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  • Author: Xiu-hui Li x
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Objective To realize the characteristics of “zheng” differentiation-treatment for hand, foot and mouth disease (HFMD), a new methodology of syndrome differentiation for different stages of HFMD has been explored.

Methods Total of 2 325 cases with HFMD were recorded by distributing them into exterior syndrome stage, interior syndrome stage, severe syndrome stage and recovered syndrome stage, respectively, and the main symptoms and subsidiary symptoms of different stages of HFMD have been observed. The major and minor pathogenesis of HFMD in different stages were obtained, and compared with the “2010 Guideline for the Diagnosis and Treatment of HFMD”.

Results It was found that the major pathogenesis of exterior stage was defined as “the invation of the wenevil to the defender of the body with the collaterals got involved”, and the minor as “qi deficiency”; in interior stage, “the fury of Gan-Yang” was the main pathogenesis, and “qi in chaos and qi deficiency” was the minor; in severe syndrome stage, “the damage of heart, liver and lung” was the main pathogenesis, and “qi in chaos” was the minor; and the pathogenesis of recovered stage was “qi-yin deficiency”. Compared with the “2010 Guideline for the Diagnosis and Treatment of HFMD”, it showed that “the obstruction of the fei-pi qi by the mixture of shi-re evil” and “the mixture of shi-re” in vivo was quite difficult to be explained in completely different context in the general situation; in the severe stage, the TCM clinical characteristics of syndrome differentiation might lose; in the early acute severe cases, the phenomenon that xin-yang and fei-qi almost ran out was difficult to be observed, then, the line between the severe and the acute severe became vague.

Conclusions The theory of syndrome differentiation by stages of HFMD was reasonable in the actual situation of clinical description on HFMD which was expected to be further tested and widely applied in the “zheng” differentiation-treatment of HFMD in the future.


Five pathogen-free miniature pigs (minipigs) were infected with the virulent strain SH08 of Streptococcus suis 2 (SS2) by intramuscular injection. The pigs died consecutively within 72 h after the challenge. An additional five non-infected pigs were euthanised and used as controls. Microstructural observations showed that degeneration, bleeding, congestion, cellular necrosis, and an increase in inflammatory cells were present in all organs and tissues except the brain. Ultrastructural observations revealed mitochondrial vacuolation and malformed or missing cristae, indicating that infection of minipigs with strain SH08 of SS2 can lead to extensive lesions in major internal organs and tissues. The findings also demonstrated that the minipig is a useful model for the study of SS2 infection.

Objective To evaluate the efficacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in the treatment of patients with common hand, foot and mouth disease (HFMD) by conducting a prospective, controlled, and randomized trial.

Methods A total of 452 patients with common HFMD were randomly assigned to receive Western medicine alone (n = 220) or combined with TCM (Reduning or Xiyanping injections) (n = 232). The primary outcome was the incidence rate of rash/herpes disappearance within 5 days, while secondary outcomes included the incidence rate for fever, cough, lethargy, agitation, and vomiting clearance within 5 days.

Results The rash/herpes disappearance rate was 45.5% (100/220) in Western medicine therapy group, and 67.2% (156/232) in TCM and Western medicine combined therapy group, with significant difference (P < 0.001). Moreover, TCM remarkably increased the incidence rate of secondary disappearance, which was 56.4% in Western medicine therapy group and 71.4% in TCM and Western medicine combined therapy group (P = 0.001). No drug-related adverse events were observed.

Conclusions It’s suggested that the integrative TCM and Western medicine therapy achieved a better therapeutic efficacy. TCM may become an important complementary therapy on relieving the symptoms of HFMD.