© Endeavour College of Natural Health endeavour.edu.au 1
CMAC221
Session 2
Bleeding and Plum
Blossom Needling
Chinese Medicine
Department
© Endeavour College of Natural Health endeavour.edu.au 2
Pre Readings
o Al Bedah, A. M. N., Khalil, M. K. M., Posadzki,
P., Sohaibani, I., Aboushanab, T. S., AlQaed,
M., & Ali, G. I. M. (2016). Evaluation of Wet
Cupping Therapy: Systematic Review of
Randomized Clinical Trials. The Journal of
Alternative and Complementary Medicine,
22(10), 768–777.
http://doi.org/10.1089/acm.2016.0193
o Cao, H., Li, X., & Liu, J. (2012). An updated
review of the efficacy of cupping therapy.
PLoS ONE, 7(2).
http://doi.org/10.1371/journal.pone.0031793
o McCann, H. (2009). Bloodletting therapy in
the Huang Di Nei Jing. Journal of Chinese
Medicine, (89), 43–49. Retrieved from
http://jcm.co.uk
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Pre Readings
o McCann, H. (2014). Pricking the vessels :
bloodletting therapy in Chinese medicine.
London: Singing Dragon. Retrieved from
ebookcentral.proquest.com. pp19-48
o Ullum, H., Rostgaard, K., Kamper-
Jorgensen, M., Reilly, M., Melbye, M.,
Nyren, O., … Hjalgrim, H. (2015). Blood
donation and blood donor mortality after
adjustment for a healthy donor effect.
Transfusion, 55(10), 2479–2485.
http://doi.org/10.1111/trf.13205
o Whisnant, B. (2016). The medical guide to
bloodletting (Version 1.1.0) [Mobile
Application Software]. Retrieved from
https://itunes.apple.com
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Definition
o Bloodletting is the removal of blood, usually from a vein;
formerly used as a general remedial measure
Medial Dictionary, 2015
Image: Hans Splinter, 2008
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History of Use
o Practised by every ancient culture
o Earliest Egyptian representation dates
to 2500BC
o Used preventively in Egypt, Greece,
Rome and China
o Most of the cases were fever related
o Western Han Dynasty tomb scrolls
(220-200BC) - Mai translates as
vessels meaning they carry Qi and
Blood
o Traditionally used a Bian stone needleNielsen, 2013, p3-4, McCann, 2009, p43-4
Image: Andrew Weil, 2010
Stone & Bone Needles
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Drop Vs Litres
o Blood letting in China was
limited to a small needle stick
where drops of blood were
allowed to seep until the blood
changed from dark to light
o In the west, they would often
bleed arteries and bleed large
amounts (litres) until the
patient passed out or died
Wikimedia Commons, 2015
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Nei Jing References
o 14 chapters in the Su Wen (SW) refer to
bloodletting
o Even Nei Jing (NJ) descriptions of
acupuncture show a close relationship to
blood letting
o Nei Jing emphasises on “closing” or leaving
the hole open – clear reference to let blood
o General areas of the body, visible blood
vessels less common applied to
acupuncture points
o Most common popliteal fossa – little
reference to upper bodyNielsen, 2013, p3-4, McCann, 2009, p43-4
Deadman et al, 2007, p299
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Rationale for Blood letting
o “Use bloodletting to treat blood
repletion” – SW Ch. 5
o “Prick the construction to let blood” –
Ling Shu (LS) – Ch. 6
o The most important action of blood
letting is quickening the blood to
expel stasis. Blood stasis and Blood
heat are forms of Blood repletion
o The construction means that blood
letting can rectify the Qi as well and
the BloodMcCann, 2009, p44, McCann 2014
Image:SMART imagebase, 2015
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o “Treat people from the East with
stone needles” – SW Ch12
o Five treatment methods for five
regions of China, stone needles
refers to bloodletting or opening
pustulating sores or abscesses.
o People from the East were said
to have very rich diets high in fish
and salt which accumulate in the
Middle Jiao
Rationale for Bloodletting
McCann, 2009, p44, McCann 2014
Image Mr.Zit, 2016
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o “Chronic blood clots should be
expelled” – LS – Ch.1
o “Decayed blood that has been
accumulated should be treated by
bloodletting to remove clots slowly”
– SW Ch. 54
o Chronic blood stasis need to be
expelled to facilitate health
o All chronic disease will lead to
blood stasis
Rationale for Blood letting
McCann, 2009, p44, McCann 2014
Image: SliderBase, 2016
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o “For light, diseases treat
shallowly, for severe
diseases treat deeply” – LS
Ch 59
o Chronic disease cause
blood stagnation at the deep
collaterals of the body
Rationale for Blood letting
Wcm1111, 2011
McCann, 2009, p44, McCann 2014
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o “When blood vessels are
diseased, regulate the blood”
(network) SW Chapter 62
o Rectify the blood (in addition to
acupuncture and herbs) with
blood letting
o Bloodletting can treat blood
pathologies including stagnation
and blood heat.
o Bleed the network vessels – small
capillaries
Rationale for Blood letting
McCann, 2009, p45, McCann 2014
Image: Jon-e, 2007
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o “If knotting occurs in the network
vessels this is disharmony of the
blood, sedate to rid the clots and
restore movement” – LS Ch64
o According to Wiseman et al. “knot” or
“bind” implies something has become
stiff, tight or hard
o Accumulation of Phlegm and Blood
sedate or drain with blood letting
Rationale for Blood letting
McCann, 2009, p44, McCann 2014
Image Wikimedia Commons
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o “When a person lives a leisurely life and is happy,
disease arises in the flesh; treat with stone needles” –
SW Ch. 24
o Meaning – when people's needs are met they are less
prone to internal damage from the emotions
o Disease are more likely to be caused by excess and
such disease manifests in the flesh
o Does this mean Bloodletting for general health??
Rationale for Blood letting
McCann, 2009, p44, McCann 2014
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o “One may let blood and qi from the yang ming; one may
let blood without damaging qi on the tai yang; one may
let blood without damaging the qi on the jue yin” – SW
Ch. 24
o Yang ming channels are full of qi and blood
o Tai yang and Jue yin have more blood than qi. So it is
safe to bleed these channels without damaging the qi
o In Tung’s acupuncture, the posterior trunk has many
points that are bled and not needled
Rationale for Blood letting
McCann, 2009, p44, McCann 2014
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Clinical Usages – Nei Jing
Dental and Teeth Pain Lumbar pain
Epistaxis (nosebleeds) Lung disease (lung heat)
Bi Syndrome and long-term stagnation Mania and withdrawal (Dian Kuang)
Headache Disease repletion (full conditions)
Heart disease – Leopard spot
puncture
Tetany (pain and stiffness and wind
stroke with tonic contracture)
Kidney disease Disease of the throat or mouth
(affected by heat)
Liver and Gall Bladder disease Traumatic injury
Loss of voice Disease of the lower abdomen
McCann, 2009, p46-8, McCann 2014
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Functions of Bloodletting
McCann 2014
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Jing Well & Jing Jin
o The Jing Jin is the first place to treat in acute trauma
(pain and inflammation) and repetitive injuries (micro
trauma)
o Activation of the Jing Jin is useful in treating pain and
increasing muscle function in sports performance –
esp. Yang meridians
o The Jing Well point is the only point shared by the
principal vessel and the Jing Jin
Reaves, 2009, p 9-11
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Jing Well and Jing Jin
Reaves, 2016
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Jing Well & Jing Jino Problems in the Jing Jin will have pain as a manifestation
can be over a wide area, diffuse and with multiple ashi
o Pain elicited by light pressure is an indication the Jing Jin is
involved
o Prick to bleed on the same side as the injury (blood vessels
do not cross
o Get ten drops of blood if you can use gravity by hanging
limbs over the table if needed
o You should get immediate change in pain reduction or an
increase in ROM
o This technique can also be used post sporting performance
to enhance recoveryReaves, 2009, p 9-11
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Modern researcho Limited more needed
o Wet cupping (hijama) has a long history especially in the
Middle East – very similar to Chinese style of blood
letting
o Similar uses Pain, esp lower back pain, trigeminal
neuralgia pain, carpal tunnel syndrome and rheumatoid
arthritis
o Zhao et al. 2009 found it to be effective for gouty arthritis
and herpes zoster when combined with electro-
acupuncture
o Niasari et al. 2007 showed wet cupping improved
LDL/HDL ratios in a small study (47)
McCann, 2014
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Blood Donors
o Ullum et al. 2015 published in Transfusion
states:
o “We observed an inverse relationship
between donation frequency and mortality.
The magnitude of the association was
reduced after adjustment for an estimate
of self-selection in the donor population.
o Our observations indicate that repeated
blood donation is not associated with
premature death, but cannot be
interpreted as conclusive evidence of a
beneficial health effect.” Ullum, et al 2015
Image: Denise Krebs, 2011
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Bleeding
o Bleed veins not arteries
o Bleed the area, not the point. Find the protruding vein(s)
o Let points clot on their own
o One or two areas at a time at most
o If needed induce pressure to locate the vein then prick
o If you are going to needle, Bleed first then needle
o Single use of any bleeding equipment
o See the BL40 area here
o Where to Bleed – the darkest collection of vessels
Whisnant 2012,
Video: lotusistitute, 2014, 2016
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Leopard Puncture
o Bleed the small vessels to clear
the stagnation or excess
o Combined with Heart channel
points as the heart tissue is the
blood vessels
o Skin problems with pathogenic
heat – red spots, itching, multiple
little abscesses
o Named because the heavy
spotting of blood would look like
those of leopard
o See Handout from CMAC211Johns, 2005, p137
Image: Whisnant, B, 2016
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Instruments
o Three-edged Needle
o They are very blunt
and will hurt your
patient
Mannix, 2015
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Lancets
o Lancets
o Again not very sharp
o Look kind of medieval
don’t they
Mannix, 2015
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So what can you use?
o Diabetic lancets without
the injecting unit
o These are very sharp and
much kinder for your
patient.
o Appropriate for shallow
points such as Jing Well
points
McCann 2014
Image: United Press International, 2015
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18 Gauge Needle
o If bleeding more than a few drops
o Use an 18 gauge piercing needle
o Some blood letting requires 2-3 ounces
(50-90mL)
o The Red Cross takes five times that
much and doesn’t worry or even talk
about ‘weak old patients.'
o This is why you CAN BLEED many
patients.
o Xu patients in the Classics are not
what we would call Xu patients today McCann 2014, Whisnant, 2012
Image: Cook Medical 2015
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Plum Blossom Needle
o Plum Blossom Needle –
sometimes called a
cutaneous needle
o Used for larger areas of
blood letting
McCann 2014, Hengze & Lanfeng
Image: Mannix, 2015
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Procedure for Blood letting
o Clean needle technique
o Hand hygiene
o Wear gloves – AHPRA states: examples of procedures
that may result in direct blood or body fluid contact
o Inspect the area to be bled
o Swab area
o Bleeding tool used to prick the area
o Cotton on hand to use more like a wick to draw the blood
up as opposed to stopping it like in acupuncture
o Pressure may be applied after this
McCann 2014, Chinese Medicine Board of Australia, 2013
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Type of Blood letting
o Point Pricking
o Specific point or area is
chosen
o Example Jing Well
Points for a sore throat
or Jing Jin conditions
o Commonly used as a
distal treatment
McCann 2014
Image: Mannix 2015
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Picking Therapy
o The Three edged needle is used to briskly insert and
flick out to cause bleeding in a cutting motion
o Could be used on fibrous tissue
o Traditionally used for draining carbuncles or boils
o Wound dressing is needed
o Not recommended in Australian clinics
McCann 2014, Hengze & Lanfeng, 2013
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Diffuse Pricking
o Using the lancet, three-edged needle or dermal hammer
to pick over a large area
o Prick 10-20 times depending on the size of the area
o Used for pain conditions including tight muscles
o Localised inflammation
o Dermatological disorders with blood heat and or blood
stasis
o Only used locally not a distal treatment
o Leopard Spot puncture
McCann 2014, Hengze & Lanfeng 2013
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Wet Cupping
o Bleed area and then place a
cup over the are to remove a
greater amount of blood.
o Also known as hijama in
Middle Eastern Cultures
o Used to treat high fevers
(when applied to GV14)
o Dispose of the cup
appropriately
o Not Encouraged at EndeavourWikimedia Commons, 2015
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Cautions and Contraindications
o Poor wound healing – Diabetic neuropathies,
or venous insufficiency
o Haemorrhagic disorders such as Haemophilia
and Von Willebrand disease
o Pregnant patients
o Those on heparin, warfarin and aspirin –
blood thinners
o Can bleed Xu patients if stagnation is present
(most likely). If you take out a little blood, it
will cause movement and new blood cells
o Clear and move then tonifyMcCann 2014, Whisnant 2012
csc1950, 2010
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Plum Blossom Needling
o Methods:
o Thumb and index finger tap the tip
perpendicularly onto the skin and bounce back
immediately
o Force comes from the wrist and should be
springy
o Repeat the bouncing movements several
times
o You can adjust the intensity according to the
patient's condition
o Tap along the channel, points or areas Hengze & Lanfeng, 2013
Image: Mannix, 2015
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Plum Blossom Intensity
o Light Tapping – gently tap the skin until it turns pink, use
on the face or other sensitive areas or when not trying to
break the skin just stimulate – ideal for children
o Medium tapping – slightly heavier and for longer – skin is
more flushed but still no blood – applicable for a broad
range of regions and disease patterns
o Heavy Tapping – Tap heavier to cause bleeding and the
skin is obviously flushed, tender points and yang
surfaces
Hengze & Lanfeng, 2013
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Don’t use these
o Hard to change the
heads without
pricking yourself
when they are in the
multipacks
o Also, there may be
blood on higher up on
the hammer
o Much better with
single use ones
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Dermal Roller
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Practical
o Practice blood letting on some Jing Well points – do
some before and after ROM tests esp hamstrings with
BL67
o Bleed the apex of the ear
o Practice leopard puncture on some spider veins
o Practice blood letting on inflamed tight muscles
o Practice three different intensity of the dermal hammer
on various areas – upper back, LI channel of the forearm
and ST channel of the lower leg
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References
o Hans Splinter, 2008, bloodletting, viewed 7th July 2015, https://www.flickr.com/photos/archeon/2911868569
o Medical Dictionary, 2015, Bloodletting, viewed 7th July 2015, http://medical-dictionary.thefreedictionary.com/blood+letting
o Epler DC. (1980). Bloodletting in early Chinese medicine and its relation to the origin of acupuncture, Bull Hist Med. Fall;54(3):337-67.
o McCann, 2009, Bloodletting therapy in the Huang Di Nei Jing, Journal of Chinese Medicine, Number 89, February 2009, pp43-9, viewed
6th July 2015, https://www.jcm.co.uk
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cYjGUG-cQ3ZwS-cQ3Sfj-cU4Asm
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agJsLg-rBhSNw-daJMcr-kEEjNk-bB4Hk7-kEEiXv-75ru51-bSeCUx-bzKkcG-bNDYji-bNDYgZ-9twUMF-4o5qMr-kEE3gc-6FdnKb-4XcXwc-
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5qsUgr-5LUEgd-7aS7TC-aqEPLj-7w8Gcr-8gP1Bz-v3sS9-5xqCaX-8L1XMa-8L52TE-kKJ3Go-4qib8v-9ApEsd-ab3N1g-bvf5Dq-eatZhe-
7qDiuJ-5WvcRb-7aNhpp-7mFQbE-5Wvct3-9EqwGn-3bqKRa-enTfYp-aauAs1-5ZgNdJ-oB4FQ-73sszN-4a7f7A-6nSnCJ-5ZgR61-6nTe6h-
qFJJTn-7qznRa-6Bgrev-aexFeF-bhCqMH-6nhBb7-9EqwGt-26w8eb-fZbyWS-aarMQv-cgLdEA-aauZPJ-9EqhjD-ap78JZ-5ZgLWw-
4Av8u7-5jdkeM
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donation and blood donor mortality after adjustment for a healthy donor effect.’ Transfusion, vol. 55, no. 10, viewed 9th July 2015,
http://onlinelibrary.wiley.com/doi/10.1111/trf.13205/full
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References
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5qsUgr-5LUEgd-7aS7TC-aqEPLj-7w8Gcr-8gP1Bz-v3sS9-5xqCaX-8L1XMa-8L52TE-kKJ3Go-4qib8v-9ApEsd-ab3N1g-bvf5Dq-eatZhe-
7qDiuJ-5WvcRb-7aNhpp-7mFQbE-5Wvct3-9EqwGn-3bqKRa-enTfYp-aauAs1-5ZgNdJ-oB4FQ-73sszN-4a7f7A-6nSnCJ-5ZgR61-6nTe6h-
qFJJTn-7qznRa-6Bgrev-aexFeF-bhCqMH-6nhBb7-9EqwGt-26w8eb-fZbyWS-aarMQv-cgLdEA-aauZPJ-9EqhjD-ap78JZ-5ZgLWw-
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References
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Colorado
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