No doubt, “Leech” is one of the main para- surgical sharp instrument. ‘Fistula in Ano’ is one of the surgical disorder of vital organ i.e. ano- rectal region. Being a vital organ and surgical- disorder “Leech” can play main safe role in the line of treatment of ‘fistula in Ano’ Basic action of Leech is anti-In flammatory, safe- anesthetic, healing nature and “Leech” wound is cosmetic. First stage of Fistula in Ano is deep seated inflammation or Abscess within 4 cms from the anal region and “Leech” is the best anti – inflammatory. Blind external Fistula in Ano is complicated than Blind internal Fistula in Ano. In this condition, specially “Leech” is the best Para- surgical sharp instrument or Anu- shastra for incision & drainage without occurring complications. Main line of treatment should be completed safely without complications No doubt “Leech” can do this job very successfully. Kshar- Sutra chikitsa is proved scientifically for fistula in Ano. If “Leech” help can be taken in pre operative management of fistula in Ano, then, we will get best result without occurring complication and in all stage of fistula in Ano. “Leech is the best remedy because fistula in Ano is surgical disorder of vital organ and Anu - shstra is the basic surgical line of treatment for such conditions, and no doubt, Leech is the best and first number one in the list of Anu- Shastra. Main aim and object of Ayurved is to prevent disease by birth, and for that Panch - Karma related according to season is the best solution. Blood letting is one of the main basic emergency way of Blood letting specially fruitful for localised surgical-disorder e.g. “fistula in ano. Clinically, “Leech” is proved best divine boon in fistula in Ano specially in pre- operative condition of ‘Fistula in Ano’ without complication.