Aphorisms on
Bloodletting

Aphorisms were useful tools used in the training of medicine, being popularised originally by Hippocrates (c. 400 BCE). They are effectively rules or guidelines to be used in treatment. Below are Aphorisms on Bloodletting derived from some of the most famous authors and physicians.

Some Aphorisms give warnings and cautions, some tell of the diseases most benefitted by Bleeding, some talk of the best times of the year or month to bleed different constitutions or ages, some discuss the meaning of the quality of blood removed, while others give guidelines as to what to do before or after Bloodletting, and what to abstain from.

Some of the most important points have been highlighted.

This has been taken from “Two Treaties, the First of Bloodletting … the Second of Cupping and Scarifying, by Culpeper, Ruland and Cole, 1663. You can purchase a copy of this text here).

Hippocrates his Aphorisms
concerning Phlebotomy

1. If the Vessels be emptied as they should be, it does good; and the patient likes it well, if otherwise not. Therefore consider the Climate, Time and Age, and Diseases, whether you ought to bleed or no.

2. All diseases by Repletion, are cured by Evacuation or Blood-letting, if large and violent, or much at the nose.

3. If any be dumb on the sudden, open the vein in the right arm.

4. A woman with child will miscarry upon bleeding, and the sooner as her child is older. (NOTE: see what Celsus says regarding bleeding during Pregnancy, below)

5. In acute diseases open a vein, when the disease is vehement, and the patient in his youth and strong.

6. The veins behind the Ears being opened, cause Barrenness.

7. If you will let blood, by reason there is blood gathered together, to turn it from the place, do it at a great distance from the part afflicted.

8. The opening of the veins beneath in the Groins, Thighs, Legs and Ankles, makes men unfruitful.

9. It is good for a man to bleed sometimes: the time of bleeding begins at February, and again at September.

The Aphorisms of Galen
concerning Bleeding

1. There are three considerations in Blood-letting; the vehemency of the Disease; the youth of the Patient; and the strength of the Faculty.

2. Nor too young, nor too old are to be let Blood.

3. They need no Blood-letting that have natural evacuation.

4. Many need bleeding after long Diseases by the three considerations mentioned

5. We Bleed when there is no fullness, when there is great pain, or in a Fracture or dislocation; or any contraction in a Joint.

6. Bleeding requires strength agreeable to the Evacuation.

7. It is not good to Bleed often in a year.

8. When you let blood, keep off far from the Artery.

9. Bleeding and Water-drinking are chief remedies of continuing Fevers.

10. When you will cure obstructions first open a Vein though there be no fullness.

11. Necessity allows and commands Blood-letting at any time or hour.

12. It is a good Remedy in continual Fevers to let Blood till they faint, if the Patient be strong.

13. Two hours after Bleeding the Patient may eat.

14. In Bleeding in continual Fevers consider not the number of Days, but only the strength.

15. If at the time of bleeding the Terms chance to flow, or the Hemorrhoids, observe it, and if the quantity voided be sufficient, leave the whole business to Nature and that flux, but otherwise bleed a little.

16. These are inconveniences that follow: loss of blood, Faintness, worse habit of body, a colder temper, discolouring of the whole body, and falling into long deadly diseases.

17. In all Fevers bleed at the first if the patient be strong.

18. It is lawful by bleeding to evacuate superfluities in a Fever.

19. In a Phlegmon of the Liver, the blood that flows thicker must be let out by opening the internal Vein in the right arm.

20. In a Frenzy and Lethargy, bleed at first coming of it.

21. In a Carbuncle bleed till they faint.

22. In great diseases, always bleed, but with respect to the age and the strength.

23. You must bleed plentifully in a Lassitude with a Phlegmon, sometimes till they faint.

24. After bleeding you must not presently refresh the Patient.

25. Abstain from bleeding when the blood is good and little, and other humours are abundant; but when it is contrary let blood.

26. If you forbear bleeding by reason of the age or for fear, let the Patient purge the more.

27. To open the Hemorrhoids, or provoke Terms, open the Ankle vein, and then purge is good with bleeding in the Arm.

28. When blood abounds, it must not presently be let out: for fasting, slender diet, looseness of belly, or purging, or bathing often, or exercise alone, or much rubbing will abate it.

29. After the opportunity of bleeding is passed, other evacuations are dangerous when there are excrements either in the Brain or the Instruments of the Spirits.

30. Bleeding must be at the beginning of Diseases, and sometimes purging.

31. Bleeding is a common way to cure diseases by Repletion.

32. Bleeding whatsoever, or wheresoever, or howsoever done, equally evacuates the whole body.

The Aphorisms of Cornelius Celsus 
out of his Book 2. Chap. 9.

1. There is scarce a Disease in which bleeding is not allowed.

2. It is an old custom to let blood in young men and women not with child.

3. But not Children and old folks, and Women with Child; for the Ancients thought the first and last age could not endure this kind of help, and were persuaded that if Women with Child should be let blood, she would abort; but after this, Custom has showed that it is otherwise; for it is not material what age the party is of, or what is in the body, but what strength the Patient is of.

4. Therefore, if a Youth be weak, or if the Women be not with Child, and be also weak; it is not good to let blood, for so the strength that remains will be taken away: but a strong Boy or old Man, and a hearty strong Woman with Child may be cured by bleeding according to Celsus.

5. But the Physician may be deceived if unskilful, because in those ages there is less strength.

6. A Woman with Child has need of strength after her cure, not only for herself, but to sustain the Child.

7. The chief art is to consider the strength of a Child, old Man, or Woman with Child.

8. There is difference to be observed between a fat and a lean body, a strong and a weak.

9. The thin bodies have more blood, the full bodies have more flesh.

10. They endure the loss of blood better, and a fat man is sooner disturbed with it if it be too much.

11. Therefore the strength of the body is better to be found by the Veins than the form.

12. Nor are these only to be considered; but the Disease; what kind it is, whether abundance or want of matter hurts; whether the body be corrupt or sound.

13. For if the matter be wanting, or be sound, that is another thing: but if it offend in plenty or be corrupt, it can no way be better helped than by bleeding.

14. Therefore in a vehement Fever when the body is red, and the Veins are swollen, bleeding is required.

15. But if the Fever be vehement, and you let blood in the height of it, you kill the patient.

16. Therefore, expect a remission: if it decreases not, but has ceased to decrease and you hope for no remission, then though it be worse bleeding then before, avoid not the opportunity.

17. Sometimes make two days work of it, if there be necessity, for it is better first to refresh the Patient, and then do it thoroughly, then to spend all the strength at once.

18. If you bleed for the whole body, open the Arm; if for a part, bleed in that part, or near it. But this cannot be done everywhere, but in the Temples, Arms, or about the Ankles.

19. Some say that blood must be drawn far off from the part affected. For that will divert the course of the matter, and take away that which offends. But that is false; for it empties the nearest part first, and blood flows thither from the remote while it bleeds: when it is stopped it will not be drawn. And experience shows, that if the head be broken, that it is best to bleed in the Arm.

20. If there be fault in the shoulder, the contrary Arm is to be bled, because if there be any evil, the part that is affected will sooner receive it. Sometimes blood is diverted when it breaks out in one part, and you let blood in another. And it ceases to flow by applying things that stop to the part, first bleeding, and giving it another vent.

21. Though bleeding be easy to an Artist, yet it is hard to an ignorant person. For the vein is joined to the arteries and the Nerves to them.
Therefore, if the Lancet touch the Nerve, there is stretching of the Nerve, which is grievous.

22. But an Artery cut, neither grows together, nor will be healed, but sometimes causes a violent flux; but if a Vein be cut, the heads or orifices being pressed down the blood stops.

23. If the Lancet be fearfully applied, it only cuts the Skin, not the Vein.

24. The Vein must be cut in the middle out of which when blood flows you must observe the colour and habit of body; for if blood be thick and black, it is bad and fit to be lost. If it be red and shining, it is sound, and the loss of it (instead of profit) hurts; therefore it must be stopped.

25. But these things cannot happen to a Physician that knows what Body ought to loose Blood.

26. If it be all black, let it often out, and bleed not again, if you have enough before fainting.

27. Tie up the arm with a Pledget dipped in cold water, and open the vein with your nail the next day, for the new Escar will easily come off, and it will bleed again.

28. But whether it be in the first or second day, that blood which first was thick and black, begins to wax red and clear, there is enough taken; therefore let the Vein be presently bound up, and kept so till there be a strong Escar which will quickly be in a Vein.

The APHORISMS OF
Arnoldus de Villa nova
out of his Book of the Regiment of Health.

1. After Bathing, or Venery, or great Exercise, bleed not by any means.

2. And also after long sickness.

3. They which serve in hot houses, and take great pains in their calling to resolve the Body, must not be let blood.

4. Bleed not in very hot nor very cold Weather.

5. The Spring and Autumn are best times to let blood in.

6. Bleed not in Pestilent Air, cloudy, or stormy Weather, or when the South-wind blows.

7. In Summer bleed at eight in the morning; in Winter at noon.

8. Let young men bleed in the first Quarter of the Moon, and old in the last.

9. Sanguine men must bleed in the first Quarter; Choleric in the second; Phlegmatic in the third; and Melancholic in the fourth.

10. If the Moon be in a sign with Evil aspect, or to any member, bleed not in that member.

11. In Aries, bleed the Head; in Gemini, the Arms; in Cancer, the Median; in Sagittarius, the Thigh; in Aquarius, the Legs and Thighs; and in Pisces, the Feet. The other parts are safe at any time.

12. If the Moon be in Taurus, Virgo, Capricorn, it is bad to let blood; if in Cancer, Scorpio, Pisces, indifferent; if in Aries, Libra, Sagittarius or
Aquarius it is good.

13. Let Drunkards and Gluttons, and those that are filled to loathing, abstain from Bleeding.

14. If any want Blood-letting, and neglect it there will be Impostumes, inward and outward, the great and small Scab, the Ringworm, Synochus, Measles, Apoplexy and Palsy, Small Pox and Spitting of Blood, Quinsey, Plague, sudden Death and Leprosy, and generally all sickness of much blood or corruption of Blood; and they that are inclinable to such Diseases, let them not neglect Phlebotomy.

15. There are many Evils by bleeding unreasonably. From often bleeding come Obstructions, Dropsies, Age hastens on, the Appetite decays, and Stomach, weakness of Heart and Liver, Trembling and Palsy, and weakness of all virtues both Natural and Animal.

16. He that is very musculous and fleshy, by accident, and he that is extenuated, and they which use to diet that breeds much blood, and live in idleness and pleasure, and dwell in Countries where there is little resolution, and that eat much flesh roasted, and drink sweet Wines, and use Baths, and no copulation, and exercise little, are more to bleed than others, and they who fast and eat Melancholic meats are to bleed less.

17. When Phlebotomy is used to evacuate and in a place near the Diseases of the part where it is, then the first blood ought to be worse than the second, and the second then the third; and if the contrary happen, there is still need of bleeding and Physic. But in some bodies that need little bleeding, it often happens that the first is better than the second, and then you may bleed again presently.

18. Before bleeding it is good to exercise, move and watch to make it move better. The Member to bleed is to be rubbed and heated, and washed with warm Water, to make the Vein plainer and the blood freer.

19. The Surgeon must be young, expert, and of quick sight, not trembling or drunk.

20. If a weak hearted patient, or one very faint is to bleed, let him first eat Bread and drink astringent Wine.

21. They whose blood is thick, immovable, and the Veins hidden, must be bathed for some days before, except the body be very plethoric.

22. Before bleeding let the Belly and Bladder be free.

23. In those that have an Impostume bleed while the colour of it changes: but when there is a simple plenitude without an Impostume, except not the change of blood, for the blood may be all alike, or good.

24. If the Blood be whitish and thin, lose but little.

25. In Summer and Spring bleed in the right side; in Autumn and Winter in the left.

26. In a venomous matter, bleed on the same side.

27. When there is great necessity open the same Vein twice in a day, or when you have not taken enough.

28. If after the Vein is opened the Blood will not flow, then it is good to cough and hawk, and clap the patient upon the Shoulders.

29. Touch the Blood as it comes forth, if it be cold, stop it presently, and also if it be very hot and thin, for in both cases, you may fear Swooning.

30. Take a drop of blood upon the Nail, if it flow off, and stand not firm, it is waterish, and must be presently stopped.

31. Or drop it into water; if it sink, it is too thick, and if it disperse and swim, it is too watery; if it be in a mean, it is good.

32. After bleeding, Exercise not that day but rejoice at home, nor Bath that day, and use no Venery till the fourth day, not sleep in the day.

33. Consider also the substance of the Blood; it is either Melancholic, Phlegmatic, Sanguine, Pure, Choleric, or Watery.

34. Melancholy is the dregs of blood, it is black, and in the bottom of the Poringer; and when there is too much of this, it is no good sign, then we may judge that the Patient is sad, envious, and curious, fearful and poor-spirited; such must use things to cleanse and increase Blood.

35. Phlegm is white, slimy, unsavoury, like whites of Eggs, and it is in the blood next above the Melancholy; this must not be too much, and if there be much of it, we judge him to be Phlegmatic naturally, sleepy, rude, and dull to action, and to spit much; but there ought to be more of this than of Melancholy.

36. Then follows pure blood; it ought to be of a purple colour, reddish or ruddy, of this there ought to be more; if there be much of it the Patient is Sanguine, and free, amiable and cheerful, laughing and of a red colour, bold and bountiful.

37. Then follows Choler which is the froth of Blood; of a Saffron colour, with glittering red; there ought to be less of this than of Blood or Phlegm, and more than of Melancholy. If there there be great quantity of this, we may judge the party Choleric, and by consequence crafty, deceitful, wrathful, bold and prodigal, apt for action, watchful and subtle.

38. Moreover you must consider the watery substance that swims at top when the blood is congealed, as whey when milk is curdled, and it is like Urine, if it be put into a Glass; and when this water is like the urine of a sound man whose blood it is, it is good; otherwise not.

39. And when this water is separated more perfectly from the blood, the better it is, and the better is the digestion and decoction in the Liver. And the contrary.

40. This water must be in the blood to make it thin, that it may pass more free through the great Veins and small, and to come to the members. Therefore it is not good that blood should be without this water.

41. For it wanted show, dryness and thickness of blood, this is in such as fast much, and watch, and eat dry and hot meats, and that study and exercise much, and in some that are well.

42. Moreover it is not good that too much water be in the blood, for it would show defect of digestion, either in respect of meat or drink, or in respect of the parts that cannot convert the meat into blood, and it shows also too much coldness and moistness of blood, and weakness of body.

43. Hence it is that they who have cold Stomachs, and Livers, and Veins, and eat cold and moist Meats, and much, and especially drink much, and exercise little, and fast not, nor watch, have such blood.

44. Also in blood there is a fleshy substance declining to white, for the Blood beginning to whiten in the Veins, because the farther digestion to convert it into Members proceeds in whitening. This digestion begins in the great veins, and end in the small with the Members of the third Digestion, namely at the outward solid members of the whole body.

45. This substance is flesh-like, and appears manifestly in Blood after it is washed, and the fatter, moister, or more watery the Blood is, the less there is in it of this substance, and the thicker (except it exceed the temper) and less fat, and without water, the more of this fleshy substance is to be seen.

46. Therefore from a great quantity of this white substance, is signified the good digestion in the Veins, and the pliableness of the Blood to turn into Members, especially when you feel it with your hands. And when there are no great things contained in it, that are not hard, but will crumble with the fingers. For by such there is signified an inclination to a Leprosy.

47. Moreover if thou would know the substance of the whole blood, cut it when it is congealed with a knife or thin stick, and if it resist not but cut easily, it signifies the subtlety of the Blood; but if it divide with difficulty, then it signifies sliminess and grossness of Blood.

48. And if Blood will not cut, though it be easily divided as it is in Oil, and water and other moist things which are easily divided, though not cut, that blood is too thin, and that thinness argues want of digestion.

49. And when blood is easily pricked but not cut then it is slimy, and that Blood is commonly Phlegmatic.

50. And when it is cut but with resistance, then the blood is gross, but not viscous or clammy.

51. You must consider also of the colour of blood; for if in one part of the Poringer it appears one colour, and in another of another colour, as in a Pigeons neck, it signifies diversities of Evil humours.

52. Therefore we must consider the true fixed colour of the blood; it is red and purple, not dark red, and that argues good Blood.

53. If it be a glittering red, it argues predominant Choler, and also if it be like Saffron. If it be frothy, it shows wind. If it be white or livid, or blue, it signifies cold predominant Phlegm, and especially if the blood be slimy, and there are other signs of Phlegm.

54. These colours may come from burning, as appears in Consumptive and Leprous persons. Green signifies burning, and especially Choler; Black and Blue signifies natural Melancholy, or that which is burnt.

55. You may also consider the taste, for it ought to be sweet; if it be unsavoury, it signifies Phlegm predominant; if bitter, Choler; if sour or
brackish, Melancholy and sour Phlegm; if it be salt, it signifies salt Phlegm and adustion of Humours.

56. The scent is also to be considered; if it be sweet and pleasant, it is good; if it stink, it shows great putrefaction in the humours.

57. Moreover if blood be drawn do quickly coagulate or congeal, it is too gross; if it be long and slow to congeal, it is too thin and undigested.

58. If it be in a mean, the blood is indifferent.

APHORISMS of Avicen,
Rhasis, Aetius, Montagnanus,
Savanarola and Damascen,
and others.

1. They that use much Blood-letting in Youth, are cured after sixty sooner than others, and their natural heat is choked, especially if they are of a cold complexion.

2. They who dwell in the Fourth or Sixth climate, may lose more blood than they that live in the Seventh, First, Second or Third.

3. They who have weak Stomachs, and cold weak Hearts and Livers, and Cold, and have cold Diseases, must not let blood; nor Melancholic persons, except their Veins be swollen. Nor pale, lean, starved, or such as eat Melancholic food, nor such as use too much Venery, nor such as have a Dysentery or Iliac, or are much bound in Belly, nor such as have not bodies prepared, nor such as are seventy, except they be strong, and have broad full veins, and used it, and when there is necessity.

4. At sixty open not the Cephalic.

5. At fifty open not the Median.

6. At seventy take heed of opening the black Vein.

7. It is good for Phlegmatic persons to open a Vein when the Moon is in Aries or Sagittarius.

8. For Melancholic, when she is in Libra or Aquarius.

9. For Choleric, when she is in Cancer or Pisces.

10. In the New and Full, abstain from Phlebotomy.

11. Let youths from fourteen to twenty-five bleed in the first Quarter (of the Moon)

12. From twenty-five to thirty-five, in the second.

13. Bleed in the morning when the Sun is risen after an hour, two, or more of sleep.

14. After noon, open the Head, Hand, and Feet veins, and the Arms in the morning.

15. Let old and sick people eat Broth and drink wine an hour or two before.

16. They who sweat easily and often want Blood-letting.

17. Usual accustomed Bleeding is not to be omitted without danger.

18. After Bleeding, drink thin and good Wine: avoid Mead, Ale, Fish, and what breeds bad blood.

19. Bleeding when there is no necessity does more harm than good.

20. After Bleeding, avoid bad Air, eat white Bread, well baked Veal, Hens, Chickens, lamb, roar Eggs, and that which breeds good humours and blood, drink pure Wine clear and thin; abstain from Cheese, Milk, Herbs, Fish, Ale, and Mirth, Anger, Sadness and Copulation

See also:

Bloodletting Article – Part 1
Bloodletting Article – Part 2
Regimen Sanitation – Bloodletting