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Combination treatment with Gua Sha and Blood-letting causes attenuation of systemic inflammation, activated coagulation, tissue ischemia and injury during heatstroke in rats



Gua Sha and Blood-letting at the acupoints were Chinese traditional therapies for heatstroke. The purpose of present study was to assess the therapeutic effect of Gua Sha on the DU Meridian and Bladder Meridian combined with Blood-letting acupoints at Shixuan (EX-UE 11) and Weizhong (BL 40) on heatstroke.


Anesthetized rats, immediately after the onset of heatstroke, were divided into four major groups: Gua Sha group, Blood-letting group, Gua Sha combined with Blood-letting group and model group. They were exposed to ambient temperature of 43 °C to induce heatstroke. Another group of rats were exposed to room temperature (26 °C) and used as normal control group. Their survival times were measured. In addition, their physiological and biochemical parameters were continuously monitored.


When rats underwent heatstroke, their survival time values were found to be 21–25 min. Treatment of Gua Sha combined with Bloodletting greatly improved the survival time (230±22 min) during heatstroke. All heatstoke animals displayed and activated coagulation evidenced by increased prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, and decreased platelet count, protein C. Furthermore, the animals displayed systemic inflammation evidenced by increased the serum levels of cytokines interleukin-1ß (IL-1ß), tumor necrosis factor α (TNF-α) and malondialdehyde (MDA). Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen (BUN), creatinine, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were all elevated during heatstroke. Core temperatures (Tco) were also increased during heatstroke. In contrast, the values of mean arterial pressure were signifificantly lower during heatstroke. These heatstroke reactions were all signifificantly suppressed by treatment of Gua Sha and Blood-letting, especially the combination therapy.


Gua Sha combined with Blood-letting after heatstroke may improve survival by ameliorating systemic inflflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.

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  1. Lim CL, Wilson G, Brown L, Coombes JS, Mackinnon LT. Pre-existing inflammatory state compromises heat tolerance in rats exposed to heat stress. Am J Physiol Regul Integr Comp Physiol 2007;292:186–194.

    Article  Google Scholar 

  2. Hsiao SH, Chang CP, Chiu TH, Lin MT. Resuscitation from experimental heatstroke by brain cooling therapy. Resuscitation 2007;73:437–445.

    Article  PubMed  Google Scholar 

  3. Tian YF, Lin CH, Hsu SF, Lin MT. Melatonin improves outcomes of heatstroke in mice by reducing brain inflammation and oxidative damage and multiple organ dysfunction. Mediators Inflamm 2013;2013:349280.

    Google Scholar 

  4. Bouchama A, Roberts G, Al Mohanna F, El-Sayed R, Lach B, Chollet-Martin S, et al. Inflammatory, hemostatic, and clinical changes in a baboon experimental model for heatstroke. J Appl Physiol 2005;98:697–705.

    Article  CAS  PubMed  Google Scholar 

  5. Hemmlgarn C, Gannon K. Heatstroke: clinical signs, diagnosis, treatment, and prognosis. Compend Contin Educ Vet 2012;35(17):E3.

    Google Scholar 

  6. Chao TC, Sinniah R, Pakian JE. Acute heat stroke death. Pathology 1981;13:145–156.

    Article  CAS  PubMed  Google Scholar 

  7. Leon LR. Heat stroke and cytokines. Prog Brain Res 2007;162:481–524.

    Article  CAS  PubMed  Google Scholar 

  8. Liu CC, Chen ZC, Cheng BC, Lin MT. Prior antagonism of endothelin-1A receptor alleviates circulatory shock and cerebral ischemia during rat heat stroke. J Pharmacol Sci 2004;96:177–187.

    Article  CAS  PubMed  Google Scholar 

  9. Nielsen A, Knoblauch NT, Dobos GJ, Michalsen A, Kapthuk TJ. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore (NY) 2007;3:456–466.

    Article  Google Scholar 

  10. Braun M, Schwickert M, Nielsen A, Brunnhuber S, Dobos G, Musial F, et al. Effectiveness of traditional Chinese "Gua Sha" therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med 2011;12:362–369.

    Article  PubMed  Google Scholar 

  11. Nielsen A. Guasha research and the language of integrative medicine. J Bodyw Mov Ther 2009;13:63–72.

    Article  PubMed  Google Scholar 

  12. Zhao JP, Piao YZ, Wang J. Effect of acupuncture combined with blood-letting by a three-edged needle on 50 cases of Bell’s palsy at the acute stage. J Tradit Chin Med 2010;30:118–121.

    Article  CAS  PubMed  Google Scholar 

  13. Kim TH, Basargard L, Kim JI, Lee MS. Mongolian traditional style blood-letting therapy: a brief introduction. Complement Ther Clin Pract 2011;17:179–183.

    Article  PubMed  Google Scholar 

  14. Chen YC, Liu YC, Yen DH, Wang LM, Huang CI, Lee CH, et al. L-arginine causes amelioration of cerebrovascular dysfunction and brain inflammation during experimental heatstroke. Shock 2008;29:212–216.

    CAS  PubMed  Google Scholar 

  15. Chang CK, Chang CP, Chiu WT, Lin MT. Prevention and repair of circulatory shock and cerebral ischemia/injury by various agents in experimental heatstroke. Curr Med Chem 2006;13:3145–3154.

    Article  CAS  PubMed  Google Scholar 

  16. Lin XJ, Li YL, Mei GP, Zou F, He DD, Liu XQ, et al. Activated protein C can be used as a prophylactic as well as a therapeutic agent for heat stroke in rodents. Shock 2009;32:524–529.

    Article  CAS  PubMed  Google Scholar 

  17. Chen CM, Hou CC, Cheng KC, Tian RL, Chang CP, Lin MT. Activated protein C therapy in a rat heat stroke model. Crit Care Med 2006;34:1960–1966.

    Article  CAS  PubMed  Google Scholar 

  18. Yang CY, Lin MT. Oxidative stress in rats with heatstrokeinduced cerebral ischemia. Stroke 2002;33:790–794.

    Article  PubMed  Google Scholar 

  19. Kao TY, Chio CC, Lin MT. Hypothalamic dopamine release and local cerebralblood flow during onset of heatstroke in rats. Stroke 1994;25:2483–2487.

    Article  CAS  PubMed  Google Scholar 

  20. Kwong KK, Kloetzer L, Wong KK, Ren JQ, Kuo B, Jiang Y, et al. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp 2009;28;1385.

    Google Scholar 

  21. Ahmed SM, Madbouly NH, Maklad SS, Abu-Shady EA. Immunomodulatory effects of blood letting cupping therapy in patients with rheumatoid arthritis. Egypt J Immunol 2005;12:39–51.

    PubMed  Google Scholar 

  22. Lee JJ, Lin MT, Wang NL, Lin CL, Chang CK. Platonin, a cyanine photosensitizing dye, causes attenuation of circulatory shock, hypercoagulable state, and tissue ischemia during heat stroke. Shock 2005;24:577–582.

    Article  PubMed  Google Scholar 

  23. Yeh CH, Chen ZC, Hsu CC, Lin MT, Chen CC. Protection in rats with heatstroke: hyperbaric oxygen vs activated protein C therapy. Eur J Pharmacol 2010;635:103–108.

    Article  CAS  PubMed  Google Scholar 

  24. Bouchama A, Kunzelmann C, Dehbi M, Kwaasi A, Eldali A, Zobairi F, et al. Recombinant activated protein C attenuates endothelial injury and inhibits procoagulant microparticles release in baboon heatstroke. Arterioscler Thromb Vasc Biol 2008;28:1318–1325.

    Article  CAS  PubMed  Google Scholar 

  25. Liu CC, Cheng BC, Lin MT, Lin HJ. Small volume resuscitation in a rat model of heatstroke. Am J Med Sci 2009;337:79–87.

    Article  PubMed  Google Scholar 

  26. Hsu SF, Niu KC, Lin CL, Lin MT. Brain cooling causes attenuation of cerebral oxidative stress, systemic inflammation, activated coagulation, and tissue ischemia/injury during heatstroke. Shock 2006;26:210–220.

    Article  CAS  PubMed  Google Scholar 

  27. Gagnon D, Lemire BB, Casa DJ, Kenny GP. Cold-water immersion and the treatment of hyperthermia: using 38.6 °C as a safe rectal temperature cooling limit. J Athl Train 2010;45:439–444.

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Song-he Jiang  (蒋松鹤).

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Supported by a grant from Administration of Traditional Chinese Medicine of Zhejiang Province (No. 2009YB023)

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Tu, Wz., Cheng, Rd., Hu, J. et al. Combination treatment with Gua Sha and Blood-letting causes attenuation of systemic inflammation, activated coagulation, tissue ischemia and injury during heatstroke in rats. Chin. J. Integr. Med. 21, 610–617 (2015).

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  • Gua Sha
  • Blood-letting
  • heatstroke
  • ischemia
  • inflflammation
  • coagulation
  • Chinese medicine