Clinical Evaluation of the Effect of Irsal-e-Alaq (Leech Therapy) in the Management of Niqris (Gout)

Niqris originated from the Greek word *“Anquroosâ€*which means big toe (the first metatarsophalangeal joint). This is the classical site for the beginning of this disease, hence the disease got this name. Renowned Unani scholars Ibn-e-Sina, Majoosi, Jurjani, Antaki described that Madda-e-Niqrisiya (Morbid matter) accumulated in intra-articular space especially in big toe cause pain and inflammation.

In modern system of medicine this disease is called ‘GOUT’. Gout is common inflammatory condition of joint. It is caused by deposition of monosodium urate crystals within the joints after chronic hyperuricemia. Prevalence of hyperuricemia varies according to the age, sex, race, geographical conditions and association with other diseases. It becomes common with increasing age: it is <0.5% in men under the age of 35 years and >7% in those aged over 75 years. It is rare in premenopausal women and increases to 2.5%-3.5% in those aged 75 years of age.

Irsal-e-Alaqis an ancient regimen of Ilaj-bit-Tadbeerused for diversion and evacuation of Akhlat-e-Fasida (morbid matter) by application of Leech on the affected parts of the body surface. Blood letting in the form of leech therapy has been utilised for preventive as well as curative measures for thousands of years by ancient Unani scholars.

 Habb-e-Suranjan is the most common Unani medicine that is used in joints pain. It has anti inflammatory and analgesic actions.

In Conventional system of medicine there is no permanent cure for Gout, only symptomatic treatment is available with analgesics and NSAIDs like Indomethacin and Urate lowering drugs like Allopurinol, Probenecid, Febuxostat etc.These drugs have many side effects.

In Unani System of Medicine many single/ compound drugs like Zanjabeel, Muqil, Darchini, Majoon Chobchini, Habb-e-Suranjan, Habb-e-Asgandetc with regimenal procedures like Hijamah-bish-Shurt (wet cupping), Irsal-e-Alaq etc. are prescribed to treat gout with minimal/no side effects. Leech saliva has several bioactive substances that are anti-inflammatory, anticoagulant, vasodilator, anaesthetic etc. Leech therapy has no adverse effect in comparison to conventional medicine. The antiiflammatory and analgesic properties of leech saliva will be helpful in treating the painful condition of joints. Therefore, it is proposed to evaluate the efficacy of leech therapy in the management of Gout.