Bloodletting in acupuncture pricks a point to release a few drops of blood. The US Council of Colleges of Acupuncture and Oriental Medicine’s Clean Needle Technique Manual (seventh edition, revised 2017) lists the names it goes by in the literature: bloodletting, pricking, bleeding and use of the three-edged needle. It says the practitioner removes only drops, until the blood’s quality and colour lighten, and, citing the standard Chinese textbook Chinese Acupuncture and Moxibustion, that bleeding specific points is still used for fevers, pain and itching. Citing a 1980 history by Dean Epler, it adds that successive versions of the Suwen suggest acupuncture itself grew out of bloodletting.
The instruments
The Lingshu’s nine needles include a lance needle, feng zhen, which the Wellcome Collection’s catalogue entry for a 17th-century woodblock of the nine identifies as the three-edged needle, used to draw blood in heat-related disorders, abscesses and swellings. Practitioners now also use lancets, and the Clean Needle Technique Manual allows only pre-sterilised, single-use disposable lancets, not the pen-like devices sold for home blood sugar testing, and recommends lancets that retract after use to protect the practitioner from needlestick injury. Wet cupping, in which the skin is pricked and then cupped to draw more blood, is covered in Cupping.
Where it is done
| Site | Points | Where the cited studies use it |
|---|---|---|
| Jing-well points of the hand | LU11 (Shaoshang), LI01 (Shangyang), PC09 (Zhongchong), TB01 (Guanchong), HT09 (Shaochong) and SI01 (Shaoze), on both hands: the “hand twelve” | Acute stroke; the points most used in the trials of a 2024 stroke review |
| Fingertips | Shixuan, the ten fingertip points, XU11A to XU11J | One trial in the same stroke review |
| Ear apex | The extra point XH06 (Erjian), catalogued among the ear points as HX01 | Acute stroke; styes |
| Back of the knee | BL40 (Weizhong) | Chosen with BL17 and SP10 for “regulating blood” in one Chinese practitioner’s account |
The jing-well points are the first of the five transport points on each channel, which Five transport points explains; the hand twelve are listed in a 2026 imaging study by Zhao and colleagues, which pricked them in order from the thumb to the little finger. The account of Weizhong comes from a 2025 paper by Zhuang and colleagues on the bloodletting practice of Professor Li Rui.
What reviews and trials report
| Source | What it covered | What it found |
|---|---|---|
| Li and colleagues, 2022 | Acute gout: 12 trials, 894 people, bloodletting against standard drugs | Less pain (mean difference −1.13, 95% CI −1.60 to −0.66) and lower C-reactive protein, a marker of inflammation; uric acid fell about as much in both groups; fewer adverse reactions with bloodletting (risk ratio 0.36) |
| Kim and Han, 2024 | Acute stroke: 17 trials, bloodletting added to conventional care | Lower scores on the NIH Stroke Scale, which grades neurological deficit (mean difference −2.08, 95% CI −3.13 to −1.02); certainty low or very low for every outcome |
| Yu and colleagues, 2021 | 360 people with impaired consciousness within 48 hours of a stroke, at several centres; half had the hand twelve pricked on admission before conventional treatment | At 80 minutes, more patients in the bloodletting group had improved consciousness; among those with moderate impairment, people with ischaemic stroke improved on the eye and speech parts of the Glasgow Coma Scale; no difference in blood pressure, breathing or pulse |
| Kim and Han, 2024 | Acute stroke: 6 trials, 530 people, ear apex bloodletting added to conventional care | Higher Glasgow Coma Scale scores (mean difference 2.75, 95% CI 1.72 to 3.78); the trials were small, at high risk of bias and poorly reported |
| Qiao and colleagues, 2020 | Styes: 11 trials, 1,718 people, ear apex bloodletting added to eye drops | More patients rated effectively treated (risk ratio 1.21, 95% CI 1.11 to 1.32); no trial reported adverse reactions |
| Wu and colleagues, 2025 | Acute shingles: 16 trials, 1,283 people, bloodletting against drugs | Fewer cases of lasting nerve pain afterwards (odds ratio 0.23, 95% CI 0.15 to 0.35); every trial was run in China and most carried a high risk of bias |
Every comparison in the table is against drugs or usual care rather than a sham bloodletting. None of these reviews tested bloodletting for fever, one of the uses the Clean Needle Technique Manual names. AcuiQ’s pages on gout, stroke and shingles list the protocols individual studies prescribed, each with its citation.
Infection control
A used lancet carries blood and can injure the practitioner, and the Clean Needle Technique Manual sets rules for both sides. Its critical rules are to clean the hands and the skin, to wear gloves throughout, to take a history of bleeding disorders and of anticoagulant, antiplatelet and anti-inflammatory medicines and supplements, not to prick skin that is inflamed, broken or infected, to use each lancing device for one patient only and each lancet for one puncture only, and to drop used lancets straight into a sharps container. It recommends eye protection.
The manual cites one outbreak in support of its rule that a lancing device is never shared. In a 2012 investigation of an Italian hospital cancer and blood disorders unit, Simone Lanini and colleagues found 6 new hepatitis B infections among 162 patients; genetic testing tied 3 of them and 1 patient already infected on admission into a single cluster, and the same viral strain was found on a lancing device used on many patients. Infection and clean needles and Bleeding and anticoagulants cover these risks in full.
What the sources cannot tell you
The reviews pool small trials, nearly all from China, with no sham control and with certainty graded low or very low where it was graded at all. The stroke trial measured consciousness for 80 minutes, not recovery. The Clean Needle Technique Manual found no review of the safety of bleeding therapies in English when it was written, so how often harms occur is not known. A protocol entry on AcuiQ names bloodletting as its modality where the study used it; Reading a protocol explains each field.