JID: WJAM

ARTICLE IN PRESS [m5G;March 26, 2021;10:59]

World Journal of Acupuncture – Moxibustion xxx (xxxx) xxx

Contents lists available at ScienceDirect

World Journal of Acupuncture – Moxibustion

journal homepage: www.elsevier.com/locate/wjam

Clinical Report

Twenty-eight cases of facial acne treated by quick puncture with

collateral-pricking cupping ✩
“”,28
Jing-ru WANG () a, Xiao SUN () a, Xiao-bin ZHANG () a, Wen-juan WEI (
) a, Cheng-yang JIANG () b, Xin QI () a, Guang-hui YIN () a, Yu-xia MA
() a,∗
a
College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
(, 250355, )
b
College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China (, 250355,
)

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To observe the clinical effect of quick puncture with collateral-pricking cupping for facial acne.
Available online xxx
Methods: Twenty-eight patients with acne were treated with pricking acne spot and abdominal region of
Keywords: three toes for bloodletting combined with collateral-pricking cupping on the back, once every 5 days, for
Acne 3 weeks in succession. A 3-month follow-up was applied to observe the reducing rate and clinical effect
Acne spot of facial skin lesions after treatment.
Foot three toes
Bloodletting Results: Of the 28 cases, 9 were cured, 12 remarkably effective, 5 effective, and 2 ineffective. The total
Collateral-pricking cupping effective rate was 92.86%.
Conclusion: The effect of pricking acne spot and abdominal region of three toes combined with collateral-
pricking cupping on the back is good, being worthy of further clinical discussion to promote its applica-
tion.
© 2021 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

Acne, also known as lung-wind acne and rosacea, is a chronic
inflammation of hair follicles and sebaceous glands. It appears
commonly to male and female in adolescent age, most frequently
in the facial and back regions. Acne is a common disease in der-
matology department. According to the statistics, 80%−90% of ado-
lescents have acne [1]. At present, it is mostly treated by using
antibiotics and hormones in western medicine, which can signif-
icantly inhibit its deterioration in short time and partially relieve
the skin lesion, but the recurrence rate is high after long-term use
of antibiotics [2], and the effect is not satisfactory. Traditional Chi-
nese medicine (TCM) external treatment can reduce the patients’
drug resistance to antibiotics, and has the characteristics of effec-
tiveness, safety, and convenient. We treated 28 acne patients by
using the methods of quick puncture with collateral-pricking cup-
ping on the back. Here is the report.
✩
Supported by National Natural Science Foundation of China: 81774402.
∗
Corresponding author.
E-mail address: myxia1976@163.com (Y.-x. MA).
Clinical data
All the 28 cases were outpatients in the Departments of
Acupuncture and Dermatology, Affiliated Hospital of Shandong
University of Traditional Chinese Medicine from June 2019 to De-
cember 2019. The patients ranged from 15 years old to 43 years
old, with an average age of (27.5 ± 8.2) years. The shortest course
of disease was 4 months and the longest 3 years, with an average
of (16.7 ± 9.9) months. According to the China Guideline for Diag-
nosis and Treatment of Acne(the 2019 revised edition) [3], 28 patients
were divided into 4 levels: levelⅠ(acne only) 8 cases, levelⅡ (with
inflammatory papules) 12 cases, level Ⅲ (with pustules) 6 cases,
and level Ⅳ (with nodules and cysts) 2 cases. Based on the syn-
drome differentiation mentioned in Acupuncture and Moxibustion
Therapeutics [4], 15 cases of the 28 cases were diagnosed as lung
meridian wind heat type, 8 cases as intestine stomach damp heat
type, and 5 cases as thoroughfare and conception vessels’ dishar-
mony type.

https://doi.org/10.1016/j.wjam.2021.03.006
1003-5257/© 2021 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.

Please cite this article as: J.-r. WANG, X. SUN, X.-b. ZHANG et al., Twenty-eight cases of facial acne treated by quick puncture with
collateral-pricking cupping, World Journal of Acupuncture – Moxibustion, https://doi.org/10.1016/j.wjam.2021.03.006
JID: WJAM
ARTICLE IN PRESS
J.-r. WANG, X. SUN, X.-b. ZHANG et al.
Fig. 1. Location of acne spot (the red arrow points to the acne spot).
Treatment
Acupoint selection
Acne spot: the patient should be in prone position with the
neck fully exposed and the hands placed under the head. Doctors
should find acne spots between the spinous processes of the first
and second cervical vertebrae. Acne spots were usually red gran-
ules, or rope-like nodules, or obvious tender spots, see Fig. 1. Three
toes refer to abdominal region of big, second, and middle toes. Re-
action points on the back: the papules or small vessels with blood
stasis around Fèishū (BL13), the color of vessels did not fade
by pressing.
Manipulation
(1) Acne spot: the patient should be in prone position. The local
area of acne spot should be disinfected conventionally. The doc-
tor wore sterile gloves, fixed the acne spot and its surround-
ing skin with the thumb, index, and middle finger of left hand,
pricked with the right hand with a disposable blood-collection
needle in a scattered way to cause bleeding, till the blood
changing from dark purple to normal color, and then cleaned
it with a 75% ethanol-soaked sterile cotton ball [5].
(2) Abdominal region of three toes: abdominal region of big, sec-
ond, and middle toes were disinfected conventionally. The doc-
tor wore sterile gloves, fixed the three toes with the left hand,
held the disposable blood-collection needle with the right
hand, quickly pricked the abdominal region of three toes to
cause bleeding, till the blood changing from dark purple to nor-
mal color, and then cleaned it with a 75% ethanol-soaked sterile
cotton ball [5].
(3) Reaction points on the back: the sterilized No.2 glass cups were
prepared before the manipulation. The patient was in the prone
position with the arms on both sides of the body. The doc-
tor was finding the papula-like protrusions or bright red sta-
sis and dark red stasis vessels in the region between scapular
areas. The doctor wore sterile gloves, fixed the reaction point
skin with the left hand, held the three-edged needle with the
right hand and inserted it perpendicularly into the stasis lo-
cation. For the papula-like protrusions, the three-edged needle
was inserted transversely, making a wound 0.2 cm to 0.5 cm
in length, and 0.1 cm to 0.3 cm in depth. After pricking, flash
cupping was applied immediately. The bright red or dark red
blood flowed out from the reaction points of the back. The to-
tal amount was 5 mL to 30 mL. The cups were retained for
5 min and then removed off. Aseptic gauze was used to clean
2
[m5G;March 26, 2021;10:59]
World Journal of Acupuncture – Moxibustion xxx (xxxx) xxx
the blood off. Iodophor was used to disinfect the local area. The
wound was covered with sterile application patch.
Supplementary acupoints: for the patients with the lung merid-
ian wind heat type, Dàzhuı̄ ( GV14) and Fèishū ( BL 13)
were added. For the patients with the intestine stomach damp heat
type, Pı̌shū (BL 20), Wèishū (BL 21), and Dàchángshū (
BL 25) were added. For the patients with the thoroughfare and
conception vessels’ disharmony, Géshū (BL17) was added. All
the supplementary acupoints were treated with collateral-pricking
cupping in the same way as that applied to the reaction points on
the back.
The above treatments were given once every 5 days for 3 weeks
in succession.
Evaluation criteria and treatment outcomes
Evaluation criteria were established on the basis of Guiding
Principles for Clinical Research of New Chinese Medicines [6]. The re-
ducing range of acne was observed to calculate the reducing rate
of skin lesions. Cured: complete disappearance of acnes or only
with pigmentation left, the reducing rate of skin lesions ≥95%. Re-
markably effective: disappearance of most acnes, the reducing rate
of skin lesions <95% and ≥70%. Effective: disappearance of some
acnes, the reducing rate of skin lesions <70% and ≥50%. Ineffec-
tive: no obvious reducing of acnes, the reducing rate of skin lesions
<50%, or increasing of skin lesions. After treatment, 9 cases were
cured, 12 cases remarkably effective, 5 cases effective, and 2 cases
ineffective. The total effective rate was 92.86%.
Typical case
A patient, female, 32 years old, came for the first time on
November 19, 2019. Chief complaint: acne-like rashes in the facial
region for more than 6 months. The patient reported that she be-
gan to have red rashes on the face since more than 6 months ago
without obvious causes. She went to the local clinic for treatment
and was given Chinese medicines for oral taking (specific details
unknown), but the effect was not satisfactory. Present symptoms:
red rashes on the face, mainly distributed in the regions of nose,
cheeks, below lips, in hard quality, later with white pus heads. At
the beginning in the growing of acnes, her facial region was dry
and itchy. Appetite was and sleep was not bad, but easy to wake
up, and urine and stools were normal. Red tongue, thin slippery
coating, greasy coating at the root part of the tongue. The left guan
pulse was rolling. Western medicine diagnosis: acne vulgaris. TCM
diagnosis: acne, stagnated heat of liver and stomach, damp heat
of intestine and stomach type. Treatment method: pricking acne
spot and abdominal region of three toes, collateral-pricking cup-
ping at the reaction points on the back. The first treatment was
on November 19, 2019, then once every 5 days. On December 17,
2019, the facial red rashes were significantly reduced, and occa-
sionally some new rashes appeared in the mandibular and eyebrow
regions. The treatment was continued for 3 weeks with the above
methods, and the facial acne basically disappeared. Follow-up for 3
months there was no recurrence. Comparison of skin lesion before
and after treatment is shown in Figs. 2 and 3.
Discussion
Acne is an inflammatory disease of hair follicles and sebaceous
glands, mainly manifested as acne, inflammatory papules, pus-
tules, nodules, cysts, scars, and other skin lesions [7]. In western
medicine, it is believed that its incidence is related to acne propi-
onic acid bacillus infection, androgen level, abnormal keratosis of
hair follicle sebaceous ducts, etc., and retinoids, antimicrobial and
JID: WJAM
ARTICLE IN PRESS
J.-r. WANG, X. SUN, X.-b. ZHANG et al.
Fig. 2. Before treatment (the photo was taken on 19th November 2019).
Fig. 3. After treatment (the photo was taken on 19th May 2020).
hormone drugs are commonly used for treatment [8]. In TCM it is
known as facial sores and lung wind acne. In TCM, it is believed
that the lung dominates the skin and hair. Acne can be induced
or aggravated by emotional factors and oily food. This is a disease
related with the lung, spleen and stomach, and liver. In Qing Dy-
nasty, Kun QI ’s Wàikē Dàchéng • Fèifēng Jiǔcì ( •
Compendium of Surgical Treatment • Lung Wind Acne) in 1665
A.D. reported that the lung wind caused by the blood heat stagna-
tion of the lung meridian could lead to acne. In Ming Dynasty, Shi-
gong CHEN ’s Wàikē Zhèngzōng ( Orthodox Treatise on
External and Surgical Diseases) in 1617 A.D. reported that acne was
the presentation of the lung damaged by the steaming of dregs in
the stomach. The occurrence of acne is attributed to the lung, and
rosacea to the spleen, that is internal disorders must have their
presentations on the surface of body. Acne is the disease caused
by heat, closely related to blood system and its basic pathogenesis
is heat toxic affecting and steaming the skin. Invasion of exoge-
nous pathogenic wind, lung meridian wind heat, accumulated heat
in the lung and stomach, and the obstruction of skin pores by the
stagnated yang on the body surface can cause the heat that affects
upward along the meridians to the face and results in skin rashes
due to disharmony between nutrient and defensive systems [9].
3
[m5G;March 26, 2021;10:59]
World Journal of Acupuncture – Moxibustion xxx (xxxx) xxx
Acne spot is a commonly used acupoint in clinic by Professor
Shu-zhong GAO from Shandong University of Traditional Chinese
Medicine. It is manifested as the red granules or rope-like nodules
or tenderness points near the spinous processes of the first and
second cervical vertebrae. The nape is a region from where gover-
nor vessel and gallbladder meridian of foot-shaoyang pass through.
governor vessel is full of yang qi. Shaoyang meridian is the pivot,
which is important for the connection of yin with yang, and nutri-
ent with defense [10].
The appearance of acne is related to qi and blood plentifulness,
pricking and bleeding can relieve the blood heat. The first and sec-
ond cervical vertebrae are in qi street, which is the place at where
qi and blood of meridians and collaterals of the whole body gather,
and is the common pathway for the running of qi and blood. Treat-
ment applied at acne spot can give full play to the role of qi street.
Internal disorders must have their presentations on the surface
of body. The reaction points on the back are the external mani-
festation of zang-fu disorders. Patients with facial acne have small
light red spots (color not be changed by pressing) in the scapular
region and the corresponding back-shu acupoints. This is the place
from where the bladder meridian of foot-taiyang passes through.
Bladder meridian is the one with more blood but less qi. Collateral-
pricking cupping here for bloodletting can clear pathogenic heat
of taiyang meridian, disperse stagnation, and relieve swelling [11],
to adjust the internal organs to achieve yin and yang balance.
Collateral-pricking cupping functions to clear internal heat of zang-
fu organs, activate blood, and remove obstruction of meridians. Or-
thodox Treatise on External and Surgical Diseases put forward that
the acne is all because of the stagnation of blood heat. Therefore,
pricking the acne spot for bloodletting and collateral-pricking cup-
ping can clear the blood heat to achieve satisfactory therapeutic
effect.
Modern studies [12,13] believe that pricking for bloodletting is
a therapy with the anti-inflammatory effect to relieve pain and
promote the regeneration and repair of tissues, it can directly re-
duce the vascular congestion in inflammatory sites, reduce the
pressure in vessels, accelerate the blood flow in microcirculation,
and reduce inflammatory response to promote the tissues’ regener-
ation and repair. The negative pressure and warm effect generated
in the process of cupping can dilate capillaries, enhance the func-
tion of removing obstruction of meridians for a better circulation
of qi and blood [14].
From the perspective of TCM syndrome differentiation, fire and
wind-heat diseases are the indications of pricking for bloodlet-
ting and collateral-pricking cupping. It is a characteristic therapy
in TCM, which is simple and effective, with a good effect of clear-
ing zang-fu heat, providing a new idea and a new method for the
clinical treatment of facial acne.
Declaration of Competing Interest
There was no potential conflict of interest in this article.
State of Human Rights
The intervention conformed to the ethical criteria.
References
[1] Fu QF, Zhang Q, Duan BF, Zhang HB, Yin KJ, Li M, et al. Prick-bloodletting com-
bined with cupping on the back for 52 cases of acne. World J Acupunt Moxi-
bust 2016;26(04):61–4.
[2] Zhang L. Clinical observation on the treatment of acne by traditional Chinese
medicine syndrome differentiation. China Prac Med 2014;9(12):236–7.
[3] Ju Q. China Guideline for diagnosis and treatment of acne (the 2019 revised
edition). J Clin Dermatol 2019;48(09):583–8.
[4] Gao SZ, Yang J. Acupuncture and moxibustion therapeutics. Beijing: Chinese
Press Traditional Chinese Medicine; 2016. p. 129–30.
JID: WJAM
ARTICLE IN PRESS
J.-r. WANG, X. SUN, X.-b. ZHANG et al.
[5] Gao SZ. One-acupoint therapy. Jinan: Jinan Publishing House; 2006. p. 44.
[6] Zheng XY. Guiding principles for clinical research of new chinese medicines,
292. Beijing: Chinese Press Traditional Chinese Medicine; 2002.
[7] Lu Y, Ji W, Zhang M, Li KF, Zhu YN, Li HN. Research progress on the
mechanism of traditional Chinese medicine treatment of acne. Technol Wind
2020(33):151–2.
[8] Li QL, Liu ZJ, Zhuang HC, Fang F, Yang Yang L. Liu’s experience in treating acne.
Chin J Tradit Chin Med Pharm 2020;35(11):5605–7.
[9] Liu Y, Zhang S, Zhu J. Clinical Observation on fire needling plus back-shu point
pricking-cupping bloodletting for delayed cystic acne. Shanghai J Acupunct
Moxibust 2019;38(08):917–21.
[10] Lu XL, Mo XF. Experience of using Fēngchí (GB20) and three forehead acu-
points as main ones in treating insomnia based on syndrome differentiation.
Chin Acupunt Moxibust 2016;36(03):259–60.
[m5G;March 26, 2021;10:59]
World Journal of Acupuncture – Moxibustion xxx (xxxx) xxx
[11] Wang SR, Ma FJ, Han JL, Ding XJ, Yi HQ. Blood letting at reaction points of the
three toes and scapular area for treatment of 24 stye cases. J Extern Therap
Tradit Chin Med 2018;27(01):35.
[12] Jia LJ, Guan HZ, Chen XZ, Yin LH, Peng DH, Hu JJ. Clinical observation on treat-
ing lumbar disc herniation with acupuncture and cupping plus oral taking of
Chinese medicines. Clin J Chin Med 2017;10(9):79–81.
[13] Gu JH. Effect analysis of the collateral-pricking for bloodletting combined
with acupuncture in the treatment of lumbar disc herniation. Chin Mod Doc
2015;53(17):127–9.
[14] Jiang CY, Zhang XB, Yin GH, Qi X, Wei WJ, Ma YX. Clinical observation on
30 cases of external humeral epicondylitis treated with electroacupuncture
at Zhǒulíng and Ashipoints combined with blood-letting cupping. World J
Acupunct Moxibust 2020;30(03):233–6.