| Study objective:To observe the clinical effect of treating exogenous fever by blood letting puncturing and cupping on Dazhui and discuss its mechanismMethod:120 cases from the fever clinics and observation room in the Second Affiliated Hospital of Guangzhou University of TCM, who were in accordance with the admission criteria, were chosen as study subjects. In relation to the time sequence, those patients were randomly divided into treatment group and control group, with the ratio of 3:1. Patients in treatment group were further divided into low dose group (<2ml), middle dose group(2-5ml) and high dose group (>5ml), according to the amount of blood let out by blood letting puncturing and cupping, with 30 cases in each group. All the four groups were given basic treatment:which referred to 4-hour intravenous infusion of 5% glucose injection or 5%Sodium Chloride Injection 500ml+Vit C+Vit B6 once a day, for three days. The treatment group also received blood letting puncturing and cupping on Dazhui in addition to basic treatment. Method:The operator firstly located Dazhui and disinfected the area, then pierced scatteredly on and around Dazhui with the right hand holding a needle (generally 3 to 5 pins), applied fire cupping on the pierced part last. The cupping time was 15 minutes and the blood was cleaned by disinfectant dry cotton balls. The treating course was carried out once a day for three days. In addition to basic treatment, the control group were given intramuscular injection of Bupleurum injection once a day for three days, when body temperature was≥37.0℃. For all four groups, temperatures before the treatment and 0.5h, 1h,2h,4h after treatment were recorded. The onset time, fever-relieving time and recovery time were also recorded and TCM syndrome score was evaluated after each treatment. Spss13.0 was utilized to analyze the temperature changes, working time, fever-relieving time and recovery time as well as TCM symptom scores so as to evaluate statistically the relationship between time and effect for the method of treating exogenous fever by blood letting puncturing and cupping on Dazhui. By analyzing the amount of blood let out, onset time, fever-relieving time and recovery time as well as effective rate, the relationship between bleeding amount and effect was evaluated for the method of treating exogenous fever by blood letting puncturing and cupping on Dazhui At the same time, all side effects and failing cases were recorded and analyzed.Results:1. Comparison of general information before the treatment:120 cases were included in this study, among whom 53 cases were male and 67 cases were female. Those patients were randomly divided into control group (Bupleurum injection) and treatment group (which was further divided into low dose group (<2ml), middle dose group(2-5ml) and high dose group (>5ml) based on the amount of bleeding). Comparing the basic data of four groups in terms of age, disease duration, gender, temperature, TCM syndrome scores and WBC count, the results showed no significant difference (P> 0.05), indicating that the groups were comparable.2. Efficacy comparison:2.1 comparison of temperature changes before and after treatment In order to observe immediate effect and delay effect, we compared temperatures recorded before treatment and 0.5h,1h,2h,4h after treatment. The results indicated that after the first treatment, the high dose group had the fastest onset time, the middle dose group had significant temperature decrease 1h after treatment, the overall effect of high dose group and middle dose group were similar. Middle dose group had better effect than low dose group and low dose group had similar effect with control group. However, the comparison of temperature changes before the second treatment showed no statistical difference, indicating that though temperature decreased significantly after the first treatment, the patients'conditions were not stable, and fever relapsed. After the second treatment, high dose group and middle dose group had significant antipyretic effect, and average temperature in high dose group had dropped to normal level. The overall effect after two treatments showed high dose group had better effect than middle dose group while middle dose group was superior to low dose group, and low dose group had commensurate effect to control group. The comparison of temperature changes before the third treatment showed statistical difference and temperatures in high dose group and middle dose group were lower than that of low dose group and control group, indicating the delay effect of high dose group and middle dose group began to appear after two treatments. Assessment of overall effect showed that high dose groups and middle dose group had similar effect, but superior to low dose group and control group and the comparison between the later two groups showed no statistical difference.2.2 Comparison of onset time, fever relieving time and recovery time: Comparison of the onset time between four groups showed that high dose group had the fastest onset time, and was significantly shorter than middle dose group and low dose group, and middle dose group had shorter onset time. But the difference between small dose group and middle dose group was not statistically significant.Comparison of the fever-relieving time between four groups showed that high dose group had better effect than middle dose group and middle dose group was superior to low dose group. But the difference between small dose group and middle dose group was not statistically significant.Comparison of recovery time between four groups showed that high dose group had considerable effect with middle dose group and their recovery time was significantly shorter than low dose group. But the difference between small dose group and middle dose group was not statistically significant.2.3 Assessment of effect by observing temperature changesChoosing axillary temperature as the observation index, the results showed that the total effect of three treatment groups were higher than that of control group. Comparing high dose group and middle dose group with low dose group and the control group, the difference was statistically significant, but the difference between high dose group and middle dose group showed no significant difference and the difference between low dose group and control group showed no significant difference, indicating high dose group and middle dose group had similar efficacy, and low dose group had considerable effect with control group. The effect of high dose group and middle dose group was better than low dose group and control group. 2.4 Relationship between treatment duration and effect Comparison of effect before and after treatment of four groups showed the effective rate increased gradually in accordance with treatment time, the difference was not statistically significant. The overall effect of high dose group and middle dose group reached its top after the third treatment, indicating that after 3 courses of treatment, the best effect could be achieved.2.5 Assessment of effect on TCM syndromes2.5.1 Comparison of TCM syndrome scores in four groups:2.5.1.1 Comparison within each group before and after treatment:high dose group and middle dose group had significant difference after the first treatment, which suggested high dose group and middle dose group worked faster on the improvement of syndromes while low dose group and control group had no significant short-term effect.2.5.1.2 Comparison between groups:Before treatment, there was no significant difference between four groups on TCM syndrome scores. But 1 day,2 days, and 3 days after treatment, comparison between groups showed high dose group and middle dose group were superior to control group in improving syndromes of patients. Low dose treatment group started to show its advantage in improving symptoms of patients exogenous fever from the second treatment.2.6 Comparison of overall effect of TCM syndrome in four groups:The total effect:high dose group> middle dose group> low dose group> control group, indicating blood letting puncturing was better than control group in the improvement of TCM syndrome, and the better the result was, the more the blood was let out. Comparison of recovery rate showed no statistical difference between four groups, and it may be because the sample was too small.2.7 Comparison of recovery in terms of symptoms of TCM syndrome between fourgroups:Comparison between two groups in terms of fever, aversion to cold, stuffy nose, body aches, sore throat, runny nose, sweating, headache, cough and thirst showed no statistical difference (P>0.05), but the treatment group had higher effective rate in improving the above symptoms than the control group, the difference was not statistically significant, maybe it was due to the small size of the sample.2.8 Comparison of four groups on differential Diagnosis of TCM: Patients in four groups were diagnosed as two syndromes by differential diagnosis of TCM which were wind-cold and wind-heat. Comparison between two groups, the differences were not statistically significant. But within a group, the effective rate of treating wind-heat syndrome was apparently higher than that of wind-cold syndrome, but the difference was also not statistically significant, maybe it was due to the small size of the sample.3 In this study,2 cases failed to finish the treatment.1 case in middle dose group dropped out because of not being able to keep puncturing treatment.1 case in control group was not available for being too busy. Therefore, the above two cases were excluded. Finally,118 cases finished the treatment, with 89 cases in treatment group and 29 cases in control group.4 Observation of side effects:in the course of treatment, two cases in the treatment group had local subcutaneous swelling after the puncturing, and the swelling disappeared after hot compress therapy for 2 to 3 days. We thought it was subcutaneous ecchymosis caused by acupuncture and cupping.2 patients in treatment group and 1 patient in control group had dizziness and fatigue, but the symptoms were relieved after rest, we thought it was caused by the patients'being too nervous. No other side effects were found.Conclusion:Treating exogenous fever by blood letting puncturing and cupping on Dazhui was a safe and effective method. With the increase of bleeding after puncturing and cupping, the onset time was faster, fever-relieving time and recovery time became shorter, and the improvement of TCM syndrome score was faster. After three times'treatment, the total effective rate was up to 96%, significantly higher than that of the control group. The immediate effect of relieving fever and long-term effect were both better. Relationship of time-effect and dose-effect was positively correlated. Therefore, this study suggested that the treating course of treating exogenous fever by blood letting puncturing and cupping on Dazhui was once per day, three days, and the bleeding amount should be more than 2ml. Treating exogenous fever by blood letting puncturing and cupping on Dazhui is simple and has high patient's compliance, should be recommended clinically.
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