MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Bloodletting has been used for centuries in many cultures. Its principle, it was assumed, consisted in re-balancing the body’s four humours. Bloodletting had a detrimental effect on most diseases and must have killed millions. It is a good historical example of the harm that ensues, if healthcare adheres to dogma. Today, we know that bloodletting is useful only in rare conditions such as polycythaemia vera or haemochromatosis (and some 30 years ago, a variation of bloodletting, isovolaemic haemodilution, was being discussed as a treatment for circulatory diseases such as intermittent claudication or stroke).

Yet, in so-called alternative medicine (SCAM), there are some practitioners who seem to find it hard to concede that ancient treatments might be not as good as they think. Thus, bloodletting has survived in this realm as a therapy for a wide range of conditions. This study assessed the efficacy of bloodletting therapy (acupoint pricking and cupping) in patients with chronic idiopathic urticaria (CIU) in a randomized, control, parallel-group trial.

A total of 174 patients with CIU were randomized into three groups:

  1. group A was treated with bloodletting therapy and ebastine (an anti-histamine),
  2. group B was treated with placebo treatment (acupoint pseudopricking and cupping) and ebastine,
  3. group C was treated with ebastine only.

The treatment period lasted 4 weeks. An intention-to-treat analysis was conducted, and the primary outcome was the effective rate of UAS7 score being reduced to 7 or below after treatment phase.

The effective rates at the end of treatment phase were different among the three groups, which were

  • 73.7% in group A,
  • 45.6% in group B,
  • and 42.9% in group C.

Multiple analysis indicated differences between groups A and B (P < 0.0125) and groups A and C (P < 0.0125) and no difference between groups B and C (P > 0.0125). No severe bloodletting therapy-related adverse events were observed.

The authors concluded that one month of bloodletting therapy combined with ebastine is clinically beneficial compared with placebo treatment combined with ebastine and treatment with ebastine only. Thus, bloodletting therapy can be an effective complementary treatment in CIU.

Amazed?

Me too!

How on earth might bloodletting help for CIU? Luckily, the authors have an answer to this question:

The clinical feature of urticaria with wheals and pruritus coming and going quickly is the manifestation of wind-evil that lurks in and circulates with blood. Hence, in the treatment of urticaria, dispersing wind is the one of the principle methods, and treating blood before wind is an important procedure because when blood flows fluently , wind-evil will resolve spontaneously. Bloodletting therapy is a direct and effective way of regulating blood.

You see, it’s all perfectly clear!

In this case, the results must be true. And the argument that patients might have known in which treatment group they had ended up (and were thus not blinded) can be discarded.

4 Responses to Oh look! Bloodletting is back!

  • I don’t think it ever went away: modern acupuncture using filiform needles is just the Maoist reworking of traditional acupuncture, employing bamboo trochars for Galenic-style bloodletting.

    “The clinical feature of urticaria with wheals and pruritus coming and going quickly is the manifestation of wind-evil”

    Thank you, Cultural Revolution. You can make the people believe in anything when the alternative is a public execution.

    Always relevant.

  • Oh, Dear.

    Ernst old bean,

    bloodletting never did go away in conventional medicine (or if it did, only briefly, in the later 1800s).

    Please remind yourself of standard treatment for hemochromatosis/polycythemia vera.*

    And you might share some affinity with the blood letting fraternity of old – I’ve seen somewhere an angry letter to a journal from some phlebotomist, penned in the 1700s, claiming that homeopathy could not possibly work – because it does not let out the bad blood. Another fine example of false preconceptions.

    Wet cupping is still very popular with our Islamic brothers. It has some historical support, it seems. As you know, bloodletting does have useful physiological effects, but modern standard precautions are certainly in order (rather than the re-used knife). Leeches were always rather more up-market.

    R.I.P. Mozart and others, mind.

    Season’s greetings,
    Will

    Some history for those interested https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2008.07361.x
    “Some benefits of venesection may still become more apparent with greater scientific attention to the subject.”
    Hmm. I wonder if it helps with Covid…

    [*] In passing, a representative case report:
    http://www.homoeopathichealing.net/DocumentedCases/PolycythemiaVera
    More proper (non pseudo-skeptic) research would be needed to confirm, no doubt.

    (Oh, and Money-Kyrle – yes it’s a case report, not a pharma study. Citing lack of a particular style of contrived evidence as a reason to suppose lack of effect is known as the ad ignorantium fallacy, aka the Prime Pseudo-Skeptic Fallacy. One should not indulge in fallacy. Merry Christmas.)

    • “bloodletting never did go away in conventional medicine (or if it did, only briefly, in the later 1800s).

      Please remind yourself of standard treatment for hemochromatosis/polycythemia vera”
      PERHAPS YOU SHOULD READ AND THINK BEFORE YOU WRITE AND BULLSHIT?:
      Today, we know that bloodletting is useful only in rare conditions such as polycythaemia vera or haemochromatosis (and some 30 years ago, a variation of bloodletting, isovolaemic haemodilution, was being discussed as a treatment for circulatory diseases such as intermittent claudication or stroke).

  • I practice blood letting the smart way.
    I donate every three months at the Red Cross donation center. I get a frequent oil change, and they are happy to take it from me…. a win win !

    Out with the old, and in with the new.

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