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JKM > Volume 45(2); 2024 > Article
Lee, Lee, Jo, and Park: A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome

Abstract

Objectives

This research is designed to analyze the relationship between Sayeok-tang(四逆湯) and systemic inflammatory response syndrome in literature.

Methods

The main treatment symptoms of Sayeok-tang(四逆湯) presented in Sanghanron(傷寒論) and Geumgweyoryak (金匱要略), and the symptoms of Ju-hwang(走黃) and Nae-ham(內陷), which is a sepsis and systemic inflammatory response syndrome in Korean medicine were analyzed. The symptoms of systemic inflammatory response syndrome presented in the related researches including diagnosis criteria and international guideline presented at the consensus conference hosted by the American College of Chest Physicians and The Society of Critical Care Medicine were also compared and analyzed.

Results

The main treatment symptoms of Sayeok-tang(四逆湯) and symptoms of systemic inflammatory response were very similar, and were almost identical to the symptoms of Nae-ham (內陷, especially Gun-ham (乾陷) and Heo-ham(虛陷)), which are the Korean medicine descriptions of sepsis and systemic inflammatory response syndrome.

Conclusions

Based on the research results, Sayeok-tang(四逆湯) can be used as a treatment of systemic inflammatory response syndrome.

Table 1
Statements Related to Sayeok-tang
傷寒論 91. 傷寒 醫下之 續得下利 淸穀不止 身疼痛者 急當救裏 後身疼痛 淸便自調者 急當救表 救裏宜四逆湯 救表宜桂枝湯
92. 病發熱頭痛 脈反沈 若不差 身體疼痛 當救其裏 四逆湯方
225. 脈浮而遲 表熱裏寒 下利淸穀者 四逆湯主之
323. 少陰病 脈沈者 急溫之 宜四逆湯
324. 少陰病 飮食入口則吐 心中溫溫欲吐 復不能吐 始得之 手足寒 脈弦遲者 此胸中實 不可下也 當吐之 若膈上 有寒飮乾嘔者 不可吐也 當溫之 宜四逆湯
353. 大汗出 熱不去 內拘急 四肢疼 又下利 厥逆而惡寒者 四逆湯主之
354. 大汗 若大下利而厥冷者 四逆湯主之
金匱要略 17–14. 嘔而脈弱, 小便復利, 身有微熱, 見厥者, 難治, 四逆湯主之.
17–36. 下利腹脹滿, 身體疼痛者, 先溫其裏, 乃攻其表. 溫裏宜四逆湯, 攻表宜桂枝湯.
Table 2
Symptoms of Ju-hwang and Nae-ham
走黃 ① 傳心: 神志 昏糊, 煩躁, 譫語, 斑疹, 血尿, 流注, 附骨疽
② 傳肺: 胸悶, 氣急, 咳嗽, 喀血, 聲嘶, 咽乾
③ 傳肝: 四肢抽搐, 角弓反張, 上視
④ 傳脾: 脘悶, 惡心, 便祕, 腹瀉, 黃疸
⑤ 傳腎: 目暗睛露, 四肢厥冷, 小便不禁

內陷 ① 火陷證: 發熱, 口渴, 便祕, 尿赤, 煩躁, 神昏, 纖語, 脇肋部痛
② 乾陷證: 發熱, 惡寒, 神疲, 譫語, 氣息, 粗促 / 肢冷, 大便溏薄, 小便頻數
③ 虛陷證: 虛熱, 形神萎頓, 納食日減, 腹痛便泄, 自汗肢冷, 昏迷厥脫
Table 3
Symptoms and Diagnostic Criteria for Systemic Inflammatory Response Syndrome
Diagnosis Criteria for Systemic Inflammatory Response Syndrome QSOFA Systolic Blood Pressure < 100 mm Hg
Highest Respiratory Rate > 21
Lowest Glasgow Coma Score < 15
SIRS Body Temperature > 38 °C or < 36 °C
Pulse Rate > 90/min
Respiratory Rate > 20/min or PaCO2 < 32 mmHg
White Blood Cell > 12,000 μL or < 4,000 μL

* PaCO2: Partial Pressure of Arterial Carbon Dioxide; QSOFA: Quick Sequential Organ Failure Assessment; SIRS: Systemic Inflammatory Response Syndrome

Table 4
Comparison of Sayeok-tang Treatment Symptoms, Systemic Inflammatory Response Syndrome, and Nae-ham
QSOFA, SIRS 傷寒論, 金匱要略 乾陷證, 虛陷證
Body Temperature > 38 °C 發熱, 頭痛, 身體疼痛 痛發熱, 虛熱
Body Temperature < 36 °C 手足寒, 惡寒 惡寒, 肢冷, 自汗肢冷
Systolic Blood Pressure < 100 mm 脈弦遲, 脈浮而遲, 脈沈, 脈弱 脈沈細, 脈虛大無力
Lowest Glasgow Coma Score < 15 - 神疲, 譫語, 形神萎頓, 昏迷厥脫
Multiple Organ Failure (Gastrointestinal) 下利淸穀, 腹脹滿, 心中溫溫欲吐 大便溏薄, 納食日減 腹痛便泄
Multiple Organ Failure (Renal) 小便復利 小便頻數

* QSOFA: Quick Sequential Organ Failure Assessment; SIRS: Systemic Inflammatory Response Syndrome

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