Name: enema of traditional chinese medicine for patients with severe acute pancreatitis
Uploaded: 2023-01-27T13:45:00.000+00:00
Duration: 6 min 5 s
Description: Watch this Scientific Journal Video about Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis at JoVE.com

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 the enema and look at the anatomical annotations (see Figure 3).
1. Pre-therapy preparation of the operator
<ol>
	<li>Include patients with principal symptoms (i.e., persistent epigastric pain).</li>
	<li>Exclude patients with the following conditions: gastrointestinal bleeding, pregnancy, severe cardiovascular disease, arteriovenous tumor, hemiplegia, stroke, cardiopulmonary-cerebral insufficiency, severe colon ulcer or infarction, hernia, abdominal surgery, patients with intestinal adhesions, ileocectomy, megacolon disease and bleeding or perforation, patients with intestinal surgery, dialysis, patients with instinctive hypertension, catatonic heart disease, or severe hemorrhoids.</li>
	<li>Exclude patients with a breakage of the perianal skin and a history of allergy to rhubarb.</li>
	<li>Ensure that patients have no psychiatric disorders and can actively cooperate with the treatment.</li>
</ol>
2. Pre-therapy preparation of the patients
<ol>
	<li>Have the patient eliminate both stool and urine before the operation.</li>
	<li>Inform the patients that is it normal to experience localized sensations such as swelling, fullness, and mild pain.</li>
	<li>Have patients promptly notify if defecation occurs or if there is discomfort. 
	&#8203;NOTE: The enema solution should be retained for more than 1 h, as the long retention time facilitates drug absorption26.</li>
</ol>
3. Preparation of the decocted medicinal liquid
NOTE: The Hospital of Chengdu University of TCM supplied the raw rhubarb27 (Rheum officinale Baill. DaHuang) (Figure 1).
<ol>
	<li>Add 30 g of raw rhubarb and 200 mL of water to the automatic decoction and packaging machine.</li>
	<li>Boil, and then simmer for 5 min.</li>
	<li>Filter with a non-woven filter package (24 mm x 30 mm).</li>
	<li>Remove residue with the non-woven filter package and cool down the remaining liquid to 37-39 &#176;C.</li>
</ol>
4. Operational procedure
<ol>
	<li>Check the patient&#39;s basic information (name, age, hospital number), verify the patient&#39;s condition, and re-evaluate them. Explain the process and advantages of an enema to the patient, making sure that they can fully understand and relax during it.</li>
	<li>Regulate the room temperature (18-28 &#176;C).</li>
	<li>Prepare all necessary items (Figure 2 and Table of Materials). Check the expiration dates and bring them to the bedside.</li>
	<li>Close all doors and windows. Ensure that the patients are not unnecessarily exposed and are kept warm.</li>
	<li>Wash and dry hands, put on disposable gloves, and measure the temperature of the enema liquid using a thermometer beside the bed.</li>
	<li>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, place the center of the treatment sheet under the buttocks, and use a pillow to elevate the buttocks by 10 cm (Figure 3).</li>
	<li>Lubricate the front end of the anal canal with paraffin oil, drain the paraffin oil from the anus, and expose the anus.</li>
	<li>Adjust the temperature of the liquid medication to be equivalent to the patient&#39;s body temperature (37-39 &#176;C) at a drip rate of 60-80 drops per minute, ensuring that the liquid level does not exceed 35 cm from the anus.</li>
	<li>Close the stopper clip (part of the disposable enema kit) and pour the liquid into the hanging bag (part of the disposable enema kit).</li>
	<li>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.</li>
	<li>Insert the anus canal 30-35 cm28 with the plastic hose (part of the disposable enema kit), open the stopper clip, and slowly drip the liquid (the dripping rate depends on the patient&#39;s condition) for 15 to 20 min. 
	NOTE: If the plastic hose is blocked, close the stopper clip immediately and squeeze the pressurized bladder (part of the disposable enema kit) to unblock it.</li>
	<li>During the infusion, constantly monitor and inquire about the patient&#39;s tolerance. Adjust the infusion rate in the event of discomfort or convenience and discontinue the infusion if necessary.</li>
	<li>Perform general Tui na (place fingertips on the perianal skin to gently knead back and forth in a circular motion) to relax the muscles around the anus, before extubation of the plastic hose (Figure 2A)29.</li>
	<li>After administering the medication, clamp and remove the plastic hose from the anal canal. 
	NOTE: The dosage for Chinese herbal enema should not exceed 200 mL.</li>
	<li>Assist the patient in drying the perianal skin by gently rubbing the anus with gauze. Help the patient assume a comfortable lying position and elevate the buttocks. 
	&#8203;NOTE: If the patient has a sluggish pulse, a pale face, cold perspiration, severe abdominal pain, and palpitation, stop the operation immediately and contact a doctor.</li>
</ol>
5. Post-operation care
<ol>
	<li>Have the patient lay in the left lateral position if they are still comfortable.</li>
	<li>Have the patient rest. Advise them to use clean bedsheets, keep the anus dry and clean, and change the bedsheets promptly after fluid flows.</li>
	<li>Observe fluid flow from the anus after the enema. Observethe shape, color, volume, and smell of the stool, to determine the success of the enema.</li>
	<li>Advise the patient not to use excessive force to relieve stools, and inform healthcare staff promptly of any constipation.</li>
	<li>Observe the patient&#39;s symptoms, temperature, blood pressure, pulse rate, heart rate, and respiration.</li>
</ol>

<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. D. <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:+A+review.">Acute pancreatitis: A review.</a> JAMA. 325 (4), 382-390 (2021).</li><li>Lee, P. J., Papachristou, G. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+insights+into+acute+pancreatitis.">New insights into acute pancreatitis.</a> Nature Reviews. Gastroenterology &amp; Hepatology. 16 (8), 479-496 (2019).</li><li>Pu, W., 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=A+5-year+retrospective+cohort+study:+epidemiology,+etiology,+severity,+and+outcomes+of+acute+pancreatitis.">A 5-year retrospective cohort study: epidemiology, etiology, severity, and outcomes of acute pancreatitis.</a> Pancreas. 49 (9), 1161-1167 (2020).</li><li>Lankisch, P. G., Apte, M., Banks, P. A. <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. 386 (9988), 85-96 (2015).</li><li>Garg, P. K., Singh, V. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Organ+failure+due+to+systemic+injury+in+acute+pancreatitis.">Organ failure due to systemic injury in acute pancreatitis.</a> Gastroenterology. 156 (7), 2008-2023 (2019).</li><li>Moggia, E., 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=Pharmacological+interventions+for+acute+pancreatitis.">Pharmacological interventions for acute pancreatitis.</a> The Cochrane Database of Systematic Reviews. 4 (4), (2017).</li><li>Szatmary, P., 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:+Diagnosis+and+treatment.">Acute pancreatitis: Diagnosis and treatment.</a> Drugs. 82 (12), 1251-1276 (2022).</li><li>Leppaniemi, A., 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=WSES+guidelines+for+the+management+of+severe+acute+pancreatitis.">WSES guidelines for the management of severe acute pancreatitis.</a> World Journal of Emergency Surgery. 13 (14), 27 (2019).</li><li>Zhang, J. J., Zhang, Z. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+on+the+characteristics+of+prescriptions+recorded+in+Treatise+on+febrile+diseases+in+treating+constipation.">Analysis on the characteristics of prescriptions recorded in Treatise on febrile diseases in treating constipation.</a> Clinical Journal of Chinese Medicine. 8, 279 (2016).</li><li>Yan, Z. X., 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=Efficacy+and+safety+of+retention+enema+with+traditional+Chinese+medicine+for+ulcerative+colitis:+A+meta-analysis+of+randomized+controlled+trials.">Efficacy and safety of retention enema with traditional Chinese medicine for ulcerative colitis: A meta-analysis of randomized controlled trials.</a> Complementary Therapies in Clinical Practice. 42, 101278 (2021).</li><li>Chen, Q., Ma, L., Akebaier, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+on+treatment+of+hyperuricaemia+by+retention+enema+of+Chinese+herbal+medicine+combined+with+allopurinol.">Clinical study on treatment of hyperuricaemia by retention enema of Chinese herbal medicine combined with allopurinol.</a> Chinese Journal of Integrative Medicine. 15 (6), 431-434 (2009).</li><li>Gao, J., 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=Changrui+enema+inhibits+inflammation-induced+angiogenesis+in+acute+radiation+proctitis+by+regulating+NF-&#954;B+and+VEGF.">Changrui enema inhibits inflammation-induced angiogenesis in acute radiation proctitis by regulating NF-&#954;B and VEGF.</a> Acta Cirurgica Brasileira. 35 (5), 202000502 (2020).</li><li>Lu, H., 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=Shenshuaikang+enema,+a+Chinese+herbal+remedy,+inhibited+hypoxia+and+reoxygenation-induced+apoptosis+in+renal+tubular+epithelial+cells+by+inhibiting+oxidative+damage-dependent+JNK/Caspase-3+signaling+pathways+using+network+pharmacology.">Shenshuaikang enema, a Chinese herbal remedy, inhibited hypoxia and reoxygenation-induced apoptosis in renal tubular epithelial cells by inhibiting oxidative damage-dependent JNK/Caspase-3 signaling pathways using network pharmacology.</a> Evidence-Based Complementary and Alternative. 2020, 9457101 (2020).</li><li>Dai, 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=Traditional+Chinese+medicine+enema+therapy+in+a+patient+with+a+confirmed+negative+SARS-CoV-2+test+in+the+respiratory+tract+but+positive+in+the+intestinal+tract:+A+case+report.">Traditional Chinese medicine enema therapy in a patient with a confirmed negative SARS-CoV-2 test in the respiratory tract but positive in the intestinal tract: A case report.</a> Frontiers in Public Health. 9, 687283 (2021).</li><li>Wan, B., Fu, H., Yin, J., Xu, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+rhubarb+combined+with+early+enteral+nutrition+for+the+treatment+of+severe+acute+pancreatitis:+A+randomized+controlled+trial.">Efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis: A randomized controlled trial.</a> Scandinavian Journal of Gastroenterology. 49 (11), 1375-1384 (2014).</li><li>Yao, P., Cui, M., Li, Y., Deng, Y. Y., Wu, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+rhubarb+on+intestinal+flora+and+toll-like+receptors+of+intestinal+mucosa+in+rats+with+severe+acute+pancreatitis.">Effects of rhubarb on intestinal flora and toll-like receptors of intestinal mucosa in rats with severe acute pancreatitis.</a> Pancreas. 44 (5), 799-804 (2015).</li><li>Wang, Y., Zhang, X., Li, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applying+hot+compresses+with+rhubarb+and+mirabilite+to+reduce+pancreatic+leakage+occurrence+in+the+treatment+of+severe+acute+pancreatitis.">Applying hot compresses with rhubarb and mirabilite to reduce pancreatic leakage occurrence in the treatment of severe acute pancreatitis.</a> Iranian Journal of Public Health. 46 (1), 136-138 (2017).</li><li>Wang, G. 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=Qingyi+decoction+attenuates+intestinal+epithelial+cell+injury+via+the+calcineurin/nuclear+factor+of+activated+T-cells+pathway.">Qingyi decoction attenuates intestinal epithelial cell injury via the calcineurin/nuclear factor of activated T-cells pathway.</a> World Journal of Gastroenterology. 28 (29), 3825-3837 (2022).</li><li>Wen, 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=Chaiqin+chengqi+decoction+alleviates+severity+of+acute+pancreatitis+via+inhibition+of+TLR4+and+NLRP3+inflammasome:+Identification+of+bioactive+ingredients+via+pharmacological+sub-network+analysis+and+experimental+validation.">Chaiqin chengqi decoction alleviates severity of acute pancreatitis via inhibition of TLR4 and NLRP3 inflammasome: Identification of bioactive ingredients via pharmacological sub-network analysis and experimental validation.</a> Phytomedicine. 79, 153328 (2020).</li><li>Li, J., Zhang, S., Zhou, R., Zhang, J., Li, Z. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perspectives+of+traditional+Chinese+medicine+in+pancreas+protection+for+acute+pancreatitis.">Perspectives of traditional Chinese medicine in pancreas protection for acute pancreatitis.</a> World Journal of Gastroenterology. 23 (20), 3615-3623 (2017).</li><li>Yang, C., 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=Traditional+Chinese+medicine+formulas+alleviate+acute+pancreatitis:+Pharmacological+activities+and+mechanisms.">Traditional Chinese medicine formulas alleviate acute pancreatitis: Pharmacological activities and mechanisms.</a> Pancreas. 50 (10), 1348-1356 (2021).</li><li>Li, F., 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=Guidelines+for+the+diagnosis+and+treatment+of+acute+pancreatitis+in+China.">Guidelines for the diagnosis and treatment of acute pancreatitis in China.</a> Journal of Pancreatology. 4 (2), 67-75 (2021).</li><li>Li, J. H., 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=Research+progress+on+the+comprehensive+treatment+of+acute+pancreatitis+with+traditional+Chinese+medicine.">Research progress on the comprehensive treatment of acute pancreatitis with traditional Chinese medicine.</a> Journal of Emergency in Traditional Chinese Medicine. 31 (3), 549-551 (2022).</li><li>Liu, M., L, Z., Wang, Y., Zeng, M., Chen, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nursing+experience+of+traditional+Chinese+medicine+enema+in+patients+with+acute+pancreatitis.">Nursing experience of traditional Chinese medicine enema in patients with acute pancreatitis.</a> World Latest Medicine Information. 18 (1), 186 (2018).</li><li>Wang, Q., Yi, F., Peng, X., Li, D., Lu, Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Dahuang+(rhubarb)+retention+enema+on+inflammatory+factors+in+patients+with+severe+acute+pancreatitis.">Effects of Dahuang (rhubarb) retention enema on inflammatory factors in patients with severe acute pancreatitis.</a> Journal of Emergency in Traditional Chinese Medicine. 25 (3), 518-519 (2016).</li><li>Zhang, Y., Lv, X. Y., Li, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+modified+rhubarb+retention+enema+in+the+treatment+of+severe+acute+pancreatitis.">Application of modified rhubarb retention enema in the treatment of severe acute pancreatitis.</a> Practical Clinical Medicine. 15 (10), 86-88 (2014).</li><li>Lai, X. H., 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=Nursing+of+patients+with+acute+severe+pancreatitis+undergoing+traditional+Chinese+medicine+retention+enema.">Nursing of patients with acute severe pancreatitis undergoing traditional Chinese medicine retention enema.</a> Journal of Emergency in Traditional Chinese Medicine. 21 (6), 1022 (2012).</li><li>Banks, P. A., 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=Classification+of+acute+pancreatitis-2012:+revision+of+the+Atlanta+classification+and+definitions+by+international+consensus.">Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus.</a> Gut. 62 (1), 102-111 (2013).</li><li>Zhang, S. S., 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=Expert+consensus+on+TCM+diagnosis+and+treatment+of+acute+pancreatitis.">Expert consensus on TCM diagnosis and treatment of acute pancreatitis.</a> Chinese Journal of Traditional Chinese Medicine. 32 (9), 4087-4088 (2017).</li><li>Shen, J. B., Wang, Z. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+of+traditional+Chinese+medicine+retention+enema+in+the+treatment+of+severe+acute+pancreas.">Clinical study of traditional Chinese medicine retention enema in the treatment of severe acute pancreas.</a> The Chinese Journal of Clinical Pharmacology. 31 (18), 1831-1833 (2015).</li><li>Zerem, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+severe+acute+pancreatitis+and+its+complications.">Treatment of severe acute pancreatitis and its complications.</a> World Journal of Gastroenterology. 20 (38), 13879-13892 (2014).</li><li>Yadav, D., Lowenfels, A. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+of+pancreatitis+and+pancreatic+cancer.">The epidemiology of pancreatitis and pancreatic cancer.</a> Gastroenterology. 144 (6), 1252-1261 (2013).</li><li>Wentao, F., 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=Research+progress+on+the+clinical+application+of+traditional+Chinese+medicine+enema.">Research progress on the clinical application of traditional Chinese medicine enema.</a> World Journal of Integrated Traditional and Western Medicine. 15 (8), 1565-1568 (2020).</li><li>Cao, Y. J., 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=Advances+in+bio-active+constituents,+pharmacology+and+clinical+applications+of+rhubarb.">Advances in bio-active constituents, pharmacology and clinical applications of rhubarb.</a> Chinese Medicine. 12, 36 (2017).</li><li>Chen, X., Valente, J. F., Alexander, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+sennosides+on+bacterial+translocation+and+survival+in+a+model+of+acute+hemorrhagic+pancreatitis.">The effect of sennosides on bacterial translocation and survival in a model of acute hemorrhagic pancreatitis.</a> Pancreas. 18 (1), 39-46 (1999).</li><li>Le, J., 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=Pharmacology,+toxicology,+and+metabolism+of+sennoside+A,+a+medicinal+plant-derived+natural+compound.">Pharmacology, toxicology, and metabolism of sennoside A, a medicinal plant-derived natural compound.</a> Frontiers in Pharmacology. 12, 714586 (2021).</li><li>Wang, X., 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=Salidroside,+a+phenyl+ethanol+glycoside+from+Rhodiola+crenulata,+orchestrates+hypoxic+mitochondrial+dynamics+homeostasis+by+stimulating+Sirt1/p53/Drp1+signaling.">Salidroside, a phenyl ethanol glycoside from Rhodiola crenulata, orchestrates hypoxic mitochondrial dynamics homeostasis by stimulating Sirt1/p53/Drp1 signaling.</a> Journal of Ethnopharmacology. 293, 115278 (2022).</li><li>Hou, 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=Salidroside+intensifies+mitochondrial+function+of+CoCl2-damaged+HT22+cells+by+stimulating+PI3K-AKT-MAPK+signaling+pathway.">Salidroside intensifies mitochondrial function of CoCl2-damaged HT22 cells by stimulating PI3K-AKT-MAPK signaling pathway.</a> Phytomedicine. 109, 154568 (2023).</li></ol>

The authors have nothing to disclose.

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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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...

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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 ...

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22.0K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. 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.

Video: Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

Inducing Pancreatic Injury in Mice Through Intraperitoneal Drug Injection

Preparing a Mice Model of Severe Acute Pancreatitis via a Combination of Caerulein and Lipopolysaccharide Intraperitoneal Injection

The treatment of severe acute pancreatitis (SAP), with high mortality rates, poses a significant clinical challenge. Investigating the pathological changes associated with SAP using animal models can aid in identifying potential therapeutic targets and exploring novel treatment approaches. Previous studies primarily induced pancreatic injury through retrograde bile duct injection of sodium taviaurocholate, but the impact of surgical damage on the quality of the animal model remains unclear. In this study, we employed various frequencies of intraperitoneal Caerulein injections combined with different doses of LPS to induce pancreatic injury in C57BL/6J mice and compared the extent of injury across five intraperitoneal injection protocols. Regarding inducing acute pancreatitis in mice, an intraperitoneal injection protocol is proposed that results in a mortality rate as high as 80% within 5 days. Specifically, mice received ten daily intraperitoneal injections of Caerulein (50 &#181;g/kg), followed by an injection of LPS (15 mg/kg) one hour after the last Caerulein administration. By adjusting the frequency and dosage of injected medications, one can manipulate the severity of pancreatic injury effectively. This model exhibits strong controllability and has a short replication cycle, making it feasible for completion by a single researcher without requiring expensive equipment. It conveniently and accurately simulates key disease characteristics observed in human SAP while demonstrating a high degree of reproducibility.

Intraperitoneal drug administration is a safe and effective non-invasive approach for inducing pancreatic injury. This study compared five distinct intraperitoneal injection protocols on mice to induce varying degrees of pancreatic injury and established a model of severe pancreatic injury to investigate the pathological changes and treatment strategies for severe acute pancreatitis (SAP).

The treatment of severe acute pancreatitis (SAP), with high mortality rates, poses a significant clinical challenge. Investigating the pathological ...

Immunology and Infection

Sodium Taurocholate Induced Severe Acute Pancreatitis in C57BL/6 Mice

Biliary acute pancreatitis induction by sodium taurocholate infusion has been widely used by the scientific community due to the representation of the human clinical condition and reproduction of inflammatory events corresponding to the onset of clinical biliary pancreatitis. The severity of pancreatic damage can be assessed by measuring the concentration, speed, and volume of the infused bile acid. This study provides an updated checklist of the materials and methods used in the protocol reproduction and shows the main results from this acute pancreatitis (AP) model. Most of the previous publications have limited themselves to reproducing this model in rats. We have applied this method in mice, which provides additional advantages (i.e., the availability of an arsenal of reagents and antibodies for these animals along with the possibility of working with genetically modified strains of mice) that may be relevant to the study. For acute pancreatitis induction in mice, we present a systematic protocol, with a defined dose of 2.5% sodium taurocholate at an infusion speed 10 &#181;L/min for 3 min in C57BL/6 mice that reaches its maximal level of severity within 12 h of induction and highlight results with outcomes that validate the method. With practice and technique, the total estimated time, from the induction of anesthesia to the completion of the infusion, is 25 min per animal.

Animal models for severe acute pancreatitis enable the study of pathophysiological changes at the initial stage, facilitating observation of the evolution of inflammatory events. Here we provide a protocol for the induction of severe acute biliary pancreatitis by retrograde infusion of sodium taurocholate into the pancreatic duct of anesthetized C57BL/6 mice.

Biliary acute pancreatitis induction by sodium taurocholate infusion has been widely used by the scientific community due to the representation of the ...

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a lack of effective treatments in the current clinical practice. With the easy accessibility of transgenic and knockout strains and their small size, which allows minimal doses of drugs required for in vivo evaluation, a well-established experimental model in mice is preferred for AP research. Moreover, SAP induced through sodium taurocholate (TC) is currently one of the most widely used and best characterized models. This model has been investigated for novel therapies and possible molecular events during the process of AP. Here, we present the generation of an AP mouse model using sodium taurocholate and a simple homemade microsyringe. Moreover, we also provide the methodology for the subsequent histology and serological testing.

A mouse model of severe acute pancreatitis is described herein. The procedure presented here is very rapid, simple, and accessible, thereby potentially allowing the study of the molecular mechanisms and different therapeutic interventions in acute pancreatitis in a convenient way.

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing pancreatitis, if it does not resolve or is accompanied with infected necrosis in the retroperitoneum. As there are rarely any visually clear separating surface in white light image between necrotic debris and adjacent inflammatory normal tissues due to extensive retroperitoneal adhesions, VARD is accompanied with the risk of vascular injury, external pancreatico-cutaneous or enterocutaneous fistulae. In view of the above disadvantages, we apply real-time intraoperative near-infrared fluorescence imaging with indocyanine green (ICG) during VARD, which enables visualization of the well-perfused adjacent normal tissues. This modified technique (ICG-guided VARD) can provide a clear separating surface during debridement and reduce the risk of vascular or enteric injury. ICG-guided VARD may facilitate surgeons to perform safer debridement in treating severe acute necrotizing pancreatitis.

This protocol presents Indocyanine Green-guided video-assisted retroperitoneal debridement (ICG-guided VARD) for treating severe acute necrotizing pancreatitis.

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing ...

Acupoint Application Combined with Acupoint Massage for Treating Constipation in a Patient with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. Constipation that reduces the quality of life and triggers the risk of diseases is a common concomitant symptom in patients with COPD. Currently, western medical treatment does not achieve the desired results for patients. A high recurrence rate accompanies it, whereas traditional Chinese medicine (TCM) has a long history and rich experience in treating chronic diseases. Both acupoint application and acupoint massage are characteristic therapies of TCM, with minor side effects, high safety, simple operation, and outstanding advantages. They are effective in treating constipation for patients with COPD and are considered an ideal alternative therapy for patients with chronic constipation. The purpose of this article is to introduce the method of acupoint application combined with acupoint massage for the treatment of constipation in patients with COPD, including the selection of points, items, treatment time, and operation procedure.

Here we demonstrate acupoint application combined with acupoint massage for treating constipation in a patient with chronic obstructive pulmonary disease (COPD).

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. ...

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute exacerbations, and quality of life in patients with COPD. Warm acupuncture and moxibustion have been shown to be effective in relieving symptoms in patients with COPD combined with abdominal distention. Warm acupuncture and moxibustion are highly effective, easy to perform, and inexpensive forms of traditional Chinese medicine treatments. The standardized practice of warm acupuncture and moxibustion is very important for the treatment of COPD combined with abdominal distension. The specific steps include selecting the appropriate acupoints for needling through syndrome differentiation treatment and selecting moxa sticks of appropriate length for moxibustion for about 30 min after the De-qi. The course of treatment lasts for one week. The following indicators are specifically assessed: the score of the COPD Assessment Test (CAT) and the abdominal distension visual analog scale (VAS). This article will clearly illustrate how to standardize the manipulation of warm acupuncture and moxibustion to relieve COPD combined with abdominal distention.

Author Spotlight: An Effective Traditional Chinese Medicinal Treatment for Chronic Obstructive Pulmonary Disease with Abdominal Distension 

Here, we present a protocol to properly manipulate warm acupuncture and moxibustion for treating chronic obstructive pulmonary disease (COPD) with abdominal distension.

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute ...

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine&#39;s acupuncture techniques offer an alternative&#160;approach to treating digestive disorders&#160;by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including&#160;Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment&#39;s effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury AGI: A Preliminary Study

Acute gastrointestinal injury (AGI) is a prevalent occurrence in intensive care units and has been linked to unfavorable patient outcomes. The current approaches focus on addressing the primary disease and providing symptomatic relief. The protocol here demonstrates the implementation of acupuncture as a therapeutic intervention for AGI.

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. ...

Laparoscopic Retroperitoneal Treatment of Necrotizing Pancreatitis Complications

Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess

In patients with severe necrotizing pancreatitis, pancreatic necrosis and secondary infection of surrounding tissues can quickly spread to the whole retroperitoneal space. Treatment of pancreatic abscess complicating necrotizing pancreatitis is difficult and has a high mortality rate. The well-accepted treatment strategy is early debridement of necrotic tissues, drainage, and postoperative continuous retroperitoneal lavage. However, traditional open surgery has several disadvantages, such as severe trauma, interference with abdominal organs, a high rate of postoperative infection and adhesion, and hardness with repeated debridement. The retroperitoneal laparoscopic approach has the advantages of minimal invasion, a better drainage route, convenient repeated debridement, and avoidance of the spread of retroperitoneal infection to the abdominal cavity. In addition, retroperitoneal drainage leads to fewer drainage tube problems, including miscounting, displacement, or siphon. The debridement and drainage of pancreatic abscess tissue via the retroperitoneal laparoscopic approach plays an increasingly irreplaceable role in improving patient prognosis and saving healthcare resources and costs. The main procedures described here include laying the patient on the right side, raising the lumbar bridge and then arranging the trocar; establishing the pneumoperitoneum and cleaning the pararenal fat tissues; opening the lateral pyramidal fascia and the perirenal fascia outside the peritoneal reflections; opening the anterior renal fascia and entering the anterior pararenal space from the rear; clearing the necrotic tissue and accumulating fluid; and placing drainage tubes and performing postoperative continuous retroperitoneal lavage.

Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis

To improve the drainage of patients with necrotizing pancreatitis complicated with peripancreatic abscess and reduce the mortality of patients with necrotizing pancreatitis, we adopted a retroperitoneal approach for peripancreatic abscess debridement and drainage by laparoscopy.

In patients with severe necrotizing pancreatitis, pancreatic necrosis and secondary infection of surrounding tissues can quickly spread to the whole ...

Improving Constipation 

Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation

Functional constipation (FC) is a dysfunctional gastrointestinal disease with the main clinical manifestations of complex bowel movements, incomplete bowel movements, reduced frequency of bowel movements, and dry and hard stools, which seriously affect patients' quality of life and psychology. Electroacupuncture improves constipation by performing acupuncture on specific points in the body to accelerate intestinal peristalsis. Chinese medicine ironing therapy (CMIT) can warm up the meridians, accelerate local blood circulation, promote gastrointestinal dynamics, and accelerate gastric emptying. This study elaborated on the method and steps of electroacupuncture combined with CMIT for functional constipation, including patient selection, material preparation, operation procedure, postoperative care, and precautions. The therapeutic effect of the method was also evaluated. The results of the study showed that after 4 weeks of treatment, compared with Western medicine alone, electroacupuncture combined with CMIT can improve the frequency of FC patients' voluntary bowel movements, constipation, and quality of life. There were no obvious adverse reactions.

Electroacupuncture combined with Chinese medicine ironing therapy can effectively improve patients' constipation symptoms and their quality of life. Here, we present a protocol to describe the treatment process of electroacupuncture combined with Chinese medicine ironing therapy for functional constipation.

Functional constipation (FC) is a dysfunctional gastrointestinal disease with the main clinical manifestations of complex bowel movements, incomplete ...

Acute Biliary Pancreatitis Model: A Method to Generate Acute Biliary Pancreatitis Mouse Model via Pancreatic Duct Infusion

Source: Serra, M. B. et al. <a href="https://www.jove.com/video/61547" target="_blank">Sodium Taurocholate Induced Severe Acute Pancreatitis in C57BL/6 Mice</a>. J. Vis. Exp. (2021)
This video describes the procedure for the generation of a mouse model with acute biliary pancreatitis via pancreatic infusion of sodium taurocholate. This model helps study pathophysiological changes induced by sodium taurocholate in the pancreas.

Source: Serra, M. B. et al. Sodium Taurocholate Induced Severe Acute Pancreatitis in C57BL/6 Mice. J. Vis. Exp. (2021)
This video describes the procedure ...