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.
(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
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
* 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
* Selenium is a co-factor for glutathione peroxides, an
enzyme protecting cells against the effects of free radicals
* This may also explain the beneficial effects of water
taken by drinking or by lavage in gastrointestinal and
* 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
* 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
* 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.
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
(vi) The Lancet, 1990, i, 470.
(vii) Fish nutrition, New York, Academic Press, 1972.
(viii) Doga Tu Biyol Dergisi (Ankara), 1988, 12, 1 (abstract
(ix) Doga Tu Biyol Dergisi (Ankara), 1989, 13, 57 (abstract
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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