An Acupuncture Technique

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

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 swelling-where 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 blood-letting.

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 blood-letting 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 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: