This work was supported by the Sichuan Administration of Traditional Chinese Medicine Special Research Project of Traditional Chinese Medicine (2021MS417).

The clinical protocol has been approved by the Administrative Committee of Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine (Record number: KY20221005). Experimental procedures were carried out in accordance with the guidelines of Hospital of Chengdu University of Traditional Chinese Medicine. The consent of the patients, who have signed an informed consent form, is required for the operation. The operator should understand the anatomy of the rectum before administering...

<ol>
	<li>Boxhoorn, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+pancreatitis.">Acute pancreatitis.</a> Lancet. 396 (10252), 726-734 (2020).</li><li>Xiao, A. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Global+incidence+and+mortality+of+pancreatic+diseases:+a+systematic+review,+meta-analysis,+and+meta-regression+of+population-based+cohort+studies.">Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies.</a> The Lancet. Gastroenterology &amp; Hepatology. 1 (1), 45-55 (2016).</li><li>Mederos, M. A., Reber, H. A., Girgis, M. 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AP is an inflammatory disease that can progress to SAP. According to numerous studies, SAP is a devastating disease linked with mortality ranging from less than 10% to as high as 85%, albeit with decreasing mortality in the recent decade33. SAP seriously impacts patients&#39; quality of life, and can even lead to death if not treated promptly and effectively. Aggressive and effective early treatment is of clinical importance34.
Chinese herbal ene...

Acute pancreatitis (AP) is an acute abdominal disease, characterized by a local pancreatic inflammatory response from an abnormal activation of pancreatic enzymes that have a digestive effect on the pancreas and surrounding organs1. As one of the most prevalent gastrointestinal reasons for hospitalization in the United States, acute pancreatitis requires increasing attention as it continues to increase worldwide2,3. In the past decade, the understanding of the pathophysiological mechanisms of acute pancreatitis has made significant strides4,5,6. About 5%-10% of cases of acute pancreatitis are associated with severe organ dysfunction; this type of pancreatitis is defined as severe acute pancreatitis (SAP)7. Early Western medical treatment of AP generally consists of fluid therapy, analgesia, nutritional support, and treatment for the cause and early complications. However, Western medical treatment still lacks specific drugs for AP at this stage8,9,10.
In traditional Chinese medicine (TCM), AP is referred to as &#34;abdominal pain&#34;, &#34;Pi Xin Tong&#34;, and &#34;pancreatic fever&#34;. TCM enema therapy is one of the most used treatments in Chinese medicine, dating back to the honey decoction method from Zhang Zhong Jing&#39;s &#34;treatise on cold pathogenic diseases&#34; in the Han Dynasty11. Its clinical efficacy is documented for the treatment of ulcerative colitis12, hyperuricaemia13, acute radiation proctitis14, acute kidney injury15, and SARS-CoV-2 in the intestinal tract16.
In recent years, an enema with TCM (rhubarb17,18, mirabilite19, and compound preparations such as Qingyi decoction20 and Dachengqi decoction21) has been widely utilized in clinical and experimental studies of SAP. It has been shown to protect pancreatic function, reduce abdominal pain and abdominal distension, and delay disease progression22,23. The 2021 Chinese guidelines for the diagnosis and treatment of AP include TCM enema24. However, it is unclear how the TCM enema should be administered to SAP patients. Therefore, we present a protocol to perform the TCM enema, providing a potent method for investigating the components and mechanisms of ethnic drugs in the treatment of SAP patients25.

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			<td>Yangzhou Yuankang Medical Equipment Co., Ltd.</td>
			<td>20220502B</td>
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			<td>Xinxiang Huakang Eisai Co., Ltd</td>
			<td>HK-38</td>
			<td></td>
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			<td>Medical gauzepad</td>
			<td>Xinxiang Huakang Eisai Co., Ltd</td>
			<td>HK-02B</td>
			<td></td>
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			<td>Medical nursing pad</td>
			<td>Hefei Mattel Care Products Co., Ltd</td>
			<td>CND502</td>
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			<td>Non-woven Filter Package</td>
			<td>Chengdu New Medical and Health Products Factory</td>
			<td>20192183#(C)</td>
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			<td>Paraffin oil</td>
			<td>Shandong Lierkang Medical Technology Co., Ltd.</td>
			<td>180801</td>
			<td></td>
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			<td>Raw rhubarb</td>
			<td>Sichuan Guoqiang traditional Chinese Medicine&#160; Co., Ltd</td>
			<td>21120104</td>
			<td></td>
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			<td>Thermometer</td>
			<td>Shenzhen Chenzhou Technology Co., Ltd.</td>
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enema of traditional chinese medicine for patients with severe acute pancreatitis

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional Chinese medicine (TCM) enema has been widely utilized in clinical and experimental studies of SAP. It has been demonstrated to have beneficial effects in protecting pancreatic function and delaying disease progression. The procedure of TCM enema is to perfuse the Chinese medicinal liquid of raw rhubarb (Rheum officinale Baill. DaHuang) from the anus into the rectum and colon. Basic steps of the procedure include boiling the herbal solution in advance, using a disposable enema kit to assist patients in taking a left lying position, raising the patient's hip 10 cm, and carefully inserting the enema 30-35 cm into the anus, with a drip speed of 60-80 drops/min. The medicine liquid temperature should be equivalent to the patient's body temperature, typically between 37-39 &#176;C. The end of the enema operation should be slow, and Tui na (massage therapy) should be administered before extubation. The medication liquid should be kept in the rectum for more than 1 h. After issuing an enema, it is essential to observe the patient's feces and abdomen, and to evaluate the remission of abdominal signs and symptoms.

In this study, the patient was admitted because of repeated epigastric pain. According to the diagnostic criteria30, the patient was diagnosed with SAP. After the patient was treated with this protocol, there was a noted therapeutic effect31.
Patient A, a female, 84 years old, was diagnosed for the first time on May 2, 2019. The patient complained of repeated epigastric distension and pain. The clinical tests showed that the serum amylase was 509...

Watch this Scientific Journal Video about Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis at JoVE.com

Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

An enema is a type of traditional Chinese medicine (TCM) therapy used to treat severe acute pancreatitis (SAP). The therapy involves instilling a TCM liquid into the rectum and colon through the anus to keep the liquid in the intestine, absorbing through the intestinal mucosa. This study aims to standardize the enema procedure for SAP patients.

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional ...

The demonstrated protocol of performing the traditional Chinese medicine enema provide a proto method for investigating the compromise and the megalin of the thoracic tracts in treating severe acute pancreatitis patients. There is complete absorption and high bioavailability as enema absorbs through the rectum. The rectal administration is simple with few side effects and is easy to dose.Enema can protect pancreatic function, reduce abdominal pain and distension, and delay disease progression. The 2021 Chinese guidelines for the diagnosis and the treatment of acute pancreatitis included-Most importantly, the indicators and the contraindicators should be kept in mind and the process must be carried out under the guidance of the super physician in your hospital. Check the patient's basic information, including name, age, and hospital number.Verify the patient's condition and reevaluate them. Explain the process and advantages of an enema to the patient, ensuring they can fully understand and relax during it. Regulate the room temperature between 18 to 28 degrees Celsius.Prepare all necessary items and, after checking the expiration dates of the materials, bring them to the bedside. Close all doors and windows and ensure that the patient is not unnecessarily exposed and is kept warm. Next, wash and dry hands, put on disposable gloves, and measure the temperature of the enema liquid using a thermometer beside the bed.Assist the patient in assuming the left lateral decubitus position. If necessary, choose the right lateral decubitus position based on the condition. Fully expose the anus and place the center of the treatment sheet under the buttocks and use a pillow to elevate the buttocks by 10 centimeters.Then lubricate the front end of the anal canal with paraffin oil and drain the paraffin oil from the anus before exposing the anus. Adjust the temperature of the liquid medication to be equivalent to the patient's body temperature at a drip rate of 60 to 80 drops per minute, ensuring that the liquid level does not exceed 35 centimeters from the anus. Subsequently, close the stopper clip of the disposable enema kit and pour the liquid into the hanging bag of the kit.Instruct the patient to open their mouth to breathe when inserting the anal canal to relax the anus and facilitate the smooth insertion of the anal canal. Next, insert the anal canal 30 to 35 centimeters with the plastic hose from the disposable kit. Open the stopper clip and slowly drip the liquid for 15 to 20 minutes.Adjust the dripping rate depending on the patient's condition. During the infusion, constantly monitor and inquire about the patient's tolerance. Adjust the infusion rate in the event of discomfort or convenience and discontinue the infusion if necessary.Perform general tui na by placing the fingertips on the perianal skin to gently knead back and forth in a circular motion to relax the muscles around the anus before extubating the plastic hose. After administering the medication, the dosage of which should not exceed 200 milliliters, clamp and remove the plastic hose from the anal canal. Once done, assist the patient in drying the perianal skin by gently rubbing the anus with gauze and help the patient assume a comfortable lying position with elevated buttocks.If, during any part of the operation, the patient has a sluggish pulse, a pale face, cold perspiration, severe abdominal pain, or palpitation, stop immediately and contact a doctor. Notable therapeutic effect was observed in patients diagnosed with severe acute pancreatitis after treating them with enema, a traditional Chinese medicine therapy using the liquid extract of raw rhubarb. For example, in the 84 year old female patient who complained of repeated epigastric distension and pain, the serum amylase was 509 units per liter compared to the reference values of 35 to 135 units per liter.The serum amylase dropped to 216 units per liter after administering the enema treatment every two hours along with conventional western medicine treatment. The level dropped to 95 units per liter upon continuing the same treatment, after which the enema frequency was reduced. Similar effects were noted for others.The clinical efficacy of the treatment was evident when the control group was compared with the experimental patients. The most important thing is to ask the patient about other diseases, such as contraindications, skin conditions, and the mental cooperation status. It's also possible to adjust Chinese medicine according to different conditions using the correct rustic treatment of the medicine.This treatment has been developed since the Han dynasty and we have synthesized it to hopefully spirit the technology to hospitals.

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Research

JoVE Journal

Medicine

16.5K visualizações.  Hospital of Chengdu University of Traditional Chinese Medicine. O protocolo demonstrado de realização do enema da medicina tradicional chinesa fornece um método proto para investigar o comprometimento e a megalina das vias torácicas no tratamento de pacientes com pancreatite aguda grave. Há absorção completa e alta biodisponibilidade como enema absorve através do reto. A administração retal é simples, com poucos efeitos colaterais e fácil de dosar.O Enema pode proteger a função pancreática, reduzir a dor e a distensão abdominal e re...