Bloodletting therapy is an effective treatment method guided by the basic theories of TCM, which aims to harmonize qi and blood, balance yin and yang, and restore righteous qi by expelling evil qi through bloodletting. “Applying bloodletting therapy to release a certain amount of blood from specific veins in the human body can treat many diseases, and its effects are remarkable, allowing many patients with critical conditions, long-term ineffective treatments, and unbearable pain to regain new life.”

“Bloodletting therapy” is also known as “bloodletting” or “collateral puncture therapy,” and it is indeed a method of TCM treatment, first recorded in the “Huangdi Neijing.” “However, bloodletting therapy is not a panacea and has specific indications; it should not be used beyond its scope.”

Bloodletting therapy is an effective treatment method guided by the basic theories of TCM, aimed at expelling evil qi and achieving the purpose of harmonizing qi and blood, balancing yin and yang, and restoring righteous qi, applicable to various diseases with “disease in the blood collaterals.”

The methods of bloodletting mainly include collateral puncture, Zanzhi puncture, and leopard pattern puncture, which have developed over time. Modern clinical bloodletting should be performed after routine disinfection, with techniques that are light, shallow, quick, and precise, with a depth of 0.1 to 0.2 inches being appropriate. The amount of blood drawn is generally a few drops to several milliliters, but it can also be as much as 30 to 60 milliliters.

1. Point puncture method

Needles can be selected from three-edged needles or coarse fine needles. There are generally three forms of point puncture.

1. Direct point puncture method: First, knead and press the acupuncture site to induce local congestion, then hold the needle with the right hand, pinching the needle handle with the thumb and index finger, and the middle finger close to the lower end of the needle, leaving 0.1 to 0.2 inches of the needle tip exposed. Quickly insert it into the previously disinfected area. After insertion, immediately withdraw the needle, gently squeeze around the puncture to allow a few drops of blood to flow out, and then apply pressure with a sterilized cotton ball. This method is suitable for peripheral areas, such as the twelve Jing points, Shixuan points, and ear apex points.

2. Grasping point puncture method: This method involves pinching the skin and muscle at the acupuncture point with the left hand, while the right hand inserts the needle to a depth of 0.5 to 1 inch. After withdrawing the needle, squeeze the area to induce bleeding. This is commonly used for puncturing points like Cuanzhu, Shangxing, and Yinchang.

3. Tying point puncture method: This method involves tying a rubber band around the upper end of the puncture site, disinfecting the area, then pressing the thumb of the left hand on the lower end of the puncture site while the right hand inserts the needle at the targeted blood vessel. After withdrawing the needle, allow a small amount of blood to flow out. Once bleeding stops, the band can be loosened, and pressure can be applied with a sterilized cotton ball.

2. Scattered puncture method

This method is also known as “cluster puncture” or “surrounding puncture.” The technique involves using a three-edged needle to puncture multiple points around the lesion to induce bleeding. This method covers a larger area compared to point puncture and is more suitable for treating skin diseases and soft tissue injuries, such as stubborn ringworm, erysipelas, and local bruising.

3. Tapping puncture method

This method is a further development based on scattered puncture, using skin needles (plum blossom needles, seven-star needles, or skin rolling needles). During operation, hold the needle handle with the right hand, extend the index finger to press on the middle section of the needle handle, and use wrist strength to perform rhythmic tapping on a specific area. The required stimulation intensity for bloodletting should be strong enough to cause bleeding like beads on the skin. This method has good efficacy for certain neuropathic pain and skin diseases.

4. Scraping puncture method

This method involves pressing the sides of the treatment area with the left hand to stabilize the skin, while the right hand uses a three-edged needle or coarse round needle to scrape the acupoint or reaction point to induce bleeding; or to penetrate the skin to scrape out or break some fibrous tissue, squeezing to induce bleeding, then covering the area with a disinfected dressing and securing it. This is commonly used for treating red and swollen eyes, erysipelas, breast abscesses, and hemorrhoids.

5. Incision and injection method

This method involves using a small scalpel or surgical knife to cut the skin, mucous membrane, or small vein at the acupoint to release a certain amount of blood, then covering it with a disinfected dressing. The incision is generally about 0.5 centimeters long, while small veins should be cut to a depth of 1/3.

6. Needle cupping method

This is a treatment method that combines needle puncture with cupping for bloodletting. It is mostly used on the trunk and proximal limbs where the cupping can be applied. The procedure involves first puncturing the area with a three-edged needle or skin needle to induce bleeding (or not), then applying the cupping. Generally, the cupping is left for 5 to 10 minutes, allowing a certain amount of blood to be drawn out. This method is suitable for treating large areas of erysipelas, neurodermatitis, sprains, and strains.

7. Fire needle method

This method, also known as fire needling, involves using a specially made coarse needle that is heated red and then inserted into a specific area to treat diseases. It is suitable for cold bi syndrome, carbuncles, etc. Contraindications and precautions:

1. Heat-clearing effect

In TCM, fever is mainly classified into two types: Yang excess heat and Yin deficiency heat. The heat-clearing effect of bloodletting is applicable to the former. Since excess Yang must correspond to excess blood, bloodletting can reduce the excess blood, thereby decreasing the evil heat in the blood vessels and normalizing the body’s qi and blood.

2. Pain relief effect

“Where there is flow, there is no pain,” meaning that diseases with pain symptoms must have blockages in their meridians. Bloodletting can directly expel the stagnant evil from the meridians, adjusting the blocked situation, and once the meridians are unblocked, the pain can be immediately relieved. Many acute diseases, such as sore throat and migraines, can achieve rapid and good results with bloodletting therapy.

3. Detoxification effect

The detoxification effect in TCM refers to the symptoms that arise when the body’s functions are impaired and cannot resist toxins, such as “red thread carbuncles” caused by excessive toxic heat, and ulcers and abscesses caused by toxic invasion. Bloodletting can expel the invading toxins from the body, and more importantly, through the action of “regulating blood and qi,” restore normal bodily functions to suppress the expansion and regeneration of pathogens.

4. Fire-clearing effect

In TCM, internal heat disturbances can lead to various diseases, often manifesting as restlessness, mouth sores, limb pain and swelling, irritability, and even fever, confusion, and delirium. Bloodletting can directly expel the fire heat evil along with the blood, making it suitable for various heat syndromes.

5. Swelling reduction effect

Swelling and pain are often caused by qi stagnation and blood stasis, leading to obstruction in the meridians. Bloodletting can directly eliminate the stagnant qi and blood and pathogens in the local meridians, promoting unobstructed meridians and achieving the purpose of reducing swelling.

6. Itch relief effect

Itching is a manifestation of wind evil existing in the blood vessels, hence the treatment principle of “treating wind by first treating blood; when blood flows, wind will naturally disappear.” Bloodletting regulates blood and qi, ensuring smooth blood flow, thus achieving the effect of dispelling wind and relieving itching.

7. Numbness relief effect

Qi deficiency cannot guide blood to the extremities, or blood deficiency fails to nourish, often resulting in numbness symptoms. Using fine needles to puncture the acupoints on the affected limbs to draw a small amount of blood to treat numbness is guided by the theory of blood promoting qi, yielding good results.

8. Anti-nausea effect

Acute vomiting is often due to excessive stomach heat or liver qi invading the stomach or food stagnation. Bloodletting can clear heat and calm the liver, as well as guide the intestinal and gastric stagnation downward, thus alleviating nausea and vomiting.

9. Diarrhea relief effect

Bloodletting treatment for diarrhea generally refers to heat diarrhea caused by food stagnation in the intestines or diarrhea caused by exposure to epidemics, leading to indistinct separation of clear and turbid. The mechanism is to clear heat and reduce fire, achieving the effect of elevating the clear and lowering the turbid.

10. Emergency effect

The so-called emergency effect refers to sudden fainting, convulsions, and loss of consciousness. Bloodletting can improve blood circulation and is an effective rescue method.

1. Contraindications

In clinical applications of bloodletting therapy, there are indications and contraindications. Therefore, it is essential to flexibly grasp the patient’s condition, constitution, the puncture site, and certain special situations to prevent accidents. The contraindications for bloodletting include:

1. Avoid deep puncture near important internal organs. The “Suwen: Discussion on Puncture Prohibitions” states, “If the organs have vital points, they must be carefully observed,” and lists the severe consequences of injuring organs, brain, and spinal cord. This understanding is consistent with modern clinical observations and should be given sufficient attention.

2. Bloodletting is prohibited for arterial blood vessels and larger venous blood vessels. Directly puncturing superficial small blood vessels for bloodletting is the basic method of bloodletting. However, strict adherence to operational techniques is required, and it is forbidden to squeeze. Bloodletting is prohibited for arterial blood vessels and larger venous blood vessels, including severely varicose veins. Caution is also required when puncturing acupoints near large blood vessels to prevent accidental injury. Recent reports have indicated that using a three-edged needle to treat acute mastitis resulted in injury to the intercostal artery, causing significant bleeding, which required surgical intervention to stop the bleeding.

3. Blood deficiency, especially in patients with blood deficiency or yin fluid deficiency, is prohibited from bloodletting. The “Lingshu: Discussion on Blood Collaterals” states: “If the pulse is strong but the blood is deficient, puncturing will lead to loss of qi, and loss of qi will lead to fainting.” Therefore, blood deficiency (including severe anemia, low blood pressure, spontaneous bleeding, or persistent bleeding after injury) should avoid bloodletting to prevent falling into the trap of deficiency. Blood and sweat share the same origin and are transformed from body fluids, so those with yin fluid deficiency or excessive sweating should also avoid bloodletting. If this method must be used, it should be determined based on the balance of pathogenic factors and righteous qi, and excessive bloodletting should be avoided.

4. Pregnant women and those with a history of habitual miscarriage should avoid bloodletting.

5. Patients who are temporarily fatigued, overfed, emotionally disturbed, or have insufficient qi and blood should avoid bloodletting.

2. Precautions

When applying bloodletting therapy, it is essential to fully consider the patient’s constitution, the state of qi and blood, the nature of the disease, and the urgency of the condition. The following points must be noted:

1. Detailed observation of the patient’s condition: The “Lingshu: End and Beginning” states: “For all puncture methods, one must observe the shape and qi.” During clinical bloodletting, it is necessary to determine the corresponding treatment principles based on the patient’s constitution, qi characteristics, and the state of spirit. The depth of puncture and the amount of blood drawn should be determined based on the patient’s height, weight, strength, and weakness.

2. Distinguishing deficiency and excess: The “Suwen: General Discussion on Deficiency and Excess” states: “When evil qi is strong, it is excess; when essence is lost, it is deficiency.” Deficiency and excess summarize the relationship between evil and righteousness. Since the effect of bloodletting mainly aims to resolve “blood excess” and remove “stagnation” to achieve disease cure, it is especially used for excess and heat syndromes.

3. Understanding the root and branch: Bloodletting therapy is often used as an important symptomatic treatment in clinical practice. For severe diseases, it is advisable to first perform bloodletting to alleviate suffering, and then based on the nature of the disease, decide whether to tonify or drain. In modern medicine, for various causes of high fever, coma, convulsions, and other critical conditions, bloodletting is first used to clear heat and open the orifices to treat the symptoms, and then the root cause of the disease is addressed.

4. Determining blood and qi: The “Lingshu: Functions” states: “The principle of using needles must be understood in terms of the location of shape and qi, left and right, up and down, yin and yang within, and the amount of blood and qi.” Therefore, the amount of qi and blood in the twelve meridians and their circulation should determine the bloodletting and the amount of blood drawn. For example, puncturing Shangyang to treat coma, toothache, and sore throat; puncturing Cuanzhu to treat headaches and red and swollen eyes; puncturing Weizhong to treat low back pain and vomiting; and puncturing Quze to treat heart pain, irritability, and vomiting are all based on the amount of qi and blood in the meridians.

5. Adapting to seasonal changes: The “Suwen: Discussion on Diagnosis” states: “Spring, summer, autumn, and winter each have their own puncture methods.” It also states: “In spring, puncture the dispersing points and the dividing points… in summer, puncture the collaterals and stop when blood is seen.” This indicates that treatment should correspond with the seasons and the natural order. Based on the seasonal changes and the corresponding organs, the treatment should be adjusted. For example, if the foot Taiyang meridian causes low back pain, bloodletting should be performed at Weizhong, but bloodletting should not be done in spring; the foot Taiyang meridian corresponds to the cold water organ, and in spring, wood is strong and water is weak, so bloodletting should not be performed. Similarly, if the foot Yangming meridian causes low back pain, bloodletting should be performed at Zusanli, but bloodletting should not be done in autumn; since Yangming corresponds to earth, which is strong in late summer, and in autumn, metal is strong and wood is weak, bloodletting should not be performed.