〔Abstract〕 Objective To observe the clinical efficacy of traditional Chinese medicine (TCM) combined with blood-letting puncture in the treatment of acute upper respiratory tract infection (AURI) with high fever in plateau residents based on the theory of Sanjiao Xuanfu combined with body discrimination theory. Methods A total of 100 patients with AURI with high fever treated in Ganzi prefecture Seda County People's Hospital from January 2023 to March 2023 were selected and divided into a control group and an observation group according to different treatment methods, with 50 cases in each group. The control group was given conventional antiviral treatment, oxygen inhalation, cough relief, water and electrolyte balance, and the observation group received TCM combined with blood-letting puncture treatment on the basis of the control group. The clinical efficacy, TCM syndrome score before and after treatment, the time of onset of fever, the total time of fever, the rate of recurrent fever after fever, the level of serum inflammatory factors and the incidence of adverse reactions were compared between the two groups. Results The total effective rate in the observation group was higher than that in the control group, and the incidence of adverse reactions was lower than that in the control group, the differences were statistically significant (P < 0.05). After treatment, the TCM syndrome score of the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). The fever rate in the observation group was lower than that in the control group, and the time of fever regression and onset of fever regression were shorter than those in the control group, the difference were statistically significant (P < 0.05). After treatment, the serum levels of C–reactive protein (CRP) 、procalcitonin (PCT) and interleukin–6 (IL–6） in the observation group were lower than those in the control group,and the differences were statistically significant (P < 0.05). Conclusion Based on the theory of Sanjiao Xuanfu and the thought of body differentiation, the treatment of AURI patients with high fever by using TCM combined with blood-letting puncture has a high cure rate, a fast speed of fever reduction, and can effectively reduce the level of serum inflammatory factors with high safety.