George Washington's Demise: A Cautionary Tale

Revisiting a strange case and an old weapon in the healing arsenal

This piece is part of a series on East Asian Medicine, together with this post on yang qi and vitality, this one on Sa’am-style acupuncture, this one on Gu syndrome, and this one and this one on constitutional types.

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There’s little more associated with quackery in the Western mind than blood-letting. Isn’t that what killed George Washington, after all?

For the record: quite possibly.

After going to dinner in wet clothes to save time (face palm) and coming down with a sore throat and respiratory infection, the first president had an absurd +/- 40% of his blood let by a series of frantic physicians in a desperate attempt to cure him. Needless to say, the cure was not successful.

So yes, bloodletting has a bad rap these days, and the practice has long since gone out of fashion in the West.

But it’s no huge surprise that I’m here to tell another side of the story—for the practice of bloodletting is alive and well in Chinese medicine, among other traditional medical systems. (Yes, leeches too, especially in Ayurveda; here’s a good article on the subject with pictures of the little parasites effecting a cure of the skin condition vitiligo.)

While I’ve seen significant quantities of blood let from a patient (using the so-called “wet cupping’ technique) most of the time we’re talking about micro bloodletting: pricking a point or set of points to remove a drop or two of blood. Often we look for dark or engorged veins, these being indicative of stagnation in the vessels, and bleed them with a quick prick of a lancet. The blood removed is easily absorbed by a single cotton ball, so for those awash in images of gore, it’s all disappointingly tame.

So, why do we bleed? Generally, to quicken the blood (removing stagnation), or to release heat.

Yesterday I had occasion to bleed a patient suffering from an illness known in Chinese as bi syndrome, or painful obstruction. After some exceptionally windy weather, not incidentally, the patient had woken up with a seized up thigh and hip, with assorted pains ‘wandering’ around her body. she was especially stiff and sore at GB 20 (behind the ear) and GB 31 (midway down the lateral thigh), two points that have “wind” in their names. This then would be wind-type bi, wind being a mobile force and general troublemaker when it comes to health.

One way of treating wind is via the blood. So in addition to giving an herbal formula and doing some regular (non-bleeding) acupuncture, I bled a few points on her legs. This more than anything gave some immediate relief, and she was able to walk up a flight of stairs without much pain for the first time in days.

This patient is becoming quite a fan of bloodletting, as several years ago when she presented with a severe sore throat, pricking a few points over the throat again gave immediate relief. This was an example of clearing heat: bleeding gives the heat an efficient outlet.

Pricking to bleed has other uses as well, mainly in connection with the specific points chosen. For instance, bleeding Lung 5 (a Lung channel point on the inner elbow) can be useful in treating cough. Bleeding the apex of the ear is well-known in Chinese medicine for treating hypertension and insomnia. And so on.

One misconception about bleeding, even within the Chinese medicine world, is that it’s only appropriate for cases of excess. While it’s true that we don’t want to go all George Washington on a weak or deficient patient (or any patient for that matter), judicious bloodletting is such an efficient way to remove obstructions and invigorate the blood that it can serve to open the way for more supplementing and nourishing therapies. Thus even delicate patients can benefit.

And what about ol’ George? I wasn’t there, but I imagine the president was shivering violently after catching his chill. Whatever his thermometer may have read, if he was indeed shivering and feeling cold, that would have been a sign that he needed to be warmed up: his system needed help mounting the fever to burn him clean. It didn’t need to be undermined by a cooling, depleting treatment like heavy bloodletting (and enemas and vomiting, both of which were also administered, inappropriately). It’s likely that blankets and hot tea would have been the right direction, although most likely a simple change of clothes immediately upon the president’s return home would have been the stitch in time that saved nine.

The cautionary tale here is not that bloodletting itself is dangerous (though there’s never cause for letting such quantities). It’s that bloodletting, like every other therapy, has to be administered appropriately—and the body’s innate intelligence must be heeded. A shivering patient should almost always be swaddled in blankets and warmed even if they’re running a 103 degree fever. Once the fever breaks, they’ll cool down naturally. But forcing them to cool down prematurely whether by means of an ice bath or by heavy bloodletting is almost always disastrous in such a case. Only in the most life-threatening of situations should the body’s intelligent preferences be overridden.

Those interested in further details on bloodletting can check out acupuncturist Henry McCann’s excellent manual, Pricking the Vessels: Bloodletting Therapy in Chinese Medicine. There’s even a free digital version available here.