(TJM) Traditional Japanese Medicine Theory

Japanese Acupuncture Techniques - Shiraku (Bloodletting) - TJM Theory

Shiraku (bloodletting) is used within a number of acupuncture styles. This section describes the use of bloodletting within a Japanese Acupuncture framework. The information presented below discusses basic theory behind the technique, guidelines for applying the technique and examples of clinical use. Some of the techniques listed here require significant amounts of training to be performed correctly and should only be performed by practitioners who have been trained properly.

  • Background Theory:
  • Both the Ling Shu & the Su Wen often mention some form of bloodletting for specific diseases.
  • Ch. 48 Ling Shu - disease will not develop into a critical condition if the Blood keeps flowing.
  • Ch. 20 Su Wen - if their is stagnation it should be resolved by bloodletting before tonification or dispersion techniques w/acupuncture a/or moxibustion.
  • Ch. 16 Su Wen - The Qi of the body flows in accordance with heaven & earth, during the spring you may bloodlet the shu points, during the summer you may bloodlet the luo connecting points. After bloodletting allow the bleeding to stop on its own accord and then press on the acupuncture point waiting for the energy to make one complete circulation around the body.
  • Clinical Usage:
  • Bloodletting is essential for resolving statis of Qi & Blood in the body.
  • It can be used as an adjunctive technique or as a complete treatment using various protocols.
  • Diagnosing Blood Stasis:
  • Patients who have undergone surgeries
  • History of gynecological disorders
  • History of external injuries
  • History of frostbite
  • History of chronic illness
  • History of psycho-emotional issues (memory loss, insomnia, dream disturbed sleep, anxiety)
  • Pain anywhere in the body, generally of a stabbing nature
  • Itching
  • Discolored pigmentation
  • Dull skin, nails a/or eyes (lack of shen in the eyes)
  • Presence of vascular spiders
  • Presence of thicker skin (callouses, etc.) on areas of the body
  • Contraindications & Precautions:
  • Contraindications:
  • Patients with bleeding disorders (hemophylia)
  • Patients on blood-thinning medications (coumadin, warfarin, etc.) - must limit to a couple drops from the jing-well points, completely avoiding larger areas
  • Advanced stages of malignant tumors
  • Patients with extreme weakness - if the stagnation arises from a deficiency you can use the jing-well points
  • Patients with diabetes - must limit to the torso area
  • Precautions:
  • Patients with any type of heart disorder - must limit to the jing-well points
  • Patients with low blood pressure a/or anemia - use caution and judgement & closely monitor the pulse for changes, if it becomes fast, superficial a/or scattered perform cone moxa on GV 14 or ST 36
  • With patient who are pregnant you should avoid the contraindicated points and the jing-well points - should limit treatment to vascular spider on the lower body (avoiding the SP 6 area
  • Use caution with patients who have HIV a/or Hepatitis
  • Possible Side Effects/Signs of Overdose:
  • Patient experiences lightheadedness - have patient lie down, elevate legs, moxa on ST 36, LI 10, GV 20 a/or CV 8
  • Patients experiences fatigue, chills, a/or alternating cold/warm - perform moxa on ST 36 a/or GV 20 or perform a hara treatment using cone moxa at CV 12, CV 6 & KD 16 bilaterally
  • Patient develops a hematoma - perform direct moxa on the bruised area
  • Bloodletting Methods for Jing-well Points:
  • Diagnosing appropriate Jing-well points
  • Darkness at the tip of the nail or at the base of the nail bed
  • Fingers that are appear bloated or feel bloated a/or swollen
  • Nails that feel cold a/or damp
  • Apply pressure to the nail, if after removing pressure the nail remains white this indicates a dysfunction
  • Arthritis a/or stiffness of the associated joints
  • Peeled cuticles a/or frostbite
  • Jing-well Technique
  • Clean the jing-well point
  • Hold the finger tightly between your thumb and index finger with the patients finger resting on your middle finger
  • Hold the lancet between your thumb and index finger so that the point is almost level with the tips of your ingers
  • Rest the tip of the lancet on the point
  • Perform the procedure with a fast downward and upward motion
  • After the puncture roll from proximal to distal on the finger with a cotton ball to increase the Blood flow to the area
  • Dosage Guidelines
  • Generally looking for the Blood to turn bright red, if it continues to be brownish or purplish you will want to continue the procedure
  • For a normal patient you can bleed 4-5 jing wells taking 10-15 drops per point
  • For a deficient patient you can bleed 1-2 jing wells taking 1-2 drops per point
  • For an excess patient you can bleed 7-10 jing wells taking 15-20 drops per point
  • Bloodletting Methods for Vascular Spiders (Sairaku Shiraku):
  • Areas where vascular spiders tend to form:
  • Head/Face:
  • SI 18 area, around the zygoma
  • On either side of the nose - hypertension
  • Around the jaw, especially is cases of bell's palsy (can be helpful in speeding recovery and regaining movement) a/or TMJ where you are likely to see the formation of the spider in the ST 5/6 area at the acute onset
  • Behind the ears - common in patients w/hypertension
  • Posterior neck (GV 14 area - common in cases of pink eye, conjunctivitis a/or macular degeneration
  • Underneath the tongue, looking for differences in color and length between the 2 vessels, if there is a difference in size, bloodlet the darker one - useful for stuttering and speech impediments
  • Back:
  • GB 21/TH 15 area - common in hypertension and locally for stiff neck/shoulders
  • SI 11 area - useful with any type of physical a/or emotional heart issues (can moxa SI 11 for tachycardia or brachycardia
  • LI 15/TH 14 area - useful with mastitis a/or skin diseases of the face
  • Between the shoulder blades - useful locally as well as for chronic gastritis, menopuase, hot flashes (can also check KD 3/6 area), meniere's, dizziness and respiratory issues such as asthma and bronchitis
  • Josen/S1 area - any complaints of the lower limbs, low back pain, dropped foot and gynecological issues
  • Chest/Torso:
  • Clavicle area - release chest tension/pressure especially where the ribs join the sternum
  • Legs:
  • GB 34 area - useful for all gynecological disorders, bleeding ulcers/hemorrhoids and sciatica
  • Bloodletting Vascular Spiders Dosage Guidelines (w or w/o cupping):
  • Normal patient - 5-7 vascular spiders, light (2 pumps) pressure with cup
  • Deficient patient - 2-3 vascular spiders, no cupping (generally)
  • Excess patient - 7-10 vascular spiders, moderate (3+ pumps) pressure with cup
  • Always apply Okyu at the site after bloodletting
  • Ranshi Ho Bloodletting Technique:
  • Appropriate Areas for the Technique:
  • Look over patients back (or anywhere) for areas w/large amounts of vascular spiders indicated Blood stasis - may also appear as areas where the skin is thickened
  • Ranshi Ho Technique
  • Place the cup on the skin for a minute or two - just until the redness appears
  • Remove the cup
  • Perform multiple lancet insertions with fast pricking motions in a circle from the inside out (approximately 5-25, generally around 12 insertions)
  • Replace the cup
  • Retain the cup until the Blood changes to a lighter color with a more viscous quality
  • Perform up to 3 rounds of Okyu or Chinetsukyu
  • Treatment for Psychoemotional Disorders:
  • Diagnose the basic element using the following guidelines:
  • Metal Element - easily tired, slow in forming ideas, tends toward melancholy
  • Water Element - often ill, frail, may experience chronic fatigue, poor memory, disinterest in their existence, sadness, desire to be separated from others
  • Wood Element - tired in the morning, difficulty getting out of bed, optimistic and anxious at the same time, aggressive
  • Fire Element - always depressed, only able to sleep for short periods of time, extraordinary memory (either really good or really poor), emotionally hypersensitive, hides emotions, timid, withdrawn, lacks self confidence
  • Earth Element - has stamina but not always willing to work, lazy, neglectful, distracted, carefree
  • Treatment Method
  • Can use bloodletting or bloodletting with cupping over the point
  • Want to use the Luo Connecting & Yuan Source points on the associated meridian, possibly including the yang meridian pair as well (i.e. metal element - LU luo LU 7 & source LU 9, possibly including the LI luo & source)

Sources and More Information

The information on our site is drawn from our own lecture notes and clinical experience. The following lecture notes were used within this section:

  • Iuliano, Diane: New England School of Acupuncture, Extraordinary Vessel Techniques Lecture Notes
  • Kuwahara, Koei: New England School of Acupuncture, Advanced Japanese Techniques Lecture Notes

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