Part Two: Infectious Diseases – IV. Western Medical Treatment

Part Two: Infectious Diseases – IV. Western Medical Treatment (1) General Care During the acute phase, bed rest is recommended, and pulse and blood pressure should be monitored regularly according to the patient’s condition. Disinfection and isolation measures should be implemented for intestinal infectious diseases. Dietary recommendations include fluids or semi-fluid foods, avoiding coarse, fibrous, oily, difficult-to-digest, or irritating foods. Administer oral rehydration salts (ORS) by dissolving 20g of glucose, 3.5g of sodium chloride, 2.5g of sodium bicarbonate, and 1.5g of potassium chloride in 1 liter of water. Alternatively, administer intravenous infusions of 5% glucose saline; for patients with acidosis, alkaline solutions such as sodium bicarbonate may be used. When abdominal pain is severe, apply a hot water bag to the abdomen; alternatively, administer Belladonna tablets (tincture) or atropine, 654-2, etc. For patients experiencing diarrhea and tenesmus, compound camphor tincture can be administered, 2ml each time, 3–4 times daily orally; acupuncture at points such as Tian Zhu and Zusanli may also be beneficial. (2) Antibacterial Medications

1. SMZ-TMP Take 2 tablets at a time, twice daily. Avoid use in patients allergic to sulfonamides, those with leukopenia, or those with hepatic or renal impairment.
2. Lutrol: Take 0.1 tablets at a time, 4 times daily orally.
3. Pipemidic Acid: Take 0.5g at a time, 3–4 times daily, for 5–7 days. (Fluoroquinolone can also be used, 0.2g at a time, 3–4 times daily.)
4. Other Antibiotics: ① Kanamycin: Take 0.5g at a time, 3–4 times daily orally or intramuscularly. ② Gentamicin: Take 160,000–240,000 units daily, orally or intramuscularly. ③ Antimicrobial Sulfate: Take 1.5–2g daily. ④ Ampicillin: Take 2–4g daily, divided into 4–6 doses, orally or intramuscularly. Patients may choose 1–2 of these medications (preferably based on antibiotic susceptibility testing), with a treatment duration of 5–7 days. (3) Toxic Dysentery For toxic dysentery, antibiotics should be administered intravenously, such as chloramphenicol, ampicillin, gentamicin, etc. Sulfonamides should be avoided in shock cases. For shock and cerebral edema, follow general principles for managing toxic shock and cerebral edema (see relevant chapters). (4) Chronic Dysentery Antibiotics should be used in combination, selected based on antibiotic susceptibility testing, with a long treatment duration—sometimes requiring multiple courses of treatment. Enemas or rectal infusions can be employed, especially for patients with long-standing intestinal mucosal lesions. These treatments can be combined with conventional medication, particularly when local enemas are used, administering 200–500ml each time, once nightly, for a course of 10–14 days. Commonly used medications include: ① 0.3% berberine solution; ② 0.1% kanamycin solution; ③ 1:5000 furacilin starch solution; ④ 5–10% garlic solution, 200ml, enhanced with 20mg of dexamethasone; immunotherapy can also be employed, such as using levamisole, 50mg each time, 3 times daily, for 2 days per week. If conditions permit, dysentery vaccines (home-made vaccines are preferable) can be administered subcutaneously every other day. All of these treatments should be administered over a course of 10–14 days. (Qiao Fuchu, Wu Bin) Chapter Sixteen: Amoebic Dysentery – I. Overview Amoebic dysentery is a gastrointestinal infection caused by Entamoeba histolytica invading the colonic wall, characterized primarily by dysentery-like symptoms. Lesions often occur in the ileocecal region, with a high tendency toward recurrence and chronicity. It can spread via the bloodstream or through direct invasion, easily leading to extraintestinal complications such as liver abscesses, lung abscesses, and brain abscesses. The primary clinical features of amoebic dysentery are abdominal pain and watery, dark red, jam-like stools. Amoebic liver abscesses typically present with slow onset, fever, right upper quadrant pain, and hepatomegaly. Entamoeba histolytica exists in the human body in three forms: large (tissue form), small (intestinal cavity form), and cysts. The former is the pathogenic form, with a diameter ranging from 15 to 25 μm, containing a nucleus and engulfed red blood cells; the latter is a non-pathogenic form (which can transform into the tissue form), containing 1–4 nuclei and rod-shaped chromosomes. Cysts can survive for 2–4 weeks under normal conditions and up to a month in water, but they are sensitive to high temperatures and 50% alcohol. Cysts are the only form capable of transmitting the disease. Chronic patients or cyst carriers serve as sources of infection. The disease is primarily transmitted through contaminated food, vegetables, fruits, drinking water, and other routes. It is most common in tropical and subtropical regions, prevalent during summer and autumn, often affecting young and middle-aged men. Cysts travel from the stomach and the upper small intestine to the terminal ileum, where low oxygen levels and alkaline secretions create favorable conditions for amoebic growth; cysts also utilize trypsin to break down the cyst wall, dividing into tissue-forming trophozoites, which continuously divide and invade the intestinal mucosa in areas such as the cecum, sigmoid colon, and rectum, where fecal matter tends to accumulate and stagnate. Through pseudopodia and proteolytic enzymes such as lysosomal enzymes and hyaluronidase, amoebic trophozoites create unique flask-shaped ulcers with small openings and large bottoms, whose base is the mucosal layer, extending along the length of the intestine. These ulcers can erode blood vessels, causing massive hemorrhage, and because the serous membrane often adheres to neighboring tissues, acute perforations are rare. Amoebic protozoa can enter the portal vein and invade the liver, forming liver abscesses. The presence of intestinal bacteria, especially Bacteroides, Escherichia coli, and Shigella, also supports the life cycle of the protozoa. According to Clark’s statistics, the localization of intestinal amoebas is as follows: cecum 87.3%, ascending colon 57.1%, rectum 39.6%, sigmoid colon and appendix each 33.3%, splenic flexure 12.6%, transverse colon 6.3%, hepatic flexure and descending colon each 4.7%, with 61% of the entire colon affected, while only 34% of lesions are localized to a specific area. The clinical manifestations of amoebic dysentery vary between acute and chronic cases, with acute forms presenting as mild, typical, or severe. The acute phase lasts from 4 days to several months, usually around 7–14 days. Mild acute cases are characterized by only a few episodes of loose stools, mild abdominal pain, without fever or systemic symptoms, and are referred to as amoebic enteritis. Typical cases often begin gradually, starting with diarrhea and abdominal pain, progressively developing into dysentery-like symptoms—stools may range from a few times a day to as many as 10 times a day, with right lower quadrant pain being common, and stools appearing dark red or jam-like, with a foul odor; systemic symptoms such as fever are relatively mild. Severe acute cases are marked by severe systemic poisoning symptoms, intense abdominal pain, vomiting, and severe diarrhea (up to 20–30 times a day), which can lead to intestinal bleeding, intestinal perforation, shock, and other complications. Chronic amoebic dysentery can manifest as prolonged cases (lasting 20–30 years without recovery), acute flare-ups, chronic latent cases (with few symptoms), or amoebic tumors (which can lead to intestinal twisting and obstruction). Laboratory tests: Total white blood cell count and neutrophils are often normal, though they may slightly increase in the early stages. Stool samples can detect trophozoites and cysts, with continuous smear examinations yielding a detection rate of over 90%. Yellow, slender, diamond-shaped Schistosoma crystals can also be observed. II. Diagnosis (1) Key Diagnostic Points Local epidemiological history and close contact history provide useful reference. Typical symptoms—including right lower quadrant pain, jam-like, foul-smelling stools, and mild systemic symptoms—are the primary basis for clinical diagnosis. Stool examination and the detection of trophozoites or cysts can aid in definitive diagnosis. Rectal endoscopy reveals typical ulcers scattered across the normal mucosa, confirming the diagnosis. Where conditions permit, stool culture for non-specific protozoa can be performed to test for antigens and conduct serological examinations, including agar diffusion precipitation tests, indirect hemagglutination tests, complement fixation tests, indirect fluorescent antibody tests, and enzyme-linked immunosorbent assays. (2) Differential Diagnosis
5. Bacillary dysentery: Based on epidemiological data, stool microscopy, culture, and rectal endoscopy can help differentiate between the two.
6. Schistosomiasis: Differentiation can be made based on epidemiological data, including hepatosplenomegaly, elevated eosinophils, egg hatching in stool, and positive worm eggs found in rectal biopsies.
7. Other conditions—such as nonspecific ulcerative colitis and colorectal cancer—also need to be differentiated. III. Traditional Chinese Medicine’s Understanding and Treatment of Amoebic Dysentery (1) Historical Medical Views on Amoebic Dysentery In the Neijing, this disease was referred to as “intestinal wandering”; in the Jin Gui, it was stated: “When there is heavy, painful defecation accompanied by a feeling of heaviness in the lower abdomen, Bai Tou Weng Tang is the primary remedy.” It was also called “diarrhea.” By the early 7th century, terms such as “red dysentery,” “red and white dysentery,” “blood dysentery,” “pus and blood dysentery,” “heat dysentery,” and “cold dysentery” emerged, indicating that traditional Chinese medicine had already recognized different types of dysentery caused by various pathogens. This disease falls under the category of “dysentery” and “worm dysentery” in traditional Chinese medicine. (2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of Amoebic Dysentery Regarding the etiology and pathogenesis of this disease, traditional Chinese medicine posits that it arises from external exposure to damp-heat, epidemic toxins, and internal dietary imbalances. Impure diet and damage to the spleen and stomach allow damp-heat, epidemic toxins, or cold-damp evils to invade the organs, disrupting the normal flow of qi and blood, causing imbalance in the intestinal channels, and leading to qi stagnation and blood congestion—resulting in pus and blood, and ultimately causing dysentery. As stated in “Classified Diagnosis and Treatment of Miscellaneous Diseases,” “All types of dysentery are caused by summer heat and dampness; generally speaking, the root cause of dysentery lies in dampness rising and heating up, gradually leading to diseases of the intestines. If the condition persists and does not heal, it can deplete vital energy, leading to spleen and kidney deficiency. When heat toxicity becomes severe, or when one consumes excessive fatty, sweet, or rich foods, dampness increases and heat is generated, causing stagnation in the intestines, affecting the liver; liver qi becomes blocked, leading to fire, burning the liver’s channels, causing qi stagnation and blood congestion, resulting in lumps under the ribs; over time, blood breakdown leads to pus, causing liver pain and liver abscesses.” As Zhang’s Medical Guide put it in “Wounds and Ulcers,” “When vital energy stagnates within the meridians, blood flow is hindered; when blood flow is blocked, defensive qi cannot pass through, becoming stagnant and unable to circulate. Consequently, heat builds up—extremely hot heat leads to flesh rot, and when flesh rots, pus forms.”

(3) TCM Differentiation and Treatment In “Essential Principles of Medicine,” it is stated: “We must determine which pathogen has harmed the body and which organ is affected. If the illness stems from damp-heat, eliminate damp-heat; if it originates from food stagnation, eliminate food stagnation. If qi is the issue, regulate qi; if blood is the problem, harmonize blood. For newly contracted illnesses that are solid, we can use methods to clear the root cause and treat the symptoms; for chronic illnesses that are deficient, we can use methods to block the root cause and treat the symptoms.” This is a fundamental approach to treating dysentery, worth referencing.

1. Liver Qi Damp-Heat The main symptoms include chills and fever, or persistent heat without relief, distension and pain under the ribs, foul-smelling stools, jam-like stools, short, red urine, intermittent episodes, bitter and sticky mouth, red tongue tip, yellowish greasy coating, and a tense, rapid or slippery, rapid pulse. Treatment focuses on clearing heat, detoxifying, and promoting diuresis and eliminating dampness. A formula combining Longdan Xiegan Decoction with Bai Tou Weng Tang, modified: 12g of Longdan Cao, 9g of Huang Qin, 9g of Zhizi, 6g of Ze Xie, 12g of Che Qian Zi, 15g of Bai Tou Weng, 9g of Huang Bai, 6g of Mu Tong, 6g of Sheng Gan Cao, 12g of Ku Shen. Brew the herbs in water, taking one dose daily (add an additional dose for enemas if necessary).
2. Liver Abscess Formation The main symptoms include chills and high fever, a hard lump under the right rib, pain that is resistant to pressure, red tongue, yellowish greasy coating, and a slippery, rapid or tense, rapid pulse. Treatment focuses on detoxifying and draining pus; a formula modified from Xianfang Huo Ming Yin is used: 30g of Jin Hua, 12g of Chuanshan Jia, 9g of Zhe Bei Mu, 9g of Zao Jiao Ci, 12g of Dang Gui Wei, 9g of Chi Shao, 12g of Bai Zhi, 15g of Bai Tou Weng, 9g of Huang Qin, 9g of Zhizi, 12g of Chai Hu, 6g of Gan Cao. Brew the herbs in water, taking one to two doses daily. Appendix: If amebic liver abscesses fail to respond to medical treatment, or if left lobe liver abscesses pose a risk of puncture or cause various complications during puncture, surgical treatment is recommended.
3. Deficiency of Vital Energy with Persistent Evil The main symptoms include persistent low-grade fever, weight loss, night sweats, a lump under the ribs, fatigue, poor appetite, pale red tongue, little coating, and a thin, rapid or fine, rapid pulse. Treatment focuses on supporting vital energy and dispelling evil; a formula combining Huang Qi and Bie Jia Powder, modified: 15g of Roasted Huang Qi, 15g of Roasted Bie Jia, 12g of Chai Hu, 12g of Qin Tiao, 12g of Fu Ling, 10g of Sheng Di, 10g of Zhi Mu, 15g of Dang Gui, 12g of Bai Tou Weng, 9g of Huang Qin, 9g of Zhizi, 12g of Chai Hu, 6g of Gan Cao. Brew the herbs in water, taking one dose daily. (4) Traditional Chinese Medicine Resources on Differentiation and Treatment of This Disease “Observations on the Efficacy of Jie Yi Sheng Hua Dan in Treating 24 Cases of Acute Amoebic Dysentery” used 20g of Jin Hua, 15g of Sheng Hang Shao, 6g of Gan Cao, and 3g of San Qi. 10 seeds of Ardisia (wrapped in longan flesh) were first taken and consumed with boiling water, followed by brewing the remaining herbs in warm water, taking one dose daily. Results: 23 cases were cured, 1 case was ineffective; treatment lasted 3–14 days, with an average of 5–2 days. (Beijing Traditional Chinese Medicine, 1987.2) It is known that herbs such as Bai Tou Weng, Huang Lian, Huang Qin, Ku Shen, Qin Pi, Bai Bu, Han Fang Yi, Ardisia, Dijin Cao, Han Lian Cao, Ma Shi Xian, Tie Aman, Feng Wei Cao, Weiling Xian, and Bi Cheng Jia possess anti-amoebic properties. Many single-herb prescriptions for treating this disease have been reported across different regions: ① Ardisia (Ku Shen): Take 30–45 seeds of Ardisia daily, packaged in capsules and taken three times a day, for a course of 5–7 days. ② Bai Tou Weng: Take 15–30g of its roots and rhizomes, brewed in water and taken three times a day, for a course of 10 days; for severe cases, add Bai Tou Weng decoction for enemas. ③ Garlic (Purple Garlic): Take 1 head daily, taken three times a day; additionally, use a 10% garlic suspension for enemas, once daily, for 7–10 days. ④ Bi Cheng Jia: Take 1g every 2 hours, taken 4 times daily, for 3–5 days. ⑤ Han Fang Yi: Take 30mg daily, taken 3–4 times a day, for 10 days; or inject 30mg intramuscularly, 1–2 times daily, for 10 days. ⑥ Chun Gen Bai Pi: Take 30–60g daily, brewed in water, optionally sweetened with sugar, taken three times a day, for 7–15 days. ⑦ Stone Garlic Alkaloid: Take 50mg daily, injected subcutaneously 1–2 times. ⑧ Bai Bu: Take 18g, Han Lian Cao: 60g, brewed in water, taken once daily. (Experience of Qiao Fuchu) Su Yiquan and others reported good therapeutic results when using “Bai Tou Weng Tang” with modifications to treat a case of chronic amoebic dysentery, as follows: 100g of Bai Tou Weng, 100g of Lian Qiao, 6g of Huang Bai, 6g of Zhizi, soaked in 500ml of water until fully infused, then boiled down to 300ml, filtered out the residue, cooled, and ready for use. The enema time was chosen during nighttime when symptoms were most pronounced.

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