History of Bloodletting in Europe

Dr. Zhu Weimin and Dr. Yang Yibin

King Charles II of England was an epicurean, with numerous mistresses who bore him 13 illegitimate children. His reign was far from peaceful: first, England experienced an outbreak of the plague, and then, in 1666, a fire in London lasted four days and three nights, destroying nearly 80% of the buildings in the city center. However, King Charles continued to enjoy women, good food, balls, and music, earning him the nickname "Merry Monarch." It was also in this year that Newton discovered gravity, contributing to England's scientific progress. Nevertheless, English medicine was very backward at that time. According to British royal archives, the "Merry Monarch" died in 1685, shortly after suffering a stroke at the age of 54. The treatment methods employed by the royal physicians were, to say the least, astonishing.

The King's Death

On the morning of the king's stroke, he awoke convulsing, his face pale, and unable to speak. Twelve physicians quickly assembled and performed a bloodletting, removing about 450 milliliters of blood. They also administered emetics, purgatives, and enemas, but his symptoms did not improve. They performed another bloodletting, removing nearly 300 milliliters of additional blood. The poor king lost more than 700 milliliters of blood in one morning. Seeing the king's critical condition, the physicians then prescribed a mixture of medicinal herbs before leaving.

On the third day, the king suffered more convulsions. The physicians administered about ten medicinal herbs and performed another bloodletting of 300 milliliters. They tried various remedies such as barley water, almonds, melon seeds, eel skin, and powdered skull, among others.

On the fourth day, after these "classic" treatments, the king's condition did not improve and he was on the brink of death. The physicians then attempted emergency measures: they shaved his head and applied a blistering agent to his scalp, intended to cause blisters and intoxication. Then, they heated a piece of iron red-hot to cauterize his skin. King Charles, suffering immensely and aware of his imminent end, thanked the physicians and asked to see the sunrise. He then began to experience difficulty breathing. The physicians drew another 300 milliliters of blood. Shortly thereafter, he lost the ability to speak and died by midday.

How Does a Chinese Doctor View the King's Treatment?

From the perspective of a traditional Chinese medicine (TCM) doctor, such a treatment is hard to believe, but it was the most advanced medical technology in England at that time. In China, more than two thousand years ago, the 《Huangdi Neijing》 provided detailed descriptions of a stroke, known as "pù jī", "bó jué", "diān jí", "piān kū", and "piān fēng". During the Eastern Han Dynasty, Zhang Zhongjing (150-219 AD) was the first to name this disease "zhōng fēng" (stroke). In his work 《Jingui Yaolue, Treatment of Stroke》, it is written: "Diseases caused by wind result in paralysis on one side of the body, or an inability to move just one arm. This is due to obstruction, with a weak and rapid pulse, caused by a stroke." The possible mechanisms of the disease include internal obstruction by phlegm-heat, simultaneous deficiency of Qi and blood, Qi stagnation and blood stasis, as well as internal movement of liver wind. The prescriptions include "Hou's Black Powder", "Xuming Decoction", "Wind-inducing Decoction", "Wu Tou Decoction", "Guizhi Shaoyao Zhimu Decoction", etc. The choice of prescriptions is based on differential clinical diagnosis. According to these mechanisms, a stroke in TCM is primarily a deficiency syndrome, sometimes accompanied by cold or heat. The principles of treatment are to tonify and promote blood circulation, tonify and regulate Qi, dissipate stasis, strengthen the earth (stomach) to generate metal (lungs), and calm liver wind. Bloodletting, on the contrary, would further weaken the Qi and blood, leading to the patient's death. The use of purgatives, emetics, and enemas is entirely erroneous.

For TCM, purgatives are appropriate for syndromes of fullness and heat in the lower part of the body, which does not correspond to a stroke. Emetics are used to treat obstructions by phlegm or undigested food in the middle and upper parts (heart, lungs, and stomach), such as for headaches, dizziness, manic-depressive disorders, and epilepsy due to food accumulation or gastric toxins. Therefore, emetics are also unsuitable. Enemas are similar to purgatives, treating fullness syndromes as deficiency syndromes, which is a fundamental error. At that time, although TCM did not yet distinguish between hemorrhagic and ischemic stroke, treatment based on a Chinese differential diagnosis would not lead to a loss of life in four days, but only to a more or less rapid recovery.

In the Qing Dynasty, Wang Qingren (1768-1831) created the "Buyang Huanwu Decoction" formula (including Chinese angelica, red peony root, chuanxiong, peach kernel, safflower, astragalus, and earthworm), specifically for treating stroke. Wang Qingren was invited to the imperial court, where he cured Mr. Lu, whom even the imperial physicians could not treat. Due to its remarkable effectiveness, this formula is still used today to treat the sequelae of strokes.

Acupuncture for treating strokes has a long history, with various techniques, especially for treating the sequelae. Bloodletting through acupuncture involves pricking specific points to release a few drops of blood during the acute phase, without weakening or exhausting the patient.

Bloodletting in Traditional Chinese Medicine

Regarding bloodletting, TCM methods are entirely different from those of Western medicine. In TCM, bloodletting is also called "cì luò fàng xuè" (刺络放血), and it involves piercing or incising specific acupuncture points and certain areas of the body with needles or sharp instruments to release a small amount of blood to treat certain diseases. This method can sometimes produce astonishing effects.

In popular practice, bloodletting is sometimes performed using the cupping technique, with a larger volume of blood released, but this remains well below several hundred milliliters. While the immediate effects are also good, the long-term effects are not necessarily guaranteed. This treatment technique dates back to prehistoric times when people discovered, through their work activities, that using sharp stones (called bianshi) to pierce and bleed affected areas could alleviate pain. Over time, this therapeutic experience was summarized and formed into a unique treatment system.

The earliest written mentions of this method are found in the 《Huangdi Neijing》. Subsequently, the application of bloodletting gradually expanded, and more and more descriptions of this method were documented. For example, the 《New Book of Tang》 reports that the court physicians of the Tang Dynasty used bloodletting on the top of the head to cure Emperor Gaozong of dizziness that prevented him from seeing.

During the Song Dynasty, this method was included in the acupuncture verses of 《Yulong Fu》. During the Jin-Yuan period, Zhang Zihe used bloodletting almost exclusively in his clinical acupuncture cases, as indicated in 《Ru men shi jian》, emphasizing that acupuncture bloodletting is the fastest method to eliminate pathogens. In the Ming and Qing Dynasties, bloodletting for treating diseases was very common, and acupuncture instruments quickly evolved, with three-edged needles classified into two types, thick and thin, better suited for clinical use.

Yang Jizhou's 《Zhenjiu Dacheng》 provides a detailed description of clinical cases involving acupuncture bloodletting. Ye Tianshi also used this method to treat throat diseases. It is important to highlight that bloodletting in TCM is performed on acupuncture points along the meridians, with a very small amount of blood. Its therapeutic efficacy relies on regulating the body through the meridian system, without affecting the circulatory system to the point of causing weakness or exhaustion in the patient. Moreover, TCM follows the principle that "deficiency should not be treated by bloodletting."

Bloodletting in Western Medicine

Bloodletting in Western medicine also has a long history, but it completely differs from that of TCM, as it involves piercing blood vessels to release a large amount of blood.

The development of Western medicine followed five successive models: the spiritualist model, the natural philosophy model, the mechanistic model, the biomedical model, and the biopsychosocial model. Bloodletting is a product of the initial spiritualist medicine, where treating a disease meant exorcising demons, similar to shamanic medicine in ancient China. Bloodletting was then an exorcism method.

Hippocrates, revered in the West as the "father of medicine," lived 2,400 years ago in ancient Greece. He created the theory of the "Four Humors," which states that the human body is composed of blood, phlegm, black bile, and yellow bile. An imbalance among these four humors would cause diseases. To restore this balance, one had to bleed in case of excess blood, vomit in case of excess bile, and administer purgatives and enemas in case of excess phlegm. If these operations were pushed to the extreme, the remedy was simple: bleed more, vomit, or purge further, until the four humors were balanced, as long as the patient had even a breath of life.

The "Four Humors" theory created by Hippocrates led Westerners to undergo very painful medical treatments. However, Hippocrates was not a fervent supporter of bloodletting; the true enthusiast was the Roman physician Claudius Galen. Galen proposed two erroneous theories, the "Tripartite Pneuma" and the "Theory of Blood Circulation," which served as the theoretical basis for bloodletting for millennia. According to Galen, menstruation in women and hemorrhoidal bleeding in men were natural mechanisms to maintain health by expelling toxic substances through the blood. He asserted that when the body could not accomplish this task due to weakness caused by illness, the help of physicians was necessary, hence the practice of bloodletting. Galen argued that blood plethory was the cause of all diseases and that bloodletting was a universal remedy. For a cold or fever, for a coccyx problem, he recommended bloodletting; for liver diseases, he bled the vein in the right arm; for spleen diseases, the vein in the left arm. The amount of blood drawn had to be sufficient to lower the patient's body temperature and slow their pulse.

At the beginning of the 19th century, faced with the spread of infectious diseases such as cholera, plague, and influenza in Europe, bloodletting was the primary treatment. Many patients died prematurely after being bled, leading to widespread dissatisfaction. Subsequently, controlled trials demonstrated that bloodletting significantly increased the mortality rate. In 1840, after observing 2,000 patients over seven years, the French physician Pierre Louis concluded that bloodletting was completely ineffective in treating pneumonia and febrile illnesses, and significantly increased mortality when used for various diseases. Other clinical trials confirmed these results.

Notably, the French scientist Louis Pasteur discovered that many diseases were caused by bacterial infections, not by an imbalance of humors. Western physicians had to abandon the practice of bloodletting, along with the erroneous theories of the "Four Humors" and "Blood Plethory".

Why Was Ancient Western Medicine Abandoned While Traditional Chinese Medicine Gains Popularity?

The main reasons are as follows:

1. Philosophical Foundations of TCM TCM is based on philosophical principles, and its treatment methods are guided by philosophical concepts such as dialectical materialism or metaphysics. Philosophy is the science that guides all other sciences, making TCM a scientific discipline.

2. A Holistic Approach to the Human Being TCM studies the human being in its entirety, as a complex of body and mind. For example, TCM teaches that "the heart houses the mind, the lungs house the corporeal soul, the liver houses the ethereal soul, the spleen houses the intellect, and the kidneys house the will". This approach emphasizes the relationship between the soul and the body, whereas Western medicine, from antiquity to the present, focuses solely on the body visible to the naked eye.

3. Understanding the Essence of the Universe TCM grasps the essence of the universe. The famous scientist Nikola Tesla stated, "If you want to understand the secrets of the universe, think in terms of energy, frequency, and vibration." The core of TCM lies in the differentiation of syndromes according to the eight principles, where distinctions between cold and heat, deficiency and excess are indicators of energy. Evaluating human energy is the secret of TCM. By understanding the essence of the universe, TCM can treat many complex diseases. As long as one does not confuse syndromes of cold, heat, deficiency, and excess, and accurately identifies the locations of organs and meridians, one can grasp the nature of the disease, making treatment simple and effective. Otherwise, treatment will be ineffective, or worse, exacerbate the disease and potentially lead to the patient's death.

Conclusion

Traditional Chinese Medicine has been tested through millennia of practice and has made a significant contribution to human health. This does not mean that in ancient China, strokes did not cause deaths; even today, the mortality rate for strokes remains high. In China, strokes are the leading cause of death, accounting for 80% of ischemic stroke cases. Like heart attacks, this disease often strikes so quickly that it leaves little time for doctors to intervene. However, the death of Charles II is undeniably linked to inadequate treatments. The physicians had enough time to treat him, but they lacked effective methods. Therefore, we must continue to learn to take care of our health by exercising, improving our diet, abandoning bad lifestyle habits, elevating our spiritual level, and reshaping our brain structure to reduce the incidence of strokes and other diseases.

04 June 2024

You might also be interested in the following article:

1. The Terrifying Optical Experiences and Natural Healing

2. Brief discussion on the philosophy of traditional Chinese medicine

3. Traditional Chinese Medicine and 《The Art of War of Sun Zi》