Authors' response: Ayurvedic methods of adversity control following leech application.

Sir,

We read the comments “Leech therapy and Infection control: No clear window”[1] on the article “Pigment reduction in Nevus of Ota following Leech Therapy: A case report” published recently in the JAIM with great interest.[2] It is true that the present practice of Ayurveda does not have a validated or well–studied protocol for preventing infections and associated adverse events of application of medicinal leeches. Ayurveda literature categorizes leeches as savish (toxic) and nirvish (non-toxic). Ayurveda possibly attempted to specify  adverse events of leech application possibility on the basis of their habitat. The leeches inhabited to clean water are proposed to be safer compared with the ones that dwell in dirty fowl water. Another possibility of cross-infection during forced pulling of leeches from the site of attachment may often lead to a regurgitation of ingested contents, which has also been explicitly suggested in the Ayurveda literature. It proposes putting a small amount of  rocksalt (saindhava) at the attachment site to ease the detachment of the leech. This minimizes the problem of regurgitation of leech at the site of attachment. Furthermore, leeches are proposed to be cleaned before their actual use by applying turmeric powder upon them. Once removed from the site, leeches are expected to emit all the ingested contents before they are used again. This procedure may be helpful to eliminate the toxic content from leeches before they can be used again. We agree that the practice of using separate leeches for each patient should always be followed to avoid any possibility of a cross-infection such as hepatitis or acquired immunodeficiency syndrome. To clean the wound caused by a leech bite and to improve the wound healing, Ayurveda recommends the local application of jatyadighrita or shatadhautaghrita at the wound site. In clinical biomedical practice, where leeches are applied for various indications, sacrificing the leech is often recommended to avoid any possibility of cross-infection.