March 4, 2008 -- SEOUL — For seven years, Duck-Im Kim and her family tried everything they could to cure a rare skin disease called purpura — a red or purple discoloration that some doctors believe is caused by bleeding underneath the skin.
"My legs started to swell one day," Kim, 48, recalls. "And then it got red, really red … all over, and lasted for weeks, sometimes months."
Besides the pain, Kim says she was too embarrassed to go out in public. It eventually led her into serious depression.
There is no definitive cause or cure known in modern medicine for purpura. Combined with inflammation, the hemorrhagic area begins with red spots, becomes darker into purple, and later fades away to a brownish-yellow color.
But now Kim is looking to another, less conventional method that she hopes will help treat her condition.
"When I was just about to give up, I learned through the Internet that making leeches to suck my blood could help," says Kim, as she sits in a waiting room in Handongha Traditional Korean Medical Clinic, in Seoul. "Disgusting, yes, but being desperate I had no other options left."
Dr. Dong-Ha Han — nicknamed "doctor leech" for his eight years of research on medical leeches — says he can treat patients with vasculitis, skin ulcer, atopic dermatitis, rheumatic arthritis, migraine and gout. His toolbox includes leeches that are starved for six months.
"The theory is you make them bite and suck clotted blood vessels, allowing fresh blood to circulate," Han explains, while holding a plastic container filled with inch-long leeches. The secret, he says, is in an enzyme known as Hirudin, a very powerful anti-coagulant in leech saliva.
The leeches are taken out of the container into a glass tube with which they can be slid onto the area of infection. Kim is now undergoing her fifth session of the treatment, which costs $220 per visit.
She flinches for a moment as the leech bites in.
"It feels like a needle poking, but the pain soon goes away," she sighs in relief. That's because leeches secrete local anesthetic enzymes naturally to avoid detection by the host.
Once attached, the leeches will suck blood from 30 to 50 minutes. From about an inch long, they will become more than three times that size. After completely feeding itself, the leech falls off and fresh blood continues to drip from that spot for a minute or two.
In this session, Kim has a total of 19 leeches attached on both her legs. During the therapy, swelling has been visibly reduced.
"The healing process allows fresh and oxygenated blood to stream into her infected area," Han explains. "That way, it would restore normal circulation."
Kim nods in approval. "It's gruesome at first. But I couldn't believe it when I saw the results."
Ancient Therapy Meets Modern Medicine
Leech therapy dates back 2,500 years to ancient Egypt, where bloodletting was practiced in the belief that it would bring balance to the human body.
Bloodletting continued on to medieval Europe, where doctors used leeches to treat tonsillitis by hanging a leech on a string and inserting it down the patient's throat. The treatment was so popular that commercial leech trading became an industry.
But supply could not keep up with extremely high demand, which led to near-extinction of the leeches used in the practice.
In Korea, leech therapy began 500 years ago. But according to Han, up until now modern medicine had largely disregarded treatments using the creatures. Now, however, he says the technique is slowly making a comeback. Indeed, many doctors are now using leeches to help restore circulation after microsurgery on ears or fingers.
"In Europe, especially in Germany, the leech therapy is widely used in modern western medical practice," said Dr. Byung-Kee Han, a plastic surgeon at Bundang Cha Hospital. But he adds that the fact that the therapy is not covered by insurance in Korea makes it a pricey option.
"There's a big market out there, but the therapy is not cost-effective, at least in Korea," he says.
Maggots May Also Have Medical Uses
Another popular biotherapy item in revival is maggots. By nature, maggots eat dead, bacteria-infected tissue without harming healthy living ones. Companies such as BioMonde (Korea) Co. Ltd. are hoping to capitalize on the use of medical maggots.
In their lab in Seoul, blowflies that have a lifetime of two to four weeks breed about 2,000 eggs each. The eggs are put into an incubator for one day to be hatched into maggots. After sterilization, they are sorted into nylon bags of various sizes. A small two-square-inch bag contains up to 200 maggots and sells for $310. Cost is high given each therapy requires three sessions, but sales at BioMonde have shot up 40 percent in the past eight months, the company said.
Dr. Chan-Yeong Heo, a plastic surgeon at Seoul National University Bundang Hospital, has found the therapy tremendously efficient on inoperable patients — those who have surgery phobia or are too old or weak to endure anesthesia.
"It's great when all other options are consumed," Heo says, adding that maggots are used mostly on microsurgery such as diabetic foot patients.
Han agrees that maggots have their applications. "Experiments have shown that maggot therapy is great on burns," he says. "It makes the skin into a perfect condition to receive a skin transplant."
Heo also favors the use of maggots on bedsore patients, especially the elderly. First, a flexible bandage is plastered around the wound to define the perimeters so that maggots cannot crawl off to other places on the body. After disinfecting the nylon bag full of maggots, he carefully places it on top of the wound.
"Patients feel a bit of a burning sensation when these maggots move around," he says.
The maggots can grow from one or two millimeters up to one centimeter in length after three to four days. During the process, not only do they eat the dead tissues on the wound, but the chemicals they naturally excrete inhibit and kill harmful bacteria.
Like leeches, maggots were widely used in medieval Europe and up until 1940s, when the medical industry made a technical leap into antibiotic therapy and surgery.
But the use of maggots in modern-day medical practice suggests that perhaps even the most unwelcome creatures can be efficient healers saving lives.
"There's no hard data on whether this works. It's only been recent that biotherapy has begun to be in the limelight," says Dr. Sae-Il Chun, dean of the Graduate School of Complimentary Alternative Medicine at Pochon CHA University in Korea. "But maggots and leeches for medical use is a legal market. And more and more, doctors are studying this academically."