• 230 • Chin J Integr Med 2012 Mar;18(3):230-232

TRADITIONAL MEDICINE
Heated Moxibustion and Bloodletting in Tibetan Medical
Literature of Dunhuang Heritage
ZHAO Qi (赵 琪)1, WU Mo-zheng (吴墨政)2, and ZHAO Ji-ping (赵吉平)1

ABSTRACT The paper introduces the heated moxibustion and bloodletting in Tibetan medical literature of
Dunhuang Heritage. It proves that the external therapies in Tibetan medicine such as heated moxibustion and
bloodletting are of very high level since the 8th century, which inspires current clinical practice. It also shows that
the extensive exchange between Tibetan medicine and various kinds of medicine such as Chinese medicine
promoted the development of Tibetan medicine.
KEYWORDS Dunhuang Heritage, Tibetan medicine, heated moxibustion, bloodletting

In the Tibetan manuscripts of Dunhuang Originally sealed in Dunhuang Grottoes,

Heritage, there are four books of Tibetan medical
literature written in Tubo Period (Tibetan regime in
ancient China from 7th to 9th centuries). These books
were compiled by LUO Bing-fen and HUANG Bu-
fan as Collection of Ancient Dunhuang Manuscripts
on Tibetan Medicine ,(1) which were then published.
Byams-pa-phrin-las, a renowned Tibetan medical
expert who examined and approved the book,
considered it to be extremely important in ancient
Tibetan literature. This paper mainly discusses the
heated moxibustion and bloodletting in this book and
its academic value.
One of the Earliest Extant Ancient Tibetan
Documents
Most manuscripts of Dunhuang Heritage were
written in the Tang Dynasty (AD 618–907). From
AD 781 to 847, Dunhuang was governed by Tubo
Dynasty and the amount of manuscripts increased
rapidly in Tibet. The above-mentioned four books
were probably written in that period. The end of the
volume for heated moxibustion states that this therapy
"is a combination of collecting many prescriptions and
the therapy in Shang-Shung region". Shang-Shung
region is the center of origin of ancient Tibetan culture
as well as the earliest birthplace of Tibetan medicine.
Byams-pa-phrin-las believes it was written before the
early 9th century when Tibetan language was collated
and stipulated for the second time, namely before
the well-known Four Medical Classics (Si Bu Yi Dian)
was written. Therefore, these four books of Tibetan
medical literature pertain to one of the earliest extant
ancient Tibetan literatures, from which we may obtain
an overview of Tibetan medicine in the 8th century.
Dunhuang Heritage was looted by Marc Aurel Stein
and Paul Pelliot shortly after it was discovered in 1900.
The scripts of these four books are now housed in the
British Library and French National Library. The three
books in Collection of Ancient Dunhuang Manuscripts
on Tibetan Medicine are from photocopies of Selections
of Tibetan Literature . These books are numbered as
P.T.1057, P.T.127, and P.T.1044, respectively. The
fourth book is from the photocopy of the library in the
University of Washington and is numbered as I.O. No.
57 of volume 56.
Heated Moxibustion in Tibetan Medicine in the
8th Century
Heated moxibustion and bloodletting have
been the main surgical techniques applied in Tibetan
medicine for a long period of time. The practitioner first
found tender points or certain points in the body surface
of patients and then applied heated moxibustion
or bloodletting according to condition of diseases.
Then, it has special curative effect on diseases of
corresponding zang-fu organs.(2) The records of Tibetan
manuscripts of Dunhuang Heritage show that these
medical techniques began to be widely applied in
Tibetan medicine before the 8th century.
©The Chinese Journal of Integrated Traditional and Western
Medicine Press and Springer-Verlag Berlin Heidelberg 2012
1. Department of Acupuncture and Moxibustion, Dongzhimen
Hospital Affiliated to Beijing University of Chinese and
Moxibustion Medicine, Beijing (100700), China; 2. Institute of
Acupuncture and Moxibustion, China Academy of Chinese
Medical Sciences, Beijing (100700), China
Correspondence to: Prof. ZHAO Ji-ping, Tel: 86-10-84013161,
E-mail: zjp7883@sina.com
DOI: 10.1007/s11655-012-1002-5
Chin J Integr Med 2012 Mar;18(3):230-232
Heated moxibustion may be used to treat a lot
of diseases. P.T.127 mentioned internal, surgical,
gynecological, and pediatric diseases, diseases of five
sense organs, as well as contagious diseases. Internal
diseases include indigestion, poor appetite, costal or
gastric pain, dull pain in ileum caused by invasion of
cold, pulmonary tuberculosis, cough, asthma, fullness in
chest, pain with cold sensation below low back, pain with
heavy sensation in low back, dizziness and headache
caused by invasion of wind, deviation or swelling in
the face, rickets in the lower limbs, pain of feet, as well
as numbness and pain of joints. P.T.1044 mentioned
deviation of mouth and nose caused by invasion of wind,
retention of urine, weakness of feet, as well as spasm
and numbness of feet caused by invasion of wind.
Even today, the moxibustion recorded in the
manuscripts is still widely applied in the treatment of
these diseases. For example, moxibustion is applied
on the points that are 2 cun lateral to the umbilicus
(Tianshu (ST25) for burp or indigestion));(3) for urinary
retention, moxibustion is applied on the point that is 1.5
cun directly below the umbilicus (Qihai (CV6));(3) and
for paralysis and weakness of the feet or pain in the
thigh, moxibustion is applied on the point where the
tip of the middle finger of patient touches the posterior
aspect of the thigh when the patient is standing erect
(corresponding to Yinmen (BL37)).(3)
It should be particularly noticed that the heated
moxibustion in these Tibetan manuscripts has
manifested the approach of treatment based on
differentiation of syndrome. For example, for poor
appetite and gastric and abdominal pain referred
to the costal regions caused by pathogenic wind, 9
cones of heated moxibustion are applied on the point
that is 1 cun directly below the sternocostal angle
and four-finger breadth lateral to the anterior midline
(Qimen (LR14)), (3) whereas if those symptoms that
belonged to heat syndrome transform into a cold
syndrome with white foam in defecation and dull
pain, 11 cones of heated moxibustion are applied on
the point that is five-finger breadth directly below the
sternocostal angle (Zhongwan (CV12)).(3)
Indeed, the treatment based on differentiation
of syndrome is the essence of acupuncture and
moxibustion. Clinically, for epigastric pain caused by
Liver (Gan) qi attacking the Stomach (Wei), we apply
acupuncture and moxibustion on Qimen (LR14),
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Front-Mu point of the Liver, whereas, for epigastric
pain caused by deficiency cold in the Spleen (Pi) and
Stomach, we apply acupuncture and moxibustion on
Zhongwan (CV12). Treatment for these two types may
both obtain satisfactory effects.
P.T.127 manuscripts also mentioned three
pathogens, which are wind, Peigen, and Chiba. To
illustrate, "for deviation and swelling in the face due
to attack of wind, 5 cones of heated moxibustion are
applied on the point in the pebble-shaped area in the
lower angle of the mandible (Jiache (ST6))." (3) "For
borborygmus caused by pathogenic wind invading the
viscus, or splenomegaly caused by pathogenic wind
invading the Liver, 7 cones of heated moxibustion
are applied on the point in the depression between
the 9th and 10th ribs (Ganshu (BL18) or Hunmen
(BL47))".(3) In Four Medical Classics , wind is called
lung. It is the right prescription to apply moxibustion
on Jiache (ST6) for wind attacking the face because
Jiache (ST6) expels wind and activates the collaterals
or to apply moxibustion on Hunmen (BL47) or Ganshu
(BL18) for borborygmus or splenomegaly because
Hunmen (BL47) disperses the stagnated Liver-qi and
regulates the flow of qi, and Ganshu (BL18) clears
away the heat in the Liver and Gallbladder (Dan) and
nourishes the Liver and Kidney (Shen).
For another example, for those who suffer
from fullness and choking sensation in the chest,
the treatment of 9 cones of heated moxibustion is
applied on the point in the upper neck (Lianquan
(CV23)).(3) The etiology of this syndrome in Tibetan
medicine is stagnation of Peigen. In Tibetan medicine,
Pei refers to water and Gen to earth; therefore,
stagnation of Peigen refers to stagnation of qi and
water. In accordance with the theory of Chinese
medicine (CM), Lianquan (CV23), a meeting point of
the Conception Vessel and the Yin Link Vessel, may
circulate qi and blood in the throat and diaphragm and
eliminate phlegm. For those who suffer from yellow
eyes and sudden pain of the bone, the etiology in
Tibetan medicine is ascending of Chiba. Chiba refers
to dryness and fire. The treatment is to apply heated
moxibustion to tips of the fingers (Shixuan (EX-UE
11)).(3) According to the theory of CM, bloodletting in
Shixuan (EX-UE11) may clear heat and help regain
consciousness. Therefore, in this case, it is quite
suitable to use Shixuan (EX-UE11) for clearing heat.
From the manuscripts, we know that, in applying
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heated moxibustion, the practitioner tried to seek the
etiology and treated the same syndromes with different
methods, namely, to apply heated moxibustion to
different areas if the syndromes were caused by
different kinds of etiology. In the 8th century, this was
already a remarkable accomplishment.
Unique External Therapies Such as Bloodletting
Bloodletting was mainly recorded in P.T.1057
with two methods, namely bloodletting in the affected
area or in the affected meridians according of different
diseases. An example of the first method is that, for
those suffering from pain, swelling, and pus in the
larynx caused by tonsillitis, the affected area can be
cut open to drain the pus and then a mixture of bear
gallbladders , Anemone obtusiloba , and Clematis
tangutica (Maxim.) Korsh are applied to the wound.
Apparently, it is scientific and effective to cut open,
drain the pus, and apply heat-clearing and anti-
inflammatory medications for suppurative tonsillitis and
peripharyngeal abscess. Another example is that, for
those suffering from inflammation in the root of teeth
with loose teeth and intolerable pain, the root of teeth
can be cut open with some black blood out, whereas,
for most syndromes, usually bloodletting is applied
in the corresponding meridians of different diseases.
To illustrate, for those suffering from diseases and
augmentation of the Gallbladder with yellow skin and
eyes, bloodletting is applied to the meridians of the eye
and Liver. For those who suffer from food poisoning with
high fever, bloodletting is applied to the two meridians of
the Lung (Fei). For cardiac pain, bloodletting is applied
to the meridian of the Heart (Xin). For a female with
hyposexuality, bloodletting is applied to the meridian of
the Heart located in the upper end of the right thumb
or to the meridian of the Liver. This bloodletting in the
affected meridians according of different diseases
embodies the concept of corresponding meridian
point selection, which is a main method of treatment in
acupuncture and moxibustion. To this day, this approach
can still be applied in contemporary acupuncture and
moxibustion, cupping, and point injection.
Development of Tibetan Medicine Cannot Be
Achieved without Extensive Exchange with
Various Kinds of Medicine
Tibetan medical manuscripts of Dunhuang
Heritage reflect the extensive exchange between
Tibetan medicine and various kinds of medicine such as
Chin J Integr Med 2012 Mar;18(3):230-232
CM, traditional Indian medicine, and Persian medicine
in the 8th century. In AD 641, the marriage between
Princess Wencheng and Songtsen Gampo promoted
strongly the exchange of the Han nationality and Tibetan
nationality in the fields of culture and medicine. In P.T.127
and P.T.1044, 1 cun and 0.5 cun are used to locate the
area for heated moxibustion and 5 or 9 moxa cones are
used to describe the duration of treatment. I.O.56 and
I.O.57 state that "the disease of the eyes indicates the
disease of the Liver, nose indicates the Lung, tongue
indicates the Heart, and ears indicate the Kidney". Those
were obviously influenced by CM. For example, chill is
treated with decoction of Rhizoma Zingiberis and liquor
of the Han nationality; irregular menstruation is treated
with Radix Paeoniae Alba and wormwood in the liquor of
the Han nationality; and oliguria is treated with Medulla
Tetrapanacis and Talcum . These are all from therapies
in CM. In addition, the end of P.T.127 states that "the
practitioner may also apply bloodletting with needles from
Tujue (or Turk, a nationality in ancient China) region".
The end of P.T.1044 states clearly that "this prescription
is from one of the surgical therapies in Indian". This not
only shows that in the 8th century cultures of different
nationalities and various kinds of medicine had extensive
exchange but also that constantly learning of the
achievements of other kinds of medicine, many of which
are from CM, enriched and promoted the development
of Tibetan medicine. Since ancient times, there has
been extremely close relationship between the Tibetan
and Han nationalities, who jointly created the great CM.
The enlightenment to us is that the present development
of CM, including acupuncture and moxibustion, may
also learn from and incorporate the accomplishments
of modern medicine and medicine of all ethnic groups.
Only by wide opening and popularizing can vigorous
development be possible.
REFERENCES
1. Luo BF, Huang BF. Collection of ancient Dunhuang
manuscripts on Tibetan medicine. 1st ed. Beijing: Ethnic
Publishing House;1983:15.
2. Hua BJ. A brief talk on the heated moxibustion in Tibetan
medicine. Chin J Ethnomed Ethnopharm (Chin) 2011;14:8.
3. Beijing Hospital of Traditional Chinese Medicine, Beijing
School of Traditional Chinese Medicine. Practical traditional
Chinese medicine. 1st ed. Beijing: Beijing Publishing
House;1975:1223-1274.
(Received January 11, 2011)
Edited by WANG Wei-xia