“Observations on the Efficacy of Differentiating and Treating 91 Cases of Shanghan”

This article describes using 60g of freshly dried Cang Er Cao, decocted in water and concentrated to 200ml. Administer orally at 100–125ml per day, four times a day. All 15 cases were successfully treated. (Shanghai Journal of Traditional Chinese Medicine, 1981.8)

“Observations on the Efficacy of Differentiating and Treating 91 Cases of Shanghan”

This article notes that when dampness is more prominent than heat, use the Huo Pu Xia Ling Tang formula; when heat is more prominent than dampness, use the Wangshi Lian Pu Yin formula; when both dampness and heat are present, use the Mao Shu Bai Hu Tang formula; when dampness and heat are combined, use the Hao Zuo Qing Dan Tang formula combined with the Qing Hang Tao Tang and the Qing Hang Bao Tang. A self-designed formula was also introduced: 30g each of Sheng Di Yu, Hong Teng, and Baishang Cao, 15g of Huang Qin, and 10g of Da Huang. It was concluded that using Da Huang helped to reduce fever faster than not using it. (Zhejiang Journal of Traditional Chinese Medicine, 1981.8)

“This article introduces the “通腑泻热法” treatment for Shanghan, using a basic formula containing Sheng Di Yu, Huang Qin, Da Huang, Bai Tou Weng, Dan Pi, and Hu Zang. When dampness is more prominent than heat, add the Huo Pu Xia Ling Tang formula; when heat is more prominent than dampness, add the Wangshi Lian Pu Yin formula. (Nanjing College of Traditional Chinese Medicine Journal, 1989.1)

“In the treatment of Shanghan with Yunnan Bai Yao, 36 cases of intestinal bleeding were treated. Adults received 2–3g per day, children received 0.05g/kg per day, administered in 4–6 doses via oral administration or nasogastric tube. Both the Yunnan Bai Yao group and the control group—30 cases in total—were treated with effective antibiotics and fluid replacement therapy. The control group used Hemostatic Sensitiv and Anluo Xue. The Yunnan Bai Yao group showed superior efficacy compared to the Western medicine group. (Chinese-Western Medicine Journal, 1989.7)

“In the treatment of Shanghan with Chinese and Western medicine, 147 cases were analyzed. Traditional Chinese medicine’s diagnostic and therapeutic approach was as follows: ① Dampness Obstructing Defensive Qi: Treat with pungent, cool herbs to release the exterior, transform dampness, and clear heat—using Yin Qiao San or Huo Pu Xia Ling Tang with modifications. ② Qi Stage Damp Heat: When dampness is more prominent than heat, treat with clearing qi and transforming dampness, using the San Ren Tang with modifications; when heat is more prominent than dampness, treat with clearing heat and transforming dampness, using the Bai Hu Jia Cang Shu Tang; when both dampness and heat are present, treat with transforming dampness and clearing heat, using the Wangshi Lian Pu Yin with modifications. Western medicine primarily chose chloramphenicol or fluphenicol. The traditional Chinese medicine group showed better efficacy and shorter recovery times compared to the control group (p<0.05, p<0.01). (Nanjing College of Traditional Chinese Medicine Journal, 1990.1)

“In the treatment of Shanghan with Chinese and Western medicine, 94 cases were observed. Upper-jiao damp heat: Use the Huo Pu Xia Ling Tang, Huo Xiang Zheng Qi San, and Xin Jia Xiang Ru for Wei stage; use the San Ren Tang for Qi stage. If damp heat has caused phlegm to accumulate and obscured the pericardium, administer the Chang Pu Yu Jin Tang with Zhi Bao Dan or An Gong Niu Huang Wan. Middle-jiao damp heat: When dampness is more prominent than heat, add Zheng Qi San with modifications; when damp heat is combined, use the Lian Pu Yin; when heat is more prominent than dampness, use the Bai Hu Jia Cang Shu Tang; when damp heat transforms into dryness and causes bleeding in the intestines, use the Xing Jiao Di Huang Tang with modifications. Lower-jiao damp heat: Use 10g each of Hua Shi, Roasted Ji, Light Bamboo Leaves, Qu Mai, and Xuan Cao, along with 30g each of Fu Ling, Zhu Lun, and Che Qian Zi, and 6g of Mu Tong. Compared to Western medicine, the traditional Chinese medicine group showed better efficacy than the control group, with significantly shorter recovery times and hospital stays (p<0.01). (Zhejiang College of Traditional Chinese Medicine Journal, 1990.4)

“In the clinical observation of 40 cases treated with Chinese and Western medicine, the Ge Gen Qin Lian Tang formula was modified: when there were surface symptoms, add Jin Yin Hua, Lian Qiao, and Soybean Leaves; when dampness was severe, add Huo Xiang, Hou Pu, and Ginger Ban Xia; when high fever caused yin deficiency and thirst with constipation, add Da Huang, Hou Pu, Guang Mu Xiang, Yi Ren, and Lu Gen; when yin was depleted and the tongue was red with little moisture, add Sheng Di, Mai Dong, and Shihu; when delirium occurred, add Antelope Horn and Chang Pu. For cases of intestinal bleeding, when body temperature dropped and the pulse became fine and rapid, use the Fugui Tang formula with modifications; when body temperature did not drop significantly and the pulse remained slippery and rapid, use the Xing Jiao Di Huang Tang combined with the Qing Ying Tang. The traditional Chinese medicine group showed better efficacy than the Western medicine group. There were statistically significant differences (p<0.05). (Zhejiang College of Traditional Chinese Medicine Journal, 1991.1)

“In the application of Da Huang Bai Ji Powder in the treatment of intestinal bleeding due to Shanghan”

This article describes grinding 3 parts of Da Huang and 2 parts of Bai Ji into powder. For cases with hidden blood in the stool, use 1g; for cases with occult blood + +, or small amounts of tarry-like stool, use 2g; for cases with occult blood +++, or large amounts of tarry-like stool, use 3g—taken orally three times a day. A total of 78 cases were treated, with an overall effective rate of 94.9%. (Guiyang College of Traditional Chinese Medicine Journal, 1991.1)

“In the analysis of the efficacy of Chinese and Western medicine in treating 67 cases of intestinal Shanghan,” the formula for clearing heat, transforming dampness, and releasing the exterior was selected: Qing Hang, Yi Yi Ren, Ge Gen, Sheng Shi Gao, Jin Yin Hua, Bai Mao Gen, Sheng Ma, Chai Hu, Ze Xie, Huang Lian, Zhi Ke, Gua Lou Pi, and others. For cases with very high fever, add Antelope Horn powder; for abdominal distension, add Areca, Buddha’s Hand, and Wood.

I. The Heat Disease – A Reversal of Accumulation Add Gua Lou Ren, Sheng Da Huang. Clear the blood, cool the blood, and resolve the heat.

Use Xing Jiao, Dan Pi, Xuan Fen, and other ingredients—like Xuan Fen, Dan Pi, and Huang, Qin, Zhi, Mu, Sheng, etc. The formula is simple, yet effective.

The country's resources are limited… Time 1, the nation’s resources are limited to 30 days…

At the same time, combine with Western medicine. Western medicine uses chloramphenicol, SMZ-TD,

P, ampicillin, cephalosporin V—compared to the control group, the traditional Chinese medicine group performed better than the Western medicine group, with statistically significant differences (p<0.05). (Zhejiang Journal of Traditional Chinese Medicine, 1992.7)

Yang Gui Ping conducted a study on 48 patients with Shanghan who had fever, administering oxygen fluoroquinolone injections to replenish water and electrolytes. The basic formula consisted of Huang Qin, Huang Lian, Yu Gao, Huang Bo, Shi Chang Pu, Bai Dou Kuo, Huo Xiang, and others—taken once daily, decocted in water and consumed three times a day. The control group received Western medicine alone. The results showed that 41 cases in the treatment group showed improvement, while 28 cases in the control group improved, with a p-value of <0.05.

The treatment group was significantly superior to the control group. (Yunnan Journal of Traditional Chinese Medicine and Chinese Medicine, 2005.5)

Dong Xue Min treated 617 cases of Shanghan and paratransient Shanghan with Shanghan medicinal tea, and set up a control group of 122 cases for comparative observation. The treatment group used Shanghan medicinal tea—mainly composed of Gui Zhi, Gan Jiang, Bai Kou Ren, Gan Cao, and others—2 bags per day, steeped in 600ml of water for 30 minutes, decocted for 15–20 minutes, and consumed hot in three batches. Eight days constituted one course of treatment. The control group received ampicillin and cefazolin via intravenous infusion, eight days constituting one course of treatment. The total effective rate for the treatment group was 96.11%, while the control group was 87.7%, with a statistically significant difference between the two groups. (Shanxi Journal of Traditional Chinese Medicine, 2007.4)

Zhu You Guang divided 66 Shanghan patients into two groups for observation. In addition to routine antibiotic treatment, the treatment group also brewed and took Ma Xing Shi Gan Tang with modifications. The prescription included: 6g of Roasted Huang Huang, 9g of Xing Ren, 60g of Sheng Shi Gao, 9g of Roasted Gan Cao, 6g of Tian Zhu Huang, 6g of Qiang Chong, 15g of Jin Yin Hua, 9g of Huang Qin, 9g of Ban Lan Gen, 12g of Sang Bai, 9g of Huo Xiang, and others—taken once daily, twice a day in the morning and evening. The control group received only standard Western medicine treatment. Both groups paid attention to maintaining water and electrolyte balance; during high fever, ice packs and alcohol rubs were used as needed, and sedatives like Diazepam could be given to patients who were restless. Comparing the two groups’ efficacy: the treatment group’s fever subsided on average in (7.3±4.5) days, while the control group’s fever subsided in (12.6±5.2) days. Statistical analysis showed a t-value of 4.43, p<0.01, with a statistically significant difference. The treatment group’s clinical symptoms of poisoning improved in (8.4±3.7) days, while the control group’s improved in (13.2±5.3) days, with a statistically significant difference (p<0.01). The treatment group saw 25 cases improve, 6 cases were effective, 2 cases were ineffective, with a total effective rate of 93.9%. The control group saw 14 cases improve, 11 cases were effective, 8 cases were ineffective, with a total effective rate of 75.8%. The comparison between the two groups showed a statistically significant difference (p<0.05). (Modern Medicine and Health, 2008.1)

V. Western Medicine Treatment

(1) Rest and Diet

Patients in the fever stage must rest in bed; after the fever subsides, they can gradually return to normal activities, starting with light movement and gradually increasing activity levels. Monitor body temperature, pulse, and blood pressure regularly, and pay attention to hygiene in all parts of the body to prevent pressure sores and lung infections. The diet should be high-calorie, highly nutritious, and easily digestible. During fever, fluid intake and soft, residue-free foods are recommended, with smaller, more frequent meals. In the recovery phase, patients should eat more frequently and avoid hard, fibrous foods that are difficult to digest, to prevent intestinal bleeding or intestinal perforation.

(2) Medicinal Treatment

1. Chloramphenicol: taken 2–4 times a day, 0.5g each time, taken orally. Once body temperature returns to normal, the dosage can be reduced to half, with a treatment duration of 14–21 days. Intermittent treatment can help reduce the recurrence rate; start with the same dosage as the continuous method, then continue for 3 days after body temperature returns to normal, take half the dose for about a week, and complete the treatment as described above. Regularly check white blood cell counts during medication.

2. Sulfamethoxazole-sulfonamide compound: taken 2 tablets each time, taken orally. The treatment duration is around 2 weeks. Patients allergic to sulfonamides, those with impaired liver or kidney function, and pregnant women should use this medication with caution—during treatment, breastfeeding should be discontinued.

3. Ampicillin is reserved for patients with significantly low white blood cell counts (below 3×10^9/L) or those with Shanghan who do not respond to the above two medications. Because this drug has a high concentration in lymphatic fluid and is excreted via the bile duct in its active form, it exhibits intestinal-hepatic circulation, making it particularly suitable for patients with bile duct infections, pregnant women, and carriers. Administered in 3–4 intramuscular or intravenous infusions, with a treatment duration of 2–3 weeks.

4. Furazolidone: has a lower recurrence rate and does not have a significant impact on the hematopoietic system. Take 600–1000mg daily, and after a period of time, reduce the dosage to half and continue for 5–7 days before discontinuing the medication. However, it takes longer to reduce fever, and it can cause gastrointestinal irritation and peripheral nerve inflammation.

5. Methotrexate is the preferred medication for this condition; its structure is similar to chloramphenicol, but its antibacterial efficacy is slightly weaker than chloramphenicol in vitro, and it has poor effects on bone marrow. It is commonly taken 15–24 times, divided into 3–4 doses. The treatment duration is the same as chloramphenicol.

(Dai Shuang Ming Qiao Fu Qu, Wu Bin) Chapter Fifteen: Bacillary Dysentery – Overview Bacillary dysentery, often referred to as “Jin Li,” is a common intestinal infectious disease caused by Shigella bacteria. Its primary clinical manifestations include acute fever and systemic toxicity, along with abdominal pain, diarrhea, tenesmus, and bloody stools. Dysentery is an ancient infectious disease; as early as 770 BCE to 476 BCE, the “Suwen” recorded “pus and blood in the intestines.” Nevertheless, dysentery still holds an important place among infectious diseases today, and its incidence has not decreased significantly. Dysentery is widespread across China, occurring year-round, with peak incidence in summer and autumn (accounting for approximately 80% of all annual cases). High rainfall in summer and autumn, coupled with high fly populations and frequent consumption of raw or cold fruits and vegetables, are major contributing factors to its high prevalence. Poor environmental hygiene can easily lead to outbreaks of dysentery.

The primary sources of infection are acute and chronic patients, as well as carriers; atypical cases are more likely to be missed or misdiagnosed, which is especially concerning. Infection typically occurs through hands, household contact, flies, food, and water, via oral transmission. The general population is generally susceptible to this disease, with preschool children and young adults (20–40 years old) experiencing the highest peak in incidence. Individuals with poor nutrition or excessive eating and drinking are more vulnerable to infection and illness.

Shigella bacteria are Gram-negative bacteria, belonging to four groups—A, B, C, and D—with 42 serotypes. They possess strong survival capabilities outside the body. The primary pathogenic factor of Shigella is endotoxin, while the Shigella group also possesses outer toxins. There is no cross-protection between different groups or serotypes, making re-infection common—and one of the key reasons for the high incidence of dysentery. Today, it is believed that for Shigella to cause disease, three conditions must be met: ① the presence of a smooth, lipid-rich “O” antigen; ② the ability to invade epithelial cells and multiply within them; ③ the production of toxins after invasion. After ingesting Shigella, the bacteria survive in gastric acid and remain viable for some time.

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