Jul 06 2010

Modern Bloodletting

I used to think that bloodletting was a Western cultural invention – part of Galenic medicine involving the balancing of the four humors, one of which being blood. Bloodletting faded away with the advent of science-based medicine in the 19th century. But it turns out that bloodletting was common throughout ancient cultures and not unique to the west.

In fact acupuncture was originally a form of bloodletting – the “needles” were really lances and the acupuncture points locations over veins to be opened. Chi, or the Chinese concept of the life force, was believed to be partly in the blood, and bloodletting could be used to free the flow of chi. This was closely related to the Galenic concept of using bloodletting to free the flow of static blood in the tissue.

For example, in the ancient medical text of Suwen, we find:

When heaven is warm and when the sun is bright,
then the blood in man is rich in liquid
and the protective qi is at the surface
Hence the blood can be drained easily, and the qi can be made to move on easily…

We also see in the text the connection of the functions of the body to celestial events. The concepts of blood, life force, and astrology all came together in acupuncture, but also in the ancient medical traditions of the West, just with different names and specific variations. The main concepts were balance and flow – lancing or needling were used to restore balance and flow to the natural rhythms dictated by the heavens.

You may be surprised to learn that these concepts have a continuous cultural connection to the present. In general the concept of bloodletting has fallen out of popularity because it seems barbaric and because the real physiological function of blood is now understood, and so are the dangers of bloodletting. But the techniques that were originally developed for bloodletting have been “rebranded” to be more acceptable to modern sensibilities (at least to a degree). And so acupuncture is now purely about chi and no longer about blood, and even more scientific explanations for how it might work are being sought. In my opinion, this is all a fool’s errand – chasing the bloodletter’s craft.

Cupping was also developed as a method of drawing out the blood. But now it is used to draw out imaginary toxins.

I had thought this “rebranding” was complete and all traces of bloodletting removed from the modern variants of these practices. But the cultural roots go deep, and even modern practitioners, relying on ancient texts, still adhere to some of the bloodletting concepts. They talk about treating blood “stasis”, which is a very Galenic concept.

The Japanese version of acupuncture, Shiraku, which survives today also closely ties together bloodletting and acupuncture (Shiraku means bloodletting). They combine cupping with lancing within an “acupuncture framework.”

The Institute for Traditional Medicine online has this gem, which extols the therapeutic benefits of “bleeding points.”

Peripheral blood-letting today is mainly carried out at the fingers and toes. At the tips of the toes, for example, are the qiduan points, located 0.1 cun behind the nails. 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.

I will have to remember that the next time a patient comes in with a stroke. It seems that the amount of blood drawn has been significantly reduced, which is good, but the ancient bloodletting concepts are all there unchanged.

Further, Acupuncture Today contains an article describing the use of bloodletting in modern acupuncture. The author, Skya Abbate, DOM, writes:

However, bleeding is a specialized technique for specific conditions that can produce effective and dramatic results when the patient’s condition is diagnosed properly and the bleeding method expertly executed.

As an example of the use of bloodletting, Abbate writes:

It can invigorate the smooth flow of qi and blood, thereby picking up and facilitating its flow when the qi and blood need invigoration. An example of this scenario occurs when a patient presents with a wiry pulse and mild feelings of stagnation that indicate qi stagnation.

The concepts of the flow of qi and blood are alive and well. I could have told you that was a quote from a medieval text and you probably would not have questioned it.

Conclusion:

When the actual history of acupuncture, bloodletting, cupping, and similar techniques are investigated we find that there are many modern myths about these practices. One myth is that there were completely different traditions in the various cultures, especially East and West. In reality, these were only cultural variations on the same themes – restoring balance and flow to blood and life energy in accordance to some astrological principles.

There is also evidence of direct cultural contact – not just reinventing the same concepts. For example, the iceman is the frozen remains of a 5200 year old man found in the Alps. He was covered with tattoos of points and lines over traditional acupuncture points. This was probably an example of therapeutic tattooing – the tattoos themselves were meant to be therapeutic. There are also needle punctures as some of these points. Think about the implications of a person living near the Alps (what is now Europe) 5200 years ago being tattooed over what later were known as acupuncture points.

It is further a myth that what we know today as acupuncture or cupping were developed in line with their modern incarnations. In reality, these techniques were just variations of bloodletting and were very deliberately and fairly recently distanced from their bloodletting roots to make them more acceptable.

And finally it is a myth that bloodletting itself has been eliminated from traditional practice. It survives in muted form in various traditions.

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20 responses so far

20 Responses to “Modern Bloodletting”

  1. johncon 06 Jul 2010 at 9:22 am

    Steve,

    Chi and Qi are the japanese and chinese words for blood.

    You’re seeing a distinction where there is overlap. Modern exercises for distributing Qi evenly around the body also, amazingly, help improve circulation.

    Who’d a thunk it eh?

  2. SARAon 06 Jul 2010 at 9:28 am

    I wondered about whether anyone was doing blood letting anymore when I was reading a novel in which it was featured. I decided that based on the love of the ‘alternative med folks’ for traditional and ancient methods, it was probably being done somewhere. I am continually confounded by their love for the “old ways”.

    Until recently it was a miracle to survive childhood much less live to be 80. We currently live to be 80,90, 100 because of science. But they eschew the science and embrace the ancient.

  3. nowooon 06 Jul 2010 at 10:05 am

    @johnc The Japanese word for acupuncture’s idea of energy or spirit is “ki” or 気, while the Japanese word for blood is “chi” or 血. They are not at all the same word. Chinese has the same distinction, but the Chinese may write the same characters slightly differently as well as pronounce them differently.

  4. Tuschkovskyon 06 Jul 2010 at 11:55 am

    “When heaven is warm and when the sun is bright,
    then the blood in man is rich in liquid
    and the protective qi is at the surface
    Hence the blood can be drained easily, and the qi can be made to move on easily…”

    I wonder whether they mistook vasodilation because of hot weather with their protective qi…

  5. johncon 06 Jul 2010 at 1:05 pm

    @nowoo

    There’s plenty of etymolgical hairsplitting that can be done.

    Japanese borrows heavily from chinese, and it’s no coincidence that chi, qi, ki etc, all sound very similar, as they have the same etymological roots.

    For example, ‘Fete’ and ‘feast’ both come from the same french word, but now have different uses, ‘regal’ and ‘royal’ both come from the same latin word, but were introduced to english at different times.

    The divergence in meaning here comes from a misunderstanding, as before concrete theories about the circulatory system were introduced to asia, the best way to describe observed phenomena was as a form of mysterious energy.

    It’s just a pity that we’re so bad at consolidating old and new wisdom. That was my point.

  6. Sastraon 06 Jul 2010 at 4:43 pm

    An example of this scenario occurs when a patient presents with a wiry pulse and mild feelings of stagnation that indicate qi stagnation.

    You mean that I can go to the doctor with complaints about “mild feelings of stagnation?” That’s rather neat. I had not thought of ‘stagnation’ as a symptom. Or is it a disease?

    “I can’t do that thing you asked, because I’ve come down with a case of stagnation. Oh, I don’t know. I just feel stagnated.” Some areas of the country, it may even be an epidemic. And, of course, ‘feelings of stagnation’ is a very good indication that one is dealing with alternative medicine in the first place. They’re still stuck on blood-letting.

    I’ll leave the term “wiry pulse” to the professionals. Maybe it has to do with something technical? All I can picture is a pulse that zaps through you like little pointy shocks.

  7. Rikki-Tikki-Tavion 06 Jul 2010 at 5:05 pm

    johnc、

    while I don’t rule out the possibility, that 気 (Ki/Qi:JP/CN) has some common roots with 血 (chi), it’s not as clear as you might think.

    Your comparison to European languages is not necessarily valid. First of all, Japanese has only 50 (-ish) different syllables. Collisions in very short words are unavoidable.

    Chinese differentiates syllables by different pronunciation patterns (e.g. high-low, high-low-high). Since I don’t speak Chinese, I can’t tell you anything about the pronunciation of 気 (spirit) and 血 (blood), but it’s entirely possible, that they do not sound at all similar to Chinese ears. Such differences would not show in romanizations.

    Steven,

    do you have any credible source for the Japanese practice (“Shiraku”)? I was curious what kanji may be behind this romanization, but I could not find any Japanese sources for it at all.

    Shiraku is not the Japanese word blood-letting. Its 瀉血 (shaketsu) or, uncommonly, 放血 (houketsu).

    The Japanese wikipedia only mentions that bloodletting was always rare, though known, on the Japanese isles, and that if anyone without a medical license practices it today, he can be charged with assault.

  8. Steven Novellaon 06 Jul 2010 at 5:53 pm

    Rikki,

    All of my sources are in English, which could mean that they are secondary. I leave it to the Japanese scholars to instruct me on the primary sources in Japanese. This could certainly be an example of exporting a myth to the West and distorting the history and facts to make it seem more accepted and legitimate.

  9. Donna B.on 07 Jul 2010 at 12:09 am

    Sastra – don’t be too hasty to denounce such descriptions of symptoms in your zeal to denounce discredited treatments. It’s quite likely that a depressed person with a decent vocabulary would describe himself as “stagnated”.

    It’s also possible that a physician diagnosing high blood pressure by feeling the pulse (before the invention of BP cuffs) might describe the pulse as “wiry”.

    I am NOT suggesting that bloodletting or acupuncture is a valid treatment, but I am suggesting that our ancestors (in whatever culture) may have correctly observed and recorded symptoms.

    Although I do remember reading about a rather rare ailment which is relieved by giving blood… some kind of iron problem? I don’t even remember enough about this to Google it and could very well be mistaken.

    But, if I’m not… one person who was improved by bloodletting in ancient days could very well have led to such treatment being prescribed for all. Successes are always advertised more than failures.

  10. Murrayon 07 Jul 2010 at 1:20 am

    I read a theory years ago that losing a certain amount of blood can be beneficial because as we evolved we lost blood regularly due to the brutal nature of life in the good old days.

    The only modern medical reason I’ve ever heard of it being used is for a condition where the iron level in the blood is very high.

  11. Rikki-Tikki-Tavion 07 Jul 2010 at 3:22 am

    Steve,

    I finally found a dictionary, that had the word shiraku in it. The kanji are 刺絡 (thorn/to pierce+entwine). With that I did find a few thousand google results.
    Shiraku does in fact mean blood letting, and it is in fact linked to acupuncture, as this BS page is eager to point out. You can google translate it to get an idea.

    http://www.kotyuten.com/shirakutoha/index.html

  12. David Hon 07 Jul 2010 at 4:12 am

    Donna B,
    Haemochromatosis id the disease you are thinking about that is treated through regular blood “removal” (in Australia it is often through blood donation).

    http://en.wikipedia.org/wiki/Iron_overload

    this is just for background info not science based research.

    I am more than a little worried that people who practise and represent bloodletting as a legimate medical proceedure are probably not going to be of the opinion that disease can be spread through blood and as such may not stricting adhere to good sterilization proceedures.

  13. BillyJoe7on 07 Jul 2010 at 7:25 am

    Rikki-Tikki-Tavi,

    “Although I do remember reading about a rather rare ailment which is relieved by giving blood”

    I think you mean blood-letting.
    Yes, I can think of two: Haemochromatosis and Polycythaemia.

    Three of my wife’s four sibs – two are twins – have haemachromatosis and donate blood regularly to keep their iron levels within the normal range.

    In polycythaemia, the problem is too many red blood cells which thicken the blood and can lead to strokes unless blood is removed periodically.

  14. elmer mccurdyon 08 Jul 2010 at 12:59 am

    The character for energy (actually it literally means air, gas or steam) is pronounced qi in Mandarin. Chi is the same word using a different romanization system. The character for blood can be pronounced either xie or xue (in different tones).

    Qi (in its traditional, not simplified, form) combines the radicals (basic parts) for air and rice, whereas xie is a very common radical in and of itself. I don’t know the history of the characters, but no, the relationship between the two certainly isn’t obvious.

  15. elmer mccurdyon 08 Jul 2010 at 2:29 am

    OK, I just found this in an online Chinese dictionary:
    氣質
    blood, gaseity, habitude, mettle, proclivity, strain, temperament

    As you can see , the first character is qi.

  16. elmer mccurdyon 08 Jul 2010 at 2:36 am

    …and the second one just means “substance.”

  17. scribe999on 08 Jul 2010 at 5:21 pm

    Having had the uncomfortable experience as a child of being held down with a strings tied tight around my finger tips while my uncle pricked them with a needle sterilized by a match flame…I’m generally against it.

    Keep in mind, this was supposed to relieve a headache. Kinda worked…my fingers were throbbing somewhat, so it de-emphasized the pain that was continuing to exist in my head.

  18. Joeon 08 Jul 2010 at 6:59 pm

    I repeat here what I posted at SBM (and Harriet somewhat echoed it). There were, originally, hundreds of acupuncture points so any mark on a person (viz., the Iceman) is likely to be within a margin of error from such a point. Therefore, I think the data is too thin to support a direct connection between his tattoos and acupuncture.

  19. mikerattlesnakeon 09 Jul 2010 at 10:59 am

    @Johnc

    from your posts it sounds like you buy into accupuncture, but I could be reading wrong. Anyhow, you said this:

    “You’re seeing a distinction where there is overlap. Modern exercises for distributing Qi evenly around the body also, amazingly, help improve circulation. Who’d a thunk it eh?”

    So which of the following is the actual health claim that accupuncture makes?

    1) The body contains a magical energy which is designed to support, heal, and create life that can be manipulated through the application of needles to specific points on the body to address specific health claims (though this mysterious all-powerful energy seems to have an effect just barely better than placebo at best and works best on self-limiting and subjective ailments, strange for such a mysterious and powerful force).

    or….

    2) Irritating tissue with needles might cause increased blood flow, causing health benefits that are nonspecific or not particularly evident.

    you can’t have it both ways.

  20. T.on 12 Jul 2010 at 5:00 pm

    Someone I’m acquainted with is being treated for a condition known as polycythemia vera (PV), a rare blood disorder.
    One of the other commenters has touched on this issue above.

    The state of the art treatment apparently consists in part of blood-letting, or more particularly, drawing off a pint or so of blood at regular intervals. Awareness of this prompted me to think about whether there may be or may have been some populations over history in which PV was prevalent, and thus where bloodletting would have made a noticeable clinical difference. My sense is that this is not the case, though, because onset of PV according to available literature most common beyond the age of 40, and the vast majority of our ancestors would not have made it to that ripe age. Nevertheless, here is an instance where bloodletting is literally a life saver in the modern world.

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