Therapeutic Effect of Sheng-Ji-San on Pressure Ulcers

American Journal of Chinese Medicine, Summer-Fall, 2000 by Yao-Chin Hsu, Heng-Hong Chang, Ming-Feng Chen, Jung-Chou Chen

Abstract: In the present study, the effectiveness of Sheng-Ji-San (SJS) in promoting the healing of pressure ulcers was evaluated. Thirty-two patients with pressure ulcers were divided into two groups. The treated group received routine medical care combined with SJS treatment and the control group received only routine medical care. After three weeks, the treated group showed a significant reduction in both surface area and depth grade, while the control group showed no significant change. The reduction ratio of the surface area of the ulcer and the effectiveness ratio for the treated group were significantly higher than for the control group. Multiple Linear Regression Analysis revealed that only the SJS treatment was significantly associated with the reduction of surface area and that the use of SJS could independently explain the observed high effectiveness ratio and a relatively high Odds Ratio of 9.539. These results indicate that SJS is effective in promoting the healing of pressure ulcers and should be considered as an adjuvant to routine therapy.

Pressure ulcers are a serious problem for hospitalized older patients. The prevalence of pressure ulcers is about 3-11% among admitted patients (Allman, 1989) and more than 33% in those who are immobilized (Berlowitz and Wilking, 1990). Severe complications such as cellulitis, osteomyelitis and sepsis often lead to higher mortality rates (four fold those of other patients). Perez (1993) reported that about 60 thousand people die of pressure ulcers and their complications per year. Pressure ulcers also result in prolonged and expensive hospitalization (Hibbs, 1989; Brandeis et al., 1990). Any treatment that can improve the healing of pressure ulcers will be beneficial in preventing the exhaustion of medical resources.

Sheng-Ji-San (SJS) is a formula from the traditional Chinese medical text of Yi-Zong-Jin-Jian in the Qing Dynasty. SJS is said to promote wound healing (Wu Qian, 1981). In this study, the effectiveness of SJS on pressure ulcers was evaluated.

Materials and Methods

Selection of Patients

Thirty-two admitted patients including 26 cases of CVA, two cases of dementia and four cases of spinal injury with pressure ulcers were recruited from the Departments of Neurological and Internal Medicine in China Medical College Hospital. Patients with the largest and deepest ulcers were enrolled in this study. The subjects were divided into a treated (n = 24) and a control group (n = 8). Patients of these two groups showed no significant differences in age, gender and disease type. The pressure ulcers of these two groups were similar in the surface area and depth grade (Table 1).

Table 1. Initial Characteristics of Subjects

Character/Group            Treated Group         Control Group
                              (N = 24)              (N = 8)

Age (years)             68.96 [  or -] 9.67   73.63 [  or -] 10.29
Gender (M/F)                   10/14                   3/5
Desease type
  CVA                           19                      7
  Dementia                       1                      1
  Spinal injury                  4                      0
Surface Area
    ([cm.sup.2])       26.71 [  or -] 29.37   35.09 [  or -] 40.35
Depth (grade)           3.04 [  or -]  0.62    3.00 [  or -]  0.53

Statistical Test

Age:            Student-T test, P = 0.2534
Gender:         Fisher's Exact test, P = 1,0000
Disease type:   Fisher's Exact test, P = 0.8235
Surface area:   Student-t test, P = 0.2365
Depth grade:    Student-t test, P = 0.7082

Definition of Pressure Ulcer

Pressure ulcers were defined as the presence of abrasion, bulla or erosion as a result of pressure over a bony prominence of the sacral or peri-trochanter area that corresponded to grade two or higher by SHEA's Scale.

Measurement of Pressure Ulcer

Surface area of the pressure ulcer is measured by repeatedly tracing the epithelial border of the ulcer on translucent plastic film (Bennett et al., 1989; Ferrell et al., 1993; Allman et al., 1987). Areas from these tracings were estimated as the average of repeated measurement with a polar planimerer (Ushikata X-plan 360). Depth grade of the pressure ulcer was determined according to SHEA's scale (Perez, 1993), and repeatedly confirmed by two observers after reviewing the photography.

Preparation of Sheng-Ji-San

The SJS formula is composed of seven Chinese herbal medicines in equal amount, including Radix Notoginseng, Resina Olibani, Resina Myrrhae, Sanguis Draconis, Black Catechu, Borneolum and Margarita. All components were purchased from the same supplier from a medical herb store after the identification of their origins by a specialist. They were finely powdered with a hammer, and mixed well with equal weight. The mixture was then finally packed into plastic containers.

Treatment of Pressure Ulcer

Routine medical care is arranged for both groups including mobilization and repeated turning every two hours by nurses or trained family. Wound care consists of cleaning and disinfecting with normal saline and Betadine one-two times per day, and wet dressing with gauze. Systemic treatment includes appropriate nutritional support as well as intensive control of infection (with antibiotics) and intercurrent illness. SJS powder is topically applied, 20 mg/[cm.sup.2] every time after wound care. The powder should be evenly spread over the surface of the pressure ulcer before it is dressed. The treated group was given both SJS and routine medical care. The control group received only routine medical care. Both groups were treated continuously for three weeks.