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Based on the Four Segments and Treatment by Syndrome

By:   |   Jul 08, 2018   |   Views: 7   |   Comments: 0

Differentiation to Lower the Mortality of Sepsis

LIU Qing-quan

Lowering the mortality of sepsis has become an important issue in the international critical care medicine because of its unacceptably high incidence. In 2004 and 2008, there were no essential breakthroughs in international guidelines for the management of severe sepsis and shock. The treatments did not meet the objective of lowering the clinical mortality of severe sepsis, which still remains at 30%-50%(1,2). The most important reasons are the complicated and unknown pathological mechanisms of sepsis and difficulty in making clear diagnosis in the early stage. It is hard to achieve an early diagnosis, early intervention and early selection of targeted therapies and drugs.

Chinese medicine emphasizes the diagnosis and treatment based on an analysis of clinical characteristics. Syndrome differentiation is the basic method of clinical judgment. Our prior professors, WANG Jin-da and WANG Bao-en, have conducted large amounts of clinical studies on the recognition of sepsis in Chinese medicine. They have put forward an innovative theory of "treatment of bacterium and toxin coordinately", which has integrated the theory of traditional Chinese medicine

(TCM) with Western medicine. They also successfully developed Xuebijing Injection, Ergotrophic Composition and Shenqi Huoxue Granule to decrease the mortality of severe sepsis successively. We have been engaged in clinical and fundamental researches on sepsis for more than 10 years. By fully absorbing our predecessors' research results and combining the pathological features of sepsis and its clinical characteristics, under the guidance of the Chinese medicine theory of combination of disease and syndrome, we put forward the scheme "based on the four segments, following the concept of wholism and equilibrium, treatment by syndrome differentiation"(3).

Treating the Septic Fever according to the Location of the Pathogenic Factors Fever is the most common symptom of sepsis, with a clinical incidence rate of 100% and has been paid most attention to by clinicians. The curative effect can be improved by the rational use of antibiotics and combined with Chinese medicine on the basis of syndrome differentiation. TCM has abundant experience in treating febrile diseases. For examples, ZHANG Zhong-jing, a well-known doctor in the Han dynasty, used syndrome differentiation of the Six meridians in the treatment of febrile diseases. YE Tian-shi, a famous physician in the Qing dynasty used the differentiation of wei, qi, ying and blood to treat seasonal febrile diseases. Based on internal injury theory, LI Dong-yuan, a well-known doctor in the Jin-Yuan dynasty created the method of benefiting qi and invigorating yang to treat febrile diseases caused by internal injuries. Considering the incidence characteristics of sepsis, we believe the cause of the fever by sepsis should be exogenous pathogens, not be "internal injuries". Therefore, we should treat it according to the syndrome differentiations of the six meridians and wei, qi, ying and blood. Its location is in three yang channels, ying-blood, and the pathogenesis is the inner occlusion of pathogenic heat, depression and stagnation of qi. The basic treatment principles should highlight the mediating, relieving exterior syndrome, clearing and letting-out pathogenic factors in deeper layers(4). The basic prescriptions are Chaihu Prescription combined with Mahuang Prescription. For example, Xiao Chaihu Decoction combined with Mahuang Decoction added with southern wood should be used for the mild case. For severely stagnated interior heat accompanied with abdominal distention and constipation, Da Chaihu Decoction with Maxing Shigan Decoction and southern wood, should be used, and for the platelet progressively decreasing with early coagulation dysfunction, which indicates the heat has penetrated into ying-blood stage, Xijiao Emergency Department of Dongzhimen

Dihuang Decoction should be used together. CHEN Shi-duo, a doctor in the Qing dynasty considered Herba Artemisiae Annuae had the function of "purging pathogenic fire-heat without consuming qi and blood"(5). Professor ZHOU Hong, from The Fourth Military Medical University, has carried out plenty of studies on Herba Artemisiae Annuae and confirmed its good, anti-inflammatory effects. It is an effective drug for the fever induced by sepsis. Herba Artemisiae Annuae, with special characteristics such as "mediating, relieving exterior syndrome and clearing out pathogenic factors in deeper layers" and shows good curative effects on sepsis. It should be used in large doses, usually more than 30 g, in compound decoctions. As the pathogenic factors are located at the exterior layer, the treatment should be taken as early as possible. "If the pathogenic factor is at the exterior location, it should be dispersed by sweating". That is to say, the treatment should be taken according to the location of the pathogenic factors to achieve curative effect.

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