1. Overview of Bloodletting Therapy in Traditional Chinese Medicine
Bloodletting therapy, also known as “needling bloodletting therapy,” is a method that involves using needles or blades to puncture or incise specific acupuncture points and areas of the body to release a small amount of blood for the treatment of diseases.
This therapy can be traced back to the Stone Age. At that time, people discovered through labor that using sharp stones—bian stones—could treat certain diseases by pricking and letting blood at the affected area. With the advancement of science, the tools for bloodletting evolved from stone to metal needles, and later specialized “sharp needles” were developed for bloodletting therapy. The earliest written records of this therapy can be found in the Huangdi Neijing, stating, “Needling the collaterals means to prick the small collaterals of blood vessels”; “When the blood is stagnant, it should be removed to release the bad blood.” It clearly states that bloodletting can treat conditions such as mania, headaches, deafness, heat-induced asthma, and epistaxis. It is said that Bian Que cured Prince Guo’s “corpse syndrome” by bloodletting at the Baihui (Hundred Meetings) point, and Hua Tuo used bloodletting to treat Cao Cao’s “head wind syndrome.” By the Tang and Song dynasties, this therapy had become one of the major practices in Traditional Chinese Medicine. The New Book of Tang records that the imperial physicians of the Tang dynasty used bloodletting on the top of the head to cure Emperor Gaozong’s “dizziness and inability to see.” By the Song dynasty, this method was included in the acupuncture verses of the “Yulong Fu.” During the Jin and Yuan dynasties, Zhang Zi He in his Rumen Shiqin recorded numerous cases of effective bloodletting, believing it to be the quickest way to attack pathogens. By the Ming and Qing dynasties, bloodletting had become very popular, and the development of needles advanced rapidly, with three-edged needles being categorized into coarse and fine types, making them more suitable for clinical application. Yang Jizhou’s Great Compendium of Acupuncture and Moxibustion detailed many cases of bloodletting; Ye Tianshi used this therapy to cure throat diseases; Zhao Xueming and Wu Shangxian compiled many bloodletting methods in Chuan Ya Wai Bian and Li Yan Pian Wen. In modern times, bloodletting therapy is still widely used, especially in folk medicine, and its value is gradually being recognized and accepted.
2. Basic Content of Bloodletting Therapy in Traditional Chinese Medicine
When it comes to bloodletting therapy, it can treat many diseases. In my clinical practice, I often use bloodletting therapy to treat diseases, especially when other treatment methods are ineffective. Bloodletting therapy often has a turning point effect. Bloodletting therapy refers to using a three-edged needle, coarse needle, or small scalpel to puncture superficial blood vessels at acupuncture points, releasing a small amount of blood to expel internal heat toxins, thus treating diseases. It has effects such as reducing swelling and pain, dispelling wind and itching, opening orifices and releasing heat, calming nausea and diarrhea, and promoting circulation and relieving blockages.
The earliest written records of this therapy can be found in the Huangdi Neijing, stating, “Needling the collaterals means to prick the small collaterals of blood vessels”; “When the blood is stagnant, it should be removed to release the bad blood.” It clearly states that bloodletting can treat conditions such as mania, headaches, deafness, heat-induced asthma, and epistaxis. It is said that Bian Que cured Prince Guo’s “corpse syndrome” by bloodletting at the Baihui (Hundred Meetings) point, and Hua Tuo used bloodletting to treat Cao Cao’s “head wind syndrome.” By the Tang and Song dynasties, this therapy had become one of the major practices in Traditional Chinese Medicine. The New Book of Tang records that the imperial physicians of the Tang dynasty used bloodletting on the top of the head to cure Emperor Gaozong’s “dizziness and inability to see.” By the Song dynasty, this method was included in the acupuncture verses of the “Yulong Fu.” During the Jin and Yuan dynasties, Zhang Zi He in his Rumen Shiqin recorded numerous cases of effective bloodletting, believing it to be the quickest way to attack pathogens. By the Ming and Qing dynasties, bloodletting had become very popular, and the development of needles advanced rapidly, with three-edged needles being categorized into coarse and fine types, making them more suitable for clinical application. Bloodletting therapy is widely used for various diseases, from common colds and fevers to severe acute illnesses, often achieving remarkable results.
3. Bloodletting Treatment in Traditional Chinese Medicine
In my experience, bloodletting is most commonly used for treating conditions such as stasis and acne, as well as skin diseases. Today, I will systematically discuss bloodletting treatment.
(1) Case Studies
Conditions such as stasis, cold syndromes, bi syndrome, atrophy syndrome, lumbar pain, sciatica, headaches, eye pain, thrombosis, adolescent acne, psoriasis, and eczema can all be treated with this method. In my clinical practice, I have treated many patients with reliable and effective results.
(2) Treatment Methods
1. Bloodletting points: For headaches, use the Dazhui (Great Vertebra) and Taiyang (Sun) points. Puncture the Dazhui with a three-edged needle 3-5 times, apply cupping, and release about 5-10 ml of blood. For the Taiyang point, puncture 2-3 times, apply cupping, and release about 2-5 ml of blood. For the ear tip, puncture and squeeze out 5-10 drops of blood. This bloodletting is suitable for headaches, eye diseases, and colds with fever.
2. For children’s throat pain, bloodletting can be done at the Shoushang (Lesser Shang) and Shangyang (Upper Yang) points. Pinch the fingertip, quickly puncture, and squeeze out about 5 drops of blood. This is suitable for fever and throat pain.
3. For lumbar pain treatment, bloodletting points include Weizhong (Middle of the Knee) and Yaoyangguan (Lumbar Yang Gate). Focus on the blood vessels at these points, puncture, and apply cupping, releasing about 50 ml of blood. For Yaoyangguan, puncture 3-5 times, apply cupping, and release about 10-20 ml of blood. This is suitable for lumbar pain and sciatica.
4. For various stasis and cold syndromes, bi syndrome, atrophy syndrome, thrombosis, adolescent acne, psoriasis, eczema, etc., bloodletting should be performed at multiple sites, tailored to the specific situation. Generally, after bloodletting, observe the effects; if one treatment is effective, there may be no need for a second or third. If a large amount of blood is released, wait 10 to 15 days for the next treatment. If the blood volume is small, bloodletting can be done every three days or once a week. The interval between bloodletting should depend on the patient’s improvement.
The primary bloodletting points are along the Foot Taiyang Bladder Meridian, based on my clinical experience. I believe that the Foot Taiyang Bladder Meridian is the largest detoxification pathway in the body; once this area is opened, all diseases will correspondingly alleviate.
Acupuncture points: Dazhui, Dazhui (bilateral), Feishu (Lung Shu, bilateral), Xinshu (Heart Shu, bilateral), Ganshu (Liver Shu, bilateral), Weishu (Stomach Shu, bilateral), Shenshu (Kidney Shu, bilateral), plus the ear tip. The bloodletting method is the same as above. If there are skin diseases, add Quze (Curve Pond) and Xuehai (Sea of Blood).
Method: Puncture 3-5 times at the Dazhui, Dazhui (bilateral), Feishu (bilateral), Xinshu (bilateral), Ganshu (bilateral), Weishu (bilateral), and Shenshu (bilateral) points, then apply cupping until no fresh blood flows out. During this cupping process, multiple cups should be applied, and the blood volume should be observed. Generally, after three rounds of cupping, no new blood should flow out. If the patient is comfortable with treatment, fewer points can be selected for staged treatment to avoid overwhelming the patient. If treatment is inconvenient, try to treat as much as possible at once to save time.
(3) Bloodletting OperationPrecautions
Some patients ask how often bloodletting should be done. This depends on the blood volume released. If the blood volume is large (around 100 ml), it can be done every 10-15 days. If less than 50 ml, it can be done once a week; if less than 30 ml, it can be done every 3-5 days.
If family members assist with the operation, treatment can be staged.
(4) Contraindications
1. Patients with bleeding disorders such as thrombocytopenia, hemophilia, or those who faint at the sight of blood, as well as patients with vascular tumors, are generally prohibited from using this therapy.
2. Anemia, low blood pressure, pregnancy, excessive hunger or fullness, intoxication, and extreme fatigue are not suitable for this therapy.
(5) Precautions
1. First, explain the procedure to the patient to alleviate unnecessary concerns.
2. Bloodletting instruments must be strictly sterilized to prevent infection.
3. When needling for bloodletting, care should be taken not to insert the needle too deeply or create a large wound to avoid damaging other tissues. When incising blood vessels, it should be a simple cut, not a severing of the vessel.
4. The general bloodletting volume is about 5 drops; it is advisable to do this once every day or two. For larger volumes, do not exceed two bloodlettings per week. 1-3 times constitutes a treatment course. If bleeding does not stop easily, apply pressure to stop the bleeding.
5. This therapy should only be used for symptomatic emergency applications. After the condition improves, a comprehensive examination should be conducted before further treatment. Bloodletting therapy should not be misused.
(6) Remarks
This therapy has been used by physicians for thousands of years, and its efficacy has improved, especially for certain acute and severe conditions, where it can provide timely rescue with rapid effects and no side effects. This therapy is based on the theory of meridians and the principles of needling, using instruments to puncture specific areas or points to release blood, thereby unblocking meridians, regulating qi and blood, and expelling pathogens. Clinical evidence shows that this therapy has effects such as calming, pain relief, heat clearing, swelling reduction, emergency rescue, detoxification, and stasis resolution. Needling bloodletting therapy is a commonly used method in modern Traditional Chinese Medicine treatment.
4. Western Bloodletting Therapy
Unlike the bloodletting therapy in traditional Chinese medicine, bloodletting was once popular in the West, with some similarities.
An example of misuse is the first President of the United States, George Washington. He was a fervent believer in bloodletting therapy and had it performed on him multiple times. On December 14, 1799, Washington fell ill with a fever and difficulty breathing. His butler and doctors performed bloodletting on him four times in one day, removing a total of about 125 ounces of blood, equivalent to about 3.5 liters, which is roughly half of an adult’s total blood volume. That evening, Washington passed away. Subsequent studies revealed that Washington was suffering from a common throat and trachea infection, and had it not been for the excessive bloodletting, he likely would not have died.
With the advancement of medical science, bloodletting therapy is no longer used today. Even for temporary effects on the “three highs” (hypertension, hyperglycemia, and hyperlipidemia), it is no longer employed. This is because Western medicine has developed a complete set of simple and convenient methods for measuring blood pressure, blood sugar, and blood lipids. For those diagnosed with the “three highs” through scientific testing, there are now more scientifically targeted treatment plans. By the 20th century, bloodletting therapy had gradually been eliminated in the West.
The theoretical basis of bloodletting therapy originates from the ancient Greek physicians Hippocrates and Galen, who believed that human life depended on four bodily fluids: blood, phlegm, black bile, and yellow bile. These four fluids correspond to air, water, earth, and fire, which is similar to the Chinese concept of “metal, wood, water, fire, and earth,” with the addition of “qi” and the omission of “metal and wood.” The ancient Greeks believed that blood was dominant among the four fluids, and Galen believed that blood was produced by the body and often “excessive,” similar to the TCM concept of “yang being often excessive while yin is often insufficient.” Thus, while TCM nourishes yin, ancient Western medicine resorted to bloodletting. Galen also connected the superficial veins and arteries under the skin with various internal organs, known as “interior-exterior relationship,” suggesting that different diseases could be treated by bloodletting at corresponding vessels, such as bloodletting from the right arm for liver diseases and from the left arm for spleen diseases.
Until the Middle Ages, the implementers of bloodletting were church monks, until Pope Alexander III in 1163 assigned this honorable task to the public, specifically to barbers. This is why the traditional barber’s pole is red, blue, and white, representing arterial blood, venous blood, and the bandages used. Barbers developed a complete set of bloodletting procedures and tools, with the cutting blade for blood vessels called the “lancet,” which is the origin of the name of the famous British medical journal, “The Lancet.”
Bloodletting therapy, which was very popular in Europe, was brought to the Americas by colonizers. The famous American physician Benjamin Rush was a promoter and practitioner of bloodletting therapy. He was the only physician to sign the Declaration of Independence, graduated from the predecessor of Princeton University at the age of 14, and later established the American medical education system. At that time, four out of every ten American doctors were his students, earning him the title of “Hippocrates of Pennsylvania.” From 1794 to 1797, during an outbreak of yellow fever in Philadelphia, Dr. Rush extensively used bloodletting therapy to treat patients with “fever diseases,” performing bloodletting on over 100 patients daily, turning his clinic’s backyard into a sea of blood, with flies breeding in the blood like a dense fog. At this time, a concerned British journalist, William Cobbett, appeared.
This journalist reviewed the death reports from those years in Philadelphia and found that the mortality rate of patients treated by Dr. Rush was significantly higher than that of other patients. He published an article stating that Dr. Rush and his students had made a significant contribution to the reduction of the human population. In a fit of rage, Dr. Rush sued the British “slanderer” in Philadelphia in 1797. The outcome of the trial was predictable: one side was a hero of Philadelphia, a famous doctor, and the other was a foreigner defaming Philadelphia’s reputation. The court ruled in favor of Dr. Rush, fining Cobbett $5,000, which was a staggering amount at the time. The court’s ruling effectively declared bloodletting therapy as valid from a legal standpoint.
However, almost simultaneously with the court’s ruling, President Washington fell ill on December 13, 1799, a Friday, which is considered an unlucky day in Western superstition. By the 14th, several of Dr. Rush’s students had bloodletting performed on Washington, removing nearly 2,500 ml of blood, which is half of the human blood volume. The result was predictable: Washington died from hypovolemic shock. At this point, people began to question whether bloodletting therapy was beneficial or harmful.
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