A Study Of The Literature On The Identification And Treatment Of Odor In Sores And Ulcers And Its Application To Patients With Gangrene

Objective:By compiling ancient and modern literature on the “odor” of sores and ulcers,establishing a “database of literature on the identification and treatment of odor in sores and ulcers”,and applying data mining techniques to uncover the rules of identification and to assess the odor of sores at the stage of gangrene and necrosis in clinical practice.The two were combined and applied to study,with the aim of enriching the TCM identification of malodorous sores and providing references for the diagnosis,treatment and improvement of prognosis of the gangrenous necrotic stage.Methods:The first part of the study was divided into two parts.In the first part,a combination of manual search and computer search was used to screen ancient and modern literature on the “odor”of sores,and the screened contents were entered into Excel software to establish a “database of literature on the identification and treatment of odor of sores”,which was classified and analyzed to summarize the theory of “identification and treatment of odor”of sores in Chinese medicine surgery.In the second part,odor assessment was performed on the sore surfaces of thrombo-occlusive vasculitis,lower extremity atherosclerotic occlusive disease,and diabetic foot at the necrotic stage with reference to international odor assessment standards,and differences in odor levels were observed between different diseases,clinical stages,Chinese medical evidence,and different pus flora.We also applied the theory of “treatment based on odor” derived from the compiled literature to enrich the Chinese medical evidence of malodorous sores and provide more ideas for the treatment of gangrene and necrosis and improvement of prognosis.Results:Part I: 1.Within the searched literature,a total of 205 articles on “odorous” sores were obtained after filtering and organizing.2.The Yellow Emperor’s Classic of Internal Medicine was the first classical work to propose odor identification,which laid the foundation for the theory of “odor identification”in Chinese medicine.3.The etiology of “odor” ulcers has internal and external causes,with cold,dampness,heat,stasis,and deficiency as the main pathogenic mechanisms.4.The treatment of “smelly”sores covers internal treatment,external treatment,special therapies,treatment contraindications,and prognostic care,and has basically formed a more complete treatment system;5.The severity of the odor determines the prognosis for regression,and when a smelly sore appears,it has generally developed into a late stage of the disease.Part II: 1.There was a significant difference(P<0.05)in the comparison of sore surface odor levels among TAO,ASO and DF,and a significant difference(P<0.05)in the comparison of sore surface odor levels among different TCM evidence types.2.For cases in the necrotic stage I of TAO,the cold-damp obstruction type was the most common,with an average score of 1 for the odor of the sore surface and the most bacterial culture results for Pseudomonas aeruginosa;for cases in the necrotic stage II,the blood stasis type was the most common,with an average score of 1.27 for the odor of the sore surface and the most bacterial culture results for Enterobacter cloacae and Escherichia coli;for cases in the necrotic stage III,the damp-heat toxic type was the most common,with an average score of 3.5 for the odor of the sore surface and the most bacterial culture results for Staphylococcus aureus and Escherichia coli.3.In ASO necrotizing stage I cases,the most common type was blood stasis,with an average score of 2.21 for sore surface odor,and the most common bacterial culture results were Enterobacter cloacae and Escherichia coli;in necrotizing stage II cases,the most common type was damp-heat and heat toxicity,with an average score of 4.04 for sore surface odor,and the most common bacterial culture results were Staphylococcus aureus and coagulasenegative Staphylococcus;in necrotizing stage III cases,the most common type was Qi and Blood deficiency,with an average score of 2.53 for sore surface odor,and the most common bacterial culture results were Pseudomonas aeruginosa.4.In DF Wagner grade 1 cases,the blood stasis type was the most common,with an average score of 3.25 for sore surface odor,and the most frequent bacterial culture results were Staphylococcus aureus and coagulase-negative Staphylococcus.In Wagner grade 2 and 3 cases,the blood stasis type and the damp-heat and toxic type were the most frequent,with mean scores of 4.37 and 4.58 for sore surface odor,and the most frequent bacterial culture results were for Enterobacter cloacae,Escherichia coli,and Staphylococcus aureus.In cases with Wagner grades 4 and 5,the most common types were heat and toxicity injuring yin and qi and blood deficiency,with an average score of 2.77 and 2.75 for the sore surface odor,and the most common bacterial culture results were Pseudomonas aeruginosa.Conclusion:There is a large amount of information on the identification of odor in the literature of traditional Chinese medicine surgery,which has been analyzed and organized to arrive at the "Theory of Treatment of Sores and Ulcers by Identification of Odor",covering many aspects of the etiology,pathogenesis,treatment rules,treatment methods,treatment contraindications,and prognosis and care of "odor" sores and ulcers.We also obtained the relationship between different clinical stages of gangrene,Chinese medical evidence and the odor level of the sore surface after clinical observation,in order to provide reference for modern clinical diagnosis and treatment of gangrene.