Hirudotherapy in France: Historical Rise, Decline, and Contemporary Clinical Revival — A Narrative Review with an Ayurvedic Perspective

Abstract

Background: France holds a unique place in the history of medicinal leech therapy (hirudotherapy). During the nineteenth century it was the world's largest consumer of medicinal leeches, and it retains a leech-farming tradition in Gironde that dates to that period. Objective: To trace the evolution of hirudotherapy in France from the Broussais era to present-day hospital practice, to summarise its current clinical indications and safety concerns, and to compare French experience with the classical Ayurvedic doctrine of Jalaukavacharana. Methods: Narrative review of indexed biomedical literature, French historical and pharmaceutical-history sources, hospital protocols, institutional theses, and producer records. Results: Leech use in France expanded dramatically in the early nineteenth century under the influence of François Broussais, leading to overharvesting of wild populations and the development of industrial leech farming in Gironde. Indiscriminate bloodletting later discredited the practice, and environmental change eliminated much of the wild stock. A single producer, Ricarimpex, preserves the Gironde tradition and supplies hospitals. Contemporary French use is concentrated in plastic, reconstructive, and trauma surgery for venous congestion, with emerging interest in osteoarthritis. Aeromonas infection and antimicrobial resistance are the principal safety concerns. Outside hospitals, practice is heterogeneous and training is short. Conclusion: The French trajectory illustrates that the therapeutic value of hirudotherapy depends on disciplined indication, controlled sourcing, and infection prevention, principles that closely mirror those described by Sushruta. Keywords: Hirudotherapy; Hirudo medicinalis; Jalaukavacharana; Broussais; France; Microsurgery; Venous congestion; Aeromonas