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· (Total 45)45 · "New Traditional Chinese Medicine" 7 4 . Experience in Using the "Newly Revised Peach Kernel and Rhubarb Decoction" to Treat Fulminant Dysentery Western Medicine Study Class of Gansu Provincial Health Bureau, Pei Zhengxue

Fulminant dysentery currently has several effective treatments, such as high-dose atropine therapy, hormone therapy, and hibernation therapy. These therapies have reduced the mortality rate of the disease, but it still hasn't reached the ideal level. Over the past three years, the author has tried using the "Newly Revised Peach Kernel and Rhubarb Decoction" to treat 26 cases of fulminant dysentery, in combination with Western medicine fluid replacement and chloramphenicol injections, with satisfactory results.

I. Case Overview The diagnosis of all 26 cases was based on the diagnostic criteria for fulminant dysentery formulated by the Chinese Medical Association at the Huangshan Infectious Diseases Conference in August 1964. Among the 26 cases, 12 were male and 14 were female. Six were under 1 year old, four were between 1 and 3 years old, eight were between 3 and 6 years old, six were between 6 and 12 years old, and two were over 12 years old. Time from onset to start of treatment: Four cases within 3 hours, twelve within 12 hours, four within 24 hours, and six after 24 hours. II. Composition and Usage of the Formula The composition of the "Newly Revised Peach Kernel and Rhubarb Decoction": Rheum palmatum 5 qian, Glauber's salt 5 qian, Peach Kernel 3 qian, Cinnamon Twig 3 qian, Licorice 2 qian, Scutellaria baicalensis 2 qian, Coptis chinensis 2 qian, Aucklandia lappa 1 qian, Portulaca oleracea 2 qian. Add 1000 ml of water to these herbs, decoct until 300 ml remains, administer three times daily via nasogastric tube for adults (can switch to oral administration once conscious), reduce dosage for children according to age. All 26 cases received Western medicine fluid replacement and intramuscular chloramphenicol injections in addition to the traditional Chinese medicine treatment; only one case used atropine therapy and hibernation therapy. When those therapies proved ineffective, the traditional Chinese medicine took effect, and there was even one case that did not use any vanadium-based drugs, relying solely on traditional Chinese medicine to achieve success. III. Observation of Efficacy Out of the 26 cases, 22 were cured, 2 died, and 2 voluntarily requested transfer due to unsatisfactory efficacy. Patients over 3 years old responded better, while those under 3 years old responded worse. Patients who sought treatment within 12 hours of onset fared better, whereas those who sought treatment after 12 hours fared worse.

IV. Case Introduction

Case 1: Chen ×, 21 years old, male, middle school student. On [February 16, 1969, 2 PM]{.underline}, He was admitted after two hours of high fever, abdominal pain, coma, and convulsions. Earlier that morning around 7 AM, the patient got up to wash and felt abdominal pain and nausea, self-administered a small bottle of ten drops of water without effect, accompanied by high fever and chills, immediately bedridden,

Two hours earlier, his consciousness gradually deteriorated, with intermittent convulsions. The patient had always been healthy. Physical examination: body temperature 40.1°C, pulse 120 beats per minute, respiration 21 times per minute, blood pressure 110/80 mmHg, patient in a state of coma with occasional convulsions, no jaundice, ecchymosis, rash, or bleeding points on the skin and mucous membranes. No obvious enlargement of lymph nodes, both pupils slightly dilated, light reflex and accommodation reflex both sluggish. Pharynx red, tonsils grade I enlarged, neck slightly stiff, heart "-", both lungs with snoring sounds, abdomen slightly distended, lower abdomen with slight softness, liver "-", spleen "-", bowel sounds weakened, shifting dullness "-", knee tendon reflex slightly hyperactive. Pathological reflexes not elicited. Blood routine test: red blood cells 4.6 million, hemoglobin 89%, white blood cells 12,300, neutrophils 80%, lymphocytes 18%, monocytes 1%; Urine routine (urine sample): yellow color, acidic, sugar "-" , protein "-" , only a few epithelial cells; Feces routine (anal swab): mucus "se," pus cells "se," red blood cells "+," roundworm eggs 0–3/low magnification; Cerebrospinal fluid: clear and transparent, Pandy's test: "-", cells "-". Diagnosis: toxic bacillary dysentery (fulminant type). Upon admission, emergency treatment was administered according to standard protocols for fulminant dysentery, immediately injecting 50 mg each of Dormicum and Phenobarbital intramuscularly, implementing sub-hibernation therapy.

Additionally, administered 30 ml of 0.5% Furacilin suspension enema, intravenous drip of 200 ml of 20% Mannitol, 200 mg of Hydrocortisone, 1000 mg of Vitamin C, along with penicillin 400,000 units every 6 hours, streptomycin 0.5 g intramuscularly every 8 hours, and chloramphenicol 0.5 g intramuscularly every 8 hours. After these treatments, the patient's convulsions eased somewhat, but the coma deepened, around midnight, Chen Shi's breathing appeared, pupils unequal in size, immediately injected 1 mg of atropine intravenously via saline drip, every five minutes, after more than ten injections, respiratory failure still showed no significant improvement, notified family "critical condition," discontinued atropine therapy, switched to traditional Chinese medicine "Newly Revised Peach Kernel and Rhubarb Decoction" treatment (nasogastric feeding), divided into three doses administered via gastric tube, completed feeding after three hours, finished feeding (around 3 pm), patient excreted about 500 ml of sticky, feces-like substance from the anus, breathing gradually stabilized, pulse stronger than before, still in a deep coma state, while continuing previous fluid therapy and antibiotic use, additionally administered one dose of "Newly Revised Peach Kernel and Rhubarb Decoction" via nasogastric tube. During medication, the patient's consciousness gradually cleared, breathing completely normalized, thereafter reduced the amount of Rheum palmatum and Glauber's salt to 3 qian each, added Angelica Sinensis 4 qian, White Peony Root 3 qian, applied cinnamon oil 8 qian daily, continued for three doses, patient recovered.

Case 2: Wang ××, female, 1 year old. Fever for half a day, convulsions for an hour, admitted to hospital. The patient started having fever that morning, crying and restless, but family didn't pay much attention. An hour ago, suddenly began continuous convulsions, family shocked, rushed to emergency room. Physical examination: body temperature 35.6°C, pulse unclear, breathing intermittent, consciousness unclear, face cyanotic, jaw clenched, white foam coming from mouth, intermittent convulsions, heartbeat weak, rhythm irregular, breathing sometimes present, sometimes absent, no wet or dry rales. Abdomen distended, bowel sounds "-" , liver and spleen "-" , no pathological reflexes elicited. Urgent feces routine (anal swab) showed mucus "thirty," pus cells "thirty."

Diagnosis: toxic dysentery (fulminant type). Immediately administered 500 ml of 10% glucose solution, 500 ml of 5% glucose-salt solution, plus 1 gram of Vitamin C intravenously, 3 mg of Lobeline intramuscularly, then one dose of "Newly Revised Peach Kernel and Rhubarb Decoction" via nasogastric tube. Prescription: Peach Kernel 2 qian, Glauber's Salt 2 qian, Rheum palmatum 3 qian, Cinnamon Twig 2 qian, Licorice 1 qian, Half a qian of Coptis chinensis, 1 qian of Aucklandia lappa, 2 qian of Scutellaria baicalensis, 1 qian of Portulaca oleracea, add 1000 ml of water, decoct until 200 ml remains, divide into three doses and complete feeding within 2 hours. After finishing medication, the child's convulsions stopped

and excreted a large amount of sticky, gelatinous substance from the anus, breathing stabilized, the next morning administered another dose of "Newly Revised Peach Kernel and Rhubarb Decoction," completed in three doses, the next morning the child was in good spirits, eating slightly better, reduced the amount of Rheum palmatum and Glauber's salt in the original formula, added Qinpi, White Peony Root, Angelica Sinensis, Hawthorn, took one dose and was discharged after recovery.

V. Discussion

Traditional Chinese medicine treats dysentery by regulating qi, promoting blood circulation, detoxifying, purging, and dispersing exterior patterns. Clinically, applying these principles, differentiating symptoms and tailoring treatment accordingly, flexibly adjusting methods, generally yields satisfactory results for ordinary dysentery. However, fulminant dysentery is different—it strikes suddenly, spreads rapidly, and once it breaks out, danger looms in an instant. Even more distinct is that in the early stages of the disease, symptoms like coma, convulsions, respiratory failure, and circulatory failure dominate, while diarrhea and other typical dysentery symptoms may not be obvious. Consequently, misdiagnosis is most likely, leading to fatalities. Chairman Mao said: "When we look at things, we must see their essence, treating their appearances merely as introductory guides. Once inside the door, we must grasp the essence—that's the reliable scientific method of analysis." According to Chairman Mao's teaching, we should view fulminant dysentery as follows: although coma, convulsions, respiratory and circulatory failure are major causes of death, from the perspective of pathogenesis, they are merely manifestations of the disease (belonging to the "symptoms"). The root cause of these manifestations is the massive accumulation of dysentery bacilli and their toxins in the intestinal cavity, continuously absorbed into the bloodstream, causing toxic reactions and edema in the capillaries of brain tissue. This is the essence of the disease that leads to death (belonging to the "substance"). The author has tried using general dysentery remedies, such as Ge Gen Huang Lian Huang Qin Tang, Xiang Lian Wan, Bai Shi Wong Tang, etc., to treat fulminant dysentery, but the effects were poor, because these remedies ignored the special characteristics of fulminant dysentery. The author has also tried using hook vine, ginger worm, purple snow pill, etc., to treat fulminant dysentery, but the effects were also poor, because these remedies only focused on the manifestations while neglecting the essence. Zhang Zhongjing proposed: "For dysentery patients with delirium, there is dry stool." He first linked intestinal diseases with brain symptoms. Zhu Danxi attached great importance to this point, starting to use nitrate to treat dysentery, saying: "In the first one or two days of dysentery,

the priority is to promote bowel movements, absolutely avoid using astringents. If necessary, use Wei Cheng Qi, Da Xiao Cheng Qi, or San Yi Cheng Qi to purge." Large doses of nitrate cleanse the intestinal cavity, quickly expelling bacteria and their toxins, thereby reducing toxic reactions in the body's capillaries, while the purging effect of nitrate also alleviates edema in brain tissue, allowing brain symptoms to ease. Therefore, for fulminant dysentery, using this "purging" measure is indeed urgent, a "cutting off the roots" treatment method, among the various contradictions of the disease, it effectively resolves the main contradiction. However, while emphasizing "purging," we must also pay attention to using methods like clearing heat and detoxifying, resolving stasis, regulating qi, and dispersing exterior patterns, so that the prescription balances addressing the main contradiction with the secondary ones. Clearing heat and detoxifying can eliminate or reduce the pathogenic effects of bacteria and toxins,

resolving stasis can improve blood circulation in the lesion, promoting healing. Regulating qi can adjust intestinal peristalsis, and when combined with resolving stasis, it can produce antispasmodic and analgesic effects, helping intestinal function return to normal. Dispersing exterior patterns is symptomatic treatment for the early stages of dysentery. We must deeply study the rich content of traditional Chinese medicine in this regard, such as Zhang Zhongjing's Ge Gen Qin Lian Tang, which integrates dispersing exterior patterns with clearing heat and detoxifying; Zhang also said: "For heat-related diarrhea with heavy symptoms, use Bai Tou Weng Tang." This principle has been highly valued by later generations of physicians. Dai Sigong was skilled at using sandalwood to regulate qi when treating dysentery, proposing: "Dysentery was historically called 'stagnant diarrhea,' caused by qi stagnation, which over time turns into dysentery, so the treatment should prioritize smoothing qi... ..." Wang Kentang used "......or abnormal downward movement, with dark purple and excruciating pain in the accumulation, this is dead blood," using peach kernel to resolve stasis. Song Dynasty scholar Yu Gang advocated using Baidu San combined with Chen Cang Mi to treat silent dysentery, while Wang Kentang used this formula to treat "red dysentery with fever," indicating that dysentery with exterior symptoms also needs exterior treatment. Based on these previous treatment principles and prescriptions for dysentery, the author, while prioritizing nitrate for purging, chose Qin Lian to clear heat and detoxify, peach kernel to resolve stasis and promote blood circulation, sandalwood to regulate qi, cinnamon twig to disperse exterior patterns, ensuring smooth blood circulation to improve peripheral circulation. Also heavily used portulaca to increase the effect of clearing heat and detoxifying. Thus formed the "Newly Revised Peach Kernel and Rhubarb Decoction." This formula is similar to Zhang Zhongjing's "Peach Kernel and Rhubarb Decoction." Checking reveals that "Peach Kernel and Rhubarb Decoction" was specifically designed by Zhang Zhongjing for bladder blood stasis, Zhang said: "If Yang disease is not resolved, heat builds up in the bladder, the person becomes狂, blood flows down, those below recover. Those outside remain unresolved, need to be addressed first, once the exterior is resolved, but the lower abdomen is still tightly contracted,

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"It can then be attacked, and Taoren Chengqi Tang is appropriate." Regarding the phrase "heat accumulation in the bladder," many commentators on the Treatise on Cold Damage have raised objections. Qian Huang pointed out: "Some commentators suggest that blood accumulates in the bladder, which is particularly unfounded," believing instead that it is due to "heat in the lower jiao, causing the blood to be scorched and forced into the ileum (the ileum being the large intestine)." As for using Taoren Chengqi Tang to treat dysentery, Wu Kun believed: "This formula is indicated for cases of acute, solid-type dysentery at the onset. If, in the early stages, purgatives are not used and astringent medicines are instead employed, leading to internal accumulation of pathogenic heat and obstruction of blood flow, resulting in abdominal pain and near-death conditions, this formula should be promptly administered." Yoshiyuki Tōdō, on the other hand, considered that this formula is primarily indicated for "acute lower abdominal pain associated with dysentery." In summary, these points provide some reference basis for using the newly formulated Taoren Chengqi Tang to treat fulminant dysentery.

Six. Small. Conclusion

① Although the treatment of 26 cases of fulminant dysentery with the "newly formulated Taoren Chengqi Tang" was conducted in conjunction with Western medical fluid replacement and intramuscular chloramphenicol, its cure rate was higher than that of antibiotic monotherapy alone and approached the efficacy of the currently well-regarded atropine therapy. Therefore, the therapeutic effect of the "newly formulated Taoren Chengqi Tang" in treating fulminant dysentery can be affirmed.

② Case one in the text achieved therapeutic effect by using this formula when atropine therapy and hibernation therapy were ineffective, indicating that this formula has unique advantages over atropine therapy and hibernation therapy in treating fulminant dysentery. Case two in the text achieved therapeutic effect by using only this formula (without antibiotics), demonstrating that the formula alone can also cure fulminant dysentery, thus providing a new avenue for further research into the efficacy of this formula.

Three Cases of Verification for Hemorrhoid Treatment—Guangdong Province Gaozhou County Health School Chen Fuhua Trainee of the Barefoot Doctor Retraining Class

Case One: Zhang ××, male, 6 years old. He had suffered from prolapse of the rectum for more than three years, with no improvement despite multiple treatments using both traditional Chinese and Western medicine. After taking four doses of the above prescription, he recovered, and there has been no recurrence for over a year.

Case Two: Deng ××, female, 50 years old. She had suffered from prolapse of the rectum for more than two years, which prevented her from working. Despite numerous treatments with both traditional Chinese and Western medicine, she still showed no improvement. After switching to five doses of the above prescription, she recovered, and there has been no recurrence for over two years.