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Selected Excerpts from Folk Bloodletting Techniques in China

By Liu Shaolin and Liu Guangrui

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Chapter 1: Double Needles and One Cup

Section 1: Pricking-Blood Therapy with a Three-Edged Needle

II. Needling Methods

Before needling, the needles must be sterilized by boiling, and the needling site should be disinfected routinely with 75% alcohol. The needle is held in the right hand using the thumb, index finger, and middle finger, while the left hand stabilizes the patient's needling site. At certain acupoints, the left hand performs pinching, pressing, or lifting actions to assist in accurately locating the bloodletting point. Depending on the condition, the following needling methods may be selected:

1. Slow Pricking (Huan Ci): The needle is slowly inserted into the vein to a depth of 0.5 to 1 fen, followed by slow bloodletting. This is suitable for bloodletting at the cubital fossa and popliteal fossa.

2. Rapid Pricking (Su Ci): The needle is quickly inserted to a depth of 0.5 to 1 fen, squeezing out a small amount of blood. This is applicable to the Twelve Jingwell Acupoints (Shi'er Jingxue) and Ten Xu Acupoints (Shixuan) at the extremities.

3. Lifting Pricking (Tiao Ci): A three-edged needle is used to pierce small veins, squeezing out a small amount of blood. This is suitable for the chest, back, and behind the ears. It is also commonly used for treating infantile malnutrition (Ganji) in children.

4. Surrounding Pricking (Wei Ci): Point pricking is performed around the painful area and the periphery of swelling, generally combined with cupping therapy (Ba Guan).

5. Cluster Pricking (Cong Ci): Using a three-edged needle, multiple point pricks are made in a small local area to induce bleeding. Cluster pricking is often combined with cupping.

6. Scattered Pricking (San Ci): Also known as Leopard-Skin Pricking (Bao Wen Ci), this method is used for point pricking over a wider area or along meridians, combined with cupping or moving cupping techniques. Alternatively, the skin at the needling site can be lifted and pinched to induce bleeding.

7. Smooth Pricking (Shun Ci): Oblique pricking from bottom to top. Before bloodletting, pressure can be applied from top to bottom towards the bloodletting point to expel evil blood primarily.

8. Reverse Pricking (Ni Ci): Oblique pricking from top to bottom. Before needling, massage can be applied up and down from the needling point to distribute the blood flow, then needling is performed to expel pathogenic factors primarily.

VI. Precautions

During three-edged needle therapy, needling should not be too deep, and blood loss should not be excessive. After bleeding, the site should be wiped, rubbed, and pressed with an alcohol cotton ball to stop bleeding. All treatment sites must be strictly disinfected to prevent infection. For patients undergoing bloodletting, needling can be performed daily or every other day; if blood loss is significant, twice a week is appropriate. For qi-releasing needling, it can be performed three times a day until the skin turns red. It is often combined with cupping suction until the skin becomes moist.

Section 2: Plum-Blossom Needle Bloodletting Therapy

Section 3: Cupping Therapy

Chapter 2: Theory of Differentiating Blood

Section 1: Differentiating Blood

V. Qi, Blood, and Meridians

The Hand-Taiyin Lung Meridian has abundant Qi and little Blood; the Hand-Yangming Large Intestine Meridian has abundant Qi and Blood.

The Foot-Yangming Stomach Meridian has abundant Blood and Qi; the Foot-Taiyin Spleen Meridian has little Blood and abundant Qi.

The Hand-Shaoyin Heart Meridian has abundant Qi and little Blood; the Hand-Taiyang Small Intestine Meridian has abundant Blood and little Qi.

The Foot-Taiyang Bladder Meridian has abundant Blood and little Qi; the Foot-Shaoyin Kidney Meridian has abundant Qi and little Blood.

The Hand-Jueyin Pericardium Meridian has abundant Blood and little Qi; the Hand-Shaoyang Sanjiao Meridian has abundant Qi and little Blood.

The Foot-Shaoyang Gallbladder Meridian has abundant Qi and little Blood; the Foot-Jueyin Liver Meridian has abundant Blood and little Qi.

Section 2: Differentiating Blood Color

I. Blood Appears Dark Red

After bloodletting at the needling site, if the blood color is dark red, it indicates that the disease mostly belongs to Heat Syndromes (Re Zheng).

II. Blood Appears Black-Red

If the blood color is black-red after surface bloodletting, it can be differentiated into External Injury (Wai Shang) and Internal Injury (Nei Shang). 1. External injuries usually occur at Ashi points (Ah Shi). They are mostly caused by the accumulation of Qi and Blood stagnation; blue-purple spots are due to blood extravasation from local collateral vessels. 2. Internal injuries: Deep internal injuries in the limbs are mostly due to blood stasis blocking the meridians; internal injuries in the head and trunk are mostly due to evil blood accumulating in the Zang-Fu organs, causing pain in the areas corresponding to those organs.

III. Blood Appears Pale Red-Yellow

When bloodletting is performed at the elbow or knee joints, if the blood color is pale red-yellow, it mostly indicates Wind-Damp Bi Syndrome (Feng Shi Bi Zheng).

IV. Blood Appears Blue-Purple

If the blood color is blue-purple after bloodletting at the back, abdomen, or ten fingers, it is mostly due to Cold Pathogens entering the interior, invading the body, and damaging Zang-Fu organ functions.

Section 3: Differentiating Blood Dynamics During Bloodletting

I. Dilute Blood That Is Difficult to Coagulate

When blood is dilute, sparse, and difficult to settle or coagulate upon needling, it indicates Blood Deficiency (Xue Xu). In clinical practice, when blood is dilute, releasing Qi is prioritized. If bleeding does not stop during symptomatic bloodletting, needling should be prohibited.

II. Dense Blood That Easily Clots

When blood easily settles and clots upon needling, it is mostly due to Qi Deficiency (Qi Xu) presenting as Excess Syndromes. In such cases, draining blood is prioritized, accompanied by regulating Qi and tonifying deficiency.

III. Slow Bleeding

If bleeding is slow after needling the skin, requiring multiple sessions with intermittent bleeding, it is mostly due to Qi and Blood deficiency, blood stasis blocking the Zang-Fu organs, weak Zang-Fu Qi mechanism, and abnormal Qi and Blood circulation failing to return to the meridians. In symptomatic treatment, the relationship between tonification and purgation must be fully grasped, prioritizing releasing Qi and activating Blood.

IV. Rapid Bleeding

If bleeding is rapid after needling the skin, it mostly indicates Excessive Heat (Re Sheng). Treatment should prioritize releasing Qi, supplemented by bloodletting to drain heat. However, needling should be prohibited or used with caution in patients with habitual purpura.

Section 4: Differentiating Other Substances

I. Blood Mixed with Pus

If pus and blood appear at the needling site, it is mostly due to toxic pathogens invading internally after external injury or chronic internal injuries turning into suppuration. Treatment prioritizes puncturing pus to detoxify. For deep pus and blood, methods to release Qi, activate Blood, and promote suppuration may be used.

II. Viscous White Fluid

If viscous white fluid is extracted by lifting pricking at the Si Feng Acupoint (Sifeng), back center, chest, or Yu Ji, it is mostly due to infantile malnutrition, impaired digestion of food and fluids, poor Qi and Blood function, and insufficient blood supply to local collaterals. Needling Si Feng can regulate the Spleen and Stomach and tonify deficiencies.

III. White Powdery Substance

...This is mostly due to long-term Qi stagnation and Blood stasis blocking collaterals, disrupting normal blood circulation, and transforming into nodules within the skin... In folk practice, these nodules are often removed by lifting pricking and squeezing. After removal, a coin is placed on the lesion, wrapped with cloth for 7 days, and then removed, causing the nodule to disappear naturally. If a coin is not used, the nodule will reappear in a few days.

IV. Transparent Fluid

...This condition is mostly edema... This syndrome should not be drained excessively; it can be treated with herbal medicine.

V. Water Droplets Hanging on the Cup

...This phenomenon mostly indicates excessive Cold-Dampness in the body... Clinically, moving cupping is used to dispel Cold Pathogens, and stationary cupping is used to drain Wind-Damp.

VI. Warm Air in the Cup

...This situation is mostly due to excessive Damp-Heat in the body. When Damp-Heat enters the interior and travels through the meridians and blood vessels, it often manifests as moisture on the palms, soles, and back. Excessive Damp-Heat often causes headache, fever, heavy and painful body, diarrhea, poor appetite, sore waist and back, etc.... Clinically, to drain Damp-Heat, needling or cupping is often performed at the palms, soles, Dazhui (GV14), Mingmen (GV4), Weizhong (BL40), Chengshan (BL57), and Shenque (CV8).

Chapter 3: Common Acupoints for Bloodletting

Chapter 4: Common Extra-Meridian Acupoints for Bloodletting

Chapter 5: Effective Prescriptions for Common Diseases Using Bloodletting

Section 1: Emergency Bloodletting

I. Coma and Shock

There are many causes of coma, such as brain diseases or poisoning. In severe cases, there is no response to strong stimuli, and consciousness is completely lost. There are also many causes of shock, clinically manifesting as pale complexion, cold sweat, cold limbs, cyanotic lips, decreased blood pressure, fine and forceless pulse, and consciousness disorders.

[Treatment]

Bloodletting with a three-edged needle at Renzhong (GV26), Shixuan (EX-UE11), and Zhongchong (PC9).

Cupping suction at Dazhui (GV14) for 2 minutes.

Plum-blossom needle meridian tapping to induce bleeding from Yintang (EX-HN3) to Baihui (GV20), and from Yintang (EX-HN3) to Taiyang (EX-HN5).

[Attached Prescription]

Bloodletting at Renzhong (GV26), Taiyang (EX-HN5), Baihui (GV20), Yongquan (KI1), Neiguan (PC6), and Zusanli (ST36). These acupoints should be needled with a 1-hour interval.

[Folk Method]

Use a small blade or bamboo tip to prick the Shixuan (EX-UE11) acupoints to release blood.

For general coma or shock, sewing needles or safety pins can be used to lightly prick the Renzhong (GV26) acupoint, followed by manual squeezing to induce bleeding.

[Case Study]

Su XX, Male, 37 years old. A passenger on a train from Chongqing to Chengdu, admitted to emergency care on April 8, 1982.

History provided by others: Sudden coma on the train, unaware of surroundings.

Symptoms: Pale complexion, cold sweat, cold limbs, fine and forceless pulse.

Diagnosis: Coma and Shock.

Treatment Principle: Rescue from reversal and restore Yang.

Treatment Method: Used a three-edged needle to prick Renzhong (GV26), Shixuan (EX-UE11), and Zhongchong (PC9) to bleed. Then, used fingers to knead Renzhong (GV26), Baihui (GV20), Waiguan (TE5), Neiguan (PC6), and Hegu (LI4). The patient recovered immediately after the procedure.

II. Heat Stroke

Heat stroke is generally a disease occurring in summer, caused by high external temperatures leading to the depletion of Yin Qi in the internal organs. Upon encountering a heat stroke patient, quickly move them to a cool, ventilated place, have them lie supine, unbutton clothes and belt, wipe off sweat, use a fan to dissipate heat, and drink some light salt water or cold drinks. For severe heat stroke with symptoms like headache, dizziness, nausea, and vomiting, acupuncture bloodletting therapy can be used.

[Treatment]

Bloodletting with a three-edged needle at Zhongchong (PC9), Weizhong (BL40), and Shixuan (EX-UE11).

Cupping suction at Dazhui (GV14), Mingmen (GV4), and Weizhong (BL40) for 2 minutes.

Plum-blossom needle tapping to induce bleeding on both sides of the spine.

[Attached Prescription]

1. Light pricking with a three-edged needle to draw slight blood at Renzhong (GV26), Shixuan (EX-UE11), and the Twelve Jingwell Acupoints (Shi'er Jingxue).

Cupping suction at Baliao (BL31-34), Quchi (LI11), and Chengshan (BL57) for 5 minutes.

Plum-blossom needle tapping to induce bleeding at Kunlun (BL60) and Yongquan (KI1).

2. Plum-blossom needle tapping on both sides of the spine, focusing on the chest/back, lower back, and cubital fossa; light pricking at Renzhong (GV26) and fingertips for bloodletting, using moderate or heavy stimulation.

[Folk Method]

Use a porcelain spoon or the edge of a broken porcelain bowl (must be smooth and blunt) dipped in water or oil to scrape the patient's anterior chest, mid-back, bilateral axillae, and cubital fossae until purple-red spots appear under the skin.

[Ancient Prescription]

1. Use a tile needle (three-edged needle) to prick the ten tips of the hands (Shixuan/EX-UE11) or the tendons at the elbow bend (Quze/PC3) and knee bend (Weizhong/BL40). Before needling, tap the blood upwards to the acupoint to cause congestion before pricking to bleed.

2. Use a three-edged needle to bleed Shaoshang (LU11). If fingers are cold, induce congestion first before pricking.

3. Open the patient's mouth and observe three purple veins under the tongue. Using the method "male left, female right," prick one drop of purple blood. The patient will awaken immediately, but do not prick the central vein.

[Case Study]

Yuan, Male, 53 years old. A farmer from the suburban commune of Emei County, Sichuan Province, first seen on August 15, 1982.

The doctor passed by while traveling and saw a person faint on the ground, providing immediate treatment.

Symptoms: Initially dizzy, heart pain and palpitations, nausea and vomiting, general weakness, flushed skin, fever, dry mouth, red and crimson tongue coating, surging pulse. Subsequently fainted and became unconscious.

Diagnosis: Heat Stroke.

Treatment Principle: Drain Heat, open orifices, and revive spirit.

Treatment Method: Used a three-edged needle to prick Shixuan (EX-UE11) to bleed, which was bright red. Used plum-blossom needle tapping at Renzhong (GV26), Neiguan (PC6), and Zusanli (ST36). Cupping suction was applied to Dazhui (GV14) and Mingmen (GV4) for 10 minutes, with intense heat rising in the cups. Half an hour later, the patient revived.

III. Sha Disease (Sha Zheng)

This disease mostly occurs in summer and autumn. It is a common epidemic, mainly manifesting as whole-body bloating and fatigue, and a sensation of goosebumps. It is mostly caused by the patient's physical weakness and insufficient righteous Qi, allowing turbid and pestilential pathogens from the exterior to invade the body, causing Qi and Blood stagnation and abnormal Qi movement.

[Treatment]

Bloodletting with a three-edged needle at Shixuan (EX-UE11) and Weizhong (BL40).

Plum-blossom needle tapping to induce bleeding at the cubital fossa and both sides of the spine.

Cupping suction at Dazhui (GV14) and Mingmen (GV4) for 10 minutes.

[Attached Prescription]

Prick the sublingual veins (Jinjin/EX-HN12 and Yuye/EX-HN13) with a three-edged needle to bleed.

Plum-blossom needle tapping at Weizhong (BL40) combined with cupping for 10 minutes to induce bleeding.

[Folk Method]

1. Use a large sewing needle to lift-prick the cubital and popliteal fossae to bleed, then rub with alcohol or ginger slices.

2. Dip hands in cold water and slap the elbows and back of the neck, then pinch the skin until it turns red-purple, then lift-prick to bleed.

3. Bloodletting at Shixuan (EX-UE11).

[Case Study]

Wu XX, Female, 47 years old. A worker at a factory on Jinbi Road, Kunming City, Yunnan Province, first seen on July 28, 1981.

History provided by others: Suddenly fainted on the road just now, face changed drastically.

Symptoms: Sudden onset, splitting headache, vomiting and diarrhea, bluish-white complexion, cold limbs, bluish-purple lips, borborygmus and colic.

Diagnosis: Sha Disease.

Treatment Principle: Restore Yang and rescue from reversal.

Treatment Method: Used a three-edged needle to prick Shixuan (EX-UE11) and Renzhong (GV26) to bleed. Plum-blossom needle tapping at Weizhong (BL40), followed by cupping suction to bleed, which came out purple-red. Basically returned to normal after half an hour.

IV. Electric Shock

In rescuing electric shock victims, quickly turn off the power source or separate the power source from the patient using insulating materials such as dry bamboo poles or wood. Move the patient to a ventilated area. Mild cases recover quickly; severe cases where breathing and heartbeat have stopped require immediate clothing removal, artificial respiration, and external chest cardiac massage. Artificial respiration can be combined with bloodletting therapy.

[Treatment]

Bloodletting with a three-edged needle at Renzhong (GV26) and Shixuan (EX-UE11).

Plum-blossom needle combined with cupping suction at Yongquan (KI1) for 3 minutes.

Plum-blossom needle tapping to induce bleeding on both sides of the spine and anterior chest.

[Attached Prescription]

Light pricking with a three-edged needle at Hegu (LI4) to bleed.

Plum-blossom needle tapping to induce bleeding at Neiguan (PC6) and Zhongchong (PC9).

V. Drowning

Place the drowning victim prone with feet elevated and head lowered, and perform artificial respiration. Pull out the tongue to prevent it from retracting and blocking the airway. Or pry open the mouth, clean mud, weeds, and foam from the nose and mouth to prevent airway obstruction. If breathing and heartbeat have stopped, immediately perform mouth-to-mouth artificial respiration and external chest cardiac massage, and simultaneously adopt acupuncture bloodletting therapy.

[Treatment]

Bloodletting with a three-edged needle at Renzhong (GV26) and Huiyin (CV1).

Cupping suction at Dazhui (GV14), Feishu (BL13), and Danzhong (CV17) for 5 minutes.

Plum-blossom needle tapping to induce bleeding at Baihui (GV20) and Yongquan (KI1).

[Attached Prescription]

Use a three-edged needle to bleed Shixuan (EX-UE11) and Zhongchong (PC9); plum-blossom needle tapping to induce bleeding on both sides of the spine and anterior chest; use cupping for moving suction on the anterior chest and back.

VI. Apparent Death

Apparent death mostly occurs in people who were previously healthy, suddenly collapsing and fainting while lying, sitting, or walking, or due to arguments, emotional agitation, or excessive joy, anger, sorrow, fear, worry, thinking, or fright.

[Treatment]

Three-edged needle bloodletting at Renzhong (GV26), Shixuan (EX-UE11), and Yongquan (KI1).

Cupping suction at Danzhong (CV17) and Dazhui (GV14) for 5 minutes.

Plum-blossom needle tapping to induce bleeding on the head and both sides of the spine.

[Attached Prescription]

Three-edged needle bloodletting at Shaoshang (LU11) and Weizhong (BL40).

Plum-blossom needle meridian tapping at Taiyang (EX-HN5) and Yintang (EX-HN3).

[Ancient Prescription]

Pry open the patient's mouth with an iron tool, and use a three-edged needle or bamboo tip to prick Jinjin (EX-HN12) and Yuye (EX-HN13). Life returns when blood flows; do not prick the central vein.

VII. Snake and Insect Bites, Rabies Bites

After being bitten by a venomous snake, quickly tie a band or cloth strip tightly above the wound (about 3-6 cm) to prevent venom from spreading upward, and immediately perform bloodletting treatment.

[Treatment]

Use a three-edged needle or plum-blossom needle to bleed the affected area bitten by the venomous snake, squeezing manually or using cupping suction.

During bloodletting, keep the affected limb low. After needling, push and squeeze downwards from above to facilitate the expulsion of venom.

[Folk Method]

After being bitten by a venomous snake, the patient can immediately cut the affected limb with a small knife or sharp object, then quickly suck the blood with their mouth or squeeze it out by hand.

[Ancient Prescription]

If the upper limb is bitten, prick Babai (EX-UE9) to bleed; if the lower limb is bitten, prick Babai (EX-LE10) to bleed. Use coarse needles, three-edged needles, or plum-blossom needles to transversely prick the dorsum of the hand (or foot) to bleed.

[Case Study]

Feng XX, Male, 30 years old. A member of the Qianfoyan Production Team in Guangyuan County, Sichuan Province, first seen on May 5, 1982.

Chief Complaint: Bitten by a venomous snake while walking at night half a month ago, with continuous redness, swelling, and pain.

Symptoms: Redness and swelling on the dorsum of the left foot, tender to touch.

Diagnosis: Venomous Snake Bite.

Treatment Principle: Reduce swelling and drain toxin.

Treatment Method: Used a three-edged needle to prick the affected area, squeezed out toxic blood manually, then applied cupping suction for 10 minutes to discharge pus and blood. Applied external medicine post-procedure. After one week, redness and swelling disappeared, and pain decreased. Prescribed one dose of Chinese herbal medicine, which led to full recovery.

[Case Study]

Qian, Male, 42 years old. A temporary worker at the Danshizi Housing Management Office in Nan'an District, Chongqing City, first seen on December 3, 1983.

Chief Complaint: Bitten by a hairy caterpillar 5 months ago, with initial redness, swelling, and pain. After treatment, redness and swelling disappeared, but pain persists.

Symptoms: Pain upon pressure on the sole of the left foot, with a hard lump, no redness or swelling.

Diagnosis: Caterpillar Bite.

Treatment Principle: Drain toxin and relieve pain.

Treatment Method: Used a three-edged needle to prick the local area to bleed, which was purple-black. After 5 minutes, applied cupping suction again to bleed, which was purple-black. Additionally, rubbed Jiu Xie (Paris polyphylla) ground in vinegar externally for 3 days, resulting in the disappearance of pain.

VIII. Motion Sickness (Car and Sea Sickness)

When patients suffer from motion sickness, it is best to rest with eyes closed, focus attention on the toes of the feet, avoid looking out the window, and remain quiet. If caused by poor air circulation, move the patient to a ventilated area, and bloodletting therapy can also be adopted.

[Treatment]