Input:

Input: 灌肠方法：采取保留灌肠方法，临睡前药加温35℃~37℃左右， 一天灌一次(即一剂)。用药前先做盐水 清洁灌肠。陈某患慢性阿米巴痢10年，经我们用白头翁汤加减保留灌肠三次(即三剂)治愈，追踪一年 无复发。(《泰山医学院学报》2000.4) 叶景华以单味白头翁治疗急性阿米巴痢疾取得较好疗效。 一般用白头翁30g,煎汤服2次，病重者 同时用白头翁50g, 煎汤作保留灌肠， 一般3~5d即可治愈，重者1周左右。慢性反复发作者，白头翁合鸦 胆子治疗可取得效果。在治疗中，未发现有明显副作用，不仅临床症状较快改善，且肠腔黏膜溃疡也随 之好转。(《中医杂志》2006.11) 包新华等介绍了近年临床常用的治疗阿米巴痢疾单验方2则如下。处方1:白头翁15~30g。用法：水 煎服，每日1剂，早晚2次分服。处方2:凤眼草30g, 龙眼肉30g, 鸦胆子15g。用法：先将凤眼草、鸦胆子去 皮研成粉，与龙眼肉捣为泥，制成药丸，每日服1次，分3次服完。(《中国民间疗法》2007.12) 四、西药治疗 (一)休息与饮食 急性期要卧床休息，进流食半流食，腹痛腹泻可用针灸疗法，或服颠茄合剂(片)1~2片，每日3~4 次，必要时肌注阿托品或654---2,或口服可待因0.03g。慢性期有消瘦、贫血、体弱者，应注意补充营养， 酌给硫酸亚铁0.3~0.6g, 每天3次，维生素B₁、C等药物。 (二)药物治疗 应先应用杀灭组织型滋养体剂，再用杀灭肠腔型滋养体剂。无症状的排包囊者，可单用肠腔型滋 养体杀灭剂。灭滴灵(甲硝哒唑):每次0.4g, 每天三次，连用五天，或用小剂量，每次0.20g, 每天2次，连 用 7d(急性)或10d(慢性)。孕妇不宜用，忌酒。偶有恶心、头昏、皮疹等副作用。甲硝磺酰咪唑1日2g, 小 儿酌减，清晨1次服，连用3~5d。吐根碱控制急性症状极为有效，剂量为lmgkg ·d,成人每日不超过 60mg, 分成30mg,1日2次，浅层皮下或肌肉注射，连用6d。毒性大，用时注意心律、血压。幼儿、孕妇、有 心肾病者忌用。重复治疗至少隔6周。喹碘仿，主要对肠腔阿米巴及包囊有效，0.5g,1 日3次口服，连用 10日。亦可用10%溶液保留灌肠。对碘过敏及甲状腺病者忌用。暴发型常合并细菌感染。故应加用抗 生素。上述抗阿米巴药宜联用(2或3联)。大量出血可输血；肠穿孔、腹膜炎必须手术者，宜在灭滴灵、抗 生素治疗下进行。 ( 乔 富 渠 吴 斌 ) 第十七章霍乱一、概说 霍乱(Cholera) 是由霍乱弧菌所致的烈性肠道传染病，属国际检疫传染病。临床表现轻重不一，轻 者腹泻，重者剧烈吐泻、脱水、循环衰竭。 霍乱自古以来在印度恒河地区流行。1817年至1923年发生6次世界性大流行。1961年起，埃尔托 (El---Tor) 生物型霍乱已扩散到亚、非、欧，被称为第7次世界性大流行，每次我国均被波及。 霍乱弧菌为革兰染色阴性，短小弯曲杆菌如逗点状，1.5~3nm, 单鞭毛，运动活泼，暗视野下，如夜 空流星。古典和埃尔托两个生物型，均属菌体抗原(O)I 群。在外环境中存活力1~2周，对干燥及一般消 毒剂甚敏感，煮沸立即被杀死。 霍乱弧菌经口侵入，在小肠定位繁殖，产生外毒素性质的肠毒素，并释放内毒素，肠毒素激活细胞 环磷酸腺苷(cAMP) 介质系统，引起肠液过度分泌，超过肠管的再吸收而剧烈吐泻，大量失去水分和电 解质，而引起循环衰竭、酸中毒、肾功能衰竭。

临床表现：潜伏期1~3d。典型患者急骤起病，先剧泻水样便，少数为米泔样或洗肉水样，稍有鱼腥

味，后继剧吐，如泻出物。经数小时至1~2d ,进人脱水虚脱期，重者休克肾衰致死，2~3d后，如脱水被纠 正，多数尿量回升，少数有发热性反应，1~3d恢复。轻型患者无明显脱水；中型脱水4%~8%,血压偏低， 24h 尿量400ml以下；重型脱水8%以上，休克，24h尿量50ml以下；中毒型不待泻吐即死于中毒性循环衰 竭。实验室检查：血浓缩，钾钠低，尿素氮增高。粪液悬滴镜检可见穿梭样细菌。血清学可助回顾性诊 断 。

二、诊断

疫区根据典型症状即可诊断，隔离处理，不典型者，需镜检或培养病原菌确诊。本病应与食物中 毒、胃肠炎及菌痢鉴别。前者有饮食不洁及同餐者发病史，先吐后泻，腹痛，黄水或脓血便；后者腹痛： 里急后重，黏液脓血便，培养粪便可获痢疾杆菌。

三、中医对霍乱的认识及治疗 (一)历代医家有关类似霍乱的论述

中医学早在《内经》即有"霍乱"病名，是因其发病急骤，吐泻并作，病情危重，顷刻之间，挥霍撩乱， 故名霍乱，其包括有现代医学所称之霍乱。《素问 ·六元正纪大论》曰："土郁之发......民病心腹胀，...... 呕吐霍乱",故霍乱当属以脾胃病变为主的外感热证。《伤寒论》更设有专篇论述，不仅讲了霍乱的特 征，还列出热多、寒多、亡阴、亡阳不同类型以及治法方药，如讲"热多欲饮水者，五芩散主之；寒多不用 水者，理中丸主之。""吐利汗出，发热恶寒，四肢拘急，手足厥冷者，四逆汤主之。"《诸病源候论 ·霍乱病 诸侯》首先提出"干霍乱"之名及其病因和证候的特点。清 ·王孟英对霍乱的发病季节、传染特征及分类 则有逼真与确切的论述："凡霍乱盛行多在夏热亢旱酷暑之年，则其证必剧。自夏末秋初而起，直至立 冬后始息。""适一朝率发，渐至阎户沿村，风行似疫。""热霍乱流行似疫，世之所同也。寒霍乱偶有所 伤，人之所独也。"

(二)中医对霍乱的病机认识

中医学归纳本病的病因有二：内伤饮食，外感疫邪。疫邪内蕴，损伤脾胃，清浊相干，扰乱胃肠，上 逆则吐，下趋而泻，传导失职，邪盛正虚，形气立毁。此相当于典型霍乱，剧烈泻吐，引发脱水、循环衰 竭 。

(三)中医辨证分型及方药

根据临床证候，中医分寒性、热性和干性霍乱三型。寒性霍乱吐泻如米泔，不臭，形寒肢冷，汗出， 舌淡，脉细。治宜温中祛寒，理中汤加味：人参15g,白术20g,干姜6g,炙甘草6g,藿香、佩兰各10g。水 煎 服，1日1剂。热性霍乱吐泻有热臭，身热烦渴，苔黄腻、脉滑数。治宜辛开清解，藿香左金丸加减：藿香 15g,吴萸12g,黄连10g,郁金10g,砂仁6g,法半夏6g,茯苓15g,黄柏12g,六一散10g。水煎服，1日1剂。干 性霍乱急危，欲吐不吐，欲泻不泻，神昏厥逆。治宜解毒开窍，玉枢丹2g或至宝丹3g,灌服，并配合针灸 提高疗效。

单方验方：①马齿苋30g, 苦参15g, 水煎服。②金银花30g,甘草15g, 水煎服。③藿香正气丸1~2丸, 每日3次。另外，寒霍乱常用十香丸、苏合香丸，热霍乱用红灵丹、行军散等。

(四)有关本病辨证论治的中医资料

《中西医结合治疗霍乱14例》包括轻型2例、中型7例、重型5例，根据脱水程度输液。吐泻期暑热证 用葛根苓连汤加减：葛根15g,黄芩12g, 黄连6g, 甘草5g, 吴茱萸3g, 薏苡仁30g。暑湿证用藿香正气散加 减：党参15g, 茯苓10g,白术10g, 甘草5g, 藿香12g, 姜半夏10,陈皮6g,黄连6g, 吴菜萸3g。脱水虚脱期， 气阴两虚证用生脉散加味：党参或太子参30g, 麦冬、五味子各15g, 黄连6g,炙甘草10g,白芍15g, 扁豆 10阴两蔗证用生心阳衰竭证用附子理中汤加味：党参30g,附子(先煎)干姜、炙甘草、白术、木瓜各10g,

黄连、桂枝各5g, 石榴皮15g。恢复期用清暑益气汤加减：太子参25g, 麦冬12g, 竹叶10g, 石斛12g, 乌 梅

15g,荷叶10g。14 例全部治愈。(《广西中医药》1990.12) 《霍乱198例临床分析及治疗体会》轻型82例(41 .4%),中型46例(23.2%),重型70例(35.4%)。中， 重型输541液，每100ml液中含氟化钠5g, 碳酸氢钠4g, 氯化钾1g,24h 输入量：中 型 成 人为400 - 8000ml, 重型>8000ml。抗菌药为痢特灵、复方新诺明或四环素。绝大多数3d后大便细菌培养转阴。快速足量合 理输液是抢救成功的关键。(《中华传染病杂志》1991.5) 对病人之转筋可用木瓜100g煎水服，或用白芍12g, 甘 草 9g, 水煎服，亦可用烧酒200ml, 加 樟 脂 15g, 用力揉擦局部；亡津者可服用姜盐汤、绿豆汤、浓茶、西瓜汁、雪梨浆等，亦可用增液汤、生脉散(或 针剂);亡阳者用四逆汤、参附汤(或针剂)。已知黄连素有抗肠毒素所引起的肠道液体分泌功能，可以 应用。 四、西药治疗 严格隔离治疗至症状消失6d后，大便培养每日1次，连续2次阴性，始可解除隔离出院。慢性带菌 者，大便连续培养7d阴性，胆汁培养每周1次，连续2次阴性，始可解除隔离，并需流行病学观察。抗菌药 作为辅助，强力霉素成人200mg1 日2次，小儿每d6mg/kg,SMZ-TMP 成人2片1日2次，吡哌酸成人0.5g1日 3次，小儿每日30mg/kg,任选一种，连服3d。补液疗法是关键，成人24h按轻中重型分别为3000~4000ml, 4000~8000ml,8000~12000ml 。 开始用生理盐水快输，血压回升时改含糖541液(每1000ml含氯化钠5g, 碳酸氢钠4g,氯化钾1g,另加50%葡萄糖20mL), 或3:2:1液(5%葡萄糖3份、生理盐水2份、1.4%碳酸氢钠 1份)。轻着尚可口服补液，每升水含葡萄糖20g, 氯化钠3.5g, 碳酸氢钠2.5g, 氯化钾1.5g)。 预防应注意饮食环境卫生。霍乱菌苗接种有效，皮下注射2次，相隔7~10d,6 岁以下0.2ml 、0.4ml;7~ 14岁0.3ml 、0.6 ml;15岁以上0.5ml 、1.0ml,保护期3~6个月。 (黄辉钊乔富渠) 第十八章脊髓灰质炎一、概说 脊髓灰质炎(Poliomyclitis) 是由脊髓灰质炎病毒引起的急性传染病。多见于幼儿，部分忠者可发生 弛缓性神经麻痹，故又名"小儿麻痹症"。临床特征为发热、上呼吸道炎症、头痛、肢体疼痛与瘫痪。约相 当于中医学中的"痿疫"、"软脚瘟"等。 脊髓灰质炎病毒属微小RNA 肠道病毒，直径24~30nm, 耐冷，60℃半小时可灭活。病毒分I、Ⅱ、Ⅲ 型，无交叉免疫，预防接种时，三型疫苗均需应用。病毒经消化道传染，在咽部及肠黏膜淋巴组织中增 殖，并引起免疫反应，形成隐性感染，少数则形成病毒血症，或通过血脑屏障，侵入神经系统，轻者无瘫 痪，重者瘫痪。病损以脊髓为主，脑干次之，脊髓病变又常以颈腰段前角运动细胞为最，故多肢瘫。神经 细胞坏死及炎症反应无特异性。病损程度与瘫痪的有无和轻重相关。

临床表现：潜伏期一般5~10d。前驱期为上呼吸道感染及胃肠炎症状，持续1~4d, 病程中止，是为 "顿挫型";前驱期症状消失后，再次发热，或无前驱期，而直接进入瘫痪前期，发热，头痛，脑膜刺激征

, 假 性 案。抗 人05g 1-4000, 氯化钠5g. 碳酸氢钠 、0.4m;7 富 渠 )

第二篇传染病 阳性，3~5d后热退，康复，是为"无瘫痪型";如体温下降时出现瘫痪，并于5~10d内扩大范围并加重者， 即已进入瘫痪期，形成"瘫痪型",其中以脊髓型常见，呈不对称弛缓性瘫痪，以下肢为多。脑干型多见 第7、第10对颅神经损害，故面瘫、吞咽困难者多，如损害呼吸及血管中枢，则可产生呼吸循环衰竭。混 合型常为脊髓型合并脑干型。脑型则少见，表现为高热、昏迷、惊厥及痉挛性瘫痪。恢复期多长达一年， 重者有脊柱侧弯、足马蹄内翻外翻等后遗症。实验室检查：血常规无明显变化；脑脊液常呈病毒性脑膜 炎改变；早期咽洗液，及病程3周内粪便作病毒分离，均可阳性；血清特异性IgM 抗体病早期即可出现。 补体结合试验双份血清4倍为阳性。 二、诊断 (一)诊断标准 依据夏秋季节、幼儿有木病密切接触史，发热肢痛，肢体出现弛缓性瘫痪，脑脊液呈病毒性脑膜炎 表现，早期血清特异性IgM 抗体阳性者，即可诊断。有条件者可作病毒分离。 (二)鉴别诊断 本病在瘫痪前期应与乙脑及其他病毒性脑膜炎和结核性脑膜炎鉴别。乙脑及其他病毒性脑膜炎 起病较急，神志障碍较著,尚有赖于血清特异性IgM抗体的检测及病毒分离。结核性脑膜炎无季节性， 起病较慢，病程长，脑膜刺激征为主，常有结核病史或接触史，脑脊液蛋白明显增高，糖与氯化物降低。 胸片、结核菌素试验及结核菌检查可有阳性发现。瘫痪期主要应与感染性多发性神经根病鉴别，该病 年龄较大，弛缓性瘫痪呈对称上行性，常伴感觉障碍，进展时间较长，脑脊液早期即以蛋白质增高为 主，细胞数不多。 三、中医对脊髓灰质炎的认识及治疗 (一)历代医家有关类似脊髓灰质炎的论述

早在《内经》中就已有类似本病的记述，如《素问 ·生气通天论》讲："湿热不攘，大筋续短、小筋弛 长，续短为拘，弛长为痿。"并提出"治痿独取阳明"的重要治则。(《素问 ·痿论》)隋 ·巢元方认为本病系 "风气伤于脾胃之经络。"李东垣更明确强调"暑伤胃气"、"湿热乘其肝肾"的病因病机。《温疫明辨》 (清)首次称本病为"软脚瘟",对本病经过的描述尤为逼真："时疫初起，腿胫痛酸者，太阳经脉之郁也 ......兼软者湿温，俗名软脚瘟"。

(二)中医对脊髓灰质炎的病机认识 本病属中医暑湿类温病，系由暑湿热毒之邪侵袭所致。病初邪从口鼻而入，侵犯肺胃，故而表现发 热、头痛、咽痛、呕恶等上呼吸道及胃肠症状。若正能胜邪，病解；如不能抗邪外出，则湿热交蒸，发热多 汗，头痛身痛，神志不宁，相当于病毒血症及脑膜炎症病变阶段；如湿热浸淫，阻滞筋脉，而致肢体麻 痹，即运动神经受损，出现弛缓性瘫痪。轻者逐渐康复，重者气血肝肾亏损，渐成痿证，后遗肢体畸形。 如邪毒深重，痰阻气机，邪陷心包，肺气欲竭，脉微欲绝，则类同脑干型，表现中枢呼吸循环衰竭险症。 (三)中医辨证分型与方药 中医辨治应根据病邪性质及病位所在，分期分型立法用药。 一般认为本病前驱期为暑湿外袭，卫 气同病，治宜解表清利湿热；瘫痪前期为湿热郁蒸气分，治宜清热化湿，宣气通络；瘫痪期多属湿热浸 淫过久，气血受阻，不能荣养筋脉，治宜清热化湿，活血通络；恢复期及后遗症期多为邪去正亏，治宜补 益气血，滋补肝肾。 1.邪犯肺胃 证见身热不扬，头痛身倦，咳嗽，呕恶，苔黄腻，脉濡数。此为前驱期，体温38℃~39℃, 以上呼吸道及消化道症状为主。治宜疏泄肺胃湿热，方用葛根芩连汤、三仁汤加减：葛根10g, 黄芩12g, 杏仁10g,薏苡仁15g,白蔻仁10g,金银花20g,连翘15g,滑石15g。水煎服，1日1剂。湿重者加苍术10g,高 热者加生石膏30g。 2 . 湿热郁蒸气分 证见发热多汗，头痛身疼，烦躁不安，或嗜睡，苔黄腻，脉滑数。此为瘫痪前期， 出现中枢神经感染病症，高热、脑膜刺激征，并可有脑脊液异常，但无瘫痪。治宜清热化湿，宣气通络。

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III. Traditional Chinese Medicine’s Understanding and Treatment of Shanghan

(1) Historical Medical Scholars’ Discussions on Similar Conditions to Shanghan

In classical Chinese medical texts, the term “Shanghan” was already recorded more than 2,000 years ago, as seen in works such as “Nan Jing,” which states: “There are five types of Shanghan.”

Part Two: Infectious Diseases

“Among them, there is stroke, Shanghan, damp-heat, heat disease, and warm disease.” The “five types of Shanghan” refer to a broad category encompassing all external-infection heat-related illnesses at that time—what we now call “generalized Shanghan,” including both modern “Shanghan” and “parasitic Shanghan.” Although Zhang Zhongjing’s “Shanghan Zabing Lun” does not mention dampness or damp-heat, it nonetheless contains extensive discussions on treating warm diseases, such as conditions like jaundice and abdominal distension. Moreover, the formula Xian Kai Kuang Jie, originally developed for treating damp-heat, has long been followed by later generations in the practice of diagnosing and treating warm diseases.

According to historical research, “Shanghan Lun” is considered one of the earliest works in the world to describe intestinal Shanghan. (Source: “Research on Zhang Zhongjing’s Teachings and Clinical Practice”)

During the Song Dynasty, Zhu Gong’s “Shanghan Lize Huoren Shu” provided profound insights into the etiology and pathogenesis of damp-heat. For instance, he wrote: “When a person has previously suffered from dampness, and then suffers from heatstroke, when damp heat combine, this leads to damp-heat.” In terms of treatment methods, Zhu Gong emphasized the importance of avoiding sweating; in terms of herbal formulas, he proposed the “Baihu Jia Cangshu Tang.” During the Jin and Yuan dynasties, Liu Hejian made significant contributions to the understanding of damp-heat, not only elaborating extensively on its pathology but also developing formulas such as Tian Shui San, which were used to treat damp-heat. According to Qiao Fuchu’s research, Wu Youke’s “Wen Yi Lun” primarily focused on this condition. Ye Tianshi, in his work “Wai Gan Wen Re Bian,” recognized that “in individuals with strong yang energy, stomach dampness is common; in those with deficient yin, spleen dampness is also prevalent—but their transformation into heat is the same.” Wu Jutong, Wang Mengying, and others further developed these theories, establishing that the pathological characteristics of damp-heat center on disorders of the spleen and stomach. They concluded that damp-heat, when transformed from heat, tends to affect the Yangming meridian while heat is more prominent; conversely, damp-heat, when transformed from cold, tends to affect the Taiyin meridian where dampness is more pronounced. Xu Shengbai’s “Shi Re Bing Bian” stated: “Most cases of damp-heat fall under the Yangming and Taiyin meridians. When the middle qi is strong, the disease resides in the Yangming meridian; when the middle qi is weak, the disease resides in the Taiyin meridian.”

(2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of Shanghan

The pathogen of damp-heat enters through the mouth and nose, primarily multiplying in the spleen and stomach before causing damage. In the early stages of the disease, the primary pathological change is the obstruction of defensive qi by dampness. When damp heat stagnates in the superficial tissues, patients may experience symptoms such as headache, chills, body aches, heaviness in the chest, and fever that lingers without relief—these are manifestations of the Wei stage. If the spleen and stomach are damaged, digestion is impaired, dampness accumulates, and qi becomes blocked, patients may experience chest tightness, abdominal discomfort, and a thick, greasy tongue coating—these are signs of the Qi stage. In the initial phase, although dampness harbors heat, the majority of cases present with dampness outweighing heat. Those with a naturally strong yang energy may see the pathogen transform from heat to the Yangming stomach; those with a naturally weak yang energy may see the pathogen transform from cold to the Taiyin spleen. When the disease affects the Taiyin, dampness predominates while heat is relatively mild; when the disease affects the Yangming, dampness is more prominent while heat is less. As damp heat transforms into dryness and fire, it can deeply penetrate the blood vessels, causing lesions in the blood vessels and leading to rashes and bleeding, or even excessive bleeding in the intestinal vessels. When heat persists for a long time, it consumes yin fluids, resulting in a condition where the pathogen is gone but the body’s vital energy remains weakened, leaving residual toxins uneliminated.

(3) Diagnostic Classification and Herbal Formulas in Traditional Chinese Medicine

1. Diagnostic Classification and Herbal Formulas

(1) Dampness Obstructing Defensive Qi: The main symptoms include chills and fever, headache, body aches, increased heat in the afternoon, chest tightness and abdominal discomfort, yellowish, sticky complexion, white, greasy tongue coating, and a slow, moist pulse. Treatment focuses on dispersing and warming fragrances to clear dampness from both the exterior and interior, using the Huo Pu Xia Ling Tang formula: 10g of Ho Xiang, 9g of Ban Xia, 12g of Chi Fu Ling, 10g of Xing Ren, 30g of Sheng Yi Ren, 10g of Bai Kou Ren, 12g of Shi Lun, 10g of Ze Xie, 12g of Dan Dou Chi, and 12g of Hou Pu, decocted in water and taken once daily.

(2) Dampness Overpowering Heat: The main symptoms include fluctuating fever, increasing heat in the afternoon, heavy head and body aches, fatigue, loss of appetite, chest tightness and abdominal discomfort, abdominal bloating and loose stools, thirst but little desire to drink, a white, greasy or white-greasy tongue coating mixed with yellow, and a moist pulse. Treatment focuses on releasing qi and clearing dampness, using the San Ren Tang formula with modifications: 12g of Xing Ren, 12g of Bai Kou Ren, 15g of Yi Ren, 10g of Ban Xia, 12g of Hou Pu, 10g of Tong Cao, 20g of Hua Shi, and 10g of Zhu Ye, decocted in water and taken once daily.

(3) Damp Heat Overlapping: The main symptoms include gradually rising fever, profuse sweating that doesn’t subside, thirst but little desire to drink, irritability and chest discomfort, nausea and vomiting, short, red urine, loose stools that are not fully formed, a red tongue coated with yellow-greasy substances, and a slippery, rapid pulse. Treatment focuses on transforming dampness and clearing heat, using the Wangshi Lian Pu Yin formula: 10g of Huang Lian, 12g each of Hou Pu and Chang Pu, 10g of Ban Xia, 10g of Shan Zhi, 10g of Dan Dou Chi, and 20g of Lu Gen, decocted in water and taken once daily.

(4) Heat Overpowering Dampness: The main symptoms include intense body heat, frequent thirst, flushed face, profuse sweating, labored breathing, chest discomfort and heaviness, yellowish, slightly greasy tongue coating, and a large, rough pulse. Treatment focuses on clearing heat and transforming dampness, using the Bai Hu Tang formula with additions: 12g of Zhimu, 12g of Hou Pu and Chang Pu, 10g of Ban Xia, 10g of Shan Zhi, 10g of Dan Dou Chi, and 20g of Lu Gen, decocted in water and taken once daily.

(5) Heat Entering the Blood Vessels: The main symptoms include severe body heat at night, irritability, occasional delirium or confusion, faint rashes, bloody stools, a dark, thin tongue coating—treatment focuses on clearing heat and draining heat, cooling the blood and dispersing blood, using the Qing Ying Tang formula with modifications: 30g of Shui Niu Jiao, 20g of Sheng Di, 15g of Chì Shu, 10g of Huang Lian, 10g of Shan Zhi, 15g of Di Yu, and 12g of Dan Pi, decocted in water and taken once daily.

(6) Qi Deficiency and Blood Loss: The main symptoms include abdominal discomfort, massive stool bleeding, sudden drops in body temperature, pale face, cold sweat, and a fine, rapid pulse—treatment focuses on replenishing qi, strengthening the body, and stopping bleeding, using the Du Shen Tang formula first, followed by the Huang Tu Tang formula: 30g of Zao Xin Tu, 20g of Sheng Di, 12g of Bai Zhu, 10g of Zhi Fu, 10g of Lu Gen, and 10g of Gan Cao, decocted in water and taken once daily.

(7) Qi and Yin Both Damaged, Residual Heat Unremoved: The main symptoms include pale complexion, emaciation, listlessness, or low-grade fever that does not subside, a fine, weak pulse, a tender, red tongue coated with yellow or dry, or even bare, without any coating. Treatment focuses on nourishing qi and generating fluids while clearing residual heat, using the Zhu Ye Shi Gao Tang formula with modifications: 10g of Zhu Ye, 15g each of Sheng Shi Gao and Taizi Shen, 12g of Mai Dong, 12g of Shihu, 20g of Shan Yao, 15g of Yi Ren, and 20g of Bai Bian Dou, decocted in water and taken once daily.

2. Common Modifications: For cases where dampness is severe but there is no chills or sweating, consider adding Cang Shu and Xiang Ru to promote fragrance and dispel dampness; if internal dampness is heavily obstructing the abdomen and causes significant discomfort, remove the bitter and moist properties of Xing Ren, instead adding Cang Shu and Pei Lan to dry dampness and harmonize the middle burner; when internal dampness is accompanied by heat and heart discomfort, remove the warming and drying properties of Hou Pu, adding Shan Zhi and Dan Dou Chi to clear heat and eliminate dampness. If dampness is predominant but the heat is not severe and the tongue coating is white and greasy, add Su He Xiang Wan to promote fragrance, dispel dampness, and open up the orifices; if heat is severe and the orifices are blocked, leading to confusion and delirium, add Zhi Bao Dan to clear the heart and open the orifices; if phlegm and heat are intertwined, making it difficult to cough up phlegm, add fresh bamboo juice to clear heat and resolve phlegm; if liver wind is stirring within the body, causing spasms and convulsions, add Quan Ma, Di Long, Centipede, and Silkworm to calm the wind; if phlegm accumulates in the throat and threatens to block the airways, quickly add Hou Zao San to clear the turbidity; if the stool contains purple blood clots, add Cai Cao and Chì Shu to promote blood circulation and stop bleeding; if the stool continues to flow slowly and the blood color is light, add Pao Jiang Tan to warm the middle burner and stop bleeding; if the stool gradually decreases and the patient feels fatigued and lacks energy, adding Dang Shen and Huang Qi to replenish the original qi is beneficial; if qi is depleted and the body sweats excessively, add Long Gu and Mu Li to strengthen the body and stop sweating.

IV. Traditional Chinese Medicine’s Clinical Data on Diagnosis and Treatment of This Condition

“Observations on the Efficacy of Feng Wei Cao Compound in Treating 28 Cases of Intestinal Shanghan”: The formula consists of 60g each of Feng Wei Cao and Yuzheng Cao, 12g of Mian Yin Chen, and 9g of Huo Xiang Geng. Usage: One dose per day; after body temperature returns to normal, reduce the dosage by half and continue for another week. For cases of intestinal bleeding, add 18g of Di Yu and 10g of Huaihua Tan; for nasal bleeding, add 9g of Lian Fang and 9g of Jiao Zhi Zi, along with 30g of Mao Gen; for cases complicated by toxic hepatitis, add 10g of Jiao Zhi. All 28 cases were successfully treated. (Xin Zhongyi, 1981.8)

“Observations on the Efficacy of Cang Er Cao in Treating 15 Cases of Shanghan”