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Unexpected Alternative Medicines Help Fight Sepsis

Chinese investigators report more sepsis patients survived at least a month if they received injections of a five-herb medicine.

Sepsis is a life-threatening condition often triggered by infection. It can occur when infection overwhelms the body’s ability to respond. As a result, the immune system begins to attack the body’s organs. Abnormal blood clotting and organ failure can make treatment especially challenging.

Physicians have a difficult time treating sepsis successfully, even when patients are hospitalized or in intensive care. That’s why doctors are anxious to find agents that can speed recovery or reduce the severity of the reaction. Clinical trials suggest that some alternative medicines might be helpful.

Chinese Herbal Medicine XBJ Shows Promise:

A Chinese study has shown that an injectable herbal medication can reduce patients’ risk of dying from this condition (JAMA Internal Medicine, May 1, 2023). The investigators included more than 1,800 patients with sepsis in this placebo-controlled trial. After a month, 19 percent of those who received five days of injections with the herbal mixture Xuebijing (XBJ) had died. In comparison, 26 percent of those who received placebo injections were dead. Those in the treatment arm also were less likely to need admittance to intensive care or to receive mechanical ventilation.

Traditional practitioners include five herbs in Xuebijing: “Carthamus tinctorius flowers (Honghua in Chinese, acting as the “monarch” component herb), Paeonia lactiflora roots (Chishao, the “minister” component herb), Ligusticum chuanxiong rhizomes (Chuanxiong, another “minister” component herb), Angelica sinensis roots (Danggui, the “adjuvant” component herb), and Salvia miltiorrhiza roots (Danshen, another “adjuvant” component herb)” (Journal of Pharmaceutical Analysis, Aug. 2022). Chinese hospitals have used it to treat sepsis and also certain cases of COVID-19.

IV Vitamin C for Sepsis:

XBJ is not the only alternative medicine doctors have tried for sepsis patients. A few years ago, preliminary reports suggested that intravenous vitamin C might be helpful against sepsis. However, studies of the treatment have been disappointing.

A Canadian study published in The New England Journal of Medicine tested IV vitamin C (NEJM, June 23, 2022). The investigators randomized 872 patients in the ICU with infection to either vitamin C or placebo. Clinicians administered vitamin C at a dose of 50 mg per kg of body weight every six hours. Those on placebo received a similar amount of infusion. If vitamin C had been helpful, patients receiving it would have been less likely to die or develop organ damage.

Unfortunately, those receiving the vitamin C treatment were more likely to die or develop organ dysfunction by the end of a month than those on placebo.

The researchers report:

“At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05).”

This finding was especially discouraging in light of a previous high-profile randomized controlled trial of intravenous vitamin C against sepsis.

Vitamin C for Sepsis Did Not Protect Organs:

An earlier study of high-dose intravenous vitamin C looked at whether this treatment could reduce organ damage compared to placebo (JAMA, Oct. 1, 2019). It did not.

However, researchers discovered an unexpected and dramatic difference in survival. Specifically, 46 percent of the 82 patients who received placebo injections had died after a month. In comparison, only 30 percent of those treated with vitamin C died. These 84 individuals also spent fewer days on average in the ICU and left the hospital sooner. Such differences in the treatment of sepsis seemed promising.

The authors call for further research to determine whether intravenous vitamin C should become part of the regimen for patients with sepsis and respiratory distress. Sadly, the current Canadian study does not support IV vitamin C as a treatment for this potentially deadly condition.

Learn More:

Health care providers will doubtless demand more research on XBJ before they adopt the use of this herbal medicine. If you would like to learn more about sepsis, you may wish to listen to Show 1201: Hard-to-Diagnose Conditions Can Be Deadly.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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  • Liu S et al, "Effect of an herbal-based injection on 28-day mortality in patients with sepsis: The EXIT-SEP randomized clinical trial." JAMA Internal Medicine, May 1, 2023. doi:10.1001/jamainternmed.2023.0780
  • Yu X et al, "Novel assays for quality evaluation of XueBiJing: Quality variability of a Chinese herbal injection for sepsis management." Journal of Pharmaceutical Analysis, Aug. 2022. https://doi.org/10.1016/j.jpha.2022.01.001
  • Lamontagne F et al, "Intravenous vitamin C in adults with sepsis in the intensive care unit." NEJM, June 23, 2022. DOI: 10.1056/NEJMoa2200644
  • Fowler AA 3rd et al, "Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: The CITRIS-ALI randomized clinical trial." JAMA, Oct. 1, 2019. DOI: 10.1001/jama.2019.11825
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