1.                  Introduction

Pruritus is a common concomitant symptoms of various skin diseases in clinic, which usually present in conjunctival, skin of the extremities, intolerable systemic itching, skin redness and swollen, incessant scratching and even blisters, affecting the life quality of patients seriously[1]. The symptom is very hard to be prevented due to the unknown pathogeny and recurrent attacks. The common Chinese and western medicine treatments are not effective, hard to recover. Blood-letting puncture and cupping is one of the ancient acupuncture treatments, which mainly used in treating madness, headache, sudden depressive disorder, heat asthma, and epistaxis. In recent years, the author has applied this method to treat pruritus. The clinical observation of effectivity and experience were summarized.

2.                  Case data

2.1.              General Information

Sixty cases diagnosed with skin pruritus were selected and randomly divided into two groups at the Second Affiliated Hospital of Medical College of the Xi University from 2013 to 2016. There were 30 cases in each group. In the Loratadine group, there were 14 males and 16 females. The oldest was 54 years old, the youngest was18 years old (average: 35.5 years old). The longest course of disease was 5 years while the shortest was 2 months (average: 3 ~ 4 years). In the A&SB treatment group, there were 12 males and 18 females, the maximum age was 55 years old, the youngest was 17 years old, (average: 36.5 years old). The longest course of disease was 5 years, and the shortest for 3 months, (average: 3 ~ 4 years) (Table 1). The following conditions need to be excluded:

·                     Skin pruritus with bacterial and fungal infections

·                     Severe endocrine, heart, lung, liver and kidney diseases

·                     Low immunity or psychosis

·                     Women with pregnant and lactating

2.2.              Symptom Classification

According to the Diagnosis and Curative Effect Standards of Traditional Chinese Medicine[2]and the chief complaints of the patients, with reference to classification and treatment of neurodermatitis, cases with pruritus were classified into three syndrome differentiations. There was no significant difference between the two groups (P>0.05), as shown in(Table 1).

3.                  Treatments

3.1.              Loratadine Group

Each patient had oral Loratadine 20 mg / tablet, one tablet at a time, once a day, 3-7 days continuously as a course of treatment.

3.2.              A&SB group (Figure 1 & Table 2)

3.2.1.         Blood-letting puncture on auricular acupoints: Choose one ear for auricular puncture. First, hand manipulations such as kneading, rubbing, twisting for 2~3min were used in order to make the whole auricle hyperemia, ruddy, clearly capillaries discernible. Then the routine sterilization of the auricle was carried out, and the areas of auricular Shenmen, ear tip, Sanjiao, kidney, endocrine and lung were selected. The 0.5 cun of intradermal needle were used to puncture the ear and extrusion bleeding with sterile gloves immediately. Once a week, two ears were alternative. The auricular Shenmen and the endocrine acupoints should be selected during the treatment. The amount of bleeding at each point was about 3 ~ 5 drops (1-1.5 ml). After the manipulation, the sterilize tapes were used to stop bleeding.

3.2.2.         Blood-letting puncture and cupping on Shu-back acupoints: The bilateral acupoints of Feihu (BL 13), Geshu (BL 17), Ganshu (BL18), Pishu (BL 20) from the Bladder Meridian of Foot-Taiyang, and Dazhui (DU 14) of Governing Meridian were selected. After routine sterilization, the triangle-edged needle pricked quickly several times to show the bleeding spot, and then followed by cupping at the same area. The amount of bleeding at each point was about 1~2ml.

3.2.3.         Local pricking blood therapy: If the skin pruritus occurred at the upper or lower extremities, two more local acupoints should be added in addition to the above acupoints. Bilateral Weizhong (BL 40) the Bladder Meridian of Foot-Taiyang were selected if the skin pruritus on the lower limbs, while Chizhe (LU 5) from the Lung Meridian of Hand-Taiyin acupoints were selected if the skin pruritus on the upper limbs. The amount of bleeding at each point was about 1~2ml.

4.                  Results

4.1.              Evaluation criteria of curative effect

Cured: pruritus of the lesion completely subsided.

Effective: pruritus occasionally, skin lesion recedes above 30%.

Invalid: itching remained, skin lesions have subsided less than 30%.

4.2.              Curative effect

Patients were treated once or twice a week for 3-5 times as a course of treatment. Among 30 patients, the shortest effective period was one week and the longest was five weeks. The average effective period was 1.5 course of treatment (times). As shown in (Table 3), in the Loratadine group, 15 cases were cured, 5 cases were effective, 10 cases were ineffective. The total effective rate was 66.7%.For the A&SB group treatment, 25 cases were cured, 3 cases were effective and 2 cases were ineffective. The total effective rate is 93. 3%.

4.3.              Follow-up observation

Relapse within 3 months: Loratadine group (n = 3) and A&SB group (n = 0);

Relapse within 6 months: Loratadine group (n = 6) and A&SB group (n = 0);

Relapse after one year: Loratadine group (n=10) and treatment group (n=5).

5.                  Conclusion

Pruritus, mainly caused by various allergic dermatitis, contact dermatitis or sunlight dermatitis, is always due to autoimmune deficiency [3]. 30 patients in the A&SB group included not only the pruritus with long-term recurrent attacks, but also the pruritus with newly attacks. Some patients could clarify their allergens, such as sunlight, seafood, climate changes, pollen, clothing, etc. On the contrary, some had no obvious illness history, no contact history or no life changes, suddenly occurred of itching symptoms, or even unbearable itching in whole day and night. Especially in recent decades, various skin inflammations with skin and mucosal pruritus as the main clinical manifestation were also increased due to the deterioration of environment and the ravage of haze [4]. After suffering from the disease, the general treatment included the western medicine or traditional Chinese medicine decoction treatment, usually supplemented with ointment for external use. In Western medicine, pruritus was mainly treated by oral antihistamine drugs, stress relief, and staying away from allergens. But the body could resist to drug and have side-effects. The effect was uncertain and easy to reoccur.

In the traditional Chinese medicine, pruritus (skin itching), redness and even detritus are the symptoms of blood deficiency and wind-dryness [5]. The disease locates in the blood. The main treatment principle is to dispel wind and activate blood circulation, and particularly emphasizes the preventive of disease and the concept of wholism. The treatment of pruritus is based on differentiation of symptoms and signs. Blood-letting Puncture and Cupping is one of important treatments in acupuncture and moxibustion of traditional Chinese medicine. The selection of auricular points emphasized the concept of global and local interaction and interrelationship. Since the disease is in the blood, the relationship between “blood” and “Qi” is like the relationship between “Yin” and “Yang”. When “Qi” moves, blood follows. Blood flows, wind will dissipate. Pruritus in the skin is highly related the theory of “lung governs Qi”, dominating of the skin and fur. Therefore, selection of auricular acupoints such as lung and kidney, Shenmen, lung, ear tip, Sanjiao and other acupoints with one ear or two ears each time, local bleeding 3-5 drops could adjust the immune function of the whole body.

Once the external immune function was strengthened and improved, it could fundamentally correct the susceptible constitution [6]. As for the body acupoints, the first choice was Geshu (BL 17) of the Bladder Meridian of Foot-taiyang. Because Geshu (BL 17) is the dominant point for blood according to the theory of “the eight cavern” from the classic Nan Jing (Canon On Eighty-One Difficult Issues). Blood-letting puncture and cupping could regulate the blood, promoting wind out of blood. The reason for the selection of Ganshu (BL18, liver), Feishu (BL13, lung), Pishu (BL20, spleen) was the lung masters skin and fur, promoting the flow of Qi and water. Liver ensured the smooth flow of Qi and regulate the activities of Qi; spleen was in charge of holding the blood together, controling the transformation and movement of fluids, Qi and blood coordinate well, then the wind would be dissipated. Blood flows smoothly, the body will be in good health. In the treatment of local skin pruritus, Wei Zhong (BL 40) on the legs, Chize (LU 5) on the arms were added for blood-letting puncture and cupping. Since pruritus is the internal dampness, which is obstructed in the body and appears on the surface of skin. Chize (LU 5) is the sea point of lung meridian.

The Lung meridian regulates physical activities and the water passages of the body up and down; adjusting the lung, the spleen and the kidney to promote the transportation of fluids. Wei Zhong (BL 40) is also the sea point of bladder meridian. The Bladder meridian runs through the body from top to the bottom of the surface. Stimulating these points promoted the regulation of activities of “Qi” so that “Qi” could transport water. If there is no more dampness and turbidity in the blood, the skin could not be itchy or irritable. Dazhui (DU 14) is the very important acupoint of Governing vessel, which can regulate body temperature in bi-directional benign regulation, promoting metabolism of the skin. When treating of skin diseases, it is priority to choose Dazhui (DU 14) to balance “Yin” and “Yang” [7]. Therefore, combination of various acupoints could improve the autoimmune function, remove water and humidity from blood, restrain the attack of skin inflammation, and finally remove the itch to achieve the purpose of treating pruritus caused by unknown allergens.In summary, pruritus treated by blood-letting puncture and cupping on auricular and Shu-back acupoints was proven effective, long-lasting, safe and convenient, which is suitable for clinical application.

Figure 1:A&SB Treatment. A:Blood-Letting Puncture On Auricular Acupoints: 0.5 Cun of Intradermal Needle Were Used to Puncture the Ear and Extrusion Bleeding After Sterilization. B:Blood-Letting Puncture and Cupping OnShu-Back Acupoints: After Routine Sterilization, The Triangle-Edged Needle Pricked Quickly Several Times to Show the Bleeding Spot, And Then Followed by Cupping at The Same Area. The Amount of Bleeding at Each Point Was About 1~2ml.

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