Chinese medicine: the prevention of nosocomial fungal infections with Bu Zhong Yi Qi Tang.

Keywords: Chinese medicine, Chinese herbal medicine, nosocomial fungal infections, Bu Zhong Yi Qi Tang

Nosocomial infections are infections that are contracted or develop while a patient is in the hospital. Since the 1980s, the incidence of nosocomial infections in US hospitals has been on the rise. While nosocomial infections due to various microbes have risen, those due to Candida albicans have increased proportionately more. According to some statistics, C. albicans is the seventh most prevalent infectious microbe found in modern hospitals. This fungus may cause digestive disturbances, thrush, cystitis, and vaginitis, any of which can complicate treatment of the primary condition and place a further burden on an already compromised immune system. If this fungus gets into the bloodstream, it may cause candidemia, with mortality reaching 50% to 60%. So this is a real problem in US hospitals.

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Candida albicans is a normal commensal fungus within the human body. However, when we talk about a Candida infection, this means that the populations of these fungi have grown out of normal proportion and control and are now causing pathological symptoms. Risk factors for developing in-hospital candidiasis include use of antibiotics and corticosteroids, malignancy, chemotherapy, malnutrition, and neutropenia. Thus, if there were some way to prevent nosocomial fungal infections, this would be a great boon to patients and their hospital caregivers alike.

On page 644 of issue 11, 2008, of Zhe Jiang Zhong Yi Za Zhi (Zhejiang journal of Chinese Medicine), Zhang Yong-jian and Lu Juan-ying published an article titled "Clinical Observations on the Prevention of Nosocomial Fungal Infections with Added Flavors Bu Zhong Yi Qi Tang." A summary of this article is presented below.

Cohort Description

Seventy-six patients admitted to the intensive care unit (ICU) of Hai Yan County Chinese Medical Hospital in Zhejiang were randomly divided into two groups: a so-called treatment group and a comparison group. All these patients presented a Chinese medical pattern of qi vacuity and suffered from conditions known to be associated with serious depression of immunity, such as chronic obstructive pulmonary disease (COPD), cor pulmonale, cancer, diabetes, and uremia. Fifty-two of these cases had used multiple types of antibiotics within the last 15 to 30 days. Twenty-five cases had used extensive corticosteroids, and 15 cases had been treated with chemotherapy.

There were 38 cases in the treatment group: 25 males and 13 females 52 to 86 years of age. Similarly, there were 38 cases in the comparison group: 22 males and 16 females 50 to 89 years of age. Therefore, in terms of sex, age, disease condition, and original disease, these two groups were considered statistically comparable for the purposes of this study.

In terms of Chinese medical pattern discrimination, all 76 cases met the diagnostic criteria for qi vacuity. This mainly meant lung-spleen qi vacuity. Signs and symptoms included qi vacuity emission of heat (or fever); incessant coughing and panting; shortness of breath; lack of strength; profuse, thin, white phlegm; devitalized eating and drinking; abdominal distention; loose stools; disinclination to speak due to fatigue; a somber white facial complexion; possible facial superficial edema; a pale tongue with white fur; and a fine, weak pulse.

                   1 week                 2 weeks

Group       Phlegm  Urine  Blood  Phlegm  Urine  Blood

Treatment     0       1      0      2       1      0
Comparison    2       3      0      4       5      0

                   3 weeks

Group       Phlegm  Urine  Blood

Treatment     3       3      0
Comparison    9       8      0

Treatment Method

All members of the comparison group were treated with supportive therapy, which consisted of the intravenous administration of physiologic water and electrolytes and maintenance of the acid-base balance. On top of this basic treatment, the members of the treatment group were also administered Bu Zhong Yi Qi Tang (Supplement the Center and Boost the Qi Decoction) with added flavors as follows:

Huang Qi (Radix Astragali), 20g

mix-fried Can Cao (Radix Glycyrrhizae), 5g

Dang Shen (Radix Codonopsis), 15g

Dang Cui (Radix Angelicae Sinensis)

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 10g each

Chen Pi (Pericarpium Citri Reticulatae), 6g

Sheng Ma (Rhizoma Cimicifugae), 3g

Chai Hu (Radix Bupleuri), 9g

One packet per day of these medicinals was decocted in water to obtain 200 milliliters of medicinal liquid. This was administered in 100 milliliter doses morning and afternoon. Fourteen days equaled one course of treatment.

Study Outcomes

All these patients' phlegm, urine, and blood were cultured for the presence of fungi at the end of one, two, and three weeks. The table on the previous page shows the presence of cultured fungi in each of these at each of these three weeks of treatment.

This shows that, by the end of the third week, there were three times more positive blood and urine fungal cultures in the patients who were only treated with supportive therapy. The table below shows the comparative rate of fungal infection in these two groups.

This shows that, by the end of the third week of treatment, 47.63% of the patients receiving supportive therapy alone had developed nosocomial fungal infections compared with only 15.79% in the group treated with Chinese medicinals and supportive therapy.

Discussion

According to Drs. Zhang and Lu, within this formula, Huang Qi, Bai Zhu, Can Cao, and Shan Yao {sic, Radix Dioscoreae) boost the spleen and stomach and supplement the lung qi. Dang Gut both nourishes and quickens the blood. Sheng Ma and Chai Hu upbear and lift clear yang as well as outthrust and scatter depressive heat. Chen Pi rectifies the qi and harmonizes the stomach. When all these medicinals are used together, they boost the qi and upbear yang while sweetly and warmly eliminating heat.

It would seem that Shan Yao was omitted accidentally from the original list of ingredients. This would account for why this formula is referred to as "added flavors" Bu Zhong Yi Qi Tang. As stated under the treatment methods, the formula is only standard Bu Zhong Yi Qi Tang. Also, Dang Shen was omitted in the discussion of the qi-supplementing medicinals in this concluding section. Sorry to say, typographical errors such as this are common in the Chinese medical journals.

Wouldn't it be wonderful if ail immune-compromised hospital patients presenting a pattern of qi vacuity were routinely administered some version of Bu Zhong Yi Qi Tang to prevent nosocomial fungal infection? When my own father was hospitalized for colon cancer, he developed a very bad case of thrush. I told the nurses on duty about this, but no one said or did anything about this. So it goes.

Copyright [C] Blue Poppy Press, 2009. All rights reserved.

Group        1 week     2 weeks      3 weeks

Treatment   1  (2.63%) 3  (7.89%)   6 (15.79%)
Comparison  5 (13.16%  9 (26.32%)  18 (47.37%)

by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

www.bluepoppy.com