The General Situation of the Ten Years' Development of MEBT/ MEBO & Its Task in the 21st Century
--Written in the 10th Anniversary after the Chinese Journal Of Burns Wounds & Surface Ulcers Started Publication
Zhang Xiangqing
139 Hospital of Chinese People's Liberation Army (253002)

The Chinese Journal of Burns Wounds & Surface Ulcers is a country-level medical learned periodical directed by Ministry of Public Health. This quarterly has been published on a continuing basis for 10 years since November 1989, when the initial issue was released. In the past ten years, under the organization and leadership of editor-in-chief Xu Rongxiang, The Chinese Journal of Burns Wounds & Surface Ulcers has kept on carrying out the aim of publication, propagandizing and reporting the information about MEBT (Moist Exposed Burn Therapy) and MEBO (Moist Exposed Burn Ointment) zealously, and treating different kinds of body surface burns, wounds and ulcers, and related diseases. Great deals of experience and significant curative effects have been acquired. As is well known, MEBT/MEBO is a new therapy for burns invented by Xu Rongxiang, a young burn scholar of our country, in accordance with the law of life, and based on the dialectical theory, methods, prescriptions and drugs of tradition Chinese medicine, so it is called "Chinese burns wounds and ulcers medicine”. The academic key point of this technique is to expose the burn tissues tridimensionally in the physiologic moist environment, to regenerate and restore them according to the law of disease development (The Chinese Journal of Burns Wounds & Surface Ulcers, similarly hereinafter, 1989, 1: 4). Since it breaches the conventional routine therapy (dryness-scab-skin-grafting) in theory and practice, it is inevitable it led to disputes in some scholars of conventional therapeutics when it came into the world. In the past 10 years, with the principle of "let a hundred of flowers blossom and a hundred schools of thought contend", we have given full play to the strong points of different kinds of medical sciences, study, approach, summarized, and exchanged the experience in treating burn wounds and ulcers from all sides, accelerated academic advancement, and promoted the development of "burn wounds and ulcers medicine", and ensured the successful realization of " popularization plan of a hundred of fruits in 10 years". Under the commitment of the editorial board of periodical office, I skimmed through all the articles published in this periodical, and read through the important treatises, so as to summarize the 10 years' academic development of MEBT/MEBO and the task in the next century. The purpose is to review the past, look forward to the future objectively, popularize and develop this new technique unshakeably. We hope that MEBT/MEBO can serve for the human health all round in the early years of the next century.
A. Statistical Analysis of Articles　　
(A) Article Types and Constitution
There were 39 issues (not including article compilation) and 1083 articles published from the initial issue of The Chinese Journal of Burns Wounds & Surface Ulcers to the second issue of 1999. These articles were classified, and the types and constitution of them were summarized in Table-1.

Table-1 Types and Constituent Ratio of the 1083 Articles

Wounds and ulcers: Including body surface wounds, knife trauma, ulcers and the related diseases.

Synthesis: Including lecture, review, commentary etc.

Others: including small renovation, small information, discussion etc.

It can be seen from the Table that the occupancies (constituent ratio) of articles on burns, wounds and ulcers are 40.35% and 20.78% respectively (61.13% in total); the articles of monographic study on burns, wounds and ulcers are the third most (13.02%). That is to say, more than 2/3 of the 1083 articles (74.15%) are articles about burns, wounds and ulcers. It can be seen from this that The Chinese Journal of Burns Wounds & Surface Ulcers has given an outstanding contribution in summarizing and perfecting ‘Chinese burns wounds and ulcers medicine'. However, it also can be seen that the philosophical articles analyzing and illuminating MEBT/MEBO are insufficient, which will be the direction of improving and perfecting the content of this journal for the future.

(B) Therapies and Constitution

According to the content of the articles, there were 140808 cases with definite therapies (there might be duplicate cases in the articles written by authors from a same unit). 87.67% of the patients used MEBT/MEBO, 12.33% of the patients did not use MEBT/MEBO (Table-2). This shows that this publication attaches great importance to the unprecedented new technique, MEBT/MEBO beyond all else.

Table-2 Therapies and Constituent Ratio of the 140808 Patients

(C) Diseases Treated by MEBT/MEBO and Their Constitution

The 123448 patients receiving MEBT/MEBO therapy are summarized in Table-3.

Table-3 The 123448 Patients Receiving MEBT/MEBO Therapy and Their Constituent Ratio

Table-3 shows: Most of the patients receiving MEBT/MEBO therapy were burn patients, nearly 4/5 (78.58%) of the total cases. Wounds and ulcers were the second most diseases (16.16%), followed by dermatological diseases, gynecologic diseases, diseases of ophthalmology, otorhinolaryngology and stomatology, chilblain, non-body-surface diseases, and the cases using MEBO series of drugs. This also shows: burns, body surface wounds and ulcers are the best indications for MEBT/MEBO, while, in the 10 years' clinical practices, its indications have been expanded to the diseases of dermatology, gynecology, ophthalmology, otolaryngology, stomatology and chilblain etc. Because of its good curative effects, the use of MEBT/MEBO in treating diseases related to burns, wounds and ulcers is on the rise. The experience is abundant and valuable.
(D) MEBT/MEBO and Treatment Level of Burns
There were 97000 cases of burn patients receiving MEBT/MEBO therapy. Among them, 96840 patients were healed and the cure rate was 99.84%. There were 90428 patients with burn surface area less than 50% TBSA, among which 90304 patients were healed and the cure rate was 99.86%; there were 6572 patients with burn surface area greater than or equal to 50% TBSA, among which 6002 patients were healed, and the cure rate was 91.33% (see Table-4). According to the total cure rate and the cure rate of extensive burn lager than 50% TBSA, MEBT/MEBO is the top-ranking burn therapy in our country even in the world.

(E) Statistics of the Patients Receiving Non-MEBT/MEBO Therapies

In the past 10 years, The Chinese Journal of Burns Wounds & Surface Ulcers has not only propagandized and reported the technological development of MEBT/MEBO, but also published some articles unrelated to MEBT/MEBO, among which there 17360 cases. The therapies of these cases are summarized in Table 5 (see Table 5).

Table 5 Therapies and Constituent Ratio of Non-MEBT/MEBO Cases

Note: The cases receiving conventional therapy included the control cases of MEBT/MEBO, treatment lessons, complication reports. Others included fundamental research and those with no indication of therapies.

17360 patients receiving non-MEBT/MEBO treatment were summarized in Table 5. Among them, there were the control cases of MEBT/MEBO (54.32%), general epidemiological survey cases (28.67%), plastic cases (14.14%), and other cases related in monographic study and other studies (2.87%). The cases receiving conventional therapy included the control cases of MEBT/MEBO, and the cases related to the treatment lessons and complications. Plastic cases included surgery plastic cases and the patients treated with MEBO Scar Reducer.

B. Evaluation on Large-amount Burn Clinical Data

The articles containing more than 1000 cases are called large-amount clinical data, and there are 13 articles of large-amount clinical data in the 437 MEBT/MEBO burn articles published in the 39 periodicals. According to the order of time when the articles were published, they include "clinical investigation report of 2076 cases treated with burn moist exposed burn therapy" written by Zhang Linxiang, Yang Kefei (1989, initial issue: 22); "clinical analysis on 1567 burn patients treated with moist exposed burn therapy"(1991, 1: 25) written by Yang Kefei, Yangjun et al., "clinical analysis of 1003 burn patients treated with moist exposed burn therapy" written by Zhao Junxiang, Yang Guoming et al.; and the articles written by Qiao Haibing (1994, 3: 29), Wi Yuyun (1996, 1: 32), Wang Hezhen (1996, 1: 27), Zhao Junxiang (1998, 4: 24), Xiao Xinming (1998, 4: 26), Wang Hong( 1998, 4: 27), Hui Lei (1998, 2: 28), Xu Degao (1998, 4: 30), Sha Guangxin (1998, 4: 31), Zhou Baoguo (1998, 4: 35).

The articles are considered to be with precise structure, true content and reliable materials based on the careful study on the above 13 articles. For example, the total cure rates were between 94.36% and 99.80% (not including the data of medium to small area burns). It is better in analgesia effects and the degree it decreases the patients' pains is bigger than that of conventional therapy. It can be concluded that MEBT/MEBO has definite curative effects and good repeatability.

It should be noted that the articles written by Zhang Linxiang and Yang Kefei were published in the initial issue, when MEBT/MEBO came into being in our country. The two old specialists, who had used conventional therapy for many years, used the new technique like sailing against the current, and had foreknowledge in the theory of Xu at that time, which indicated their vision in the development of science was still keen although they were old. What they did not only produced deep influence on the decision by Ministry of Public Health on September 1, 1991, who decided to popularize the moist exposed burn therapy and moist exposed burn ointment in all country, but also were the true turn of the revolutionary academic advancement ("the great historic turn on burn therapeutics") in thought and actions. Undoubtedly, their foreknowledge and actions were a noiseless call to the young scholars, the subsequent scientists who transformed and carried out the MEBT/MEBO techniques. For this reason, we should praise them for the popularization of MEBT/MEBO techniques and their great devotions to the start-up of the "popularization plan of a hundred of fruits in 10 years" of Ministry of Public Health, at the time 10 years after The Chinese Journal of Burns Wounds & Surface Ulcers started publication.

There were also other old specialists who struck out on this new path, such as professor Ma Enqing. He is the burn surgery professor of Hunan Medical University , who has great scientific attainments in burns, and made an example for us in understanding, popularizing MEBT/MEBO techniques and the related fundamental research. Professor Xu Rongxiang evaluated these old specialists as follows: the innovation in academic thought and medical treatment techniques is not a simple thing some people do not have such good idea, concept, academic sense and scholastic attainments as professors Zhang Linxiang, Yang Kefei, Ma Enqing, Zhang Xiangqing do (1997, 3: 33). The contributions by Professor Ma Enqing are to be described in "infection of burn" and related sections.

"Clinical analysis of 1003 patients treated with moist exposed burn therapy" was written by the two middle-aged and young scholars, Zhao Junxiang and Yang Guoming in the early nineties (1992, 1: 36 ). They summarized the clinical experience in treating 1003 burn patients with MEBT/MEBO in the burn center, Nanshi hospital, Henan, in the nearly 3 years between December, 1987 to October, 1990. Among them, there were 386 cases of severe and very severe burns (38.5%), 118 cases of children with severe burns or burns with burn surface area exceeding 50%TBSA (11.8%). There were 977 cases in this group, and the total cure rate was 97.41%. According to the data provided by the article, the half lethal burn area (LA50) was 82.11%TBSA. The curative effects of Nanshi Hospital in the late 1980s and early 1990s were as followed: the probability of dying was 50% when the burn area was 82.11%TBSA. It has been reported domestically that the half lethal burn area is 75.93%TBSA. The author also indicated: LA50 had reached 75-80%TBSA or above in our country (Li Ao et al., Burn Therapeutics, the peoples medical publishing house, 1995; 2). The reason Nanshi Hospital acquired such good curative effects may include both the supervision and direction by Professor Xu Rongxiang, and the use of new MEBT/MEBO techniques by the middle-aged and young scholars without blind worship for conventional therapy.

C. Study on Improving Stasis Zone

There were 3 pathological zones in the deep burn wound from superficies to interior: the surface layer (or core zone) is the inconvertible necrotic zone, the bottom layer (or peripheral zone) is the hyperemia zone and inflammatory reaction zone; the layer between the above zones is the st asis zone. According to the above pathological changes, the key points of burn wound treatment includes not only to prevent the sta sis zone from developing into hyperemia zone, but also to treat it with effective therapies to reduce and recover it, which is the fundamentality of the technical design of MEBT/MEBO. The microcirculation change law of conventional dry exposed therapy had been proved by Professor Xu Rongxiang through the experimental study on the microcirculation of burnt rabbit ear (1994, 4: 42): after injury, the blood capillaries of sta sis zone and hyperemia zone were constricted, and the blood stream in the blood capillaries increased; 30 minutes after injury, the blood vessels were blurred, and the tissue edema was apparent; 3 days after burn injury, the wounds turn dry, most of the terminal capillary blood vessels were stagnant, the blood stream decreased, and the number of blood vessels was reduced; 10 days after injury, the injury area was almost completely necrotic, and only 1 case recovered (1/7). MEBT/MEBO treatment group: The changes within 10 minutes after injury was similar to that of the conventional treatment group, but the tissue edema and the blood vessel blur change occurred later than those of the conventional treatment group did; 3 days after burn injury, the wound was moist, most of the terminal blood vessels were in flow condition, the flowing true capillaries increased, the blood capillary blood stream in the core zone was normal, there was no formation of blood capillary network in the sta sis zone, but there still existed true capillaries and blood stream; 10 days after injury, most of the wounds were healed (6/7).

It is believed at present that the progressive necrosis of the sta sis zone includes several change events, such as dermis ischemia, blood clotting and blood vessel obstruction. It has many kinds of causes, and it is related to vasospasm, abnormal hemorrheology, oxygen free radical and neutrophilic granulocyte conglutination etc. It was brought forward by Xu Rongxiang many years ago that the enlargement of burn wound stasis zone occurred not only in the local part, but also in the whole body. There forms progressive thrombosis in the microcirculation of whole body due to the blood coagulation mechanism, blood vessel structure and pelohemia changes in the local area. The changes in the local area and in the whole body interact as both cause and effect. The above viewpoint of Xu was confirmed by Wang Guangshun et al. in "study on the hemorrheology in the burnt rabbits treated with MEBO". The apparent viscosity of blood and the plasma viscosity of the 10% TBSA Ⅱ degree burns in the back of rabbit treated with dry exposed therapy alone were significantly higher than those in the MEBO treatment group. The above indices only increased 24 hours after injury in the MEBO treatment group, and there were no statistical difference between the normal animals and the burnt animals 2, 3, 6 days after injury. As a result, in MEBO treatment, the drugs act on the local area, but they can improve the microcirculation indices of the whole body (hemorrheology), thereby promote the restoration of the local burnt areas.

It has been proved by the animal experiments by Yan Ze et al. (First Military Medical University) recently (1998, 4: 21) that there was a sharp decline of blood in the microcirculation in the sta sis zone in the burn wounds of both the MEBO treatment group and conventional dry exposed therapy group in the early stage of Ⅲ degree burns in the rabbit back, which decreased to the minimal values after 2 hours. However, the blood flow decreases in different time phases (5min-72h) in the conventional therapy group were significantly greater than those in the MEBO treatment group (p<0.01). The content of MDA (malondialdehyde), the oxygen free radical product in the stasis zone of both groups increased 4 hours after injury. However, the content in the MEBO group began to decrease before long and reached the values before injury at 24 hours after injury, while that in the conventional therapy group kept persistently high. The moisture content of stasis zone 4 and 48 hours after injury was higher than that before injury, but the increase in the MEBO group was not as significant as that in the conventional therapy group. It can be seen from this that there was difference in the capillary permeability and tissue edema degree in the two groups. The necrotic area of the conventional therapy group (20.96± 3.1 mm 2 ) was significantly higher than that of the MEBO treatment group( 8.38± 1.78 mm 2 ) 14 days after injury. The author considered MEBT/MEBO could improve the microcirculation of wound stasis zone, alleviate the local progressive damage in the early stage of burns.

It can be concluded from the above research results that MEBT/MEBO can improve the stasis zone of burns. These studies provided sufficient theoretical bases for the clinical curative effects of MEBT/MEBO and the action principles of MEBO.

D. Third Degree Burns and "Combination of Drugs and Knife" and "Ploughing Therapy”

(A) Treatment on third Degree Burn Wounds

The therapy for third degree burn wounds was definitely described by Xu Rongxiang in the "burn moist exposed burn therapy" courses and teaching materials in the middle and late 1980s (1989, 1: 9): The third degree burn wound was different from the deep II degree burns due to the necrosis of all layers of skin. In the conventional therapy, the necrotic tissues were excised by surgery, then skin-grafting treatment was used, and there were no other effective methods. This may be the reason why nobody performed further study on this for a number of years. It has been found by Xu through clinical practice that the superficial third degree burn wounds diagnosed according to common clinical diagnosis standard were completely healed by MEBT/MEBO treatment. Therefore, he performed further intensive study. It was proved by histological examination that 20% of the eccrine glands existed in the subcutaneous tissues; the sweat gland epithelia could grow on the wounds and cover the wounds so that skin-grafting could be avoided. It was also considered small area of deep third degree burn wounds could be treated with this technique, and also could be healed through the propagation of epithelia at the edge of wound. However, large area of deep third degree burn wounds should be also treated with skin grafting. As a matter of fact, a great number of superficial third degree wounds considered to be in need of excision of eschar and skin-grafting have been healed by MEBT/MEBO. All these cases had systemic clinical data or image proof, such as the cased reported by Xiao Mo in "treatment experience of MEBT/MEBO promoting the regeneration and restoration of deep burn wounds" (1999, 1: 18). The deep third degree burns in which the muscle layer has been damaged are difficult to treat. Xu Rongxiang held that MEBT/MEBO was used to liquidize and remove the necrotic layer, the subcutaneous tissues should be kept as much as possible, and then skin grafting was performed to cover the wounds. It should be noted that excision of eschar was replace by drug liquefaction with the view of avoiding injury to the subcutaneous tissues in negligence (1997, 3: 8). It has been proved by clinical practice that the local area treated with this therapy was plump, and this therapy was better than conventional excision and skin-grafting therapy.

There was another key problem in the treatment of superficial third degree and deep third degree wounds, namely the release of pressure on deep tissues by necrotic skin, so as to protect the whole layer of the necrotic skin. After the whole layer of skin is damaged, the flexibility of skin disappears due to the damage to the fiber structure in the dermis; the hypodermic fluid pressure will increase because of the progressive increase of the exudation in the subcutaneous tissues. It has been proved by the fundamental research by Zhang Xiangqing (1995, 1: 13) that the fluid pressure in the subcutaneous tissues around the annular eschars could be as high as more than 35cm H 2 O, which might lead to the obstruction of the blood circulation in the distal ends of limbs (fingers) or limit the expansion ratio of neck and chest. Xu Rongxiang advocated the pressure on the deep tissues by the necrotic skin should be released in the early stage, ploughing therapy should be used to accelerate the transformation of information tissues in the subcutaneous tissues, so as to make the fresh skin island tissues grow (1997, 3: 9).

( B)"Combination of Drugs and Knife" and "Ploughing Therapy"

With regard to the treatment on large-area degree wounds with MEBT/MEBO techniques, Xu Rongxiang has analyzed the local basic changes of third degree burns in the initial issue (1989, 1: 9) and indicated large-area third degree burns should be also treated with skin grafting, and reported the bold attempt of Nanyang Burn Center on the treatment of third degree wound necrotic tissues. Many incisions were made on the necrotic tissues with scalpels in order to enhance the liquefaction effects of drugs and improve curative effects. In the beginning of 1990, Zhao Junxiang et al. put forward the method of "many times of excision of necrotic tissues in turn with knife" in the article "experience in the treatment of 4 cases of large-area burns with moist exposed burn therapy" (1990, 1: 18 ). In the ensuing year, Yang Kefei brought forward the new conception of treating third degree wounds with combination of drugs and knife based on a great lot of clinical practice (1991, 1: 25 ). Yang believed that the treatment effects on third degree wounds with MEBO alone were not as good as those with combination of drugs and knife. "Combination of drugs and knife" means that drugs promote the effects of knife, while knife enhances the potency of drugs, drugs and knife are combined to remove the third degree necrotic tissues in a short time. Since this method was really effective for the treatment on third degree wounds, which could protect the vital tissues free of damage, accelerate the liquefaction of necrotic tissues, his article about "combination of drugs and knife" was used for reference by other doctors before long. In 1992, Zhao Junxiang, Yang Guoming et al. put forward the special term "ploughing therapy" in the article " Clinical Reports of 103 Patients Treated with Moist Exposed Burn Therapy and Ploughing Therapy". The initial method was using scalpel to make a "well" form scratch, and then a suitable "ploughing knife" was developed. The objective of using this method was to give play to the action of drugs on the wounds, so as to create a good liquefaction environment for the third degree wounds, and save the dead-alive tissues as much as possible. Owing to the reasonable design of this method, it is also used by other doctors for reference, and plays a major role in treating third degree wounds. On June 23, 1997 , Xu Rongxiang confirmed the above method in the "Advanced Academic Course for Leaders in Burn Field". He said it was difficult to get ideal liquefaction effects when using the methods applied on deep II degree burns to treat deep third degree burns, that is, the hydration reaction, enzymolysis reaction, rancidity reaction and saponification were difficult to be started. Therefore, ploughing therapies and other therapies should be used to assist it. For the third degree wounds with muscular layer damaged, most of the necrotic tissue layers can be excised, MEBT/MEBO should be applied on the wounds to culture granulation tissues, grow dermal cells, and cover the wounds (1997, 3: 44 - 45).

E. Clinical and Experimental Study on the Effects of Anti-inflammation and Preventing and Treating Infections

(A) Anti-inflammatory Action of MEBO

The inflammatory reactions and bacterial infections of burnt tissues are two different concepts, but they are often mistaken for each other by some persons. It was believed by Xu Rongxiang in the article "Anti-inflammatory Action and Principle of MEBT/MEBO" ( The Chinese Burns Wounds and Ulcers , Page 11) that one of the changes of burns was inflammation, but for a number of years people were only absorbed in the study of bacteria impairment, and inflammatory reactions were lost sight of, therefore there was still few methods and drugs to treat burn inflammatory reactions. The burn wound itself is an ‘infected wound'from the view of inflammation, but this does not mean the wound has been infected (by bacteria). This viewpoint of Xu is similar to the present knowledge of burn pyaemia. It has been confirmed that the essence of pyaemia is the reaction of the human body to the inflammatory materials, such as tumor necrosis factor, interleukin, platelet activating factor, leukotrienes and oxygen free radical etc. If these materials are not cleaned up in time, they will lead to extensive endotheliitis, disturbance of blood coagulation, abnormal angiotasis and cardiac muscle inhibition etc. Bacteria are one of the principal materials starting up the above factors and leading to the chain reaction, but except for bacteria, different kinds of damages, such as trauma, heat injury, shock etc., can directly start up the chain reaction of inflammatory factors. After the inflammatory reaction is started up, it can continue not dependent on the presence of infective agents, and result in multi-aspect impairment to the human body. Its presentation is the same with results of bacteria start-up.

MEBO contains natural β-beta-sitosterol, the local application of which can generate favorable anti-inflammatory actions. Its mechanism of action is similar to that of glucocorticoid, which can lower capillary permeability, reduce hyperemia and exudation, so as to inhibit inflammatory reactions. According to molecular pharmacology, β-beta-sitosterol can be combined with inflammatory factors and form intermediate factor, thereby eliminate the actions of inflammatory factors, and inhibit the growth and reproduction of bacteria (1997, 3: 40 ). Furthermore, another antiphlogistic component in MEBO is baicalin, the anti-inflammatory actions of which are realized by counteracting the actions of epinephrine, noradrenalin and catecholamine. It can block β 1 and β 2 receptors, eliminate superoxides, alleviate stress and inflammatory reactions. The study on the oxygen free radical removing functions of MEBO has been confirmed by the animal experiment by Yan Ze (1998, 4: 21 ). The content of malondialdehyde (MDA) in the tissues of wound having treated with MEBO is significantly lower than that in the dry exposed treatment group.

(B) Effects of Preventing and Curing Infection

It was indicated by Xu Rongxiang in the academic report "Great Historic Turn in Burn Therapeutics" that burn environmental pollution mainly referred to the aggression of the bacteria in the air, therefore there was no denying that a great lot of bacteria in the environment might adhere to the outer layer of the drug. However, since there was no water or oxygen contained in the drug layer, the aerobic bacteria in need of water could not reproduce. If anaerobic bacteria fell onto the wounds, the cere would insulate them in the air for a while, thus they would be oxidized, and their growth would be inhibited (1989, 1: 9). The following has been confirmed by the study of Xu: The wounds of the same depth could be divided into two parts, and were inoculated with Pseudomonas aeruginosa. One part was bound up with the wound moist, and moist exposed burn therapy was applied on the other. It was found on the second day that there was green fluid exudation on the binding-up top dressing and there appeared infection signs in the wounds. This indicated that the drugs in the area of binding-up would be absorbed by the top dressings, the inoculated bacteria were in direct touch with the necrotic tissues of wounds, and began to grow and reproduce. In the area treated with moist exposed burn therapy, the inoculated bacteria also adhered to the drug layer, but the drugs inhibited the growth and reproduction of them. The mechanism concerned with this finding is required to be further explored.

The first scholar conducting prevention and cure study against bacterial infection was Professor Ma Enqing, Hunan Medical University , who performed many times of clinical and experimental studies on the bacteriostatic action of this therapy in succession (1990, 1: 25 ). It has been shown in clinical research that MEBO has bacteriostasic activity on Pseudomonas aeruginosa (the positive incidence of wound germiculture is only 17.7%), but it has weak actions on Staphylococcus aureus and Escherichia coli. However, there was no sepsis in the patients with positive wound germiculture results. He thought: MEBO was lipophilic oil soluble concentrate with good actions of inducing flow, and made against the growth and reproduction of these bacteria. Subsequently, Professor Ma directed his graduate student, Chen Xiaowu to conduct a comparative study on the control actions of MEBO , SD -Ag cream and warming exposed therapy on Pseudomonas aeruginosa infection (1990, 3: 29 ). They came to a conclusion that MEBO had similar inhibiting action on Pseudomonas aeruginosa with that of the present acknowledged effective inhibitor SD-Ag, and had the same control action on the invasive infection of Pseudomonas aeruginosa to the burn wounds. In the meantime, the study on the inhibiting action of MEBO on Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli by Lin Zhengya et al. (1990, 1: 55) indicated: the wound infection rate of the above 3 dominant bacteria at admission were 80.76%, 84.61% and 92.30% respectively. Germiculture results at 4, 7, 10 days after MEBO treatment: The infection rates of Pseudomonas aeruginosa were 53.84%, 19.23% and 0% respectively; the infection rates of Staphylococcus aureus were 61.53%, 26.92% and 15.38% respectively; and the infection rates of Escherichia coli were 65.38%, 34.61% and 26.92% respectively. It was proved by the above study that MEBO had significant bacteriostasic activity on Pseudomonas aeruginosa, and had a control action to a certainty on other dominant bacteria, such as Staphylococcus aureus, Escherichia coli etc. The bacteria count study on the wounds treated with MEBO by Zhang Xiangqing also proved (1991, 4: 5) that MEBO could inhibit the growth of Pseudomonas aeruginosa, and its action was stronger than that of SD - Ag and SD - Zn. Luo Chengqun et al. summarized the bacteria detection results of 155 specimens in 63 patients treated with MEBO (1998, 2: 10). The positive incidence of wound bacterial culture was 84.5% (131/155), but the positive incidence of blood bacterial culture was only 5% (2/40), and the 2 positive specimens were from the same patient. It was also confirmed that Staphylococcus aureus was the most, while Pseudomonas aeruginosa decreased to the 8th most. This indicated MEBO had powerful inhibiting effects on Pseudomonas aeruginosa. It also indicated although there were bacteria growing on the wounds, there was little chance of hematogenous spread. However, the hematogenous spread rate of dry therapy was as high as 49.1% according to the "Correlation Studies on the Wound Bacteria Positive Incidence and Hematogenous Spread in Dry Therapy" conducted by Wang Yongwu (1993,3 ： 2). It was proved by the experimental study of Wang Guangshun (1992, 3: 7) that MEBO could prevent and control the bacterial infection of wounds. Zhou Zhongquan found (1994, 3: 34 ) the Pseudomonas aeruginosa infection occurring during SD - Ag treatment could be treated with MEBO.

Professor Qu Yunying et al. ( Binzhou Medical College ) disclosed the reason why MEBO could inhibit the growth of bacteria and what the action mechanism was. She first studied the continuous passage culture of proteus, Escherichia coli and Staphylococcus aureus in the culture medium containing MEBO (1996, 1; 19). It was found there was variation in the biological characteristics of bacteria, there was synergistic action between MEBO and antibiotics, MEBO could increase the periphery white blood cells, PMN percentage and the phagocytic function of abdominal cavity phagocytes in the experimental animal. It was indicated by the author that MEBO could lead to the variation in the biological characteristics of common pathogens in burn wounds, slow down the growth and reproduction speed of bacteria, lower the pathogenicity of pathogenicity, enhance the nonspecific immunity of human body, so as to resist bacterial infection. It was confirmed by the study of Qu Yunying et al. (1998, 4: 15) that MEBO could result in the variation in the biological nature of anaerobic bacteria with spore (Clostridium tetani), anaerobic bacteria without spore( bacteroides fragilis, Propionibacterium) and fungi (Candida albicans), and MEBO could influence the reproduction speed and invasiveness of bacteria. Therefore, it was believed MEBO was a drug that could accelerate the healing of wounds with two-way regulating effects and strong broad-spectrum antibacterial actions.

F. Clinical Observation and Experimental Study on Analgesic Effects

There were a large proportion of articles reporting the analgesic effects of MEBO in the 39 issues. The author reviewed the articles with detailed record data, conducted a statistical analysis and added analysis and discussion.

( A) Clinical Observation on Analgesic Effects

Xi Zhengping et al. conducted a comparative study on the analgesic effects of MEBO and that of SD-Ag (1997, 1997, 4: 26 ). 325 patients were included (166 patients in MEBO group, and 159 patients in SD- Ag group). The age, burn area and depth of the two groups were similar. The degree of pain in the original article was expressed with + and -. In order to conduct statistical analysis and make clear the problem, five levels (very good, good, fair, bad, very bad) were used in this article. The five levels were as follows:

•  Very good (++++): There were no pains, and the functions were normal.

•  Good (+++): There were no pains without movement, and the pains could be tolerated during movement.

•  Fair (++): There were rest pains that could be tolerated and were aggravated during movement.

•  Bad (+): There were rest pains and intramuscular injection of analgesic was in need.

•  Very bad (-): There was sharp pain, and hibernation agent even anaesthetic was in need.

The analgesic effects and the degree of pains of the two groups of patients were summarized in Table 6 according to the above standard of criterion (see Table-6 ).

Table-6 Comparison on Analgesia Effects

It was proved by Table 6 that there was no pain during dressing change in the MEBO group. The analgesic effects of MEBO were better than those of conventional therapy. In the conventional therapy group, only 56.60% (90/159) of patients could endure pains, and other patients should be treated according to the symptoms. Zhou Guojian reported 135 adult burn patients with burn area larger than 30%TBSA (1998, 2: 43 ). The sensitive rate to pains was used as the principal observational index. It was found that the sensitive rate to pains in the MEBO group (72 patients) was 3% and that in the SD-Ag group (65 patients) was 90%. Su Yongtao observed analgesic effects on a group of burn patients most of which were of deep second degree (1998, 2: 32 ). Whether analgesic treatment was required and the pains were aggravated during dressing change were used as the indices of judgment for pain response. The results were as followed: The incidence rate of pain in MEBO group was 23.33%, and the incidence rate of pain in SD-Ag group was 83.33% (X2=10.848, p<0.01). The observed results of Heng Yang et al. (1997, 4: 24 ) were as followed: The incidence rate of pain in MEBO group (100 cases) was 3%, and the incidence rate of pain in SD-Ag group (100 cases) was 86%, and there was significant difference between the two groups. Zhao Junxiang (1998, 4: 25) reported that the analgesic effects lasted for 3-6 minutes after 6218 patients took MEBO for external use, but the effects in some patients were not satisfactory, in whom (5 case in this group) the pains began to be alleviated 5 days after injury (5 days after applying this medicine). He believed the leading cause of the above phenomenon was related to the applying method of medicine, overdose and underdose (the wounds would be easy to be dry) might result in pains, and there should be no dryness or maceration. It can be seen from above that MEBO treatment resulted in different analgesic effects indicating standard use of MEBO counted for much. Wang Hezhen et al. analyzed the analgesic effects on 4373 patients (1996, 4: 27 ). The degree of reaction to pains of the patients was concerned with the applying time. Applying the ointment immediately after injury had better effects than postponed application did. In the patients using the ointment within 4 hours after injury (507 cases), the pains were alleviated after 3-15 minutes. The longer the time between the injury and applying the drug was, the later the analgesic effects occurred. The author speculated that the tissues generated less media when the drug was applied earlier, thus the secondary impairment to the injured nerve endings induced by environmental factors could be alleviated. Furthermore, it was concerned with the causes of burns and the tolerance of the patients to pains.

(B) Fundamental Research in Analgesic Effects

Although the analgesic time and effects of MEBO reported were different, the analgesic effects and the degree of pains eased were affirmative. MEBO had better analgesic effects than SD-Ag therapy did. In order to illuminate the mechanism of the analgesia of MEBO, Hang Guoying et al. observed the influence of MEBO on the threshold of pain of rabbit skin (1998, 2: 1). 19 animals were divided into 3 groups: saturated potassium chloride stimulation group, wound pain group and control group, and behavior pain-measuring methods were used for measurement. The pain threshold changes before and after application of MEBO: The results were as followed: The basic threshold of pain (mean±SD) in saturated potassium chloride electrode stimulation group was 2.079±0.214mA, the threshold of pain increased 3-30 minutes after MEBO was applied (significantly increased 6-9 minutes after application), the average values reached 2.986±0.283mA, and there was significant difference between the basic value and the increased value (p<0.001). The results of wound pain group were similar to those of the above group as followed: The basic threshold of pain was 1.968±0.054mA, the threshold of pain increased 3-30 minutes after MEBO was applied (significantly increased 9-18 minutes after application), the average values reached 2.986±0.283mA (mean±SE), and there was significant difference between the basic value and the increased value (p<0.001). The average values of basic threshold of pain in the control group was 2.087±0.282mA, and there was no significant difference between the basic value and the value after analgesic V aseline cream was used (p>0.05). It was believed by the author that MEBO participated in the analgesic effects on skin. The action mechanisms may include the following aspects:(1) MEBO infiltrated into skin, protected the algesiroreceptors from damage, and lowered the sensibility of algesiroreceptors to algogenic substances. (2) MEBO made the K + penetrate into skin and the algogenic substances released from the damaged tissues diluted by the tissue fluid around and carried away by blood circulation so as to alleviate the pains through its actions of activating blood circulation to dissipate blood stasis, expanding blood vessels and ameliorating microcirculation.

It is believed by Xu Rongxiang that the development of burn pains is mainly due to the stimulation to the damaged or unhurt pain sense nerve endings directly or indirectly by burn tissues and wounds. The conventional methods (including analgesia with Chinese traditional medicine and anaesthesia have no satisfactory analgesic effects; moreover, they may result in tissue damage. Therefore, the analgesic treatment on burns is a tall problem. One of the guiding ideology of the development of MEBO by Xu Rongxiang is to change the surface charge in peripheral nerves in the area with or without burns, and to turn it into normal state. The primary functions include protecting the wound surface, insulating the air, avoiding the stimulation of dryness, relaxing the arrectores pilorum, making the discharge unobstructed, and removing the metabolic products including algogenic substances in time. Du Huaien believed (1998, 2: 3) there was relation between burn pains and the stimulation by inflammatory substances, MEBO had favorable anti-inflammatory actions and could help to relieve pains. Sha Guangxin analyzed the functions MEBO with traditional Chinese medicine theories (1998, 4: 31), and he believed there were many ingredients that could activate blood circulation to dissipate blood stasis, and improve microcirculation, so as to change the pains due to obstruction into indolence due to unobsturction.

G. Healing Modes of Wounds and the Skin Quality after Wound Healing

(A) Comparison of the Healing Modes of Wounds

There are two modes of wounds healing: natural healing and surgery healing. In the conventional therapy, the burn wounds, eaqual or more severe than deep second degree, are treated with excision of eschar and skin grafting. The superficial second degree wounds are treated with natural healing. The epithelia are fragile in the natural healing of deep II degree wounds. There will appear blisters, even rupture and apparent scar after movement, pulling and abrasion. The functions are severely affected. The survival dermis is damaged due to dryness, infection, and necrosis. As a result, the burn wounds turn from deep second degree into third degree, so this kind of wound is usually treated with skin-grafting. In thethird degree wounds, the dermis and appendage are damaged, therefore skin-grafting is in need except for very small-area wounds in which self-healing may occur (Li Ao et al. Burn Therapeutics, 1995, Page 200). However, the author believes MEBT/MEBO is in favor of the natural healing of different kinds of burn wounds based on the summary and study of the wound treatment experience reported in The Chinese Journal of Burns Wounds & Surface Ulcers in the past 10 years. The quality of skin after healing is not the same with that in the conventional therapy. The so-called quality of skin should include the physical, biochemical, immunological and detoxification functions. But for burns, the principal evaluating indices include whether there is scar proliferation and its degree, whether the scar affects function, whether the skin color is normal, the elasticity, the protective and defense function, respiratory function and thermoregulation actions. Heng Yang et al. reported the treatment of deep second degree and second -third mixing degree wounds (1997, 4: 24 ). The 200 patients were treated with MEBO and SD-Ag randomly (100 cases in each group). Since the deep second degree or second-third mixing degree wounds are similar, the healing modes and development are summarized in the following table for analysis (Table-7).

Table-7 The Healing Modes and Development of Deep second and Deep second-third Mixing Degree Wounds

It was shown in Table-7 that, MEBO treatment could lead to natural healing in deep second degree and second-third mixing degree wounds, skin grafting treatment was not in need, and the incidence rate of scar in MEBO group was significantly lower than that in conventional therapy group.

The clinical observation results by Fang Tiyi et al. in 1994 (1994, 1: 17 ) were very similar to those of Heng Yang. The author reported the treatment results of 238 cases of different kinds of wounds, in which there were 123 cases of deep second degree and superficial third degree patients. Among them, 71 patients were treated with MEBO, and 52 patients were treated with SD-Ag. In MEBO group, the self-healing rate was 100.0%, and the incidence rate of scar was 4.0%; In SD - Ag group, the self-healing was 38.46% (that is, 61.54% of the patients were treated with skin grafting), and the incidence rate of scar was 100%. There was significant difference in both self-healing rate and incidence rate of scar between the two groups( p<0.01, X2 ＞ 50).

(B) Self-healing Time of Wounds and the Quality of Skin

Wang Chengchuan et al. conducted a clinical observation on the natural healing time of different depths of wounds (1996, 1: 24 ). The results were as followed: the self-healing days of superficial II degree wounds were 7.90±1.17 days, the color and elasticity of skin were normal after 3 months' treatment; the self-healing time of deep II degree wounds was 21.25±2.94 days, and there was no obvious scars; the self-healing time of superficial third degree wounds was 39.45±6.91 days, and there was superficial scar and skewbald change; the deep third degree wounds lasting for more than 4 weeks which were estimated to be incapable of self-healing were treated with auto-skin-grafting, the skin-grafting area was comparatively plump, and the elasticity and function were normal. Wang Shiyou performed a clinical observation on 15 cases of extensive burns with different depths treated with MEBO (1998, 1: 26 ), and the results were the same with those reported by Wang Chengchuan. The self-healing time of deep second degree wounds was 25.23±2.74 days; The self-healing time of superficial third degree wounds was 34.54±6.91 days; the self-healing time of deep third degree wound with a diameter no more than 20cm was 51.45±9.63 days. In the 10 months' follow-up, there were no obvious scars in the deep second degree wounds; the third degree wounds were treated with MEBO SCAReducer after healing, and there was only a few scars. It was found in the comparative study of Xiao Mo (1999, 1: 18 ) that the treatment course of MEBO was significantly shorter than that of SD-Ag. The superficial second degree wounds treated with MEBO could be healed in 5-7 days, while those treated with SD-Ag were healed in 8-10 days. MEBO could make deep second degree superficial type, deep second degree deep type and superficial third degree wounds healed 7 days, 10 days and 20 days earlier respectively.

It was believed by Li Chuangji (1999, 2: 23) that ploughing therapy used in the early stage of deep second degree and third degree wounds could accelerate the liquefaction and healing of wounds. In the 51 cases of extensive burns he reported (one patient died from alimentary tract massive haemorrhage), the healing time of deep second degree superficial type wounds was 20.0±1.5 days, the healing time of deep second degree deep type was 26.5±2.6 days, and the healing time of superficial third degree was 31.0±4.5 days. In the 11 cases of deep third degree wounds, there were 3 patients with a burn area larger than 80%TBSA, the third degree wounds reached the deep fascia, and they were treated with operative treatment after 1 month. The average healing time of deep third degree wounds was 56.0±5.6 days. It was brought forward by the author that ploughing therapy in the early stage of deep burns could prompt the healing of wounds. The treatment results of small-area deep wounds reported by Hu Jianwu et al. (1997, 4: 44 ) could be compared with those reported by Li Chuanji. The self-healing time of MEBO group and SD-Ag group was summarized in Table-8.

Table-8 Self-healing Time of Small Area Wounds (day)

Note ： 1. The above wounds were all small-area burn wounds in the hands. 2.There was no significant difference in deep third degree wounds, while there was significant difference in the other groups ( p ＜ 0.01). 3. Deep third degree burn wounds should be also treated with skin grafting.

Two conclusions could be acquired based on the analysis on the results in Table 8 and the comparison with the results from Li Chuanji as followed:(1) MEBT/MEBO treatment was better than SD- Ag therapy for superficial/deep second degree and superficial third degree wounds. It could not only shorten the healing time, but also reduce the scar after healing; (2) In the wounds of same depth, the healing time could be affected by many factors, among which the burn area was a dominating influencing factor; the larger the burn area was, the longer the healing time was. What Li Chuanji reported was extensive burn (>50%TBSA). Ploughing therapy was used in the early stage, which could accelerate the healing of wounds, and shorten the healing time to that of small-area wounds. Furthermore, there was no scar formation like that in the SD-Ag group. Based on the analysis of the above cases, the difference in the self-healing time of the burn wounds of the same depth was a normal phenomenon, because there were many factors affecting the healing of wounds, such as the burn wound area, whether there was infection, whether there were complicated injury and complications, age, sex etc. Therefore, the healing time was not the most important thing; the quality of skin should be looked upon as the primary standard for curative effect judgment.

( C) Excision of Eschar and Quality of Skin

Excision of eschar in deep burns is a new burn treatment therapy with the technological development of surgery. This method was adopted by most of scholars in a long time in the past; many extensive burn patients were healed, so it became the "uniform therapy" in many doctors' viewpoints. However, with the appearance and accelerated acceptance of MEBT/MEBO technique, it was found by more and more scholars that, excision of eschar was not an ideal therapy for burn wounds if the wounds are not more severe than deep second degree. The article of Cui Xiaolin and Yang Junting has proved this (1999, 2: 17 ). The two authors conducted a random sample on the clinical data of 9 burn treatment centers in 8 provinces (cities), and performed a comparative study on MEBT/MEBO, SD-Ag and excision of Eschar & skin-grafting in the early stage. The wounds of the two groups of patients were both of deep second degree, and there was no statistical difference in the injury causes, traumatic conditions and the burn area between the two groups. The statistical results were summarized in Table-9.

Note: The rates of very good and good results in the two groups were compared. P ＜ 0.01.

Comparison of the self-healing rate in the two groups: X 2 ＝ 20.994,p ＜ 0.01.

Comparison of the incidence rate of scar in the two groups: X 2 ＞ 100, p ＜ 0.01.

Table-9 Comparison of the results of the Three Therapies

The following conclusions can be drawn from Table Zhang-9: 1.The incidence rate of scar and disability rate in MEBO group were lower than those in SD-Ag group and eschar excision group. 2. The mortality rate of MEBO group was 1.8% (only 6 patients died), which was significantly lower than that of SD-Ag and eschar excision group. The cause of death included extensive burn and inhalation injury. 3.The complications, healing days and the times of skin grafting in the late stage in MEBO group were significantly less than those in the other two groups (p<0.01 or p<0.05). It should be noted that only standard MEBT/MEBO technique not including skin-grafting was in need for deep II degree wounds, but some patients in this group had received the auto-skin-grafting. According to the article, the leading causes of using skin-grafting therapy instead included large burn area, injuries in the functional part or other reasons. But the most important reason was that standard MEBT/MEBO technique was not used. Furthermore, using skin-grafting therapy instead in the midway of treatment was the leading cause resulting in higher incidence rate of scar than that in the cases treated with only MEBT/MEBO. For this reason, it was still necessary to perform standard MEBT/MEBO technical operations. In the study on the relation of MEBT/MEBO technique and the quality of skin after healing, many researchers focused on the physical property of skin, and there was lack of study on the biochemical, immunological, and detoxification properties of skin, so the study on these aspects was required to be further explored.

H. Hot Potato in Conventional Therapy and MEBT/MEBO

The contribution of conventional therapy in the past time should not be neglected, but it is true that there are many difficult problems in it. Since some problems were thought to be inevitable in burn treatment, such as complications, scar formation, pain response, and the degree of pains, people were used to these false matters, which were thought to be true. Some problems thought to be unchallenged, were not solved due to a variety of reasons, so that the healing time was prolonged. It can be seen now some difficult problems are easy to be resolved by MEBT/MEBO techniques. As a result, some scholars have changed their viewpoints, and had a good grip of this, but there are still some scholars moving in a rut. I hope the following summary of experience can provide beneficial illumination to everybody.

(A) Using MEBT/MEBO instead of SD-Ag Therapy in the Early Stage of Burns

In the articles about burn treatment, many cases were treated with MEBT/MEBO after SD-Ag was applied in the early stage. The reasons for changing treatment methods included: 1.The patients had been treated with SD-Ag before admission, and there were some complications; 2. Excision of eschar was refused by the patients; 3. The pains were not alleviated; 4. The excision of eschar failed, and large area of wounds were exposed. Li Yunzhen, Wang Hongsheng has cured a patient with total burn area of 98%TBSA and third degree burn area of 92%TBSA with moist therapy after dry therapy (1997, 4: 22 ). The patient had been treated with SD-Ag dry exposed therapy for 12 days. Because the state of illness was very severe, the patient was admitted under the condition of no other treatment measures. They used MEBT/MEBO therapy accompanied with combination of drugs and Saw Plough Blade. Most of the superficial third degree and deep third degree wounds were healed 140 days after injury, and only 10% TBSA of deep third degree wounds were healed after auto-skin-grafting was applied. Wang Qingli, Zhang Xiangqing et al. (1994, 4; 25) reported: one patient with 93% total burn area and third degree concentrated sulphuric acid burn area of 70% TBSA, was treated with excision of eschar and particle skin-grafting and allo-skin-grafting 4 and 8 days after injury. Most of the allotransplants became necrotic and fell off 12 days after surgery, and the autotransplants had not survived yet. Most of the wounds were exposed, and there was no autotransplant covering the wounds. Under these conditions, MEBT/MEBO was used. The wounds were healed three months after injury with several times of autotransplantation of small-area skin. Sun Wucheng has reported a similar case (1993, 3: 33): the patient with a total burn area of 95% and third degree burn area of 90% TBSA, was treated with excision of eschar, particle skin grafting and allo-skin-grafting, but the survival rate of skin was not ideal (less than 60%). After MEBT/MEBO and appropriate auto-skin-grafting were used, the wounds were healed. Nanshi Hospital had the most clinical experience in treating burn wounds with moist therapy after dry therapy was used. They have reported in an experience summary recently that 11 patients in the group with burn area more than 50%TBSA had received SD-Ag therapy before admission. The leading causes for changing treatment methods included severe pains, influence by the patients receiving MEBT/MEBO therapy, slow courses of SD-Ag treatment, and abnormal changes, such as drying crack, hemorrhage and infection etc.

(B) Treatment of Granulation Wounds after Skin-grafting

Granulation wounds were usually due to the failure of excision of eschar in conventional therapy, or the wounds after "decrustation" and "scab-peeling". In the conventional therapy, auto-skin-grafting was performed after the fresh granulations grew out. The treatment mode after skin-grafting was dressing change, dressing, dressing change for a second time, redressing until the scars were healed. Since the dressing change was performed in cycles day by day or every other day and unnecessary disinfection and external use of some anti-infectives were conducted, the pains and damages to epithelia were too severe for the patients to endure. One of the disadvantages of this processing mode was comparatively longer course of disease because it was a long time for the skin graft to be transplanted, survive in the transplanted area, spread and grow, cover the wounds, and survive steadily. The factors directly concerned with the healing time included systemic conditions, and whether there were infection, hemorrhage, edema in the local area. Any of the above abnormal changes might prolong the healing time, and result in skin-grafting failure. As is well known, hemorrhage was a familiar impairment in conventional dressing change, because it was usual that the skin graft or new epithelial tissues adhered to the gauze were taken off when removing the inner-layer top dressing. However, this was a common dressing change method in conventional therapy, therefore it was thought to be reasonable after it was learned by many beginners. Furthermore, the granulation tissues in the skin-grafting wounds were scar tissues, so that scars were thought to be unimportant.

Since MEBO was invented, the first person applying MEBT/MEBO on the wounds of auto-skin-grafting was Xing Jun et al. (1990, 2: 12 ). He reported the experience using MEBT/MEBO after auto-skin-grafting. The distances between auto-skin-grafts were between 1.2cm and 1.5cm. The shortest time of covering the wounds was eighteen days, and most wounds were healed within 3 weeks. According to the report of dry therapy experience (Li Ao, Burn Study, 1995: 126), the distances of auto-skin-grafts were between 0.7cm and 1.2cm, the spread speed of cells was 0.2-0.5mm/day (mean= 0.26mm/day), and the cells covered the wounds completely after about 28-30 days. The distances between different skin-grafts in MEBO group reported by Xing Jun were larger than those in conventional therapy group, but the healing time in MEBO group was 1 week shorter than that in conventional therapy group. This indicated MEBO could accelerate the growth of epithelial cells, and promote the early healing of skin-grafts. Zheng Jianzhong (1992, 2: 25) reported third degree granulation wounds were healed 7-10 days after small skin-grafting (dressing was changed 3 times a day) and application of MEBO.

When discussing which of moist exposed therapy or moist dressing therapy was better for granulation wounds after skin grafting, the research results by Zhang Guoqiang (Binzhou Medical College) indicated MEBT/MEBO was the best (1996, 1: 35). The author observed 22 wounds in 11 patients. Two wounds with skin-grafting were selected: one wound was treated with MEBT/MEBO, the other wound was treated with MEBO dressing therapy. The results were as followed: the healing time of wounds treated with MEBT/MEBO was 15.09±2.12 days, while the healing time of wounds treated with MEBO dressing therapy was 22.27±2.37 days. The two groups were compared: t=7.457, p<0.01(the computational results was calculated by the editorial board). Therefore, granulation wounds after skin-grafting could be treated with MEBO without dressing. Thoroughgoing MEBT/MEBO therapy was labor-saving, convenient and effective.

Long Jianhong, Ma Enqing et al. (Hunan Medical University, 1994, 3: 22) found the skin-grafting survival rate after pretreatment with MEBT/MEBO was significantly higher than that without MEBT/MEBO treatment. In the 14 patients treated with MEBT/MEBO, the pH values of 11 wounds were between 7.0-7.5, the skin-grafting survival rate of 78.5% of the patients was larger than 90%; in the 14 patients not treated with MEBT/MEBO, only 4 patients had a pH value of 7.0- 7.5, and only 58.57% of the patents had a survival rate greater than or equal to 90%. There was significant difference between the two groups according to chi-squared test (p<0.05). This finding indicated MEBT/MEBO therapy applied on third degree granulation wounds treated with conventional therapy before skin-grafting, could improve the survival rate of auto-skin-grafting.

(C) Treatment of Residual Wounds

Residual burn wound was another hot potato resulted from conventional therapy because of insufficient skin sources, high graft density, unhealed wounds due to skin-grafting failure, the new epithelia intolerant to abrasion or the new epithelia with blisters and diabrosis in the healed wounds. The residual wound was described in the domestical textbook as followed: the granulation tissues of residual wound were aged and dropsical, the fibreboard formed in the basal part was stiff, contracted and inelastic, which might affect the blood supply of granulation tissues in the surface layer. Ulceration might occur repeatedly in the residual wound, which was difficult to be healed after long-time dressing change. Indeed, there appeared erosion, which merged into sheet. The patients felt very painful, and it was difficult to treat (Fang Zhiyang et al, Burn Theory & Practice, 373). For this reason, it seemed reasonable to call it "hot potato". In the conventional therapy, thoroughgoing excision surgery was advocated, auto-skin-grafting was performed after excision of fibreboard in the basal layer, but the skin-grafts might not survive.

The author has read more than 20 articles about the treatment on residual wounds with MEBT/MEBO, but the persons using this therapy in the early period were Long Jianhong (1989, 1: 34) and Chen Yushi (1989, 1: 44). Long reported two patients with a wound of 6cm×3cm and 7cm×8cm respectively, and Chen reported 21 cases. All the patients were healed. After this, Yao Shihong (1990, 2: 32 ), Liang Darong (1990, 3: 8), Zhou Zhili (1990, 3: 10 ), Shan Guixiang (1990, 4: 36 ) et al. reported more cases. Zhou Rongfang (1994, 1: 18 ) reported 156 cases, and all of them were healed. Professor Xiao Mo cured a patient with large residual wounds (1993, 3: 22 ): one female patient was treated with conventional therapy in Jishuitan Hospital due to extensive burn. After 3 months, 30%TBSA of wounds was not healed, and there appeared a massive bedsore. After application of MEBT/MEBO, effects came into being after 5 days, the residual wounds were healed after 1 month, and the pressure sore was healed after 47 days. Liang Darong treated a patient with 15%TBSA residual wound, who received 3 skin grafting surgeries, but the results were not successful. After MEBT/MEBO therapy was used for 2 weeks, the wounds were healed. For this reason, MEBT/MEBO technique can heal residual wound, which is looked upon as a hard nut to crack in the conventional therapy.

J. Treatment of Patients in Groups

It is believed by domestically scholars that burn in groups refers to more than 10 burn patients or more than 5 serious burn patients. It features a great number of patients, serious injury state, limited time, high requirements in clinical organization and emergency treatment, onerous treating and caring task, and great need in drugs and medical devices etc. According to the above standard, our periodical has reported 22 batches of burns treated with MEBT/MEBO in the past 10 years, in which there were 283 patients (12.86 patients/batch, not including foreign emergency treatment data). There were 36 patients in the batch with most patients (Chen Shiping, 1998, 2: 39), and there were 7 patients in the batch with least patients (Zhang Jun, 1998, 3: 17). The batch reported first was the batch reported by Pu Zuyu et al. (1990, 4: 7), which included 31 patients. Zhao Junxiang reported the treatment experience of 6 batches including 54 patients (1996, 3: 17); Wang Shiyou reported 3 batches including 24 patients (1999, 2, 24); Han Quanfu reported 12 patients (1996, 3: 23); Li Yanbin, Ren Xianyuan reported 11 patients (1998, 2: 42); Hou Shiming, Wang Bianliang reported 28 patients (1997, 4: 28); Yang Longguang, Li Wenhui (1998, 2: 47) reported 31 patients(The reports including less than 10 patients were omitted). The leading injury caused including burn of combustible materials concerned with 260 patients (91.87%), among them there were 16 patients with gas explosion injury (the patients without a note of gas burn in batch were omitted). Based on the burn area, the distribution conditions of burns were as followed: 81 patients with a burn area of less than 30%TBSA (28.62%), 89 patients with a burn area of 31%-50%TBSA (31.45%), 113 patients with a burn area of more than 50%TBSA (39.93%). There were 25 patients with a burn area of more than 70%BSA. There were 202 patients with serious and very serious burns (71.38%). Since most of the patients were injured by combustible materials (80.92%), many of them (45.23%) had inhalation injury, that is, almost half of the patients had inhalation injury of different degrees. Thus it can be seen the injury state of these patients in batch was serious, but the cure rate of these cases was as high as 81.27% (23/283). The principal treatment experience was summarized as follows:

(A) Tracheotomy was conducted as early as possible to keep respiratory tract unobstructed

Tracheotomy was conducted in the early stage after injury in the 29 patients diagnosed as severe inhalation injury in this group. The so-called "as early as possible" means there is no time to wait or observe, and tracheotomy should be performed actively to keep respiratory tract unobstructed. Wang Shiyou believed the treatment principle of burns in batch with inhalation injury was as followed: tracheotomy should be performed as early as possible in order to prevent larynx edema, pressure on airway, and the death by suffocation due to viscous secretion and exudates, and the mucous membrane falling off. It was believed by Han Quanfu that tracheotomy should be conducted as early as possible in the patients with deep burn in the head and face, trachyphonia and the patients who had dyspnea or mouth of fish-mouth change. But it should be pointed out that tracheotomy was only an emergency measure, and the principal problem was the severity of inhalation injury, because the mortality rate of serious inhalation injury could be as high as 100% (Li Zhaozhou, 1983), and some patients might die at once. In the 31 patients reported by Pu Zuyu and Yang Shunbing, all had trachyphonia; there were 11 patients with a burn area of 50-70%TBSA and 12 patients with a burn area of 51-93%TBSA; 8 patients died within 96 hours after injury. Although tracheotomy was also performed on the dead patients, there lives were not saved. A great number of patients died, and they were all treated with MEBT/MEBO, and this was the so-called "5.19" event. The state of inhalation injury was judged based on the part and range of the injury, and the injury depth of pathological changes was often neglected. The local pathological change of respiratory tract injury was similar to that of skin burn. There were also superficial injuries and deep injuries. When the respiratory tract mucous membrane was injured by heat, the exudation of body fluid occurred first. The law of exudation in respiratory tract injury was also similar to that in skin burns, and the exudation was most serious in 48-72 hours. For this reason, in the 8 dead patients with inhalation injury in the early stage reported by Pu Zuyu, the severe exudation in respiratory tracts might be the leading cause resulting in the early death of the patients, and the therapy in the local area had nothing to do with the death of the patients.

( B) MEBT/MEBO should be used in time, and therapies should not be changed without important reasons

After reviewing the articles about burns in batch, we learned that all the patients could be treated with MEBT/MEBO in the early stage after admission; According to the principle of treatment, MEBT/MEBO could be used to treat the patients with serious injury, shock or inhalation injury together with emergency treatment. The principle of management for wounds of different kinds of depth was similar to that of non-batch burns, and proper operation of MEBT/MEBO could be used in both conditions. Deep burn wounds difficult to be liquefied could be treated with combination of drugs and knife and ploughing therapy. If these therapies were used, therapies should not be changed. Yang Longguang, Li Wenhui (1998, 2: 17 ) summed up the experience and reported 31 black powder burn patients with extensive burn (>30%TBSA, maximal 93%TBSA) and inhalation injury. In the treatment course of MEBO, early death occurred in 9 patients after injury. For a variety of reasons, the other 22 patients were divided into two groups: 12 patients were treated with SD-Ag, and the other 10 patients were continually treated with MEBO. Their states of injury were similar: there were 5 patients in MEBO group and 4 patients in SD-Ag group with a burn area of 30- 50%TBSA; there were 5 patients in MEBO group and 8 patients in SD-Ag group with a burn area of 55- 83%TBSA; in the SD-Ag group, MEBO ointment was cleaned thoroughly, SD-Ag suspensoid and chloramphenicol gauze were used externally, and infrared lamp was used to prompt the dryness of wounds. As a result, in MEBO group, the 10 patients were healed without skin grafting, and the scar was not obvious; in SD-Ag group, 5 patients died. These results made the people expecting for the success of SD-Ag therapy disappointed. There was still no systematic study on the pathological change in the patients treated with SD-Ag after MEBT/MEBO therapy and its hazard. The author provided some simple opinions based on clinical observation, but this might be eyewash. After the wounds were treated with MEBO for 1 week, the wounds were in the second stage of wound liquefaction, the superficial tissues were necrotic and liquefied from superficies to interior, and a great lot of liquefied materials emerged onto the surface with MEBO as white liquefied matters. At this time, so long the administration of drugs was continued, the wounds would be covered with these liquefied matters completely, and so long the application of MEBT/MEBO was continued, autogenous healing would take place in the deep second and superficial third wounds. However, the liquefied matters in the deep layer had been started up by MEBO, and should be discharged to the surface layer. At this time, the start-up effects of MEBO were terminated, and SD-Ag, chloramphenicol and drying measures with contrary effects to those of MEBO were added, so that the pathogenic factors were not eliminated completely.

It was laudable that excision of eschar was not performed on these burn patients in batch, which was uncommon in our country. In conventional therapy, excision and skin grafting were actively performed on the deep wounds in batch, and even "flow process" treatment was used. Excision of eschar in burns in batch was different from the operative treatment in solitary burn. The leading reason was that there were few patients conducting standard operation, because the doctors performed these operations came from different departments. How serious damages will the secondary impairment lead to? However, these practical problems were neglected by some scholars, which was wrong.

K. Treatment of Extensive Burn and Burn Rehabilitation Star

(A) Statistics on the Curative Effects of Extensive Burn

It has been mentioned in "Statistical Analysis of Articles" that there were 97000 cases of burn patients treated with MEBT/MEBO reported in this periodical in 10 years, the total cure rate was 99.84%. Among them, there were 6572 patients with a burn area of greater than or equal to 50%TBSA, 6002 patients were healed, and the cure rate was 91.33%. In this section, comprehensive analysis will be conducted on the treatment of the so-called extensive burn (that is, serious and very serious burns) in China . In order to follow the first principles of clinical research, lower sampling error, make the statistical results more accurate, and reflect the level of MEBT/MEBO treatment on extensive burns, the author only analyzed the article with sample number greater than 50. If the same author published two or more similar articles, only the articles including more samples and the recent articles would be selected. Some articles included more than 50; even hundreds of and thousands of patients, but the data required in this article could not be obtained, so these articles were excluded. The case reports of the patients difficult to be treated were also excluded. According to the above criteria, there were 20 articles meeting the requirements, which were summarized in Table-10.

It was shown in Table-10 that 20 authors utilized MEBT/MEBO to treat 5143 cases of extensive burn. 360 patients died and the mortality rate was 6.99%. Since there were more than 1000 cases, the mortality rate can represent the probability of dying, that is the probability of dying of the extensive burns treated with MEBT/MEBO in the past 10 years was 6.99%. This result was similar to that reported by Wang Hong and Zhao Junxiang, which indicated the more the number of cases was, the smaller the sampling error was, the lower the feasibility of departure from population was. Since there were 7 patients discharged from hospital of themselves, the cure rate of extensive burn patients in the whole group was 93.70%. In order to learn the total level of MEBT/MEBO treatment on burns, the author performed a statistics on the original data in another article of Zhao Junxiang (1003 cases). The burn area was used as independent variable X, and fatality rate was used as dependent variable Y. The half lethal area (LA50) of MEBT/MEBO therapy was 82.11%TBSA. The original data were published in issue 1 of 1992, indicating that this therapy had reached or exceeded the national level in the nineties (see "Evaluation on A Large Amount of Clinical Data"). 。

In the original articles, "Moist Exposed Burn Therapy" by Xu was used as the reference for extensive burn treatment. Proper local MEBT/MEBO therapy and systemic complex treatment were used, and abundant clinical experience was obtained. Most of the authors conducted an analysis and discussion on the causes of death. In order to sum up experience and lessons, confirm the curative effect, and save more patients. The causes of death provided in the article were analyzed as follows:

The complications included shock, infection (inflammatory reaction syndrome, pyaemia), MODS etc.

Compared with MEBO: p<0.05;

Compared with MEBO: p<0.01

Table Zhang-10 Statistics of Large-sample, Extensive Burn Cases (Number of Cases)

Note: 1. No. 3, 6, 8, 12, and 16 only provided the data of burn area of 31-100%.

2. No. 9, 13, 20 were all the data of burn area larger than 51%.

3. If the same author had two or more articles, only the article including comparatively more cases or the recent articles were selected.

4. Most of the patients were adults, only a small proportion of the patients were children.

(B) Analysis on Cause of Death

The 20 authors reported 5143 cases of patients with a burn area larger than 30%TBSA treated with MEBT/MEBO. 360 patients died and the mortality rate was 6.99%. According to the analysis on the original data, the overlarge burn area and the concomitant primary inhalation injury were the primary cause leading to death, and the occurrence of different kinds of complications was closely related to the two primary causes of death. The sample quantity reported by Wang Hong and Zhao Junxiang was maximal (3356 cases, 65.25% of the total cases), analysis based on these two articles would significantly reduce the error in sampling process. Moreover, the incorporate fatality rate (7.56%) was very similar to the total fatality rate (6.99%).

1. Relevance analysis on burn area and fatality rate: was summarized in Table-11 based on the data provided in the article by Wang Hong (see Table-11).

T able 11 Correlation Analysis on Burn Area and Fatality Rate

Table-11 showed that the larger the burn area was, the higher the fatality rate was, that is, the fatality rate increased with the burn area increased. The data from Zhao Junxiang also proved the relation between burn area and death. In the 65 patients with a burn area larger than 90% TBSA, 24 patients (39.92%) died, that is, when burn area increased to 90% TBSA, almost 40% of the patients were confronted with death, and there were 29.92% of the dead patients with a burn area exceeding 90% TBSA. Moreover, all of the 6 dead patients reported by Mi Qinghui had a burn area larger than 80% TBSA, indicating large burn area was the primary cause of death.

2. Analysis on inhalation injury and fatality rate: About half of the authors adverted inhalation injury might lead to the death of patients and other complications, such as pulmonary infection, pulmonary edema, ARDS etc. In the 12 dead patients reported by Zhang Linxiang, 6 patients died of inhalation injury (burn of respiratory tract). Most of them died in 24-72 hours, some died because of acute suffocation. Zhao Junxiang has pointed out in many articles that inhalation injury might result in the death of patients. Therefore, inhalation injury was as dangerous as large burn area. The conditions of these patients changed very fast, dyspnea occurred very earlier, so the combination of respiratory hypoxemia and the hypoxemia in shock stage could result in the death of patients in 48-72 hours. Thus it can be seen there are oliguria, anuria or instable hemodynamics in the patients dying in the shock stage, irreversible serious systemic anoxia may be the leading cause resulting in the early death of patients, and dyspnea was the most important, because there was few difficulty in the resuscitation of simple shock. Therefore, in serious inhalation injury or burn of respiratory tract, no matter what effective therapy is used, it may be of no help to the impairment resulted from inhalatory materials.

3. Analysis on delayed treatment and fatality rate: Delayed treatment on extensive burn had the maximal effects on the resuscitation of early-stage shock at the soonest. The statistical results of Han Quanfu were as followed: in the 37 delayed-resuscitation patients with shock, 15 patients died; while in the 69 shock patients with timely resuscitation, only 4 patients died; there was significant difference between the two groups (p<0.01). This indicated: if the resuscitation of shock patients was delayed, there was serious disorder in the internal environment, and it was inevitable that there wound be many troubles in the late-stage treatment. Furthermore, in the two dead patients reported by Wang Shiyou, one patient was a 3-year-old child, who had been treated with other therapy in other hospital 8 days after injury, and serious systemic infection and DIC took place; the other patient was an adult admitted 3 days after injury from other hospital, and multiple organ failure took place in the second day. In the strict sense of the word, these two patients should not be calculated as dead cases treated with MEBT/MEBO, because irreversible fatal complications had taken place before application of MEBO.

4. Analysis on the complications: in the cases treated with MEBO, shock is an early complication, the late complications taking place afterwards reported by different researchers are different. But it was observed that the incidence rate of sepsis was not higher than that of conventional therapy. According to the data of Zhao Junxiang, only 4% of the patients had systemic infection (sepsis), and 8.33% of the patients had cardiac insufficiency. Therefore, Xu Rongxiang repeatedly stressed the importance of cardiac function protective treatment in the extensive burn patients. There were many reports about stress ulcer with hemorrhage: Zhao Junxiang reported 24 cases, while Zhang Linxiang reported 5 cases. The other causes of death included single or multiple organ failure and serious pulmonary infection etc. However, there was no report on hypoalbuminemia. One of the reasons was that all the authors attached great importance to nutritional treatment in the articles, but the definite cause was still to be further explored.

5 ． Analysis on cause of death and death chain: it is believed in the conventional therapy that the death process of burn patients is very complicated, and can not be explained with single cause of death. Zhang Xiangqing (1990, 4: 6) summarized and analyzed the causes of death of 38 patients treated with conventional therapy according to "Root Cause Expansion Mode". The causes of death of burn patients were divided into 4 types: (1) root cause of death: large burn area, deep burns and serious burn of respiratory tract were the primary cause resulting in death. If there were no these pathological changes, the patients would not die. (2) direct cause of death: the fatal complications taking place in the treatment course, such as shock, ARDS, sepsis, DIC, massive haemorrhage of alimentary tract, acute failure of heart, kidney, lung, brain and liver. (3) intermediate causes of death: the serious complications taking place before and after the direct causes of death appeared, such as hypoalbuminemia, disorder of water, salt, and acid-base balance, pulmonary infection, visceral organ insufficiency etc.( 4) concomitant causal factors: the preexisting diseases before injury, such as diabetes, emphysema, coronary heart disease, hypertension, cerebrovascular accident etc. The author also indicated the 4 causes of death formed a death chain: root cause of death-burn of body surface and respiratory tract; intermediate cause of death- serious and lasting hypoalbuminemia; direct cause of death- ARDS, shock, sepsis, visceral hemorrhage, organ failure etc. They form a death chain of similar mode: the cause of death may result in death directly (usually in the early stage); the root causes of death can be dealt carefully with, but there may be a series of complications, such as bacteria sepsis; the common causes of death include hypoalbuminemia, systemic failure etc. Hypoalbuminemia is easy to be rectified and treated with remedial actions, which can prompt the death of patients due to direct causes, but it is not regarded as direct cause of death. The hypoalbuminemia incidence rate of dry therapy is high due to the continual excision of eschar in the early stage of injury, skin-grafting, the complicated dressing change for large-area wounds, and the abnormal function of alimentary tract in the early stage of burns (within half a month). According to the death analysis in the patients treated with MEBT/MEBO, the two root causes of death are the same with those in conventional therapy, but the primary direct cause of death is not sepsis. Pulmonary infection and stress ulcer hemorrhage seem to plan an important part, but the incidence rate of them is lower than that in conventional therapy. Hypoalbuminemia may not be the intermediate cause of death in MEBT/MEBO group, because there are a great number of patients whose shock treatment was delayed. Delayed resuscitation may be one of the intermediate causes of death resulting in some fatal complications in the patients. Preexisting diseases mainly include cardiovascular diseases and diabetes, which can be aggravated by burns, and the prognoses of burn patients may be affected. In a word, the rank order of causes of death and the structural pattern of death chain of MEBT/MEBO should be further explored in future.

(C) Burn Rehabilitation Star

"Burn Rehabilitation Star" is a newborn thing during the clinical popularization of MEBT/MEBO, which is a concept distinctly different from the "Peak Level" in treating patients with a burn are greater than greater than 90%TBSA and third degree burn area of 70%, 80%, or even 90% in conventional therapy. "Peak Level" only means the patients survive, and the life-quality is neglected. However, the "Burn Rehabilitation Star" of MEBT/MEBO technique contains other meaning, that is, the fire-new life medical technology is applied to obtain the best effects for life-quality. According to the evaluation criteria of "Burn Rehabilitation Star"(1996, 1: 18), our periodical together with "Chinese Burn Wounds and Ulcers Science And Technology Center" and "the Chinese Burn Association of the Integration of Traditional and Western Medicine" has evaluated two batches of rehabilitation stars (23 persons): 10 persons in the first batch in 1996, and 13 persons in the second batch in 1998. The average total burn area of the 23 "Burn Rehabilitation Stars" was 95.57±3.55%TBSA. Among them, there were 20 adults and 3 children. The average age of the 20 adults was 27.75±7.57 years, and the ages of the 3 children were 4, 7 and 9 years respectively. In the first batch, all the patients had second and third degree burns with an average burn area of 93.00±2.98%TBSA (maximal 98%TBSA, minimal 90%, a 7-year-old child); in the second batch, the average burn area was 92.15±4.06%TBSA, the average third degree burn area was 31.92±16.38%TBSA (the maximal burn area was 100% in a 4-year-old child, including deep second degree burn area of 25% and third degree burn area of 5%). All the 23 rehabilitation stars were healed naturally with MEBT/MEBO treatment without skin-grafting or dysfunction (the color photograph at the end of issue 1, 1996 and issue 4, 1998 for details). These "stars" were verified, appraised and selected from the more than 200 cases by the panel of experts and part of the members of international burn institute. The solemnness, staidness of the appraisal and the results were unquestionable, because all the patients participated in the "Burn Rehabilitation Star" prize-presenting convention, and the leaders in related department and the representatives taking part in the convention all witnessed the actual situation.

K. MEBT/MEBO & A Completely New Life Medicine

(A) Development of Burn Life Medicine

The concept of life medicine has been used for a long time, which is the science focusing on protecting and improving human health, preventing and treating disease. Due to the influence by the development of science, its meanings in different stages were different. How to protect the vital cells in the burn tissues from degeneration and necrosis and how to make the tissues recover as soon as possible correspond with the philosophic theory of convalescence medicine, but there was a lengthy tortuous path in solving this problem. Before the 19th century, the science was undeveloped, and almost everything that can be imagined was used to treat fresh burn wounds, the patients had to endure these disregarding the curative effects and pains. At that time, claret burn therapy was popular. It was proposed that claret was heated for half an hour, and cold water was added. The floater was removed, and mixed with grease, oven-dried earthworms and the moss inside the crania of hanged persons. These procedures were conducted under moonlight, and beryl, dry porcine brain, red santalum, and mummy was added. Obviously, theses mystical procedure was used to create difficulties for the patients (Alexander Trauma 1986, 26: 1). Subsequently, Copeland (1887) brought forward the burn wound exposed therapy, and Bernhard (1904), Senve (1905), John (1910) responded to him. But this went into hard times after a while. In 1947, Wallace renewed the exposed therapy at Edinburgh in 1947, which was continued to use to this day. However, today's conventional exposed therapy has developed from the exposed therapy of the time and has been added with SD-Ag and drying therapy. Excision of eschar is the so-called "burn surgery" appearing with the development of surgery techniques. Indeed, it has obtained a lot of achievement, and changed the conclusion extensive burn inevitably resulted in death, which was a invigorating achievement at that time. Therefore, the treatment mode for deep burns formed:” dryness of burn wounds with SD-Ag-excision of eschar and skin-grafting to cover the wounds". To this day, the 21 century with life sciences as center has come, and what should we treat the conventional burn therapy? In the Science and Technology Facing New Century Academic Annual Conference in Commemoration of 40th Anniversary of the Establishment of China Association for Science and Technology, Zhang Wenkang, the minister of Ministry of Public Health specially invited us to give an academic report titled "Develop Life Sciences, Promote People's Health". He adverted:” The advent of life sciences' era not only means a completely new revolution in medicine, health service, agriculture, forestry, animal husbandry, side-line production, fishery, and environmental sciences, but also promotes the development of the whole science, economy and society". The life sciences have developed for a long time, and there will be important breakthrough before long. The total trend is to combine microscopic view with macroscopic view, part with whole, structure with function, and study the relation between living phenomenon, vital activity laws and environment from different levels. The breakthrough will occur in the study on the levels of molecular, cell, system and the whole body, and the study on important living phenomenon and bioinformation. The leading fields include molecular biology, cell biology, development biology, neurobiology, ecology, and most important of all, medicine and agriculture. All the medical workers, especially the burn researchers, should chew over the talking of Minister Zhang Wenkang, because there is still serious