Effect of Bloodletting at Shaoshang and Shangyang Acupuncture Points on Outcome and Prognosis of Severe Community-Acquired Pneumonia in the Elderly.

OBJECTIVES: The aim of this study was to explore, whether treatment with bloodletting at Shaoshang and Shangyang acupuncture points would affect therapy outcome and prognosis for severe community-acquired pneumonia (SCAP) in the elderly. METHODS: A total of 62 patients, who met the diagnostic criteria for SCAP, were enrolled in the study and randomly divided into two groups, i.e., treatment group (n = 31) and control group (n = 31). All patients received a therapy according to the Chinese Clinical Practice and Expert Consensus of Emergency Severe Pneumonia from 2016. In addition to that, a bloodletting at Shaoshang (LU11) and Shangyang (LI1) acupuncture points was applied for the treatment group. This intervention was repeated for three times (ones daily), bloodletting a volume of 2-3 ml at each time point. Differences in a main index of clinical efficacy, body temperature (T), respiratory rate (RR), heart rate (Hr), white blood cell count (WBC), neutrophil percentage (N%), and C-reactive protein level (CRP) as well as different scores (CURB-65 score, SOFA score, and Apache II score) were compared between groups. Moreover, the 28-day mortality was compared between treatment and control group. The statistical methods involved in carrying out the current study include t-test, Wilcoxon test, and chi-square test. RESULTS: The clinical effective rate of the treatment group was 82.9%, which was significantly higher than the 17.1% in the control group (P < 0.05). After finishing the intervention, the treatment group showed significantly lower T (37.28 ± 0.54 vs. 37.82 ± 0.81), RR (20.06 ± 2.67 vs. 23.71 ± 6.85), Hr (81.71 ± 10.38 vs. 93.84 ± 15.39), CUBR-65 score (2.16 ± 0.74 vs. 3.03 ± 0.98), and SOFA score (5.84 ± 3.83 vs. 8.16 ± 4.2) compared to the control group (P < 0.05). The 28-day mortality rate of the treatment group was significantly lower than in the control group (12.9% vs. 45.2%, P = 0.05). CONCLUSIONS: Bloodletting at Shaoshang and Shangyang acupuncture points can support improving the clinical treatment efficacy for SCAP and reduce the 28-day mortality rate in the elderly.

Efficacy and safety of bloodletting for herpes zoster: A protocol for systematic review and meta-analysis.

BACKGROUND: The study aims to evaluate the effectiveness and safety of bloodletting therapy for herpes zoster. METHODS: The following electronic databases will be searched from PubMed (1966 to March 2020), the Cochrane Central Register of Controlled Trials (update to March 2020), EMBASE (1980 to March 2020), China National Knowledge Infrastructure (1979 to March 2020), Wan Fang Data (1980 to March 2020), Chinese Scientific Journal Database (1989 to March 2020), Chinese Biomedical Database (1978 to March 2020) and traditional Chinese medicine Literature Analysis and Retrieval Database (1949 to March 2020). All randomized controlled trials without any limitation of blinding or publication language about this topic will be included, exclude cohort studies and case reports. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis, and/or descriptive analysis will be performed based on the included data conditions. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from cure rate, converting to clinical diagnosis rate, and side effects of bloodletting. CONCLUSION: This study will provide the evidence of whether bloodletting is an effective and safe intervention for herpes zoster. PROSPERO REGISTRATION NUMBER: CRD42020171976.

The effect of auricular therapy on blood pressure: A systematic review and meta-analysis.

BACKGROUND: Although a number of clinical studies have investigated the effectiveness and safety of auricular therapy for treating hypertension, the overall evidence remains uncertain. AIMS: We aimed to evaluate the evidence for the effect of auricular therapy on blood pressure using meta-analysis methodology. METHODS: We searched PubMed, Embase, Cochrane Library databases, Clinicalkey, China National Knowledge Infrastructure, China Scientific Journal Database and Wanfang Database and Chinese Biomedicine for trials that compared the effects of auricular therapy to that of sham auricular therapy, antihypertensive drugs, or no intervention on blood pressure. Blood pressure values before and after treatment, magnitude of blood pressure change between baseline and post-intervention, and the efficacy rate, as outcomes, were synthesized by RevMan 5.3. Continuous outcomes were expressed as weighted mean differences, and dichotomous data were expressed as relative risks with 95% confidence intervals. RESULTS: We systematically reviewed 44 randomized controlled trials (involving 5022 patients through June 2018). Auricular acupressure plus antihypertensive drugs might be more effective than antihypertensive drugs alone in both reducing systolic blood pressure value after treatment (n=464 patients; mean difference, -5.06 mm Hg; 95% confidence interval, -6.76- -3.36, p<0.00001; I2=32%), decreasing diastolic blood pressure after treatment (n=464 patients; mean difference, -5.30 mm Hg; 95% confidence interval, -6.27- -4.33, p<0.00001; I2=0%) and the efficacy rate (relative risk, 1.22; 95% confidence interval, 1.17-1.26; p<0.00001; I2=0%). CONCLUSION: Auricular therapy could be provided to patients with hypertension as an adjunct to antihypertensive drugs for lowering blood pressure value and achieving blood pressure targets.

Bloodletting therapy for treating patients with chronic urticaria: A systematic review and meta-analysis protocol.

BACKGROUND: Chronic urticaria is a common disease affecting patients' quality of life, and leading to substantial burden to both patients and society. Many trials have shown that bloodletting therapy is effective in treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. This protocol aims to present the methods used to assess the effectiveness and safety of bloodletting therapy for patients with chronic urticaria. METHODS: The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomised controlled trials related to bloodletting therapy for treating chronic urticaria will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. For data synthesis, we will select either the fixed-effects or random-effects model according to heterogeneity assessment. Disease activity control will be assessed as the primary outcomes. Response rate, recurrence rate and adverse events will be evaluated as secondary outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. DISSEMINATION AND ETHICS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. TRIAL REGISTRATION NUMBER: PROSPERO CRD42018111143.

Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion.

A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.

[Treatment by bloodletting in the past and present].

INTRODUCTION: Therapeutic bloodletting has been practiced at least 3000 years as one of the most frequent methods of treatment in general, whose value was not questioned until the 19th century, when it was gradually abandoned in Western medicine, while it is still practiced in Arabic and traditional Chinese medicine. CONTENT: In modern medicine bloodletting is practiced for very few indications. Its concept was modeled on the process of menstrual bleeding, for which it was believed to"purge women of bad humours. "Thus, bloodletting was based more on the belief that it helps in the reestablishment of proper balance of body "humours" than on the opinion that it serves to remove excessive amount of blood as well as to remove toxic "pneumas" that accumulate in human body. It was indicated for almost all known diseases, even in the presence of severe anemia. Bloodletting was carried out by scarification with cupping, by phlebotomies (venesections), rarely by arteriotomies, using specific instruments called lancets, as well as leeches. In different periods of history bloodletting was practiced by priests, doctors, barbers, and even by amateurs. In most cases, between one half of liter and two liters of blood used to be removed. Bloodletting was harmful to vast majority of patients and in some of them it is believed that it was either fatal or that it strongly contributed to such outcome. In the 20th century in the "Western"medicine bloodletting was still practiced in the treatment of hypertension and in severe cardiac insufficiency and pulmonary edema, but these indications were later abandoned. CONCLUSION: Bloodletting is still indicated for a few indications such as polycythemia, haemochromatosis, and porphyria cutanea tarda, while leeches are still used in plastic surgery, replantation and other reconstructive surgery, and very rarely for other specific indications.

The effect of traditional wet cupping on shoulder pain and neck pain: A pilot study.

OBJECTIVES: Wet cupping therapy (WCT) is a traditional complementary method recommended to decrease the symptoms of a lot of diseases and used in the treatment of pain syndromes. In this pilot study, the possible effects of wet cupping therapy on nonspecific neck and upper shoulder pain were investigated. METHODS: Sixty one eligible volunteer participants with nonspecific neck and upper shoulder pain for at least 3 months were allocated. The Numeric Rating Scale (NRS) was used to assess pain scores. Pain scores were recorded before and after wet cupping therapy. RESULTS: The mean scores of neck pain in study group were 7.02 (SD = 1.8) before and 3.70 (SD = 2.2) after cupping therapy. The decrease of pain scores between pre- and post-test was statistically significant (p < 0.05). DISCUSSION: It can be stated that WCT has potential therapeutic effect in nonspecific neck and upper shoulder pain. Future full-scale randomized controlled trials will be needed to provide firm evidence of the effectiveness of this intervention.

The Use of Wet Cupping for Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial.

OBJECTIVES: To evaluate the effectiveness and safety of wet cupping therapy as a single treatment for persistent nonspecific low back pain (PNSLBP). DESIGN: Randomized controlled trial comparing wet cupping versus no treatment in PNSLBP. SETTING: Outpatient clinic in three secondary care hospitals in Saudi Arabia. PATIENTS: Eighty eligible participants with PNSLBP for at least 3 months were randomly allocated to an intervention group (n=40) or to a control group (n=40). INTERVENTIONS: Six wet cupping sessions within 2 weeks, each of which were done at two bladder meridian (BL) acupuncture points among BL23, BL24, and BL25. Only acetaminophen was allowed as a rescue treatment in both groups. OUTCOME MEASURES: The Numeric Rating Scale (NRS), McGill Present Pain Intensity (PPI), and Oswestry Disability Questionnaire (ODQ) were used as outcome measures. Numbers of acetaminophen tablets taken were compared at 4 weeks from baseline. Adverse events were recorded. RESULTS: At the end of the intervention, statistically significant differences in the three outcome measures favoring the wet cupping group compared with the control group were seen: NRS score, 29.2 (95% confidence interval [CI], 24.6-33.8) versus 57.9 (95% CI, 53.3-62.6), respectively; PPI score, 1.17 (95% CI, 0.96-1.4) versus 2.3 (95% CI, 2.1- 2.7); and ODQ score, 19.6 (95% CI, 16.5-22.7) versus 35.4 (95% CI, 32.3-38.5) (p=0.0001). This improvement continued for another 2 weeks after the end of the intervention. Acetaminophen was used less in the wet cupping group, but this difference was not statistically significant. No adverse events were reported. CONCLUSIONS: Wet cupping is potentially effective in reducing pain and improving disability associated with PNSLBP at least for 2 weeks after the end of the wet cupping period. Placebo-controlled trials are needed.

Wet-cupping removes oxidants and decreases oxidative stress.

OBJECTIVES: Wet-cupping therapy is one of the oldest known medical techniques. Although it is widely used in various conditions such as acute\chronic inflammation, infectious diseases, and immune system disorders, its mechanism of action is not fully known. In this study, we investigated the oxidative status as the first step to elucidate possible mechanisms of action of wet cupping. MATERIAL AND METHODS: Wet cupping therapy is implemented to 31 healthy volunteers. Venous blood samples and Wet cupping blood samples were taken concurrently. Serum nitricoxide, malondialdehyde levels and activity of superoxide dismutase and myeloperoxidase were measured spectrophotometrically. RESULTS: Wet cupping blood had higher activity of myeloperoxidase, lower activity of superoxide dismutase, higher levels of malondialdehyde and nitricoxide compared to the venous blood. CONCLUSION: Wet cupping removes oxidants and decreases oxidative stress.

[Analysis of the medicinal leech effects on the state of arterial functions of aged probationers, using hardwarily software system "Angioscan-01"].

The state of elderly patients arterial wall after the putting of one medicinal leech was estimated by use hardwarily software system "Angioscan-01". There was compared the effect of one medicinal leech on indicators of vasomotor function of endothelium of small resistance arteries and of middle arteries of muscular type. Stickiness index and augmentation index were determined in order to evaluate the medicinal leech effect on the rigidity state of arterial wall. It is shown that the putting of one leech stimulates the improving of endothelium vasomotor function and of normalization arterial wall stickiness. It is supposed the participation in this process the secretion of the medicinal leech salivary cells, which, as has been shown recently, is able to activate e-NOS and n-NOS in human endothelium culture (HUVEC) and increase NO level. Elevation of share stress during occlusion test is also stimulated NO production in vascular endothelium.

The effects of wet cupping on serum high-sensitivity C-reactive protein and heat shock protein 27 antibody titers in patients with metabolic syndrome.

INTRODUCTION: It has previously been reported that increased level of serum heat shock proteins (Hsps) antibody in patients with metabolic syndrome. It is possible that the expression of Hsp and inflammatory markers can be affected by cupping and traditional Chinese medicine. There is a little data investigating the effects of cupping on markers of inflammation and Hsp proteins, hence, the objective of this study was evaluation of the effects of wet cupping on serum high-sensitivity C-reactive protein (hs-CRP) and Hsp27 antibody titers in patients with metabolic syndrome. SUBJECTS AND METHODS: Serum Hs-CRP and Hsp27 antibody titers were assessed in samples from 126 patients with metabolic syndrome (18-65 years of age) at baseline, and after 6 and 12 weeks after treatment. One hundred and twenty-six patients were randomly divided into the experimental group treated with wet cupping combined with dietary advice, and the control group treated with dietary advice alone using a random number table. Eight patients in case group and five subjects in control groups were excluded from the study. Data were analyzed using SPSS 15.0 software and a repeated measure ANCOVA. RESULTS: Serum hs-CRP titers did not change significantly between groups (p>0.05) and times (p=0.27). The same result was found for Hsp27 titers (p>0.05). CONCLUSION: Wet-cupping on the interscapular region has no effect on serum hs-CRP and Hsp27 patients with metabolic syndrome.

[Research of bleeding volume and method in blood-letting acupuncture therapy based on data mining].

Through computer-based technology and data mining method, with treatment in cases of bloodletting acupuncture therapy in collected literature as sample data, the association rule in data mining was applied. According to self-built database platform, the data was input, arranged and summarized, and eventually required data was acquired to perform the data mining of bleeding volume and method in blood-letting acupuncture therapy, which summarized its application rules and clinical values to provide better guide for clinical practice. There were 9 kinds of blood-letting tools in the literature, in which the frequency of three-edge needle was the highest, accounting for 84.4% (1239/1468). The bleeding volume was classified into six levels, in which less volume (less than 0.1 mL) had the highest frequency (401 times). According to the results of the data mining, blood-letting acupuncture therapy was widely applied in clinical practice of acupuncture, in which use of three-edge needle and less volume (less than 0.1 mL) of blood were the most common, however, there was no central tendency in general.

Percutaneous excretion of iron and ferritin (through Al-hijamah) as a novel treatment for iron overload in beta-thalassemia major, hemochromatosis and sideroblastic anemia.

Iron overload is a big challenge when treating thalassemia (TM), hemochromatosis and sideroblastic anemia. It persists even after cure of TM with bone marrow transplantation. Iron overload results from increased iron absorption and repeated blood transfusions causing increased iron in plasma and interstitial fluids. Iron deposition in tissues e.g. heart, liver, endocrine glands and others leads to tissue damage and organ dysfunction. Iron chelation therapy and phlebotomy for iron overload have treatment difficulties, side effects and contraindications. As mean iron level in skin of TM patients increases by more than 200%, percutaneous iron excretion may be beneficial. Wet cupping therapy (WCT) is a simple, safe and economic treatment. WCT is a familiar treatment modality in some European countries and in Chinese hospitals in treating different diseases. WCT was reported to clear both blood plasma and interstitial spaces from causative pathological substances (CPS). Standard WCT method is Al-hijamah (cupping, puncturing and cupping, CPC) method of WCT that was reported to clear blood and interstitial fluids better than the traditional WCT (puncturing and cupping method, PC method of WCT). In other word, traditional WCT may be described as scarification and suction method (double S technique), while Al-hijamah may be described as suction, scarification and suction method (triple S technique). Al-hijamah is a more comprehensive treatment modality that includes all steps and therapeutic benefits of traditional dry cupping therapy and WCT altogether according to the evidence-based Taibah mechanism (Taibah theory). During the first cupping step of Al-hijamah, a fluid mixture is collected inside skin uplifting due to the effect of negative pressure inside sucking cups. This fluid mixture contains collected interstitial fluids with CPS (iron, ferritin and hemolyzed RBCs in thalassemia), filtered fluids (from blood capillaries) with iron and hemolyzed blood cells (hemolyzed RBCs, WBCs and platelets). That fluid mixture does not contain intact blood cells (having diameters in microns) that are too big to pass through pores of skin capillaries (6-12nm in diameter) and cannot be filtered. Puncturing skin upliftings and applying second cupping step excrete collected fluids. Skin scarifications (shartat mihjam in Arabic) should be small, superficial (0.1mm in depth), short (1-2mm in length), multiple, evenly distributed and confined to skin upliftings. Sucking pressure inside cups (-150 to -420mmHg) applied to skin is transmitted to around skin capillaries to be added to capillary hydrostatic pressure (-33mmHg at arterial end of capillaries and -13mmHg at venous end of capillaries) against capillary osmotic pressure (+20mmHg). This creates a pressure gradient and a traction force across skin and capillaries and increases filtration at arterial end of capillaries at net pressure of -163 to -433mmHg and at venous end of capillaries at net pressure of -143 to -413mmHg resulting in clearance of blood from CPS (iron, ferritin and hemolyzed blood cells). Net filtration pressure at renal glomeruli is 10mmHg i.e. Al-hijamah exerts a more pressure-dependent filtration than renal glomeruli. Al-hijamah may benefit patients through inducing negative iron balance. Interestingly, Al-hijamah was reported to decrease serum ferritin significantly (by about 22%) in healthy subjects while excessive traditional WCT was reported to cause iron deficiency anemia. Al-hijamah is a highly recommended treatment in prophetic medicine. In conclusion, Al-hijamah may be a promising adjuvant treatment for iron overload in TM, hemochromatosis and sideroblastic anemia.

Wet cupping therapy restores sympathovagal imbalances in cardiac rhythm.

OBJECTIVES: A recent study showed that cupping had therapeutic effects in rats with myocardial infarction and cardiac arrhythmias. The current studyaimed to investigate the possible useful effects of cupping therapy on cardiac rhythm in terms of heart rate variability (HRV). MATERIALS AND METHODS: Forty healthy participants were included. Classic wet cupping therapy was applied on five points of the back. Recording electrocardiography (to determine HRV) was applied 1 hour before and 1 hour after cupping therapy. RESULTS: All HRV parameters increased after cupping therapy compared with before cupping therapy in healthy persons. CONCLUSIONS: These results indicate for the first time in humans that cupping might be cardioprotective. In this study, cupping therapy restored sympathovagal imbalances by stimulating the peripheral nervous system.

[Exploration on the application characteristics of bloodletting therapy for the diseases relevant with soft tissue infection by data mining technology].

OBJECTIVE: Using the data mining technology to analyze the application law of bloodletting therapy for the diseases relevant with soft tissue infection and explore the effect specificity of bloodletting therapy. METHODS: The variety of diseases treated with bloodletting therapy was taken as the sample data by collecting the reports from the periodical literatures. The network database of bloodletting literature was set up. The association rule of data mining technology was adopted to extract the information on the diseases relevant with soft tissue infection in the periodical literatures. The frequency item of the superiority disease category was calculated. And the deep mining was done in terms of the needle device, point selection and the bleeding amount separately. The application law of bloodletting therapy was summarized in the treatment of the diseases relevant with soft tissue infection. RESULTS: Fourteen kinds of relevant diseases of soft tissue infection treated with bloodletting therapy were included in the contemporary periodical literatures, of which, the reported case number and the reporting frequency were the highest for hordeolum and breast abscess. The three-edged needle was used the most frequently in the manipulation. The acupoints selected were the local Ashi points, combined with the symptomatic acupoints. The bleeding amount was not normalized by the ideas of different physicians. CONCLUSION: The bloodletting therapy achieves the better curative effect on some diseases relevant with soft tissue infection and this therapy deserves to be further promoted in clinical practice.

Mongolian traditional-style blood-letting therapy.

Blood-letting therapy is one of the most important treatments in traditional Mongolian medicine (TMM). To observe the practice of Mongolian traditional-style blood-letting therapy (MTSBLT), two TMM clinics in Mongolia were visited in 2012 and two practitioners and a patient were interviewed. The interviews provided information on several characteristic features of MTSBLT, including its three stages: preparation, blood-letting, and recuperation. In the preparation stage, an herbal decoction, such as Braivu sumtan, is given for 3-5 days, during which time massage, cupping, and moxibustion can be applied. In the blood-letting stage, specific points, which differ from acupuncture points, are selected according to the patient's symptoms, and the targeted vein is incised just once. At this time, about 10 mL of blood is drained. In the recuperation stage, the patient needs to be cautious about diet and refrain from excessive physical exercise to prevent adverse effects. The patient interviewed had a favorable attitude toward blood-letting, believing that MTSLBT was an effective treatment for his symptoms.

[Discussions on history of the bloodletting therapy overseas].

To introduce the origin, development and theoretical source of the bloodletting therapy overseas. The bloodletting therapy, which was based on Hippocrates's four fluid theories, had the therapeutical effect and therefor spread abroad. Many people not only thought this therapy was benefit, but also let out blood regularly. During the medieval Europ, the bloodletting therapy reached its top, which was caused by the part-time job of barber. It was questioned when spreading in the America. After that, as the development of the other medical method, the disadvantage was exposed. With several clinical mistherapies, it faded away from the stage of history. The recent research shows that the normative bloodletting therapy could treat some diseases.