A Comprehensive Report on the Therapeutic Effect of MEBO in Treating 4954 Cases of Various Wounds and Ulcers Yang Kefei, Ma Jianming, 202 Hospital of Shenyang Military Region， Yang Qi, Department of [Abstract] Various wounds and ulcers are frequently encountered diseases difficult to be healed in many areas all over Wounds and ulcers include burns, open injury, wound infection of body surface, refractory skin and mucous membrane ulcers etc. The common properties of these diseases are as follows: (1) There are symptoms and physical signs in body surface and mucous membrane; (2) There are similar pathological changes in disease development, such as exudation, infection, ulcers; (3) There are skin mucous membrane ulceration and soft tissue injury; (4) There are regeneration and restoration of connective tissues and epithelial tissues. In summary, burn wounds and ulcers refer to all the ulceration and wounds difficult to be cured in body surface mucous membrane, soft tissues and muscle tendons, and bone substance. Four thousands, nine hundreds and fifty four cases discussed in this articles were selected from the articles published in The Chinese Journal of Burns Wounds & Surface Ulcers from the initial issue of 1989 to the fourth issue of 1994, the articles published in the first, second and third burns wounds and surface ulcers academic conference, and the cases collected by the authors for many years in clinical practice. There were 77 kinds of burns wounds and surface ulcers. The cure rate of the 4954 cases was more than 92%, and the effective rate reached 100%. The average course of disease was 4.36 years. The average healing time was 16.18 days. Compared with routine treatment, MEBO therapy can reduce treatment course, alleviate pains, and restore health and lower medical expenses. MEBO is a scientific, advanced and practical new drug for the treatment of wound and ulcer patients. Therefore, MEBO is worthy to be popularized. The data of these cases are summarized as follows: A. SUMMARY
(A)
Gender and Age Twenty-five hundred and ninety one males (54.32%) and 2263 (45.68%) females were included in this study (male: female= 1:0.84); 535 cases were children (10.80%), 4203 cases (84.84%) were grown-ups, and 216 cases (4.36%) were senile. (B) Types of disease:
(C) Course of Disease and Healing Time:
(1)
Course of disease: The minimum duration of the average courses of disease was 0.63 year (7.56 month), the maximum duration of the average courses of disease was 8.08 years; the average duration of the average courses of disease was 4.36 years. The minimum duration of the course of certain patient was 0.18 year; the maximum duration of the course of certain patient was 41 years. There were 59 patients with a course of more than 5 years but less than 10 years, 48 patients with a course of more than 10 years but less than 20 years, 27 patients with a course of more than 20 years but less than 30 years, 14 patients with a course more than 30 years. In total, there were 148 patients (2.99%) with a course of more than 5 years. (2) Healing time: The healing time of different kinds of wounds and ulcers is shown in the following table:
B. ANALYSIS ON THE COMMON EFFECTS OF MEBO IN TREATING WOUNDS MEBO is a local treatment based on the philosophy of "wounds" and "ulcers" of traditional Chinese medicine and modern microcirculation study. The principle of MEBO is as follows: it can make the wound regenerate and renovate in a humid physiological tridimensional environment without maceration; it can make the necrotic tissue layer of wound liquidized, dissolved and removed without damage through the actions of basic substances and medicament form of this drug; it make the exudates, secretion, liquidized matters, metabolic products of the wound, chemical substances and microorganisms released from cytoclasis discharged from the wound based on the automatic inducing flow of drugs, thus reduce the probability of redamage and reinfection, best protect the vital tissue cells, and accelerate the regeneration and restoration of wound. According to the above action mechanisms of MEBO, MEBO can alleviate pains and reduce infections of wound of burns, wounds and ulcers without making the wound deepened or leaving scars. The four enormous problems of burns, wounds and ulcers (that is, pains, infections, deepening and scars), have been studied by the specialists and scholars of different countries, but they have not been solved now. We have used MEBO to treat more than ten thousand cases of burns and wounds, and five thousand cases of ulcers. The clinical practice has proved that the four international problems (that is, pains, infections, deepening and scars) have been solved by MEBO, which has obvious curative effects. The action mechanisms of MEBO on treating these four enormous problems are described as follows: (A) Obvious and permanent analgesia effects: (1) After the ointment is applied on the wound, it changes from ointment into oil under the action of room temperature and skin temperature. These two layers cover the wound air-tightly, and protect the nerves of pain sense and their damaged broken ends of the naked wound tissues from the stimulation of physical factors, such as ambient air and temperature. (2) This ointment keeps the wound moist without maceration, dryness or scars, reduce the stimulation to wound tissues and nerves of pain sense, and alleviate the pain due to wounds. (3) The ointment infiltrates into the wound tissues, mitigate the spasm of arrectores pilorum, and relieve the pain of wound that can not be oriented. (4) The automatic liquid flow circulation and unobstructed inducing flow of the ointment in the wound tissues, remove the harmful substances and organisms, such as the chemical substances released due to cytoclasis, metabolic products and microorganisms from the wounds, so as to reduce the lasting exquisite invasive damages and pains of the tissues and nerves. (5) After the ointment is applied, the damages and pains due to medical treatment are greatly alleviated. (6) The persistent and refractory pains due to circulatory disturbance, edema, anoxia, and the pains because of microorganisms, are appeased. It has been observed in clinical practice that MEBO had obvious and lasting analgesia effects on 98.65% of the patients. Especially, its curative effects on the wound of children were better. The analgesia effects on long-time wound of wound and ulcer patients came later. The pains were relieved or disappeared 5～10 minutes after the ointment was applied on the wound of most of the burn patients. (B) High capacity and effects in controlling wound infections. The mechanisms are as follows: (1) Isolate wound, and reduce contamination: As is well known, there are two sources of different kinds of wound infections: one is contamination from extraneous sources, mainly including the microorganism invasion in the air and medical pollutions; the other is contamination from internal source, mainly referring to the bacterial infection inside the human body. Generally, there are about 1000 aerobic bacteria and semi-aerobic bacteria in 1 cm2 of normal skin, accounting for 1～10% of the total bacteria in the human body. There are anaerobic bacteria and semi-anaerobic bacteria in the visceral organs in the human body, accounting for 90～99% of the total bacteria. These inside and outside florae are called "normal florae" in non-pathogenic conditions. When the environment and conditions change, there forms flora imbalance, resulting in systemic or local infection. After MEBO is applied on the wound, its two-layer structure covers the wound tightly, isolate the environmental pollution, and reduce the invasion of external bacteria, so as to achieve the objective of isolating wound and abating pollution. (2) Unobstructed draining, bacteria removal: MEBO forms automatic liquid flow circulation in the wound tissues, remove the bacteria in the wound tissues in the condition of unobstructed draining, so as to decrease the bacterial concentration in the wound, control the bacterial infection from inside, relieve or get rid of systematic and local bacterial infection, and abate the invasion of anaerobic bacteria and semi-anaerobic bacteria (3) Destroying the existing and reproduction environment of bacteria: As is well known, aerobic bacteria and semi-aerobic bacteria can live and reproduce well in a humid environment, while anaerobic bacteria and semi-anaerobic bacteria can live and reproduce well in a humid environment with no oxygen or little oxygen. So long as this existing condition is destroyed, the bacteria cannot live. MEBT and MEBO block the supply of nutrition, water and oxygen which are essential for bacteria, destroy the existing condition of bacterial by binding MEBO with the wound necrotic tissues through the lipophilic function of MEBO, so that various bacteria cannot survive in the wound and the ointment, and they are removed from the wound through the inducing flow excretory function of the ointment. As a result, the local and systemic bacterial infections are controlled. This method is completely different from dry therapy: moist environment is favorable for the regeneration of tissue cells. Especially, the regeneration action is very obvious in the cells impending death. Moreover, this environment is harmful for bacteria, so that MEBO has specific function of anti-infection. (4) Direct or indirect bactericidal and bacteriostatic functions: Although the bactericidal effects and the bacteriostatic actions of MEBO are weak, when it is used together with other active ingredients, such as phellodendron bark ester oil, it has direct bactericidal effects and bacteriostatic actions, and can reduce bacteria and control infections. In total, the manifestation of the anti-infection effect of MEBO is as follows: It has important functions of blocking bacteria, inhibiting bacteria, removing bacteria, and destroying the existing conditions of bacteria. Therefore, MEBT and MEBO have strong capacity in controlling infections. Although only weak bacteriostatic and bactericidal effects were observed in the experiments, its powerful infection control capacity could be proved by the clinical practice. (C) The effects of preventing and cure of the re-damage and progressive necrosis: It has been proved by clinical practice that MEBO can prevent the progressive necrosis and deepening of various wounds. For new wound, MEBO should be used as early as possible, in order to prevent the re-damage due to the deepening and dryness of wound and afterheat, and alleviate the re-damage due to the toxic substances in the wound tissues. These effects are described as follows: (1) Prevent the re-damage on the wound due to dryness: Dry scarring therapy for burns, wounds and ulcers is a method at the price of destroying the wound furtherly. The wounds are directly exposed in the air and air heater. This will aggravate re-damage due to dryness, and accelerate the oxygenation, nitridation and the transformation of industrial waste gas in air. Large numbers of oxygen free radicals and other toxic substances are released, and lead to severe re-damage of wound tissues and cells. At present, this therapy is still used. It violates the law of the natural development of wound, and it is a wrong therapy. It certainly will result in damages, and bring pains to the patients. MEBT and MEBO are used to provide a physiologically moist environment in accordance with the law of the natural development of wound, remove the necrotic tissues from superficial to interior in the wound from the wound, reduce the hotbed suitable for the growth and reproduction of bacteria in the wound, promote the regeneration of the cells impending death, make the vital cell regenerate and restore, and accelerate the healing of wound. These measures not only prevent the dryness and damage of the wound, but also protect the wound, avoid the progressive necrosis of wound, accelerate the healing, and reduce the disabled. (2) Abate re-damage due to afterheat of wound: It has been observed in clinical practice that the higher the damaging heat temperature is, the higher the afterheat temperature is, the longer the duration time is, and the more severe the wounds are. It has been confirmed by experimental study that the exudation is most severe 3～4 hours after 60 seconds' burns. During this time, tissue edema is apparent. After this time, the symptoms and signs will last for 30 hours, and will turn alleviated gradually. Therefore, the afterheat damage in the first few hours after injury should not be negligible. If MEBO is applied as early as possible, the afterheat damage can be alleviated, so as to make the microcirculation unobstructed, lower the permeability of capillary vessels, remove the re-damage of wound tissues due to afterheat, and help to the restoration of wound. (3) Alleviate the re-damage due to harmful substances in the wound: According to the theory, after the human skin and mucous membrane are damaged, there are pathological and physiological changes in cellular morphology and functions in the damaged area. Moreover, the damaged and dead cells will release large numbers of toxic substances, chemicals and metabolic products such as histamine, 5-HT, polypeptides, catecholamine, prostaglandin, thromboxane, and epinephrine, which do great harm to the wound. The re-damage actions on the capillary vessels and lymphatic vessels are especially severe. For example, the H H receptor in histamine (a sort of material) does great damages to the connection parts of the endothelial cells in the capillary wall, resulting in high capillary permeability, decreased effective circulatory volume and swollen tissues. This belongs to internal-source damages. If these harmful substances cannot be cleared in time, there surely occurs the re-damage inside the wound. These phenomena are usually seen in dry therapy, and cannot be got rid of. This problem cannot be solved by the inside adjustment of the human body. For this reason, the re-damage inside the wound tissues certainly will be aggravated, and this is the foregone conclusion of dry therapy. There are 3 methods to remove the re-damage due to harmful substances when MEBT and MEBO are used. First, the active ingredients in MEBO, such as β-beta-sitosterol and wound ulcer agents can destroy, neutralize these harmful substances and alleviate the damages. Second, since MEBO has a draining excretory function in the wound tissues, which can remove the chemical substances and metabolic products out of the wound with the necrotic tissue granules, alleviate or avoid the progressive necrosis of wound tissues. Third, MEBO can get rid of the microcirculatory disturbances, provide the wound tissues and cells with ample nutrition and oxygen, reduce the damage degree of tissues to the minimum, prevent the progressive necrosis of wound tissues, so as to protect the wound and accelerate the regeneration and restoration in essence. (D) There are no scars or fewer scars left in the surface of deep II burns, wounds and ulcers: As is well known in the past, the surfaces of burns, wounds and ulcers were healed with scars. This was a final conclusion all over the world, and there was no disagreement for several decades. At present, it has been proved in theory and practice by large numbers of cases with burns, wounds and ulcers that were treated with MEBO, that there were no scars or few scars left after the wound was healed. After using MEBO, the scars of third-degree burn wound are thin and soft, and have little influence on their functions. The main mechanisms of its curative effects include: (1) The dermal cells in the survival dermis tissues of the wound regenerate and divide faster under the effect of MEBO, fill up the impairment of dermis tissues, so as to restore the wound. (2) The proportion of survival fibrous tissues and epithelial tissues in wound dermis is 4:1, and increases from 4:1 to 20:1 since four days after the injury. There are more than 5 times of normal fibrous tissues, and the epithelial tissues almost stop growing. In this condition, if no measures are taken, the fibrous tissues will develop and the wound will be healed in the form of scars. In order to solve this problem, MEBO is used. MEBO can adjust the imbalance ratio, control the excessive regeneration of fibrous tissues, stimulate the regeneration and division of epithelial cells, change the restoration mode of dry method, and make the wound healed physiologically with no scars or fewer scars in accordance with the natural regeneration and regeneration laws of skin. (3) MEBO should be applied as soon as possible to treat the stasis tissues in the deep second-degree burn wound (6-12 hours after injury), to make the microcirculation of stasis areas return to normal, turn superficial, and there will be no or fewer scars left after the wounds are healed. (4) In the area of survival cutaneous appendages, such as hair follicles, sweat glands, sebaceous glands, their discharge ducts, and the openings of their broken ends, the smooth muscles of the discharge ducts relax, the openings keep open under the actions of MEBO, so that the regenerating and dividing basal cells in the cutaneous appendages are excreted to the wound, and cover it. As a result, epidermidalization forms. The form and function of skin will return to normal one year after the wounds are healed. However, after the wound and ulcer wounds are healed by MEBO, thin soft scars will be left, because the course of disease is long, the wound granulation is aging, and the scar tissues in the base have formed. But there are few keloids, and the wound is small, therefore the functions will not be impaired severely. C. CLINICAL OVERVIEW (A) Analysis on the common properties of the clinical therapies for different kinds of wounds and ulcers: (1) Long course of disease and difficult treatment: In the past, there was no effective method to treat wounds and ulcers; wounds and ulcers were difficult to cure; the course of disease is long; the patients felt great pains and had heavy economic burden. Therefore, many medical workers felt a delicacy about the treatment. We summarized 4954 patients with different kinds of wounds and ulcers, who were treated with MEBT and MEBO. Obvious curative effects were obtained, and the course of treatment was reduced. Based on the statistical analysis, the shortest average course of disease was 0.63 year, the longest average course of disease was 8.08 years, the shortest average curing time was 10.59 days, the longest average curing time was 21.58 days, and the average curing time was 16.18 days. We summarized and compared the ulcer patients in order to make clear its effects. In the MEBO group, there were 785 cases, the average cure time was 13.41±3.75 days; in the control group with routine treatment, there were 552 cases, and the average cure time was 33.76±5.8 days. There was significant difference between the 2 groups (P<0.001). In a word, when MEBO was used to treat ulcers, the course of treatment turned shorter, the curative effects became higher, and the treatment problem of these diseases was solved. (2) Debridement of aging wound: In the aging wound, the granulation tissues look aged and pale with rough granules. Generally, no hemorrhage occurs when the granules are touched. The epithelia at the edge of wound grow slowly or stop growing. There are big caves and impairment in the wound, which are difficult to be leveled up. There is fibrous tissue rings at the edge of wound. The epithelia hang upside-down on the wall of wound, restrict the growth of granulations, and hinder the new epithelia crawl and spread into the wounds. To treat these aging wounds, complete debridement should be performed before treatment. The aging tissues, the fibrous rings at the edge of wound, and the epithelial tissues hanging upside-down should be removed. A new wound forms, and then MEBO is applied. This will stimulate the regeneration of granulations and growth of epithelia with half effort and double result. (3) Usage of MEBO: When the wounds are exposed and moist, the ointment is applied with the thickness of 1-2 mm between the 4th hour and the 6th hour in the first time. Dressing change is conducted twice a day, the thickness of ointment should be 2-3 mm, and decompression bandaging should be used. Liquidized substances, secretions and residual ointment should be cleared before administering the ointment. (B) Observation on the curative effects of MEBO therapy on different kinds of body surface ulcers: Thirty-one types (2675 cases, 53.99% of the total cases) of surgery wounds and ulcers are summarized, which are the most frequently encountered diseases. The patients have great pains, and the treatment is difficult with long course. In order to solve this problem, several viewpoints and treatment methods about the use of MEBO are summarized. (1) Pathogenic mechanisms of body surface ulcers: The wound of body surface skin ulcer due to any cause which is not healed after 2 weeks is called aging granulation tissue ulcer wound. The granulation tissues are aged with edema and formation of basilar fibers, and stiff without elasticity, which damage the blood supply of surface layer granulation tissues. The longer the granulation tissues form, the older the granulation tissues are, the harder the basilar fiber plate is, the more difficult the inferior small arteries and veins pass through the fiber plate to supply nutrition, water, oxygen to the above granulation tissues. As a result, the granulation tissues are of hyperplasia, and the edema is aggravated. These are the key factors of edematization in granulation tissues. If the edema of granulation tissues can not be ameliorated and progressive fibrosis appears, the small arteries, veins and lymphatic vessels are obstructed. The rough-and-tumble hyperplasia of capillary vessels, the decrease of skin oxygenation, the prolongation of dermal papilla, the formation of polypus-like hypertrophic damages, lead to insufficient blood supply and ulcer formation ultimately. (2) Therapeutic effects and procedures: 2675 cases of chronic body surface ulcers were treated with MEBO. Both exposure and bandaging strapping resulted in obvious effects. MEBO supplied a humid physiological environment to ulcer wound, and material basis to the renewal and regeneration of damaged skin tissues and accessories, so as to accelerate the regeneration of aging granulation tissues, and enhance the regeneration power of the wound edge epithelial tissues. In addition, MEBO had special anti-infection actions. All these formed the basis of restoration for the wound. The fibrous rings around the wounds began to turn soft 5～7 days after MEBO was applied on obstinate wound. At this time, the damaged tissues were made a clean sweep of, and fresh tissues were exposed. Continual administration of the ointment could stimulate the spread of epithelias of wound edges and skin islands into the wounds. According to the description of Du FQ, after the aging granulation tissues proliferated to some degree, there was short of blood supply, the granulation tissues turned offwhite, the granulation tissues depressed from the prominent central parts to the wound edges gradually without influence on skin nails or islands. The mechanisms of this clinical phenomenon are still unclear. I think it may be concerned with the following factors: (1) There is short of blood of supply due to granulation tissue hyperplasia, resulting in ischemic necrosis and the desquamation of necrotic tissues; (2) Because the skin nails and islands are restrained by the granulation tissues in the base, after the raised granulation tissues turn depressed and drop off, the bases of the wound of skin nails and islands are exposed. After the annual-ring-like fiber rings around the skin islands are removed, the spread of the skin nails and islands is especially obvious; (3) There are large numbers of sebaceous glands, hair follicles, sweat gland epithelia in the granulation tissues. If instrument are used to remove the granulation tissues, the survival epithelia are easy to be damaged. In this condition, the granulation tissues can be removed with blunt methods gently to accelerate the healing of wound. (3) Analysis of curative effects: the common wounds and ulcers in surgical department include: burn wound, chronic body surface ulcers, different degrees of bedsores, skin wound, infection of incisional wound and bacterial chronic sinus tracts. After these diseases were treated with MEBO, pain was alleviated, treatment course was reduced, curative effects were enhanced, functions were recovered, and the possibility of turning disabled was lowered. MEBO brought a new way to the obstinate wounds and ulcers. MEBO therapy is different from routine treatment. We summarized the comparative data of MEBO group and routine treatment control group. Treatment group (MEBO Group): 785 cases, the average cure time is 13.41±3.75 days; Control group: 552 cases, the average cure time is 33.76±5.80 days. P<0.001 The following examples are used to compare the curative effects of the two groups: Example 1: Shi Hao, Xiao Mo used MEBO to treat 10 patients of bedsore with MEBO, in order to conduct comparative analysis on curative effects of the 24 wounds in the treatment group and 16 wounds in the control group. It can be concluded from the above data that, MEBO group had better curative effects than complex mint camphor oil group did. The differences of both cure rates (X2=8.81, P<0.01) and effective rates (X2=4.27, P<0.05) were statistically significant.
(B)
Curative effect analysis of MEBO in wounds and ulcers of dermatology:
(1)
Diseases and patient's conditions: seventeen kinds of wound and ulcer diseases of dermatology (574 cases, 11.59% of the total cases) are summarized in this article. The common diseases include herpes zoster, eczema, condyloma acuminatum, children impetigo herpetifomis and new-born diaper dermatitis. The effective rate of MEBO was more than 96.5%. These are inflammatory reaction diseases due to bacteria and virus, and they are not difficult to cure. However, the cure rates of the obstinate diseases with unclear etiological factors, such as psoriasis, refractory eczema, were low. (2) Treatment methods: 1. Debridement was performed and contamination was removed before the ointment was applied, in order to improve drug effects. 2. The wet packing techniques, treatment time and the thickness of the ointment should be mastered. More ointment should be used in wet packing, and decompression bandaging should be used until the packing gauzes did not drop off. 3. Saline or benzalkonium bromide should not be used to wash the wounds in removing liquidized matters and secretions before applying the ointment next time, for fear that the wound was stimulated and drug actions were lowered. 4. When treating herpes zoster, before the ointment was used, the wound and the areas around the wound should be disinfected with alcohol, and the herpes and blebs should be rubbed with disinfected dry gauzes or cut with scissors to make them broken for discharge, and then make the wound dry. The ointment was applied after the surface turned dry in order to improve the effects. 5. Condyloma acuminatum usually occurred in the perineum of males and females, so that perineum should be kept clean in order to prevent the development and proliferation of condyloma acuminatum. Doctors should tell patients this information to help cure the disease. (3) Analysis of curative effects: Some cases treated with the ointment had good curative effects, low recurrence rate. Some cases difficult to be treated, such as eczema, psoriasis, had bad curative effects. However, in total, good curative effects were acquired with short treatment course, good curative effects, reduced infections and pains, and fewer scars. For example, Chen YL treated diaper dermatitis of children with MEBO, and observed the results. One hundred and fifty-two cases of diaper dermatitis of babies and infants were included. They were divided into 2 groups: 105 in MEBO Group, 47 in Jingwanhong Group. The experimental group was treated with MEBO, while the control group was treated with Jingwanhong. The details are described in the following tables.
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