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Traditional chinese medicine diagnosis "yang-xu zheng": significant prognostic predictor for patients with severe sepsis and septic shock.

Lin SJ, Cheng YY, Chang CH, Lee CH, Huang YC, Su YC - Evid Based Complement Alternat Med (2013)

Bottom Line: TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor- α , Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit.APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors.APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences.

View Article: PubMed Central - PubMed

Affiliation: Department of Chinese Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan ; Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan ; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.

ABSTRACT
Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM) Zheng diagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor- α , Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors. The multivariate logistic regression analysis identified Yang-Xu Zheng as the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs of Yang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis "Yang-Xu Zheng" may provide a new mortality predictor for septic patients.

No MeSH data available.


Related in: MedlinePlus

Hypothesis of pathogenesis of sepsis in traditional Chinese medicine. Solid rectangles denote “pathogen-excess type” TCM Zhengs. Void rectangles denote “human body-deficiency type” TCM Zhengs. Arrows denote possible transition directions and pathways of TCM Zhengs.
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fig1: Hypothesis of pathogenesis of sepsis in traditional Chinese medicine. Solid rectangles denote “pathogen-excess type” TCM Zhengs. Void rectangles denote “human body-deficiency type” TCM Zhengs. Arrows denote possible transition directions and pathways of TCM Zhengs.

Mentions: The human body-deficiency type manifests in late phases of sepsis, in which there is overexpression of inflammatory mediators and multiple impaired functions of body organs [28]. Along with disease progress, pathological heat in Qi-, Nutrient-, and Blood-phase consume Qi-, Blood, Yin, and Yang, four basic elements to maintain body functions in TCM perspective. Therefore, Qi-, Blood-, Yin-, and Yang-Xu (氣虛證, 血虛證, 陰虛證, 陽虛證) were the four TCM Zhengs finalized in human body-deficiency type. Finally, experts' opinions on the hypothesis of pathogenesis in TCM reached consensus. Figure 1 illustrates a hypothesis of possible transition directions and pathways of TCM Zhengs from bacterial or viral infection to human death. Diagnostic criteria of each TCM Zheng were modified and established from TCM literature, considering easiness to operate in the environment of an Intensive Care Unit (Table 1).


Traditional chinese medicine diagnosis "yang-xu zheng": significant prognostic predictor for patients with severe sepsis and septic shock.

Lin SJ, Cheng YY, Chang CH, Lee CH, Huang YC, Su YC - Evid Based Complement Alternat Med (2013)

Hypothesis of pathogenesis of sepsis in traditional Chinese medicine. Solid rectangles denote “pathogen-excess type” TCM Zhengs. Void rectangles denote “human body-deficiency type” TCM Zhengs. Arrows denote possible transition directions and pathways of TCM Zhengs.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824639&req=5

fig1: Hypothesis of pathogenesis of sepsis in traditional Chinese medicine. Solid rectangles denote “pathogen-excess type” TCM Zhengs. Void rectangles denote “human body-deficiency type” TCM Zhengs. Arrows denote possible transition directions and pathways of TCM Zhengs.
Mentions: The human body-deficiency type manifests in late phases of sepsis, in which there is overexpression of inflammatory mediators and multiple impaired functions of body organs [28]. Along with disease progress, pathological heat in Qi-, Nutrient-, and Blood-phase consume Qi-, Blood, Yin, and Yang, four basic elements to maintain body functions in TCM perspective. Therefore, Qi-, Blood-, Yin-, and Yang-Xu (氣虛證, 血虛證, 陰虛證, 陽虛證) were the four TCM Zhengs finalized in human body-deficiency type. Finally, experts' opinions on the hypothesis of pathogenesis in TCM reached consensus. Figure 1 illustrates a hypothesis of possible transition directions and pathways of TCM Zhengs from bacterial or viral infection to human death. Diagnostic criteria of each TCM Zheng were modified and established from TCM literature, considering easiness to operate in the environment of an Intensive Care Unit (Table 1).

Bottom Line: TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor- α , Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit.APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors.APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences.

View Article: PubMed Central - PubMed

Affiliation: Department of Chinese Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan ; Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan ; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.

ABSTRACT
Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM) Zheng diagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCM Zheng diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor- α , Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency of Nutrient-phase heat, and Qi-Xu and Yang-Xu Zhengs were significantly higher in nonsurvivors. The multivariate logistic regression analysis identified Yang-Xu Zheng as the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and without Yang-Xu Zheng revealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs of Yang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis "Yang-Xu Zheng" may provide a new mortality predictor for septic patients.

No MeSH data available.


Related in: MedlinePlus