Is Chinese bloodletting the same as conventional bloodletting?

I get enquiries, from time to time, about whether Chinese medicinal bleeding can be used to remove significant volumes of blood, in a similar way to conventional bloodletting. Whaaaat? I hear you say. Yes, conventional medicine does still include bloodletting. It’s known as therapeutic phlebotomy.

Phlebotomy is when you have a blood sample taken to run some tests on the blood. Therapeutic phlebotomy is when you have a larger quantity of blood taken, simply to get rid of some blood. This can be needed to help with unusual conditions such as polycythemia vera or hemochromatosis. These involve having excessive amounts of iron, or of red blood cells. The blood taken in these procedures is usually not retained, like when you donate blood, but disposed of.

The short answer is no. Chinese medicinal bleeding is not suitable for releasing blood on that scale. And here’s a longer answer …

The quantity of blood

Therapeutic phlebotomy usually extracts 250-500ml of blood. This is comparable to blood donation, which takes 470ml of blood in Australia, or around 8% of your total blood volume.

Chinese medicinal bleeding is done in several ways, but the way that would produce the most blood is by direct bleeding from a superficial vein. We do not take, or extract, the blood. We briefly pierce the vein and let the body release as much as it wants to release.

Often the initial blood is very dark, it can be almost black, showing that the blood is oxidised and has not been circulating in a healthy way. Then it runs a healthier red colour. And then the bleeding stops. The body releases the old stagnant blood that has been stuck in that vein, and then it clots the puncture to stop the bleeding.

I have read that it is possible for the body to release 200ml this way. But in my experience even 50ml is an uncommonly large quantity for the body to release. This is much less than the amounts taken for therapeutic phlebotomy or blood donation.

Releasing large amounts of blood is never the goal. Releasing even a couple of drops of dark stagnant blood result in a very successful procedure.

The diagnosis

Chinese medicinal bleeding is done according to Chinese medical principles. First there must be a Chinese medical diagnosis, based on signs and symptoms, that indicates that bleeding may help. Often this would be ‘Blood Stagnation’.

Without a relevant Chinese medical diagnosis, it would not be ethical to perform bleeding.

Available veins

One possible symptom of Blood Stagnation is superficial veins visible on the surface of the body. These are known as thread or spider veins, and are usually purple, red or blackish, not the blue colour of healthy veins. If you don’t have any of these, it is not possible to do Chinese medicinal bleeding from a vein.

There are other forms of Chinese medicinal bleeding, such as wet cupping, but these tend to produce even less blood than bleeding from a vein.

We never directly bleed varicose veins, which are bulging out from the surface.

Scope of practice & insurance

For all these reasons, we are not registered and insured to provide Chinese medicinal bleeding for purposes which are not related to a relevant Chinese medical diagnosis.

Patient satisfaction

People’s reasons for requesting Chinese medicinal bleeding for the purpose of releasing quite a lot of blood vary. Basically, I have to say, that Chinese medicinal bleeding techniques are unlikely to achieve the desired results.

How much blood will be released is not a matter of negotiation or guarantees. It is not the case that we can promise to release a certain quantity.

If extracting relatively large quantities of blood is your goal, it seems unlikely that you would be satisfied with the results of Chinese medicinal bleeding.

References

Image by allinonemovie from Pixabay

Traditional Chinese medicinal bleeding (blood-letting) for high blood pressure

Blood-letting might not sound like a modern treatment for high blood pressure, but this element of traditional Chinese medicine is starting to receive some feedback from up to date scientific research.

High blood pressure (hypertension)

High blood pressure is not ideal. Even if you’re not feeling any symptoms like headaches or blurred vision, it can be quietly doing damage in the background to your kidneys, heart and your risk of a stroke.

What does the research say?

Enough studies have been done on this question that researchers have been able to do systematic reviews and meta analyses, meaning studies of all the available studies, where they can pool the patient data and re-examine it.

“Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of Blood Letting Therapy as complementary and alternative approach for treatment of hypertension [high blood pressure] could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.”A 2019 systematic review and meta analysis of bloodletting for high blood pressure

“Bloodleting on ear apex as monotherapy or adjuvant therapy might have benefits in treating primary hypertension [high blood pressure]… However, since the number of studies included and the sample sizes were small, and the methodological quality was poor, these findings should be interpreted with great caution. Further well-designed studies need to be conducted to confirm these results.”A 2018 systematic review and meta analysis of bloodletting for high blood pressure

Basically, so far they seem to be concluding that although there have been some good signs in some studies, the evidence base is not yet clear, and further research, including more rigorous studies, will be needed to reach clear conclusions.

Traditional Chinese medicinal bleeding

People often have a few questions about what is involved in receiving traditional Chinese medicinal bleeding. This is a much milder treatment to receive than you may imagine! The best approach will be tailored to your individual diagnosis, circumstances and preferences, but often it can involve allowing just a few drops of blood to bleed from the top of your ear. In my clinic I use automated ‘click’ lancets for this, like the ones people with diabetes use to prick their fingers and test their blood. Generally people don’t find it painful at all, just a feeling of pressure.

Additionally, if you have superficial dark veins visible on your skin, for example on your legs, it may also be beneficial to bleed those a little. In traditional Chinese medical terms, this can release what is known as ‘stagnant’ blood, blood which has not been circulating properly and may be getting oxidised. (We never bleed raised/swollen varicose veins directly.) In any scenario though, we let your body decide how much blood it wants to release, and the quantities are always a fraction of, for example, making a blood donation.

Give it a try

If you’d like to see whether traditional Chinese medicinal bleeding may help your high blood pressure, just get in touch.

References

Chan-Young Kwon, Boram Lee, Ju Ah Lee, Efficacy and safety of bloodletting on ear apex for primary hypertension: A systematic review and meta-analysis,
European Journal of Integrative Medicine, Volume 23, 2018, Pages 90-100, ISSN 1876-3820, https://doi.org/10.1016/j.eujim.2018.09.011.

Xiong, Xj., Wang, Pq. & Li, Sj. Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin. J. Integr. Med. 25, 139–146 (2019). https://doi.org/10.1007/s11655-018-3009-2

Image by Myriams-Fotos from Pixabay

Acupuncture, electroacupuncture, and blood-letting for gouty arthritis

As anyone who’s ever suffered it knows, gout is a horrible business. It’s a metabolic condition which can lead to a build up of uric acid in your system, forming crystals in your joints, and flaring up with nasty pain, swelling and redness in your joints.

As the scientific research into traditional Chinese medicine is becoming more advanced, it has been interesting to see studies done on not just standard acupuncture, but also electroacupuncture and traditional Chinese medicinal bleeding (blood-letting).

Acupuncture for gout

In 2018 a systematic review (a study of all the available studies) concluded that:

Ten RCTs [Randomised Controlled Trials] involving 852 gouty arthritis patients were systematically reviewed. Among them six studies of 512 patients reported a significant decrease in uric acid in the treatment group compared with a control group, while two studies of 120 patients reported no significant decrease in uric acid in the treatment group compared with the control group. The remaining four studies of 380 patients reported a significant decrease in visual analogue scale score in the treatment group … The results of the studies included here suggest that acupuncture is efficacious as complementary therapy for gouty arthritis patients.”

Electroacupuncture for gout

Electroacupuncture is a technique which uses a small machine with wires and clips, to apply a small electric current across some of the acupuncture needles. Generally this gives an odd, tapping, kind of feeling, rather than being painful. In 2024, a research team did a systematic review and meta analysis (where the data from multiple studies is pooled and re-examined) and found that:

“This systematic review examined 15 randomized controlled trials that investigated the use of electroacupuncture as a treatment for AGA [Acute Gouty Arthritis] … The current meta-analysis suggests that electroacupuncture and conventional treatments have comparable efficacy and safety in targeting painful symptoms in patients with AGA … Our study showed that when electroacupuncture and medication were used together, there was a more significant decrease in serum uric acid than alone.”

Traditional Chinese medicinal bleeding (blood-letting) for gout

A 2022 systematic review and meta analysis is not presented in the most accessible language, but it concluded that:

“BLT [Blood-Letting Therapy] is effective in alleviating pain and decreasing CRP level [serum C-reactive protein] in AGA [Acute Gouty Arthritis] patients with a lower risk of evoking adverse reactions.”

CRP is a blood test that is indicative of your body’s level of inflammation.

More research ongoing

All three studies (like other studies into many different kinds of medical intervention) also noted limitations in the evidence base to date, and encouraged further research into these topics.

I was surprised to find all three of these systematic reviews on this topic, it’s fabulous to see the evidence base moving forwards! I look forward to hearing what comes next.

Try Chinese Medicine for your gout symptoms

I offer all three of these treatments, in a fully tailored approach driven by your individual needs and preferences. To see if they may be able to help in your case, just get in touch.

References

Lee WB, Woo SH, Min BI, Cho SH. Acupuncture for gouty arthritis: a concise report of a systematic and meta-analysis approach. Rheumatology (Oxford). 2013 Jul;52(7):1225-32. doi: 10.1093/rheumatology/ket013. Epub 2013 Feb 18. PMID: 23424263.

Ni Z, Xiao Q, Xia Z, Kuang K, Yin B, Peng D. Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials. Front Immunol. 2024 Jan 4;14:1295154. doi: 10.3389/fimmu.2023.1295154. PMID: 38239361; PMCID: PMC10794621.

Li SH, Hu WS, Wu QF, Sun JG. The efficacy of bloodletting therapy in patients with acute gouty arthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2022 Feb;46:101503. doi: 10.1016/j.ctcp.2021.101503. Epub 2021 Nov 11. PMID: 34814062.

Image by cnick from Pixabay

Medicinal bleeding for psoriasis

Bloodletting might not be the first thing you’d think of as a modern treatment for psoriasis, but research suggests that it may be able to help.

Psoriasis often involves chronic pain, and is not a nice condition to have. Genetics play a big role, and it’s now recognised as an immune disorder. Triggers for a new flareup can be as minor as small cuts or scrapes, infections or cold weather. New biological therapies have proved to be a powerful help for many people suffering with psoriasis, but sadly not everyone’s psoriasis has responded well.

Medicinal bleeding

Bloodletting, or medicinal bleeding is part of traditional Chinese medicine, like acupuncture, cupping and moxibustion. Less research has been done for this therapy than for some of those other techniques, so it’s not that often that i come across relevant research that reaches the level that I can share it with you. So I was interested to come across a study looking at the effectiveness of medicinal bleeding for psoriasis.

Wet cupping

Traditional Chinese medicinal bleeding can be performed in various ways, but this study looked at wet cupping. This is where we make small incisions in the skin and then use a cup to create a vaccum and draw out a small amount of blood. When I do wet cupping, I use automatic lancets like people with diabetes use, which generally gives a sensation more of pressure than of any pain. I use fully disposable cups for this, for hygeine and infection control.

In traditional Chinese medical theory, this helps to release some toxicity along with the blood, and makes space for fresh blood to move into the tissues, promoting your body’s flow of Qi and blood. This explanation does not have scientific evidence to support it so far, but what research has been able to look at is the results of treatment. Does bloodletting help psoriasis?

Research results

In 2023 a team did a systematic review and metanalysis of the studies of medicinal bleeding for psoriasis, which means they took a close look at all of the available studies on this topic. They whittled them down to 10 studies with 833 patients. They looked at Psoriasis Area and Severity Index (PASI), adverse effects, and the Dermatology Life Quality Index (DLQI), and found:

“Bloodletting cupping combined with conventional treatment can achieve the ideal treatment for psoriasis. However, the combined treatment in psoriasis needs to be further evaluated in high-quality RCTs with large sample sizes to enable future studies in clinical use.”

“We found no significant difference in adverse reactions.”

2023 systematic review and metanalysis of the studies of medicinal bleeding for psoriasis

As is common in medical research, they also noted limitations in the research performed so far, and encouraged further studies with large samples to improve the confidence of this result.

Get in touch

So if you continue to suffer with psoriasis, and would like to try medicinal bleeding to see if it may help, just get in touch.

Reference

Ma, X., Li, D., Zhao, M., He, J., Yang, F., & Kong, J. (2023). Bloodletting cupping combined with conventional measures therapy for psoriasis: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine, 10. https://www.frontiersin.org/articles/10.3389/fmed.2023.1132928

Image from the British Acupuncture Council.

Bloodletting & leeches? Old fashioned treatments are more in fashion than you might think…

Traditional Chinese bloodletting seems to be having a bit of a rennaissance. Say what now? I hear you asking… yup, it definitely sounds a bit odd! When I first studied acupuncture, it was mentioned in our textbooks and our classes, but we didn’t get any practical teaching.

Traditional Chinese bloodletting

Since 2014 though, two master practitioners of this art in the US, Dean Mouscher and Henry McCann, have both published books specifically on this subject – Chinese Medicine Bloodletting and Pricking the Vessels. And the Sidney Institute of Traditional Chinese Medicine has recently published this 18 minute video discussing the various techniques.

I started to hear lots of stories from other acupuncturists about their experience of bloodletting and wet cupping, and I got very fascinated. I read both the new books, took live online courses with both teachers, and did an online course as well with Susan Johnson, another American practitioner, with decades of experience. I got so interested that I even got a qualification in phlebotomy – the western practice of venepuncture, that happens when you go and get a blood test taken.

It feels like this Chinese tradition has been a bit dormant in the west, but is springing back to life.

What does science say?

For sure we have to be very careful before we make any claims of medical benefit for this treatment. This is not an area where tons of medical research has been done, or an evidence base has been established to show whether this is a medically effective procedure.

At the top of the pyramid of research studies is a meta analysis. This type of study is a review of the individual research studies on a topic, which re-analyses the combined results from those studies. I had a quick look and found six in this area, all published in the last five years:

“Blood Letting Therapy is effective in alleviating pain and decreasing serum C-reactive protein level level in acute gouty arthritis patients with a lower risk of evoking adverse reactions.”

A 2022 systematic review and meta analysis of bloodletting for gouty arthritis

“BL at EX-HN6 [the ear apex] as an adjunctive therapy to eye drops may benefit stye. However, high-quality RCTs [randomised controlled trials] addressing on this issue is still needed to warrant the findings of this study.”

A 2020 systematic review and meta analysis of bloodletting for styes (eyelid infections)

“Bloodletting therapy might be an effective and safe treatment for chronic urticaria [hives], but the evidence is scarce. More high quality trials are needed in the future.”

A 2019 systematic review and meta analysis of bloodletting for chronic urticaria (hives)

“Although some positive findings were identified, no definite conclusions regarding the efficacy and safety of Blood Letting Therapy as complementary and alternative approach for treatment of hypertension [high blood pressure] could be drew due to the generally poor methodological design, significant heterogeneity, and insufficient clinical data. Further rigorously designed trials are warranted to confirm the results.”

A 2019 systematic review and meta analysis of bloodletting for high blood pressure

“Bloodleting on ear apex as monotherapy or adjuvant therapy might have benefits in treating primary hypertension [high blood pressure]… However, since the number of studies included and the sample sizes were small, and the methodological quality was poor, these findings should be interpreted with great caution. Further well-designed studies need to be conducted to confirm these results.”

A 2018 systematic review and meta analysis of bloodletting for high blood pressure

“A few small studies suggested that wet cupping alone versus antihypertensive medication significantly reduced blood pressure… However based on current evidence, no firm conclusions can be drawn and no clinical recommendations made. Research projects included need validation. Studies indicate that wet cupping is a safe therapy.”

A 2019 systematic review and meta analysis of wet cupping for high blood pressure

So, from this we can see that the scientific evidence base for traditional Chinese bloodletting is thin on the ground. It addresses only a few conditions, and it mostly concludes that more research is needed before we can draw any clear conclusions.

And hospitals are using leeches

Some of my patients look a bit puzzled when I mention traditional Chinese bloodletting, or wet cupping. It just sounds so weird! Right?

But one nurse I treat, she just nodded away, totally unphased, and said, yes, when she had worked at Royal Perth Hospital, she had been in charge of applying the leeches. Yes, leeches are in use again by plastic surgeons across the world, including right here in Perth! They’re a method of clearing oxidised old blood and re-establishing circulation when small items such as fingers are surgically reattached. Here’s a 2021 news story about leeches ‘saving a schoolgirl’s finger’ at Fiona Stanley Hospital.

So yup, the old stuff, the weird stuff, it’s still going on…

Chinese bloodletting in Perth

So, I’ve got no plans to introduce leeches to my practice! But, I do offer traditional Chinese bloodletting and wet cupping to my patients, where it’s a good fit for them.

You’re very welcome to get in touch if you’d like to know more.


References

Chan-Young Kwon, Boram Lee, Ju Ah Lee, Efficacy and safety of bloodletting on ear apex for primary hypertension: A systematic review and meta-analysis,
European Journal of Integrative Medicine, Volume 23, 2018, Pages 90-100, ISSN 1876-3820, https://doi.org/10.1016/j.eujim.2018.09.011.

Qiao HW, Liu NW, Wang J, Huang S, Yu L, Chen Z. Bloodletting at EX-HN6 as an adjunctive therapy to eye drops for stye: A meta-analysis. Medicine (Baltimore). 2020 Aug 7;99(32):e21555. doi: 10.1097/MD.0000000000021555. PMID: 32769896; PMCID: PMC7593029. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593029/

Qin Yao, Xinyue Zhang, Yunnong Mu, Yajie Liu, Yu An, Baixiao Zhao, “Bloodletting Therapy for Patients with Chronic Urticaria: A Systematic Review and Meta-Analysis”, BioMed Research International, vol. 2019, Article ID 8650398, 9 pages, 2019. https://doi.org/10.1155/2019/8650398

Shuting Lu, Shizheng Du, Anne Fish, Cong Tang, Qingqing Lou & Xuefang Zhang (2019) Wet cupping for hypertension: a systematic review and meta-analysis, Clinical and Experimental Hypertension, 41:5, 474-480, DOI: 10.1080/10641963.2018.1510939

Si-Hui Li, Wei-Shang Hu, Qiao-Feng Wu, Jun-Gang Sun,
The efficacy of bloodletting therapy in patients with acute gouty arthritis: A systematic review and meta-analysis, Complementary Therapies in Clinical Practice, Volume 46, 2022, 101503, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2021.101503

Xiong, Xj., Wang, Pq. & Li, Sj. Blood-Letting Therapy for Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin. J. Integr. Med. 25, 139–146 (2019). https://doi.org/10.1007/s11655-018-3009-2

https://www.9news.com.au/national/twenty-leeches-used-to-help-save-perth-schoolgirls-finger/7a596e66-eb52-4045-8d3f-99d3277b5804