Sepsis is the leading cause of death and critical illness worldwide, and Traditional Chinese Medicine has certain advantages in preventing and treating sepsis. On the premise of clarifying the common symptoms of sepsis, further establishing its primary and secondary symptoms can provide a basis for the establishment of diagnostic criteria for sepsis symptoms.

To explore the primary and minor symptoms of common syndromes in sepsis combining clinical investigations and expert questionnaires providing a basis for the establishment of diagnostic criteria for Traditional Chinese Medicine syndromes in sepsis.

Collect 1 082 sepsis patients admitted to the intensive care units (ICUs) of 8 hospitals, including the First Affiliated Hospital of Henan University of Chinese Medicine, the First Affiliated Hospital of Zhengzhou University, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Henan Provincial People's Hospital, the First People's Hospital of Zhengzhou, Hainan Traditional Chinese Medicine Hospital, Chinese Medicine Hospital of Puyang, and the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Collected the clinical data and established a database from May 2021 to August 2022. Using descriptive statistics, Logistic regression, and artificial neural networks to analyze the symptoms of common sepsis syndromes and determine the primary and minor symptoms. Based on clinical investigation, an expert questionnaire survey was conducted using the Delphi method to further determine the primary and minor symptoms of common syndromes.

Based on clinical investigations and expert questionnaires, combined with the results of statistical analysis, data mining and the Delphi method, in accordance with the principles for determining primary and secondary symptoms of common syndromes, and considering clinical practice, the primary and secondary symptoms of common syndromes of sepsis were finalized after group discussion. The main symptoms of phlegm heat obstructing the lungs were cough, excessive phlegm, yellow sputum color, etc., the minor symptoms were fever, thirst, chest tightness, etc. The main symptoms of intense exuberant heat toxin syndrome were high fever, irritability, and shortness of breath, etc., while the minor symptoms included delirium, red tongue, and burnt yellow fur, etc. The main symptoms of Yangming fu-organ excess syndrome included delirium, abdominal pain, and fullness of the epigastric region, etc., while the minor symptoms included hot flashes, thirst, and irritability, etc. The main symptoms of blood stasis and toxin obstruction (damage) syndromes were purple and dark nails, blue and purple lips, dark red or purple tongue, etc., while the minor symptoms were delirium, high fever, chest and rib pain, etc. The main symptoms of lung Qi deficiency syndrome are cough, thin phlegm, and white phlegm color, etc., while the minor symptoms were fatigue, weakness, and spontaneous sweating, etc. The main symptoms of Yin deficiency and internal heat syndrome were dry cough, dry throat, irritability, etc., while the minor symptoms were wheezing, thirst, dry mouth, etc. The main symptoms of Qi and blood deficiency syndrome were fatigue, weakness, dizziness, etc., while the minor symptoms were mental lethargy, drowsiness, lack of Qi, and laziness, etc. The main symptoms of Yin exhaustion and Yang deficiency syndrome were dizziness, restlessness, and shortness of breath, etc., while the minor symptoms were mouth opening, shoulder lifting, drowsiness, and red tongue, etc.

This study clarifies the primary and minor symptoms of eight common syndromes in sepsis, including phlegm heat obstructing the lungs syndrome, intense exuberant heat toxin syndrome, Yangming fu-organ excess syndrome, blood stasis and toxin obstruction (damage) syndrome, lung Qi deficiency syndrome, Yin deficiency and internal heat syndrome, Qi and blood deficiency syndrome, and Yin exhaustion and Yang deficiency syndrome. These can provide a basis for establishing diagnostic criteria for these syndromes.