Atlas by Organ System
Twelve anatomic categories, every condition in the registry, cross-walked to specialty pages.
A complementary view to the Coverage Map: where Coverage Map organizes by evidence tier, this atlas organizes by organ system. Each of the twelve categories below lists the conditions ASH catalogues, the tier distribution within the category, and the cross-walk to the matching clinical-specialty page where one exists.
Across 12 populated categories, the registry currently holds 199 conditions. Tier framing is honest: most off-label applications are Tier C investigational; the FDA-cleared scope (K040187) is narrow and lives entirely in the surgical-reconstruction category.
Surgical Reconstruction
3Tier A: 3 \u00b7 Tier B: 0 \u00b7 Tier C: 0
The only FDA-cleared scope for medicinal leeches (K040187, 2004): relieving venous congestion in compromised tissue flaps and microsurgical replants. Mechanical drainage plus hirudin-mediated anticoagulation buys 5–10 days while neovascular ingrowth restores outflow.
Musculoskeletal
35Tier A: 0 \u00b7 Tier B: 4 \u00b7 Tier C: 31
The largest single Tier B indication: knee osteoarthritis. Multiple RCTs (Michalsen et al., Stange et al.) report short-term pain reduction comparable to topical NSAIDs. Tier C evidence extends to lateral epicondylitis, trigger finger, plantar fasciitis, and other tendinopathies.
- Knee Osteoarthritis
- Thumb Carpometacarpal (CMC-1) Osteoarthritis
- Lateral Epicondylitis (Tennis Elbow)
- Plantar Fasciitis
- Fibromyalgia
- Acute Gout Flare
- Mid-Substance Achilles Tendinopathy
- Rotator Cuff Tendinopathy
+ 27 more in this category
Vascular
19Tier A: 0 \u00b7 Tier B: 3 \u00b7 Tier C: 16
Hirudo medicinalis saliva contains hirudin (direct thrombin inhibitor), calin (anti-platelet), and destabilase (fibrinolytic) — a rational mechanistic match for venous stasis and microcirculatory disorders. Off-label clinical evidence covers chronic venous insufficiency, hemorrhoidal disease, and post-thrombotic syndrome.
- Chronic Venous Insufficiency (CEAP C3-C5)
- Venous Leg Ulcer
- Post-Thrombotic Syndrome
- Varicose Veins (Symptomatic Tributaries)
- Raynaud's Syndrome (Primary)
- Primary or Secondary Lymphedema
- Post-Mastectomy Lymphedema
- Deep Vein Thrombosis (Post-Acute Phase Symptoms)
+ 11 more in this category
Dermatological
41Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 41
Hirudotherapy in dermatology is largely investigational: case series in keloid scars, hidradenitis suppurativa, periorbital lipoma reduction, and chronic ulcers. The bite-wound prolonged ooze and local anti-inflammatory cascade are the proposed mechanism.
- Livedo Reticularis
- Lipodermatosclerosis
- Insulin Injection Lipohypertrophy
- Androgenic Alopecia
- Rosacea (Erythematotelangiectatic)
- Plaque Psoriasis (Localized)
- Atopic Eczema (Localized Refractory)
- Keloid and Hypertrophic Scarring
+ 33 more in this category
Neurological
37Tier A: 0 \u00b7 Tier B: 2 \u00b7 Tier C: 35
Neurological applications are predominantly Tier C investigational — cervicogenic headache, migraine prevention, post-herpetic neuralgia, idiopathic facial paralysis. Proposed mechanisms involve local nerve decompression via edema reduction and anti-inflammatory salivary peptides.
- Cervical Radiculopathy
- Lumbar Radiculopathy (Sciatica)
- Migraine
- Tension-Type Headache
- Sciatica (Non-Discogenic / Piriformis)
- Bell's Palsy (Acute Idiopathic Facial Paralysis)
- Trigeminal Neuralgia (Classical / Idiopathic)
- Lumbosacral Radiculopathy (Non-Discogenic)
+ 29 more in this category
Cardiovascular
4Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 4
Cardiovascular indications remain investigational and are not first-line therapy: angina pectoris, post-MI rehabilitation, hypertension. Russian and German integrative-medicine traditions form most of the published literature; rigorous RCT evidence is absent.
Ophthalmologic
3Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 3
Investigational use for glaucoma (intraocular pressure modulation), central retinal vein occlusion, and certain inflammatory eye conditions. Applied to periorbital tissues, never the globe itself. Evidence is limited to small Russian-language pilots.
ENT (Otolaryngology)
17Tier A: 0 \u00b7 Tier B: 1 \u00b7 Tier C: 16
Ear/nose/throat applications include post-traumatic ear replantation (Tier A), and investigational use in sudden sensorineural hearing loss, chronic rhinosinusitis, and Meniere's disease. Microsurgical scope here overlaps with reconstructive surgery.
- Chronic Rhinosinusitis
- Subjective Tinnitus
- Ménière's Disease (Adjunctive)
- Pulsatile Tinnitus (Vascular-Origin Subtype)
- Meniere's Disease (Vestibular Attack Frequency)
- Peripheral Vertigo (BPPV-Refractory / Vestibular Neuritis Recovery)
- Chronic Tonsillitis (Investigational Cervical Adjunct)
- Recurrent Otitis Media in Adults (Investigational)
+ 9 more in this category
Gastrointestinal
10Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 10
GI applications are investigational and topographic — abdominal wall placement for hepatic congestion, irritable bowel symptoms, and chronic pancreatitis. Mechanism is hypothesized to involve hepatic venous decongestion and segmental autonomic modulation.
- Hemorrhoids (Grade II-III, Symptomatic)
- External Thrombosed Hemorrhoid (Acute, <72h)
- Chronic Anal Fissure (>8 Weeks)
- Non-Alcoholic Fatty Liver Disease (Investigational Adjunct)
- Hepatic Portal Congestion (Non-Cirrhotic, Investigational)
- Chronic Pancreatitis (Investigational Pain Adjunct)
- Ulcerative Proctitis (Investigational Adjunct)
- Symptomatic Gilbert Syndrome (Investigational Adjunct)
+ 2 more in this category
Urogenital
11Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 11
Urological applications include chronic prostatitis / chronic pelvic pain syndrome and erectile dysfunction of vascular origin. Evidence is Tier C, with the largest series from integrative-medicine clinics in Eastern Europe.
- Peyronie's Disease (Stable Phase)
- Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS)
- Chronic Prostatitis / Chronic Pelvic Pain Syndrome (Extended Protocol)
- Interstitial Cystitis / Bladder Pain Syndrome (Investigational)
- Peyronie's Disease (Extended Investigational Adjunct)
- Varicocele (Investigational Adjunct)
- Chronic Epididymitis (Investigational Adjunct)
- Chronic Orchialgia (Investigational Adjunct)
+ 3 more in this category
Gynecologic
12Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 12
Reported off-label uses include adenomyosis, chronic pelvic pain, and post-cesarean adhesions. All indications are Tier C investigational; pregnancy is a relative contraindication for all hirudotherapy applications.
- Lactational Mastitis (Non-Suppurative)
- Endometriosis-Related Pelvic Pain
- Primary Dysmenorrhea
- Chronic Pelvic Pain Syndrome (Non-Specific)
- Premenstrual Syndrome (Investigational)
- Polycystic Ovary Syndrome (Investigational Adjunct)
- Vulvodynia (Investigational)
- Cyclical Mastalgia (Investigational Adjunct)
+ 4 more in this category
Other
7Tier A: 0 \u00b7 Tier B: 0 \u00b7 Tier C: 7
Conditions that do not fit cleanly into a single organ-system category — systemic, multi-system, or rare presentations catalogued for completeness of the registry.
- Metabolic Syndrome (Investigational Adjunct)
- Hashimoto's Thyroiditis (Investigational Cervical Adjunct)
- Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (Investigational Adjunct)
- Stage III Postsurgical Lymphedema (Highly Investigational Adjunct)
- Recurrent Aphthous Stomatitis (Investigational Adjunct)
- Chronic Postsurgical Pain Syndrome (Investigational Adjunct)
- Dercum Disease (Adiposis Dolorosa, Investigational Adjunct)
How to read this atlas
- Tier A conditions are FDA-cleared (K040187 scope: venous congestion in surgical flaps). They live almost entirely in the surgical-reconstruction category.
- Tier B conditions are off-label but supported by at least one RCT or systematic review. Most concentrated in the musculoskeletal category (knee OA, lateral epicondylitis).
- Tier C conditions are investigational \u2014 mechanistic rationale, case series, or small pilots. Read the per-condition page for honest framing of what the evidence does and does not say.
- The cross-walk link on each card points to the matching clinical-specialty page where one exists \u2014 those pages give a clinician-oriented view of the same conditions with safety protocols.
For the tier-based view, see the Coverage Map. For the full conditions list, see the Conditions Atlas.