---
title: "Bloodletting"
url: "https://acuiq.com/wiki/techniques/bloodletting"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "techniques"
basis: "Classical and modern"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 6
sources: 11
---

# Bloodletting

_Pricking points to release a few drops of blood: the instruments, the points it uses, what reviews of gout, stroke, shingles and styes report, and the infection controls it needs._

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](https://www.ccahm.org/images/ccaom/Documents/7th_Edition_Manual_English_June_2017.pdf) (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](/wiki/techniques/cupping).

## Where it is done

| Site | Points | Where the cited studies use it |
| --- | --- | --- |
| Jing-well points of the hand | [`LU11`](/points/LU11) (Shaoshang), [`LI01`](/points/LI01) (Shangyang), [`PC09`](/points/PC09) (Zhongchong), [`TB01`](/points/TB01) (Guanchong), [`HT09`](/points/HT09) (Shaochong) and [`SI01`](/points/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`](/points/XU11A) to `XU11J` | One trial in the same stroke review |
| Ear apex | The extra point [`XH06`](/points/XH06) (Erjian), catalogued among the ear points as [`HX01`](/points/HX01) | Acute stroke; styes |
| Back of the knee | [`BL40`](/points/BL40) (Weizhong) | Chosen with [`BL17`](/points/BL17) and [`SP10`](/points/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](/wiki/nomenclature/five-transport-points) explains; the hand twelve are listed in a [2026 imaging study](https://pubmed.ncbi.nlm.nih.gov/41987435/) 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](https://pubmed.ncbi.nlm.nih.gov/40229160/) 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](https://doi.org/10.1016/j.ctcp.2021.101503) | 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](https://doi.org/10.3390/healthcare12202060) | 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](https://doi.org/10.1007/s11655-020-3093-8) | 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](https://doi.org/10.1097/md.0000000000040694) | 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](https://doi.org/10.1097/md.0000000000021555) | 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](https://doi.org/10.3389/fneur.2025.1674245) | 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](/symptoms/gout), [stroke](/symptoms/stroke) and [shingles](/symptoms/herpes-zoster) 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](https://doi.org/10.1371/journal.pone.0033122) 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](/wiki/safety/infection-and-clean-needles) and [Bleeding and anticoagulants](/wiki/safety/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](/wiki/method/reading-a-protocol) explains each field.

### Sources

1. Council of Colleges of Acupuncture and Oriental Medicine, Clean Needle Technique Manual: best practices for acupuncture needle safety and related procedures, 7th edition, revised May 2017 — https://www.ccahm.org/images/ccaom/Documents/7th_Edition_Manual_English_June_2017.pdf
2. Wellcome Collection, The nine ancient acupuncture needles, 17th-century Chinese woodblock (detail showing the lance, stiletto and round-sharp needles), catalogue entry — https://wellcomecollection.org/works/a5ksatfj
3. Zhao J, Chai C, Yao G, et al, Multidimensional effect of acupuncture bloodletting technique at hand twelve jing-well points on the functions of thalamus and related brain regions, Zhongguo Zhen Jiu 2026 (Chinese, English abstract) — https://pubmed.ncbi.nlm.nih.gov/41987435/
4. Zhuang S, Li R, Duan H, Liu S, Tian T, LI Rui's experience in acupoint selection and clinical cases in treatment with bloodletting therapy, Zhongguo Zhen Jiu 2025 (Chinese, English abstract) — https://pubmed.ncbi.nlm.nih.gov/40229160/
5. 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, Complementary Therapies in Clinical Practice 2022 — https://doi.org/10.1016/j.ctcp.2021.101503
6. Kim M, Han C, Bloodletting for acute stroke recovery: a systematic review and meta-analysis, Healthcare 2024 — https://doi.org/10.3390/healthcare12202060
7. Yu NN, Xu ZF, Gao Y, et al, Wake-promoting effect of bloodletting puncture at hand twelve jing-well points in acute stroke patients: a multi-center randomized controlled trial, Chinese Journal of Integrative Medicine 2021 — https://doi.org/10.1007/s11655-020-3093-8
8. Kim M, Han CH, Bloodletting at the ear apex for acute stroke: a systematic review and meta-analysis of randomized controlled trials, Medicine 2024 — https://doi.org/10.1097/md.0000000000040694
9. 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 2020 — https://doi.org/10.1097/md.0000000000021555
10. Wu D, Jiang Y, Wu Q, et al, Efficacy and safety of bloodletting therapy for acute herpes zoster: a systematic review and meta-analysis, Frontiers in Neurology 2025 — https://doi.org/10.3389/fneur.2025.1674245
11. Lanini S, Garbuglia AR, Puro V, et al, Hospital cluster of HBV infection: molecular evidence of patient-to-patient transmission through lancing device, PLoS One 2012 — https://doi.org/10.1371/journal.pone.0033122