To investigate the Chinese medicine treatment of chronic refractory wounds with combined Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. METHODS: Chronic refractory wounds with combined Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infections were treated with a combination of internal herbal medicine and a combination of external treatment methods, such as compressing, twisting, dragging, nibbling, wet compressing, infusion, hot baking, cotton padding, and wrapping, in a phased and orderly manner. 251 cases were cured. 169 cases, 33 cases with apparent effect, 45 cases with improvement, and 3 cases without healing. The healing rate was 67.33%, and the healing time ranged from 7 days to 191 days, with an average of (57.25±39.46) days. The conversion rate of Pseudomonas aeruginosa was 92.21%, and the time to conversion was (22.72±16.16) days; the conversion rate of methicillin-resistant Staphylococcus aureus was 95.56%, and the time to conversion was (21.16±19.50) days. CONCLUSION: The comprehensive treatment plan of Chinese medicine combined with internal and external treatment can promote the healing and bacterial transformation of chronic refractory wounds with combined Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infection. Chronic refractory trauma is a common and multifaceted disease in surgical practice, characterized by complex etiology, long course, recurrence, easy recurrence after healing, and the possibility of cancer in a few cases, which is a major problem in clinical wound repair. Western medical treatment firstly focuses on the etiological treatment of chronic hard-to-heal wounds, such as controlling diabetes and improving blood circulation, and secondly focuses on the prevention of wound infection and protection of wounds, such as anti-infection, surgical debridement, skin grafting, various dressings and wound coverings, vitamins and zinc preparations, etc. to create conditions for wound healing in order to make hard-to-heal wounds heal naturally. With the deepening of the understanding of wound healing, people have shifted from a passive waiting state to active regulation, mostly using topical growth factors to regulate wound healing with some effect, but lacking safe and effective active measures to accelerate wound healing. Studies have shown that trauma infection is one of the main factors affecting trauma healing. For the treatment of trauma infection, Western medicine mainly applies systemic antibiotics, and some scholars have also adopted local medication for trauma, however, the bacterial spectrum and drug resistance of trauma bacteria change with the use of antibiotics, and the drug-resistant strains are on the rise, which makes trauma treatment more difficult, especially for difficult trauma with combined Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infection, trauma purulent secretion The results of bacterial culture and drug sensitivity tests suggest that antibiotics are mostly insensitive or resistant, and the application of antibiotic treatment is not very effective, which is one of the recognized treatment problems in the medical community. From May 1993 to January 2005, we treated 251 cases of chronic hard-to-heal wounds with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infections by using a comprehensive treatment plan that combines internal and external evidence and eliminates stasis and eliminates wound infections, while significantly accelerating the growth and healing of chronic hard-to-heal wounds. The results are reported as follows. 1. Data and Methods 1.1 Subjects 251 patients with chronic refractory wounds combined with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infections who were hospitalized in the Department of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine from May 1993 to January 2005. 1.2 Diagnostic criteria Skin ulcer wounds caused by various reasons, which have not healed after conventional treatment for more than 1 month. 1.3 Case inclusion criteria Meet the diagnostic criteria of the disease and bacterial culture of traumatic secretions suggesting the growth of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. For example: blood circulation disorders of limb ulcers: occlusive atherosclerotic ulcers, thrombo-occlusive vasculitis ulcers, lower limb varicose veins ulcers, lower limb deep vein thrombosis ulcers; diabetic ulcers; pressure ulcers, such as decubitus ulcers; various traumatic or trauma-combined infectious ulcers; radioactive ulcers; sinus tracts or fistulas formed for various reasons. 1.4 Case exclusion criteria Those who did not meet the diagnostic criteria and inclusion criteria. Patients who meet the diagnostic criteria but have one of the following conditions: combined with serious primary diseases such as cardiovascular, cerebrovascular, hepatic, renal and hematopoietic system, psychiatric patients; combined with neurotrophic disorders; combined with serious infections, patients in critical condition; pregnant or lactating women, allergic or allergic to therapeutic drugs; cancerous ulcers; not treated as prescribed, unable to judge the efficacy or incomplete data. 1.5 Observation indexes 1.5.1 Trauma healing time: the time required for complete epithelialization of the trauma surface from the time the trauma surface is medicated. 1.5.2 Bacterial infection of the trabecular surface: Take deep pus secretion from the trabecular surface with a sterile cotton swab before each dressing change, place it in a sterile test tube and send it to the microbiology laboratory, inoculate the specimen with blood agar plate, MAC, and culture it for 2 days, observe the growth of colonies, dry the smear naturally, perform microscopic examination after Gram staining, and determine the bacterial species. Calculate the time to turn negative of traumatic bacterial culture and turn negative rate. 1.6 General data 251 patients, 151 males and 100 females, aged from 8 to 92 years old, of which 129 patients were older than 60 years old, accounting for 51.39% of the total. There were 347 traumas in 251 patients, with a trauma area of 0.2 cm × 0.2 cm to 20 cm × 25 cm and a sinus fistula depth of 0.7 cm to 15 cm, with a maximum of 11 ulcer traumas and 2 sinus fistulas in the same case. There were 84 cases of traumatic Pseudomonas aeruginosa infection and 167 cases of methicillin-resistant Staphylococcus aureus infection. Associated diseases: 104 cases of polycarbonate, 27 cases of sinus fistula, 25 cases of soft tissue infection, 26 cases of desquamation, 16 cases of canker, 16 cases of acanthotic canker, 15 cases of head gangrene, 11 cases of burns, 9 cases of epiphyseal gangrene, 5 cases of decubitus ulcers, and 3 cases of traumatic infection. Past medical history: history of local trauma 57 cases, history of local trauma surgery 81 cases, diabetes mellitus 43 cases, varicose veins 51 cases, connective tissue disease 2 cases, coronary heart disease 47 cases, hypertension 70 cases, cerebral infarction 26 cases, hepatitis and syphilis 1 case each. The overall principle is to combine disease identification and evidence identification, overall and local evidence identification, and internal and external treatment. 2.1 Internal treatment After admission, the patients were classified according to their different diseases, systemic and localized trauma, and treated separately. In the early stage of wound healing (inflammation stage): the wound is not yet exhausted, pus is dripping, the skin around the sore is red and swollen, the evidence belongs to damp-heat congestion, fire and poison incandescence evidence, the treatment is to clear heat, dampness and detoxification, with “clearing” as the main treatment, supplemented with blood circulation and blood stasis, healing and toxicity, draining the liver and strengthening the spleen, etc. Commonly used drugs such as silver flower, dandelion, deer, Dioscorea Z, yellow cypress, coix seeds, Tu Fu Ling, etc. In the late stage of wound healing, to eliminate stasis and create muscle (granulation tissue proliferation stage and tissue reconstruction stage): the wound pus and rot have been exhausted, the new muscle is difficult or not born, the evidence belongs to the deficiency of positive qi, veins and ligaments stasis evidence, the treatment is to support the positive and eliminate stasis, to “mend”, “pass” as the main treatment, with the help of the “spleen”. The main treatment is to help correct the stasis, to “tonify” and “pass”, and to supplement the treatment by harmonizing with the ying and to support the toxin to produce muscle, and to nourish the liver and kidney, commonly used drugs such as raw astragalus, prunus ginseng, atractylodes, poria, angelica, red peony, chuanxiong, danshen, peach kernel, safflower, dilong, Xianling spleen, dogwood, yellow essence, rehmannia, bone marrow, dolichos, mulberry, chicken blood vine, kudzu, etc. In addition, according to the similarity of the site of disease, we can add meridian inducing drugs. For the head, face, neck and neck, add chrysanthemum and dahurica; for the upper limbs, add mulberry branch and turmeric; for the chest, abdomen, waist and back, add Chai Hu and Xia Ku Cao; for the lower limbs, add cow’s knee and dou Shu; for the bones, add bone fat and bone crushed tonic. 2.2 External treatment The treatment is based on local identification of the trauma surface and is divided into three stages. The stage of removing decay: according to the amount of pus and decay on the wound surface and the difficulty of decay, the external medicine is based on 7.3 dan, 8.2 dan, 9.1 dan, golden yellow ointment, Qing Dai ointment, red oil ointment, and according to the condition, the decoction of Chinese herbal medicine for clearing heat and relieving dampness and detoxification (Horsetail 30g, Huang Lian 15g, Huang Bai 15g, Rhubarb 15g, Tu Fu Ling 30g, Alum 30g, Wu Bei Zi 30g) is applied wetly or by perfusion, wound enlargement, thread dragging, nibbling and other therapies. . Stasis stage: topical medication is based on Fuhuangbiotic healing oil, punching and cream, and the use of the Chinese herbal decoction (30g of raw Astragalus, 15g of Huangjing, 30g of Danshen, 15g of Angelica, 15g of Safflower) wet compress or infusion, hot baking therapy, etc. The stage of muscle growth: topical medicine is mainly based on muscle growth powder and white jade cream, and padding cotton and wrapping therapy are also used. 3, Treatment results 3.1 Criteria for determining the efficacy The efficacy was evaluated according to the Diagnostic and Efficacy Criteria for Chinese Medical Evidence formulated by the Medical Secretary of the State Administration of Traditional Chinese Medicine and the Shanghai Municipal Chinese Medical Evidence Treatment Routine (2nd edition) [4, 5]. Cured: complete healing of the trauma or sinus fistula. Significant effect: reduction of trauma area or sinus fistula depth by ≥50% or more. Improved: ≥20% reduction in the area of the wound or depth of the sinus fistula. Ineffective: reduction of trauma.