The Research Of Baihutang Clysis On Treating Qifen Of Epidemic Febrile Disease

Fever is common clinical symptom, as far as modern medicine is concerned, there are two kinds of fever: infectiousness and the non- infectiousness, latter including the aseptic necrosis matter absorption, the antigen - immune body response, endocrine and the metabolism dysfunction and the thermotaxic center dysfunction and so on. Reasons of fever are complex, but the high fever is one of emergencies, it is common in all kinds of diseases. During the high fever, internal environment and homeostasis will change. If patient with high fever can not be treated effectively in time, it will do the enormous harm to patient, even death. At present, the following is usual ways for fever and specially for high fever: physical way, NSAlDs, glucocorticoid, the antibiotic and the Chinese herbs.In ancient books of the Chinese traditional medicine pharmacy, there is much record about fever, they are abundant during all previous dynasties, but until the Ming and Qing Dynasties time, theory of epidemic febrile disease was formed, many febrile diseases were treated effectively guided by theory of epidemic febrile disease. After 1949, more and more clinical evidences indicate: febrile diseases can be effectively treated guided by theory of epidemic febrile disease. Since outbreak of SARS and birds flu, clinician attach great importance to theory of epidemic febrile disease, but there are some questions as far as clinical practice is concerned, such as patient's compliance and so on. This research used method of endotoxin intravenous injection to make animal model, studied the relation between different ways of Baihutang intake and effect in treating Qifen of epidemic febrile disease.First, literature studies of Qifen of epidemic febrile disease1. Clinical treatment situation of Qifen of epidemic febrile disease at presentAs far as high fever is concerned, common clinical treatment includeds: The physical therapy, NSAIDs, glucocorticosteroid, the antibiotic and the Chinese medicine. The physical therapy is only an expediential policy, there are some ralative contraindictions and absolute contraindictions, as for NSAIDs, such as: digestive tract ulcer and (or) the diseases of blood system. It is well known serious results after abuse of glucocorticosteroid. At present, the antibiotic has been widely uesed to treat fever caused by infection, but drug resistance, the double infection, dysbacteriosis are well known by more and more people. Now the antibiotic in recently day by day brings to people's attention regarding the endotoxin release influence. When choosing antibiotic, doctor often emphatically considered infection factor and so on bacterium type, medicine sensitivity as well as poisonous side effect, antibiotic sterilization process inevitably is following the bacterium disintegration and the certain quantity bacterium endotoxin release, it is different as far as different antibiotics killing bacteria and endotoxin release are concerned. Because the endotoxin plays an important role in S I R S and MODS, more and more doctors pay attention to endotoxin. At present, the use of antibiotic is facing the unprecedented huge challenge.As for Chinese medicine, there are not the above malpractice. As for some diseases with fever (or fever is the main symptom in some diseases), it is well known that theory of epidemic febrile disease can guide clinical practice, in the long historical process, ancient doctors studied and inherited past worthies' theory and the experience, expanded and enriched theory and the practice. We should better study and inherit them.The Baihutang appeared firstly in the book " treatise on febrile disease ", after " treatise on febrile disease ", ancient doctors utilized theory of epidemic febrile disease to treat epidemic febrile disease effectively. Baihutang can treat Qifen of epidemic febrile disease, it is cool and can protect body fluid. In Baihutang, gypsum is very cold, it treats Qifen of epidemic febrile disease and body fluid are protected. Anemarrhena is bitter and nourishing and moistening, anemarrhena can improve treat effect of gypsum. Qifen of epidemic febrile disease can be seen in diferent diseases and different periods in some diseases. Since 1949, more researches of Baihutang on treating Qifen of epidemic febrile disease have been carried, as for clinical practice, there are some shortcomings. Regarding the emergency patient, apozema was not actual, specially for some high fever patients with coma, it is difficult for both doctors and patients to accept apozema. It is necessary to regarding this kind of reality, It is necessary to change oral administration of apozema.2. Research of external therapy of Chinese medicineDevelopment of external therapy of Chinese medicine is promising, and important part of Chinese medicine therapy, paralleling with internal therapy of Chinese medicine, moreover, it can make up internal therapy of Chinese medicine. External therapy of Chinese medicine can be used to treat many kinds of diseases. There are many literature materials, in external therapy of Chinese medicine. External therapy of Chinese medicine is guided by principles of whole prospective and diagnosis and treatment on the basis of an overall analysis of the illness and the patient's condition. In clinical practice, it can treat some diseases by applying drugs through skin, orifice of the body and acupoint. Compared with internal therapy of Chinese medicine, external therapy of Chinese medicine is more quick, easily to operate and safe.3. The research of Chinese medicine clysisBased upon pharmacology research and the anatomy as well as the physiology theory, development of clysis of traditional Chinese medicine is promising. The Chinese medicine dosage of clysis is made of Chinese medicine liquid, directly filled into either dripped into the rectum, acting wholly or locally.After clysis, drugs are dissolved in secretory juice of the intestinal tract, then absorbed through mucous membrane. The medicine directly enters into circulation after the rectum absorption, both has prevented the gastric juice and each kind of enzyme from destroying the medicine, and avoided the liver filtering effect. Following are advantages of clysis: higher bioavailability;more quickly absorbing, more effective. So clysis suits to the treatment acute disease. Moreover, it can utilize advantages of Chinese medicine. Tests indicate that Chinese medicine clysis activate more quickly than bolus, tablet, aqua, suppository and muscle injection, nearly achieves the vein injection effect. Clysis is not limited by medicine and dosage-form, preparing more easily, using safely and easily.4. Review of BaihutangThe Baihutang appeared firstly in the book " treatise on febrile disease ", composed by the gypsum, anemarrhena, polished round-grained nonglutinous rice, the licorice. Its indication is Yangming jing syndrome with sympotoms of high fever, sweaty, thirsty and strong pulse. The latter doctors enriched and developed its indications after the massive clinical practices. At present, therapy mechanism of theBaihutang is not yet clear. From the 70's to the 90's, therapy mechanism of the Baihutang is researched, but different results appeared, so it is not sure how Baihutang treat diseases, although so, Baihutang can alleviate fever effectively, and its indications have exceeded record of " treatise on febrile disease ", widely used in various clinical branches.5.Research of relations among heat, blood stasis and endotoxin in Qifen of epidemic febrile disease.Based upon the literature material, in Qifen of epidemic febrile disease, there are close relations among heat, blood stasis and endotoxin. During pathogenesis, development and prognosis, the endotoxin plays the important role, the endotoxin can result the heat and the stasis, affect the clinical treatment, so the endotoxemia is the core. It is window to judge treatment effect whether endotoxemia can effectively be treated.The endotoxin is one kind of important pyrogens, which participates in the pathology process of fever, it may activate the neutral granular cell and so on, and make them release endogenous pyrogen, which may result fever by acting the thermotaxic center, even the trace endotoxin can cause the body temperature rise. Other pathological results because of endotoxin include: ischemia-reperfusion injury, dysfunction of the micro circulation, DIC, similar to the concept of the traditional Chinese medicine "stasis". As for patients in ICU, treatment of endotoxemia is key.Second, research of animal experiments on Baihutang clysis on treating Qifen of epidemic febrile diseaseTest one- making animal experiments of Qifen of epidemic febrile disease: it hasbeen several dozens years since animal models of Qifen of epidemic febrile disease were researched. It is different from animal models of wet-heat of epidemic febrile disease, which are made in wet-heat weather with heavy food and salmonella typhimurium. It is common for animal models of Qifen of epidemic febrile disease to use endotoxin. This model conforms to characteristics of Qifen of epidemic febrile disease. Since this model has been made, many pathological changes have been researched, such as "stasis" and how endotoxin affects disease. As far as treatment is concerned, scientists attach great importance to endotoxin. After using the method of endotoxin intravenous injection, animal model of Qifen of epidemic febrile diseasewas successfully made.The experiment indicates that: before animal model was made, domestic rabbits have used to environment of lab, temperature of different groups of domestic rabbits is nearly same. After animal model was made, except control group, other groups of domestic rabbits appeared: body temperature slowly rising, and temperature rising significantly until 1 hour compared with control group, named, animal model was made successfully, at the same time, there were not statistics difference among all groups of animal model. After animal model was made, the endotoxemia in domestic rabbit appeared whose direct symptom is fever. According to anus temperature measured, the domestic rabbits' temperature obviously elevated after animal model was made, which was result of pyrogen because of endotoxin.Test two-research of Baihutang clysis on decreasing temperature in Qifen of epidemic febrile disease: many related researches of Baihutang apozem have been carried, in Qing Dynasty's doctors regarded Baihutang as typical formula in treating Qifen of epidemic febrile disease. In clinical practice, oral adminstration is popular. But it is difficult for patients with serious infection, coma and those who can not accept oral adminstration. As for clinical practice, Qifen of epidemic febrile disease is common, and Qifen phase is crucial time when body is defending and disease developes. In this phase, disease will recover or become worse, so it is important to treat effectively disease which is in the phase of Qifen. The phase of Qifen is center between outside and inside including Yingfen and blood fen and determines prognosis.The experiment indicates that: After animal model was made, using deferent medicines in deferent groups until 2.5 hours, temperature decreased quickest in promethazine hydrochloride group, which can be explain by Pharmacology characteristic of promethazine hydrochloride. After 3 hours, temperature in Baihutang clysis group decreased slower than in promethazine hydrochloride group. After 4 hours, temperature in Baihutang clysis group decreased more effectively than both in promethazine hydrochloride group and Baihutang injection in the visceral cavity group. After 5 hours, temperature decreased effectively in following sequence: Baihutang clysis, Baihutang injection in the visceral cavity and promethazine hydrochloride. Based on Chinese medicine theory, Baihutang can treat heat of Qifen. Drug can be absorbed better after clysis because drug is absorbed through the intestinal tract without first pass effect, which can explain why temperature decreasedeffectively and strongly in Baihutang clysis group. Although promethazine hydrochloride can decrease temperature quickly, it acts for a short time which can be observed in the curve:a longer plat phase. After 3 hours, promethazine hydrochloride decreases temperature slowly. Both Baihutang clysis group and Baihutang injection in the visceral cavity group decreases temperature continually after 3 hours.Test three- research of Baihutang clysis on preventing development from Qifen to Yingfen and Bloodfen in Qifen of epidemic febrile disease: stasis is a characteristics because serious heat consumes body fluid and blood viscosity improves and the speed of flow thickly slows down. In the modern medicine, pathological results in endotoxemia such as ischemia-reperfusion injury, dysfunction of the micro circulation, DIC, are similar to the concept of the traditional Chinese medicine "stasis". Symptoms of MOFS because of endotoxemia include: sweaty, dysphoria, face red, dyspnea, pulse weak, tongue dry and red, which are similar to deficiency of both Qi and Yin and exhaustion of Yin and Yang. The pathological mechanism of Qifen of epidemic febrile disease because of endotoxin is "excessive heat, stasis, exhaustion of Yin and Yang". Modern medicine indicates that thrombocyte plays the important role in bleeding and blood coagulation. Thrombocyte has the following characteristics: adhesion and coagulation, release, clot recovery and attachment. There are many ingredients which are involved in blood coagulation with function of accelerating blood coagulation. Number of red blood cell is an important index to judge viscosity of blood. So number of both thrombocyte and RBC are two important indexes to observe stasis in Qifen of epidemic febrile diseaseThe experiment indicates that: when Baihutang decreases temperature, number of thrombocyte decreases and is very close to that in control group without significant statistical deference. Number of thrombocyte in both promethazine hydrochloride group and Baihutang injection in the visceral cavity group is higher than that in control group with significant statistical deference. Number of RBC in Baihutang clysis group is lower than that in promethazine hydrochloride group with significant statistical deference and is very close to that in control group. Number of thrombocyte is an important index which is involved in bleeding and blood coagulation. And viscosity of blood depends on number of RBC. After Baihutang clysis, number of thrombocyte is very close to that in control group, number of RBC is lower than that in promethazine hydrochloride group with significant statistical deference and is very close to that in control group. It indicates that Baihutang clysis can prevent effectivelydisease development from Qifen to Yingfen and bloodfen when it treats heat of Qifen. It proves the ancient concept that use of Baihutang in patients with real heat of Qifen can save patients' lives. Theory of epidemic febrile disease including Wei, Qi, Ying and blood can not only guide treatment of real heat, but also inherit the prevention theory of ((The Yellow Emperor's Canon of Internal Medicine)) and ((treatise on febrile disease)) .Test four- research of Baihutang clysis on eliminating endotoxin in Qifen of epidemic febrile diseaserendotoxin is a kind of pyrogen which participates in pathological mechanism of fever with many biological activities. Specially in body, endotoxin acts many ways such as complement system, blood coagulation, kinin and other body fluid ingredients and granulocyte, RBC, mononucleophage, thrombocyte and so on to make cells adhere to each other, cytolemma injury and cytolysis. Intermediate product between endotoxin and fluid can activate cell to stimulate a complicate chain reaction. Symptoms are results of endotoxin's biological effect. Endotoxin can result in organ dysfunction even failure. It is the key for treatment to eliminate endotoxin and improve ability to defend from endotoxin. A single herb is not enough to treat endotoxemia, compound prescription can make endotoxin lose activity by damaging endotoxin structure or improving immunity to eliminate endotoxin or accelerating evacuation to prevent endotoxemia because of endotoxin from intestinal tract. When Baihutang treats fever and prevent disease from Qifen to Yingfen and bloodfen, it is key for research whether Baihutang can effectively eliminate endotoxin, so is research for new drug.The experiment indicates that: in both Baihutang clysis group and Baihutang injection in the visceral cavity group, Baihutang can effectively eliminate endotoxin with significant statistical deference when decreasing temperature. Compared with Baihutang injection in the visceral cavity group, amount of endotoxin in Baihutang clysis group is more lower. It indicates that Baihutang can effectively eliminate pyrogen. Based on literature material, endotoxin plays an important role in pathological mechanism of infection. Eliminating endotoxin means etiological treatment. When Baihutang clysis treats fever, heat is treated, and amount of endotoxin falls, so body fluid and Qi are protected which can explain why Baihutang clysis treat fever longer and stronger. It is the key for treatment to eliminating endotoxin in blood to prevent disease from developing. Experiment result also indicates that Eliminating endotoxin is important mechanism for Baihutang clysistreating Qifen of epidemic febrile disease.Objective: To Study effect and mechanism of Baihutang clysis on treating Qifen of epidemic febrile disease.Method: To use the method of endotoxin intravenous injection to make animal model, and study the relation between different ways of Baihutang intake and effect in treating Qifen of epidemic febrile disease.Result: The defervescence of Baihutang clysis on treating Qifen of epidemic febrile disease is longer and better than Baihutang oral adminstration and promethazine hydrochloride. Moreover, after Baihutang clysis, domestic rabbit's quantity of blood platelet approaches the control group, and endotoxin can be eliminated effectively. Conclusion: Baihutang clysis can treat Qifen of epidemic febrile disease effectively, and prevent development from Qifen to Yingfen or Xuefen.