OBJECTIVE To investigate the impact of Qingwen Baidu Decoction (antipyretic and antitoxic decoction) combined with blood purification on macrophage polarization-related factors in patients with sepsis based on the "heat-toxicity" theory, and explore its mechanism.

METHODS A total of 80 patients with sepsis who were admitted to Sanshui Hospital of Foshan Hospital of Traditional Chinese Medicine from Jan. 2023 to Dec. 2024 were selected as the study subjects and randomly divided into a control group and an experimental group. The control group received basic supportive treatment combined with blood purification intervention, while the experimental group received an additional oral administration of Qingwen Baidu Decoction on the basis of the above regimen. The clinical data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores, traditional Chinese medicine (TCM) syndrome scores and dynamic changes in macrophage polarization-related factors interleukin (IL)-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β)on the 1 st, 3rd and 7th days and the therapeutic efficacy were compared between the two groups.

RESULTS On the 7th day of treatment, the APACHE Ⅱ score (12.16±2.41 vs. 15.62±2.56), SOFA score (3.83±1.24 vs. 5.58±1.59) and TCM syndrome score (11.64±3.13 vs. 15.84±4.02) in the experimental group were all lower than those in the control group (P < 0.05). The levels of IFN-γ on the 1 st, 3rd and 7th days of treatment in the experimental group were lower than those in the control group, and the levels of IL-6 and TNF-α on the 3rd and 7th days of treatment were also lower than those in the control group (P < 0.05). The levels of IL-4 and IL-10 increased on the 1 st, 3rd and 7th days of treatment(P < 0.05), and the level of TGF-β on the 3rd and 7th days was higher in the experiment group than that in the control group (P < 0.05). The total effective rate of treatment in the experimental group (95.00%) was higher than that in the control group (87.50%) (P < 0.05).

CONCLUSION The combination of Qingwen Baidu Decoction and blood purification therapy can enhance the clinical therapeutic efficacy in patients with sepsis by regulating macrophage polarization (suppressing M1-type factors IFN-γ/TNF-α and promoting M2-type factors IL-4/IL-10/TGF-β), thereby maintaining immune balance, which demonstrates significant clinical application value.