| Professor Zhang Shuwen is an archiater and doctoral supervisor of Infection Department of Beijing Friendship Hospital affiliated to Capital Medical University; She is the academic experience inheriting instructor of the fifth batch of aged Chinese traditional medicine experts. She has made in-depth study in diagnosis and treatment of infectious diseases, sepsis and severe sepsis by combining traditional Chinese and western medicines. In the many years of clinical process, she has formed unique academic thoughts and accumulated rich clinical experience.1.The Origin of Professor Zhang Shuwen’s Academic Thoughts.Professor Zhang Shuwen is an archiater and doctoral supervisor of Department of Infection and Critical Care Medicine of Beijing Friendship Hospital affiliated to Capital Medical University. She is the academic experience inheriting instructor of the third, fourth and fifth batch of aged Chinese traditional medicine experts. Professor Zhang has more than 40 years of experience on treatment of acute infectious diseases by combining traditional Chinese and western medicine. She was a western medicine doctor, later went to learn the Chinese medicine class, and then she devoted herself to the career of combination of Chinese and western medicine. In recent 30 years, Professor Zhang has been in the research group led by Professor Wang Baowen. Together with Professor Zhao Shuying, they have been engaged in clinical research of acute infectious disease by combining traditional Chinese and western medicine.2.Summary of Professor Zhang Shuwen’s Academic Thoughts and Clinical Experience.In the learning process, I feel that Professor Zhang has inherited the academic thoughts of Professor Wang Baoen, but has her own unique innovative ideas. Professor Zhang advocates: Western medicine can differentiate the disease, Chinese medicine can differentiate the syndrome. Application of the method of combining traditional Chinese and western medicine can realize complementary advantages of Chinese and western medicines on diagnosis and treatment, so can improve the clinical curative effect; For severe acute febrile patients, the clinical curative effect will be better when use the method of combining traditional Chinese and western medicine for diagnosis and treatment. On the basis of western medicine diagnosis and treatment of severe acute febrile disease, traditional Chinese medicine’s evidence-based analysis concept is an important complement, which can improve the curative effect; The infectious multiple system and organ failure can be differentiated as four main TCM syndrome types;In TCM diagnosis and treatment process, we should pay attention to strengthening the body resistance and eliminating evil. When strengthening the body resistance, we should protect the spleen and stomach and nourish Yin; when eliminating evil, we should attach great importance to the heat-clearing method method and purgative method.Professor Zhang and Professor Wang Baoen had began to make diagnosis and give treatment for multiple system and organ failure in the early 1970s, completed TCM clinical syndrome differentiation and established the corresponding principle-method-recipe-medicines for infectious multiple system and organ failure in 1980s. They established a complete diagnosis and treatment system from principle-method-recipe-medicines aspects. From 2003 to 2007, they conducted clinical verification of this system by clinical research of multi-center large sample. Severe acute febrile disease, namely, infectious multiple system and organ failure has four main TCM syndrome types:excessive heat syndrome, blood stasis syndrome, gaseous distention syndrome and syncope and collapse syndrome. Heat syndromes can be divided into excessive heat syndrome, heat in the wet syndrome, excessive heat injury Yin syndrome. Every syndrome’s differentiation points are as follows. Excessive heat syndrome is manifested as fever, red tongue, yellow coating on the tongue, like cold drinks, large and vigorous pulse. Heat in the wet syndrome is manifested as fever, red tongue, yellow greasy coating on the tongue, not thirsty, not want to drink, only hot lingering. Excessive heat injury Yin syndrome is manifested as fever, red tongue, little fluid on the tongue, little or no coating on the tongue, dry mouth, want to drink. Blood stasis syndrome’s differentiation points include a fixed pain, petechiae, ecchymoses, dark purple tongue, platelet decline, abnormal laboratory indices of blood coagulation function. Gaseous distention syndrome’s differentiation points include abdominal distention, reduced or absent bowel sound, no independent defecation and exhaust. Syncope and collapse syndrome’s differentiation points include acro-cold and damp, thready rapid pulse, faint pulse verging on expiry, blood pressure drops.The therapeutic principle of heat syndrome is heat-clearing and detoxifying, strengthening the body resistance and eliminating evil. Professor Zhang is good at using Compound Heat-clearing Granule (composed of herba patriniae, dandelion, barbed skullcap herb, giant knotweed, etc) for treatment of heat syndromes.Aimed at blood stasis, Professor Zhang takes replenishing qi, activating blood and dispersing blood stasis as the method of treatment, and the prescription often applies Qishen Huoxue Granule (composed of Raw Radix Astragalis, angelica sinensis, rhizoma ligustici wallichii, Salvia miltiorrhiza, red paeony root, safflower, etc.) to promote the blood circulation and remove blood stasis in the early stage.Aimed at gaseous distention syndrome, Professor Zhang often takes the method of regulating the flow of vital energy, reducing excessive inflation, purging away excessive heat and removing bowel obstruction, applies traditional Chinese medicine Tongfu Granules (composed of magnolia officinalis, elecampane, rhubarb, immature bitter orange, pericarpium citri reticulatae, pericarpium citri reticulatae viride, raw radix astragalis and angelica sinensis) to relieve the abdomen.Aimed at Syncope and collapse syndrome, Professor Zhang often advocates benefiting qi for activating blood circulation, rescuing from collapse by restoring Yang, promoting blood circulation and invigorating Yin, so as to promote the micro-circulation. Qishen Huoxue Granules, Pulse-activating Injection and Shenfu injection are commonly used in the prescription for treatment.Professor Zhang thinks that, although the traditional Chinese medicine has no concept of how dirty failure, sepsis, Huangdi’s Internal Classics in the spring and autumn period, Treatise on Febrile Diseases written by Zhang Zhongjing and Six-meridian Syndrome Differentiation in the Han Dynasty, Treatise on Tepidity written by Ye Tianshi and Syndrome Differentiation of Weifen in the Qing Dynasty, are all famous in treatment of acute infectious diseases. These treatises have treated a large number of patients for thousands of years, and accumulated a wealth of experience. Take the modern medicine’s diagnosis and treatment of infectious multiple system and organ failure as the base, and apply Chinese medicine’s syndrome differentiation and treatment, then we can obtain good clinical effect. Professor Zhang pays special attention to comprehensive analysis by the four examination methods of traditional Chinese medicine, especially attaches great importance to the interrogation and advocates "ten question song"Professor Zhang thinks that, interrogation is to ask systematic and purposeful questions to the patients or accompanying person, including the patient’s physical condition, living habits, onset causes, pathogenesis and treatment process, current symptoms and past medical history, family history, and so on. In particular, these questions can include inquiry about cold and heat, inquiry about sweating, inquiry about pain, inquiry about sleep, inquiry about diet, inquiry about urine and stool, etc.Professor Zhang has a unique understanding about heat with dampness or damp-heat syndrome. She thinks, since Huangdi’s Internal Classics, there has been some record of traditional Chinese medicine on damp-heat syndrome, saying that" if heat and dampness is not removed, the big tendon will be short, and the small tendon will be slack". "Nanjing" has classified damp-heat syndrome as one of the five kinds of typhoid disease. This was discussed in all later dynasties. Especially in the late Qing period, along with the development and mature of the science of seasonal febrile diseases, the research about damp-heat diseases has got great progress, such as Ye Tianshi’s Treatise on Tepidity, Xue Shengbai’s Treatise on Differentiation and Treatment of Damp-heat Diseases. Wu Jutong"s Treatise on Differentiation and Treatment of Epidemic Febrile Disease gave more detail about damp-warm syndrome. In the chapter "sick of dampness in autumn" in Treatise on Seasonal Diseases written by Lei Shaoyi, two diseases—damp-heat syndrome and damp-warm syndrome were classified. At this point, all these treatises have provided extremely rich and valuable literatures and guideline for today’s clinical research on damp-heat diseases.For patients with acute infectious diseases, some of them have the clinical manifestation of heat lingering and difficult to bring down the fever, prolonging the fever process. The clinical syndromes include:being thirsty and not want to drink; full and stuffy Ren meridian; fat and whitish even thick and greasy tongue. Xue Shengbai pointed out in his "Warm Heat Disease" that, "for damp heat syndrome patients, they will be intolerant to cold, then get fever without chill, sweat out, mass in chest, white tongue, be thirsty and don’t want to drink". Xue Shengbai took this as the outline of treatment of damp-heat diseases. For damp-heat disease, the treatment shall be given to the heat and dampness at the same time, according to the priority order. Generally speaking, if the evil is in the upper-burner (weifen), follow the study of Ye Tianshi that "warm evil is at weifen, use pungent cool medicine to remove the evil heat and sweat out", use sweet-scented and cool agent such as Huoxiang Zhengqi Powder and Sanren Decoction. If the evil is in the medium burner, give medicines which help to disperse and remove obstacles. The book Medical Faculty Marking Line points out that:"for predominant wet person, remove his dampness; for predominant heat person, remove his heat. If dampness is more than heat, he may not be treated by heat method, which will produce more dampness; If heat is more than dampness, he may not be treated by wet method, which will produce more heat." For prominent wet patient, take the priority to eliminate the dampness, then clear the heat, with the prescription of Huopu Xialing Decoction and Buhuangjin Zhengqi Powder. For prominent heat patient, take the priority to clear the heat with bitter cold herbs, then remove the dampness, with the prescription of Lianpu Drink and Decoction of Scutellaria Root and Talc, and so on.Clinically, for dampness patients, we mainly use ageratum, perrin and Liuyi Powder in the summer, and mainly use Sanrcn Decoction in the winter. In recent years, Professor Zhang has keen interest in constitution of traditional Chinese medicine and treatment based on syndrome differentiation. She realizes that the TCM constitution is an important part of the basic theory of TCM, it is an emerging discipline and we should conduct comprehensive and systematic research on the clinical application related to TCM constitution. For example, carry out clinical and basic research about unknown heat (fever of unknown origin) and the TCM constitution and gene, so as to provide basis for diagnosis and treatment of unknown heat with traditional Chinese medicine. In the three years of clinical practice following Professor Zhang, I often feel I do not know how to start the diagnosis and treatment for some cases; but after Professor Zhang’s analysis and suggestion, I often feel suddenly enlightened, so this experience and thought is very valuable. Professor Zhang is especially good at making diagnosis and giving treatment for severe acute external heat diseases, namely severe sepsis, severe acute pancreatitis, fever of unknown origin, infections caused by low immune function such as pneumonia after renal transplantation, large carbuncle, lung abscess, liver abscess, etc. She often uses the method of combining the traditional Chinese medicine and western medicine, and this method often receives good effect.3.Clinical research of Compound Heat-clearing Granules’effect on the inflammation markers of patients with sepsis of excessive heat.Purpose:to observe the Compound Heat-clearing Granules’effect on the inflammation markers of patients with sepsis of excessive heat. Methods:choose 60 cases meeting the standard of sepsis of excessive heat from the patients of Infection Department of Beijing Friendship Hospital during the period from May 2014 to May 2015, randomly divided into Chinese medicine group and control group with each 30 cases, and give routine western medicine treatment to both groups (add Compound Heat-clearing Granules to the Chinese medicine group). Test the inflammation marker changes of both group cases before and after the treatment, including IL-10, TNF-a, TREM-1, TLR4, PCT, CRP, etc. Results:the effective rate of Chinese medicine group is 90.6%, and the control group is 75.2%, so the curative effect of Chinese medicine group is better than that of control group (p< 0.05); days for body temperature drop to normal:the Chinese medicine group is 7.50±5.35 days, and the control group is 8.44±5.64 days, so there is no significant difference between the two groups (p> 0.05); hospitalization days:the Chinese medicine group is 12.25±3.21 days, and the control group is 12.14±4.25 days, so there is no significant difference between the two groups (p> 0.05). After treatment, both groups’inflammation markers including TREM-1, TLR4, CRP, PCT and TNF-ahave decreased, and the Chinese medicine group has more obvious decrease at TREM-1, TNF-a and PCT than the control group (p< 0.05); the IL-10 marker has risen after treatment, there is no significant difference between the two groups (p>0.05); TREM-1 is positively correlated to IL-10 and TNF-a (p<0.05); Conclusion: when Compound Heat-clearing Granules is used in the treatment of sepsis, it has some effect on the inflammation markers of patients with sepsis of excessive heat. After treatment, TREM-1, CRP, TNF-aand PCT have decreased, and the Chinese medicine group has more obvious decrease at TREM-1, TNF-a and PCT than the control group, which indicates that Compound Heat-clearing Granules can treat sepsis by intervening the inflammatory factor. |
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