1 Medical Classics’ Discussions on Similar Conditions

(1) Medical Classics’ Discussions on Similar Conditions

As early as 2,000 years ago, traditional Chinese medicine recorded “pus and blood under the intestinal valve,” also known as “Chiro.” The Neijing also provided comparisons and distinctions between the small and large intestines, as well as between three types of diarrhea: “Dysentery” and “Diarrhea.” The Jin Gui included both dysentery and diarrhea under the general term “Xia Li.” It was during the Eastern Jin Dynasty that Ge Hong first referred to this condition as “Li.” The Zhi Bing Yuan Hou Lun (written by Chao Yuanfang during the Sui Dynasty) provided a detailed classification of this disease, categorizing it into “Twenty Types of Dysentery Symptoms,” which were further divided into “acute” and “chronic” categories. The book also distinguished between red and white diarrhea based on heat and cold, noting that seasonal imbalances in cold and heat, wind, cold, heat toxins, physical labor, and dietary habits could all contribute to the development of the disease. It emphasized integrating the physiological and pathological aspects of the spleen, stomach, large intestine, qi and blood, and body fluids to analyze the underlying mechanisms of the disease. The Qian Jin Yao Fang, written by Sun Simiao during the Tang Dynasty, described this condition as “stagnant diarrhea” (some foreign sources refer to it as “special constipation”), and proposed four theories regarding dysentery: cold, coldness, dampness due to childhood malnutrition, and infantile dysentery. The Dan Xi Xin Fa also introduced the concept of “epidemic dysentery”: “When an epidemic occurs, dysentery spreads within a single household, with similar transmission patterns across families.”

In terms of treatment, the Shang Han Lun stated: “For heat-induced diarrhea with heavy defecation, the Bai Tou Weng Tang is effective,” and also mentioned the Taohua Tang. These formulas aimed to clear the intestines, detoxify, warm the interior, and promote bowel movements. The He Jian Liu Shu, in “Stagnant Diarrhea,” suggested: “If there is tenesmus, then use methods to induce defecation; if there is abdominal pain, then use methods to harmonize qi; if the body feels heavy, then eliminate dampness; if the pulse is wiry, then dispel wind.” It was also noted that “when qi flows smoothly, pus and blood naturally heal; when qi is regulated, tenesmus naturally resolves,” which remains a fundamental approach to treating dysentery to this day. The book also highlighted valuable experiences such as “When treating all kinds of dysentery, Huang Lian and Huang Bo serve as the principal herbs, with their bitter and cold properties effectively addressing damp-heat conditions.” Later, during the Ming and Qing Dynasties, understanding of dysentery deepened further. Ye Tian Shi believed that “the fundamental principle of treating dysentery lies in the dual concepts of clearing and blocking,” while Yu Chang proposed the “reverse-flowing boat” method. Gu Songyuan outlined four key principles for treating dysentery: warming and tonifying, excessive defecation, sweating, and excessive urination (from the Yi Jing, Volume 8, “Dysentery”). Many works on dysentery were subsequently published.

(2) TCM’s Understanding of the Pathogenesis of Bacillary Dysentery Regarding the causes of dysentery, as the Dan Xi Xin Fa put it: “All conditions originate from damp-heat.” The Lei Zheng Cai Cai also noted: “Dysentery arises in summer and autumn… The condition is caused by dampness and heat accumulating in the stomach, leading to stagnation of qi and blood, trapping waste products in the intestines, causing intestinal fluid to overflow and form pus and blood, which then stagnate due to obstruction. Thus, it is classified as ‘stagnant diarrhea.’” Based on ancient and modern understandings, TCM believes that the onset of this disease is related to exposure to external pathogens, dietary injuries, emotional distress, weakness of the spleen and stomach, and other factors. Although the disease originates in the large intestine, it can ascend to the spleen and stomach, descend to the liver and kidneys, and even lead to pathogenic factors invading the pericardium and affecting the heart’s spirit. The primary pathogenesis of this disease involves damp-heat or cold-dampness obstructing the Yangming intestinal meridian, leading to impaired intestinal motility, poor descending and ascending functions, stagnation of qi and blood, and damage to the intestinal membranes and blood vessels.

The disease progresses to a state of damp-heat or cold-dampness, where food stagnation accumulates in the intestines, and the patient may experience heat excess with dampness, dampness with heat, or both. For instance, when internal cold-dampness harms the middle burner, or when damp-heat causes diarrhea, and heat is removed while dampness remains, and the spleen’s yang is damaged, one may experience cold-dampness syndrome. If one is exposed to deep damp-heat toxins, or if righteous qi cannot resist the pathogen, the disease may spread to the blood vessels, invade the pericardium, and trigger liver wind, leading to high fever, altered mental status, convulsions, and even life-threatening conditions like internal obstruction and external collapse—these are the critical manifestations of toxic dysentery. If damp-heat toxins surge upward and attack the stomach, they may cause “closed-mouth dysentery.” If one stops defecation too early, leaving the door closed and allowing pathogens to remain, and if dietary habits are not properly regulated, waste products accumulate, and the righteous qi is already weakened, the disease may develop into intermittent, recurring dysentery (chronic bacillary dysentery).

(3) TCM Differentiation and Classification of Syndromes, along with Herbal Formulas

1. Differentiation and Classification of Syndromes, along with 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 diarrhea that is red and white, anal burning, and red tongue with yellowish greasy coating, and a slippery, rapid pulse. 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 White Headed Herb, 6g of Agarwood, 6g of Licorice. Brew in water and take 1–2 doses daily.

(2) Toxicity Overwhelming (Acute Severe Bacillary Dysentery, Toxic Dysentery): The main symptoms include high fever and intense thirst, severe abdominal pain, profuse, bright purple or bloody diarrhea, or pale complexion, cold extremities. The tongue is red and dark red, coated with yellow and dry苔, and the pulse is either rapid or weak and slow. Treatment focuses on clearing heat, detoxifying, cooling the blood, and replenishing qi—using the Scutellaria Root Detoxification Decoction combined with Shengmai Powder, modified: 9g of Scutellaria Root, 9g of Goldthread, 6g of Phellodendron Bark, 15g of White Headed Herb, 9g of Red Peony, 9g of Cortex Phellodendri, 15g of Arctium, 12g of Codonopsis, 9g of Ophiopogon. Brew in water and take 1–2 doses daily (if necessary, administer via nasal feeding, rectal infusion, or enema).

(3) Heat-Toxin Obstruction: The main symptoms include sudden onset of chills and high fever, headache and stiff neck, altered mental status and convulsions, elevated blood pressure, foul-smelling stools, constipation, red and dry tongue, yellowish greasy coating, and a slippery, rapid or wiry pulse. 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, modified: 12g of Rheum officinale, 3g of Goldthread, 9g of Phellodendron Bark, 9g of Gardenia Fruit, 9g of Scutellaria Root, 9g of Kudzu Root, 15g of Honeysuckle, 9g of Cortex Phellodendri, 6g of Red Peony, 9g of Fresh Polygonum cuspidatum. Brew 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 fear of cold, tasteless mouth and poor appetite, dull abdominal pain, thin, light-colored stools, pale red tongue, thin white coating, and a weak, fine pulse. 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, modified: 15g of Codonopsis, 9g of Dried Ginger, 12g of Fried Atractylodes Rhizome, 12g of Wu Zhu Yu, 12g of Coptis Root, 9g of Forsythia, 9g of Fructus Corni, 9g of Hawthorn, 9g of Hawthorn Fruit, 12g of Ligusticum Chuanxiong, 12g of Angelica Sinensis, 12g of Rehmannia Root, 12g of Curcuma Longa, 12g of Pinellia Ternata, 12g of Fritillaria Cirrhosa. Brew in water and take 1 dose daily.

(5) Yin Blood Deficiency: The main symptoms include bloody diarrhea that is red and white, dry mouth and thirst, worsening at night, red and dry tongue, with a glossy, peeling coating, and a fine, rapid pulse. Treatment focuses on supporting the body’s defenses to stop dysentery, nourishing yin and clearing heat—using the Huang Lian, A Jiao, and Zhuyi Decotions combined with Zuchi Pills, modified: 15g of A Jiao, 6g of Huang Lian, 9g of Huang Chen, 12g of White Peony, 12g of Dang Gui, 12g of Gou Qi. Brew 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 string-like mass in the left lower abdomen. The tongue is dark with bruising and spots, the coating is white, and the pulse is fine and wiry. Treatment focuses on regulating qi, dispersing stasis, and stopping diarrhea—using the Shaoyu Chu Yu Decoction, modified: 10g of Peach Kernel, 10g of Safflower, 10g of Radix Rehmanniae, 10g of Red Peony, 20g of Rehmannia Root, 10g of Dried Ginger, 12g of Cinnamon, 12g of Frankincense, 12g of Carthamus, 12g of Ligusticum Chuanxiong, 10g of Huang Lian, 12g of Chicken Gizzard. Brew in water and take 1 dose daily.

2. Adjustments for Each Syndrome “Treating dampness that hinders urination is not the proper approach.” For each syndrome, 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 syndrome can optionally include Shen Qu, Hawthorn, Malt, Chicken Gizzard, Citrus Aurantium, or Areca Nut; “When blood flows, pus naturally heals; when qi is regulated, tenesmus naturally resolves,” so each syndrome can optionally include Agarwood, Citrus Aurantium, Areca Nut, Peony, Rubia Tinctorum, or Arctium as qi-regulating herbs; for poor appetite, add Jiao San Xian or Chicken Gizzard; for abdominal distension, add Citrus Aurantium, Thick Ginger, Orange Peel, Fried Radish Seed; for abdominal pain, add Yuan Hu, Frankincense, Myrrh, Five Lingzhi, and Sophora Flower; for vomiting, add Fresh Ginger, Pinellia, Bamboo Shoots; for excessive diarrhea, add Roasted Areca Nut, Arctium Root, Large Yellow Onion, Pomegranate Peel, Black Plum, or Five-Grain Seed; for fainting or cold shock, add Codonopsis, Polygonum Cuspidatum, Turmeric, 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 with Xie Bai. For damp-heat dysentery, where dampness outweighs heat, use Kǔ Shen Qi Wei Tang with modifications: 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, use Gui Shao Qi Wei Tang (with Angelica Sinensis, White Peony, Radish Seed, Citrus Aurantium, Areca Nut, Licorice, and Plantago Seed). Old Chinese physician Huang Rui Shao’s experience in treating dysentery was: in the early stages, use the Si Wu Tang (Honeysuckle and White Peony, each 30g, 9g of Thick Ginger, 6g of Licorice, brewed in water and taken); for those with deficient qi and blood, use Fu Qing’s Gui Shao Tang (Angelica Sinensis, White Peony, Citrus Aurantium, Areca Nut, each 6g, 9g of Talc, 3g of Frankincense, 3g of Licorice, brewed in water and taken); 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, or Bai Tou Weng Tang; where dampness predominates, use Xiang Lian Ping Wei San with modifications or Wood Fragrance, Areca Nut pills with modifications. ② Those with cold-damp overlap use Jin Bu Huan Zheng Qi San with modifications, or use Si Jun Zi Tang with modifications; those with prolapse of the anus due to deficiency of qi and blood use Buzhong Yi Qi Tang or Sheng Yang Yi Wei Tang with modifications. ③ For Yin Deficiency with Damp-Heat, use Huang Lian A Jiao Tang or Zuchi Pills with modifications. ④ For Spleen and Kidney Yang Deficiency, use Si Shen Wan with modifications. ⑤ For those with alternating heat and cold, use Ume丸 with modifications. (Zhonghua Neikang Za Zhi, 1964.11)

For toxic dysentery, some researchers divided toxic dysentery into two types: ① Real Heat Obstruction Type—use Kudzu Root, Huang Qin, Huang Lian, Honeysuckle, Danpi, White Peony, Mang Xiao, Portulaca, and others, brewed in water and taken; for those experiencing vomiting, add Raw Hematite; for convulsions, add An Gong Niu Huang Pill. ② Yang Deficiency and Failure Type—use Aconit, Burnt Ginger, Roasted Licorice, White Peony, Cinnamon, Huang Lian, Chuan Pu, Shan Yu Rou, and others, brewed in water and taken. The basic treatment principles remained unchanged. Among 10 cases treated, 9 were cured. Some researchers also categorized patients into three types—mild, high fever with wind movement, and high fever with coma—using the Gui Shao Qinlian Tang combined with Shao Yao Tang for mild cases, supplemented by Zi Xue Dan; for those with high fever and wind movement, 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 energy and blood, allowing pathogenic toxins to escape. Acupuncture at Shaoshang, Chize, Weizhong, and bloodletting to drain toxic heat from the meridians, helping to open the pathways and allow the toxin to leave the body, while gradually restoring qi and blood flow, followed by the use of Zhibao Dan to eliminate impurities and clear the mind, and then, with slight relief, continue taking prescribed herbal formulas. (Practical Internal Medicine, 1986)

Additionally, in recent years, researchers observed the relationship between the timing of movement in patients with chronic bacillary dysentery—such as spleen deficiency, spleen and kidney deficiency—and the brainwave patterns, autonomic nervous system activity, 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 noticeably lower in chronic bacillary dysentery due to spleen and kidney deficiency, while spleen deficiency showed a slightly lower level, 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 antipathogenic effects include Huang Lian, Qin Pi, Andrographis paniculata, Portulaca oleracea, Kǔ Shen, Lactuca sativa, White Headed Herb, as well as pomegranate peel, five-grain seeds, feather grass, Arctium, Purple Ginseng, Tibetan Blueberry, tea leaves, Compton’s weed, and leaf of the tree of life—all of which are effective against dysentery bacteria (test tube experiments have shown that their antibacterial effects are linked to tannins). Huang Qin, Huang Bo, Khoe, Dandelion, Purple Ground Ivy, Land Grass, Iron Amaranth, Fish Mint, Frankincense, Hawthorn, Five Grains, 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% Chrysanthemum Yellow decoction, 200ml; for cases with erosion, use 8g of Sour Cabbage, 5g of Phellodendron Bark, 7g of Honeysuckle, 5g of Burdock, 5g of Arctium, brew in water until 200ml, 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)