Integrating Classical and Contemporary Perspectives on Leech Therapy in Eye Disease: An Ayurveda-Biomedicine Evidence Synthesis

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