Blood-Pricking Therapy: TCM Bloodletting to Expel Pathogens & Harmonize Qi

Blood-Pricking Therapy

Blood-pricking therapy is an effective therapeutic method that, under the guidance of basic TCM theory, eliminates pathogenic factors by releasing blood, thereby achieving the purposes of harmonizing and regulating qi and blood, balancing yin and yang, and restoring zheng qi. It is suitable for various diseases "located in the blood collaterals."

The main blood-pricking methods include collateral pricking, repeated shallow pricking, and leopard-spot pricking, with further development by later generations. In modern clinical practice, all blood-pricking procedures should be performed after routine disinfection. The manipulation should be light, shallow, rapid, and accurate, with an appropriate depth of 0.1–0.2 cun. Generally, the amount of bleeding is appropriately from a few drops to several milliliters, though in some cases it may be as much as 30–60 milliliters.

I. Spot-Pricking Method

The needling instrument may be a three-edged needle or a thick filiform needle. There are three common forms of spot-pricking.

1. Direct Spot-Pricking Method. First, knead, pinch, and press the area to be needled to induce local congestion. Then, hold the needle in the right hand, grasping the needle handle with the thumb and index finger, with the tip of the middle finger resting firmly against the lower end of the needle shaft, leaving 0.1–0.2 cun of the needle tip exposed. Aim at the disinfected area and swiftly insert the needle. (Fig. 11) Withdraw the needle immediately after insertion, gently squeeze the area around the needle hole to allow several drops of blood to escape, and then press the needle hole with a sterile cotton ball. This method is suitable for peripheral areas, such as blood-pricking at the twelve Jing-well points, the ten Shixuan points, and the ear apex point.
2. Pinching Spot-Pricking Method. In this method, the thumb and index finger of the left hand pinch up the skin and muscle at the acupoint to be needled, while the right hand holds the needle and inserts it to a depth of 0.5–0.1 cun. (Fig. 12) After withdrawing the needle, pinch and squeeze the local area to induce bleeding. It is often used for blood-pricking at acupoints such as Zanzhu (BL2), Shangxing (GV23), and Yintang (EX-HN3).
3. Ligating Spot-Pricking Method. In this method, first tie a rubber band around the upper end of the area to be needled. After local disinfection, press the thumb of the left hand on the lower end of the area, and the right hand holds the needle, aiming at the blood vessel of the area to be pricked. (Fig. 13) Withdraw the needle immediately to allow a small amount of blood to flow out. After the bleeding stops, release the band and press the needle hole with a sterile cotton ball.

II. Scattered Pricking Method

This method is also called "cluster pricking" or "surrounding pricking." The method involves using a three-edged needle to prick multiple points around the lesion — above, below, left, and right — to induce bleeding. Compared with the spot-pricking method, it covers a larger area and uses more needle insertions. It is often suitable for the treatment of dermatological conditions and soft tissue injuries, such as stubborn tinea, erysipelas, and local blood stasis.

III. Tapping Pricking Method

This method is a further development based on the scattered pricking method. The instrument used is a cutaneous needle (either a plum-blossom needle, seven-star needle, or a cutaneous rolling needle is acceptable). During the operation, hold the rear end of the needle handle with the right hand, with the index finger extended and pressed on the middle segment of the handle. Use the strength of the wrist to perform even, rhythmic, spring-like tapping on a designated area. The stimulation intensity required for blood-pricking should be relatively strong, tapping with force until beads of blood appear on the skin. This method has relatively good therapeutic effects on certain types of neurogenic pain and dermatological conditions.

IV. Pricking and Picking Method

During the operation of this method, the left hand presses on both sides of the treatment area to fix the skin. The right hand holds a three-edged needle or a thick round needle and pricks the acupoint or reaction point open to induce bleeding. Alternatively, the needle may be inserted deeply into the skin, and some fibrous tissue is picked out or picked apart, with bleeding encouraged by squeezing. The local area is then covered with a sterile dressing and secured. It is often used to treat conditions such as red, swollen, painful eyes, erysipelas, acute mastitis, and hemorrhoids.

V. Cutting and Spotting Method

In this method, a small eyebrow scalpel or surgical blade is used to cut the skin, mucous membrane, or a small vein at the acupoint, releasing an appropriate amount of blood, and the area is then covered with a sterile dressing. The incision for the cutting and spotting method is generally about 0.5 cm in length; for a small vein, cutting through one-third of it is considered the appropriate degree.

VI. Needle-Cupping Method

This is a therapeutic method in which needling is combined with the application of fire cupping to release blood. It is often used on the trunk and proximal areas of the limbs where a cup can be securely attached. During the operation, first use a three-edged needle or a cutaneous needle to prick the local area until blood is seen (or not seen), and then apply a fire cup. Generally, the cup is retained for 5–10 minutes and removed once a certain amount of blood has been drawn into the cup. This method is suitable for treating conditions with relatively large lesions, such as erysipelas, neurodermatitis, and sprains and contusions.

VII. Fire Needling Method

This method, also known as fire needling, is a therapeutic method in which a specially made thick needle is heated until red-hot and then inserted into a designated area to treat disease. It is suitable for conditions such as cold impediment and clove-sores.

Contraindications and Precautions

I. Contraindications

In the clinical application of blood-pricking therapy, there are both indications and contraindications. Therefore, one must act flexibly according to the patient's disease condition, constitution, the blood-pricking site, and certain special circumstances, in order to prevent accidents. The contraindications for blood-pricking are as follows:

1. Deep needling must be avoided in areas adjacent to important internal organs. The Suwen · Ci Jin Lun (Basic Questions: Treatise on the Prohibitions of Needling) points out: "The zang organs have their vital regions, which cannot but be carefully observed," and "Going against this will bring misfortune." This chapter lists the serious consequences of injuring the zang-fu organs, brain, and spinal cord through needling — observations that are largely consistent with modern clinical understanding and deserve adequate attention.
2. Blood-pricking is prohibited on arterial vessels and larger venous vessels. Directly pricking superficial small vessels to release blood is a fundamental method of blood-pricking. However, the operational technique must be strictly mastered, and one must on no account jab wildly. For arterial vessels and larger venous vessels, including severe varicose veins, blood-pricking should be prohibited. When needling acupoints near large blood vessels, the operation must also be performed with caution to prevent accidental vascular injury. There have been two recent reports of using a three-edged needle to treat acute mastitis, which accidentally injured the intercostal artery, causing massive hemorrhage that could only be stopped through surgical incision and ligation.
3. Blood-pricking is prohibited for patients with deficiency patterns, especially those with blood deficiency or depletion of yin fluids. The Lingshu · Xue Luo Lun (Spiritual Pivot: Treatise on the Blood Collaterals) points out: "When the vessel qi is exuberant but the blood is deficient, needling will result in the loss of qi; losing qi will cause collapse." Therefore, those with blood deficiency — including patients with relatively severe anemia, hypotension with a tendency toward spontaneous bleeding, or uncontrolled bleeding after injury — should be prohibited from receiving blood-pricking, so as to avoid the error of further depleting deficiency. Blood and sweat share the same source, both being transformed from body fluids. Therefore, those with habitual depletion of yin fluids or excessive sweating and purgation are also prohibited from blood-pricking. If the use of this method is truly necessary, it should be determined according to the relative strength of the pathogenic factors and zheng qi, and copious bleeding should be avoided.
4. Blood-pricking is prohibited for pregnant women and those with a history of habitual miscarriage.
5. Blood-pricking should be avoided when the patient is temporarily fatigued, hungry, overly full, emotionally disturbed, or in a state of qi and blood insufficiency.

II. Precautions

When applying blood-pricking therapy, one must fully consider factors such as the robustness or weakness of the patient's constitution, the exuberance or debilitation of qi and blood, and the deficiency-excess nature, severity, and urgency of the disease. The following points must be observed:

1. Carefully Examine the Physical Form and Spirit. The Lingshu · Zhong Shi (Spiritual Pivot: On the End and the Beginning) points out: "In all methods of needling, one must examine the patient's physical form and qi." When clinically performing blood-pricking, the corresponding therapeutic principles must be determined based on the patient's constitutional state, temperament characteristics, and the exuberance or debilitation of spirit and qi. The depth, manipulation, and amount of bleeding in blood-pricking should be determined according to the individual's height, stoutness or thinness, and constitutional strength or weakness. The scope of application and methods of blood-pricking should be determined according to whether the spirit and qi are in excess or insufficient.
2. Distinguish Deficiency and Excess. The Suwen · Tong Ping Xu Shi Lun (Basic Questions: General Treatise on Deficiency and Excess) states: "When pathogenic qi is exuberant, this is excess; when essential qi is depleted, this is deficiency." Deficiency and excess summarize the relationship between pathogenic factors and zheng qi. Since the action of blood-pricking is primarily to achieve the goal of curing disease through resolving "blood excess" and eliminating "stagnant and old accumulations," it is particularly suitable for excess patterns and heat patterns.
3. Know the Branch and the Root. Blood-pricking therapy is often used clinically as an important method for treating the branch aspect of disease. The treatment principle emphasized is to first apply blood-pricking to relieve the patient's suffering, and then to choose between tonification and drainage according to the deficiency or excess nature of the disease. In modern practice, for critical conditions caused by various factors — such as high fever, coma, and convulsions — blood-pricking is first applied to drain heat and open the orifices as a branch treatment, after which the underlying cause of the disease is addressed as the root treatment.
4. Determine the Qi and Blood Status. The Lingshu · Guan Neng (Spiritual Pivot: On Abilities) points out: "The principle of using needles requires that one must know the location of the body's form and qi, the left and right, upper and lower, the yin and yang in the interior and exterior, and the relative abundance or scarcity of qi and blood." Therefore, whether to apply blood-pricking and the amount of blood to be released must be decided according to the abundance or scarcity of qi and blood in the twelve meridians and their circulation conditions. Clinically, pricking Shangyang (LI1) to treat coma, toothache, and sore, swollen throat; pricking Zanzhu (BL2) to treat headache and red, swollen, painful eyes; pricking Weizhong (BL40) to treat lower back pain and vomiting and diarrhea; and pricking Quze (PC3) to treat heart pain, vexation, heat, and vomiting — all of these are based on the relative abundance of qi and blood in the meridians.
5. Comply with the Seasons. The Suwen · Zhen Yao Jing Zhong Lun (Basic Questions: Treatise on the Essentials of Diagnosis and the End of the Meridians) states: "Spring, summer, autumn, and winter — each has its own appropriate needling." It also says: "In spring, needle the scattered acupoints and the interstices... In summer, needle the collateral acupoints, stopping when blood is seen." This indicates that humans correspond with heaven and earth and follow the sequence of the four seasons; therefore, blood-pricking to treat disease should also vary according to the seasons. Based on the mechanism of the waxing and waning of the four seasons and five elements matched with the zang-fu organs, the decision is made according to whether the meridian qi of the affected meridian in the patient with lower back pain is exuberant or not. For example, if foot Taiyang vessel disorder causes lower back pain, the Weizhong (BL40) point of the Taiyang meridian should be selected for blood-pricking. However, in spring, blood should not be drawn, because the foot Taiyang meridian is the meridian of the cold-water organ; in spring, wood is exuberant while water is in decline, yet the Taiyang meridian qi is at its most exuberant, so blood should not be drawn. If foot Yangming vessel disorder causes lower back pain, the Zusanli (ST36) point of the Yangming meridian should be selected for blood-pricking. However, in autumn, blood should not be drawn, because the Yangming belongs to earth; earth is exuberant in late summer, while in autumn, metal is exuberant and wood is in decline — therefore, blood-pricking to drain it is not permitted. The rest may be inferred by analogy.