Where Doctor Fish Lick Disease
by Dr Levent Undar, Dr Ali Akpınar and Dr Atilla Yanıkoglou
May 10, 1990 Hospital Doctor Vol C10 No 19

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 socalled doctor fish of KANGAL.

These fish can be found in the pools of a hotspring 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 13km 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.

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Licker ... gives relaxing underwater skin message

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Striker ... a specialist in human skin disease

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 emphasised for its biological and therapeutic aspects (i).

The springs were first noticed by people from neighbouring 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), orthopaedic and traumatological sequelae (fractures, joint trauma, and muscle disease), gynaecological 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.

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Down to the bone ... doctor fish eat their weaker colleaues

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 glutathion peroxidase, 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 gynaecological 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 hotspring 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.

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Post-prandial contentment ... a prospective patient is ignored

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 hotspring, there is a psychological component to this massage which generates a feeling of wellbeing in patients with neurologic and rheumatic diseases, and with 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 wellbeing.

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 hyperkeratinized 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 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 lenght of 19cm. Its body is also convered with large scales.

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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 uncrowded 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 aquarimun have been observed to search for food and to strike out at, not only a hand, but also anythingimmersed: for example, a pencil, or an insect.

Fish fed adequately in an aquarium did not do this.

Cannibalism has also been observed. Hungry fish attack and eat weak or injured fish until only the skeleton is left.

The observation that the population of fish in the pools remains constant supports the theory that the fish are cannibals.

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.

We need to look, too, at the possiblity that they could transmit hepatitis and HIV.

  1. (i) Fen Bilimleri Dergisi (Sivas), 1987, Supplement 5,1 (abstract in English)

  2. (ii)Ankara Bilgi Basımevi, 1969 (in Turkish)

  3. (iii)Science, 1983, 220, 472.

  4. (iv)The Lancet, 1989, ii, 1093.

  5. (v)Vet Facult Dergisi (Ankara), 1983, 30, 276 (abstract in English)

  6. (vi)The Lancet, 1990, i, 470.

  7. (vii)Fish nutrition, New York, Academic Press, 1972.

  8. (viii)Doga Tu Biyol Dergisi (Ankara), 1988, 12, 1 (abstract in English).

  9. (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 Akpınar and Dr Yanıkoglou are with the department of biology in the faculty of science and art, Cumhuriyet University, Sivas, Turkey. click here to make online booking


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