्त्येताः सलिलाढ्चसुगन्धिषु ।
न च संकीर्णचारिण्यो न च पङ्केशयाः सुखाः ॥१५॥

A verse here: –

The nirvisha jalauka

–        live in regions wherein plenty of fragrant water is found
–        do not feet on dirty foods
–        do not live in slush 

Jalauka Posana: Rearing of leeches:-

तासां ग्रहणमार्द्रचर्मणा, अन्यैर्वा प्रयोगैगृह्णीयात् ॥१६॥

अथैनां नवे महति घटे सरस्तडागोदकपङ्कमावाप्य निदध्यात्, भक्ष्यार्थे चासामुपहरेच्छैवलं, वल्लुरमौदकांश्च कन्दांश्चूर्णीकृत्य: शय्यार्थं तृणमौदकानि च पत्राणि; त्र्यहात्र्यहाच्चाभ्योऽन्यज्जलं भक्ष्यं च दद्यात्; सप्तरात्रात् सप्तरात्रच्च घटमन्यं संक्रामयेत् ।१७॥

Moist leather is the best material which we can use to catch and collect the leeches. Any other ideal method can be followed for the same purpose. After collecting them, they shall be placed in a big new pot. Care should be taken to see that these pots are filled with clean water collected 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 we have placed the leeches. 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 once 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).

 Ayogya Jalauka: Leeches unfit for use:-               

स्थूलमध्याः परिक्लिष्टाः पृथ्व्यो मन्दविचेष्टिताः ।
अग्राहिण्योऽल्पपायिन्यः सविषाश्च न पूजिता ः ॥१८॥

One verse here:-

One verse here – 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

Jaluka Avacharana: Method of applying leeches on the body:-

अथ जलौकोवसेकसाध्यव्याधितमुपवेश्य संवेश्य वा, विरूक्ष्यचास्य तमवकाश्ं मृद्रोमयचूर्णैर्यद्यरुजः स्यात्  गृहीताश्च ताः सर्षपरजनीकप्रतिग्धगात्रीः सलिलसरकमध्ये मुहुर्तस्थिता विगतक्लमा ज्ञात्वा ताभी रोगं ग्रहयेत् । श्लक्ष्णशुक्लार्द्रपोतावच्छन्नां कृत्वा मुखमपावृणुयात् : अगृह्णन्त्यै क्षीरबिन्दुं शोणितविन्दुं वा दद्यात्, शस्त्रपदानि वा कुर्वितः यद्येवमपि न गृहीयात्तदाऽन्यां ग्राहयेत् ॥१९॥

The patient suffering from a disease which is curable by jalaukacharana – 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.

यदा च निविशतेऽश्वखुरवसाननं कुत्वोन्नम्य च स्कन्धं तदा जानीयाद्वह्णातीति; गृह्णन्तीं चार्द्रवस्त्रावच्छान्नां कृत्वा धारयेत् ॥२०॥

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.

दंशे तोदकण्डुप्रादुर्भावैर्जानीयाच्छु द्धमियमादत्त इति; शुद्धमाददानामपनयेत : अथ शोणितगन्धेन मुञ्चेन्मुखमस्याः सैन्धवचूर्णेनावावकिरेत् ॥२१॥

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.

अथ पतितां तण्डुलकण्डनप्रदिग्धगात्रीं तैललवणभ्यक्तमुखीं वामहस्ताङ्गष्टाङ्गुलाभ्यां गृहीतपुच्छां दक्षिणहस्ताङ्गुष्ठाङ्गुलिभ्यां शनैःशनैरनुलोममनुमार्जयेदामुखात्, वामर्यत्, तात्वद्यावत् सम्यग्वान्तलिङ्गानीति । सम्यग्वान्ता सलिलसरके न्यस्ता   भोक्तुकामा सतीचरेत्। या सीदती न चेष्टतेसा दुर्वान्ता, तां पुनः सम्यग्वामयेत्  । दुर्वान्ताया व्याधिरसाध्य इन्द्रमदो नाम भवति। अथ सुवान्तां पूर्ववत् सन्निदध्यात् ॥२२॥

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.

शोणितस्य योगायोगानवेक्ष्य शतधौतघृताभ्यङ्गः , तत्पिचुधारणं वा; जलौकोव्रणान मधुनाऽवघट्टयेत् , शिताभिरद्धिः परिषेचयेद्वध्नीत वा, कषायमधुरस्निधशीतैश्च प्रदेहैः प्रदीह्यादिति ॥२३॥

Shatadhauta Ghrita i.e. ghee washed one hundred times in water or decoction of herbs having cold potency shall be used anointing the region of bite, after having noticed the signs of proper and improper sucking of blood by the leech.

Alternatively, a swab dipped in the mentioned ghrita shall be placed on the site of bite.

Below mentioned can be used over the wound caused by the leech –

–        massage with honey
–        bathing or sprinkling of cold water on the wound
–        bandaging the site of wound
–        application of paste of astringent and sweet tasting herbs which also are unctuous and have cold potency followed by bandaging

Master Dalhana recommends anointment with shatadhauta ghrta in case of Samyak yoga i.e. when signs of proper bleeding are available. In case of hina yoga i.e. when signs of inadequate bleeding is seen, the surgeon should squeeze the wound caused by leech to facilitate more flow of blood. The wound shall be bathed with cold water and tied with a cloth so as to stop the bleeding in case of atiyoga i.e. signs of excessive bleeding are evident. Finally, cold poultice shall be applied and bandaging done in case of mithya yoga i.e. when signs of improper bleeding are seen.

क्षेत्राणि ग्रहणं जातीः पोषणं सावचारणम् ॥
जलौकसां च यो  वेति तत्साध्यान् स जयेद्रदान ॥२४॥

Another verse here:-

Only those physicians who has the knowledge of the below mentioned, as related to leeches, will be efficient in curing the diseases caused by leech administration –

–        habitat of leeches
–        method of catching and collecting the leeches
–        varieties of rearing the leeches
–        proper mode / method of administration of leeches

इति श्रीसुश्रूतसंहितायां सूत्रस्थाने जलौकावचारणीयो नाम त्रयोदशोऽध्यायः ॥१३॥

 Thus ends the Thirteenth chapter by name Jalaukavacarana, in Sutra Sthana of Susruta Samhita.