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:10.5281/zenodo.23434983

DOI

INTERNATIONAL

JOURNAL

OF

DIAGNOSTICS

AND

RESEARCH

Hirudotherapy in France: Historical Rise, Decline, and Contemporary Clinical Revival

—

A

Narrative Review with an Ayurvedic Perspective

M. Danh Sang Sambo

1

2 Avenue de La Libération, 60200 Compiègne, France

.

2

Article Info:

Article Received on : 02 /10/2026

Article Reviewed on: 09/10/2026

Article Published on : 15/10/2026

Corresponding Author:

M. Danh Sang Sambo

ORCID ID:

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

Cite this article as: -

Sambo MDS. Hirudotherapy in France: Historical Rise, Decline, and Contemporary Clinical Revival

—

A

Narrative

Review

with

an

Ayurvedic

Perspective.

International

Journal

of

Diagnostics

And

Research.

2026Oct17;4(1):78

–

83.

doi:10.5281/zenodo.23434983

Issue : 01

INTERNATIONAL

JOURNAL

OF

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AND

RESEARCH

Volume : 04

Copyright @ : - M Danh Sang Sambo Inter. J.Digno. and Research IJDRMSID0147

|

ISSN :2584-2757

78

Introduction :

The

medicinal

leech

has

been

used

therapeutically

for

more

than

two

millennia,

with

references

in

Egyptian,

Greco-Roman,

Chinese,

and

Indian

medical

traditions

[1,2].

In Ayurveda, Sushruta described

Jalaukavacharana

(leech

application)

as

the

gentlest

form

of

Raktamokshana

(therapeutic

bloodletting),

classifying

leeches into twelve types, six venomous (

Savisha

) and

six

non-venomous

(

Nirvisha

),

and

specifying

their

collection, storage, application, and post-procedure care

[3].

Among

Western

nations, France

occupies

a

distinctive

position. It was the epicentre of the nineteenth-century

leech

boom,

experienced

a

sharp

collapse

of

the

practice, and has since reintegrated leeches into modern

surgical

care

[1,4].

This

review

examines

that

trajectory

and considers what it offers hirudotherapy practitioners,

including

those

working

within

the

Ayurvedic

framework.

Methods :

This

is

a

narrative

review.

Sources

included

peer-

reviewed

biomedical

articles

on

the

clinical

use

of

Hirudo

medicinalis;

French-language

historical

and

pharmaceutical-history

literature;

hospital

clinical

protocols

and

a

hospital

pharmacy

thesis;

records

published

by

the

principal

French

leech

producer;

and

descriptions

of

practice

outside

hospitals.

The

study

drew

classical

Ayurvedic

content

from

the

Sushruta

Samhita.

Given

the

heterogeneity

of

sources,

no

quantitative synthesis was attempted.

Historical Development

The Broussais era

The rise of leech therapy in France is closely associated

with

François-Joseph-Victor

Broussais

(1772

–

1838),

a

surgeon

of

the

Napoleonic

army

whose

"physiological

medicine" attributed most disease to inflammation,

particularly of the gastrointestinal tract

[4,7].

He favoured

local

blood

depletion

by

leeches,

and

under

his

influence

France

became

the

world's

largest

consumer

of medicinal leeches

[4,8].

Historical reviews record that

France imported tens of millions of leeches annually at

the height of the practice

[1].

In some regions, the leech

largely displaced the lancet, and an entire economy

of

harvesting,

farming,

storage,

importation,

and

application developed around the animal

[6].

Overexploitation and the birth of leech farming

Demand

rapidly

exceeded

natural

supply.

Producer

records describe how harvesting that initially took only

standard-sized

animals

became

uncontrolled

as

prices

rose;

the

largest

pond

at

Capestang

in

Gironde,

once

yielding

around

15,000

leeches

per

day,

declined

drastically within fifteen years [5]. Farming emerged as

the

solution.

Gironde

farmers,

notably

the

Béchade

family, addressed the central problem of feeding, and by

1854

leech

farming

in

the

department

extended

over

roughly

5,000

hectares,

much

of

it

used

for

grazing

horses

on

which

the

leeches

fed

[4].

Contemporary

accounts

describe

driving

old

or

injured

livestock

into

marshes

to

feed

the

leeches,

practices

that

would

be

unacceptable

today

[8].

The

Brière

marshes

and

the

Audenge

basins

in

Gironde

were

among

the

most

productive

centres,

grading

leeches

by

size

much

as

commercial seafood is graded

[6].

Decline :

Excess

ultimately

discredited

the

practice.

Prolonged

convalescence,

haemorrhage,

and

skin

infections

resulting

from

indiscriminate

use

undermined

confidence

in

Broussais'

doctrine

and

in

leeches

themselves

[4].

Sanitary

problems

in

farming

areas,

linked to the use of diseased horses and marsh flooding,

compounded the decline

[4].

Over the following decades,

marsh drainage and agricultural chemical use

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eliminated much of the wild leech population in France

[1].

Nevertheless,

leeches

never

disappeared

entirely

from therapeutics

[6].

Continuity of Supply: The Gironde Tradition

A

notable

feature

of

the

French

story

is

institutional

continuity.

The

Béchade

enterprise

passed

through

family

succession;

in

1901,

it

established

breeding

basins at Audenge on the Arcachon basin, and in 1960,

the business adopted the name Ricarimpex

[5].

In 2001

the

company

established

a

breeding

laboratory

to

intensify and control production, and in 2002 it obtained

ISO 9001 certification

[5].

It describes itself as the only

French

enterprise

continuing

Gironde's

tradition

of

hirudiniculture

[4]

,

and

it

maintains

more

than

one

million

specimens

in

approximately

fifteen

basins

at

Audenge,

supplying

reconstructive

surgery,

cosmetology, and the pharmaceutical industry

[8].

Table

1 summarises key milestones.

Table 1.

Milestones in the history of hirudotherapy

in France

Period	Milestone
Early 19th c.	Broussais' physiological doctrine popularises local bloodletting by leeches; France becomes the largest consumer [4,8]
1815 – 1850s	Rising demand drives overharvesting of wild stocks and steep price increases [5,6]
1854	Leech farming in Gironde extends over about 5,000 hectares [4]
Late 19th c.	Complications of indiscriminate use discredit Broussais' doctrine; practice declines [4]
1901	Breeding basins established at Audenge, Gironde [5]
1960	The enterprise adopts the name Ricarimpex [5]
1970s	Renewed interest alongside reconstructive and microsurgery [9]
2001 – 2002	Breeding laboratory established; ISO 9001 certification obtained [5]
2004	US FDA clearance of medicinal leeches as a medical device, noted in French hospital literature [14]

Contemporary Clinical Practice in France

Hospital use

In

contemporary

French

practice,

live

leeches

are

largely

confined

to

hospitals,

principally

plastic,

reconstructive,

and

trauma

surgery

departments;

despite

renewed

interest

from

the

1970s,

hirudotherapy

has

remained

at

the

margins

of

available

therapeutics

[9].

The

principal

indication,

consistent

with

international

practice,

is

venous

congestion

in

replanted

digits

and

in

flaps,

where

venous

outflow

is

inadequate

[10,11].

Leech

saliva

contains hirudin and other bioactive molecules with

anticoagulant, vasodilatory, anti-inflammatory, and

local

anaesthetic

effects

that

together

relieve

congestion

while

the

tissue

re-establishes

venous

drainage

[2,10].

Protocols

in

French-speaking

hospitals

describe

sequential

application

of

individual

leeches

for

approximately

20

–

45

minutes,

spontaneous

detachment when engorged, retrieval with forceps,

and prohibition on forcible removal; application is

by medical

prescription and supply is

coordinated

through the hospital pharmacy

[16].

Osteoarthritis and other indications

Interest

has

also

grown

in

musculoskeletal

use.

French

pharmaceutical

literature

notes

application

in

osteoarthritis

[9].

Randomised trials in

Germany

have

reported

short-term

pain

relief

in

knee

osteoarthritis

following

leech

therapy

compared

with

topical

diclofenac

[12]

and

in

a

separate

randomised study

[13].

Reviews also describe use in

thrombophlebitis,

haematoma,

and

varicose

conditions,

although

the

evidence

for

these

indications is less robust

[2,17].

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Infection risk and prophylaxis

The

main

safety

concern

is

infection

with

Aeromonas

species,

which

are

part

of

the

leech's

obligate

gut

flora

and

help

digest

blood

[15].

A

retrospective

study

at

CHU

Amiens-Picardie

reviewed nine years of hospital hirudotherapy and

noted

that

hirudotherapy-associated

infections

and

antimicrobial

resistance

in

Aeromonas

are

increasingly

reported;

it

also

proposed

a

decontamination

protocol

for

leeches

before

dispensing

to

clinical

wards

[14].

The

international

literature

widely

recommends

antibiotic

prophylaxis

during

therapy

[10,11,15].

Other

risks

include

prolonged

bleeding

requiring

transfusion,

allergic reactions, and scarring

[15,17].

Practice outside hospitals

Outside

hospitals,

hirudotherapy

in

France

is

offered

by

a

small,

heterogeneous

group

of

practitioners.

Directories

list

hirudotherapists

who

may

be

general

practitioners,

naturopaths,

practitioners of Chinese medicine, or reflexologists;

training courses typically last one to five days and

cover

regulation,

traceability,

storage,

application,

hygiene,

disposal,

mechanisms

of

action,

and

contraindications

[18].

This variability in practitioner

background

and

training

contrasts

with

the

controlled

hospital

environment

and

highlights

an

area where clearer standards could improve patient

safety.

Discussion:

An Ayurvedic Perspective

The

French

experience

offers

an

instructive

comparison with the classical Ayurvedic approach.

Sushruta presented leech therapy not as a universal

remedy but as a targeted procedure: .

Jalaukavacharana

was recommended especially for

Pitta-vitiated

blood

and

for

patients

unsuited

to

more aggressive bloodletting, such as children, the

elderly,

women,

and

the

delicate

[3].

He

specified

selecting suitable non-venomous leeches, preparing

them,

applying

them,

managing

the

wound,

and

caring for the leech after use

[3].

Broussais'

system

departed

from

each

of

these

principles.

It

applied

leeches

indiscriminately,

in

very large numbers, based on a single speculative

pathology, and the resulting complications led to its

collapse

[4].

The modern French revival

succeeded

by

reintroducing

discipline:

narrow,

well-defined

indications;

reliable

farmed

sources;

single-use

leeches;

pharmacy

control;

and

infection

prophylaxis

[5,14,16].

In effect, contemporary French

hospital

practice

has

rediscovered

the

structured,

indication-driven

logic

that

Ayurveda

codified

many centuries earlier.

Ayurvedic

practitioners

should

pay

particular

attention

to

two

areas.

First,

modern

Jalaukavacharana

protocols should incorporate the

French

emphasis

on

microbiological

safety,

including

Aeromonas

surveillance

and

decontamination.

Second,

French

producer

practice,

including

controlled

breeding,

quality

certification,

and

prolonged

pre-use

fasting,

provides a useful benchmark for leech sourcing in

India.

Conversely,

the

Ayurvedic

framework

of

patient

assessment

and

indication-specific

application

could

inform

France's

currently

heterogeneous non-hospital practice.

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Limitations :

This

narrative

review

draws

partly

on

historical,

institutional,

and

grey-literature

sources,

which

may

be

subject

to

bias.

Figures

on

nineteenth-

century

leech

consumption

vary

between

sources.

Published

data

on

the

volume

and

outcomes

of

contemporary

French

hirudotherapy,

particularly

outside hospitals, are limited.

Conclusion :

Hirudotherapy

in

France

has

passed

from

uncontrolled mass use, through near-abandonment,

to

a

precise

and

evidence-guided

role

in

reconstructive

surgery.

The

continuous

Gironde

farming

tradition

links

these

phases.

The

central

lesson of the French experience is that the value of

the

medicinal

leech

depends

on

disciplined

indication,

controlled

sourcing,

and

rigorous

infection

prevention.

These

principles,

articulated

in the Sushruta Samhita, remain equally relevant to

modern Ayurvedic and biomedical practice.

Declarati

o

n :

Conflict of Interest :

None

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ISSN: 2584-2757

DOI :

10.5281/zenodo.23434983

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Inter. J.Digno. and Research

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