Bloodletting

Bloodletting is a complete emptying, producing an eruption of “abundance,” and abundance is the excess of the amount of juices beyond their uniform presence in the vessels. There are two types of people who should be bled: some are those who are predisposed to diseases and are exposed to them if they bleed a lot, and others are those who have already been exposed to the disease. People of each of these types should be bled either because of the abundance of blood, or because of the poor quality of the blood, or for both reasons. Those predisposed to diseases are, for example, people prone to inflammation of the sciatic nerve, to blood gout, to pain in the joints depending on the blood, as well as those who have hemoptysis due to a rupture in the lungs of a vessel with thin tissue that bursts every times when the blood becomes profuse. Such are also people predisposed to epilepsy, to sakta and to melancholy, and the blood rushes to the “places of suffocation”,

predisposed to tumors of the viscera and hot inflammation of the eyes, as well as people whose kidney bleeding has stopped, which usually occurred, and women whose cleansing has suddenly stopped. In the last two cases, the complexion of these people does not indicate the need for bloodletting, since it is grey, white or green. Those people who have weakness in the internal organs with a hot nature are best bled in the spring, even if they are not sick with such diseases, and those who have received a blow or fallen are bled as a precaution so that they do not develop a tumor. When a person has a tumor and there is a fear that it will open before it matures, he is bled, even if there is no need for this and there is no plethora.

You should know that while these diseases are only feared, but the person is not yet sick, then bleeding is more permissible, but if the person is already sick, then bloodletting should first be completely abandoned: it softens the excess and causes it to flow throughout the body, mixing with healthy blood . Sometimes during bloodletting the substances that need to be expelled are not ejected at all, and this makes it necessary to re-use blood extractors.

When it turns out that the disease has matured and has passed the initial and final stages, then at that moment, if bloodletting is necessary and nothing prevents this, blood should be let out. Under no circumstances should they bleed or perform a bowel movement on a day when the disease is moving, for this is a day of rest, and for the patient, a day when they seek sleep and the disease progresses rapidly.

If with a given disease there are several crises during a certain period, then it is completely unacceptable to release a lot of blood. On the contrary, if the doctor can calm the patient, he does so, and if he can no longer do so, then let him open the blood slightly and leave a supply of blood in the body for further bloodletting, if the need arises, and also in order to preserve strength for the fight. with crises.

If a person who has not been bled for a long time complains in winter about the abundance of blood, then he should bleed, leaving a certain amount of blood in reserve. Bloodletting diverts the blood in the opposite direction and often blocks the nature.

If strength weakens from frequent bloodletting, then many bad juices are born; fainting occurs at the beginning of bloodletting due to the suddenness of the unusual intervention; Vomiting preceding bloodletting is one of the contraindications prohibiting bloodletting, as is vomiting that occurs at the very time of bloodletting.

Know that bloodletting stimulates the movement of juices until they calm down after it stops. Bloodletting and kulanj rarely occur at the same time.

Pregnant women and those undergoing purification are allowed to bleed only when absolutely necessary, for example, when it is necessary to stop heavy bleeding and the patient’s strength allows her to bleed. It is best and most imperative that pregnant women not be bled at all, since this will kill the fetus.

You should know that not every time the mentioned signs of overflow appear, it is necessary to bleed; overflow sometimes even occurs from immature juices, and in such cases bloodletting is very harmful. If you bleed, the juices do not ripen and you can fear the death of the patient.

When a person has a predominance of black bile, it does not matter if he is bled and then the stomach is emptied through relaxation. But you must observe the patient’s complexion under conditions that we will talk about later, and take into account the degree of tension in the blood vessels: the spread of tension throughout the body in itself firmly suggests the idea of ​​​​the need to bleed.

If a person has little praiseworthy blood and there is a lot of bad juices in his body, then bloodletting takes away his good blood and replaces it with bad.

If a person’s blood is bad and scanty, or if it strives for an organ, the desire for which bad blood brings great harm, so that bloodletting is necessary, then you should take a little blood from him, then feed him with praiseworthy food, then let him bleed a second time and do bloodletting for several days so that the bad blood comes out and leaves the good blood in its place. If the bad juices of such a patient are of a bilious nature, then you should first manage to remove them by slightly relaxing the stomach or vomiting, or calm them down and try to better calm the patient. If the juices are thick, then the ancient doctors forced such patients to take a bath in the bathhouse and vigorously walk about their business. Sometimes they were given softening sikanjubin, boiled with hyssop and thyme, before bloodletting and after it, before repeating the bloodletting.

When a doctor is forced to bleed due to weakness of strength due to fever or other bad juices, then let him divide the bloodletting as we have said. “Narrow” bloodletting better preserves the patient’s strength, but it sometimes causes thin, clear blood to flow and retains thick and cloudy blood.

As for the “wide” bloodletting J, it leads to fainting faster, is more effective in the sense of purifying the blood, and the wound heals more slowly. “Wide” bleeding is better for those who are bleeding as a precaution and for obese people. It is better to widen the incision in winter so that the blood does not freeze, and it is better to narrow it in summer, if necessary.

When bleeding, the person being operated on should lie on his back, which will best save strength and not cause him to faint.

As for fevers, bloodletting should be avoided in case of severe fevers due to intense heat and in all fevers in general, except acute ones, at the beginning and during the days of the attack. Bloodletting is rarely used for fevers accompanied by spasms; if there is a need for bloodletting, since spasms, when they occur, cause insomnia, severe sweating and loss of strength, then a supply of blood should be left for this. The same is true when they bleed a patient with fever, if his fever is not from putrefaction: he should bleed a little blood, leaving it in reserve to resolve the fever. If the fever is without strong heat and, moreover, rotten, then take into account the above-mentioned ten rules, then look into the bottle with urine: if the water of the urine is thick, reddish, and besides, the pulse is high, and the face is swollen and the fever is in no hurry to tire him, then let the patient bleed at a time when the stomach is empty and there is no food there.

If the urine water is liquid or fiery in color and your face has become haggard since the onset of the illness, then beware of bleeding. If there are breaks and pauses during fever, then open the blood during the pauses. Also consider the nature of the chill: if the chill is strong, then beware of bleeding.

Observe the color of the blood that comes out; if it is liquid and whitish, then immediately hold it and generally be on guard so that bloodletting does not bring on the patient one of two complications: stimulation of bile juices or stimulation of cold juices.

When it is necessary to bleed during a fever, do not pay attention to the talk that this cannot be done after the fourth day of illness: it can be done, if necessary, at least after the fortieth day. This is the opinion of Galen, although if the signs of fever are reliable, then it would be better to hurry with bloodletting and do it earlier. If there is an omission here, then open the blood at the time when you understand it, as long as it is necessary, having first taken into account the ten rules mentioned.

Often, bloodletting during fevers, even if there is no direct need for it, strengthens the nature of harmful matter, reducing its quantity; such bloodletting is possible if the appearance, age, strength of the patient and other data allow it.

As for blood fever, it inevitably involves emptying by bloodletting - not strong at first, but when the disease has matured - strong; Often such a fever breaks off during bloodletting.

One should beware of letting blood in a very cold nature, in very cold countries, in severe pain, after a juice-dissolving bath and after copulation, as well as at the age of less than fourteen years - if possible, and in old age - if possible, unless possible rely on appearance, on muscle density, on the width and filling of blood vessels and on the complexion of the face. Old men and young men with such data can dare to bleed. Young men are bled gradually, little by little and little by little.

Bloodletting should be avoided if possible if the body is very thin or very fat, loose, white and flabby, or yellow and bloodless. Beware of releasing blood from a body exhausted by long-term illnesses, unless the poor state of the blood requires it. Then let the blood flow and look: if it is black and thick, then remove it, but if you see that it is colorless and liquid, then close the incision immediately, as this is a very dangerous sign.

Avoid bleeding if the stomach is full of food, so that instead of being expelled, immature matter does not rush into the vessels. This should also be avoided when the stomach and intestines are filled with mature or close to maturity excesses, trying to remove them better from the stomach and adjacent areas by vomiting, and from the lower intestines - by any means possible, at least by an enema. Beware of bleeding in those suffering from indigestion - it is better to postpone bloodletting until the indigestion has passed, as well as in those whose mouth of the stomach is acutely sensitive or weak, or who suffers from the formation of bile in the stomach. One should beware of rushing to bloodletting in such people, especially on an empty stomach.

A person suffering from an exacerbation of sensitivity of the mouth of the stomach is recognized by the fact that it is unpleasant for him to swallow anything spicy, and weakness of the mouth of the stomach is recognized by a small appetite and pain in the mouth of the stomach.

When the mouth of the stomach tends to accumulate bile, and bile is formed there in large quantities, this is recognized by a constant feeling of nausea, and the patient vomits bile every now and then, and by a feeling of bitterness in the mouth. If such people are bled without first examining the mouth of the stomach, then this poses a great danger; sometimes some of them even die.

A person suffering from an exacerbation of sensitivity or weakness of the mouth of the stomach should eat a piece of clean bread dipped in some sour condensed juice with a pleasant smell, and if the weakness comes from a cold nature, then dipped, for example, in sugar water with spices, in a mint drink with musk or in maybih with musk, and then bleed.

As for people who have bile in their stomach, they should be induced to vomit by giving them a lot of hot water with shikanjubin to drink, then make them eat a piece of bread and let them rest for a while, then bleed.

If the patient is strong, the lost good blood should be replaced with fried meat, although it is a heavy meal, because if fried meat is digested, it nourishes very well. However, it should be given as little as possible, since the patient's stomach is weak due to bloodletting.

Sometimes they bleed from the vessels to stop bleeding from the nose, from the uterus, from the anus, from the chest or from some abscesses, diverting the blood in the opposite direction; it is a powerful and beneficial treatment. The incision should be very narrow, and the blood should be opened many times, not in one day, unless necessary, but day after day, releasing as little blood as possible each day. Generally speaking, multiplying the frequency of bloodletting is better than multiplying the amount of blood released.

Bloodletting, which is not necessary, stimulates the flow of bile and causes dryness of the tongue and similar phenomena; it should be replaced with barley water and sugar.

When someone wants to release blood again, the blood should be released from the vessel, cutting it lengthwise, so that the movement of the muscles does not prevent the wound from healing, and widening the incision. If there is a fear that the wound will heal quickly, then place a rag soaked in olive oil with a little salt on it and tie a bandage on top. If you lubricate the incision site with oil when bleeding, this prevents rapid healing and reduces pain. Namely, you need to lightly rub the cut area with olive oil or something like that, or immerse your hand in the oil and then rub it with a rag. Sleeping between the first and repeated bloodletting speeds up the healing of the incision.

Remember our words that in order to have a bowel movement in winter with the help of medicine, you should wait for a “southern” day. The same applies to bloodletting.

Know that when they bleed the possessed, the insane, and those who need to bleed at night, while sleeping, the incision must be narrow so that continuous bleeding does not occur. This also applies to anyone who does not need secondary bloodletting.

Know that secondary bloodletting is postponed according to the degree of weakness, and if there is no weakness, then the delay limit for secondary bloodletting is one hour. When performing secondary bloodletting, after a short period of time, they want to extract blood from the patient in one day. Bloodletting with an oblique incision is more suitable for those who want to bleed a second time on the same day, a transverse incision is for those who want to do a secondary bloodletting after a while, and a longitudinal incision is for those who do not want to limit themselves to one secondary bloodletting, as well as for those who want to sharpen the blood a little every day, for several days.

The more painful the bloodletting, the slower the incision heals. Excessive evacuation during secondary bleeding causes fainting, unless the person receiving secondary bleeding has first eaten something. Sleep between the first and second bloodletting does not allow those excesses that are carried into the depths of the body in sleep due to the entrainment of juices to rush out along with the blood.

Among the beneficial properties of secondary bloodletting is that it preserves the patient’s strength and at the same time provides the complete emptying that he needs. Secondary bloodletting works best when delayed for two or three days.

Sleeping soon after bloodletting sometimes causes weakness in the limbs, and bathing before bloodletting often makes it difficult for the blood to escape, making the skin thick and predisposing it to slippery, unless the patient has very thick blood.

The patient should not fill himself with food immediately after bloodletting: on the contrary, he should take food gradually and carefully at first. You should also not engage in physical work after bloodletting; on the contrary, it is better to try to lie on your back; and you should not take a softening bath.

If someone bleeds himself and his hand swells after this, let him bleed on his other hand for as long as he can stand it, and then he must apply a white lead plaster to the incision, and apply strong cooling medicines to the hand around the incision.

When a person bleeds himself, whose body is overcome by spilled juices, then the bloodletting turns out to be the cause of the stimulation of these juices, which spread throughout the body and mix; this forces multiple consecutive bloodlettings.

Blood with black bile also forces you to bleed several times in a row, and the condition immediately becomes easier. In old age, however, this gives rise to diseases and, in particular, sakta. Bloodletting often excites fevers, and these fevers disperse putrefaction throughout the body. Every healthy person, when he bleeds himself, should take the drinks that we talked about in the section on drinking.

Know that some of the vessels that let blood flow are veins, and some are arteries. Bleeding is only allowed from the arteries in very rare cases, and one should beware of the danger of bleeding that arises from this; This is least likely to cause an aneurysm, namely when the incision is very narrow. However, if there is no danger of bleeding, the benefits of bleeding from an artery are very great for special diseases in which blood is released from an artery. It is most useful to bleed from an artery when there are bad diseases in the organ adjacent to it caused by liquid, acute blood. If blood is drawn from a nearby artery and it is not dangerous, then this is very useful.

The vessels on the arm from which blood bleeds are as follows: as for the veins, there are six of them, the mullet, the “black” vein, the basil, the vein of the forearm, the “saving” vein and the vein, which is given the special name “axillary”, that is, one of branches of basil. The safest of them is the vein kifal. All three first veins should be opened above the hand, not below it or near it, so that the blood comes out well, just as it naturally flows, and to avoid the danger of affecting a nerve or artery. The same applies to mullet. The longitudinal incision of the mullet during bloodletting heals very slowly, since it is a vein passing through the joint, and with veins that do not pass through the joint, the situation is the other way around; The sciatic vein, the “saving” vein and some other vessels are best opened during bloodletting with a longitudinal incision. In this case, you should move away from the beginning of the muscle to the soft spot and widen the incision, without making one incision after another, otherwise the vein will swell.

Most of those who make a mistake about the place of bloodletting on the cyphale do not hit the right place with the first blow, even if it is strong. On the contrary, harm arises precisely from the repetition of blows.

The slowest healing on a mullet is an incision made during bloodletting, drawn lengthwise; the incision is widened when they want to perform secondary bloodletting.

If the mullet cannot be found, then they look for some of its branches passing from the outside of the forearm. During bloodletting, the “black” vein poses a danger to the nerve passing under it; in some places this vein passes between two nerves; should try to open with a longitudinal incision and open the blood with a sharp blow.

Sometimes there is a nerve above the “black” vein, thin and elongated, like a tendon; this must be recognized and be careful not to hit it with a lancet, so that chronic numbness of the hand does not occur. If someone has thicker vessels, then this branch is more visible, and a mistake here is more harmful. And if a mistake does occur and this nerve turns out to be damaged, then do not heal the incision, apply medications to it that prevent healing, and treat it in the same way as nerve injuries are treated. We talk about this in Book Four.

Be careful not to bring cooling agents near such an incision, such as, for example, squeezed juice of black nightshade and sandalwood, but on the contrary, lubricate the adjacent area and the entire body with heated oil.

The vein of the forearm is also best opened obliquely, unless it deviates to the side at both ends, then it is opened longitudinally. Bisilik poses a great danger, since there is an artery, nerves and muscles underneath it; when opening it, be careful, because if the artery opens, the blood does not stop or stops with difficulty.

In some people, the basil is surrounded by two arteries. When the doctor finds one of them, he thinks that everything is fine, whereas he ended up with the second one; it behooves you to investigate this.

If you bandage the basil, then in most cases there will be swelling there - sometimes from the artery, and sometimes from the basil. Be that as it may, you should untie the tourniquet and carefully rub the swelling, then apply the tourniquet again. If the swelling returns, this is repeated, but there is no benefit, then it doesn’t matter if you leave the basil and open its branch, called the axillary vein, that is, the one that runs down the inside of the forearm. The swelling often becomes dense. The tourniquet and swelling often slow down the beating of the artery and make it bulge and rise, so that the artery is mistaken for a vein and opened.

If you have overtightened any vessel and a swelling like a lentil or bean has formed on it as a result of the overtightening, then treat it as we said about the basil. When opening the basil, the further you go down to the elbow, the safer it is, and let the direction of the incision go along the vessel in the direction opposite to the artery. The error when opening the basil is not only related to the artery. There is a muscle and a nerve underneath it, and the error can also occur because of them. We already told you about this in the anatomy section.

A sign that an error has occurred with basil and the lancet has entered the artery is the release of liquid, light red blood, which flows out as if in spurts, and the artery becomes soft to the touch and subsides. In this case, hasten to plug the hole in the incision with hare hair with incense powder, dragon's blood, aloe and myrrh, apply a little yellow or some other vitriol to this place, sprinkle it as much as possible with cold water, pull the artery above the opening site and apply a bandage that stops blood. When the bleeding stops, do not untie the bandages for three days, and after three days you should also be as careful as possible. Apply a lotion with astringents to the area surrounding the incision. Many of those who let blood cut the artery of the patient; this is done so that the vessel shrinks and the meat covers it and stops the bleeding.

Many people die as a result of uncontrollable bleeding, and some of them die due to constriction of the organ and severe pain from the tourniquet, which was tightened, wanting to hold back arterial blood, so that the organ entered the path of necrosis.

Know that bleeding sometimes also occurs from veins. Know that mullet bloodletting removes most of the blood from the neck and overlying areas, as well as some blood from the areas below the neck, but does not go beyond the liver and false ribs. It does not cleanse the underlying areas in any significant way.

Regarding the “black” vein, the judgment should be average between kifal and basil, while basil removes blood from the area of ​​the “furnace of the body” to the lower parts of the “furnace”.

The ulnar vein is similar to the mullet and the “saving” vein; they say that bleeding from its right side is useful for pain in the liver, and from the left side - for pain in the spleen, and that the blood is released from it until it stops by itself. The hand of the one who is being bled from this vein should be placed in hot water so that the blood does not stop and comes out easily if it descends weakly, as is the case with most of those who are bled from the “saving” vein. The “saving” vein is best opened with a longitudinal incision. The “axillary” vein should be judged in the same way as the basilica.

As for the artery from which blood bleeds on the right hand, this is the artery located on the back of the hand, between the index and thumb. Draining blood from it is surprisingly useful for chronic pain in the liver and in the abdominal obstruction. Galen dreamed that someone ordered him to bleed himself from this artery because of the pain he felt in his liver. Galen did this and recovered.

Sometimes blood is also released from another artery, which deviates more into the palm. The usefulness of this is close to the usefulness of bleeding from the above-mentioned artery.

If someone wants to bleed from a vessel in his hand, but does not succeed, then let him not persist in tightening and tightly tying the vessel and cutting it again; on the contrary, it is better to leave the vessel alone for a day or two.

If necessity requires repeating the incision on the same day, then the doctor should rise above the first incision, but not go below it.

A tight bandage causes swelling; cooling a cloth applied to the cut and moistening it with rose water or cooled water is beneficial and suitable.

The tourniquet should not move the skin from its place either before or after bloodletting. On the body of a thin person, applying a tourniquet causes the vessels to become empty and blood does not pass through them, but on an overly obese body, the looseness barely allows you to see the vessel until you tighten it.

Some doctors who bleed use subtle tricks to numb the pain and numb the arm by tying the arm tightly with a tourniquet and leaving it there for an hour; others lubricate the thin "hair" of the lancet with oil, and this, as we have said, relieves the pain and slows down the healing of the incision.

When the mentioned vessels are not visible on the hand, but their branches are visible, then press on these branches with your hand and rub them.

If the blood, when you stop rubbing, quickly rushes to the branches of the vein and swells them, then the vein is opened, and if not, then it is not opened. When they want to wash the incision site, they pull the skin so that it covers the incision, wash it, and then return it to its place. After this, a rag is applied, and the best shape of the rag is considered to be round, and the incision is tied.

If fat moves into the incision site, it must be carefully removed, but it cannot be cut off. You should not attempt to perform secondary bloodletting in such people without a second incision.

Know that it takes a certain amount of time to stop the bleeding and bandage the incision, although this period may vary. Some people can withstand the withdrawal of five or six rittles of blood even during fever, while others, although healthy, cannot withstand the withdrawal of one rittle. In this case, three circumstances should be taken into account: firstly, whether the blood is retained or flows freely; secondly, the color of the blood is taken into account. Its color often becomes very thick, and the blood that comes out first comes out liquid and colorless. If there are signs of overflow, and circumstances require bloodletting, then in no case should you be deceived by this. Sometimes the color of the blood becomes thicker in a person suffering from tumors, as the tumor attracts blood to itself. Thirdly, you must take into account the pulse, from which you should not remove your hand during bloodletting,

So, if the retention of blood weakens or the color of the blood changes, or the pulse decreases, especially in the direction of weakness, then stop the bleeding, and also in the case when yawning, stretching, hiccups and nausea appear. If a change in the color of the blood or even the degree of its retention quickly occurs, then rely in this case on the pulse.

Most likely, fainting during bloodletting occurs in people of a hot nature, thin and with a loose physique, and people with a balanced physique and dense flesh are the slowest to faint.

They say: with a doctor who bleeds, I should have lancets, both with a “hair” and without a “hair”. A lancet with a “hair” is more suitable for moving vessels, such as the jugular vein. Have with him a ball of raw or dressed silk, and a stick or feather to induce vomiting. The doctor should have hare hair, a medicine of aloe and frankincense and a bag of musk, as well as medicine with musk and musk cakes in case fainting occurs; fainting is one of the dangerous phenomena during bloodletting, and the patient sometimes feels bad. In this case, the doctor should quickly apply a silk ball to the incision, induce vomiting in the patient with his instrument, let him smell the bag of musk and make him swallow a little musk medicine or a cake - then the patient’s strength will be revived.

And if the patient begins to spit blood, then let the doctor hurry and plug the incision with hare hair and medicine with incense. How rarely does fainting occur when the blood is still on its way out! On the contrary, it usually occurs only after the bleeding has stopped, unless the blood flows excessively. However, one should not pay attention to the approach of fainting with constant fevers, at the beginning of an attack of sakta, with sore throats, with thick, large destructive tumors and with severe pain; in such cases, we use the remedy only when the patient’s strength is significant.

We happened to expand after talking about the vessels of the hand about other objects, and we forgot about the vessels of the foot and other vessels. We must now connect our reasoning with these vessels and say the following.

As for the vessels of the leg, the sciatic vein belongs to them; it is torn off from the outside near the heel, either below it, or above, between the thigh and heel, and tied tightly with a rag or bandage. It is best to pre-warm the leg in water, and it is best to open the vein lengthwise. If the sciatic vein is not visible, then its branch passing between the fifth and fourth fingers is opened.

The benefits of bloodletting from the sciatic vein for pain in the sciatic nerve are very great; it is also great with gout, varicose veins and elephantiasis; secondary bloodletting from the sciatic vein is difficult.

This also includes the jugular vein, which runs along the inside of the heel area. It is more visible than the sciatic vein, and it is opened to empty the organs located below the liver of blood and to divert blood from high-lying areas to the lower ones. Bloodletting from the lymphatic vein significantly intensifies menstruation and opens the openings of the kidney cones.

Analogy requires that bloodletting from the sciatic and sciatic veins be similar in benefit, but experience gives great advantage to the action of opening the sciatic vein for pain in the sciatic nerve. This is explained by its position opposite the sciatic nerve. It is best to open the jugular vein obliquely and transversely.

This also includes the vessel on the bend of the knee. It behaves in the same way as the jugular vein, but only acts stronger than the jugular vein in relation to the intensification of menstruation, as well as for pain in the anus and with kidney pain.

This also includes the vessel located behind the tendon of the sole. It is like a branch of the jugular vein and behaves in the same way as the jugular vein.

Bleeding from the vessels of the leg is generally useful for diseases arising from matter that goes to the head, as well as diseases from black bile. It weakens the strength more than bleeding from the vessels of the hand.

As for the vessels to be opened in the head area, it is best to open them obliquely, with the exception of the jugular vein. Among these vessels there are veins, and there are also arteries. Veins are, for example, a vessel on the forehead that rises between the eyebrows; opening it helps with heaviness in the head, especially in the back, heaviness in the eyes, and constant chronic headaches.

The vessel located on the crown of the head is opened for migraines and ulcers on the head, as well as the two temporal veins that wind at the temples, and the two veins in the corners of the eyes; in most cases they are visible only if you squeeze the throat. The incision on them should not go deep, otherwise a fistula will often form.

Only a little blood flows from these veins; opening them is useful for headaches, migraines, chronic inflammation of the eyes, lacrimation, eyesores, scabs and pimples on the eyelids and night blindness.

Blood is also drawn from three small vessels located behind the area adjacent to the earlobe, where it adjoins the hair growing in the ear. One of these three veins is more visible than the others; it is opened at the onset of cataract formation and when the head receives vapors from the stomach; it also helps with ulcers in the ear, on the back of the head and in diseases of the head.

Galen denies the truth of the tales that people who have dedicated themselves to God bleed from two vessels behind their ears in order to destroy the ability to produce offspring. These veins also include the jugular veins. There are two of them, and they are opened at the onset of leprosy, with severe sore throat, with suffocation and acute shortness of breath, as well as with hoarseness from pneumonia, with lichen resulting from an abundance of hot blood, with diseases of the spleen and pain in both sides. According to what we said earlier, these veins should be opened with a lancet with a “hair”; As for the method of pulling the vessels, then after ligating the neck, the head should be tilted in the direction opposite to the side of the opening of the vessel so that the vessel is stressed; in this case, you should observe in which direction the vessel is most strongly displaced, and take blood from the opposite side. The vein needs to be pulled across, and not longitudinally, as is done with the sciatic and sciatic veins, but the vein should be opened longitudinally.

This also includes the vessel located at the tip of the nose. It is opened at the place where the tip of the nose bifurcates; if you press this place with your finger, it splits into two; This is where it is pierced. The amount of blood flowing from it is insignificant; opening it is useful for freckles, unclean complexion, kidney problems, pimples that occur in the nose, and also for itching in the nose. However, bleeding from this vessel sometimes causes chronic, scab-like redness that spreads throughout the face. In this case, the harm from bleeding from this vessel is much greater than the benefit.

Bleeding from the vessels lying under the bone behind the ear near the occipital cavity is useful for dizziness from liquid blood and for chronic pain in the head.

The veins of the head region include chahar rag, that is, four vessels; There are a pair of them on each lip. Bleeding from them is useful for ulcers in the mouth, for gums, for pain, swelling and looseness of the gums, as well as for ulcers on them, for kidney problems and for cracks in the cones.

This also includes the vessel lying under the tongue, on the inside of the chin; It is used to bleed for sore throats and tumors of the tonsils.

This also includes a vessel under the tongue itself, from which blood is released when there is heaviness in the tongue resulting from an abundance of blood. It should be opened longitudinally, since when opened transversely it is difficult to stop the bleeding.

This also includes a vessel near the hairs on the lower lip, which is opened when there is bad breath.

This also includes a vessel near the nostrils, which is opened when the mouth of the stomach is treated.

As for the arteries located in the head, one of them is the artery in the temple, which is sometimes opened, sometimes cut, sometimes pulled upward, sometimes cauterized; this is done to arrest the acute, liquid catarrhal discharges pouring into the eyes, and at the beginning of the formation of dilation of the pupil.

This also includes two arteries located behind the ears. They are opened for various types of eye inflammation, at the beginning of the formation of cataracts and cataracts, as well as for night blindness and chronic headaches. Opening this artery is not without danger, and healing after it is slow. Galen says that one man, wounded in the throat, had an artery damaged and a considerable amount of blood flowed out. Galen used a medicine against bleeding with incense, aloe, dragon's blood and myrrh and retained the blood, and the wounded man stopped having chronic pain in the hip area.

The vessels of the body from which blood bleeds include two vessels on the abdomen; one of them is located on the liver, and the other on the spleen. Blood is drawn from the right vessel for dropsy, and from the left for diseases of the spleen.

Know that there are two times for bloodletting: the time of choice and the time of necessity. The time of choice is the time at the dawn of the day, after digestion of food and bowel movements are completed; As for the time caused by necessity, this is the time when bloodletting is obligatory and it is not permissible to apply it, so that one does not have to pay attention to any interfering circumstance.

Know that a dull lancet causes great harm; it hits the vein and does not get deep into the vessel, causing swelling and causing pain. When you use the lancet, do not push it with your hand, pressing, but act carefully, unnoticeably, until the tip of the lancet reaches the inside of the vessel; if this is done roughly, then the tip of the lancet often breaks imperceptibly, and the lancet slips off and does not expose the vessel. If you persist in bleeding with such a lancet, you will only increase the harm. Therefore, before bleeding, you should try how the lancet enters the skin, and this must be done before a second blow, if you want to apply it.

Try to fill the vessel with blood so that it swells - then the lancet will slip and move less. If the vessel resists this and when pulling it is not visible that it is filled, then release it and pull it several times, rub it down and up, squeezing the vessel until you cause it to swell and make it visible. Test this by pressing two fingers on any places where you know the vessel is drawn.

Hold the blood with both fingers, then hold it with one, and lift the other, letting the blood flow; You will feel under the motionless finger the rush of blood when it is allowed to flow, and the ebb when the flow is stopped.

It is necessary that the tip of the lancet penetrates a certain distance under the skin, but not far, otherwise the lancet can penetrate deeply and enter an artery or nerve. The vessel should be filled most with blood where it is thinnest. Regarding how to hold the lancet, I will say that it should be held with the thumb and middle finger, leaving the index finger for palpation.

You should take hold of the middle of the piece of iron, without taking it higher; if you take it higher, the hand holding the lancet will tremble. If the vessel moves to one side, then counteract this by pulling and squeezing from the opposite side; if it moves equally in both directions, then avoid opening it longitudinally.

Know that you should press and press according to the degree of hardness and thickness of the skin, depending on the quantity and abundance of meat. The tourniquet should be close to the place where the vein is opened, and if the tourniquet hides the vessel, then make a mark above the vessel and be careful that the vessel does not move away from the mark when tightening. At the same time, while drawing blood, grab the vessel with a hook.

If the vessel does not obey you and it is difficult to force it to perform, then open the skin over it, especially in thin people, and use a hook. If ligation and constriction of the vessel occurs during bloodletting itself, this prevents the vessel from filling with blood.

Know that people who sweat a lot due to congestion need bloodletting. Patients suffering from fever and headaches, who are supposed to be treated by bloodletting, often have a natural relaxation of the stomach, and they completely do without bloodletting.