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.


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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