Blood covered the hotel room where Tsetsi Stoyanova had checked in for the night. It stained the sheets and the towels and trailed over the bed. The mess dribbled out from a wound on Stoyanova's back. It smelled. Not like sweat or iron but something else — something strong.
"The bleeding wouldn't stop. It just kept on going and going and going," Stoyanova says. "I made everything red and bloody."
But Stoyanova, then in her 30s, wasn't nervous about losing blood. She was excited. It was why she'd journeyed across her home country of Bulgaria.
Earlier that day, she and her boyfriend had clambered up a remote hilltop outside the city of Kardzhali, searching for a special lake renowned among certain locals. When they came across a stand of trees covered in ribbons, they knew they'd found it.
It was the peak of summer and the sun had turned the usually wide lake into a dried-up swamp. Stoyanova wiggled her toes in the muddy shore to entice what she had been pursuing for months: a thirsty leech.
Growing up, Stoyanova had been surrounded by folk remedies and alternative medicine. If someone in her family had a cold or the flu, they would treat it with fire cupping. Her mother and grandparents would take turns lighting a flame over the sick person's back and extinguishing the fire under a glass cup, making the enclosed skin redden and rise. Later, she got really into enemas. She used them on a daily basis for years.
So when she heard about a lake somewhere in southern Bulgaria, full of an "extremely healing variety of leech" she was drawn to the place. Supposedly, people had been going there for years to seek out the creatures. They would tie a ribbon to a tree if they found a leech to drink their blood. And Stoyanova was determined to join them.
The healing power of leeches has been immortalized for thousands of years, in the tombs of Egyptian pharaohs, verses of ancient Greek poetry, and early medical writings in Arabic, Chinese, and Sanskrit.
The Greek philosopher Hippocrates, sometimes called the father of medicine, asserted that disease arose from an imbalance of bodily fluids: phlegm, black and yellow bile, and blood. He claimed releasing "impure" blood could prevent sickness and cure disease. Physicians took the advice to heart. In the 2018 book Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood, journalist Rose George writes, "Bloodletting was as unquestioned as Band-Aids."
For early doctors looking to rid patients of what they believed was an unhealthy excess of blood, leeches were a perfect fit for the job. Different cultures used a number of species for bloodletting, but the most renowned was Hirudo medicinalis, also known as the European medicinal leech.
In the Middle Ages, the use of leeches spread as barbers added the animals to their toolkits of razors and scissors. At the time, the professionals were just as likely to drain blood and extract teeth from their clients as they were to cut hair.
The leech craze reached a peak in the early 1800s, when a famous French surgeon named François Broussais alleged that all disease stemmed from an inflammation in the gut and could be relieved by bleeding. Since cut-open veins tended to infection and often released too much blood, Broussais advocated for the use of leeches as a safer alternative.
In Biotherapy – History, Principles and Practice, a textbook about the use of living organisms in the treatment of disease, authors Olga Gileva and Kosta Mumcuoglu explain that doctors all over the world, from Brazil to Eastern Europe, used leeches to treat everything from headaches to epilepsy and tuberculosis. Russian emperors and English princes employed leeches when they fell ill. Embroidered leeches adorned women's dresses in France. Doctors prescribed the creatures with such frenzy that leech populations throughout Europe grew scarce.
Bloodletting eventually died out with the advent of antibiotics and the rise of modern medicine. But the use of leeches didn't disappear. The therapy survived to treat pain and reduce inflammation alongside other low-cost folk remedies, particularly in Eastern Europe where some pharmacies sold leeches by the jar well into the 1960s.
Today, using leeches for medical treatment is called hirudotherapy. Many of its professional practitioners, called hirudotherapists, promote leech therapy to treat a long list of medical conditions, from asthma to infertility. Through places likes the Academy of Hirudotherapy in Las Vegas — which charges $10,000 for its full course — almost anyone can become certified in the practice.
Some hirudotherapists specialize in beauty treatments and offer leech facials, in which the bloody contents of a leech's stomach are spread over a client's face in a sticky mask that's supposed to reduce wrinkles and promote glowing skin. Celebrities like the actor Demi Moore and model Miranda Kerr have talked about getting the treatment, boosting its popularity in recent years.
Stoyanova hardly knew anything about leech therapy or hirudotherapists back when she was trying to find the fabled lake with its treasure trove of leeches, nearly five years ago. She wasn't even sure what would happen if one bit her.
She’d spent days hunting down a vendor who sold leeches at a market near Kardzhali. Only then did she manage to get directions to the small village near the lake. She and her boyfriend took a taxi as far up the road as they could go and started walking. They stopped shepherds to ask for directions. They wandered in circles. The day started to get cold.
It wasn’t until late in the afternoon that Stoyanova and her boyfriend finally reached the shallow lake. She stuck her feet in the water and waited.
Eventually, one leech took the bait.
“It started coming in my direction and it was really huge,” she says. She scooped it up and stuck it on her back. Within seconds, the nearly three-inch-long leech latched onto her skin, unlocking its three jaws and unleashing hundreds of teeth to saw into the bountiful supply of warm blood.
“It was just a little pinch,” Stoyanova says. “You actually don’t feel anything after that.”
The pain of a leech bite is fleeting because of a clever chemical trick. In that first incision, leeches inject their prey with a natural painkiller so they can continue their work in the wild unnoticed.
As they drink their fill — swelling up to eight times their size — leeches pump hirudin and other blood-thinners into the wound to keep the blood from clotting. “You relax and let it do its job and then it peacefully drops off of you, into the water,” Stoyanova says.
The hirudin compound sticks around in the bloodstream long after a leech falls off its prey and swims away. A leech bite will keep bleeding, releasing a mix of lymphatic fluid and blood, sometimes for 12 hours or more.
That’s why, after walking back to the road, hitchhiking to the hotel and cleaning up as best she could, Stoyanova was still bleeding. “There was no way to stop it,” she says.
And yet, all that blood didn’t scare her. The next day Stoyanova wanted to experience the full effects of bloodletting. She’d bought some leeches from the vendor who’d given her directions to the lake, just in case she couldn’t find it. “We decided to apply maybe seven or eight leeches,” she says. The result was bloodier than before. “That was just too extreme to do when you’re away from home.”
The pilgrimage to the lake was just the beginning of Stoyanova’s blooming infatuation with leeches. Before heading back home, she stocked up on leeches from the vendor to explore the potentials of leech therapy, using herself as a guinea pig. Over the next few months, she stuck the animals behind her ears, inside her mouth, and along her legs. She used leeches over 200 times that year, she says.
Stoyanova has been working with leeches ever since. She keeps a hundred or so in a clear bucket at home and uses them for minor medical conditions, for bloodletting, and for fun.
“They don’t really work for everything,” she says. “But they do work for many, many things.”
Last year, she put a few dozen leeches on a balding man’s head. A few months later, she says his hair grew back. “Although it did grow back in white,” she admits.
Then, there’s the story she tells of a man whose leg was going to be amputated — the skin was turning black, from his toes to his thighs. A local nun heard about Stoyanova and her leeches and called her in.
“We placed about 60 on his leg,” Stoyanova says. New, pink tissue started to grow. Pus drained from beneath the blackened skin. “They canceled his amputation the following week,” she says. “It’s very emotional.”
She’s posted videos online of feasting buffalo leeches that can grow the length of your arm and documented the effects of leeches to treat varicose veins, toothaches, broken bones and back pain. Her YouTube channel has attracted more than 100,000 subscribers, and she started a website leech.com, which sells leeches.
Other enthusiasts swap similar tales of using the parasitic pets online. A recent post on a leech therapy Facebook group shows a picture of four swollen buffalo leeches, each the length of a Popsicle stick, curled up on a women’s back like a pile of sleeping seals. “Treating a muscle strain,” the caption reads.
A different post says, “Another wild Saturday night! 4 leeches on my knee and one on my usual spot in the elbow crease, and a 2-hour movie cued up.”
Across social media groups, people trade tips for how to raise leeches at home — the best websites to buy them from, how to make a leech enclosure, what to do when one gets sick. Stoyanova gives her own advice: their water should be changed by hand — the cast-off skins get stuck in filters. They can live for up to a year between meals. The hungriest swim the quickest in search of food. They make great pets, she says. Someday, she hopes to write a book on the care and use of leeches.
The mainstream medical community has long denounced bloodletting and many of the claims made by leech therapy advocates as quackery. But in the last few decades, leeches have found a footing in established medicine.
Molecular biologists have identified dozens of compounds in leech saliva that can reduce inflammation, disinfect wounds, dilate blood vessels, and prevent clotting. Clinicians have made use of these substances to manage knee pain from osteoarthritis; drain large collections of blood, called hematomas; and treat patients recovering from tissue transplants and reconstructive surgeries.
In 2004, the Food and Drug Administration cleared leeches for medical use — along with flesh-eating maggots that gnaw on rotting wounds — for tricky surgical procedures, like reattaching a thumb or flap of skin.
“When you attach something, you have to connect arteries, veins, tendons — the whole bit,” says Marcia Barnes, a nursing professor at Cumberland University who’s worked in plastic surgery for more than 20 years.
Often, it takes time for blood to start flowing well through a surgically connected vein, after the procedure. The resulting fluid congestion can cause clogging, damaging the delicate, newly attached tissues.
“When we become concerned about the blood collecting in that area, we’ll jump to leech therapy,” Barnes says. “They do it so well.”
Hospitals that use leeches have strict guidelines for leech therapy. Nurses rarely place more than six leeches on a patient at a time. Once a leech has done its job, it’s dunked in a bleach solution and disposed of.
And those leeches don’t come from the wild, like some far-flung lake in Bulgaria. Pharmaceutical companies supply hospitals with leeches from special manufacturers that grow the animals for medical use.
At one of those facilities, a company called Biopharm, based in Wales, maturing leeches are cared for by Carl Peters-Bond, an aquaculture specialist who’s raised leeches for over two decades. He feeds newborns sheep’s blood and monitors their growth, moving them from tropical conditions to cooler tanks as they age.
The animals can be difficult to rear. Leeches fed the same meals grow to different sizes. They’ll breed one week and not the next. And a leech can’t be sent off to a hospital until its stomach is empty, so Peters-Bond puts his leeches on a fasting diet. He makes sure the hungry parasites don’t eat each other and oversees a daily swimming regiment.
“They need exercise,” he says. “Bit like us really. If we sit on the couch we’re not going to lose any weight. So we’ve got to keep them moving.”
He’s heard of people who use leech therapy outside of hospitals, but he’s largely skeptical of the practice. “Some of them are a bit weird,” he says. “There’s not enough evidence on quite a lot of it to say that they’re going to work.”
The majority of Peters-Bond’s leeches end up in hospitals, but not all of them. The company sends a few hundred to veterinarians in the area who use the leeches on cats and dogs — often, French bulldogs — with hematomas. A few will go to players from local rugby and kickboxing teams who show up at Biopharm after a blow to an ear forms a nasty blood clot.
And sometimes Peters-Bond gets a shooting pain in his elbow. It’s an old injury that flairs up from repetitive strain. “I call it leech picker’s elbow,” he says.
When the pain gets bad enough once every few years, Peters-Bond will take a leech from its tank and coax it to bite his elbow. It helps ease the discomfort. “They do change the nature of the pain and they are reasonably effective,” he admits.
Ali Korhan Sig, a medical microbiologist at Hacettepe University in Turkey, has worked to separate the myths of leech therapy from the realities. He studies the proteins in leech saliva and points to scientific evidence that shows the therapy can treat a wide range of diseases and disorders. But he worries that people outside of the medical profession misuse leech therapy.
“Practitioners aren’t usually doctors,” Sig says. “[They’ll say] ‘Oh you have a headache? Let’s do leech therapy. You have a knee problem? Let’s do leech therapy. Do you have a cancer? Let’s do leech therapy.’”
There’s a strict standard of care for leech therapy in doctor’s offices and hospitals, but not for hirudotherapists, who aren’t regulated by any medical board, says Ron Sherman, a biotherapy expert and founder of the BioTherapeutics, Education & Research Foundation. Some hirudotherapists position leeches around the site of a client’s discomfort, while others place them along acupuncture meridians. “I’m not sure whether that’s hocus pocus or not,” says Sherman, who’s also a medical doctor specializing in infectious diseases.
Hirudotherapists looking for certification courses or leech distributers will often contact Sherman through his work with the biotherapy foundation. He believes working with them can only improve their quality of care, but he doesn’t endorse their treatments. “I really can’t judge what these individuals do, because I don’t know their practice,” he says.
Sherman adds that leech therapy comes with real medical risks. A wound that won’t clot can cause significant blood loss. And some people don’t have much blood to spare.
“Nothing is benign,” he cautions. “You need to know what you’re doing.”
Stoyanova says she doesn’t encourage anyone to try leech therapy. She only works with people who are already open to the idea. “Because when you start putting leeches on those people who are non-believers they will be grossed out. They will be scared. They won’t be able to stand it.”
Even new patients who come to her excited to try leech therapy can sometimes feel anxious about attaching the slimy creatures to their skin. But, she says, leeches have a way of growing on people.
“It’s been written that even some people start loving this animal after they’ve had it suck their blood,” she says.
Fearing leeches was never a problem for Stoyanova, she vows.
“I loved them from the very beginning.”