CMAC221 WK02 Lecture BleedingPlum-BlossomNeedling · acupuncture points o Most common popliteal fossa –little reference to upper body Nielsen, 2013, ... o Wet cupping (hijama) has

© Endeavour College of Natural Health endeavour.edu.au 1

CMAC221

Session 2

Bleeding and Plum

Blossom Needling

Chinese Medicine

Department


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


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


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


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


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


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


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


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


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



Image: SliderBase, 2016


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


Wcm1111, 2011



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



Image: Jon-e, 2007


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



Image Wikimedia Commons


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??




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




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


Functions of Bloodletting

McCann 2014


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


Jing Well and Jing Jin

Reaves, 2016


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


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


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


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

https://www.youtube.com/watch?v=G9qzqDxya20

https://www.youtube.com/watch?v=CcVzv9FeL1c


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


Instruments

o Three-edged Needle

o They are very blunt

and will hurt your

patient

Mannix, 2015


Lancets

o Lancets

o Again not very sharp

o Look kind of medieval

don’t they

Mannix, 2015


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


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


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


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


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


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


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


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


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


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


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


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


Dermal Roller


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


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

o Nielsen, A, 2013, Gua sha: a traditional technique for modern practice second edition, Churchill Livingstone, Elsevier, Edinburgh

o Andrew Weil, 2008, Ancient Therapies, viewed 8th July 2015, https://www.flickr.com/photos/drweil/5005357200/in/photolist-8CiLj5-

cYjGUG-cQ3ZwS-cQ3Sfj-cU4Asm

o McCann, H 2014, Pricking the vessels bloodletting in Chinese medicine, Singing Dragon, London, viewed 8th July,

<http:www.eblib.com.au>

o Wcm1111, 2011, Blood clot, viewed 8th July 2015, https://www.flickr.com/photos/chrismoody1111/5563007102/in/photolist-9tzScy-9tzS25-

agJsLg-rBhSNw-daJMcr-kEEjNk-bB4Hk7-kEEiXv-75ru51-bSeCUx-bzKkcG-bNDYji-bNDYgZ-9twUMF-4o5qMr-kEE3gc-6FdnKb-4XcXwc-

hXyM2-6y8UAf-6VsZRm-h6AkDE-5oJfLf-kEEoQZ-5GrjPE-5Gn2TZ-kEEoki-bvFLyn-5ksy8x-oJmfsS-9RX7QA-5kwPYC-4Vh4U-tSmvaA-

7B7J41-dH6d5M-8XG1UV-4mdyU-7B3UKx-4XrQcW-9P4BZC-d3CUH3-bvFLKZ-bvFLEB-9oHHi2-5Gn2Tz-5WjZqM-kEEEbg-5GrjNU-

kEGk33

o Nucleus Medical Media Inc, 2015, Clot Formation – Medical Illustration, viewed 8th July2015, http://ebsco.smartimagebase.com

o Peter Isotalo, 2006, Physician letting blood from a patient. British Library, London. Scanned from Maggie Black's "Den medeltida

kokboken", Swedish translation of ''The Medieval Cookbook'' ISBN 91-7712-380-8, viewed 8th July 2015,

https://commons.wikimedia.org/wiki/File:Blood_letting.jpg#file

o Denise Krebs, 2011, Donating Blood, viewed 9th July 2015, https://www.flickr.com/photos/mrsdkrebs/5962705617/in/photolist-a5UqDg-

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

o Ullum, H., Rostgaard, K., Kamper-Jørgensen, M., Reilly, M., Melbye, M., Nyrén, O., Norda, R., Edgren, G. and Hjalgrim, H. (2015), ‘Blood

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


References

o Zhao, Q, et al 2009, ‘Observation on therapeutic effect of electroacupuncture plus blood-letting puncture and cupping combined with diet

intervention for treatment of gouty arthritis’, Zhongguo Zhen Jiu 29:711-713

o Nisari, M, Kosari F, and Ahmadi, A, 2007, ‘The effect of wet cupping on serum lipid concentrations of clinically healthy young men: a

randomised controlled trial’, Journal Alternative Complementary Medicine, Volume 13 Issue 1 pp79-82

o United Press International, 2015, Hepatitis C testing recommend for baby boomers, viewed 8th July 2015,

http://www.upi.com/Health_News/2013/06/25/Hepatitis-C-testing-recommended-for-baby-boomers/3751372177733/

o Cook, 2015, Small Gage Ova-Stiff™ Ovum Aspiration Needle, viewed 9th July 2015,

https://www.cookmedical.com/products/wh_kopstwh_webds/

o "Drawn blood" by Iwansw - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons, viewed 9th July 2015,

https://commons.wikimedia.org/wiki/File:Drawn_blood.jpg#/media/File:Drawn_blood.jpg,

o Denise Krebs, 2011, Donating Blood, viewed 9th July 2015, https://www.flickr.com/photos/mrsdkrebs/5962705617/in/photolist-a5UqDg-

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

o Chinese Medicine Board of Australia, 2013, Infection Prevention and Control Guidelines for acupuncture practice, viewed 9th July 2015,

http://www.chinesemedicineboard.gov.au/Codes-Guidelines/Guidelines-for-advertising-regulated-health-services.aspx

o Thambirajah, R, 2009, Cosmetic acupuncture: a traditional Chinese medicine approach to cosmetic and dermatological problems,

Churchill Livingstone Elsevier,

o Hengze X & X, Lanfeng, 2013, Acupuncture techniques 2: additional needling techniques, Peoples Medical Publishing House

o Lotusintstite, 2014, Master Tungs bleeding for back pain – online acupuncture CEU, Viewed 23rd July 2015,

https://www.youtube.com/watch?v=G9qzqDxya20

o Whisnant, B, 2012, Blood letting for clinical efficacy, Lotus institute of integrative medicine, City of Industry California, Viewed 23rd July

2015, <www.elotus.org>

o SliderBase, 2016, Coronary heart disease, viewed 8th June 2016, https://i.ytimg.com/vi/BVEhQxz8M5I/maxresdefault.jpg

o Mr.Zit, 2016, Biggest Zit on hand “Mr Zit”, viewed 8th June 2016, https://i.ytimg.com/vi/l2RygEbWFfY/hqdefault.jpg


References

o Jon-e, 2007, 365.37: Fever, viewed 6th July, 2015, https://www.flickr.com/photos/jon-e/356550219/in/photolist-xvpXz-e5EWe6-6a7Es2-

rAUKfe-5Ywk5e-ojW1Tp-7uUovT-e2voZE-jDnkp8-bEXC9g-5HLLUB-dRP5gv-oH7EgG-5QQs74-9e9Dzz-6pKjDV-XkHmB-qHFNBb-

5CPzRH-rngaAK-6hdJy8-7FJKeg-rrUXCe-7fek4p-7TDW9X-guUgaa-4NP2fu-7xwtKH-9xhLkp-7VKHaE-2ikfn-6PvyV3-5HUXYZ-4Mi32Y-

6dfp4S-a3qzDZ-9LZQ1J-e53ofF-h8bvCd-Fk6QU-9gniQM-5bBkm6-6LmRBS-6tbm8K-8SDNuV-rWSQen-eobrqv-dkzkFj-7MNhDc-

nafQMN

o WikiMedia Commons, 2006, Ganglion-cyst, viewed 8th June 2016, CC BY-SA 3.0,

https://commons.wikimedia.org/w/index.php?curid=831278

o Reaves, W, 2009, The acupuncture handbook of sports injuries & pain: a four step approach to treatment, Hidden Needle Press, Boulder

Colorado

o Whisnant, B, 2016, Leopard spotting puncture, private collection

o Reaves, W, 2016, Acupuncture treatment of sports injuries and pain, 17-19th June 2016,

o lotusinstitute. (2016). Bloodletting therapy: where to bleed -- online acupuncture CEU. Retrieved July 3, 2017, from

https://www.youtube.com/watch?v=CcVzv9FeL1c


Documents

CMAC221 WK02 Lecture BleedingPlum-BlossomNeedling · acupuncture points o Most common popliteal fossa –little reference to upper body Nielsen, 2013, ... o Wet cupping (hijama) has