BLEEDING PERIPHERAL POINTS:

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

Sângerarea punctelor de la extremităţi

Înţeparea unei vene sau artere mici, la vârful degetelor mâinii, la degetele
picioarelor, sau în partea de sus a urechii - este o tehnică bine cunoscută în rândul
acupuncturisti. Pentru a occidentalul neinițiat, aceasta terapie poate părea chiar mai
ciudată decât acupunct care ra obişnuită, însă poat fi explicată ca o metodă de
reglare a fluxului de Qi în meridiane. În acest caz, câteva picături de sânge lăsate să
curgă dintr-unul sau mai multe puncte periferice prin înţepare rapidă, se spune ca
are efecte semnificative. După cum se menționează în „Bazele de acupuncturii
chineze (1), "Procedura ar trebui să fie bine explicată pacientului înainte de a fi
efectuată, pentru a înlătura temerile sale.”

"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
theLingshu, 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 rdcentury (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 theEnglish-
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), guanc
hong (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)
anddaling (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 sifeng points.

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 infantile malnutrition, dyspepsia,
digital arteries and veins pertussis (squeeze out yellowish-
white fluid)
Yuji (LU-10) reflux branch of the cephalic vein fever, sore throat, tonsillitis
in the thumb
Bafeng  and qidua dorsal venous network of the foot swelling, pain and numbness of the
n foot, snakebite
baxie dorsal subcutaneous network of swelling, pain and numbness of the
hand 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 headache, red and swollen eyes
fascia
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.