III Other Modalities—Treatment Tools Complementary to Acupuncture

17 Bleeding Techniques: Ancient Treatment for Acupuncture Physicians

18 Liniments, Sprays, and Powders

19 An Overview of the Therapeutic Application of Moxibustion

20 The Mineral Infrared Therapy Device

21 Practical Threading Therapy

An ancient Oriental treatment technique applicable for many conditions, but which the modern day practitioner may be hesitant to use in his/her treatment plans, is bloodletting. The reluctance to use this method could be due to the drawing of blood that can transmit blood-borne pathogens, or maybe there is 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 properly diagnosed and the bleeding method expertly executed and matched to the diagnosis. Bloodletting has four major therapeutic aims that are useful in the clinical arena. Let us review them:

1. It can invigorate the smooth flow of qi and blood, thereby augmenting and facilitating the free flow of the qi when it needs invigoration. An example of this is when a patient presents with a wiry pulse and mild feelings of distention that indicate liver qi stagnation and the qi simply needs to be moved.
   
2. It disperses qi and blood stasis as in the case of backache or spider veins caused by qi and blood stagnation.
   
3. It can drain excess heat and fire. Such excess includes pathogenic factors, for instance caused by an invasion of the lung by wind heat that produces a fever and very sore throat.
   
4. Finally, bleeding can bring down yang rising as in the variety of high blood pressure due to liver yang rising. Note: not all hypertension has this etiology and hence bloodletting is not suitable for those differentiations.

There are numerous clinical conditions that are suitable for treatment with bleeding that have the four differentiations listed above, and some of these are outlined later in Tables 17.1 and 17.2.

The categories of acupuncture points that are the most common to bleed are those that have shallow depths of insertions such as ear acupuncture points, scalp points, and jing (well) points. Other points that can be bled are those whose energetics lend themselves to bleeding such as BL- 40 (wei zhong), 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 (collateral = channel) pricking method. With this style of needling a discrete point or spot is bled such as a jing (well) point like LI-1 (shang yang) to relieve a toothache due to excess heat, or LU-11 (shao shang) 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 point such as GV-14 (da zhui) 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 treated is pinched between the thumb and the index fingers and held while the practitioner punctures the point. This action isolates the point as well as promotes venous pooling, which facilitates bleeding. Bladder 2 (zan zhu) is a common point to pinch and bleed for sinus congestion or headache.

As effective as it, bleeding is contraindicated for certain conditions. One of the most important prohibitions is that it is not suitable for yin vacuity or false heat. Bleeding in this case can actually weaken the patient, as the heat is not real but is arising from vacuity.

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 equally apply to patients who are extremely weakened, anemic, hypotensive, or pregnant. Depending upon the point treated, the patient can be bled either in a sitting position for bleeding a jing (well) point, or in a reclining position in order to pinch BL-2 for instance.

Table 17.1 Points, bleeding method, and clinical conditions

Prior to bleeding the practitioner should have all of the required treatment tools within the work area. Next, 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 protective gloves, and the bleeding tool of choice. Off the field have an open biohazard sharps container, a biohazard trash container, extra 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 % isopropyl alcohol and allowed to dry naturally.

Clinical Notes

Table 17.1 summarizes common points amenable to bleeding, the style of bleeding technique to use, and the clinical conditions related to the points that are bled. Table 17.2 correlates the clinical results of bleeding with specific modalities.

Table 17.2 Bleeding results and corresponding modalities for specific clinical conditions