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.

脓毒症是全球范围内死亡和危重疾病的主要原因，中医药防治脓毒症具有一定优势。在明确脓毒症常见证候的前提下进一步确立其主次症，可为脓毒症证候诊断标准的建立提供依据。

结合临床调查及专家问卷探讨脓毒症常见证候主次症，为脓毒症中医证候诊断标准的建立提供依据。

选取2021年5月—2022年8月河南中医药大学第一附属医院、郑州大学第一附属医院、中国中医科学院广安门医院、河南省人民医院、郑州市第一人民医院、海南省中医院、濮阳市中医院、广州中医药大学第一附属医院共8家医院重症监护病房（ICU）住院治疗的脓毒症患者1 082例，收集其临床资料并建立数据库；采用描述性统计、Logistic回归、人工神经网络分析脓毒症常见证候的症状，判定主次症。在临床调查基础上，采用德尔菲法开展专家问卷调查，进一步确定常见证候的主次症。

基于临床调查及专家问卷，综合统计分析、数据挖掘及德尔菲法的结果，依据常见证候主次症判定原则，并结合临床实际，经小组讨论后，明确脓毒症常见证候的主次症。痰热壅肺证主症为咳嗽、痰多、痰色黄等，次症为发热、口渴、胸闷等；热毒炽盛证主症为高热、烦躁、喘促等，次症为谵语、舌质红、苔焦黄等；阳明腑实证主症为谵语、腹痛、脘腹痞满等，次症为潮热、口渴、烦躁等；瘀毒阻（损）络证主症为爪甲紫暗、口唇青紫、舌暗红或紫暗等，次症为谵语、高热、胸胁刺痛等；肺气虚证主症为咳嗽、痰清稀、痰色白等，次症为神疲、乏力、自汗等；阴虚内热证主症为干咳、咽干、烦躁等，次症为喘促、口渴、口干等；气血两虚证主症为神疲、乏力、头晕等，次症为精神萎靡、嗜睡、少气懒言等；阴竭阳脱证主症为神昏、烦躁、喘促等，次症为张口抬肩、嗜睡、舌质红等。

明确脓毒症痰热壅肺证、热毒炽盛证、阳明腑实证、瘀毒阻（损）络证、肺气虚证、阴虚内热证、气血两虚证、阴竭阳脱证8种常见证候的主次症，为证候诊断标准的建立提供了依据。