BLEEDING PERIPHERAL POINTS:

An Acupuncture Technique

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 the Lingshu, 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 swellingwhere 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 bloodletting.

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 3rd
century (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 bloodletting 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 threeedged 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 the EnglishChinese Encyclopedia, pricking the jing-well point shaoshang (LU11), is mentioned as one of the treatments for severe cough due to
wind-heat affecting the lungs; the jing-well point zhongchong (PC9), as well as the non-peripheral points at the limb joints, quze (PC3) 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 jingwell 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 bloodletting 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 heatblood-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 WellPoints refer to bilateral hand well points: shaoshang (LU-11),
shangyang (LI-1), zhongchong (PC-9), guanchong (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 twirlingpricking 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:
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) and daling (PC-7), which are
punctured and stimulated with the reducing method.
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.

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).
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 13 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 proper palmar digital

arteries and veins

fever, coma, sunstroke, unconsciousness,

numbness of the hands and feet

Shierjing behind the corner of the fingernails, network of the
proper palmar digital arteries and veins

fever, coma, sore throat,

tonsillitis
sifeng

network of the proper palmar digital arteries and veins

infantile malnutrition, dyspepsia, pertussis (squeeze out

yellowish-white fluid)
Yuji (LU-10)

reflux branch of the cephalic vein in the thumb

fever, sore throat, tonsillitis

Bafeng and qiduan

dorsal venous network of the foot

pain and numbness of the foot, snakebite

swelling,

baxie

dorsal subcutaneous network of hand

swelling, pain

and numbness of the hand, snakebite

Ear apex, supratragic apex, and earback posterior auricular artery
and vein fever, tonsillitis, red and swollen eyes, hypertension
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-40) great and small saphenous veins of the
popliteal fossa

sunstroke, acute vomiting and diarrhea,

systremma
Yintang branches of the medial frontal artery and vein
headache, dizziness, red and swollen eyes, rhinitis
Taiyang venous plexus inside temporal fascia
and swollen eyes

headache, red

Baihui (GV-20)

anastomotic network of the left and right

superficial temporal artery and vein and occipital artery and vein
fever, tonsillitis, red and swollen eyes, hypertension
jinjin and yuye

lingual vein

stuttering

he qiduan and bafeng points.

The shixuan points

Figure2: The shixuan points.

apoplexy, stiff tongue, and

The sifeng points

Figure3: The sifeng points.

The baxie points