Acute arsenic poisoning from realgar water: Case series from Guilin, China.

Surface soil and groundwater in Australia have been found to contain high concentrations of arsenic. The relative importance of long-term human exposure to these sources has not been established. Several studies have investigated long-term exposure to environmental arsenic concentrations using hair and toenails as the measure of exposure. Few have compared the difference in these measures of environmental sources of exposure. In this study we aimed to investigate risk factors for elevated hair and toenail arsenic concentrations in populations exposed to a range of environmental arsenic concentrations in both drinking water and soil as well as in a control population with low arsenic concentrations in both drinking water and soil. In this study, we recruited 153 participants from areas with elevated arsenic concentrations in drinking water and residential soil, as well as a control population with no anticipated arsenic exposures. The median drinking water arsenic concentrations in the exposed population were 43.8 micro g/L (range, 16.0-73 micro g/L) and median soil arsenic concentrations were 92.0 mg/kg (range, 9.1-9,900 mg/kg). In the control group, the median drinking water arsenic concentration was below the limit of detection, and the median soil arsenic concentration was 3.3 mg/kg. Participants were categorized based on household drinking water and residential soil arsenic concentrations. The geometric mean hair arsenic concentrations were 5.52 mg/kg for the drinking water exposure group and 3.31 mg/kg for the soil exposure group. The geometric mean toenail arsenic concentrations were 21.7 mg/kg for the drinking water exposure group and 32.1 mg/kg for the high-soil exposure group. Toenail arsenic concentrations were more strongly correlated with both drinking water and soil arsenic concentrations; however, there is a strong likelihood of significant external contamination. Measures of residential exposure were better predictors of hair and toenail arsenic concentrations than were local environmental concentrations.

Arsenic is a valuable component in tumor treatment and traditional Chinese medicine and has seen widespread use in processing, manufacturing, and agriculture. Although rare, arsenic poisoning can occur in forensic practice. Elusive pathological changes, as well as obscure clinical signs, may cause arsenic poisoning to go unrecognized. Here, we report four cases of fatal acute arsenic poisoning, with careful observation of pathological changes and collection of postmortem specimens for arsenic concentration analysis. Additionally, we reviewed six cases of fatal arsenic poisoning in the past 20years. In the present study, microvesicular steatosis in the peripheral areas of the hepatic lobules and acute splenitis were observed, which are rare findings in acute arsenic poisoning. This study summarizes the histopathological features of arsenic poisoning and presents data on arsenic distribution. Arsenic concentrations in the liver and kidneys can increase the reliability of identifying arsenic poisoning. Furthermore, in traditional Chinese medicine-related deaths, arsenic poisoning needs more attention.

Objective To understand the changes of arsenic poisoning in drinking water arsenic poisoning areas in Inner Mongolia Autonomous Region, to provide a scientific basis for timely adjustment of local arsenic poisoning prevention and control measures. Methods In accordance with the requirements of the national Surveillance Scheme of Drinking-Water-Borne Endemic Arsenism, 38 villages were selected from 8 cities as monitoring sites in Inner Mongolia Autonomous Region in 2015. The situation of the villages in improving water quality and operation of the arsenic reducing projects was investigated, water samples were collected to detect water arsenic content of all the monitoring villages exposed or previously exposed to high arsenic water in the resident population, and 30 adult patients with arsenic poisoning were tested urine arsenic level. Results Thirty-eight monitored villages had changed the water sources; the change rate was 100.00% (38/38) . Water arsenic content qualified projects were 17, covering 36 villages. The project with water arsenic content exceeded the national standard was 1, the rate of exceeded standard was 5.56% (1/18), covering 2 monitored villages. In the 36 water arsenic content qualified natural villages, 4 163 people were examined, and arsenic poisoning patients detection rate was 10.21%(425/4 163). The incidence of mild, moderate, severe and skin cancer cases was 7.59% (316/4 163), 1.68% (70/4 163), 0.86% (36/4 163) and 0.07% (3/4 163), respectively, no new cases and new skin cancer cases. In the natural villages where the content of arsenic in water exceeded the standard, 461 resident people who were drinking high arsenic water were examined. The detection rate of arsenic poisoning patients was 3.69% (17/461), no moderate, severe, new and skin cancer cases. A total of 1 107 patients with arsenic poisoning were tested for urinary arsenic levels in the 36 villages with normal water available and water arsenic levels in the range of 0.000-0.441 mg/L with a median of 0.011 mg/L. The content of urinary arsenic in 60 patients with arsenic poisoning was detected in the 2 natural villages with the arsenic content exceeded the standard. The range was 0.030-0.268 mg/L and the median was 0.155 mg/L. Conclusions The projects of anti-arsenic water have effects in Inner Mongolia Autonomous Region. But there are still water projects with water arsenic content exceeded the standard, which seriously affects the health of residents, and the water management and maintenance of water projects needs to be strengthened. Key words: Arsenic poisoning; Water improvement project; Monitoring results

To explore the regularity of traditional Chinese patent medicines for the treatment of hyperlipidemia recorded in Newly Edited National Chinese Traditional Patent Medicines,the Composition Principles of Chinese Patent Drugs,New Drug Conversion Standard,the Compilation of National Standard for Traditional Chinese Medicines and Chinese Pharmacopoeia. Researchers extracted the information of prescriptions from these cases according to the inclusion and exclusion criteria. Then microsoft excel 2010 was used to conduct frequency statistics and count the frequency of traditional Chinese medicine. SPSS Clementine( ver.12. 0) and SPSS( ver. 18. 0)were adopted respectively for frequency analysis,association rules analysis,cluster analysis and factor analysis. Besides,KMO test and Bartlett spherical test were performed for factor adaptation test. Finally,a total of 173 traditional Chinese medicines were included,involving 94 Chinese patent medicine prescriptions. The frequency results of traditional Chinese medicine showed that there were 33 kinds of high-frequency traditional Chinese medicine,mainly including those for tonifying medicine,activating blood and resolving stasis and blood-stasis,and clearing damp. The association rules analysis found out 12 association rules of drug pairs,3-herb pairs of 25 and4-herb pairs of 6. Totally 11 medicine groups with relevance were respectively extracted by cluster analysis. KMO test and Bartlett spherical test indicated that the method was suitable for factor analysis and 11 common factors were respectively extracted by factor analysis. The association rules reflected the therapeutic method for tonify the liver and kidney,activating blood and resolving stasis. Cluster analysis and factor analysis showed the therapeutic method of Qi-enriching and Yin-nourishing,and the factor analysis focused more on removing blood stasis and dampness. The decision tree with hawthorn as the dependent variable reflects the importance of alisma orientalis and fructus schisandrae in the drug matching. In conclusion,data mining technique can comprehensively analyze the regularity of prescriptions of traditional Chinese patent medicine for hyperlipidemia,and is helpful for guiding the development of Chinese patent medicines and the clinical practice of traditional Chinese medicine.

Objective Through studying the relationship between different concentrations of arsenic in drinking water and ECG changes, to investigate the effects of arsenic on human cardiovascular system. Methods During 2008-2013, people that over 20 years old and over 10 years of drinking arsenic water were investigated in 15 villages of Shanxi Province and Inner Mongolia according to the historical data of endemic arsenic poisoning through drinking water, who were divided into control group(< 0.01 mg/L), low arsenic group(0.01-< 0.05 mg/L), medium arsenic group(0.05-< 0.10 mg/L) and high arsenic group(≥0.10 mg/L) according to the concentration of water arsenic. Arsenic concentrations in drinking water samples were detected by the method of hydride generation atomic fluorescence spectrometry. ECG-site inspections were finished to record 12-lead ECG. The effect of different concentrations of arsenic in drinking water on ECG was studied. Results ECG of 1341 people were surveyed, and abnormal rate was 11.56% (155/1 341), including abnormal rate of control group, low arsenic group, medium arsenic group and high arsenic group which was 5.7% (9/158), 12.85% (59/459), 12.02% (28/233), and 12.02% (59/491), respectively. The abnormal rate of control group was lower than that of low arsenic group, medium arsenic group and high arsenic group (χ2 = 6.141, 4.391, 5.090, all P < 0.05). ECG changes were characterized by cardiac arrhythmias and ST-T changes. A variety of arrhythmias abnormal rate of control group [0(0/158)] was lower than that of low arsenic group, medium arsenic group and high arsenic group [4.58% (21/459), 3.86% (9/233), 3.46% (17/491); χ2 = 7.483, 6.247, 5.618, all P < 0.05]. In addition, there were significant differences among the four groups in the rates of right ventricular enlargement and myocardial ischemia (χ2 = 9.525, 9.848, all P < 0.05). Conclusions ECG changes of the residents in the areas of water-borne-endemic arsenic poisoning are characterized by cardiac arrhythmias and ST-T changes. Water arsenic concentration exceeding 0.01 mg/L could significantly increase the ECG abnormal rate, indicating that arsenic in drinking water has a certain effect on heart tissue. Key words: Water-borne-endemic arsenic poisoning; Electrocardiography; Cardiac arrhythmias; ST-T changes

Objective To observe the therapeutic effects of continuous blood purification(CBP) combined with traditional Chinese medicine on systemic inflammatory response syndrome(SIRS) of severe acute pancreatitis(SAP) patients on the base of routine treatment. Methods A total of 60 cases of severe acute pancreatitis patients were randomly divided into treatment group (continuous blood purification plus traditional Chinese medicine group,n=30) and control group(n=30).For all SAP patients,except recording vital signs daily, the changes of WBCs and biochemical indicator were recorded at the 0,1st,3rd,5th,7th day. The scores of APACHEⅡ were measured before and 7 days after treatment. The relief time of abdominal pain, the first defecation time, the incidence of operation and multiple organ dysfunction syndrome (MODS), case-fatality rate and mean hospitalized days were recorded and compared between the two groups. Results The 1st,3rd,5th,7th day after treatment every indicator (including body temperature, heart rate, respiratory rate, the sum of white blood cell and the level of plasma CRP and arterial blood lactate) in treatment group was reduced significantly more than that in control group(P＜0.05). At the 7th day after treatment, the score of APACHEⅡwas lower than that before treatment in the two groups(P＜0.05), and in treatment group that was more dramatically lowered(P＜0.01). The relief time of abdominal pain and the first defecation time in treatment group were significantly less than those in control group(P＜0.01). In the two groups,the serum amylase levels decreased at 1st compared to the value before therapy,but there was no difference between the two groups(P＞0.05),and the declination was most significant after therapy for 3,5 and 7 days. In addition, the serum amylase value was much lower in treatment group than that in control group at 3,5,7 days(P＜0.01); In treatment group, the incidence of operation and MODS, case-fatality rate were lower than those in control group(P＜0.05),and mean hospitalized days were lower significantly(P＜0.01).Conclusions On the base of routine treatment, application of continuous blood purification(CBP) combining with traditional Chinese medicine could significantly prevent SIRS development, improve prognosis.So we suggest early use of CBP and traditional Chinese medicine in SAP patients. Key words: Continuous blood purification; Traditional Chinese medicine; Severe acute pancreatitis; Systemic inflammatory response syndrome; Multiple organ dysfunction syndrome

Cultural festivals can attract cultural tourists, extend the tourist season and add vibrancy to the cultural scene. However, there is relatively little research on how festivals affect tourist experience of the destination or outcomes such as satisfaction or repeat visitation. This study used the Event Experience Scale to measure tourist experiences at three cultural festivals in Hong Kong – the Lantern Festival, Dragon Boat Festival and the Cheung Chau Bun Festival. The findings show that tourist experiences of these festivals are distinct, and they positively affect destination image and behavioural outcomes. Relative to permanent attractions and tours, festival experiences elicit stronger affective, conative and novelty responses. Festivals also convey a stronger impression of Hong Kong as a destination exhibiting Chinese and traditional culture, but less as a global city. The festival experience is associated with positive outcomes, namely greater satisfaction, intention to recommend and intention to return.

Traditional Chinese patent medicine (TCPM) is widely used for essential hypertension (EH) in China. However, there is no critically appraised evidence, such as systematic reviews or meta-analyses, regarding the potential benefits and disadvantages of TCPM to justify their clinical use and recommendation. The aim of this review was to systematically evaluate and meta-analyze the effects of TCPM for EH.Seven databases, the Cochrane Library, PubMed, EMBASE, the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Chinese Biomedical Literature Database, and the Wanfang Database, were searched from their inception to August 2014 for relevant studies that compared one TCPM plus antihypertensive drugs versus antihypertensive drugs alone. The methodological quality of the included trials was assessed using the Cochrane risk-of-bias tool. The primary outcome measures were mortality or progression to severe complications and adverse events. The secondary outcome measures were blood pressure (BP) and quality of life (QOL).Seventy-three trials, which included 8138 patients, on 17 TCPMs were included. In general, the methodological quality was low. Two trials evaluated the effects of TCPMs on mortality and the progression to severe complications after treatment, and no significant difference was identified compared with antihypertensive drugs alone. No severe adverse events were reported. Thirteen TCPMs used in complementary therapy significantly decreased systolic BP by 3.94 to 13.50 mmHg and diastolic BP by 2.28 to 11.25 mmHg. QOL was significantly improved by TCPM plus antihypertensive drugs compared with antihypertensive drugs alone.This systematic review provided the first classification of clinical evidence for the effectiveness of TCPM for EH. The usage of TCPMs for EH was supported by evidence of class level III. As a result of the methodological drawbacks of the included studies, more rigorously designed randomized controlled trials that focus on mortality and cardiovascular events during long-term follow-up are warranted before TCPM can be recommended for hypertensive patients. Two TCPMs, Song ling xue mai kang capsules and Yang xue qing nao granules, should be prioritized for further research.

Background: Niu Huang Jie Du Pian (NHJDP) is a widely used realgar-containing Chinese medicine remedy. Most brands are composed of eight ingredients: Niuhuang (Calculus Bovis), Xionghuang (realgar), gypsum (calcium sulphate), Dahuang (Radix et Rhizoma Rhei), Huangqin (Radix Scutellariae), Jugeng (Platycodon grandiflorum), Bingpian (borneol), and Gancao (Radix Glycyrrhizae uralensis, licorice root). Most users are not aware that Xionghuang (realgar) contains arsenic disulphide [As2S2]. Inorganic arsenic poisoning after therapeutic overdoses has been reported in Chinese literature, but no report of acute, intentional overdose of NHJDP has been published. We report a case of intentional overdose of NHJDP leading to arsenic poisoning. Case Presentation: A 33-year-old woman ingested approximately 100 tablets of NHJDP bought over the counter, along with her usual antidepressants. She presented with somnolence, agitation, epigastric pain and repeated vomiting, compatible with clinical toxicities of NHJDP reported in Chinese literature. At presentation, blood and spot urine arsenic levels were 440.9 and 7,495 nmol/L, respectively. The patient’s condition improved rapidly after admission and chelation therapy was not deemed to be necessary. Discussion: Despite the self-limiting clinical course, the high arsenic level in the patient’s blood and urine raises safety concerns regarding the use of NHJDP in the community. Inconsistencies in the sales regulation of arsenic-containing products, and a lack of product label warning regarding arsenic content, may potentiate inadvertent arsenic poisoning. Conclusion: Clinician should be aware of the possibility of inorganic arsenic poisoning when treating patients with overdose of Chinese medicine remedies that contain Xionghuang (realgar). Proper product labelling may help reduce inadvertent arsenic poisoning.

A cultural practice of drinking realgar wine leading to elevated urinary arsenic and its potential health risk

BackgroundSyndrome differentiation is a commonly used methodology and practice in Traditional Chinese Medicine (TCM) guiding the diagnosis and treatment of diseases including heart failure (HF). However, previous clinical trials seldom consider the impact of syndrome patterns on the outcome evaluation of TCM formulae. Qiliqiangxin (QLQX) capsule is a TCM formula with cardiotonic effect to improve the cardiovascular function for heart failure with proven efficacy from well-designed clinical trials. Though, there is no clinical trial with a large sample size and long assessment period that considers the relationship between TCM syndrome differentiation and the treatment efficacy of QLQX. In the present study, we design a study protocol to evaluate the relationship between TCM syndrome differentiation and the severity of heart failure as well as its progression. Furthermore, we will evaluate the impact of the TCM syndrome patterns on the efficacy of QLQX in the outcome of heart failure.MethodsThis is a clinical study conducted in conjunction with an ongoing clinical trial (QUEST Study) by sharing the parent patient populations but with different aims and independent designed roadmaps to investigate the TCM syndrome pattern distributions and the impacts of syndrome pattern types on the efficacy of QLQX in HF treatment. The clinical trial involves over 100 hospitals in mainland China and Hong Kong SAR with 3080 HF patients. By assessing the morbidity and re-hospitalization, we will verify and apply a modified TCM Questionnaire to collect the clinical manifestations of HF and acquire the tongue images of the patients to facilitate the syndrome differentiation. We will base on the “2014 Consensus from TCM experts on diagnosis and treatment of chronic heart failure” to evaluate the TCM syndromes for the patients. A pilot study with at least 600 patients will be conducted to evaluate the reliability, feasibility and validity of the modified TCM questionnaire for syndrome differentiation of HF and the sample size is calculated based on the confidence level of 95%, population size of 3080 and 5% margin of error. Secondly, we will investigate the characteristic of TCM syndrome distribution of HF patients and its correlation with the functional and biochemical data. Furthermore, we will evaluate the relationship between the TCM syndrome patterns and the efficacy of QLQX in the treatment of heart failure. Lastly, we will investigate the implication of tongue diagnosis in the severity and therapeutic outcome of HF.Expect outcomesTo our knowledge, this is the first large scale clinical trial to evaluate the impacts of TCM syndrome differentiation on the progression and therapeutic outcome of HF patients and explore the diagnostic value of TCM Tongue Diagnosis in HF patients. We expect to obtain direct clinical evidence to verify the importance of TCM syndrome differentiation for the diagnosis and treatment of HF.Trial Registration: The trial was registered at Chinese Clinical Trial Registry, http://www.chictr.org.cn. (Registration No.: ChiCTR1900021929); Date: 2019-03-16.

A comprehensive analysis of the associations between the consumptions of 17 food products with urinary concentrations of arsenobetaine, total arsenic, arsenous acid, dimethylarsinic acid (UDMA), monomethylarsonic acid (UMMA), and total inorganic arsenic for US children aged 3-5 years (N = 439), children aged 6-11 years (N = 2139), adolescents aged 12-19 years (N = 2434), and adults aged >= 20 years (N = 10902) was conducted. Data from National Health and Nutrition Examination Survey for 2005-2016 were used for this study. Concentrations of arsenobetaine were as much as > 15 times higher among consumers of fish/shellfish than non-consumers for children aged 6-11 years, > 12 times higher for children aged 3-5 years, > 13 times higher for adolescents, and > 7 times higher for adults. Consumption of rice as opposed to non-consumption of rice was associated with as much as 36.5% higher concentrations of total arsenic, 12.7% higher concentrations of arsenous acid, 43.9% higher concentrations of UDMA, 18.2% higher concentrations of UMMA, and 14.1% higher concentrations of total inorganic arsenic. Thus, consumption of fish/shell fish and rice was associated with higher concentrations of organic/inorganic arsenic. In addition, consumption of alcohol was also found to be associated with higher concentrations of organic/inorganic arsenic. However, consumption of milk and milk products, vegetables, organ and other meats, and nutritional drinks was found to be associated with lower concentrations of organic/inorganic arsenic. Thus, while consumption of several foods is associated with higher concentrations of arsenic, there are also foods whose consumption is associated with decreased concentrations of arsenic. Further studies are needed to identify foods that may lead to decreased concentrations of arsenic and as such arsenic toxicity.

Arsenic is a well-known toxic metalloid that enters the soil through both natural processes and anthropological activities and occurs in the form of various chemical species. Absorption of arsenic by plant root is influenced by many factors, including plant species, the concentration of arsenic in the soil, soil properties such as pH and clay content, and the presence of other ions. Aquaglyceroporins mediate the uptake of As3+ and undissociated methylated arsenic species in plants, whereas being a phosphate analog, As5+ is taken up by phosphate transporter. The primary cause of As3+ toxicity is its interference with a variety of enzymes because it has a high affinity to sulfhydryl groups found in many enzymes, whereas being a phosphate analog, As5+ can substitute inorganic phosphate in a plethora of biochemical processes, thus affecting the key metabolic processes in the cell. Arsenic toxicity is also mediated by oxidative stress by producing excessive reactive oxygen species (ROS) and affecting antioxidant defenses in plants. In arsenic non-hyperaccumulating plants, reduced uptake of As5+ due to suppression of the high-affinity phosphate uptake system, As5+ reduction to As3+ by arsenate reductase and subsequently complex formation with thiols, particularly phytochelatins (PCs) and glutathione and sequestration in roots provide tolerance to arsenic. In hyperaccumulator plants, arsenic tolerance mechanisms involve enhanced As5+ uptake, decreased As3+–thiol complexation, As3+ efflux to the external medium, significant enhanced xylem translocation, and sequestration of As3+ in vacuoles of fronds/leaves. There is a need to remediate arsenic contaminated soils and reduce the concentration of arsenic in the edible parts of the crops grown in these areas. Enhanced understanding of the mechanisms of arsenic uptake, translocation, resistance, accumulation, transport, and toxicity in plants is needed for the production of arsenic-resistant plants for safe cropping and phytoremediation. The existence of natural variation in arsenic tolerance of plants and soil-microbiota can be utilized for this purpose. Arsenic hyperaccumulator plants take up and sequester exceptionally high concentrations of arsenic in the aboveground parts and hence offer a great promise to phytoremediation of arsenic. Plant breeding techniques and genetic engineering approaches have been employed to enhance arsenic tolerance in plants. Arsenic-tolerant crop plants with less arsenic in edible parts and very high arsenic accumulation in leaves have been developed, but their performance under various soil conditions, climatic conditions, and geographical areas remains to be tested. Approaches till now are focused on the introduction of few genes associated with detoxification, sequestration, and efflux of arsenic in plants; however, to make real progress, a multifaceted transgenic approach using multiple gene targets and testing in various field conditions is required.

Traditional Chinese herbal medicine is widely used for primary health care worldwide as it mostly consists of herbs or herbal extracts known to be safe. However, owing to the intentional or unintentional addition to herbs of lead-containing bases or pastes, lead poisoning from traditional Chinese medicine (TCM) remains a serious issue. We report here a case of lead poisoning caused by long-term use of homemade TCM. A 66-year-old man was admitted for periumbilical pain and constipation. A detailed medication history revealed that the patient had been using homemade TCM for the past 8 months. Screening for heavy metals showed that the patient had a blood lead level of 657 μg/L and his wife, who was asymptomatic, had a blood lead level of 488 μg/L. Chemical analysis confirmed a lead concentration of more than 4,000 mg/kg in the TCM. Both individuals were advised to discontinue the medications and chelation treatment was immediately initiated for the husband. The patient's periumbilical pain was noticeably relieved after treatment, and blood lead levels returned to normal after three treatment rounds. We also review here the literature to summarize the usual reasons for taking TCM and common features of lead poisoning. Our findings suggest that potential exposure to lead from TCM treatment must be considered when diagnosing unexplained cases of abdominal colic in China. The Chinese health authority should speed up legislation to improve the regulatory framework of TCM, especially regarding small private clinics.

To evaluate the clinical efficacy and safety of Xuebijing injection in treatment of sepsis and multiple organ dysfunction syndrome (MODS). A prospective multicenter clinical study was conducted. The patients with sepsis, severe sepsis, or MODS admitted to Department of Emergency and Critical Care Medicine of 70 hospitals across the country during 2006 to 2008 were enrolled. All of the patients received the basis treatment of conventional therapy, plus Xuebijing injection of 50-100 mL, 2-3 times a day for 5-7 days, and the dose might be increased in serious cases. The vital signs, 24-hour urine output, Glasgow coma score (GCS), white blood cell count (WBC), platelet count (PLT), Marshall score, gastrointestinal function score, syndrome of traditional Chinese medicine (TCM), blood lactate (Lac), blood glucose, serum creatinine (SCr), and total bilirubin (TBil) were observed before treatment, 1, 3, and 5 days after treatment, and at the end of the treatment. The results of above mentioned parameters after the treatment were compared with that before treatment in each patient. At the same time, the occurrence and the degree of adverse reactions were recorded to evaluate the safety of Xuebijing injection. A total of 2,574 patients were enrolled, and in 2,509 cases the treatment was completed in, with a drop of 65 cases. 704 cases were diagnosed to have sepsis, 768 with severe sepsis, and 1,037 with MODS. According to TCM, in 1,951 cases syndrome of stasis-toxin in the interior, and in 558 syndrome of excessive exuberance of heat-toxic in the interior were diagnosed. After the treatment of Xuebijing injection combined with conventional therapy, the temperature, heart rate, respiration rate, blood pressure, WBC, PLT, GCS, 24-hour urine output, blood glucose, Lac, SCr, TBil, Marshall score, gastrointestinal function score, as well as the symptoms, signs and TCM tongue condition and pulse condition, and TCM scores were significantly improved in all patients as well as the patients with sepsis, severe sepsis, or MODS (P<0.05 or P<0.01). The effective rate of all patients and the patients with sepsis, severe sepsis, or MODS was 89.20% (2,238/2,509), 92.76% (653/704), 91.54% (703/768), 85.05% (882/1,037), respectively, and the 28-day survival rate was 93.90% (2,356/2,509), 98.01% (690/704), 96.35% (740/768), 89.30% (926/1,037), respectively. In 3 patients with MODS adverse events (0.12%) occurred, including 2 cases of stress ulcer and 1 case of Adams-Stokes syndrome. After clinical evaluation, the adverse events were found to be unrelated with the study medication, and Xuebijing injection was continued till the end of treatment. Xuebijing injection combined with conventional therapy may effectively ameliorate systemic inflammatory response, protect organ function, alleviate the symptoms, improve organ functions, and elevate the clinical cure rate. Adverse events occur occasionally. Xuebijing injection is found to be safe.