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Based on the four segments and treatment Syndrome

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Updated: Friday, Apr 03,2009, 10:31:08 PM
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Based on the four segments and treatment Syndrome
The differentiation of the mortality of the Lower Sepsis
LIU Qing-quan
Reduce the mortality of sepsis has become an important issue in medical care to international criticism because of its high incidence too. In 2004 and 2008 there was no breakthrough in the international guidelines for the management of severe sepsis and shock. The treatments did not achieve the goal of lowering the fatality rate of severe sepsis, which remains at 30% -50% (1.2). The main reasons are the complexity of pathological and unknown mechanisms of sepsis and the difficulty of diagnosis clear from the beginning. It is difficult to reach an early diagnosis, early intervention and early the selection of targeted therapies and drugs.

Chinese medicine focuses on diagnosis and treatment based on an analysis of clinical characteristics. Syndrome differentiation is the basic method of clinical trial. Our teachers before, WANG Jin-da and Wang Bao-en, led to large amounts of clinical studies on the recognition of sepsis in Chinese medicine. They presented a new theory of "treatment of the bacteria and the toxin in coordination, which has incorporated the theory of traditional Chinese medicine
(TCM) with Western medicine. They also succeeded in developing Xuebijing injection, Ergotrophic Composition Shenqi Huoxue Granule and diminish the severe sepsis mortality successively. We are engaged in clinical and basic research on sepsis for more than 10 years. Fully absorbing our predecessors research results and combining the pathological features of sepsis and its clinical characteristics, under the leadership of the Chinese medicine theory of the combination of disease and syndrome, we emphasized the regime "based on the four segments, following the concept of wholism and balance, the treatment of syndrome differentiation" (3).

Treatment of septic Fever depending on the location of the pathogenic factors of fever is the most common symptom of sepsis, with an incidence rate of 100% clinic and was paid the most attention by clinicians. The curative effect can be enhanced through rational use of antibiotics and combined with Chinese medicine based on syndrome differentiation. TCM is abundant experience in the treatment of febrile illnesses. For example, Zhang Zhong-jing, a famous physician of the Han Dynasty used syndrome differentiation Six meridians in the treatment of febrile illnesses. YE Tian-shi, a famous doctor of the Qing Dynasty used the differentiation of wei qi, ying and blood to treat seasonal febrile diseases. Based on the theory of internal injuries, LI Dong-yuan, a famous doctor of the Jin-Yuan Dynasty established the method to benefit Qi and invigorating yang to treat febrile diseases caused by internal injuries. Considering the impact of the characteristics of sepsis, we believe that the cause of fever, sepsis must be by exogenous pathogens, not to be "internal injuries". Therefore, we should deal with the syndrome differentiation of the six meridians and wei qi, ying and blood. Its location is within three yang channels, Ying-sang, the pathogenesis and the interior is occlusion pathogenic heat, depression and stagnation of qi. The base salary should highlight the principles of mediation, relieving the exterior syndrome, clearing and letting out pathogens in deeper layers (4). The basic requirements are combined with Chaihu Prescription Prescription Mahuang. For example, Xiao Chaihu decoction combined with Mahuang decoction with added southern wood must be used for mild cases. To seriously stagnated along with the interior heat abdominal distention and constipation, Da Chaihu decoction with maxing Shigan decoction and south of the wood must be used, and the platelet count gradually decreases at the beginning of coagulation dysfunction, which indicates the heat has penetrated the blood-ying stage Xijiao Emergency Department of Dongzhimen

Hospital affiliated to Beijing University of Chinese Medicine, Beijing (100700), China
Tel: 86-10-84013120, E-mail: liuqingquan_2003@yahoo.com.cn
Dol: 10.1007/sl 1655-009-0016-x
Dihuang decoction should be used together. CHEN Shi-duo, a doctor of the Qing dynasty considered Herba Artemisiae Annuae had the 'purging pathogenic fire without heat consume the qi and blood "(5). Professor Zhou Hong, the Fourth Military Medical University, has conducted numerous studies of Herba Artemisiae Annuae and confirmed its good quality, anti-inflammatory effects. It is an effective medication for the fever caused by sepsis. Herba Artemisiae Annuae, with special features such as "mediation, relieving the exterior syndrome and clearing pathogenic factors in the deeper layers and showed the curative effects on sepsis. It should be used in high doses, usually more than 30 g, consisting of decoctions. Since pathogens are located outside the layer, treatment should be taken as soon as possible. "If the pathogenic factor is outside the location, it should be dispersed through sweating. Ie, treatment should be based on the location of pathogens to achieve healing.

Regulating Qi and blood should be made in the treatment of coagulation dysfunction Sepsis Studies show that coagulation dysfunction is one of the main pathological mechanisms of sepsis, showing earlier reduction of platelets and later onset of disseminated intravascular coagulation (DLC). Even those who have symptoms of severe criticism in May be accompanied by shock. These are crucial points of severe sepsis. TCM considers that belongs to the pathogenesis of blood stasis syndrome. The main pathogenesis of sepsis is the accumulation of toxic heat and disruption of flow of Qi, causing mutual congealing of stasis of blood and toxins in the collateral, consumes qi, reduces the yin and yang . Therefore, it is a complex pathogenesis of the "interpenetration of asthenia and sthenia. But "the dysfunction of qi and blood" caused by the freezing of mutual stasis of blood and toxins is the main pathogenesis of sepsis in the process of coagulation dysfunction.

Therefore, it is essential to regulate the Qi and blood on the basis of "qi acting as commander of blood and be the mother of Qi." Patients helping and stasis of blood congealing syndrome toxin in a low level must be treated with the principle of regulating qi, activating blood and detoxification. The formula is established by Xuefu Zhuyu decoction WANG Qing-s, a famous doctor of the Qing dynasty, and Xue bijing for intravenous transfusion. The curative effect could be achieved in three or five days. "depletion syndrome" may appear in the case that the most obvious symptoms of the disease Shaoyin, such as sweat, cold extremities, unstable blood pressure trend is downward, small pulse virtual disappearance ", it is important to strengthen Qi and to recover the exhaustion that time, combined with promoting blood circulation and relieve toxin . Shengmai Powder and Shenfu decoction May be used by adding Notoginseng Radix, Radix angelicae
Sinensis, Flos safflower, Rhizome Rhei and Radix. Also, Shengmai injection of 100 mL and 100 mL per injection Shenfu can be used by continuous venous pump once a day, and Xuebiqing injection of 100 mL venous pumped twice a day. This can be effective in preventing the development of DIC in the stage of fibrinolysis and hemorrhage (6). The key in this phase is early intervention, and regulation of Qi and blood under the pathological mechanisms of the deficiency and excess syndromes at first.

Treatment of Septic Lung Injury should be combined with treatment of lung and large intestine, simultaneously, the "Lung" is the main body first injured in severe sepsis and characterized by acute lung injury at the beginning and as as acute respiratory distress syndrome in the late stage. Mechanical ventilation is the key for the symptomatic treatment, but essentially, it supports only the function of the body and provides the opportunity for other therapies. After many years of clinical practice, we found that traditional Chinese medicine plays a crucial role in the treatment of acute lung injury. The characteristics of acute lung injury are shortness of breath at the beginning of dysfunction and gastrointestinal symptoms such as constipation and abdominal distention or arise after mechanical ventilation in most patients. Therefore, the lung is still seriously injured, the development of acute respiratory distress syndrome or even led to treatment failure.

The pathogenesis of the syndrome differentiation of traditional Chinese medicine is that "stasis and the poison of collateral damage the lungs and then send the result of the large intestine and in the transport of dysfunction, which leads to both disorders lung and large intestine at the same time. " As "the lung and large intestine are correlated intérieurs externally by the meridians in traditional Chinese medicine, they must be treated simultaneously and Xuanbai Chengqi decoction, made by Wu Ju-Tong, a famous doctor of the Qing dynasty, added with the functions of herbs to promote blood flow, detoxification and the opening of collateral, such as salviae Miltiorrhizae Radix, Radix Paeoniae Rubra, Radix Notoginseng etc. In decoction, Radix Rhei and rhizomes should be used at doses elevated release of the obstacle of waste in the stomach and intestines. Practice has proved that the therapy of Chinese medicine can not only treat pulmonary lesions, but also to prevent the occurrence of acute respiratory distress syndrome.

Treatment of Multiple Organ Failure Syndrome should strengthen Genuine Qi and rescue exhaustion. The final outcome of sepsis is multiple organ dysfunction syndrome multiple organ failure, which is the main cause of sepsis death.

Therefore, prevention and treatment of multiple organ dysfunction syndrome is the key to lower the mortality of sepsis. Body of technical support in Western medicine can only sustain life but can not reduce the fatality rate. However, applications of these techniques play a crucial supporting role in Chinese medicine to cure it. If sepsis develops at the stage of multiple organ dysfunction, its clinical features are similar to "features of the syndrome of worsening disease Taiyang meridian and three yin disease," which belongs to the prostration syndrome " to the depletion of vital qi.

At this stage, treatment emerging from the collapse should be made immediately. Symptoms of prostration syndrome of sudden high fever, cold extremities, profuse sweating, unstable blood pressure, or decrease in blood platelets. Single decoction of ginseng can be used with red ginseng in any dosage, but not less than 30 g. May it be thick decocted and taken frequently. The author has successfully saved a patient with septic acute respiratory distress syndrome, acute renal failure, DLC step in fibrinolysis and chocs, red ginseng 250 g were taken decocted thickly and often nasal feeding within 24 h, and the patient was in a stable condition, five days later. Although ginseng decoction is only effective in the clinic, the key is to seize the administration of its amount and time. If the symptoms of yang deficiency with the confinement and disturbance of qi transformation, as polyhidrosis, oliguria, four extremities of cold and lack of spirit appear, it is to restore the lifting of the collapse and yang Shenfu decoction is mainly used. If patients have symptoms of oliguria and acute renal failure, herbs should be given: prepared Radix Aconite lateralis Preparata, Radix and Rhei Rhizome, Calcing fossilia ossis mastoid and oysters, carbonized Radix Sanguisorbae, so thick decocted by rectal drop by drop, in May that effectively prevent and treat acute renal dysfunction (7). In general, the goal of treatment at this stage should be to save the patient from the exhaustion of yin and yang as the heart, protect the functions of organs and, ultimately, reduce mortality.

Over the past two years under the direction of the basic theory of Chinese medicine, we followed the concept of wholism andequilibrium and used six-ying meridians and blood, as the syndrome differentiation system. Based on the four segments, we havealready cured 96 patients severe sepsis and the mortality rate was 19.18%. It shows the advantages and potential of the ability of traditional Chinese medicine in the treatment of sepsis.

At present, we have formed a relatively complete set of the protocol to treat sepsis. During the next stage, multi-center, randomized controlled blinded clinical trials are conducted in the following studies. Outcomesof hope that these studies in the next three years in May gradually lay the foundation for reducing deaths from sepsis TraditionalChinese ways of medicine

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