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Acupuncture and Modern Bloodletting

Last year Ben Kavoussi published an interesting article on SBM called Astrology with Needles in which he purported a historical connection between acupuncture and bloodletting. I had previously thought that bloodletting was a uniquely Western cultural invention – part of Galenic medicine involving the balancing of the four humors, one of which being blood. (In the West bloodletting faded away with the advent of science-based medicine in the 19th century.) I was intrigued by this connection and have since been doing my own reading on the topic. 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 blood letting 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 Tradition 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.

Posted in: Science and Medicine

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25 thoughts on “Acupuncture and Modern Bloodletting

  1. J. Martin says:

    Just yesterday I videoskyped with a friend who lives in Beijing, and we talked about “TCM,” especially about acupuncture and cupping in China. I was surprised to hear that cupping seems alive and well over there, wondering about its possible connection to medieval Europe—and bang! came along your post.

    What’s more, I was rather stunned to learn from her that cupping as a catch-all remedy is actually endemic where she lives, and people displaying suction marks out of their tees a familiar sight. Not only has it survived, it seems, but in some places not in “muted” forms at all.

  2. Werdna says:

    One thing that cheeses me off is the mythology of holism with Eastern medicine. While I agree that modern vendors in North America of eastern medicine do seem to stress this (possibly in Asia too but I lack a sample). Although there are a few well-preserved historical medical texts – like any set of surviving works it’s difficult to figure out how much of the norm they represent. Certainly *some* of it i.e. 藥性論 is in a symptom/remedy format. How is that any more holistic than the so-called ‘pill pusher’ mentality?

  3. art malernee dvm says:

    At least modern medicine has separated the bleeding from the purging or are the Acupuncturist now sending home cleansing enemas?

    Death of a President …

    “The times are ominous indeed, when quack to quack cries purge and bleed. ”

    art malernee dvm fla lic 1820

  4. Joe says:

    I have always doubted the claims that the 5200-year-old mummy showed anything directly related to acupuncture. It seems there were 365 original acupuncture points. Thus, just about any spot on the body is within the error limits of an acupuncture point.

    Although the two may have started in the same mystical ideas, the evidence that the Europeans and Asians used the same points because of some direct connection is rather thin.

  5. Finally, some “logic” for the existence acupuncture. I can see the development from bloodletting to mere needles, electric needles, hot needles, etc. Of course, it doesn’t explain the “how” any better than before–it’s still woo–but at least there’s a historical perspective.

    I wonder if the Ice Man’s tattoos were something other than therapeutic–what if he was a traveling shaman or even a teacher? Maybe he was the acupuncture textbook, so to speak.

    Bloodletting at the tips of the toes certainly would relieve pain in the instep–there would be no time to worry about the instep with a needle in your toe.

  6. “Said to be useful for emergency treatment for stroke”? Good grief, what puffery! Who said? I pity the foo’ who tries to treat a stroke with needles in the toes! There’s a lawsuit waiting to happen.

    This is a common deceptive tactic I’d never specifically noticed before: make an alt-med treatment seem more impressive by claiming that it’s “good for” serious conditions … problems that the practitioner will never actually encounter in the wild, and (usually) wouldn’t dare to treat even if they did!

  7. gilescooper says:

    Bloodletting can in fact be very healthful, even life-saving (especially if your blood type is O-negative). Personally I try to let blood as often as I am able. Of course, the health benefit is not for you, it is for the person who receives the blood.

    http://www.redcrossblood.org/

  8. aaronupnorth says:

    When patients come to my emerg with a stroke I always stick a needle in the qiduan point of there finger….which is to say, I always check a finger-prick glucose.
    Dr. J

  9. daijiyobu says:

    When I was in naturopathy school, studying the naturopaTHICK [ah-ha-ha-ha], I remember in their mandatory TCM class getting needled for the first time. So, after a diagnosis via 5-element and yin-yang woos, it was decided that one point that was needed to stick was on my pinkie-toes.

    I never thought much of acupuncture or TCM, and still don’t. Mainly a superstitious, medieval parlor trick, to me. But, I was rather amazed, to the extent that I still remember it clearly, even to this day, at the small amount of blood that came out of such a shallow pinstick. I can see the humoral-like connection the superstitious, archaic mindset would make.

    BTW, regarding cupping and “imaginary toxins”, is anyone familiar with naturopathy’s “emunctorology”?

    (http://www.foundationsproject.com/documents/FNM_Emunc-Webcall-30oct08.pdf )

    Just as naturopathy claims that a vital force is a physiological fact, the THICKS are reviving emunctorology as a “science” of waste elimination / detoxification pathways for their new textbook (see http://www.foundationsproject.com/documents/FNM_Ed_Retreat_eBook_032407last.pdf ).

    There, FNMP poses the question: what is the difference between drainage (e.g. http://www.susanjonesnd.com/biotherapeuticDrainage.shtml ) and detoxification (http://www.naturesintentionsnaturopathy.com/body-detox/detoxification-for-the-body.htm )?

    Hmmm. What is the difference between Bigfoot and Sasquatch?

    -r.c.

  10. wales says:

    Just google “therapeutic phlebotomy”. Bloodletting is alive and well in western medicine, apparently for multiple medical purposes.

  11. wales says:

    Apparently bloodletting was initially modeled after menstruation. Not surprising that this idea occurred to people, since women generally live longer than men (presumably they did in the past as well, if they survived childbirth).

    Bloodletting or more politely “therapeutic phlebotomy” is still used in modern western medicine not only for patients with “iron overload” but for those “cyanotic patients with hyperviscosity”.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769278/

  12. Calli Arcale says:

    Yep. I have a friend who has hemochromatosis; the treatment is regular phlebotomy. (Phlebotomy is also the term for drawing blood for blood donations or for medical testing.) It’s not for the same purposes as in the bad old days, of course. In hemochromatosis, the person can’t break down iron properly, which leads to a massive surplus of it in the blood. This is unhealthy, and the simplest treatment is regular bloodletting.

  13. wales says:

    Yes Calli, thanks for pointing out the difference between “phlebotomy” (donating blood) and “therapeutic phlebotomy” (bloodletting as medical treatment).

  14. Dawn says:

    @wales: the difference is that today phlebotomy is used only for specific medical indications, like hematochromatosis, not every illness that comes down the pike.

    If your doctor suggests it for your next major illness (not doing a blood culture to see what’s making you sick, but blood letting just to remove a pint or two) I think you should run away. However, if you have one of the medical diseases that phlebotomy help with, then go for it.

  15. BillyJoe says:

    Calli Arcale,

    “In hemochromatosis, the person can’t break down iron properly, which leads to a massive surplus of it in the blood.”

    Iron is an element so it can’t actually be “broken down”.
    In fact, the problem in haemachromatosis is that too much iron is absorbed from the bowel.

    And the surplus is not retained in the blood but deposited in various organs – in the pancreas causing diabetes, in the joints causing arthritis, in the gonads causing infertility, and in the liver causing cirrhosis. Other organs more rarely

    (Three of my wife’s four siblings – two are twins – have haemachromatosis and donate blood every three months to avoid the consequences of iron overload)

  16. Calli Arcale says:

    Yes, that was foolishly said; I was referring to the iron-containing compounds that one actually encounters. Elemental iron isn’t that easy to come by, given how easily it oxidizes, and even people taking iron supplements are not taking elemental iron.

    I found several sites discussing hemochromatosis. One discussed an inability to properly break down hemoglobin when disposing of retired red blood cells, resulting in more soluble iron in the bile which is then resorbed, thus interfering with the body’s main method for disposing of iron. (Hemoglobin is of course an iron-containing compound.)

    I also found several sites saying that it was absorbing too much iron from the diet, while also claiming that the body cannot rid itself of iron at all. I’m not sure the latter is true, given that iron is found in bile (in the form of bilirubin, a product the liver makes out of heme).

    I furthermore found a site explaining that there are several types of hemochromatosis, including that caused by lots of transfusions as well as that which is genetic. So it is possible that there are multiple right answers to the question of how it works.

  17. Harriet Hall says:

    Very enlightening. Thanks, Steve.
    I just have one quibble. It is mere speculation to make any connection between the Ice Man’s tattoos and either therapeutic tattooing or acupuncture. We have no idea what people were thinking back then. People might look at today’s earring holes and other piercings and attribute them to attempts at therapy when they are really only a fad based on aesthetic considerations.

    I get a kick out of archaeologists who find an odd artifact and call it a “ritual” object. What rituals? How could they possibly know?

  18. jhanson says:

    We were definitely taught bloodletting in acupuncture school, never by pints, but usually a few drops or so. In practice, I’ve never done it and I know few people who have. Patients are less than receptive. For most, acupuncture is a relaxing experience after the needles are put in, bloodletting is definitely not.

    Some acupuncture systems, e.g. Tung’s, have a heavier focus on bloodletting, particularly if superficial venules are prominent in the area of the pain/complaint.

  19. BillyJoe says:

    Calli Arcale,

    “I furthermore found a site explaining that there are several types of haemochromatosis, including that caused by lots of transfusions”

    Some divide these into Hereditary Haemochromatosis (genetic) and Secondary Haemochromatosis (eg secondary to transfusions), but the better terms are probably Haemochromatosis and Haemosiderosis respectively.

    In Haemochromatosis too much iron is absorbed form the gastrointestinal tract. In Haemosiderosis it gets in by a more invasive method (such as transfusions)

    In both cases there is too much iron in the system and, because it cannot be efficiently removed from the system, it gets deposited into the various organs described previously.

  20. Ben Kavoussi says:

    Dear Steven,

    Great post and very thought-provoking comments. To add to the discussion, I would like to make a few comments.

    I had the pleasure of hosting the author of the book you quote, the historian and epistemologist Paul Unschuld, for a talk on acupuncture in Berkeley in 2008. Amongst many eye-opening comments, Paul Unschuld also mentioned that the exchange of medical ideas and procedures along the Silk Road was substantially more prevalent than we can ever imagine, and that the ideas of Hippocrates and Galen have travelled east, as much as many Chinese notions of health and disease have travelled westward. In the Middle Ages this was predominantly done by the Muslin spice traders. It is therefore not surprising to find the same healing practices, such as bloodletting and cupping, amongst the Chinese, the Persians, the Arabs and the Greeks.

    Also, the historian Paul Buell believes that the formative text of acupuncture, the Huang Di Nei Jing Su Wen (The Yellow Emperor’s Classic), is not so much a medical text as it is an astrological compendium. Medicine and astrology were intimately intertwined throughout the history, and the rationale for many medical interventions such as bloodletting was simply the dispositions of the Havens.

    However, as I also mention that in the early 20th Century, a physician called Cheng Dan’an (1899-1957) proposed that the effects of needling could possibly be explained by their neurostimulatory effect. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting. His reform also included replacing coarse needles with the filiform ones in use today.

    It is therefore inaccurate to state, as the NCCAM does on its website, that “Acupuncture has been practiced in China and other Asian countries for thousands of years.” To the contrary, what we know today as “acupuncture” is purely a product of 20th Century, which was originally a type of bloodletting with fine needles, but after Cheng Dan’an’s reform, became a crude type of neurostimulation based on Chinese starlore and astral mythology. This is why the effects of “true” needling are very close to the effects of “sham” needling in well-conducted acupuncture RCTs.

    I hope this brings some additional material into the discussion.

    Ben Kavoussi
    Balad, Iraq

  21. wales says:

    According to this article, cupping/bloodletting are still practiced concomitantly (called Hijamah) by those practicing traditional Arabic medicine. Needles don’t seem to be involved, rather a blade is used to make incisions.

    The article gives a detailed study of the practice of Hijamah, as well as bloodletting in 20th century western cardiac care. It is apparently written by a western-trained physician. Interesting juxtaposition of photos of the “primitive” horn cupping tools and the “modern” plastic cups.

    http://www.hmc.org.qa/heartviews/VOL5NO2/special_section.htm

  22. Ben Kavoussi says:

    Indeed, Hijamah is still practiced amongst the Muslims. There are even video instructions on YouTube. This type of practice might briefly benefit an inflamed joint, due to the removal of the pro-inflammatory cytokines along with the blood. But it is just a temporary and rudimentary fix, not a cure. Besides, it is most often done in unsanitary conditions.

  23. juliany8s says:

    Thank-you Dr. Novella and Cpt. Kavoussi,
    Great post and comments that shed light onto the origins and development of acupuncture. I had wondered about the claims between Chinese and Japanese acupuncturists that theirs is the truer and older form of acupuncture. It seems that the Japanese folks have it half right (as far as you explain Chinese acupuncture) but mess up their own story.

  24. Ben Kavoussi says:

    Dear juliany8s,

    Acupuncture with fine needles, Chinese or Japanese, cannot be ancient. The “Nine Needles” described in the Yellow Emperor’s Inner Classic, are a set of pins and lancets that necessary cause bleeding. What we know today as acupuncture is a 20th Century practice that is based on an ancient myth.

  25. juliany8s says:

    Dear Ben Kavoussi,
    Oops! I realise that I was not clear in my last post. A teacher I had when I studied Japanese acupuncture would scoff and say that TCM was created by the Maoist government. He would always follow it up with something about the antiquity (and superiority) of Japanese acupuncture. My teachers of Chinese acupuncture would scoff at the newness (and therefore inferiority) of Japanese acupuncture and celebrate the usual and erroneously varying age of TCM (between 2000-5000 years old depending on the teacher).

    I have seen a replica of the nine needles and wondered how they could be used in any way like I was taught to use needles. The explanation was always the flat and simplistic, “they did things differently back then”. How true! but not in the way that was implied.
    Not long ago I came to understand the history of acupuncture as you and others have laid it out.
    Many thanks!
    Julian
    p.s. Can you recommend any further reading in this vein?

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