Source: journal of traditional chinese medicine1979; (5):38~40
experience
1. Application of clearing away heat and toxic materials, dredging fu-organs and promoting diuresis: Agkistrodon halys venom is a mixed poison, but it mainly promotes blood circulation. Traditional Chinese medicine is called "two poisons of wind and fire", and fire is the main poison, so the treatment is also based on clearing heat and detoxifying. Dandelion, Herba Violae, Herba Hedyotidis Diffusae, Herba Scutellariae Barbatae, Flos Chrysanthemi Indici and Herba Hedyotidis Diffusae all have anti-venom effects, and the clinical effect is good. Motherland medicine also emphasizes diuresis when treating snake wounds, and it has long been said that "the snake cannot come out, but the snake venom is bound inside". This argument has important clinical significance. Some people label snake venom with iodine, thinking that radioactive substances discharged from urine in the early stage still combine with protein, and then gradually become free iodide. This study suggests that some snake venom is excreted from the kidney at an early stage, so early use of diuretics can accelerate the excretion of venom through urine and reduce the degree of poisoning. At the same time, due to the maintenance of urine,
2. Application of Ginseng: We sometimes use western medicine respiratory stimulants, cardiac glycosides and antihypertensive drugs when rescuing critically ill patients with respiratory failure, heart failure and shock caused by Agkistrodon halys bite, but all of them are ineffective. After adding 6 ~ 9g of American ginseng, the condition gradually improved.
3. Application of adrenocortical hormone: To treat patients with severe snake injury, the dosage of adrenocortical hormone should be large, with hydrocortisone 200-400 mg and dexamethasone 25-30mg/ day. For patients with severe poisoning, although the symptoms of early poisoning are not obvious, large doses can prevent the development of the disease to some extent. Animal experiments show that the tolerance of animals with adrenalectomy to Agkistrodon halys venom is obviously reduced. At this time, if exogenous corticosteroids are supplemented, not only the normal tolerance can be restored, but also the tolerance of animals to snake venom can be further improved at a certain dose. Adrenal cortex failure is an auxiliary cause of death from snake venom poisoning when the severely poisoned person is dying. Animals that died of snake venom poisoning showed pathological changes such as bleeding, congestion and cell infiltration. The above experiments provide a theoretical basis for the application of high-dose hormones in clinical treatment of snake venom poisoning.
4. Application of respiratory stimulant: The main factor that snake venom causes dyspnea is blocking the conduction of peripheral nerves and paralyzing respiratory muscles. Therefore, the application of respiratory stimulants should master "early use" and "moderate amount". "Early use" means that when patients have difficulty breathing, they should take clonidine 0.25 ~ 0.5g/ time or lobeline 3 ~ 6mg/ time as soon as possible, and inject subcutaneously or intramuscularly every half hour to two hours, and at the same time increase the oxygen supply. If necessary, add 3 ~ 6 mg of lobeline and 8 ~ 16 mg of ruisu to hypertonic glucose solution for intravenous drip. "Appropriate amount" means that the dosage should not be too large. This is good for improving breathing. If the patient has entered the late stage of respiratory failure and his breathing surface is shallow or irregular, it is often ineffective to use respiratory stimulants at this time. If the dosage is too large, it can increase the oxygen consumption, lead to the respiratory center becoming inhibited due to excessive excitement, and also cause irritability and convulsions, making breathing more difficult.
5. Application of pressor: The shock caused by Agkistrodon halys bite is hypovolemic shock. Shock can be stopped after early correction of blood volume, because it does not affect the functional damage of important organs. 500 ml of dextran with medium or low molecular weight can be used for rapid intravenous infusion, and it can be used in 1 ~ 2 hours, and can be reused if necessary, and it can be used in 24 hours 1000 ~ 1500 ml. As for antihypertensive drugs, it is not advisable to use them as soon as possible, but those who have not stopped shock after correcting blood volume and acidosis can use antihypertensive drugs as appropriate. When choosing antihypertensive drugs, the toxicity of snake venom to myocardium and kidney must be considered. Therefore, drugs that damage myocardium and reduce renal blood flow, such as neofolin and norepinephrine, should not be used. If the patient has red face, wet limbs, weak pulse and low blood pressure, TCM syndrome differentiation is yin-yang deficiency type, that is, 20 ~ 100 mg alamin is added into 500ml 10% glucose solution for intravenous drip, and Shengmaisan is used to replenish qi and nourish yin to invigorate the heart. If the patient shows pale face, cold limbs, cyanosis at the end, poor capillary filling, small pulse difference and low blood pressure, TCM syndrome differentiation is yang failure type. 0.5 ~ 1 mg isoproterenol can be added into 500ml 10% glucose solution for intravenous drip, and Shenfu decoction can be used to restore yang to rescue adverse reactions.
6. Local treatment: Ligation at the upper end of the wound is one of the important first-aid measures to prevent the absorption of venom, but the ligation should not be too tight, as long as it can block the reflux of lymph and venous blood. Ligation time should be relaxed every 20 ~ 30 minutes 1 ~ 2 minutes. If the ligation is too tight, the local blood circulation will be blocked for too long, and wound infection will often cause finger (toe) necrosis. We have treated more than ten cases of finger (toe) necrosis. If finger (toe) bone necrosis occurs, don't do finger amputation easily. It's just that external application of traditional Chinese medicine can make dead bones separate, fall off and heal, and generally won't affect the function of injured fingers. Regarding the problem of local wound enlargement, using a knife to cut directly along the meridians on the two tooth marks is beneficial to detoxification and not easy to damage blood vessels, and the depth of the incision can reach subcutaneous. For those with severe limb swelling, eight evils or Feng Ba can be used for detoxification. If you do too much deep detoxification on swollen limbs, it will increase the chance of infection, and snake venom contains a proteolytic enzyme, which can decompose protein, destroy tissues, and then cause infection, which can make local tissues seriously necrotic and fester, and finally form a huge ulcer, which is not easy to heal. If there is tissue necrosis or ulcer, topical Chinese medicine has a good effect.