On an ordinary morning at the end of December 2023, Professor Qiu Changlin came to work in the clinic as usual.
At this time, a tall young man crept into the consultation room, followed by a simple middle-aged woman. "Doctor Qiu, we're here to send you a pennant, do you remember him, you see how good he is now!."The middle-aged woman said as she handed over the pennant, "You are really the benefactor of our family, at that time I thought that my child would never be able to stand up again......."”
A meal, eat a "distress sheet".
The story also begins with a "distress sheet". On October 22, the Medical Department of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine (Zhejiang Provincial Hospital of Traditional Chinese Medicine) received an "Application Form for External Consultation" from a large tertiary brother hospital in the province, inviting Professor Qiu Changlin, a famous teacher of traditional Chinese medicine in Zhejiang Province, and the medical team to jointly consult a severe case in the hospital. The patient, Xiao Li (pseudonym), 25 years old, developed symptoms such as abdominal distension and pain and double vision after a restaurant meal. Two days later, his symptoms worsened acutely, and he called emergency ** while he was still conscious, and was rushed to a hospital near his place of residence for emergency treatment. The doctor made a preliminary diagnosis of food poisoning.
Sure enough, after further testing, Xiao Li's serum test report showed that botulinum toxin type A was positive!Xiao Li's condition deteriorated very quickly, and he developed weakness in opening his eyes, difficulty swallowing, and progressive weakness in his limbs. Chest CT showed that there was an infection in the lungs, coupled with the patient's weak sputum cough, oral secretions were difficult to discharge, and the risk of aspiration was extremely high, and the situation was very dangerous. Xiao Li was immediately transferred to the ICU for endotracheal intubation, and further antivenom and piperacillin tazobactam were used to fight infection.
After nearly two weeks**, although Xiao Li's vital signs were stabilized, the symptoms of limb weakness and respiratory muscle weakness continued to be unrelieved, and the condition became more complicated. In the face of this kind of patient with muscle weakness, the brother hospital immediately thought of Professor Qiu Changlin, a famous Chinese medicine teacher with myasthenia gravis in Zhejiang Provincial Hospital of Traditional Chinese Medicine. After receiving the consultation order, the medical department of the hospital and Professor Qiu Changlin's team attached great importance to it and set off for consultation as soon as possible.
Qiu Changlin is consulting Xiao Li.
It is reported that botulism is a life-threatening infectious disease mediated by botulinum neurotoxin, which is mainly characterized by cranial nerve paralysis, and can develop into limb weakness and respiratory failure in severe cases. The most common symptoms of botulism are difficulty swallowing, blurred vision, difficulty speaking, gastrointestinal symptoms, etc. The most common signs are descending paralysis, ptosis, and ophthalmoplegia. Symptoms and signs can progress over a period of hours to days, initially with only mild visual changes or abdominal discomfort (in patients with foodborne botulism), followed by progressive cranial nerve palsy followed by bilateral symmetrical flaccid paralysis and, in severe cases, life-threatening!It is both a toxic drug and a life-saving drug.
After learning more about the patient's condition, Professor Qiu Changlin's team came to the patient's side for further diagnosis and treatment. Combined with its clinical manifestations, Professor Qiu Changlin said that Western medicine diagnosed him with botulism, which is very clear and accurateThe diagnosis of traditional Chinese medicine is considered to be impotence, combined with the information of the four diagnoses of traditional Chinese medicine, the syndrome differentiation is spleen deficiency and dampness resistance, the patient is phlegm and dampness, feeling the evil poison, and the damp poison is trapped in the muscles, muscles and veins, so the whole body is weak and weak. He suggested that, on the basis of maintaining the existing anti-infection**, add the in-hospital preparation of traditional Chinese medicine of the Provincial Hospital of Traditional Chinese Medicine: Nux Nux capsules, and use it together with the traditional Chinese medicine decoction to strengthen the spleen and dispel dampness.
Xiao Li shook hands strongly!"Magical strychnine!Miraculous Chinese Medicine!After taking the medicine for three days, the family was pleasantly surprised to find that the strychnine worked. One week after the combination of strychnine combined with traditional Chinese medicine decoction**, the situation has changed more obviously, the weakness of the patient's limbs has improved significantly, and the distal end of the limbs can be lifted off the bed with the proximal end, although it can not last for some time, but the opening of the eyes and mouth is much more powerful than before. The family happily sent text messages to Professor Qiu Changlin's team every day to inform them of the daily physical changes, which further verified the accuracy of the first thought. "For strychnine, we know that this is a relatively toxic traditional Chinese medicine, and to be honest, some experts in the medical team were also apprehensive at first. The medical team at Brother Hospital also had a reassurance. "Now that we have all taken it, in the major and difficult diseases, Chinese medicine can indeed play a good synergistic role, and we also praise the traditional medicine of the motherland!"On the 12th day after the intervention of strychnine capsules and traditional Chinese medicine decoction, Xiao Li was successfully weaned off the ventilator. A month later, Xiao Li was transferred out of the ICU and entered the general ward for follow-up *** Last week, Xiao Li ** was discharged from the hospital, and his mother found Professor Qiu Changlin with full gratitude and sent him a pennant (see picture). The family said, "Thanks to Chinese medicine, I never thought that Chinese medicine would work so quickly." At that time, we almost felt hopeless, but then we saw that he was getting better every day, and our whole family is very grateful to you!
Qiu Changlin had a cordial conversation with Xiao Li and his mother.
How did the "highly toxic" strychnine, which used to change "on the rivers and lakes", become a life-saving medicine?"The key is to accurately control its dosage and standardize its preparation methods. When used properly, strychnine can be a life-saving medicine that can turn enemies into friends. Professor Qiu Changlin said, "In terms of traditional Chinese medicine, there has been a relatively systematic understanding of strychnine since the Ming Dynasty. "At present, with the joint efforts of several generations of traditional Chinese medicine practitioners in the hospital, the use of modern scientific and technological means has carried out more in-depth research on the medicinal value of strychnine, and the use of strychnine to carry out some specific diseases has accumulated rich experience, and developed in-hospital preparations. As early as the 80s of the last century, the Department of Neurology of Zhejiang Provincial Hospital of Traditional Chinese Medicine took the lead in conducting research on Strychnine, and published the "Experimental and Clinical Research on Strychnine Gravis Gravis", which found that it has an immunomodulatory effect, and the effect of mild myasthenia gravis is obvious with Strychnine alone. Professor Qiu Changlin created a series of formulas for myasthenia gravis through staging syndrome differentiation, and developed the manufacturing process of strychnine capsules and obtained national patents. Subsequently, more in-depth research was carried out on the medication method, dosage, prevention and treatment of toxic side effects and the dose-effect relationship of Nux nux nux Nowadays, strychnine combined with hematopoietic stem cell transplantation in hematology is refractory to critical myasthenia gravis and has achieved good long-term results. At present, Nux Nux Capsule is widely used in the hospital in the process of myasthenia gravis, spinal cord injury, peripheral nerve disease after chemotherapy, paralysis after stroke and other diseases, and has achieved very good results. "In the future, we will develop a new strategy for stroke around strychnine, and use the ideas and methods of modern medicine to further explore the mechanism of action and pharmacokinetics of strychnine, and expand its methods in lower motor neuron disease. Professor Qiu Changlin said.
By the way, a reminder.
In daily life, we must pay attention to the prevention of foodborne botulism
Botulism can occur all year round
Botulism is a serious toxic diseaseThe case fatality rate is high, mainlyCaused by ingestion of food contaminated with botulinum toxin
Botulinum toxin is a neurotoxin produced by Clostridium botulinum and other clostridial bacilli, which is divided into 8 types: A, B, C, C, D, E, F, and G, among them, four types A, B, E, F can cause human poisoning, mainly acting on nerve endings, inhibiting the release of acetylcholine, and causing muscle paralysisIn severe cases, death can occur due to respiratory failure
Botulism can occur all year roundThe types of food that cause poisoning vary from region to region and different dietary habits, and home-made fermented foods (such as stinky tofu, soybean paste, noodle sauce, etc.) and air-dried meat products are mainly used in China.
The incubation period for botulism is generally 12 to 48 hours, and patients usually have it in the early stagesSymptoms such as tiredness, fatigue, headache, and dizzinessIn the later stage, blurred vision, drooping eyelids, hoarseness, dysphagia, and dyspnea may occur. After consuming the suspicious food, once the above related symptoms appear, should:Seek immediate medical attention**, and carryBring leftover food
The National Center for Food Safety Risk Assessment reminds that in general, the risk of ingesting botulinum toxin spores is relatively small, but the intestinal flora of infants and young children has not yet been fully establishedBotulinum toxin spores germinate, multiply, and produce toxin in the intestines of infants and young children, causing infectious botulism
Therefore, by all meansScientifically prepare, make and feed infant food, and do a good job of cleaning and disinfection of containersIf it is not eaten immediately, it should be refrigerated in time to prevent the contamination of these foods by botulinum toxin spurs in the environment.
How to prevent botulism?
Be cautious when buying cooked meat and fermented foods onlineBe cautious about choosing ready-to-eat food purchased onlineDo not buy, do not eatProduced by unknown origins or small workshopsVacuum-packedBulk cooked meat products, fermented foods, especially ready-to-eat cooked meat products that need to be refrigerated.
Purchased from local stores, markets, etc. for travel or businessVacuum packaging is not recommended for bulk cooked meat products
It is worth reminding that ready-to-eat cooked meat products and bulk cooked meat products that need to be refrigerated and storedDo not express or carry it at room temperature over long distances, which should be stored and transported in refrigerated conditions and consumed as soon as possible.
Proper storage and handling of cooked meat productsClostridium botulinum is widely distributed in nature and is mainly found in the form of spores in soil and animal fecesIt is easy to contaminate food
Clostridium botulinum spores are extremely heat-resistant, averageIt is difficult to inactivate it at the cooking temperatureHowever, because Clostridium botulinum is a strictly anaerobic bacterium, its spores can germinate, multiply and produce toxin in a warm, humid and anaerobic environment, therefore, oxygen and temperature are the key factors to control its harm.
Bulk ready-to-eat meat products should not be stored at room temperature in vacuumCold chain transportation is required, preserved pre-packaged ready-to-eat cooked meat products should be purchased afterRefrigerate as soon as possible, which should not lose the cold chain protection for a long time.
At the same time, botulinum toxin is not heat-resistant, and it can usually be destroyed by heating 100 minutes at 100 minutesThorough heating is effective in preventing botulism
Be cautious with homemade fermented foods and meat products
When preparing plant-based fermented foods (such as stinky tofu, bean paste, noodle sauce, etc.) and meat products such as bacon, cured meat, and air-dried beef at home, it should:Ensure the cleanliness of raw materialsRemove soil and impurities, and try to prevent pigs, cattle and mutton from being polluted by feces and soil during slaughter, storage and transportationThe production process is hygienic
Content**: China Journal of Traditional Chinese Medicine.