Issue : 01
INTERNATIONAL
JOURNAL
OF
DIAGNOSTICS
AND
RESEARCH
Volume : 04
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
17
P
ISSN No. : 2584-2757
Volume : 04
Issue : 01
DOI
:10.5281/zenodo.23434363
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding Author: Dr. Nilesh Dalvi ORCID ID: 0009-0003-1689-7019
ISI Impact Factor (2025-26): 1.345
IIFS Impact Factor (2026-27): 6.0
Article Info: Article Received on : 07 /10/2026 Article Reviewed on: 09/10/2026 Article Published on : 15/10/2026
Cite this article as: - Dalvi N, Sreenivasulu M, Mogle P. Integrating Classical and Contemporary Perspectives on Leech Therapy in
Eye Disease: An Ayurveda-Biomedicine Evidence Synthesis. International Journal of Diagnostics And Research.
2026Oct17;4(1):17–28. doi:10.5281/zenodo.23434363
Abstract
Background: Jalaukavacharana (leech application) is a type of Raktamokshana (bloodletting). Ayurvedic texts
describe it for diseases caused by vitiated Pitta and Rakta. Many eye diseases (Netra Roga) are described as Pitta-
Rakta diseases, and Ayurvedic eye doctors still use leeches for painful, congested conditions around the eye. In
modern medicine, medicinal leech therapy (MLT) is mainly used in reconstructive surgery, and a few case reports
describe its use for periorbital hematoma.
Aim: To review what classical Ayurvedic texts say about Jalaukavacharana in Netra Roga, and to compare this with
the modern medical evidence on leech therapy that is relevant to the eye.
Materials and Methods: This is a narrative review. We read Ayurvedic review papers and searched the web on 7
October 2026 for papers on leech therapy and on leech use around the eye in PubMed-indexed and AYUSH-related
journals. A classical statement was included only if we could confirm it in a printed edition or in a named secondary
source.
Results: Ayurvedic texts place Jalaukavacharana under Raktamokshana for Raktaja and Pittaja eye diseases. We
checked six disease-procedure links directly in printed editions of the Sushruta Samhita and Ashtanga Hridaya.
Modern evidence for the eye region is limited to a few case reports on bleeding around and on the eye, and two small
single-group studies of Jalaukavacharana in Abhishyanda (allergic conjunctivitis) from Ayurvedic journals. Leech
saliva contains known active substances such as hirudin, calin and hyaluronidase. We found no controlled trial of
Jalaukavacharana for any classical eye disease.
Conclusion: The classical idea of removing bad blood from a congested site fits with what we know about leech
saliva. However, the evidence is weak and comes from single case reports and two small studies without comparison
groups. Well-planned clinical studies with a fixed procedure and safety monitoring are needed before any claim of
benefit can be made.
Keywords: Jalaukavacharana; Raktamokshana; Netra Roga; hirudotherapy; medicinal leech therapy; Shalakya
Tantra; Ayurveda; periorbital hematoma
Integrating Classical and Contemporary Perspectives on Leech Therapy in Eye Disease: An
Ayurveda-Biomedicine Evidence Synthesis
Dr. Nilesh Suresh Dalvi
1
, Dr. Murari Sreenivasulu
2
, Dr. Pravin Sudamrao Mogle
3
1
Professor, Department of Prasuti Tantra evum Stree Roga, Vaidya Yagyadatta Sharma Ayurved Mahavidyalaya, Khurja,
Bulandshahar, Uttar Pradesh, India
2
Professor and Head, Department of Shalakya Tantra, Vaidya Yagyadatta Sharma Ayurved Mahavidyalaya, Khurja,
Bulandshahar, Uttar Pradesh, India
3
Associate Professor, Department of Shalakya Tantra, Poornayu Ayurved Chikitsalaya Evam Anusandhan Vidyapeeth
(Women's College), Tilwara Ghat, Jabalpur, Madhya Pradesh, India
G
A
R
V
Issue : 01
INTERNATIONAL
JOURNAL
OF
DIAGNOSTICS
AND
RESEARCH
Volume : 04
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
17
Introduction :
Shalakya Tantra is one of the eight branches
(Ashtanga) of Ayurveda. It deals with diseases of
the parts above the collarbone, mainly the eye, ear,
nose and throat. This branch gives special attention
to eye care (Netra Chikitsa). A well-known saying,
sarvendriyanam nayanam pradhanam ("of all the
senses, the eye is the most important"), reflects this.
The Uttaratantra of the Sushruta Samhita gives a
long account of eye diseases and their treatment.
Raktamokshana (bloodletting) is used when vitiated
blood (Rakta) and Dosha, especially Pitta, are
thought to cause disease. It can be done in more
than one way. Siravedha (opening a vein) suits
larger areas. Jalaukavacharana (leech application)
suits small, delicate and surface areas such as the
eye. A third method, Pracchana (scraping or
pricking the skin), is also mentioned. These
methods are explained in a review by Singh and
Rajoria
[1]
.
Outside Ayurveda, leech therapy came back into
use in Western medicine from the 1980s. Surgeons
use medicinal leeches (purpose-bred Hirudo
medicinalis) to relieve blood congestion after
reattaching body parts or after flap surgery
[2]
. The
United States Food and Drug Administration
cleared the medicinal leech as a medical device in
2004
[2]
. Many Netra Roga are described as Pitta-
Rakta diseases with redness, burning, congestion
and pain. For this reason, Jalaukavacharana has
long been suggested for some of them. Recent
Indian papers on the Ayurvedic care of eye disease
show that interest in this area continues
[3]
, although
good comparative trials are still lacking.
The Ayurvedic and the modern approaches come
from very different backgrounds. This review puts
them side by side. We state clearly what the
classical texts say about Jalaukavacharana in Netra
Roga, what modern research has actually shown
about leech therapy near the eye, and where the two
views meet or do not meet. We state openly any
classical reference we could not confirm in a
printed edition, and we have not invented any
verse, page, trial, or reference.
Materials and Methods :
This is a narrative review, not a systematic review.
We did not run a full database search with article
counts, so there is no PRISMA flow diagram. For
classical texts we used the Sushruta Samhita
(Sutrasthana and Uttaratantra) and the Ashtanga
Hridaya. The Ashtanga Sangraha was looked at
only where it was quoted in secondary papers. For
modern literature we searched the web on 7
October 2026 for papers in PubMed-indexed
journals and in AYUSH-related journals (for
example J Ayurveda Integr Med, AYUSHDHARA,
Indian J Tradit Knowl, Int J Ayurveda Pharma Res
and J Ayurveda Integr Med Sci), and we read the
abstract or full text on the journal page. Search
words included "medicinal leech therapy",
"hirudotherapy" and "Hirudo medicinalis" together
with "ophthalmology", "ocular", "periorbital" or
"eyelid". We also searched "Jalaukavacharana" or
"Raktamokshana" together with "Netra Roga".
Direct searches of PubMed and Europe PMC could
not be run in our setting, and we did not search
Scopus, Web of Science or the Cochrane Library,
so some papers may have been missed
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
19
.We included peer-reviewed articles, case reports,
case series and reviews on (a) Jalaukavacharana or
Raktamokshana in Netra Roga, (b) leech therapy
around the eye, or (c) the actions of leech saliva
that could matter for the eye. We left out web pages
with no clear source, promotional material, and any
classical reference that we could not confirm. Each
modern paper was grouped by study type and by
how close it was to the eye. We kept three things
apart in the text: what the classical books say, what
modern studies show, and our own interpretation.
Results
Raktamokshana And Jalaukavacharana In
Classical Texts
In Ayurvedic scholarship, Raktamokshana is a
cleansing procedure that removes vitiated Rakta
and the Dosha mixed with it, most often Pitta, from
the diseased site or from the body. It is counted
among the Ashtavidha Shastrakarma (eight surgical
and para-surgical procedures) in the Sutrasthana of
the Sushruta Samhita. It is advised for Raktaja and
Pittaja diseases that show redness, burning, local
heat, and congestion. These include skin disease
(Kushtha), joint disease and eye disease. Secondary
sources list old age, young age, pregnancy, great
weakness and bleeding disorders as reasons to
avoid it. These match the modern cautions about
bloodletting.
Jalaukavacharana means placing live leeches on a
diseased site to draw out vitiated blood in a
controlled way. The Sushruta Samhita has a
separate chapter on leeches
[1]
. It divides leeches
into "Savisha" (venomous) and "Nirvisha" (non-
venomous) kinds. Only the non-venomous kinds
are used for treatment. A good leech is active,
hungry, of fair size and free from disease. The
procedure has three steps. Purva Karma is cleaning
the site and preparing the leech. Pradhana Karma
is placing the leech and watching it feed. Paschat
Karma is care of the bite site and watching for
reactions. The Sushruta Samhita gives a clear sign
for removal. Pain (toda) and itching (kandu) at the
bite show that the leech is now taking pure blood,
and it should then be removed. If it does not let go
because of the smell of blood, Saindhava (rock salt)
powder is sprinkled on its mouth (Su. Su. 14/21, p.
58)
[4]
. For Jalaukavacharana in particular, the eye
is a common example of a delicate site where
Siravedha is not practical.
Classical References In Netra Roga
The Uttaratantra of the Sushruta Samhita sorts eye
diseases by the part of the eye involved:
Sandhigata, Vartmagata, Shuklagata, Krishnagata,
Sarvagata and Drishtigata Roga. Secondary
sources also list seventy-six eye diseases. Some
Sarvagata diseases, such as Abhishyanda
(inflammation of the conjunctiva) and Pittaja
Timira, are said to need Raktamokshana or
Jalaukavacharana when Rakta and Pitta are the
main cause. Table 1 reproduces the list given by
Alaskar, Shaikh, and Shaikh
[5]
, which covers eight
eye diseases. It is reported here as given by that
source. Readers who need the exact verse should
check a printed edition.
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
20
Table 1. Raktamokshana/Jalaukavacharana in
selected classical Netra Roga, as reported in a
secondary source[5]
Classical
condition
Reported
procedure
Type of
evidence
Puyalasa
Siramokshana
followed by
Upanaha
Direct
textual
indication
(secondary
source)
Vataja
Abhishyanda
Siramokshana
Direct
textual
indication
(secondary
source)
Pittaja
Timira
Sarpipana and
Siravedhana
Direct
textual
indication
(secondary
source)
Savrana
Shukla
Sarpipana,
Siramokshana
followed by
Jalaukavacharana
Direct
textual
indication
(secondary
source)
Kaphaja
Timira
Sarpipana and
Siravedhana
Direct
textual
indication
(secondary
source)
Pittaja and
Kaphaja
Abhishyanda
Ghritapana then
Siravedhana
Direct
textual
indication
(secondary
source)
Pothaki
Jalaukavacharana
Direct
textual
indication
(secondary
source)
Raktaja
Abhishyanda
Siravedha and
Jalaukavacharana
Direct
textual
indication
(secondary
source)
Unlike Table 1, we checked the entries in Table 1a
in printed editions of the Sushruta Samhita
[6]
and
the Ashtanga Hridaya
[7]
,
[8]
. They can be quoted as
verified classical indications for Jalaukavacharana
in Netra Roga.
Table 1a. Verified classical (primary-source)
indications for Jalaukavacharana in Netra Rog
Classical
condition
Verified
citation
Note
Raktaja
Abhishyanda and
Raktaja
Adhimantha
Su. Ut. 12/8
(p. 42)
Verified
against ref. [6]
Ragaprapta
Timira
Su. Ut.
17/54 (p.
58)
Verified
against ref. [6]
Kukunaka
Su. Ut.
19/10 (p.
76); A.H.
Ut. 9/27 (p.
808)
Sushruta locus
per ref. [6];
Ashtanga
Hridaya locus
per refs. [7,8]
Netraruk
A.H. Su.
26/42 (p.
323)
Verified
against refs.
[7,8]
Paksmasadana
A.H. Ut.
9/18-19 (p.
808)
Verified
against refs.
[7,8]
Kshatashukra
A.H. Ut.
11/30 (p.
814)
Verified
against refs.
[7,8]
Three Levels Of Evidence
Table 2 groups the material into three levels. The
first is a direct textual indication reported in a
secondary source. The second is an Ayurvedic
interpretation in which later authors extend a
classical idea. The third is a modern extrapolation,
our own suggestion based on leech studies outside
the eye, not stated in any classical or Ayurvedic
source.
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
21
Table 2. Structured evidence correlation
Classic
al Netra
Roga
Dosha/pa
thogenesi
s (brief)
Categ
ory
Modern
clinical
correlatio
n
Evide
nce
level
Raktaja
Abhishy
anda
Rakta-
Pitta
vitiation;
conjuncti
val
congestio
n
Direct
(seco
ndary
sourc
e)
Allergic/in
flammator
y
conjunctiv
itis
(interpreti
ve)
Two
small
single-
group
studies
in
Abhish
yanda
(allergi
c
conjun
ctivitis
), see
Table
4;
case-
level
eviden
ce near
the eye
Pittaja
Timira
Pitta
vitiation
affecting
Drishti
Direct
(seco
ndary
sourc
e)
No direct
modern
correlate
establishe
d
None
identifi
ed
Pothaki
Localized
Rakta-
Pitta
vitiation,
eyelid
margin
Direct
(seco
ndary
sourc
e)
Chalazion
/hordeolu
m-type lid
pathology
(interpreti
ve)
None
identifi
ed
specifi
c to
this
entity
Savrana
Shukla
Ulcerativ
e
corneal/s
cleral
involvem
ent
Direct
(seco
ndary
sourc
e)
No direct
modern
correlate
establishe
d
None;
extrap
olation
only
Periorbi
tal/eyeli
d
hemato
ma (not
classical
)
Not
applicabl
e
Mode
rn
extrap
olatio
n only
Post-
traumatic/
post-
surgical
hematoma
Case
reports
/series
(Table
4)
Procedure Near The Eye
The classical text tells the doctor to remove the
leech when pain and itching appear at the bite, and
to sprinkle rock salt powder on its mouth if it will
not let go
[4]
. Modern safety rules are stricter and do
not rely on classical texts. The leech should be
purpose-bred, quarantined, and used only once, and
should come from a regulated supplier. Clean the
skin around the eye with aseptic care. The eyeball
and cornea must be shielded, for example with a
moist pad, so that the leech never touches the
cornea or conjunctiva. Someone must watch the
leech the whole time. Remove it gently with saline,
a flick of the finger, or a drop of local anesthetic or
alcohol on its front sucker. Pulling it off can make
it vomit gut bacteria into the wound. Some surgical
protocols give antibiotics because of the risk of
Aeromonas infection from the leech gut
[9]
. Watch
the site for prolonged bleeding because leech saliva
can delay clotting for a long time. The leech should
be thrown away after use. Leech therapy must
never replace proper eye care in sight-threatening
problems such as orbital compartment syndrome, a
ruptured eyeball, or bleeding behind the eye with
high eye pressure. Its recorded modern use is only
as an extra treatment for soft tissue around the eye,
and not for disease inside the eye.
What Leech Saliva Contains
Leech saliva contains more than twenty active
substances. Several of them could matter for
swollen and congested tissue around the eye
[2]
.
Table 3 lists some of them.
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
22
Table 3. Selected leech salivary bioactive
molecules and their documented actions
Molecule
Docume
nted
mechani
sm
Evidence type
Ocular/p
eriocular
relevance
Hirudin
Direct,
potent
thrombin
inhibitor;
local
anticoagu
lant
Biochemical/ph
armacological
Sustains
local
bleeding
to
evacuate
pooled/co
ngested
blood
Calin
Inhibits
collagen-
mediated
platelet
adhesion
Biochemical/in
vitro
Supports
sustained
local
bleeding
at the site
Destabilase
Isopeptid
ase;
thrombol
ytic/anti-
aggregat
ory
action
Biochemical/in
vitro
Proposed
contributo
r to local
clot
dissolutio
n
Hyaluronida
se
Degrades
hyaluroni
c acid,
increasin
g tissue
permeabi
lity
Biochemical/in
vitro
Facilitates
spread of
other
salivary
compone
nts
Histamine-
like/vasodil
atory
substances
Local
vasodilati
on,
increased
blood
flow
Biochemical/ph
armacological
May aid
decongest
ion of
pooled
periorbita
l blood
Anti-
inflammator
y/analgesic
constituents
Local
anti-
inflamma
tory and
analgesic
effect
Clinical
observation;
mechanism
incompletely
characterized
Reported
local pain
relief in
published
case
material
These actions are well shown for skin and soft
tissue, where almost all leech studies were done.
We found no data on how leech saliva acts on the
cornea, conjunctiva or inside the eye. Applying
skin findings to these tissues is only a guess.
Modern Reports From The Eye Region
Leech use around the eye is reported mainly in two
situations. One is draining an eyelid or periorbital
hematoma after injury or surgery
[10]
,
[11]
. The
other is harm caused when leeches were placed
near the eye for another reason, such as headache
[12]
. We also include a case from outside the eye,
because it shows how leeches were used to clear a
hematoma
[13]
. Ayurvedic journals report three
further studies. Syam Chandran and colleagues
[14]
gave Jalaukavacharana to 30 patients with
Abhishyanda (allergic conjunctivitis) in three
sessions on alternate days. Symptoms improved;
the absolute eosinophil count improved in 23.3% of
patients, and no side effects were reported.
Prakruthi and Hamsaveni
[15]
treated 20 patients
with Vataja Abhishyanda in two sessions five days
apart and reported improvement in all measured
symptoms and signs. Both studies had one
treatment group and reported no comparison group.
Sreenath and Gopikrishna
[16]
reported one patient
with subconjunctival hemorrhage after a road
traffic accident, in whom healing was reported after
leech therapy. We found no controlled trial of
Jalaukavacharana for any classical eye disease.
Table 4. Contemporary published reports of
periorbital/ophthalmic leech application
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
23
Stu
dy
Y
ea
r
Condi
tion
Desig
n
n
Interven
tion
Main
findin
g
Evi
den
ce
stre
ngth
Men
age
and
Wri
ght
[10]
19
91
Perior
bital
hemat
oma
(traum
a)
Case
report
1
Leech
applicati
on to
eyelid
Hema
toma
evacu
ated;
globe
exami
nation
enable
d
Ver
y
low
Bun
ker
[11]
19
81
Perior
bital
hemat
oma
(head
injury)
Clinic
al
comm
entary
N
S
Leech
evacuati
on
Rapid,
painle
ss
decon
gestio
n
descri
bed
Ver
y
low
Sevi
mli
et al.
[12]
20
21
Perior
bital
ecchy
mosis
(adver
se
event)
Case
report
1
Leech
applied
to
glabella
for
headach
e
Self-
limiti
ng
ocular
bruisi
ng as
compl
icatio
n
Ver
y
low
Mar
quez
-Gil
et al.
[13]
20
23
Non-
ocular
post-
proced
ural
hemat
oma
Case
report
1
Medicin
al leech
applicati
on
Comp
lete
healin
g at 2
weeks
Ver
y
low`
Sya
m
Cha
ndra
n et
al.
[14]
20
25
Abhish
yanda
(allergi
c
conjun
ctivitis
)
Singl
e-arm
trial
3
0
Jalaukav
acharan
a, 3
sessions
on
alternate
days
Sympt
oms
impro
ved;
eosino
phil
count
impro
ved in
23.3%
; no
side
effects
report
ed
Low
Study
Ye
ar
Cond
ition
Desig
n
n
Interv
ention
Main
findin
g
Evid
ence
stre
ngth
Prakr
uthi
and
Hams
aveni
[15]
20
18
Vataj
a
Abhis
hyan
da
One-
group
study
2
0
Jalauk
avach
arana,
2
sessio
ns
five
days
apart
Impro
veme
nt in
all
measu
red
sympt
oms
and
signs
Low
Sreena
th and
Gopik
rishna
[16]
20
21
Subc
onjun
ctival
hemo
rrhag
e
(trau
ma)
Case
report
1
Leech
applic
ation
Heali
ng
report
ed
Ver
y
low
There are no controlled studies. Evidence for leech
therapy in eye care is limited to single-case reports
and two small, single-group studies. It can suggest
ideas for study but cannot show that the treatment
works.
Safety
Leech therapy has real risks. Bleeding can last long
because hirudin and calin stop clotting, and the
blood vessels around the eye are delicate. Infection
is possible because Aeromonas hydrophila and
related bacteria live in the leech gut, so some
protocols give antibiotics. Repeated or long feeding
can cause anemia, especially in small or weak
patients. Some people react to the proteins in leech
saliva. People taking blood thinners or antiplatelet
drugs have a higher bleeding risk, and most
protocols treat this as a relative reason to avoid
leeches. Other problems are injury to the eyeball or
cornea, long-lasting bruising and scarring.
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
24
Leeches must be regulated, quarantined and used
once A trained clinician must watch throughout.
Emergencies such as a ruptured eyeball, bleeding
behind the eye with compartment syndrome, and
endophthalmitis need standard eye or surgical
treatment at once. Leech therapy has no recorded
role in them. The classical cautions given in
secondary sources
[1]
are similar: old age, young
age, pregnancy, great weakness and bleeding
tendency. Readers who need the exact verse for
each caution should check a printed edition.
Gaps In Research
No adequately powered randomised trial of
Jalaukavacharana exists for any classical Netra
Roga. No fixed procedure has been published for
the eye (leech type and size, time on the skin,
number of sittings, gap between sittings). There are
no agreed outcome measures, and no study has
tested leech saliva on tissue of the eye region itself.
Reviews of grey literature on Ayurvedic procedures
exist for wound care
[17]
, but we found none for
leech therapy in eye disease. It is also hard to match
classical Netra Roga names with modern
diagnoses. Useful next steps include: a randomised
controlled trial of Jalaukavacharana added to
standard care for Abhishyanda (allergic
conjunctivitis), building on the two small single-
group studies; a randomised trial of
Jalaukavacharana added to standard care for
periorbital soft tissue problems, using measures
such as photographic scoring of hematoma and a
pain scale; a comparison with Siravedha or with
standard medicines for Pitta-Rakta type conditions;
laboratory work on leech saliva proteins in tissue
models; a study linking Dosha-based findings with
blood or tissue markers; and a written standard
procedure for use near the eye.
Discussion :
The classical texts, read through secondary
scholarship and our own checks of printed editions,
make it clear: Raktaja and Pittaja eye diseases can
be treated with Raktamokshana, and
Jalaukavacharana is chosen for delicate or surface
sites. We could confirm six specific disease-
procedure links (Table 1a). The links in Table 1
come from a secondary source and should be
treated as provisional until checked. Modern
research supports leech therapy for blood
congestion and soft-tissue hematoma in general,
and a few case reports support it for hematoma
around the eye. Two small single-group studies in
Abhishyanda (allergic conjunctivitis) report
symptom relief
[14]
,
[15]
, but without a comparison
group they cannot show that the leeches caused the
change. It does not support leech therapy for the
wider group of classical eye diseases, such as
Pittaja Timira or Drishtigata diseases, because we
found no study on them. An earlier review by
Pundge and Kotangale looked at Jalaukavacharana
in Netra Roga
[18]
and covered a similar range of
classical indications. Our review differs in that it
keeps citations in printed editions, except those
from secondary sources, and grades the modern
evidence more carefully. Three more Ayurvedic
reviews list eye conditions for which
Raktamokshana or Jalaukavacharana is advised.
Smitha and Vaghela name Raktaja Abhishyanda,
Kukunaka, Pakshmashata, Kshatashukra (Savrana
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
25
Shukla) and Kacha
[19]
.Silamwar and colleagues,
and Mule and colleagues, list Abhishyanda,
Adhimantha, Siraharsha, Sirotpata, Puyalasa,
Vatparyaya, Anyatovata, Sashopha Akshipaka and
Ashopha Akshipaka, and attribute the list to
Sushruta
[20]
,
[21]
. These papers give no verse
numbers for this second list, so we treat it as
provisional until we check it against a printed
edition. We also read Su. Ut. 12/8 in a second
printed edition with Dalhana's commentary
[4]
,
where Su. Ut. 12 is titled Raktabhishyanda
Pratishedha. Smitha and Vaghela
[19]
and Silamwar
and colleagues
[20]
also list bdellins and eglins (anti-
inflammatory), and Silamwar and colleagues add a
factor Xa inhibitor among the active substances of
leech saliva. These substances have not been tested
in eye tissue, so their relevance here is unknown,
and more study is needed. Silamwar and colleagues
[20]
and Mule and colleagues
[21]
also suggest that
leech application helps aqueous humour drain in
glaucoma. They provide no pressure measurements
or supporting studies, and we do not endorse this.
Silamwar and colleagues
[20]
discuss the
anticoagulant action of hirudin and calin in
subconjunctival hemorrhage but provide no data.
One report describes this bleeding as a
complication of leech therapy
[12]
, and one case
report describes healing of post-traumatic
subconjunctival hemorrhage after leech therapy
[16]
.
The two views meet in one situation: congestion or
hematoma of the soft tissue around the eye. The
classical idea is to remove the locally vitiated
Rakta. The modern explanation is local relief of
congestion through the anticoagulant and blood-
vessel-widening actions of leech saliva. These
explanations differ but point to a similar effect.
They differ in how much they cover. Classical
Netra Roga includes diseases of the cornea,
conjunctiva, and the inside of the eye, and there is
no modern leech data for these. Stretching the
hematoma findings to these diseases is not justified.
Some Ayurvedic ideas resemble modern ones:
Raktadushti (spoiled blood) and local inflammation
or congestion; Raktamokshana and local reduction
of blood volume; Jalauka and controlled blood
removal together with active saliva; Srotodushti
(blocked channels) and poor small-vessel flow.
These are possible comparisons and not proven
matches. We found no study that links these
Ayurvedic ideas to measurable changes in the body,
so they remain working ideas and do not prove the
classical theory.
At present, the evidence is not enough for routine
use. The only uses with any published support are
as an extra treatment for hematoma or bleeding
around the eye and for Abhishyanda, always under
proper eye or surgical care. Even there the evidence
comes from single cases and small groups without
controls. Use for other classical eye diseases should
be called investigational. The next steps are a few
well-planned pilot and comparison studies with a
fixed procedure, clear outcome measures and open
reporting of side effects, done under the supervision
of an eye specialist.
Conclusion :
Jalaukavacharana has a long and consistent place
in Ayurvedic eye care for Rakta-Pitta type Netra
Roga. Modern science gives a reasonable, though
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
26
incomplete, explanation for how leech saliva could
ease congestion, inflammation and pain. Modern
evidence from the eye region is limited to a few
case reports of bleeding around the eye, a few
reports of side effects, and two small single-group
studies on Abhishyanda. These findings suggest,
but do not prove, a benefit in congestion of the soft
tissue around the eye. They do not cover the wider
range of classical Netra Roga. More study with
fixed methods and comparison groups is needed
before Jalaukavacharana can be said to work in
Netra Roga. Ayurvedic doctors and eye specialists
should plan this work together, with registered
protocols and proper ethics approval.
Acknowledgements :
The authors thank the faculty of the Department of
Shalakya Tantra and the Department of Prasuti
Tantra evum Stree Roga, Vaidya Yagyadatta
Sharma Ayurved Mahavidyalaya, Khurja, for
institutional support during preparation of this
review.
References :
1. Singh SK, Rajoria K. Medical leech therapy
in Ayurveda and biomedicine - a review. J
Ayurveda Integr Med 2020;11(4):554-564.
2. Sig AK, Guney M, Uskudar Guclu A,
Ozmen E. Medicinal leech therapy - an
overall perspective. Integr Med Res
2017;6(4):337-343.
3. Ahirwar S, Vaghela DB, Pawar DK,
Ahirwar AK. Ayurvedic approach for
prevention of Netra Roga. J Emerg Technol
Innov Res 2022;9(8):c267-c271.
4. Acharya JT, Acharya NR (editors).
Susrutasamhita of Susruta, with the
Nibandhasangraha commentary of
Dalhanacharya and the Nyayachandrika
Panjika of Gayadasacharya on
Nidanasthana. Varanasi: Chaukhamba
Sanskrit Sansthan; Reprint 2010.
5. Alaskar FM, Shaikh TA, Shaikh AAG.
Review article of management of Netra
Roga: modern diagnostic methods and
specific Ayurveda treatment. Eur J Pharm
Med Res 2020;7(3):198-200.
6. Sastri KA (editor). Susrutasamhita of
Maharsi-Susruta, Part II (Uttaratantra), with
Ayurveda-Tattva-Sandipika Hindi
commentary. Kashi Sanskrit Series 156.
Varanasi: Chaukhambha Sanskrit Sansthan;
Reprint 2025. ISBN 978-81-89798-20-8.
7. Kunte AM, Navre KS (editors); Paradkar
HS (reviser). Astangahrdayam of Vagbhata,
with Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana
commentary of Hemadri. Kashi Sanskrit
Granthamala 385. Varanasi: Chaukhambha
Sanskrit Sansthan; Reprint 2018.
8. Tripathi B (editor). Astangahrdayam of
Srimadvagbhata, with 'Nirmala' Hindi
commentary. Vrajajivan Ayurvijnan
Granthamala 27. Delhi: Chaukhambha
Sanskrit Pratishthan; Reprint 2022. ISBN
978-81-7084-125-8.
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
27
9. Riede FS, Koenen W, Goerdt S, Ehmke H,
Faulhaber J. Medicinal leeches for the
treatment of venous congestion and
hematoma after plastic reconstructive
surgery. J Dtsch Dermatol Ges
2010;8(11):881-888.
10. Menage MJ, Wright G. Use of leeches in a
case of severe periorbital haematoma. Br J
Ophthalmol 1991;75(12):755-756.
11. Bunker TD. The contemporary use of the
medicinal leech. Injury 1981;12(5):430-432.
12. Sevimli N, Karadag R, Karadag AS.
Periorbital ecchymosis and subconjunctival
hemorrhage due to leech therapy for
headache. Arq Bras Oftalmol
2021;84(2):183-185.
13. Marquez-Gil KY, Mesa E, Kouka N,
Fonarov I, Casadesus D. Medicinal leeches
to aid in post-procedural hematoma
evacuation. Cureus 2023;15(8):e43338.
14. Syam Chandran C, Keskar M, Dev AG,
Krishnan U. Effect of Jaloukavcharan in
Abhishyanda w.s.r. allergic conjunctivitis.
Indian J Tradit Knowl 2025;24(6):519-527.
15. Prakruthi G, Hamsaveni V. A clinical study
on Jaloukavacharana in the management of
Vataja Abhishyanda w.s.r. to allergic
conjunctivitis. AYUSHDHARA
2018;5(3):1714-1720.
16. Sreenath PS, Gopikrishna BJ. Clinical
efficacy of Jaloukavacharana (leech
therapy) in subconjunctival haemorrhage - a
case study. J Ayurveda Integr Med Sci
2021;6(5):299-302.
17. Dudhamal TS. Review of grey literature on
Ayurveda wound healing formulations and
procedures - a systematic review. J
Ayurveda Integr Med 2023.
18. Pundge SJ, Kotangale YT. Role of
Jalaukavcharana in netraroga. Int J
Ayurvedic Med 2015;6(3):202-205.
19. Smitha GS, Vaghela DB. Role of
Jaloukavacharana in Netraroga - a
conceptual study. World J Pharm Pharm Sci
2025;14(7):1597-1604.
20. Silamwar VL, Jagtap P, Kumbhar V. Role
of Jalaukavcharana in Netrarogas. World J
Pharm Res 2021;10(8):246-255.
21. Mule C, Chandankhede A, Mule KC.
Hirudotherapy (Jalaukavacharan) in
Netraroga according to Sushrutha: a review.
Int Ayurvedic Med J 2016;4(11):3431-
3435.
Declaration :
Conflict of Interest: None
Issue : 1
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 4
Copyright @ : - Dr.Nilesh Dalvi Inter. J.Digno. and Research IJDRMSID0141 |ISSN :2584-2757
28
ISSN: 2584-2757
DOI :10.5281/zenodo.23434363
Dr. Nilesh Dalvi Inter. J.Digno. and Research
This work is licensed under Creative
Commons Attribution 4.0 License
Submission Link : http://www.ijdrindia.com
Benefits of Publishing with us
Fast peer review process
Global archiving of the articles
Unrestricted open online access
Author retains copyright
Unique DOI for all articles
https://ijdrindia.com