从邪伏湿遏论脓毒症合并多重耐药菌感染

Discussion About Sepsis Complicated with Multi-drug Resistant Bacteria Infection from the Perspective of Latent Pathogens and Suppressed Dampness

脓毒症合并多重耐药菌感染病机为正虚、邪伏、湿遏。正气虚弱,卫外不足,易于感染耐药菌,毒邪更损正气,气虚复感外邪,毒邪内陷,隐伏于内,失治误治伤正后,伏邪乃发。湿邪使正不识邪,阻邪外出。邪毒内陷,与湿相交,或热自内发,蒸动湿邪,湿热壅遏,难解难分;或寒湿相得,邪毒冰伏,阳失鼓动,邪郁不达,缠绵难愈,变证多端。治疗当以扶正、透邪、祛湿为法则,兼顾气血阴阳,方用芪归银方。偏热盛者,给予达原饮加减,病在少阳,加柴胡、青蒿等和解表里;病在太阳,加羌活、独活等疏达通络;病在阳明,加大黄、芒硝、葛根等升清泻浊;病在厥阴,加羚羊角、生牡蛎等平肝熄风;病在少阴,加淡豆豉、玄参等滋阴透邪。偏寒盛者,可用化湿败毒方、清肺排毒方、宣肺排毒方等,若寒胜伤阳,可用麻黄附子细辛汤、麻黄附子甘草汤等鼓动元阳,散寒除湿。

The pathogenesis of sepsis complicated with multi-drug resistant bacteria infection is deficient healthy qi,latent pathogens and suppressed dampness.Deficient healthy qi and insufficient defensive qi are easy to be infected with drug-resistant bacteria,so toxin pathogen may damage healthy qi even more.If qi deficiency is complicated with external pathogens,toxin pathogen may be deeply trapped and hidden inside body.If the patient loses the opportunity of treatment or gets mistreatment,healthy qi will be injured and latent pathogens will occur.Dampness pathogen makes healthy qi not recognize it leading to preventing pathogen from going out.The pathogen toxin is invaginated and intersects with the dampness,or the heat is generated from the inside,steaming the dampness pathogen,and the dampness heat is choked up,which is inseparable;Or cold and dampness are mixed,the dampness pathogen is frozen,the yang loses the motivation to move,the pathogens and depression will intermingle each other and the syndromes will be changeable.Therefore,the treatment should be based on the principle of strengthening healthy qi,penetrating pathogens and removing dampness,giving consideration to both qi,blood,yin and yang,Astragalus and Chinese Angelica and Flos Lonicerae Japonicae Decoction can be used.For patients with excessive heat,Modified Membrane-Source-Opening Decoction can be used.For disease in the lesser yang meridian,Chaihu(Radix Bupleuri) and Qinghao(Herba Artemisiae Annuae) can be added to harmonize exterior and interior.For disease in the greater yang meridian,Qianghuo(Radix et Rhizoma Notopterygii) and Duhuo(Radix Angelicae Pubescentis) can be used to dredge meridians.For disease in the yang brightness meridian,Dahuang(Radix et Rhizoma Rhei),Mangxiao(Natrii Sulfas) and Gegen(Radix Puerariae Lobatae) can be used to ascend lucidity and purge turbidity.For disease in the reverting meridian,Lingyangjiao(Cornu Saigae Tataricae) and raw Muli(Concha Ostreae) can be use to pacify liver and extinguish wind.For disease in the lesser yin meridian,Dandouchi(Semen Sojae Praeparatum) and Xuanshen(Radix Scrophulariae) can be used to nourish yin and penetrate pathogens.For the patients with excessive cold syndrome,Dampness-Clearing and Toxin-Resolving Decoction,Lung-Clearing and Toxin-Resolving Decoction,Lung-Dispersing and Toxin-Resolving Decoction,etc.can be adopted.If excessive cold hurts yang,Ephedra and Aconite and Asarum Decoction,Ephedra and Aconite and Licorice Decoction can be used to stimulate original yang,dispel cold and remove dampness.