BLEEDING PERIPHERAL POINTS:

An Acupuncture Technique
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Piercing a vein or small artery at the tip of the body-finger tips, toes, or top of the
ears-is a technique well-known among acupuncturists. To the uninitiated Westerner,
this therapy may seem even stranger than standard needling that is explained as a
method of adjusting the flow of qi in the vessels. In this case, a few drops of blood let
out from one or more peripheral points by quickly stabbing the skin with a lance is
said to have significant effects. As mentioned in Fundamentals of Chinese
Acupuncture (1), "The procedure should be thoroughly explained to the patient
before it is performed to allay his or her fears."

Letting out blood is among the oldest of acupuncture techniques. Indeed, it has
been speculated that acupuncture started as a method of pricking boils, then expanded
to letting out "bad blood" that was generated by injuries or fevers, and finally
allowing invisible evil spirits and perverse atmospheric qi (most notably "wind")
escape from the body (2). Only later, perhaps as the needles became more refined and
as scholars developed of a more subtle theoretical framework, were thin filiform
needles used as the primary acupuncture tools for the purpose of adjusting the flow of
qi and blood, without necessarily releasing something from the body.

The Lingshu (Spiritual Pivot) and its companion volume, the Suwen (Simple
Questions), written around 100 B.C., established the fundamentals of traditional
Chinese medical ideas and acupuncture therapy (3, 4). Originally, there was a set of 9
acupuncture needles, which included the triangular lance, sword-like flat needles, and
fairly large needles (see Figure 1). In the Lingshu (3) these ancient needles are
numbered and the needle designs and qualities are associated with what the numbers
represent. Regarding the fourth needle, which has a tubular body and lance-like tip,
the text states: "This can be used to drain fevers, to draw blood, and to exhaust
chronic diseases." The seventh needle is described as being hair fine (corresponding in
form to the most common of the current needles); it is said to "control fever and chills
and painful rheumatism in the luo channels." In modern practice, using the lance as a
means to treat chronic diseases has been marginalized (except to treat acute flare-ups
of chronic ailments), while the applications of the hair-fine needle has been greatly
expanded beyond malarial fevers and muscle and joint pain.

The Lingshu has several references to the use of blood-letting. In the chapter on
hot diseases, it states:
 For a hot disease with frequent frights, convulsions, and madness,
treat the blood channels. Use the number four lance needle. Quickly
disperse when there is an excess. When there is insanity and a loss of
hair, treat the blood and the heart.

The use of the lance needle to treat the blood channels is a reference to blood-
letting. The indications of blood-letting for alleviating heat, convulsions, and mental
distress has persisted to modern times. For example, when treating the jing (well)
points at the beginning or end of the meridians, the general indication that has come
down to us today is for fevers and mental illness.

The lance needle is also recommended, in the same chapter of the Lingshu, for
treatment of a hot disease where the whole body feels heavy and the center of the
intestines is hot, and when there are spasms around the navel, and the chest and ribs
are full. Among the points suggested to be bled are "those points on the cracks of the
toes." Drawing blood, which is mentioned repeatedly in this chapter of the Lingshu, is
usually accompanied by instructions that one should drain it from the luo vessels,
which are described in this text as visible vessels, apparently corresponding to veins.
For example, it is said that one should examine above the anklebone to see if
the luo channels are full; if so, drain until blood is seen.

An entire chapter of the Lingshu is devoted to the luo vessels in which questions
are answered about blood-letting therapy. It is said that: "When the blood and qi are
both abundant and the yin qi is plentiful, the blood will be slippery so that needling
will cause it to shoot out." On the other hand, "When much bleeding takes place with
needling, but the color does not change and there are palpitations and depression, it is
because needling the luo channel causes the channel to empty." The change in color
that is anticipated occurs when the bad blood, which is described as thick and black,
has been eliminated and normal red blood appears.

The Suwen (4) also has a chapter on treating the luo vessels. It makes three
references to blood-letting, all in association with the point ranggu (KI-2); in general,
the ranggu point is needled, and then the capillary in front of the point is to be bled.
This is used in treatment of swollen throat and for abdominal swelling and fullness
that accompanies either heart pain or injury. Similarly, in the Lingshu chapter on
water swelling, a case of abdominal swelling-where the skin is tight like a drum-is
described; the therapy recommended is to draw blood from the luo channels. The
location of blood-letting is not specified, though it is stated that the problem should be
treated in the lower part of the body.

In the Suwen chapter about needling of the channels properly, it is said that:
 When one administers acupuncture during the spring, it is
appropriate to needle shu (stream) points. In fact, bloodletting is a
preferred technique....In the summer, one can also practice
bloodletting, but it is preferable to use superficial luo points. Allow
the bleeding to stop by itself, so that the pathogen will be completely
eliminated."

In the Suwen chapter on seasonal organ pathology, blood-letting is mentioned for

excess conditions, and the key therapeutic technique is usually to address an entire
channel, which is sometimes done at or near its peripheral points. Thus, it says, for
excess of the liver, bleed the jueyin and shaoyang channels; for excess of the spleen,
one is instructed to bleed points of the taiyin, yangming, and shaoyin; for excess of the
lung, bleed the shaoyin channel; for excess of the kidney, bleed
the shaoyin and taiyin channels. Only the excess of the heart is treated somewhat
differently: one is instructed to needle and bleed points under the tongue
(jinjin and yuye) and at yinxi (HT-6).

The Suwen chapter on malaria-like illnesses has an interesting instruction for

needling the finger tips:
When malaria begins to flare-up, it will start at the extremities. If the
yang has already been injured, the yin will be affected as well.
Before the flare-up, therefore, one should tie the ten fingers with
string. This way, the pathogen cannot enter more deeply and the yin
cannot come out. After tying the fingers, observe the luo channels.
Where purple stagnation appears in the channels, perform blood-
letting.

Thus, one looks for those specific veins that are congested in order to apply this
therapy, rather than picking certain points or channels theoretically. The particular
practice described here, of trying to avert the flare-up by locating the stagnation and
draining the blood is described as "ambushing the enemy before being confronted."
The approach to making the veins stand out is one that is still mimicked today, with
massaging and pressing to assure that when the vein is lanced blood will flow out,
though the original purpose was also diagnostic-determining which vessel had the
pathogen to be let out.

The most comprehensive traditional text on acupuncture is the Jia

Yi jing (Systematic Classic of Acupuncture), published in 1601, though attributed to
work originally done by Mi Huangfu in the 3 rd century (5). It includes an extensive
explanation of the #4 needle used for blood-letting:
 The number four pertains to the four seasons. When a person, after having been
struck by one of the winds of the eight directions and four seasons, develops a chronic
illness where the evil has invaded and penetrated the channels and connecting vessels
[luo], then this condition is treated by the sharp needle....It has a cylindrical body and
a pointed end of three blades and is one cun and six fen in length. It is used to drain
heat and let out blood to dissipate and drain chronic diseases. Accordingly, it is said
that, if the disease is securely housed within the five viscera, the sharp needle should
be selected and draining technique applied to the well [jing] and brook [shu] points
according to the seasons.

As with the earlier texts, blood-letting is mainly recommended in Jia Yi jing for
conditions of abdominal swelling, malarial-type diseases with alternating fever and
chills (Chinese: nue), and certain painful conditions, particularly lower back pain. The
main idea is to eliminate bad blood, as in this case of treating an injury:
The unraveled vessel causes people to suffer from splitting lower
back pain with irascibility....Needle the unraveled vessel
at weizhong (BL-40), pricking the binding connecting vessel there
which is like a millet grain. Upon being pricked, the vessel will
ejaculate black blood and, once the blood turns red, the treatment
may be stopped.

In sum, for excess type syndromes, bleeding is recommended because it can drain
the excess, alleviate congestion and stasis, and remove the pathogens. As described
in Fundamentals of Chinese Acupuncture, the function of blood-letting therapy is
"to drain heat or quicken the blood and qi and relieve local congestion." The method
of carrying out blood-letting is described:
This procedure is done by first applying pressure to restrict the blood
flow of the area, to increase the visibility of the veins and to cause
the blood to flow out more easily when the vein is pricked. The point
is then swiftly and decisively pricked to a superficial depth of about
0.1 cun and a few drops of blood are allowed to escape. Lastly, the
point is pressed with sterile cotton until the bleeding ceases.

The last instruction, which is a modern practice, differs from the ancient one in
which the bleeding is allowed to continue until it stops on its own. In the Jia Yi jing,
there is a discussion of treating alternating chills and fever, in which blood-letting is
recommended and the amount of blood to be let out is "appropriate to the fatness or
thinness of the patient," thus a relatively larger amount for heavier persons.

In Essentials of Acupuncture (6), the use of the three-edged needle (lance) is

said to be used for high fever, mental disorders, sore throat, and local congestion or
swelling. As to technique, the point to be bled is pricked superficially, just 0.05-0.1
cun (inches) deep, which should be light and superficial and the amount of bleeding to
be "determined by the pathological condition." Vigorous pricking is not permissible.
In general, acupuncturists are cautioned about using bleeding therapy for persons who
have weakness of their yin or yang qi, because the treatment can "strip" away these
essences. Virtually all acupuncture texts mention contraindications for blood-letting
therapy in persons who have already suffered from hemorrhage (including post-
partum) and for those who are quite weak. This method is not recommended for
pregnant women. Today, blood-letting is most often recommended for peripheral
points.

PERIPHERAL POINTS BLOOD-LETTING

Peripheral blood-letting today is mainly carried out at the fingers and toes (7). At the
tips of the toes, for example, are the qiduan points, located 0.1 cun behind the nails
(see Figure 2). These are said to be useful for emergency treatment for stroke or for
numbness of the toes, also for redness, swelling, and pain of the instep of the foot.
Near the toe webbing, there is another set of points, the bafeng (eight wind) points,
four on each foot (see Figure 2). These can be needled either by standard procedure
with shallow oblique insertion, or they can be pricked to cause bleeding. The points
are indicated for swelling of the legs, toe pain, snake bite to the foot or lower leg, and
swelling and pain of the dorsum of the foot.

Similarly, at the tips of the fingers are the shixuan points, located 0.1 cun behind
the nails (see Figure 3). Pricking these points to let out blood is said to be useful for
coma, epilepsy, high fever, and sore throat. A little further down, at the finger creases
(the lower of the two creases along the finger joints), are the sifeng points (four wind
points; the thumb, which has only the one crease, is not included; see see Figure 4).
Pricking these to let out plasma fluid that is yellowish white, is said to treat
malnutrition and indigestion in children and whooping cough. Finally, points between
each pair of fingers, at the top of the webbing joining the fingers, are the baxie points
(see Figure 5). These can be acupunctured with shallow insertion of 0.5-0.8 cun depth
or pricked to cause bleeding, used to treat snakebite of the hand.

The terminal jing points, known by some as ting points, are also pricked to let out
blood. These "well" points, of which there are 12, are mainly located at the tips of the
fingers and toes (the exception is KI-1); below are some of the indications for
bleeding these points:

 Shaoshang ) LU-11: thumb, radial side): sore throat, epistaxis, pain of

fingers, febrile disease, mental disorders, loss of consciousness.
 Shangyang (LI-1: index finger, radial side): toothache, sore throat,
numbness of fingers, febrile disease, loss of consciousness.
 Zhongchong (PC-9: middle finger, at fingertip): cardiac pain,
irritability, loss of consciousness, aphasia with tongue stiffness, febrile
disease, heat stroke, infantile convulsions, feverish sensation of the
palm.
 Guanchong (TB-1: ring finger, ulnar side): headache, redness of eyes,
sore throat, stiffness of the tongue, febrile disease, irritability.
 Shaochong (HT-9: little finger, radial side): cardiac pain, pain in
chest, mental disorder, febrile disease, loss of consciousness.
 Shaoze (SI-1: little finger, ulnar side): febrile disease, loss of
consciousness, sore throat, corneal disease.
 Yinbai (SP-1 : big toe, medial side): abdominal distention, uterine
bleeding, mental disorder, dream disturbed sleep, convulsions.
 Dadin (LV-1: big toe, lateral side): prolapse of uterus, hernia, uterine
bleeding, enuresis.
 Lidui (ST-45: 2nd toe, lateral side): facial swelling, toothache,
distending sensation of chest and abdomen, cold in leg and foot, febrile
disease, dream disturbed sleep, mental confusion.
 Yonguqan (KI-1: sole of foot, between metatarsals 2-3): pain in vertex
of the head, dizziness, blurring of vision, sore throat, aphonia, dysuria,
dyschesia, infantile convulsion, loss of consciousness, feverish
sensation in the sole.
 Qiaoyin (GB-44: 4th toe, lateral side): one-sided headache,
ophthalmalgia, deafness, pain in the hypochondriac region, dream
disturbed sleep, febrile disease
 Zhiyin (BL-67: little toe, lateral side): headache, nasal obstruction,
epistaxis, ophthalmalgia, feverish sensation in the sole.

Finally, there is pricking of the ear apex (tubercle) to let out blood, as a
similar basic technique. All these peripheral point bleeding treatments
are used for heat and excess syndromes. As an example, treating the
ear apex by bloodletting has been recommended to treat hordeolum, an
eye infection (8).

Peripheral blood-letting is distinguished from a practice of

pricking the skin to release blood prior to applying cups, that provide
an additional stimulus to the area and cause more blood to be extracted.
However, like the peripheral point bleeding, it is used to let out
pathogens and heat. A report on treatment of acute diseases with
blood-letting followed by cupping suggested that the technique would
remove toxic heat from the interior (9). In general, the author believed
that:
The combination of bleeding and cupping aims at
eliminating the toxic factors and removing stagnation,
promoting resuscitation, and clearing heat, activating qi
and blood circulation in the meridians and collaterals,
relieving swelling and pain in order to facilitate the
elimination of pathogenic qi and the restoration of
good health.

He gave examples of blood-letting and cupping at dazhui (GV-

14), taiyang (Extra-2), and weizhong (BL-40). Weizhong, at the back of
the knee, is probably the most frequently mentioned non-peripheral
point for bleeding therapy, with or without cupping; quze (PC-3), at the
corresponding point in the crease of the elbow, is next most frequently
used. Dazhui (GV-14), the meeting point of all six yang channels with
the governing vessel, is treated for many acute heat syndromes, with
standard acupuncture, blood-letting, and cupping.

Some of the peripheral blood-letting applications are easy to

understand, at least theoretically, from the basic concept of letting out
tainted blood; for example, to treat a poisonous snake bite where
venom has been injected into the nearby portion of the limb. Similarly,
swelling and pain of the foot by letting out blood at the toes is
conceptually understandable within this paradigm. The treatment of
stroke (apoplexy), coma, mental dysfunctions, and epilepsy by this
method may be related to the concept that a vicious wind penetrates to
the center and causes severe disruption to the normal brain function;
the wind turbulence generates heat in the blood; alternatively, a disease
with high fever can cause these damaging sequelae. This heat may be
released by causing bleeding from these points, under the concept that
the blood is a vehicle for carrying out the excess heat. In the English-
Chinese Encyclopedia of Practical Traditional Chinese
Medicine (10) under the condition called wind-stroke, in addition to
several acupuncture points to be treated by standard needling, the
authors mention using a three-edged needle to cause bleeding at
the jing-well points. The Encyclopedia states that "pricking the 12 jing-
well points helps to eliminate heat and bring resuscitation."

The problems of high fever, bleeding, sore throat, and headache

might also be understood in terms of being treated by letting out heat
 via the removal of bad blood or excess blood. In the English-Chinese
Encyclopedia, pricking the jing-well point shaoshang (LU-11), is
mentioned as one of the treatments for severe cough due to wind-heat
affecting the lungs; the jing-well point zhongchong (PC-9), as well as
the non-peripheral points at the limb joints, quze (PC-3)
and weizhong (BL-40), are indicated for pricking to release blood for
treatment of high fever with heat in the ying and blood
levels. shixuan points at the fingertips, as well as PC-3 should be
pricked, the book suggests, for treatment of heat stroke (summer heat
disturbing the heart and requiring resuscitation). Bleeding at the jing-
well point zhongchong (PC-9) is also suggested for treatment of
syncope of the excess type, while pricking of the 12 jing-well points is
part of the therapy for severe sun stroke. Another recommendation for
treating sunstroke is the combination of quze (PC-3), weizhong (BL-
40), and dazhui (GV-14) as well as the 12 jing-well points all being
pricked to cause bleeding.

MODERN VIEWS
Blood-letting is a method of therapy that is difficult to explain in modern
terms. Aside from the traditional theoretical basis for these treatments
in letting out heat and excess factors, a key issue is whether it actually
produces the claimed effects. Many Western acupuncturists have stated
informally that they get dramatic results from this treatment method,
but, unfortunately, there is no evidence presented to support such
contentions. Despite the frequent mention of treating peripheral points
by blood-letting in both ancient and modern Chinese medical texts,
there is little reference to this technique in Chinese medical journal
reports. Very few articles focus specifically on use of this technique.
Further, descriptions of therapies for the disorders that peripheral
blood-letting is supposed to successfully treat rarely include that
method. Instead, standard acupuncture techniques without blood-
letting, as well as herbal therapies, are described. Therefore, the
effectiveness of the technique must be questioned, at least until further
evidence has accumulated.

When the method of peripheral blood-letting is used, it is usually

combined with other therapies (e.g., standard acupuncture or even
Western drugs) that might be sufficient to explain the claimed
beneficial effects. In a report on treating hordeolum by bleeding the ear
tubercle mentioned in the previous section, the eyes were also treated
with antibiotics. In an article on treatment of patients with persistent
hiccup (1 to 15 days) with bleeding of jing-well points, the treatment
was accompanied by standard acupuncture at several points (BL-13,
BL-17, BL-21, ST-44, ST-45, LI-1, and LI-4). It was reported that 95
out of 131 patients were cured after one treatment (9). It is difficult to
know how much of a contribution was made by the peripheral blood-
letting.

A Chinese physician who has used the blood-letting at the

hand jing-well points extensively for emergency cases wrote a report
on his experience (see Appendix 1). In his general analysis of
treatment strategies and in two case presentations, he described use of
standard acupuncture therapy, particularly needling of LI-4, along with
bleeding the hand jing-well points bilaterally. It was not possible to tell
whether the same results could have been attained without the blood-
letting portion of the treatment. One of the claims commonly made by
Western acupuncturists is that blood-letting at the jing-well points or at
the ear can rapidly decrease blood pressure. Yet, in a clinical study
conducted in Beijing with patients carefully monitored for responses to
acupuncture therapy for hypertension, blood-letting was not a
technique employed (10). The author claimed a good effect with
standard acupuncture, using such points as LI-4, LI-11, GB-20, LV-3
and BL-17. In all these cases, hegu (LI-4) was needled; it is possible
that this is the most effective point. Blood-letting at the ear apex was
mentioned only in passing as one ear acupuncture technique in the
book Traditional Chinese Treatment of Hypertension (14), but was
reported to be highly effective for hypertension in a single case report
(15).

Today, we know that the peripheral blood has the same content as
the rest of the blood that circulates in the body, and that there is no
reason to expect that the blood let out by this method is "bad blood,"
other than in a purely symbolic role. While standard acupuncture
therapy is depicted as being effective, in part, by releasing various
transmitter substances (e.g., endorphins), by stimulating local blood
flow (e.g., by dilating vessels), and by producing changes in the brain
that may have both systemic and highly specific effects, letting out a
small amount of blood (usually just a few drops) remains without a
suitable explanation for the potent effects claimed. The technique used
to let out the blood is one of quick and light pricking to pierce the skin
and vein. Unlike standard acupuncture, this method does not involve
getting a qi reaction or other evidence that the body is responding on a
deep level.
 Blood-letting occurs in numerous contexts in the modern world.
Millions of people donate a pint of blood, sometimes regularly;
millions more prick fingertips every day to get a blood sample for
diabetes testing. While these experiences are not as specific as aiming
for certain acupoints to release blood, the large number of points at the
periphery indicated for blood-letting in the Chinese literature, often
with overlapping indications, suggests that the technique does not
necessarily require a high degree of specificity for the location. Do
diabetics and blood donors suffer substantially less from syndromes of
heat and excess?

Therefore, acupuncturists should be somewhat cautious in making

claims of effectiveness and should request clinical trials to evaluate the
method, especially now that funding for acupuncture trials is being
provided in the U.S. Since many of the applications of this method are
for acute syndromes or disorders easily measurable, it should be
possible to compare the effects of blood-letting at acupoints versus
non-acupoints, or blood-letting by pricking versus pricking without
releasing blood, as well as to compare standard acupuncture to blood-
letting for treating a particular disorder.

SUMMARY
Blood-letting is an ancient therapy that was an essential part of traditional
acupuncture practice described in the original texts and which persists
today, particularly for treatment of emergency cases, such as loss of
consciousness, high fever, and swellings. Most of the blood-letting
therapy relies on treating peripheral points of the fingers and toes. Its
purpose is to alleviate excess conditions, particularly heat syndromes
and fluid swelling, and to promote resuscitation. A traditional concept
was that the release of blood would draw out the excess. This therapy
is somewhat difficult to explain in modern terms, and, therefore,
requires some investigation and research before any substantial claims
of effectiveness can be made. Practitioners often note what appear to
be prompt and dramatic results from the therapy, suggesting that its
efficacy should be easy to confirm using short-term trials. In most
cases, peripheral blood-letting (or other blood-letting therapy) is
accompanied by standard acupuncture, especially with points that are
not far from the blood-letting points, such as the hand/wrist points LI-
4, LU-7, and PC-6 and the foot/ankle points LV-2, LV-3, and KI-3,
suggesting that these other points may contribute significantly to the
observed therapeutic outcome. As a symbolic therapy-of letting out
excess, bad blood, toxins, or heat-blood-letting is a potent technique
 for both the practitioner and the patient, and its use represents a
continuation of the earliest traditions of acupuncture.

APPENDIX 1. Clinical Application of Twelve Well Points by Duan

Gongbao.
The following brief report (12) was edited slightly for readability and to
avoid repetition:
In many years' clinical practice, I used blood-letting
method of "Twelve Well-Points" to treat emergencies
such as coma, syncope, acute infantile convulsion,
wind-stroke syndrome, hysteria, epilepsy, etc., and
have achieved immediate results. Twelve Well-Points
refer to bilateral hand well points: shaoshang (LU-
11), shangyang (LI-1), zhongchong (PC-
9), guanchong (TB-1), shaochong (HT-9)
and shaozhe (S-I 1) which belong to the three yin and
three yang meridians of the hand and are located at the
finger tips. The 6 well-points of the yang meridians
belong to metal and are the beginning points of the
three yang meridians of the hand, while the other 6
well-points of the yin-meridians belong to wood and
are the ending points of the three-yin meridians of the
hand.
The indications of the Twelve Well-Points are acute
febrile diseases, cerebrovascular diseases, wind-stroke
syndrome, syncope, acute infantile convulsion, manic
and depressive psychosis, etc. The Twelve Well-Points
can be used for eliminating heat, resolving phlegm,
restoring consciousness, and promoting resuscitation. It
is recorded in the classic book Lingshu that psychiatric
diseases are related to the five zang-organs, so, the
well-points are often used. It also says that blood
diseases are related to the heart, thus, blood-letting can
eliminate pathogenic heat and cause resuscitation.
Therefore, pricking for bleeding and twirling-reducing
or twirling-pricking of the well-points can be used to
treat mental disorder, excess type of wind-stroke
syndrome, acute infantile convulsion resulting from
attack of pericardium by heat, heart disturbed by
phlegm-fire, or mental confusion due to phlegm,
syncope due to high fever, etc. After routine
 sterilization with 75% alcohol, hold a sterilized three-
edge needle to prick these well-points rapidly, then
squeeze the local point forcefully to let a few drops of
blood out.
When the patient falls into sudden mental changes, loss of
consciousness or mental disorder, the Twelve Well-
Points are treated to induce resuscitation, as follows:

1. Accumulation of phlegm-heat in the lung and heart

confused by phlegm: in case of invasion of the
pericardium by pathogenic factors, it is treated by
ventilating the lung and resolving phlegm, clearing away
pathogenic heat from the heart to cause resuscitation.
The 12 well-points are used in combination
with chize (LU-5), shenmen (HT-7) and daling (PC-7),
which are punctured and stimulated with the reducing
method.
2. Attack of the pericardium by pathogenic summer-heat:
in case of heatstroke due to accumulation of pathogenic
heat to block qi flow, it is treated by clearing away
pathogenic heat from the heart to cause resuscitation,
restoring the consciousness. The well-points are selected
in combination with reducing shenmen (HT-7) and
pricking quze (PC-3) to let a bit blood out.
3. Wind-stroke: in case of excess syndrome of stroke, it is
treated by clearing away heat, inducing resuscitation and
waking up the patient from unconsciousness. The 12
well-points are punctured in combination with needling
by the reducing method yongquan (KI-1) and hegu (LI-
4).
4. Interior heat-syndrome: in case of acute infantile
convulsion due to high fever and wind stirring inside, it
is treated by clearing away heat and toxic materials,
eliminating pathogenic heat from the heart, calming the
liver to stop the wind, and by using well-points
combined with needling by the reducing
method hegu (LI-4) and taichong (LV-3).
As an example, Mr Wang, aged 58 years, a farmer,
suddenly fell into coma; he had flushed complexion,
 lockjaw, deviation of the eyes, rigidity of both hands,
rattling sound in the throat due to phlegm, full and taut
pulse. His syndrome was heart stirred by phlegm-fire,
producing an excess type of wind-stroke syndrome.
Therapeutic principles applied were eliminating heat,
resolving phlegm, causing resuscitation, and restoring
consciousness. Acupoint selection included the Twelve
Well-Points pricked to let a bit of blood out; hegu (LI-
4) and taichong (LV-3) were punctured and stimulated
with reducing method (needles retained for 10
minutes). After treatment, the patient was restored to
consciousness immediately, accompanied with slight
deviation of the mouth and eyes, weakness of the upper
and lower limbs on the left side. Thereafter, acupoints
on the face and limbs were punctured continuously.
Half a month later, he returned to normal.
As another case, a male baby, aged 2 1/2 years,
experienced high fever, convulsion, lockjaw, muscular
spasm of the four limbs, and loss of consciousness.
Differentiation of syndromes indicated acute infantile
convulsion due to excessive interior heat and wind
stirring inside. Therapeutic principles applied were
dispelling wind and removing heat, calming the
internal wind and relieving convulsion and spasm.
Acupoint selection included the Twelve Well-Points
which were pricked to let a bit of blood out, combined
with puncturing and stimulating hegu (LI-
4), taichong (LV-3), and jiexi (ST-41) with the
reducing method. After treatment, the baby was
restored to consciousness immediately. Half an hour
later, his fever abated and he spoke and laughed as
usual.
The effects of the Twelve Well-Points in causing
resuscitation, clearing away heat from the heart and
tranquilizing the spirit, ventilating the lung, and
regulating yin and yang are derived mainly from the
combined application of the Three Yin and Three Yang
Meridians of the hand. Shaoshang (LU-11)
and shangyang (LI-1) serve to ventilate the lung,
remove heat from the throat, regulate the wei qi to
 relieve the exterior syndrome, and reduce
fever. Zhongchong (PC-9) can function in clearing
away heart-fire and accumulated heat of the
pericardium, tranquilizing, inducing resuscitation and
restoring consciousness. Guanchong (TB-1) can clear
away the pathogenic fire of the upper-jiao and remove
the accumulated heat in
the shaoyang meridian. Shaochong (HT-9) is used to
clear away heart fire, tranquilize, and regulate heart
qi. Shaozhe (SI-1) serves to remove heart fire, ease
mental anxiety, and eliminate accumulation of heat in
the taiyang meridian. The aforementioned acupoints
are only suitable for recuperating depleted yang and
rescuing the patient from collapse, rather than for
prostration (deficiency) syndrome due to sudden
exhaustion of yang of emergence or due to exhaustion
of qi from chronic disease because of excessive
weakness of the primordial qi. Therefore, the Twelve
Well-Points should be used according to differentiation
of syndromes. Otherwise, erroneous application of
these acupoints will bring the patient with unfavorable
influence and even miss the opportunity for emergency
treatment because of delay.

APPENDIX 2. Clinical Application of Blood-Letting Therapy by

Yang Haixia

The following report (15) includes the full text of the physician's
instructions on treatment, and then his case reports, which are
shortened considerably for presentation here.

The operator needs to massage the determined area for

blood-letting to cause local congestion, and clean the
skin area for disinfection according to the routine
procedure. Fix the acupuncture point or vein in the
blood-letting area with one hand, and hold a sterilized
three-edged needle with the other hand to prick the
point or vein 1-3 mm deep quickly and then remove the
needle immediately. Press and squeeze the muscle
around the pricked point or vein to cause bleeding. The
amount of bleeding caused for each treatment varies
from a few drops to several milliliters of blood
 according to the individual cases, the areas for blood-
letting, and the patients' conditions. Clinical practice
has proved that this therapy has the functions of
inducing resuscitation, reducing heat, invigorating
blood, removing stagnation and obstruction in the
channels, and can be mainly applied to treat excess,
heat, and acute syndromes.
Case 1. Chronic headache caused by hyperactivity of
yang. Extra points taiyang and yintang were pricked to
let out a few drops of blood. Shortly after treatment,
the pain disappeared suddenly, without relapse.
Case 2. Apparent small stroke, causing sudden deviation
of mouth, left eye being closed, and chewing
dysfunction. An obviously distended vein in the mouth
was pricked to cause bleeding, once per week. Body
acupuncture with electric stimulation was used
additionally, every other day. After 30 days treatment,
facial muscles returned to near normal.
Case 3. Apparent small stroke with rigidity, pain, and
numbness of tongue accompanied by dysphasia. Extra
points jinjin and yuye of the lingual vein were pricked
for bleeding. Two treatments resolved the disorder.
Case 4. Intermittent dizziness, tinnitus, and heaviness of
the head due to hypertension. Blood-letting was done
on the ear apex on both sides and the groove on the
back of the ears to let out a few drops of blood. After
five treatments, the blood pressure was stabilized at a
lower level with relief of symptoms.

APPENDIX 3. Summary of Major Blood-Letting Points

The following tables are derived from the Advanced Textbook on
Traditional Chinese Medicine and Pharmacology (13).

Summary of Peripheral Points for Blood-Letting

This table does not include the jing-well points, which are manly used for
the same indications as the other points listed here, except for the
unique pediatric therapy of the sifengpoints.

Point Name Distribution of Blood Vessels Indications

shixuan at the fingertips, network of the fever, coma, sunstroke,
 proper palmar digital arteries and unconsciousness, numbness of the
veins hands and feet
Shierjing behind the corner of the fingernails, fever, coma, sore throat, tonsillitis
network of the proper palmar digital
arteries and veins
sifeng network of the proper palmar digital infantile malnutrition, dyspepsia,
arteries and veins pertussis (squeeze out yellowish-
white fluid)
Yuji (LU-10) reflux branch of the cephalic vein in fever, sore throat, tonsillitis
the thumb
Bafeng and qiduan dorsal venous network of the foot swelling, pain and numbness of the
foot, snakebite
baxie dorsal subcutaneous network of hand swelling, pain and numbness of the
hand, snakebite
Ear apex, posterior auricular artery and vein fever, tonsillitis, red and swollen
supratragic apex, eyes, hypertension
and earback

Summary of Body Points for Blood-letting

This table does not include the point dazhui (GV-14), which is also often
used in blood-letting, especially accompanied by cupping. Dazhui has
he indications of treating various heat syndromes and fevers, and
epilepsy.

Point Name Distribution of Blood Vessels Indications

Chizi (LU-5) cephalic vein sunstroke, acute vomiting and
diarrhea
Quze (PC-3) cephalic vein sunstroke, suffocating feeling in the
chest, fidgets
Weizhong (BL- great and small saphenous veins of sunstroke, acute vomiting and
40) the popliteal fossa diarrhea, systremma
Yintang branches of the medial frontal artery headache, dizziness, red and swollen
and vein eyes, rhinitis
Taiyang venous plexus inside temporal fascia headache, red and swollen eyes
Baihui (GV-20) anastomotic network of the left and fever, tonsillitis, red and swollen
right superficial temporal artery and eyes, hypertension
vein and occipital artery and vein
jinjin and yuye lingual vein apoplexy, stiff tongue, and stuttering

REFERENCES

5. Ellis A, Wiseman N, and Boss K, Fundamentals of

Chinese Acupuncture, 1988 Paradigm Publications,
Brookline, MA.
6. Unschuld P, Medicine in China: A History of Ideas,
1985 University of California Press, Berkeley, CA
7. Wu jingnuan (translator), Ling Shu or The Spiritual
Pivot, 1993 The Taoist Center, Washington DC.
8. Ni Maoshing (translator), The Yellow Emperor's
Classic of Medicine, 1995 Shambhala Publications,
Boston, MA
9. Yang Shouzhong and Chace C, The Systematic Classic
of Acupuncture and Moxibustion , 1994 Blue Poppy
Press, Boulder, CO.
10. Anonymous, Essentials of Chinese Acupuncture, 1980
Foreign Languages Press, Beijing.
11. Long Zhixian (general chief editor), Acupuncture and
Moxibustion, 1999 Academy Press, Beijing.
12. Wang Zhao, Wan Xiaosong, and Zhang
Qiuying, Treatment of hordeolum by blood-letting at ear
apex, Journal of Traditional Chinese Medicine 2001;
21(3): 213-214.
13. Yin Ying, Blood-letting at a single point for treatment of
acute diseases, Journal of Traditional Chinese Medicine
1997; 17 (3): 214-216.
14. Xu Xiangcai (chief editor.), The English-Chinese
Encyclopedia of Practical Traditional Chinese
Medicine, (volume 6) 1989 Higher Education Press,
Beijing.
15. Tian J, Acupuncture treatment of 135 cases with hiccup,
World Journal of Acupuncture and Moxibustion 1999;
9(l):54-55.
16. Duang Gongbao, Clinical application of twelve well
points in emergency treatment, World Journal of
Acupuncture and Moxibustion 2000; 10(2).
17. State Administration of Traditional Chinese Medicine
and Pharmacy, Advanced Textbook on Traditional
Chinese Medicine and Pharmacology, volume 4, 1997
New World Press, Beijing.
18. Hou jinglun, Traditional Chinese Treatment for
Hypertension, 1995 Academy Press, Beijing.
19. Yang Haixia, Clinical application of blood-letting
therapy, Journal of Traditional Chinese Medicine 2002;
22 (1): 26-28.

August 2002
Figure 1: The nine original acupuncture needles.
Figure 2: The qiduan and bafeng points.

Figure 3: The shixuan points.

Figure 4: The sifeng points.
Figure 5: The baxie points.