Bleeding Techniques: Ancient Treatments for Acupuncture Physicians
By Skya Abbate, DOM
An ancient Chinese treatment technique that can apply to many conditions the modern-day practitioner may be hesitant to use in his or her treatment plans is bloodletting. Perhaps there is reluctance to use this method due to the drawing of blood, which can transmit blood-borne pathogens; there may also be some concern about causing the patient potential discomfort.
However, bleeding is a specialized technique for specific conditions that can produce effective and dramatic results when the patient's condition is diagnosed properly and the bleeding method expertly executed.
Bloodletting has four major therapeutic aims that are useful in the clinical arena:
It can invigorate the smooth flow of qi and blood, thereby picking up and facilitating its flow when the qi and blood need invigoration. An example of this scenario occurs when a patient presents with a wiry pulse and mild feelings of stagnation that indicate qi stagnation.
It disperses qi and blood stasis, as in cases of backache or spider veins.
It can drain excess heat and fire. Such excess includes pathogenic factors, as in an invasion of the Lung by wind heat that produces a fever and extremely sore throat.
Finally, bleeding can bring down yang rising, as in the varieties of high blood pressure due to Liver yang rising. (Note: not all cases of high blood pressure have this etiology).
There are numerous clinical conditions suitable to treat with bleeding that have the aforementioned differentiations. Some of these conditions are outlined later in this article to remind the practitioner of bleeding's clinical applicability.
The most common acupuncture points to bleed are those with shallow insertion depths, such as ear acupuncture points, scalp points and jing (well) points. Other points that can be bled are those with energetics that lend themselves to bleeding, such as BL 40 (weizhong), to release summer heat; the ear apex point for acute conjunctivitis; or local points for pathologies such as bruises or varicosities.
There are three types of bleeding techniques. The first is called the "spot-pricking or collateral (pertaining to meridian) pricking method." With this style, a discrete point or spot is bled, such as a jing (well) point like LI 1 (shangyang) to relieve a toothache due to excess heat, or LU 11 (shaoshang) to treat a sore throat due to excess heat.
The second method is called the "clumping or area-pricking method." With this approach, pinprick motions are made on a relatively large scale, such as GV 14 (dazhui) to reduce excess heat in the Lungs, as in the case of pneumonia.
The last type of bleeding is called the "pinching method." With this technique, the point to be treated is pinched between the thumb and index finger. This action isolates the point and promotes venous pooling, which facilitates bleeding. Bladder 2 (zanzhu) is a common point to pinch and bleed for sinus congestion or headache.
As efficacious as it is, bleeding is contraindicated for certain conditions. One of the most important prohibitions is that it is not suitable for yin-deficient (false) heat. In this case, bleeding can actually weaken the patient, as the heat is not real, but arises from deficiency. In general, patients with diabetes; bleeding disorders such as hemophilia; or patients who may bleed easily (such as those on blood thinners) should not be bled. Bleeding contraindications also apply to patients who are extremely weakened, anemic, hypotensive or pregnant. Depending on the point to be treated, the patient can be bled either in a sitting position for bleeding a jing (well) point, or in a reclining position to pinch BL 2.
Prior to bleeding, the practitioner should have all of the required treatment tools within the working area. Next, the hands are washed, and a clean field is established with paper towels or professional toweling, upon which are placed dry sterile cotton balls, alcohol preps, tight fitting latex gloves and the bleeding tool of choice. Off of the field, have an open biohazard "sharps" container; a biohazard trash container; extra latex gloves; and goggles and facemask, in the event of excessive bleeding. Don a double pair of tight-fitting gloves to guard against the transmission of infectious blood-borne pathogens. As always, the point to be bled is swabbed with 70 percent isopropyl alcohol and allowed to dry naturally.
Bleeding tools include the regular acupuncture or filiform needle; a medical lancet; the shoni-shin needle (or Japanese pediatric needle); the traditional three-edge needle; or the plum blossom needle (seven-star or cutaneous needle). If using the spot-pricking or pinching method, the discomfort of bleeding can virtually be eliminated via a rapid insertion to the desired shallow depth of about 0.05-0.1 cun. Elicit 1-2 drops of blood (some practitioners say up to 10) by squeezing the point. Absorb the blood with sterile cotton, and dispose in the biohazard trash container along with the used gloves. If there is so much blood in the cotton ball that it can be wrung out, it must be disposed of in the biohazard sharps unit. If the bleeding tool is not reusable, dispose of it immediately in the sharps container after pricking the point. Place a Band-Aid on almost all points that are bled (i.e., distal jing points) to allow them to heal and to prevent infection, and then wash your hands.
The frequency of bleeding is contingent upon the patient's medical condition. If the patient has an excess heat condition such as tonsillitis, bleeding can be performed once a day until the symptom abates. If the patient has a blood stasis condition, bleeding can be done 1-2 times per week.
The table below summarizes common points amenable to bleeding, the style of bleeding to use, and clinical conditions suitable to the bleeding technique.
LU 11 (shaoshang)
Sore throat of the excess type; exogenous invasions tonsillitis; stuffiness and pain in the chest; asthmatic breathing; stomach ache; frontal shoulder pain