A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome

Ju-Hyun Lee; Sang-Bae Lee; Eun-Heui Jo; Min-Cheol Park; Lee, Ju-Hyun; Lee, Sang-Bae; Jo, Eun-Heui; Park, Min-Cheol

doi:10.13048/jkm.24020

JKM > Volume 45(2); 2024 > Article

Lee, Lee, Jo, and Park: A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome

Original Article

The Journal of Korean Medicine 2024; 45(2): 1-8.

Published online: June 01, 2024

DOI: https://doi.org/10.13048/jkm.24020

A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome

Ju-Hyun Lee¹

, Sang-Bae Lee²

, Eun-Heui Jo³^{, 4}^{, *}

, Min-Cheol Park⁴^{, 5}^{, *}

¹Department of Medical Support, Imsil-gun Medical Center, Imsil, Jeollabuk-do, Republic of Korea

²Bugang Korean Medicine Clinic, Bucheon, Gyeonggi-do, Republic of Korea

³Department of Acupuncture and Moxibustion, Wonkwang University Korean Medicine Hospital, Deokjingu, Jeonju, Jeollabuk-do, Republic of Korea

⁴Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea

⁵Department of Korean Medicine Ophthalmology, Otolaryngology, and Dermatology, Wonkwang University Korean Medicine Hospital, Iksan, Jeollabuk-do, Republic of Korea

Correspondence to: Eun-Heui Jo, Department of Acupuncture and Moxibustion, Wonkwang University Korean Medicine Hospital, 99, Garyeonsan-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54887, Republic of Korea, Tel: +82-63-270-1022, Fax: +82-63-270-1199, E-mail: freezo@wonkwang.ac.kr

Corresponding author: Min-Cheol Park, Department of Korean Medicine Ophthalmology, Otolaryngology, and Dermatology, Wonkwang University Korean, Medicine Hospital, 895 Muwang-ro, Iksan-si, Jeollabuk-do, 54538, Republic of Korea, Tel: +82-63-859-2821, Fax: +82-63-841-0033, E-mail: spinx11@wonkwang.ac.kr

Received February 1, 2024 Revised March 29, 2024 Accepted May 7, 2024

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.

Keywords: Literature Study, Sayeok-tang(四逆湯), Systemic Inflammatory Response Syndrome, Traditional Medicine

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.
金匱要略	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

참고문헌

1. Yoon, JY, & Kwon, JY. (2010). Inflammation and sepsis. Acute Crit Care, 25(1), 1-8. https://doi.org/10.4266/kjccm.2010.25.1.1

2. Bone, RC, Balk, RA, Cerra, FB, Dellinger, RP, Fein, AM, & Knaus, WA, et al. (1992). Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest, 101(6), 1644-1655. https://doi.org/10.1378/chest.101.6.1644

3. Jaffer, U, Wade, RG, & Gourlay, T. (2010). Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth, 2(3), 161-175.

4. Nyström, PO. (1998). The systemic inflammatory response syndrome: definitions and aetiology. J Antimicrob Chemother, 41(1), 1-7. https://doi.org/10.1093/jac/41.suppl_1.1

5. Mang WJ. (2015). Sanghanron Commentary. Iksan. Wonkwang University Press Office;p. 276-281.

6. Rho EJ. (2018). Gobangyuchwi. Seoul. Barun Herbal Medicine;p. 592-597.

7. Brislinger, D, Daxböck, C, Roβmanith, E, Stückler, M, Lang, I, Falkenhagen, D, Tang, Bai Hu, Tang, Si Ni, & Bi, Xue. (2018). Tang amplify pro-inflammatory activities and reduce apoptosis in endothelial cells in a cell culture model of sepsis. J Ethnopharmacol, 225, 309-318.

8. Liu, J, Peter, K, Shi, D, Zhang, L, Dong, G, & Zhang, D, et al. (2014). Anti-inflammatory effects of the Chinese herbal formula Shini Tang in myocardial infarction rats. Evid Based Complement Alternat Med, 2014, 309378.

9. Jiangsu University of Chinese Medicine Sanghan Laboratory. (2001). Sanghanron Commentary. Seoul. Yeogang Publisher;p. 91-92. p. 209p. 413-417. p. 491-493.

10. Kwak DR. (2002). Geumgweyoryak Commentary. Seoul. Seongbosa;p. 418-419. p. 436-438.

11. College of Korean Medicine Dermatology & Surgery Textbook Compilation Committee. (2007). Text of Traditional Korean Dermatology & Surgery. Pusan. Sunwoo;p. 185-191.

12. Singer, M, Deutschman, CS, Seymour, CW, Shankar-Hari, M, Annane, D, & Bauer, M, et al. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287

13. Chakraborty RK, Burns B. Systemic inflammatory response syndrome. StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing;(2023). Jan. [cited 2023 Dec 11]. Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK547669/

14. Gauer, R, Forbes, D, & Boyer, N. (2020). Sepsis: Diagnosis and management. Am Fam Physician, 101(7), 409-418.

15. Purvis, D, & Kirby, R. (1994). Systemic inflammatory response syndrome: Septic shock. Vet Clin North Am Small Anim Pract, 24(6), 1225-1247.

16. Horn, KD. (1998). Evolving strategies in the treatment of sepsis and systemic inflammatory response syndrome (SIRS). QJM, 91(4), 265-277. https://doi.org/10.1093/qjmed/91.4.265

17. Dinarello, CA, Gelfand, JA, & Wolff, SM. (1993). Anticytokine strategies in the treatment of the systemic inflammatory response syndrome. JAMA, 269(14), 1829-1835. https://doi.org/10.1001/jama.1993.03500140081040

18. Matsuda, N, & Hattori, Y. (2006). Systemic inflammatory response syndrome (SIRS) Molecular pathophysiology and gene therapy. J Pharmacol Sci, 101(3), 189-198. https://doi.org/10.1254/jphs.CRJ06010X

19. Kung, SE, & Oh, MS. (2013). Effects of Sayeok-tang on papain-Induced osteoarthritis in mice. J Physiol & Pathol Korean Med, 27(2), 212-224.

20. Choi, YK, & Kang, MS. (2007). A case report of Ge-yan-jiu & herbal medicine complex treatment on Jue zheng caused by Wang yang. J Int Korean Med, 28(1), 187-192.

21. Ju YS. (2013). Jeungbo Ungok Herbology. Wanju. Wooseok;p. 767-773. p. 776-779. p. 1219-1224.

22. Kim, MS, & Kim, YS. (1981). Studies on the positive inotropic mechanism of Aconiti Tuber. Korean J of Pharmaoclogy, 17(1), 9-16.

23. Cho, EH, & Lee, TH. (2006). Effects of Coptidis Rhizoma and Aconiti Lateralis Preparata Radix on the change of plasma corticosterone level and rectal temperature induced by LPS. Kor J Herbol, 21(2), 77-85.

24. Choi, CW, & Oh, MS. (2014). Study on antioxidant and anti-inflammatory effects of components of Mahwangbujaseshin-tang. J Korean Med Rehabi, 24(4), 15-28.

25. Li, X, Ao, M, Zhang, C, Fan, S, Chen, Z, & Yu, L. (2021). Zingiberis Rhizoma Recens: A review of its traditional uses, phytochemistry, pharmacology, and toxicology. Evid Based Complement Alternat Med, (2021). https://doi.org/10.1155/2021/6668990

26. Yin, L, Guan, E, Zhang, Y, Shu, Z, Wang, B, & Wu, X, et al. (2018). Chemical profile and anti-inflammatory activity of total flavonoids from Glycyrrhiza Uralensis Fisch. Iran J Pharm Res, 17(2), 726-734.