Leech therapy in medicine traces its historical roots and evolution back to the ancient Greeks and Egyptians, who employed leeches for bloodletting. This was followed in medieval Europe whereby leeches gained popularity in treating various ailments from headaches to fevers. The Renaissance witnessed a surge in leech use, with the advent of medical literature documenting their application in diverse medical contexts. The 19th century medicinal leech's role in bloodletting reaches its zenith, followed by a decline in the early 20th century with the advent of modern medicine. However, a resurgence occurs in the latter half of the century, fuelled by advancements in microsurgery and the discovery of hirudin, an anticoagulant in leech saliva which remains a pivotal part of many reconstructive surgery departments for the salvage of venously congested tissues.  The rich tapestry of medicinal leech therapy, tracing its historical roots and evolution as a therapeutic modality, the captivating narrative of leeches in medicine, from ancient civilizations to contemporary applications will be further discussed.