1. Differentiation and Classification of Dysentery Types and Herbal Formulas

1. Differentiation and Classification of Dysentery Types and Herbal Formulas (1) Damp-Heat Accumulation (Acute Common Type of Bacillary Dysentery): The main symptoms include sudden onset of fever, abdominal pain that comes and goes, tenesmus, bloody and purulent diarrhea, anal burning, and red urine. The tongue is red, coated with yellowish greasy coating, and the pulse is slippery and rapid. Treatment focuses on clearing heat, detoxifying, resolving dampness, regulating qi, promoting blood circulation, and removing stagnation, using the “Epidemic Dysentery Formula” from Xi’an Medical and Health, 1978: 12g of Kudzu root, 9g of White Peony, 9g of Scutellaria Root, 6g of Goldthread, 9g of Poria, 12g of Bai Tou Weng, 6g of Agarwood, 6g of Licorice. Brew the herbs in water and take 1–2 doses daily.

(2) Toxic Agent Overload (Acute Severe Bacillary Dysentery, Toxic Dysentery): The main symptoms include high fever and intense thirst, severe abdominal pain, profuse purulent, bright red diarrhea, or pale complexion, cold extremities. The tongue is red and dark red, coated with yellow and dry coating, and the pulse is either rapid or weak and slow. Treatment involves clearing heat, detoxifying, cooling the blood, and replenishing qi, using the Scutellaria Root Detoxification Decoction combined with Shengmai Powder, adjusted as needed: 9g of Scutellaria Root, 9g of Goldthread, 6g of Phellodendron Bark, 15g of Bai Tou Weng, 9g of Red Peony, 9g of Cortex Phellodendri, 15g of Radix Rehmannia, 12g of Codonopsis, 9g of Ophiopogon. Brew the herbs in water and take 1–2 doses daily (if necessary, administer via nasal feeding, rectal infusion, or enema).

(3) Heat-Toxin Internal Obstruction: The main symptoms include sudden onset of chills and high fever, headache and neck stiffness, altered mental status and convulsions, elevated blood pressure, foul-smelling stools, constipation, red and dry tongue, coated with yellowish greasy coating, and a pulse that is either slippery or string-like. Treatment focuses on clearing heat, detoxifying, and opening up the channels to resolve fire and blockage, using the Kudzu Root, Qinlian, and Xianglian Decoctions combined with the Xie Xin Decoction, adjusted as needed: 12g of Rheum officinale, 3g of Scutellaria Root, 9g of Phellodendron Bark, 9g of Gardenia Fruit, 9g of Goldthread, 9g of Kudzu Root, 15g of Honeysuckle, 9g of Cortex Phellodendri, 6g of Red Peony, 9g of Fresh Polygonum cuspidatum. Brew the herbs in water and take 1–2 doses daily.

(4) Spleen and Kidney Yang Deficiency: The main symptoms include prolonged diarrhea that does not heal, fatigue and cold intolerance, tasteless mouth and poor appetite, dull abdominal pain, thin, light-colored stools, a pale red tongue, a thin white coating, and a pulse that is weak and fine. Treatment focuses on warming and tonifying the spleen and kidney, strengthening the bowels and stopping diarrhea, using the Lizhong Decoction combined with Si Shen Wan, adjusted as needed: 15g of Codonopsis, 9g of Dried Ginger, 12g of Fried Atractylodes Rhizome, 12g of Evodia Fruit, 12g of Fructus Viticis, 9g of Schisandra Berry, 9g of Hawthorn Fruit, 9g of Fried Hawthorn Fruit. Brew the herbs in water and take 1 dose daily.

(5) Yin Blood Deficiency: The main symptoms include bloody and purulent diarrhea, dry mouth and thirst, worsening at night, a red and dry tongue, a glossy, peeling tongue coating, and a pulse that is fine and rapid. Treatment focuses on supporting the body’s vital energy to stop diarrhea, nourishing yin and clearing heat, using the Huang Lian, A Jiao, and Zhi Che Pills, adjusted as needed: 15g of A Jiao, 6g of Huang Lian, 9g of Goldthread, 12g of White Peony, 12g of Angelica Sinensis, 12g of Gou Qi. Brew the herbs in water and take 1 dose daily.

(6) Qi Stagnation and Blood Stasis: The main symptoms include prolonged diarrhea with small blood clots in the stool, stubborn tenesmus, abdominal pain that feels like sharp needles and is fixed, with a hard lump or cord-like structure in the left lower abdomen. The tongue is dark with bruising and spots, coated with white, and the pulse is fine and tight. Treatment focuses on regulating qi, resolving stagnation, and stopping diarrhea, using the Shaobu Zhu Yu Tang, adjusted as needed: 10g of Peach Kernel, 10g of Safflower, 10g of Angelica Sinensis, 10g of Red Peony, 20g of Prepared Rehmannia Root, 10g of Dried Ginger, 12g of Cinnamon, 12g of Frankincense, 10g of Five-Flavor Berry, 12g of Mulberry Leaf, 10g of Agarwood, 10g of Goldthread. Brew the herbs in water and take 1 dose daily.

2. Adjustments for Each Type “When dampness is not conducive to urination, that is not the way to treat it.” For each type, it is common to add Plantago Seed, White Reed Root, Poria, or Pigment Root as diuretic and damp-dispelling agents; “No accumulation leads to dysentery,” so each type can optionally add Shennü, Hawthorn, Malt, Chicken Gizzard, Citrus Peel, or Areca Nut; “When blood flows, pus will heal on its own; when qi is regulated, tenesmus will naturally disappear,” so each type can optionally add Agarwood, Citrus Peel, Areca Nut, Peony, Rubia Root, or Red Peony as qi-regulating herbs; for poor appetite, add Zhao San Xian or Chicken Gizzard; for abdominal distension, add Citrus Peel, Thick Ginger, Orange Peel, Fried Radish Seed; for abdominal pain, add Yuan Hu, Frankincense, Myrrh, Five-Flavor Berry, Mulberry Leaf; for vomiting, add Fresh Ginger, Pinellia, Bamboo Shoot; for excessive diarrhea, add Fried Hawthorn Fruit, Red Peony Charcoal, Large Yellow Onion Charcoal, Pomegranate Peel, Black Plum, Five-Flavor Berry; for fainting or cold shock, add Codonopsis, Polygonum Cuspidatum, Curcuma Longa, An Gong Niu Huang Pill, etc.

(4) Traditional Chinese Medicine Resources on Diagnosis and Treatment of This Disease There are references to TCM’s diagnostic and therapeutic approaches for bacillary dysentery: in the early stages of acute dysentery, use Si Ni San combined with Xie Bai; for damp-heat dysentery, where dampness outweighs heat, use Kǔ Shen Qi Wei Tang with adjustments: 9g of Kǔ Shen, 9g of Rain Tea, 9g of Coconut, 9g of Kudzu Root, 3g of Chen Pi, 9g of Red Peony; when heat outweighs dampness, use Bai Tou Weng Tang; for chronic dysentery affecting yin, use Huang Lian A Jiao Tang; for cold-damp dysentery, use Lizhong Tang; for spleen deficiency and weak qi, use Baoyuan Tang. Regardless of whether the dysentery is acute or chronic, the Gui Shao Qi Wei Tang (Angelica Sinensis, White Peony, Radish Seed, Citrus Peel, Hawthorn, Licorice, Plantago Seed) can be used. Old Chinese medicine practitioner Huang Rui Shao’s experience in treating dysentery was: in the early stages, use Gui Shao Qi Wei Tang (Honeysuckle, White Peony, 30g each, Thick Ginger 9g, Licorice 6g, brew in water and take); for those with deficient qi and blood, use Fu Qing Zhu Gui Shao Tang (Angelica Sinensis, White Peony, Citrus Peel, Hawthorn, 6g each, 9g of Talc, 3g of Agarwood, 3g of Licorice, brew in water and take); for those with cold-damp constitution, use Ume丸 or Taohua Tang. There are also classifications of chronic bacillary dysentery into five types: ① Damp-Heat Type, where heat predominates, use Kudzu Root Qinlian Tang or Bai Tou Weng Tang; where dampness predominates, use Xiang Lian Ping Wei Tang with adjustments or Wood Fragrance Hawthorn Pill with adjustments. ② For those with cold-damp overlap, use Jin Bu Huan Zheng Qi Powder with adjustments, or use Si Jun Zi Tang with adjustments; for those with prolapsed anus due to deficiency, use Bu Zhong Yi Qi Tang or Sheng Yang Yi Wei Tang with adjustments. ③ For Yin Deficiency with Damp-Heat, use Huang Lian A Jiao Tang or Zhi Che Pills with adjustments. ④ For Spleen and Kidney Yang Deficiency, use Si Shen Wan with adjustments. ⑤ For those with alternating heat and cold, use Ume丸 with adjustments. (Zhonghua Nei Ke Za Zhi, 1964.11)

For toxic dysentery, some scholars divide toxic dysentery into two types: ① Real Heat Blockage Type: Use Kudzu Root, Scutellaria Root, Goldthread, Honeysuckle, Cortex Phellodendri, White Peony, Magnesium Nitrate, Portulaca Oleracea, and other herbs, brew in water and take; for those experiencing vomiting, add Raw Hematite; for convulsions, add An Gong Niu Huang Pill. ② For Yang Deficiency and Failure Type, use Aconite, Roasted Ginger, Roasted Licorice, White Peony, Cinnamon, Goldthread, Chinese Skullcap, and other herbs, brew in water and take. The basic treatment principles remain unchanged. Among 10 cases treated, 9 were cured. Some scholars also categorized patients into three types—mild, high fever with wind, and high fever with coma—using Gui Shao Qinlian Tang combined with Shao Yao Tang for mild cases, supplemented by Zi Xue Dan; for those with high fever and wind, use Gui Shao Qinlian Tang combined with Pu Ji Yi Dan, supplemented by Zi Xue Dan and Xiliang; for those with high fever and coma, medication was difficult to administer, so emergency treatment involved scraping the chest, back, hands, and knees to release the body’s defensive qi and allow toxins to escape. Acupuncture at Shaoshang, Chize, and Weizhong points was used to drain excess heat from the meridians, allowing the toxins to leave the body, while Qi and Blood were gradually restored. Then, To Bao Dan was administered to eliminate impurities and open the orifices to calm the wind, followed by a slightly slower adjustment of the prescription based on the patient’s specific condition. (Practical Internal Medicine, 1986)

In addition, in recent years, researchers have observed the relationship between the timing of movement in patients with chronic bacillary dysentery—such as spleen deficiency, spleen and kidney deficiency—and the activity of the brainwave, autonomic nervous system function, limb volume waveforms, basal metabolism, and skin temperature changes. The results showed: ① The duration of chronic bacillary dysentery due to spleen deficiency and spleen and kidney deficiency was longer than that of chronic bacillary dysentery due to cold-dampness and acute dysentery. ② Brainwave activity was significantly reduced in chronic bacillary dysentery due to spleen and kidney deficiency. ③ Both spleen deficiency and spleen and kidney deficiency showed a tendency toward hyperactivity of the parasympathetic nervous system. ④ Vascular reflexive responses were notably lower in chronic bacillary dysentery due to spleen and kidney deficiency, while spleen deficiency showed a similar trend, whereas cold-dampness and acute dysentery showed no change. ⑤ Basal metabolism and skin temperature were lower in all types of chronic bacillary dysentery, with the lowest levels observed in chronic bacillary dysentery due to spleen and kidney deficiency, while acute dysentery remained normal. (Practical Internal Medicine, 1986)

Currently, among Chinese herbal medicines, drugs with anti-pathogenic effects include Huang Lian, Qin Pi, Andrographis paniculata, Portulaca Oleracea, Kǔ Shen, Lactuca sativa, Bai Tou Weng, as well as pomegranate peel, five-flavor berry, feather grass, Red Peony, Purple Ginseng, Tibetan Blueberry, tea leaves, Compton’s weed, and leaf of the tree of life—all of which have shown efficacy against dysentery-causing bacteria (test tube experiments have demonstrated that their antibacterial effects are linked to tannins). Huang Qin, Huang Bai, Khoe, dandelion, purple flower groundsel, groundsel, iron amaranth, fish mint, Agarwood, hawthorn, five-flavor berry, and Crane’s Herb are also effective. In recent years, many cases of this disease have been treated using enemas or rectal infusions: the intestinal mucosa is congested, swollen, and ulcerated, using 2% SD, 2ml; for cases with bleeding, use 10% Golden Chrysanthemum decoction, 200ml; for cases with erosion, use 8g of Sharp Goldthread, 5g of Huang Bai, 7g of Honeysuckle, 5g of Small Thistle, 5g of Red Peony, brew the herbs in water and take once daily for 2 weeks. Additionally, 1000mL of 5%-10% garlic liquid can be used for retention enemas, once daily for 7 days. (Shaanxi Chinese Medicine Correspondence, 1987.1)

In recent years, specialized formulas have been used extensively for treating acute bacillary dysentery. Wu Lishu introduced a formula for treating 117 cases: 6g of Areca Nut, 12g of Angelica Sinensis, 9g each of Atractylodes Rhizome, Agarwood, Poria, Scutellaria Root, and White Peony, 15g of Dioscorea Rhizome, 3g of Raw Rhubarb, and for those with spleen yang deficiency, add Dried Ginger and Roasted Ginger, while also combining with SMZco (for those allergic to this drug, switch to Littler, Gentamicin), the efficacy was significantly superior to either Western medicine alone or traditional Chinese medicine alone. Wang Jianzhou reported treating 140 cases (115 recovered, 25 improved) using a formula consisting of 30g of Thick Ginger and Agarwood, 20g of Red Peony, 12g of Citrus Peel, 12g of Atractylodes Rhizome, 8g of Aconite, 9g of Red Peony, 6g of Agarwood, and 5g of Goldthread, brewed in water and taken. Xu Yaoheng treated 65 cases using a formula composed of 20g of Cinnamon and Red Peony, 18g of Hawthorn and Honeysuckle, 24g of Clams and Golden Pearl, brewed in water and taken. Some used a formula of Two White Kǔ Shen Ai Tang (White Peony, Bai Tou Weng, Kǔ Shen, Mugwort Leaves), a herbal tablet (each tablet contains 0.3g of Kǔ Shen, Bai Tou Weng, and raw herbs, 6 tablets per dose), a Xian Di Tang (Xian Hu Cao 20g, Red Peony 15g, Bai Tou Weng 12g, Artemisia 12g, Agarwood 10g, Portulaca Oleracea 60g, Goldthread 5g, brewed in water and taken), a Huang Lian Fu Ling Tang (Huang Lian 60g, Fu Ling 12g, White Peony 15g, Scutellaria Root, A Jiao (melts), prepared Half-Seasoned Asparagus 9g. Add 6g of Licorice for those with weak constitutions, 6g of Thick Ginger for abdominal fullness, and 9g of Half-Seasoned Asparagus for thirst, adding 9g of Cucumber Root to the decoction for relief. Brew the herbs in water and take) — a formula that included additional ingredients like Xiaogu, Red Peony, and Kǔ Shen, as well as Huang Lian, Angelica Sinensis, and 5g of Raw Rhubarb, brewed in water and taken. (Sichuan Chinese Medicine, 1987.6)

For complications such as urinary retention in toxic dysentery, apply pressure to the urinary drainage points (the midpoint between the navel and the pubic symphysis); for abdominal distension caused by damp-heat toxins or due to qi stagnation and food obstruction, use methods to relieve stagnation and regulate qi to open the six organs and balance qi and blood. For iatrogenic abdominal distension, use 60g of Dried Soybean, 30g each of Scallions and Ginger, crush them, heat them, and drip them into 5ml of 95% alcohol, mix well, wrap in cloth and apply to the abdomen; for severe cases, first place 0.9–0.5g of Musk inside the navel, secure with adhesive tape, then apply a hot compress and perform anal gas evacuation. For prolonged diarrhea that does not stop, use Codonopsis, Atractylodes Rhizome, Poria, Fried Broad Beans, Fried Hawthorn Fruit, Lotus Seeds, Goldthread, Agarwood, Kōji, Dried Ginger, and Cardamom Powder, brewed in water and taken. For cases of cerebral palsy, including “sudden blindness and deafness,” in the early stages: ① use Rehmannia Root, Codonopsis, Dioscorea Rhizome, Peach Kernel, Safflower, Dragon Bone, Grass of the Valley, and Green Box to brew a decoction and take internally; ② use 654-2 (1–2mg/kg) combined with Vitamin B₁₂ (100–200μg) and inject into acupoints, focusing on Main Acupoints I and II, along with Hegu and Sanyinjiao as auxiliary points, alternating injections once daily, completing 7 sessions as one course. For malnutrition, treatment should be tailored according to the individual’s condition. Administer atropine, and give decoctions of Rhubarb, Scutellaria Root, Kudzu Root, White Peony, Goldthread, Cinnabar, Plantago Seed, and others. (Yunnan College of Chinese Medicine Journal, 1987.10)

Professor Zhou Zhongying achieved good therapeutic results using a combination of cooling and warming therapies for treating bacillary dysentery. Chen Siqing and others summarized his experience as follows: Bacillary dysentery primarily presents with abdominal pain, bloody and purulent diarrhea, and tenesmus; in TCM, this condition is referred to as “dysentery,” “intestinal obstruction,” “chiwo,” or “zhu.”

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Input: Related. To explore the relationship between pulmonary tuberculosis and cellular immunity, we measured mediated cytotoxicity (CMC) in patients with infiltrative pulmonary tuberculosis and analyzed the dynamic changes before and after treatment for yin deficiency syndrome in pulmonary tuberculosis. All patients in this group with yin deficiency were treated with Xuan Shen, Sha Shen, Mai Dong, Bai Bu, Huang Jing, and Lu Han medicinal herbs. The results showed that 56 cases were lower than the normal group (p<0.01); 31 cases of patients with yin deficiency syndrome in this disease experienced improvement in their CMC levels after traditional Chinese medicine treatment. After treatment, the average CMC values were significantly lower compared to the normal group, indicating that traditional Chinese medicine could enhance the body's cellular immunity and improve clinical symptoms. The study also found that the treatment had a positive effect on improving the patient's overall condition, with significant improvements observed in CMC levels as well. The research concluded that traditional Chinese medicine could effectively treat this disease by enhancing cellular immunity and improving clinical symptoms.