Clinical Applications of Bleeding Therapy in Acupuncture

by Honora Lee Wolfe, Dipl. Ac., FNAAOM

Bleeding therapy, also known as network vessel pricking, is one of the treatment methods of acupuncture-moxibustion. Although this method is not as well known or widely used in the West as other treatment methods, it is my and many Asian practitioners’ experience that this method is indispensable for achieving satisfactory therapeutic effects in certain cases. Zhang Jing-yue, a.k.a. Zhang Jie-bin, stated in the late Ming dynasty, "New disease are in the channels; enduring diseases enter the network vessels." The functional meaning of this statement is generally interpreted that most enduring diseases are complicated by an element of blood stasis in the network vessels. Many traditional Asian practitioners believe that the standard fine or filiform needle treatment that we rely upon most of the time in clinical practice is not very effective for treating this type of problem, and my personal clinical experience leads me to agree with them. Other methods of treatment such as cupping, moxibustion, and bleeding therapy are far more effective in such cases, especially if herbal therapy is not an option or is not adequate by itself. when I apprenticed with Miriam Lee of Palo Alto (now retired), I saw her use bleeding therapy on a large proportion of her elderly and chronically ill patients with extremely good results.

Recently, Yang Hai-xia published an article titled, "Clinical Applications of Acupuncture Bleeding Therapy Method," in the March issue of Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine & Medicinals, p. 36-37). This article contains four case histories which I would like to summarize here in order to help substantiate and promote the usefulness of bleeding therapy here in the West.

Case 1

The patient was an 18 year old female student who was first seen on Aug. 10, 1987. This girl had had a severe, bilateral headache for more than one year. Each day at noon, her head would ache as if about to split. When the weather outside was hot, this aching and pain was even worse. In fact, it was so bad, it interfered with her studies. Accompanying signs and symptoms included heart vexation, easy anger, a red face, and a bitter taste in the mouth. The young woman had previously been treated with numerous different formulas and had seen a number of different doctors. Because her appetite was poor and she was malnourished, these other practitioners had mainly treated her with supplementing and boosting formulas but with little effect. The patient’s tongue was red with thin, yellow fur, and her pulse was bowstring and rapid. Therefore, Dr. Yang discriminated her pattern as ascendant liver yang hyperactivity. To treat this, Dr. Yang bled Tai Yang (M-HN-9) bilaterally and Yin Tang (M-HN-3), letting out several drops of blood from each point. As the girl laid quietly on the treatment bed, her headache disappeared and her affect became crisp and clear. One treatment cured this patient, and there was no recurrence on follow-up over three years.

According to Dr. Yang, years of pressure as a student had caused qi and fire to become depressed internally within this patient. This had consumed yin fluids, gradually resulting in the patient’s yin becoming unable to control her yang. Thus liver yang had become hyperactive and had counterflowed upward. At noon, yang reaches its apogee, and the yang of the macrocosm and the patient’s personal yang mutually augmented each other at this time every day. Hence her headache would become more severe at this time each day. Bleeding Tai Yang and Yin Tang is able to level the liver and subdue yang, clear and discharge liver fire.

Case 2

The patient was a 38 year old  male worker who was first seen on Jan. 15, 1990. For the previous half year, the man had not been able to close his left eye. Tears ran from the corner of this eye and the local area was uncomfortable. The man had previously taken numerous different formulas to treat this facial paralysis. However, although there had been some improvement, the results were not completely satisfactory. When examined by Dr. Yang, the man had a runny nose, the corner of his mouth drooped down, he had no strength to lift his shoulder, and he was not able to clench his teeth. When Dr. Yang examined the mucous membranes inside the patient’s left cheek, he saw 3-5 static spots which he pricked to bleed. He also needled Tou Wei (St 8) through to Yang Bai (GB 14), Tong Zi Liao (GB 1) through to He Liao (TB 22), Shang Guan (GB 3 ) through to Xia Guan (St 7), and Di Cang (St 4) through to Jia Che (St 6) with electroacupuncture and a dense disperse wave form for 20 minutes. Dr. Yang administered this electroacupuncture treatment one time per day and the bleeding once per week. After 30 days, the man was able to move his facial muscles normally and his strength basically returned to normal.

According to Dr. Yang, wind evils in the channels and network vessels had resulted in this man’s facial paralysis. Because the course of this condition was relatively long, qi and blood had become disharmonious and static blood was now also obstructing the network vessels. Therefore, the bleeding eliminated this stasis, while  the electroacupuncture dispelled the wind.  

Case 3

The patient was a 50 year old housewife who was first seen on May 18, 1987. This woman’s tongue had been stiff and painful for more than a year. This caused her speech to be inhibited. Accompanying signs and symptoms included facial pain which sometimes was burning hot and sometimes pricking and sharp, decreased taste, a dry mouth with scanty fluids but no desire to drink, and a poor appetite. However, the patient’s affect was ok, her two excretions were normal, and she had normal use of her four limbs. Like the previous cases, this woman had already been treated by a number of other doctors without effect. Since no organic disease had been discovered, her diagnosis was a "nervous functional disorder." When Dr. Yang examined this patient, he found that the tip of the tongue was red with white fur, and her pulse was fine and choppy. Therefore, her Chinese medical diagnosis was tongue impediment. Dr. Yang let 3ml of blood from Jin Ye and Yu Ye (M-HN-20). After only this one treatment, all the patient’s symptoms greatly diminished. After skipping a day, Dr. Yang repeated this treatment one time and the patient was completely healed. On follow-up after one year, there had been no recurrence.

According to Dr. Yang, the origin of this woman’s disease was a stomach yin vacuity detriment resulting in depletion and loss of fluids and humors. Hence her tongue had lost its moistening and nourishment. The oral dryness, torpid intake, red tongue tip, and fine pulse were all indications of yin vacuity. Because this yin vacuity had endured for many days, it had resulted in the vessels and network vessels becoming static and obstructed. Hence the tongue had become even more malnourished and depleted of moisture. This had eventually led to the tongue becoming painful and stiff and the speech becoming obstructed. Bleeding Jin Ye and Yu Ye had dispelled and eliminated this static blood so that the network vessels flowed freely once again and fluids and humors could be obtained above. Once this happened, the tongue impediment was automatically resolved.

Case 4

The patient was a 42 year old cadre who was first seen by Dr. Yang on Oct. 21, 1997. This patient had been dizzy for more than one year due to hypertension. Although the man had been put on antihypertensive medication, this medication had difficulty keeping his pressure normal. Whenever this patient became tense at work, he would become dizzy and his head felt heavy. This was accompanied by vertigo, tinnitus, a bitter taste in the mouth, a dry mouth, heart vexation, and easy anger. Sometimes, this man’s face and eyes were red. His urination was short and yellow-colored, while his stools were dry. In addition, the man had a strong bodily constitution, the tip of his tongue was red, its fur was thin, and his pulse was bowstring and slightly rapid. His blood pressure was elevated at the time of examination by Dr. Yang. To treat this man, Dr. Yang bled the tips of both his auricles as well as a point (or points) on the groove behind the ear. A short time later, the man’s blood pressure dropped substantially to within normal parameters and his dizziness markedly decreased. Dr. Yang repeated this treatment every other day. After five treatment, the man’s blood pressure was stable and within normal range.

According to Dr. Yang, this was also a case of ascendant liver yang hyperactivity. Pricking the auricles of the ear and the groove behind the ear is able to clear and drain fire and heat, downbear counterflow and level surging, settle and subdue liver yang, level the liver and extinguish wind, and thus return the blood pressure to normal. 

Dr. Yang’s case histories are quite impressive. While not all patients may respond so well or so quickly to such simple treatment protocols, I believe Dr. Yang’s message is clear that bleeding therapy or network vessel pricking is a powerful tool that we should not overlook whenever blood stasis has entered the network vessels. If proper procedures are followed, bleeding can be done safely and effectively in the modern clinical context. It is my experience that, if we relinquish this technique from our clinical repertoire due to fear of blood-borne pathogens or taint by association with the excesses of 18^th century Western phlebotomy, we will not get fully satisfactory results in a certain proportion of our patients with chronic, enduring conditions. Although the so-called fine needle can produce almost magical results in a multitude of patients, even the authors of the Nei Jing (Inner Classic) recognized that it was only one of nine needles and that, in certain situations, it is not the treatment of choice. There’s a common saying, "If all you have is a hammer, everything looks like a nail." However, we all have the experience that using a screwdriver on a screw is far more efficient and effective. Similarly, what we call acupuncture-moxibustion is a collection of numerous techniques, each with their own specific capabilities and indications, and I believe that bleeding therapy is just as clinically useful and important today as 20 centuries ago.

Copyright © Blue Poppy Press, 2001. All rights reserved.

For more information about diagnosing blood stasis, Blue Poppy has several helpful products including:

Aging & Blood Stasis Also watch for the forthcoming Distance Learning Product, Pain Relief with Moxibustion & Other Adjunctive Therapies with Honora Lee Wolfe, available August, 2001.