About fish species and the patients

Featured by Assoc.Prof.Dr. Levent Undar, the Faculty of Science, Dr. M. Ali Akpinar and Dr. Atilla Yanikoglu, Deparment of Internal Medicine, Faculty of Medicine and Deparment of Biology of Cumhuriyet University, 58040 Sivas - Turkey.

Dr. Fish (Doctor Fish) Garra rufa

PATIENTS with chronic, intractable disease tend to seek help from a wide range of alternative sources. But among the more bizzare is the treatment given by the so called doctor fish of KANGAL. These fish can be found in the pools of a hot-spring near Kangal, a small town in Turkey. The area is also known for the Kangal dog, a sheepdog, and a sheep with an extra rib. The spring is 13 km from Kangal in a tiny settlement, consisting of a hotel, some pensions, a camping area, a small restaurant, a market and four bathing pools, three of which are open-air. The pools have concrete walls and floors paved with pebbles and drain into a stream which runs between the buildings. The water, with a pH of about 7.2, is isothermal and maintains a temperature of about 35 ° C throughout the year. It has features which make it drinkable (i).

The presence of selenium (1.3ppm) has been emphasized for its biological and therapeutic aspects (i).
The springs were first noticed by people from neighboring villages in the early 1800s.
The pools were built in 1900, and were opened to the public in 1963 (ii).

The water has been reported as being beneficial in rheumatic disease, neurologic disorders (neuralgia, neuritis, paralysis), orthopedic and traumatological sequelae (fractures, joint trauma, and muscle disease), gynecological problems (by lavage), skin diseases, urolithiasis (by drinking), and psychosomatic disorders (a report from the Clinic and Institute of Physical Therapy and Hydrology, Faculty of Medicine Ankara University, March 2, 1967)(ii).

But psoriasis is the disease which has made the spring so popular as a therapeutic aid (ii).

* The fish strike and lick the psoriatic plaque - or plaques of other skin diseases - which have been softened by the water.
* This clears away the scales, causes minor bleeding, and exposes the lesion to water and sunlight.
* This may also cause drainage of pus in patients with abscesses.
* The high level of selenium in the water, an element the topical application of which is beneficial in some diseases, is reported to be the most important factor for wound healing (i).
* Selenium is a co-factor for glutathione peroxides, an enzyme protecting cells against the effects of free radicals (iii).
* This may also explain the beneficial effects of water taken by drinking or by lavage in gastrointestinal and gynecological disorders.
* Observers, other than those from Turkey, reported that bathers were enthusiastic about the doctor fish and none expressed disappointment (iv).
* Wide interest in the doctor fish encourages people with neurological and rheumatic diseases to visit the hot-spring to immerse themselves in its pools.

A school of fish surround the body and strike and lick it. The initial pleasant sensation and relaxation of “micro-massage” is replaced by a tingling sensation over the skin. This massage is given particularly by the younger fish, which need many more nutrients for their rapid growth. It may be that, in addition to the benefits of hydrotherapy from the hot-spring, there is a psychological component to this massage which generates a feeling of well-being in patients with neurologic and rheumatic diseases, traumatic diseases and with traumatic sequalae.

The faith of desperate patients in these sacred fish, and the experience of being in a different environment may also contribute to this feeling of well-being.

* Not only the ill, but also the healthy, visit the spring to consult the doctor fish.
* People with healthy skin probably benefit by the fish clearing away hyper keratinized portions of their skin.
* Two types of fish are involved. Both are members of the Cyprinidae family and are adapted to living in a hot milieu (i) (v).
* The so-called striker is Cyprinion macrostomus.
* It has a terminal mouth and a length of 15 to 20cm.
* It is covered with relatively large scales, and has six to eight irregularly arranged lateral spots of various sizes.
* The second fish, known locally as a licker, is Garra rufa obtusa.
* It has a crescent-shaped ventral mouth and a maximum length of 19cm. Its body is also covered with large scales

The so-called jabbers are not a third type of fish but the immature from of the strikers, which lose their lateral spots during maturation (vi). Both fish are omnivorous, a well-known feature of Cyprinidae (vii), and feed on phytoplankton and zooplankton. But only small amounts of plankton have been found in the pools (i). This is said to retard the growth and development of the fish, making them aggressive and predatory (viii). In winter when the pools are not crowded, the fish look for food like a flock of hungry sheep. In summer, they assault the human bodies in the pools (i). They prefer to attack diseased rather then healthy skin simply because it is easier to nibble at it. It has been shown experimentally that food deprivation is the reason why the fish eat off man (i).

Fish starved for 21 days in an aquarium have been observed to search for food and to strike out at, not only a hand, but also anything immersed: for example, a pencil, or an insect. Fish fed adequately in an aquarium did not do this. The effects of these feeding habits and the high temperature of the water on the internal biochemistry of the fish has also been investigated (viii), (ix).

The role the doctor fish can play in therapeutic medicine deserves proper study.

(i) Fen Bilimleri Dergisi (Sivas), 1987, Supplement 5,1 (abstract in English)
(ii) Ankara Bilgi Basimevi, 1969 (in Turkish)
(iii) Science, 1983, 220, 472.
(iv) The Lancet, 1989, ii, 1093.
(v) Vet Facult Dergisi (Ankara), 1983, 30, 276 (abstract in English)
(vi) The Lancet, 1990, i, 470.
(vii) Fish nutrition, New York, Academic Press, 1972.
(viii) Doga Tu Biyol Dergisi (Ankara), 1988, 12, 1 (abstract in English).
(ix) Doga Tu Biyol Dergisi (Ankara), 1989, 13, 57 (abstract in English).

Dr. Undar is associate professor of internal medicine in the Faculty of Medicine, and Dr. Akpinar and Dr. Yanikoglu are with the department of Biology in the Faculty of Science and Art, Cumhuriyet University, Sivas, Turkey.

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