Leech therapy, or Jalaukavacharana in Ayurveda, is an ancient therapeutic practice utilizing medicinal leeches (Hirudo medicinalis) to treat various ailments by drawing impure blood and promoting healing. This method, detailed in classical Ayurvedic texts like the Sushruta Samhita, has a long history of use for treating blood-related disorders (Raktaja) and inflammatory conditions. The therapeutic efficacy of leech therapy is attributed to the bioactive compounds secreted in leech saliva, such as hirudin (an anticoagulant), hyaluronidase (which enhances tissue permeability), and calin (a vasodilator). These compounds improve blood circulation, reduce inflammation, and facilitate wound healing. Contemporary applications of leech therapy have expanded beyond Ayurveda, finding utility in reconstructive plastic surgery, osteoarthritis, venous insufficiency, and chronic pain management. Compared to other bloodletting methods, leech therapy is minimally invasive, cost-effective, and environmentally sustainable, especially with advancements in leech cultivation. This review examines the clinical benefits, bioactive components, and potential for integrating leech therapy into modern healthcare systems. Additionally, it explores the environmental and economic advantages of leech farming and compares leech therapy with other traditional treatments like poultice therapy (upanaham). Despite its ancient roots, leech therapy continues to show promise as an alternative, integrative treatment in both traditional and modern medical practices.