त्रयोदशोऽध्यायः ।अथातो जलौकावचारणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discuss the Chapter which treats of leeches and of how and which to use (Jalaukavacaraniya adhyaya). 1
नृपाढचबालस्थविरभीरुदुर्बलनारीसुकुमाराणामनुग्रहार्थं परमसुकुमारोऽयं शोणितावसेचनोपायोऽभिहितो जलौकसः ॥ २ ॥
तत्र वातपित्तकफदुष्टशोणितं यथासंख्यं श्रृङ्गजलौकालाबुभिरवसेचयेत् सर्व्वाणि सर्व्वेर्वा, विशेषतस्तु विस्राव्यं श्रृङ्गजलौकालाबुभिर्गृह्णीयात् ॥३॥
Leeches should be applied where the patient would be found to be old or imbecile, or a woman, or an infant, or a person of an extremely timid disposition, or a person of a delicate constitution, and as such is not fit to be surgically operated upon, since this mode of bleeding is the gentlest that can be possibly devised. the blood vitiated by the deranged wind (Vayu), bile (Pitta), and phlegm (Kapha) should be respectively sucked through a horn, by leeches and a gourd appliance (Alabu-Yantra) or with whichsoever of them is available at the time, irrespective of the cause of such vitiation, whenever such bleeding or sucking would be found to be imperatively necessary. 2-3
भवन्ति चात्रउष्णं समधुरं स्निग्धं गवां श्रृङ्गं प्रकीर्तितम् । तस्माद् वातोपसृष्टे तु हितं तदवसेचने ॥ ४ ॥
शीताधिवासा मधुरा जलौका वारिसम्भवा । तस्मात् पित्तोपसृष्टे तु हिता सा त्ववसेचने । ॥ ५ ॥
अलाबु कटुकं रुक्षं तीक्ष्णञ्च परिकीर्त्तितम् । तस्मात् श्लेष्मोपसृष्टे तु हितं तदवसेचने ॥६॥
Authoritative verses on the subject: A cowhorn is described in the Sastras as of a hot or heat making potency, and as possessed of a slightly cooling (Snigdha) or soothing (Madhura) property. Accordingly it should be used in sucking the blood vitiated through the action of the deranged bodily wind. Leeches, which are born in water, are possessed of Madhura (sweet or soothing) properties, and hence they should be used in sucking the blood vitiated through a deranged condition of the bile (Pitta). the gourd (Alabu) is pungent, parching and irritating in its potency and should be therefore used in sucking the blood vitiated through the action of the deranged phlegm (Kapha). 4-6
तत्र प्रच्छिते तनुवस्त्रपटलावनद्धेन श्रृङ्गेण शोणितमवसेचयेदा चूषणात्। सान्तर्दीपयाऽलाब्वा ॥७॥
Mode of application: The part from which the blood is to be sucked should be first scarified or slightly cut in two or three places, and then the mouth or the open end, of the horn, covered with a thin piece of muslin tied round its edges should be placed over it and sucked with the mouth through the aperture at its tip or top-end, or with a gourd appliance equipped with a lighted lamp placed in its inside. 7
अथ जलायुका वक्ष्यन्ते । जलमासामायुरिति जलायुका, जलमासामोक इति जलौकसः ।
ता द्वादश; तासां सविषा: षट्, तावत्य एव निर्व्विषाः ॥८॥
तत्र सविषा:- कृष्णा कबुरा अलग इन्द्रायुधा सामुद्रिका गोचन्दना चेति। तास्वञ्जनचूर्णवर्णा पृथुशिराः कृष्णा ।
वर्म्मिमत्स्यवदायता छिन्नोन्नतकुक्षिः कबुरा। रोमशा महापार्श्वा कृष्णमुख्यलग ।
इन्द्रायुधवदूर्ध्वराजिभिः चित्रिता इन्द्रायुधा । ईषदसितपीतिका विचित्रपुष्पाकृतिचित्रा सामुद्रिका |
गोवृषणवदधोभागे द्विधाभूताकृतिरणुमुखी गोचन्दनेति ॥९॥
The term Jalauka (leeches) may be etymologically interpreted to mean creatures whose life (Ayu) or whose longevity is in, or depends upon, water, whereas the derivative meaning of the term Jalauka (leeches) is based upon the fact of their dwelling (“Oka”-dwelling place) in water (Jala). Leeches may be divided into twelve distinct species of which six are venomous, and six non-venomous. The six venomous species are named Krsna, Karbura, Alagarda, Indrayudha, Samudrika and Gocandana. The leeches of the first-named species (Krsna) are marked by thick heads, and of a colour resembling powdered lampblack. The leeches of the Karbura type have extended or elongated bodies like the Varmifishes, and are indented and thick at the waist. The Alagarda leeches are hairy, thick and round at the sides, and black at the mouth. The leeches of the Indrayudha species are marked on the surface with up-pointed rainbow coloured lines. the skins of the Samudrikas are blackish yellow, dotted over with white spots of a variety of shapes. Leeches which are provided with narrow mouths and are marked by bifurcating line at the bottom like the scrotal sac of a bull are called Gocandanas. 8-9
ताभिर्दष्टे पुरुषे दंशे श्वयथुरतिमात्रं कण्डूर्मूर्च्छा ज्वरो दाहश्छर्दिमदः सदनमिति लिङ्गानि भवन्ति । तत्र महागदः पानालेपननस्यकर्म्मादिषूपयोज्य: । इन्द्रायुधदष्टमसाध्यमित्येताः सविषाः सचिकित्सिता व्याख्याताः ॥१०॥
A person bitten by any of the abovesaid venomous leeches has an irresistble inclination to scratch the seat of the bite which is marked by a considerable swelling. Fever, with burning, retching, drowsiness and delirium supervenes and ultimately the patient loses all consciousness. The remedy consists in the administration of an antitoxic medicine known as Mahagada, as snuffs, potions and unguents, etc. A bite by an Indrayudha usually proves fatal. Venomous leeches, as well as cures for their bites, have thus been described. 10
अथ निर्व्विषाः– कपिला पिङ्गला शङ्कुमुखी मूषिका पुण्डरीकमुखी सावरिका चेति । तत्र मनः शिलारञ्जिताभ्यामिव पार्श्वाभ्यां पृष्ठे स्निग्धमुद्गवर्णा कपिला । किञ्चिद्रक्ता वृत्तकाया पिङ्गाशुगा च पिङ्गला। यकृद्वर्णा शीघ्रपायिनी दीर्घतीक्ष्णमुखी च शङ्कुमुखी। मूषिकाकृतिवर्णाऽनिष्टगन्धा च मूषिका । मुद्गवर्णा पुण्डरीकतुल्यवक्त्रा पुण्डरीकमुखी । स्निग्धा पद्मपत्रवर्णाष्टादशाङ्गुलप्रमाणा च सावरिका, सा च पश्वर्थे । इत्येता अविषा व्याख्याताः ॥११॥
The non-venomous species include Kapilas, Pingalas, Sankumukhis, Musikas, Pundarikmukhis and Savarikas. The Kapilas are coloured like Manah-Sila (realgar) at the sides, and their backs are tinged with a glossy hue like that of a Mudga pulse. The Pingalas have a reddish colour, are round in shape and capable of speedy locomotion. The Sankumukhis are marked by a blackish red hue like that of the liver, are provided with sharp elongated mouths, and are capable of sucking blood with the greatest swiftness. The Musikas are coloured like the common blind moles, and emit a fetid smell from their bodies. The Pundarikmukhas are coloured like the Mudga pulse and are so called from the fact of the resemblance of their mouths to the fullblown lotus lilies (Pundarikas). The Savarikas have cold bodies marked with impressions like lotus leaves and measure eighteen fingers’ width in length, and they should be employed in sucking blood from the affected parts of lower animals. This exhausts the list of nonvenomous leeches. 11
तासां यवनपाण्ड्यसह्यपौतनादीनि क्षेत्राणि । तेषु महाशरीरा बलवत्यः शीघ्रपायिन्यो महाशना निर्व्विषाश्च विशेषेण भवन्ति ॥१२॥
The countries, such as Turkestan (Yavana), the Deccan (Pandya), the tract of land traversed by the Ghat mountains (Sahya), and Pautana (modern Mathura), are the natural habitats of these leeches. The leeches, found in the aforesaid countries, are specially non-venomous, strong, large-bodied, greedy and ready suckers. 12
तत्र सविषमत्स्यकीटदर्दुरमूत्रपुरीषकोथजाताः कलुषेष्वम्भः सु च सविषा: । पद्मोत्पलनलिनकुमुदसौगन्धिककुवलयपुण्डरीकशैवलकोथजाता विमलेष्वम्भःसु च निर्व्विषाः ॥१३॥
The venomous leeches have their origin in the decomposed urine and fecal matter of toads and venomous fishes in pools of stagnant and turbid water. The origin of the non-venomous species is ascribed to such decomposed vegetable matter, as the petrified stems of the several aquatic plants known as Padma, Utpala, Nalina, Kumuda, Saugandhika, Kuvalaya Pundarika, and the common zoophytes which live in clear waters. 13
भवति चात्र
क्षेत्रेषु विचरन्त्येताः सलिलेषु सुगन्धिषु |
न च सङ्कीर्णचारिण्यो न च पङ्केशयाः सुखाः ।।१४।।
Authoritative verse on the subject: The non-venomous leeches swim about in sweet scented waters, live on non-poisonous weeds, lie on the leaves of flowering water plants instead of on the dank and oozy beds of pools, and such blood from the affected part of a human organism without causing any discomfort. 14
तासां ग्रहणमार्द्रचर्म्मणान्यैर्वा प्रयोगैगृह्णीयात् । अथैनां नवे महति घटे सरस्तडागोदकपङ्कमावाप्य निदध्यात्।
भक्ष्यार्थं चासामुपहरेच्छैवलं वल्लूरमौदकांश्च कन्दांश्चूर्णीकृत्य शय्यार्थं तृणमौदकानि च पत्राणि, द्व्यहात् त्र्यहाच्चाभ्योऽन्यज्जलं भक्ष्यञ्च दद्यात् । सप्तरात्रात् सप्तरात्राच्च घटमन्यं संक्रामयेत् ॥ १५ ॥
Leeches should be caught hold of with a piece of wet leather, or by some similar article, and then put in to a large-sized new pitcher filled with the water and ooze or slime of a pool. Pulverised zoophytes and powder of dried meat and aquatic bulbs should be thrown into the pitcher for their food, and blades of grass and leaves of water-plants should be put into it for them to lie upon. The water and the edibles should be changed every second or third day, and the pitchers should be changed each week, (the leeches should be transferred to a new pitcher at the end of every consecutive seven days). 15
भवति चात्र ।
स्थूलमध्याः परिक्लिष्टाः पृथ्व्यो मन्दविचेष्टिताः। अग्राहिण्योऽल्पपायिन्यः सविषाश्च न पूजिताः । । १६ ।।
The authoritative verse on the subject: Leeches that are venomous, thick about the middle, elongated, of slow locomotion, Vol. 1-7 look fatigued, do not readily take to the part they are applied to, and capable of sucking only a small quantity of blood, should be looked upon as not belonging to the proper or the commendable type. 16
अथ जलौकोऽवसेकसाध्यव्याधितमुपवेश्य संवेश्य वा, विरुक्ष्य चास्य तमवकाशं मृद्गोमयचूर्णैर्यद्यरुजं स्यात् । गृहीताश्च ताः सर्षपरजनीकल्कोदकप्रदिग्धगात्रीः सलिलसरकमध्ये मुहूर्त्तस्थिता विगतक्लमा ज्ञात्वा ताभी रोगं ग्राहयेत् । श्लक्ष्णशुक्लार्द्रपिचुप्रोतावच्छन्नां कृत्वा मुखमपावृणुयात् अगृह्णन्त्यै क्षीरबिन्दुं शोणितबिन्दुं वा दद्याच्छस्त्रपदानि वा कुर्व्वीत । यद्येवमपि न गृह्णीयात् तदान्यां ग्राहयेत् ॥१७॥
Then having seated or laid down the patient suffering from a disease which requires the application of leeches, the seat of bleeding, if not previously ulcerated, should be roughened by dusting it over with a composition of loose earth and pulverised cowdung. Then the leeches should be taken out of their receptacles and sprinkled over with water saturated with mustard seed and pasted turmeric. Then for a moment they should be kept in a basin full of water, and after they have regained their natural vivacity and freshness, they should be applied to the affected part. Their bodies should be covered with a piece of thin and wet linen, or with a piece of white cotton. The affected part should be sprinkled over with drops of milk or blood, or slight incisions should be made into it in the event of their refusing to stick to the desired spot. Other fresh leeches should be applied even when the preceding measures should prove ineffectual. 17
यदा च निविशतेऽश्वखुरवदाननं कृत्वोन्नम्य च स्कन्धं तदा जानीयाद् गृह्णातीति, गृह्णन्तीञ्चार्द्रवस्त्रावच्छन्नां धारयेत् सेचयेच्च दंशे तोदकण्डूप्रादुर्भावैर्जानीयाच्छुद्धमियमादत्त इति, शुद्धमाददानामपनयेत् । अथ शोणितगन्धेन न मुञ्चेन्मुखमस्याः सैन्धवचूर्णेनावकिरेत् ॥१८॥
That the leeches have taken to the affected part may be inferred from the mouths of the leeches assuming the shape of a horse-shoe, and the raised and arched position of their necks after they had become attached to the seat of the disease. While sucking, the leeches should be covered with a piece of wet linen and should be constantly sprinkled over with cold water. A sensation of itching and of a drawing pain at the seat of the application would give rise to the presumption that fresh blood was being sucked, and the leeches should be forthwith removed.¹ Leeches refusing to fall off even after the production of the desired effect, or sticking to the affected part out of their fondness for the smell of blood, should be sprinkled with the dust of powedered Saindhava (rock salt.) 18
अथ पतितां तण्डुलगुण्डनप्रदिग्धगात्रीं तैललवणाभ्यक्तमुखीं वामहस्ताङ्गुष्ठाङ्गुलीभ्यां गृहीतपुच्छां दक्षिणहस्ताङ्गुष्ठाङ्गुलीभ्यां शनैः शनैरनुलोममनुमार्ज्जयेदामुखात्, वामयेत् तावद यावत् सम्यग्वान्तलिङ्गानीति। सम्यग्वान्ता सलिलसरकन्यस्ता भोक्तुकामा सती चरेत् । या सीदति न चेष्टते सा दुर्व्वान्ता, तां पुनः सम्यग् वामयेत्! दुर्व्वान्ताया व्याधिरसाध्य इन्द्रमदो नाम भवति । अथ सुवान्तां पूर्व्ववत् सन्निदध्यात् ॥१९॥
शोणितस्य च योगायोगानवेक्ष्य शतधौतघृताभ्यङ्गस्तत्पिचुधारणं वा, जलौकोव्रणान् मधुनावघट्टयेच्छीताभिरद्भिश्च परिषेचयेद् बघ्नीत वा, कषायमधुरस्निग्धशीतैश्च प्रदेहैः प्रदिह्यादिति ॥२०॥
After falling off, the leeches should be dusted over with rice powder and their mouths should be lubricated with a composition of oil and common salt. Then they should be caught by the tail-end with the thumb and the forefinger of the left hand and their backs should be gently rubbed with the same fingers of right hand from tail upward to the mouth with a view to make them vomit or eject the full quantity of blood they had sucked from the seat of the disease. The process should be continued until they manifest the fullest symptoms of disgorging. Leeches that, had vomited the entire quantity of blood sucked as above, would briskly move about in quest of food if placed in water, while the contrary should be inferred from their lying dull and inert. These should be made to disgorge again. Leeches not made to emit the entire quantity of the sucked blood stand in danger of being attacked with an incurable disease peculiar to their genus, and which is known as Indramada. The leeches should then be put into a new pitcher, and treated as before laid down, after they had fully emitted the sucked blood.
1. The leeches, though a blissful dispensation of Nature in themselves, instinctively draw off the vitiated blood from a diseased part, attacking the healthy vital fluid (red blood) when the former has been completely tapped or sucked.
An ulcer incidental to an application of leeches should be rubbed with honey or washed with sprays of cold water, or bound up with an astringent (kasaya) sweet and cooling plaster, according to the quantity of blood removed from the part.¹ 19-20
भवति चात्र
क्षेत्राणि ग्रहणं जाती: पोषणं सावचारणम् ।
जलौकसाञ्च यो वेत्ति तत्साध्यान् स जयेद् गदान् ।।२१।।
Authoritative verse on the subject: The physician who is fully conversant with the habitat, mode of catching, preservation and application of leeches, can well aspire to cure the diseases which yield to them or in which their use in indicated. 21
इति सुश्रुतसंहितायां सूत्रस्थाने जलौकावचारणीयो नाम त्रयोदशोऽध्यायः ॥१३॥
Thus ends the thirteenth Chapter of the Sutrasthana in the Susruta Samhita which treats of Leeches and of how and which to use.
1. In case of full and proper bleeding (Yoga) the ulcer should be rubbed with clarified butter technically known as the Satadhauta (lit: hundred times washed) Ghria (clarified butter), or a piece of cotton, soaked in the same substance, applied as a compress over the part. The ulcer should be rubbed with honey in a case of insufficient bleeding, while it should be washed with a copious quantity of cold water if excessive bleeding (Ati-Yoga) should set in. Similarly in a case marked by the absence of any bleeding at all (Mithya-Yoga) a sour, sweet and cooling plaster should be applied over the ulcer.
