Dong-Ha HanDong-Ha Han

Handongha Korean Handongha Korean Traditional Medical Clinic, Traditional Medical Clinic,

Seoul, KoreaSeoul, Korea

Treatment of Treatment of Thromboangiitis Obliterans Thromboangiitis Obliterans

(Buerger's disease) by (Buerger's disease) by Leech TherapyLeech Therapy

The 12th International Conference on Traditional Medicine

• A disease due to the inflammatory occlusion of peripheral arteries, causing circulatory disorders in toes and/or fingers

• Leo Buerger (1879~1943, USA) first described the pathology in 1908.

• Also known as Thromboangiitis Obliterans (TAO)

What is Buerger's disease ?What is Buerger's disease ?

• Male smokers below 40 years old exhibit a high incidence of the disease

• Male : Female = 9 ： 1

Who Are Affected by TAO?Who Are Affected by TAO?

• Ischemia by arterial occlusion usually occurs.• Inflammation is intermittent.• Inactive phase ranges from a few weeks to

several years.• Arteries in toes and hands are usually affected.• Infection and/or gangrene may appear in later

stage.

Presenting Symptoms of TAOPresenting Symptoms of TAO

• Intermittent claudication• Resting pain is continuous and relapsing.• Dysesthesia, sensory & tactile function loss,

burning pain • Pallor and coldness of the involved toes and/or

fingers• Redness unrelated to position• Absence of or weak pulse in dorsal plantar a.,

posterior tibial a., ulnar a. and radial a. • Intermittent relapse without complete

remission

Presenting Symptoms of TAOPresenting Symptoms of TAO

• Prohibition of smoking (indispensable)

Conventional Tx of TAO Conventional Tx of TAO

General Principle

• Sympathectomy• Artificial vessel or Bypass graft• Amputation

Surgery

• Antiplatelet, Vasodilator, Anticoagulant

Medication

• For focal ischemic ulcerFoot Care

• OnsetOnset – December 2004 – December 2004• First visitFirst visit – November 2005 – November 2005• SmokingSmoking – for 30 years, quit after onset – for 30 years, quit after onset• Lesion / SymptomLesion / Symptom – Left thumb / redness, pain, – Left thumb / redness, pain,

stiffness, numbness.stiffness, numbness.• Conventional Medical TreatmentConventional Medical Treatment - p.o. medication - p.o. medication • Leech TherapyLeech Therapy – total 6 sessions – total 6 sessions

(3~5 leeches/session) (3~5 leeches/session)

Case 1 : Park○○ M /53Case 1 : Park○○ M /53

After 1st session

After 5 sessions

Leech Therapy

Midpoint ofthe treatment course

• OnsetOnset – 30 – 30 years ago, relapsed at a month and a years ago, relapsed at a month and a half agohalf ago

• First visitFirst visit – 30 – 30thth May 2007 May 2007• SmokingSmoking – ex-smoker, not smoking on the first visit – ex-smoker, not smoking on the first visit • Lesion / SymptomLesion / Symptom – Right 3– Right 3thth, 4, 4thth toes / toes / progressive progressive

gangrenegangrene• Conventional Medical TreatmentConventional Medical Treatment – no p.o. – no p.o.

medication medication with recommended amputationwith recommended amputation• Leech TherapyLeech Therapy – total 7 sessions – total 7 sessions

(8 leeches/session) (8 leeches/session)

Case 2 : Seo○○ M/51Case 2 : Seo○○ M/51

At the First Visit

After 7 Sessions

Leech Therapy

Midpoint ofthe treatment course

• OnsetOnset – January 2007 – January 2007• First visitFirst visit – 9 – 9thth June 2007 June 2007• SmokingSmoking – current smoker – current smoker• Lesion / SymptomLesion / Symptom – Right 3– Right 3thth finger / finger / progressive progressive

gangrenegangrene• Conventional Medical TreatmentConventional Medical Treatment - p.o. medication - p.o. medication • Leech TherapyLeech Therapy – total 4 sessions – total 4 sessions

(3 leeches/session) (3 leeches/session)

Case 3 : Kim○○ M/47Case 3 : Kim○○ M/47

At the First Visit

After 4 Sessions

Leech Therapy

Midpoint ofthe treatment course

• OnsetOnset – 10 years ago – 10 years ago• First visitFirst visit – 23 – 23rdrd March 2007 March 2007• SmokingSmoking – ex-smoker – ex-smoker• Lesion / SymptomLesion / Symptom – Both 3– Both 3rdrd fingers, left 2fingers, left 2ndnd finger, both 1 finger, both 1stst

toes/ toes/ progressive gangreneprogressive gangrene• Conventional Medical TreatmentConventional Medical Treatment - p.o. medication - p.o. medication with with

recommended amputationrecommended amputation• Leech TherapyLeech Therapy – total 8 sessions – total 8 sessions

(6 leeches/session) (6 leeches/session)

Case 4 : Kim○○ M/53Case 4 : Kim○○ M/53

At the First Visit

After 8 Sessions

Leech Therapy

Midpoint ofthe treatment course

• OnsetOnset – June 2006 – June 2006• First visitFirst visit – 9 – 9thth January 2007 January 2007• SmokingSmoking – current smoker – current smoker• Lesion / SymptomLesion / Symptom – Left thumb/ – Left thumb/ progressive progressive

gangrenegangrene• Conventional Medical TreatmentConventional Medical Treatment - p.o. medication - p.o. medication • Leech TherapyLeech Therapy – total 6 sessions – total 6 sessions

(4 leeches/session) (4 leeches/session)

Case 5 : Lee○○ M/63Case 5 : Lee○○ M/63

At the First Visit

After 6 Sessions

Leech Therapy

Midpoint ofthe treatment course

• OnsetOnset – 2005 (remote), December 2007 (recent) – 2005 (remote), December 2007 (recent)• First visitFirst visit – 29 – 29thth April 2008 April 2008• SmokingSmoking – current smoker – current smoker• Lesion / SymptomLesion / Symptom – Right foot / redness, pain– Right foot / redness, pain• Conventional Medical TreatmentConventional Medical Treatment – initial p.o. – initial p.o.

medication, but no p.o. medication at first visit medication, but no p.o. medication at first visit • Leech TherapyLeech Therapy – total 3 sessions – total 3 sessions

(6 leeches/session) (6 leeches/session)

Case 6 : KimCase 6 : Kim○○○○ M/44M/44

Leech Therapy After 3 Sessions

At the First Visit At the First Visit

• CasesCases : Six male patients at the age of 51.8 : Six male patients at the age of 51.8 ±± 6.52 6.52• Leech therapyLeech therapy

1.1. Species of Leech : Hirudo medicinalis Species of Leech : Hirudo medicinalis (aseptically breeded at Biopharm Co., Ltd., UK)(aseptically breeded at Biopharm Co., Ltd., UK)

2.2. 5.6 5.6 ±± 2.07 number of leech therapy sessions 2.07 number of leech therapy sessions were performed.were performed.

3.3. 5.4 5.4 ±± 1.95 leeches were used per session for 1.95 leeches were used per session for each patient. each patient.

• After leech therapyAfter leech therapy : All subjective symptoms : All subjective symptoms disappeared and gangrenous lesions have healed.disappeared and gangrenous lesions have healed.

ResultsResults

• Suggested Mechanism of ActionSuggested Mechanism of ActionThe aim of leech therapy is not just blood suction The aim of leech therapy is not just blood suction but also the injection of bioactive components but also the injection of bioactive components (ex. Hirudin), which are released from the salivary (ex. Hirudin), which are released from the salivary gland of leeches into the patient’s circulatory gland of leeches into the patient’s circulatory system. These bioactive components have various system. These bioactive components have various curative effects on TAO lesions.curative effects on TAO lesions.

• Expected Effects of Leech TherapyExpected Effects of Leech Therapyanti-inflammation, pain relief, anti-congestion, anti-inflammation, pain relief, anti-congestion, improvement of circulation, regeneration of improvement of circulation, regeneration of microvessels, tissue neogenesis, immunologic microvessels, tissue neogenesis, immunologic stabilitystability

DiscussionDiscussion

DiscussionDiscussion

• SPECIAL PRECAUTIONSSPECIAL PRECAUTIONS

1. 1. TAO patients who use anticoagulants or anti-TAO patients who use anticoagulants or anti-platelet medicines should be carefully treated platelet medicines should be carefully treated with leech therapy. with leech therapy.

2.2. Because of the use of living organisms, Because of the use of living organisms, infection should always be considered.infection should always be considered.

• Leech therapy may be helpful to some of the Leech therapy may be helpful to some of the progressive Buerger's disease patients who progressive Buerger's disease patients who are irresponsive to conventional medication or are irresponsive to conventional medication or waiting for amputation surgery.waiting for amputation surgery.

• Further clinical research (ex. Clinical trial Further clinical research (ex. Clinical trial comparing comparing Leech TherapyLeech Therapy to conventional to conventional

conservative treatment) is needed.conservative treatment) is needed.

ConclusionConclusion

Thank you!