Objective To explore the effect of Dachaihu decoction on the Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)signaling pathway and gastrointestinal mucosal barrier in rats with severe heat stroke.Methods Sixty SPF grade Sprague-Dawley(SD)male rats were divided into normal control group,model group,Dachaihu decoction standard dose group and Dachaihu decoction high dose group of 15 rats in each group.The heat stroke model was replicated in the rats at temperature(40.5±0.5)℃and humidity(65.0±2.0)%;the normal control group was not treated.From 6 hours after mold making,drug intervention was carried out in the Dachaihu decoction high dose group and the Dachaihu decoction standard dose group of 3.38 g·kg-1·d-1 and 1.69 g·kg-1·d-1,every 8 hours for 2 days.Equal amounts of normal saline were administered to the normal control group and model group.At 6,24 and 48 hours after the molding,5 mL abdominal main artery blood from 5 rats were randomly collected from each group,and the blood was obtained by enzyme-linked immunosorbent assay(ELISA)to determine the levels of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),D-lactic acid,intestinal fatty acid-binding protein(I-FABP).At the same time,the ileum tissue was retained,and the protein expression of TLR4 and NF-κB in intestinal tissue was determined by Western blotting.Some of the ileal tissue was obtained for hematoxylin-eosin(HE)staining,and the intestinal histopathological changes were observed under light microscopy.Results The normal control group of rats had no significant change,and the other three groups showed heatstroke symptoms after mold making.The overall mortality in drug group were significantly lower than that in the model group[3.3%(1/30)vs.20.0%(3/15),P＜0.05].Compared with the normal control group,the serum IL-1,TNF-α,I-FABP,D-lactic acid and the protein expression levels of TLR4 and NF-κB in the model group,Dachaihu decoction standard dose group and Dachaihu decoction high dose group all increased.Compared with the model group,at 24 hours and 48 hours after molding in the Dachaihu decoction standard dose group and Dachaihu decoction high dose group,the serum IL-1,TNF-α,I-FABP,D-lactic acid and the protein expression levels of TLR4 and NF-κB significant decreased[24 hours:TNF-α(ng/L):69.20±4.32,59.37±4.31 vs.76.99±5.02,IL-1(ng/L):132.68±4.93,112.59±9.64 vs.146.75±10.12,I-FABP(mmol/L):504.35±22.23,453.37±32.38 vs.542.58±13.83,D-lactic acid(mmol/L):114.55±8.52,90.57±3.09 vs.127.87±8.37,protein expression of TLR4(A value):1.50±0.08,1.23±0.01 vs.1.86±0.08,protein expression of NF-κB(A value):1.61±0.05,1.21±0.05 vs.1.97±0.08;48 hours:TNF-α(ng/L):58.46±5.13,38.98±5.53 vs.90.21±3.02,IL-1(ng/L):119.12±4.57,84.12±5.08 vs.170.20±6.21,I-FABP(mmol/L):436.04±27.63,321.85±22.03 vs.618.79±12.31,D-lactic acid(mmol/L):87.35±6.84,70.38±4.33 vs.154.14±10.83,protein expression of TLR4(A value):1.19±0.05,1.10±0.13 vs.2.09±0.06,protein expression of NF-κB(A value):1.15±0.09,0.97±0.08 vs.2.20±0.02,all P＜0.05].The expression levels of TNF-α,I-FABP,TLR4 and NF-κB protein in Dachaihu decoction high dose group decreased significantly at 24 hours and 48 hours compared with the standard dose group,however,IL-1 and D-lactic acid decreased significantly at 48 hours after molding(all P＜0.05).The pathology observation showed that,compared with the model group,the intestinal mucosa villus,the lamina propria drop and haemorrhage was decreased in the Dachaihu decoction standard dose group and Dachaihu decoction high dose group.Telangiectasia was reduced and no ulcer formation was observed.Conclusion Dachaihu decoction can inhibit TLR4/NF-κB signaling pathway,reduce intestinal inflammatory response,thus reduce gastrointestinal damage,and protect the gastrointestinal mucosal barrier in rats with severe heatstroke.

Objective To explore the effect of Fuling Sini decoction on cardiac function in patients with sepsis-induced cardiomyopathy(SIC).Methods Sixty SIC patients admitted to the department of intensive care unit(ICU)of Shenzhen Hospital(Longgang)of Beijing University of Traditional Chinese Medicine(TCM)from January 2021 to December 2022 were divided into a control group and a treatment group using a random number table method,with 30 patients in each group.Both groups received routine treatment,and the treatment group received Fuling Sini decoction(consisting of Poria cocos 30 g,Dry ginger 12 g,Ginseng 10 g,Prepared aconite 12 g,and Roasted licorice 15 g)based on routine treatment.Each dose was decocted into 200 mL,1 dose per day,divided into 3 times.Both groups of treatments lasted for 8 days.The use time of vasoactive drugs,ICU stay time and total hospital stay time,the 28-day mortality of two groups were recorded.TCM symptom score,sequential organ failure assessment(SOFA),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),procalcitonin(PCT),arterial oxygenation index(PaO2/FiO2),blood lactic acid(Lac),cardiac troponin Ⅰ(cTnⅠ),N-terminal pro-brain natriuretic peptide(NT-proBNP),heart type-fatty acid binding protein(H-FABP),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),mitral orifice early diastolic blood flow velocity(E),mitral orifice late diastolic blood flow velocity(A),and E/A ratio and tricuspid annular plane systolic excursion(TAPSE)were observed.Results The use time of vasoactive drugs,ICU stay time,and total hospital stay time in the treatment group were significantly shorter than those in the control group[use time of vasoactive drugs(days):4.47±2.16 vs.6.32±3.23,ICU stay time(days):9.18±3.32 vs.12.25±4.39,total hospital stay time(days):13.58±5.14 vs.17.13±6.65,all P<0.05].There was no statistically significant difference in the 28-day mortality between the treatment group and control group[20.00％(6/30)vs.43.33％(13/30),P>0.05].After treatment,the APACHE Ⅱ score and SOFA score in both groups decreased compared to before treatment,with a more significant decrease in the treatment group.The comparison between the two groups was most significant after 8 days of treatment(APACHE Ⅱ score:13.71±3.37 vs.16.21±3.82,SOFA score:3.24±0.85 vs.4.13±1.56,all P<0.05).After treatment,both groups showed a significant decrease in TCM syndrome scores compared to before treatment,with a more significant decrease in the treatment group(26.25±6.44 vs.29.43±6.83 on 3 days of treatment,21.42±4.22 vs.24.81±4.65 on 5 days of treatment,14.43±3.45 vs.17.58±4.56 on 8 days of treatment,all P<0.05).After treatment,PCT,Lac,and H-FABP in both groups decreased compared to before treatment,while PaO2/FiO2 increased,the treatment group showed more significant changes compared to the control group,especially after 8 days of treatment[PCT(μg/L):2.47±1.18 vs.3.54±1.51,Lac(mmol/L):1.86±0.41 vs.2.33±0.64,H-FABP(μg/L):4.67±1.22 vs.6.34±1.55,PaO2/FiO2(mmHg,1 mmHg≈0.133 kPa):297.63±53.92 vs.265.44±48.38,all P<0.05].After treatment,cTnI,NT-proBNP,LVESD,and LVEDD first increased and then decreased in both groups,while LVEF,E/A ratio and TAPSE first decreased and then increased,reaching a valley or peak at 8 days of treatment.Moreover,the above indicators showed statistical significance compared to the control group[cTnI(μg/L):0.15±0.06 vs.0.24±0.13,NT-proBNP(ng/L):825.43±164.73 vs.1234.40±243.37,LVESD(mm):48.36±4.46 vs.52.64±5.15,LVEDD(mm):38.39±3.22 vs.41.87±2.65,LVEF:0.55±0.08 vs.0.50±0.07,E/A ratio:1.23±0.12 vs.1.12±0.08,TAPSE(mm):22.45±2.23 vs.20.55±2.66,all P<0.05].Conclusion Fuling Sini Tang can improve the TCM syndrome of SIC patients,improve heart function,reduce myocardial injury,and shorten hospitalization time,making it a treatment worthy of clinical promotion.

Objective To analyze the acupoint selection rule of acupuncture and moxibustion in the treatment of gastrointestinal dysfunction associated with sepsis,thereby providing a reference for clinical treatment.Methods A systematic search was conducted in several databases,including China national knowledge infrastructure(CNKI),China Science Periodical Database,Chinese Science and Technology Journal Database,Chinese Biomedical literature database(CBM),Wanfang Data,and VIP Database,from the inception of the databases until September 30,2023.The collected literature was organized in an Excel database and subjected to descriptive analysis.Association rule analysis and cluster analysis were performed using SPSS 26.0 and SPSS Modeler 18.0 software.Results Finally,35 acupuncture and moxibustion prescriptions in 35 articles were selected for frequency statistics.The results showed 33 acupoints were used to treat gastrointestinal dysfunction in sepsis,with an overall frequency of use of 176 acupoints.The top 10 acupoints used by acupuncture and moxibustion for the treatment of gastrointestinal dysfunction in sepsis from high to low were Zusanli,Tianshu,Shangjuxu,Zhongwan,Neiguan,Xiajuxu,Guanyuan,Qihai,Shangwan,Xiawan.The top 3 were Zusanli(16.5%),Tianshu(13.6%),Shangjuxu(11.9%).The most commonly used meridians were the Foot Yangming Stomach Meridian(52.8%),Ren Meridian(23.9%),and Foot Taiyin Spleen Meridian(8.0%).The main sites for acupoint selection were the lower limbs(44.9%)and abdomen(41.5%).The most commonly used acupoints were combined acupoints below specific acupoints(35.2%),followed by recruited acupoints(27.8%).The results of high-frequency acupoint correlation analysis showed that the acupoints with the highest comprehensive support were Zusanli,Tianshu,Zhongwan,and Shangjuxu.Cluster analysis identified 5 effective clusters(Quchi acupoint-Sanyinjiao acupoint-Neiting acupoint-Daheng acupoint-Jiaji acupoint-Yinlingquan acupoint-Shangwan acupoint-Xiawan acupoint,Guanyuan acupoint-Qihai acupoint-Neiguan acupoint-Xiajuxu acupoint,Tianshu acupoint-Shangjuxu acupoint,Zhongwan acupoint,Zusanli acupoint)and 4 commonly used acupoint combinations(Guanyuan acupoint-Qihai acupoint-Neiguan acupoint-Xiajuxu acupoint,Tianshu acupoint-Shangjuxu acupoint,Zhongwan acupoint,Zusanli acupoint).Conclusions Acupuncture treatment for gastrointestinal dysfunction in sepsis is mainly based on the treatment of"spleen and stomach",with local acupoint selection and acupoint selection along the meridian as the main approach.It emphasizes the application of specific acupoints,especially the Xiahe and Mu acupoints.