SHIRAKU 刺絡療法（１） Japanese Specialized Bloodletting Therapy
History When you read the inner classic with special attention to Bloodletting, sixty percent of the treatments in the Su Wen and Ling Shu talk about the use of bloodletting. At that time, bloodletting was the central focus of an acupuncture treatment. Once it was an effective form of treatment, but it became misused with the short of education and many people died. Bloodletting must be used with caution because it can have side effects.
Purpose of Bloodletting The classics say that "Ki governs blood and that blood is the mother of Ki". Blood provides the foundation for the creation of energy in the body. According to the Nan-Jing, “Bloodletting is used to treat the basic problems of the body”. It states: “Bloodletting is the first form of treatment to be used on the patient. It acts as a good foundation for other forms of treatment”.
Purpose of Bloodletting (2) When conditions are excess with stasis, bloodletting is indicated. Needless to say diagnosis is very important to making the best use of bloodletting. It will smooth and disperse evil Ki. Choose the meridian, which has the most stagnation of Ki. It is a effective form of treatment in the emergency situation. It has a powerful effect on the extremities. Effects from treatment with bloodletting last for a long time, thus having the potential of reducing the frequency of treatments.
Contraindications - Precautions There are no absolute prohibitions to bloodletting. But in, is more cautious with the dosages and number of points used. 1. Cardiac problems 2. Hemophilia 3. Cerebral Embolism 4. Tuberculosis 5. Anemia 6. Extreme Weakness 7. Malignant Tumors
Reactions from Bloodletting Cerebral Anemia, Light Headedness Elevated Body Temperature Fatigue Exaggeration of Symptom Hematoma
Overdose Lie the patient down and make them comfortable. Give them something warm to drink. Burn cone moxa on CV8 (navel) on a salt bed. or burn cone moxa or direct moxa on ST36, GV20, CV14. Bloodletting on the Jing points (TW). A basic principle of recommended usage is to begin on the extremities and then move to other (more local) areas of the body.
Equipment/Materials Three edged needle or lancet Gloves and Facemask Cotton Balls, Paper towel Alcohol 10% bleach solution in a spray bottle and bucket Biohazard Containers Spills - If blood gets on the table or floor put on gloves and a lab coat, Clean the area immediately with a bleach solution.
Sterilization Methods - Chemicals Bleach Solution: Make a diluted solution of 1 cup of bleach to 9 cups of water for the correct concentration. Let the cups soak for 1 hour and make sure that all blood is completely off of the cups before you put the cup in the solution. Only one day use. Gluteraldehyde or Sidex both from Johnson & Johnson can be used as is. Soak cups for 10-30 minutes or as per directions. One week continuing use.
Jing -Well Points According to Western physiology, the greatest amount of the Cerebral cortex's function is used for the operation of the hands. It also affects the autonomic and sympathetic nervous systems. Blood gathers from distant areas just like water in a well. Just as with well water, when we check the quality of the water, it tells us something about the quality of the soil around it.
Jing -Well Points (2) Jing-Well Points are located at the nail beds of the fingers and toes. It is an area of the vascular system where the artery and vein connect with each other. This area stagnates easily from any abnormality in the body. This makes it is an easy area to check for problems. Jing-Well Points is often used for an emergency treatment.
Diagnosis Decide from the pulse and abdomen, whether the condition is an overall deficiency or excess. Then isolate the meridians involved based on channel symptomology and confirm it by looking and palpation at the fingers and toes. Check the Jing points for the degree of blood stasis. darker red, swollen, puffy, darker color or look lack luster Color of the nail: ashen white, dark red or purplish . A cold and/or numb feeling at the fingertips. Stiff, hard to move joints. Peeled cuticles or frostbitten fingers.
Jing-Well Point Indications LU) radial or both sides:Tonsillitis, pharyngeal catarrh, mumps, asthma, teeth fever LI) radial side: neck lymphadenitis, bronchial asthma, and lower jaw toothache PC) radial side: palpitations, neurosis, paralysis of the median nerve, high fever PC) ulnar side: (represents the Diaphragm) Difficulty swallowing, hiccups, stiff shoulder TH) ulnar side: Headache, brain congestion, eye congestion, dizziness, pharyngeal pain HT) radial side: Loss of consciousness, shock, Heart disorders, dypsnea, neurosis SP) medial side: Indigestion, acute gastroenteritis, infantile seizures
Dosages On average draw 15-20 drops of blood from each point. One drop is half the length of an azuki bean or 2-3mm long. Internal problems take 15-20 drops. Muscular-skeletal problems take 20-30 drops. Children and sensitive patients use help of customary amount. Stop squeezing once the blood color changes. It can also be used for tonification i.e. in a Lu deficient pattern bleed LU11. Taking 2-3 drops with light needling can help tonify the organ.
Color and Viscosity of Blood The healthy color of blood is bright red. The darker the color is the worse condition and prognosis. A dark color is expected when first coming out of the Jing point. It will change as it is bled. The viscosity of the blood also reflects the severity of the condition. The more slowly blood flows, the more viscous it is, and the worse the condition and prognosis. Dark blood is usually more viscous.
Technique Wear one or two layers of gloves on each hand for bloodletting. Wipe the point with alcohol. Have several alcohol soaked cotton balls on hand and table. Place the middle finger of your left hand (right handers), under the finger you will bloodlet. Place the index finger and thumb of that same hand on each side of their finger near the nail bed. Video1 Video Take a lancet in the thumb and forefinger of your right hand and place it in line with your index finger. Video
Technique (2) 6. It is recommended to use a fresh needle for each Jing point or area bloodlet. 7. Where the lancet is placed in the forefinger determines how deep the cut will be. By using the index finger as a lever, it also acts as a measuring gauge and insures better control. 8. Place it such that the largest smooth facet of the 3-edged needle is facing towards you. 9. Place the fingernail of your index finger on their finger near the Jing point. Then tip of the lancet meet with the jing-well point. Video
Technique (3) 10. Relax your shoulder, elbow, wrist of your insertion hand and take the deep breath. Please be freed from fixed mind about puncturing. 11. The needle depth is to about 0.5mm for sensitive patients or children, and about 1mm for average patients. 12. Roll the index finger towards you until get lancet vertical position to the point where the needle cuts the skin at the Jing point, then lift off straight of the point. Video
Technique (4) 13. Put the used lancet in the sharps biohazard container. 14. Use the middle finger of your right hand to draw the blood out of the Jing point by rolling/pressing from the distal phalangeal joint toward the Jing point, while the right thumb and forefinger hold a alcohol soaked cotton ball to wipe the blood. video
Technique (5) 15. The desired action is a gentle smooth stroke, squeeze, and wipe several times until the desired dosage is drawn. Then take a dry cotton ball and hold pressure on the point until it stops bleeding
16. Take one glove off and place it with any bloody cotton in the other hand and then remove the other glove inside out so that the contaminated contents are inside of the second glove.
Classifications of Bloodletting Three Categories 1. Bloodletting of veins 2. Bloodletting on vascular spiders 3. Bloodletting on cutaneous areas of the skin which is used when you don't see vascular spiders. But you see the signs from blood stasis. There are two basic types: A: Bloodletting the extremities - on the top of the head, nose, tongue, Jing points. B: Bloodletting on areas of the skin
Bloodletting Vascular Spiders Reasons for Appearance Evil Qi – OPI Skin→ Son Raku(Grandchild) → Raku(Luo)→ Kei (Meridians)→ Hara(Stomach and intestines)→Zang(Organs)→
Spiders take on different shapes some are thin, some are thick. It tends to have wiggle worm shaped spiders. We can often find small spiders near varicose veins. We should blood let these smaller veins and spiders. This is especially good for pregnant women. Spiders are easy to find on smooth, tight skin. On skin that has wrinkles we should stretch the skin to locate them, i.e. elderly, obese patients.
Aanastomotic branch Spiders is that they come from the stagnation of blood in the vessels in an artery, vein, or capillary. It is in the transition areas of each type of blood vessel that make it easy for stagnation to take place. (Where arteries turn into veins, veins into capillaries, etc.)
Valve of vein Physical trauma also damages valves and makes the body feel cold. Stress causes muscle tightness and disturbs the smooth flow of blood. In adjoining areas blood vessel valves usually open automatically and are all regulated by temperature and pressure. They consist of one-way valves, and when they don't function well they must be bypassed. A thicker bypass shows up as a spider. It represents the congestion of blood in an artery or vein because the valves aren't functioning properly.
The shape of the blood cell It lowers the blood function because it changes the shape of the blood cell. The blood cell becomes larger than the vein. It must change its shape to flow through the vein. Because it can't change its shape it begins to stick inside the vessel. The cause of this is unknown. It may come from the eating habits.
Dosages As we squeeze, it changes its color and viscosity. The dark color changes gradually. The blood in the vein changes as well as the blood in the spider. But blood in the vein is much darker than blood in the spider. Once the change occurs we can stop squeezing. There is always a risk of drawing too much blood, so be cautious. The purpose is not to get lots of blood, but to stimulate blood circulation. Some people can give lots of blood, but for other people this creates negative reactions. We must use good judgment in treating based on the patient's needs and lifestyle. In pregnant women the dosage is less than 1/2 the average person. Light cupping is good.
IMPORTANT AREAS FOR BLOODLETTING - Body Regions
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