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; avoid foods that are high in fiber, oil, difficult to digest, or irritating. 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, administer alkaline solutions such as sodium bicarbonate. When abdominal pain is severe, place a hot water bag on the abdomen; alternatively, administer Belladonna tablets (tincture) or atropine, 654-2, etc. For patients experiencing diarrhea and tenesmus, administer Compound Camphor Tincture, 2ml each time, 3–4 times daily orally; acupuncture at points such as Tian Zhu and Zu San Li may also be beneficial. (2) Antibiotics

1. SMZ-TMP Take 2 tablets each 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 each time, 4 times daily orally.
3. Pipemidic Acid: Take 0.5g each time, 3–4 times daily, for 5–7 days. (Fluoroquinolone can also be used, taking 0.2g each time, 3–4 times daily.)
4. Other Antibiotics: ① Kanamycin: Take 0.5g each time, 3–4 times daily orally or intramuscularly. ② Gentamicin: Take 160,000–240,000 units daily, either orally or intramuscularly. ③ Antimicrobial Sulfate: Take 1.5–2g daily. ④ Aminobenzoic Acid: Take 2–4g daily, divided into 4–6 doses, orally or intramuscularly. Patients may choose any 1–2 of these medications (preferably based on antibiotic sensitivity testing), with a treatment duration of 5–7 days. (3) Toxic Dysentery For toxic dysentery, antibiotics should be administered intravenously using chloramphenicol, aminobenzoic acid, gentamicin, and other agents. 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 sensitivity testing, with long treatment courses—sometimes requiring multiple cycles of treatment. Enemas or rectal infusions can be employed, especially for patients with long-standing intestinal mucosal lesions. These treatments can be used in conjunction with conventional medication, particularly when local enemas are administered, using 200–500ml per session, 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, supplemented with 20mg of dexamethasone; immunotherapies can also be employed, such as administering levamisole, 50mg each time, 3 times daily, for 2 days per week. If conditions permit, administer dysentery vaccines (homegrown vaccines are preferable) via subcutaneous injections 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 dysenteric symptoms. Lesions are often located in the ileocecal region, with a tendency toward recurrence and chronicity. It can spread through the bloodstream or 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 cyst form. 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 chromosomal structures. Cysts can survive for 2–4 weeks under moderate conditions and up to a month in water, but are sensitive to high temperatures and 50% alcohol. The cyst form is the sole infectious form of this 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, and often occurs in 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 facilitate amebic 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, amebic trophozoites create unique flask-shaped ulcers with small openings and large bottoms, whose base is the mucosal layer, capable of 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. Amebic 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 of these parasites. 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 exhibiting mild, typical, and severe presentations. The acute phase lasts from 4 days to several months, usually 7–14 days. Mild acute cases are characterized by occasional watery 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, eventually developing dysenteric symptoms—stools may range from a few times a day to around 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 cases are marked by severe systemic poisoning symptoms, intense abdominal pain, vomiting, and diarrhea—often reaching 20–30 bowel movements per day, leading to intestinal bleeding and intestinal perforation, potentially resulting in shock. 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 show that the total white blood cell count and neutrophil levels 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) Diagnostic Key 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 main 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 protozoan infections can be performed to identify antigens for serological testing, 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 easily differentiate between bacillary dysentery and amoebic dysentery.
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 require differential diagnosis. III. Traditional Chinese Medicine’s Understanding and Treatment of Amoebic Dysentery (1) Historical Medical Views on Amoebic Dysentery In the “Inner Canon,” this disease is referred to as “intestinal wandering”; in the “Golden Cabinet,” it is 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 is 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 the diverse 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 Traditional Chinese Medicine attributes the etiology and pathogenesis of this disease to external 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 and blood stagnation, which then transforms into pus and blood, resulting in dysentery. As stated in “Miscellaneous Sources of Disease – Dysentery Origins,” “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 qi, leading to spleen and kidney deficiency. When heat toxicity becomes severe, or when excessive consumption of rich, sweet, and greasy foods occurs, dampness increases and heat is generated, causing stagnation in the intestines, affecting the liver. Liver qi becomes depressed and generates fire, which burns the liver’s channels, causing qi stagnation and blood congestion, leading to lumps under the ribs. Over time, blood breakdown results in pus, causing liver pain and liver abscesses.” As Zhang’s Medical Handbook – “Wounds and Ulcers –” “When the vital energy stagnates within the meridians, blood flow is obstructed; when blood flow is obstructed, the defensive qi cannot flow freely, becoming stagnant and unable to move. Thus, heat builds up—extremely hot heat leads to flesh rot, and when flesh rots, pus forms.”

(3) Traditional Chinese Medicine’s Differentiation and Treatment In “Essential Readings on Medicine – Dysentery,” it is stated: “We must determine which pathogen has harmed the body and which organ is affected. If the cause is damp-heat, eliminate damp-heat; if the cause is stagnation, eliminate stagnation. If the cause is qi, regulate qi; if the cause is blood, harmonize it. For newly contracted conditions that are real, we can use methods to clear the root cause and treat the symptoms; for chronic conditions 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 Meridian Damp-Heat The main symptoms include chills and fever, or persistent heat without relief, distension and pain in the flank, foul-smelling stools, jam-like stools, short, red urine, intermittent episodes, bitter and sticky mouth, red tongue tip, yellowish-greasy coating, and a wiry, rapid or slippery, rapid pulse. Treatment focuses on clearing heat, detoxifying, and promoting diuresis and eliminating dampness. The formula uses Longdan Xiegan Tang combined with Bai Tou Weng Tang with modifications: 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 Bo, 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 lump in the right flank, pain that is resistant to pressure, red tongue, yellowish-greasy coating, and a slippery, rapid or wiry, rapid pulse. Treatment focuses on detoxifying and resolving pus; the formula uses Xianfang Huo Ming Yin with modifications: 30g of Jin Yin Hua, 12g of Chuanshan Jia, 9g of Zhe Bei Mu, 9g of Shao Jiao Ci, 12g of Dang Gui Wei, 9g of Chishao, 12g of Bai Zhi, 15g of Huang Lian, 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 dose daily. Appendix: If amebic liver abscesses fail to respond to medical treatment, or if left liver lobe abscesses pose a risk of puncture or if puncture leads to various complications, surgical treatment is recommended.
3. Deficiency of Vital Energy with Persistent Heat The main symptoms include persistent low-grade fever, weight loss, night sweats, a lump in the flank, fatigue, poor appetite, pale red tongue, little coating, and a thin, wiry, or fine and rapid pulse. Treatment focuses on supporting vital energy and eliminating evil; the formula uses Huang Qi Bie Jia San with modifications: 15g of Roasted Huang Qi, 15g of Roasted Bie Jia, 12g of Chai Hu, 12g of Qin Teng, 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 the Differentiation and Treatment of This Disease In “Observations on the Efficacy of Jie Yi Sheng Hua Dan in Treating 24 Cases of Acute Amoebic Dysentery,” 20g of Jin Yin Hua, 15g of Sheng Hang Shao, 6g of Gan Cao, and 3g of San Qi were used. First, the powder of San Qi and the seeds of Yan Dan were taken and dissolved in boiling water, then the remaining herbs were decocted and taken warm, one dose per day. Results: 23 cases were cured, 1 case was ineffective; the treatment course ranged from 3 to 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, Yan Dan Zi, Di Jin Cao, Han Lian Cao, Ma Chi Xuan, Tie A Lan, and others possess anti-amoebic properties. Many single-herb formulas for treating this disease have been reported across different regions: ① Yan Dan Zi (Ku Shen): Take 30–45 Yan Dan Zi seeds 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, decocted in water and taken three times a day; 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: 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, decocted in water, optionally sweetened with sugar, taken three times a day, for 7–15 days. ⑦ Shi Fa Alkaloid: Take 50mg daily, injected subcutaneously 1–2 times. ⑧ Bai Bu: Take 18g, Han Lian Cao: 60g, decocted 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 Bo, 6g of Zhizi, soaked in 500ml of water until fully infused, decocted down to 300ml, filtered and cooled for later use. The enema time was chosen during nighttime when symptoms first appeared.

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Input: Pancreatic cancer presents with upper abdominal pain radiating to the back, accompanied by progressive obstructive jaundice; liver cancer is characterized by progressive hepatomegaly and pain in the hepatic region, with positive AFP levels. X-rays, ultrasound, and CT scans can all aid in diagnosis. Leukemia and malignant histiocytosis may present with fever, hepatosplenomegaly, lymphadenopathy, jaundice, and bleeding; bone marrow examination can serve as a definitive diagnostic tool.