Child typhoid is an infection of the intestines that spreads to the blood and other parts of the body. It is caused by Salmonella typhimurium. Major symptoms include acute severe diarrhea, intestinal bleeding, perforation, secondary circulation capacity reduction, systemic infection and reticular system proliferative response (1). As the typhoid bacilli enter into the intestinal tract, they start reproduction, while penetrating into the bloodstream and causing bacteremia. Salmonella typhimurium can release endotoxins that can enter myocardium (2). Phagocytic endotoxin stimulates and activates the mononuclear phagocytic system in the blood and under the mediation of such an effect, the endotoxin entered into the myocardium may create irreversible damage to the cardiac muscle cells which may eventually lead to the manifestation of myocarditis (3).

Typhoid is usually treated with a course of antibiotic medication. However, the curative effects of conventional Western medicine treatment, including antibiotics, circulation capacity maintenance and other symptomatic support treatments have not been ideal. Traditional Chinese medicine (TCM) ‘Ling Gui Long Mu soup’, is composed of various compounds, such as radix paeoniae alba, cassia twig, angelica, astragalus, ginseng, antelope horn, keel, oysters and liquirice (4). Evidence has shown that ‘Ling Gui Long Mu soup’ has promising curative effects for treating patients with heart yang deficiency (5).

Thus, the present study investigated the clinical effects of TCM ‘Ling Gui Long Mu soup’ combined with conventional Western medicine in treating child typhoid complicated by myocarditis.

The continuous development of preventive medicine and people's health care awareness have led to a significant reduction in the incidence of child typhoid, although the outbreak of typhoid fever in the rural and remote areas of China remains a problem (6). Typhoid has been defined as an acute gastrointestinal infectious disease. Pathogenic bacteria causing typhoid includes Salmonella typhimurium and Salmonella paratyphi A. In the last century, as ampicillin, chloramphenicol, and cotrimoxazole appeared and were used against typhoid fever, this disease was gradually controlled (7). Nonetheless by the end of the 20th century, multi-resistant Salmonella typhimurium strains began to emerge and made the treatment more complicated. The third generation cephalosporin and quinolone antibiotics were capable of improving the clinical symptoms, reducing the complications, and improving the long-term prognosis. However, the emergence of resistant strains created an obstacle and typhoid fever combined with toxic hepatitis, encephalitis, myocarditis, acute renal failure and other serious complications limited the application of antibiotics to some extent (8,9).

Typhoid bacilli with their endotoxin can directly damage the cell membrane, thus harming myocardial cells. Following a Salmonella typhimurium infection, the patient's body enters a hypersensitive state. During the course of the treatment a large number of lysed bacteria can release a considerable amount of endotoxin and allergenic debris into the bloodstream. Allergens have the capacity to cause severe allergic reactions in patients who are in hypersensitive state. This condition may lead to further damage to the cardiac muscle cells (10,11).

Western medication for typhoid complicated by myocarditis was only limited to antibiotic therapy and symptomatic supportive therapy. On the other hand, Chinese medicine for typhoid achieved good symptomatic results on the symptoms of heart-yang deficiency (12). TCM held that typhoid was a ‘damp-warm disease’, which was characterized for damp-heat, slow onset, slow transformation, heat lingering, and long duration. In clinic, it was often shown in lienogastric syndromes (13). The disease was first recorded in ‘the Internal Canon of Medicine’, which described it as ‘damp abundance leads to soggy diarrhea’ (14). TCM for the treatment of typhoid was derived from damp-warm disease, with a focus on qi leel, while paying attention to four NOs: i) no diaphoresis; ii) no salivation promotion; iii) no liquid increment; and iv) no bitter cold exposure. Only if the activities of qi was regulated well, the body fluid may be regenerated, the thirst be relieved, dampness-heat be cleared, spleen-stomach be smoothened, and all symptoms disappeared (15).

‘Ling Gui Long Mu soup’ used in the present study has the capacity to inhibit the autoimmune problems, effectively inhibit the abnormal reactions in the body and achieving curative effects. The prescription of ‘Ling Gui Long Mu soup’ included Radix Paeoniae Alba which nourished the blood and eased the pains; cassia twig which relieved exterior syndromes, dispeled the cold, regulated the pulse, warmed the meridian, removed obstructions and activated yang; angelica was able to enrich and invigorate the blood, ease the pains and regulate menstruation; astragalus membranaceus that was sweet warm could invigorate vital energy and blood; American ginseng that is sweet cold could invigorate the lungs and decrease the internal heat, promote salivation and dispel tiredness; Cornu Antelopis that could diminish swelling and remove stasis, replenish blood and detoxify, sooth liver and subside interior winds; keel that could calm the breath and compose the spirit; ostracean that was salty in taste and cold-natured and could suppress liver-yang and calm the liver; liquorice that was sweet in taste and could tonify the spirits (13,15,16). In the present study, we treated one group of the patients with ‘Ling Gui Long Mu soup’ combined with Western medicine antibiotic therapy and the other group with pure Western medicine antibiotic therapy. The results showed that the total efficiency of the treatment for the patients treated with ‘Ling Gui Long Mu soup’ and antibiotics was significantly higher. The improvement rate of TCM group was significantly better, and the levels of the CRP and CK-MB after treatment was reduced more significantly when compared to the control group treated solely with Western medicine therapy. CK-MB is a sensitive enzymatic indicator released in the early period after a myocardial injury event. CRP level can reflect the inflammatory reactions in the body.

In conclusion, TCM ‘Ling Gui Long Mu soup’ can reduce the intensity of myocardial injury, significantly improve the clinical efficacy of child typhoid complicated by myocarditis, and improve the syndrome. Therefore, ‘Ling Gui Long Mu soup’ proved to be beneficial in clinical practice.