Dysentery is an intestinal infectious disease marked by abdominal pain, tenesmus and frequent passage of bloody and mucous stools caused by an attack of pestilent dampness-heat evil.

Etiology and Pathogenesis

The causes of dysentery are an overindulgence in cold drinks and raw fruits, contaminated foods, dampness-heat, pestilent evil, cold-dampness, etc., leading to the dysfunction of intestines. Stagnation of qi and blood with damage of intestinal collaterals is responsible for the formation of bloody and mucous stools, and the obstruction of fu-organ qi leads to abdominal pain and tenesmus.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome Differentiation An acute case manifested by abdominal pain, tenesmus, discharge of bloody and mucous stools, yellow and greasy tongue coating and wiry and smooth pulse is mostly attributed to sthenia and heat syndrome. A chronic case accompanied by sallow complexion, loss of appetite, fatigue and weak pulse usually represents a deficiency and cold syndrome. Besides, there are some cases in which the heat and cold and asthenia and stheniz syndromes coexist.

B. Therapeutic principles In general, dysentery of heat type is treated by heat-clearing therapy and dysentery of cold type by warming therapy. An acute case with sthenia syndrome is treated by purging therapy, while a chronic case with asthenia syndrome by tonifying therapy. Accordingly, a combination of the therapies should be adopted when the case presents a complication of the syndromes. In short, the therapy of removing evil and that of supporting healthy qi ought to be applied flexibly on the basis of syndrome differentiation.

Classification and Treatment

A. Dysentery of dampness-heat type

Manifestation: Frequent passage (more than 10 times a day) of bloody and mucous stools, abdominal pain, tenesmus, burning sensation of anus, fever, general aching, oliguria with reddish urine, yellow, greasy tongue coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat and dampness, regulate qi, and activate blood circulation.

Prescription: The Modification of Paeoniae Decoction

Radix Paeoniae Alba 15-30 g
Radix Angelicae Sinensis 12 g
Radix Scutellariae 9 g
Cortex Phellodendri 9 g
Flos Lonicerae 15 g
Radix Glycyrrhizae 5 g
Radix Aucklandiae 9 g
Semen Arecae 9 g
Rhizoma Coptidis 9 g
Radix et Rhizoma Rhei 6 g
Herba Portulacae

Remarks: Add Radix Puerariae, Herba Schizonepetae and Radix Ledebouriellae and omit Coptidis, Phellodendri and Rhei for incipient cases with superficies-syndrome such as fever, chilliness, general aching, etc. Add Radix Pulsatillae Decoction for those with predomination of het. Add Powder for Regulating the Function of the Stomach for those with predomination of dampness.

B. Fulminant dysentery

Manifestations: Abrupt onset of passage of bloody and mucous stools, severe abdominal pain, burning and bearing-down sensation in the anus, high fever, irritability, nausea and vomiting, sudden convulsions, coma or even collapse syndrome in some cases, red tongue with yellow, greasy coating and thready and rapid pulse; in some cases, convulsions, collapse or even coma appear prior to other digestive symptoms.

Therapeutic principles: Clear away heat and toxic materials, and cool the blood.

Prescription: The Modification of Pulsatillae Decoction

Remarks: Add Calculus Bovis Bolus for Resurrection or Cornu Rhinocerotis Pill for Resurrection for cases with coma and delirium due to an attack of heat caused by pestilent toxins. For cases with high fever and convulsions, add Ramulus Uncariae cum Uncis, Scorpio and Rhizoma Acori Graminei, and Combine with acupuncture therapy by puncturing the acupoints Renzhong (Du 26), Hegu (L.I. 4), Quchi (L.I. 11) and blood-letting from Shixuan point (Extra 30). For cases with collapse-syndrome with symptoms such as grayish-white complexion, coldness of extremities, spontaneous sweating, thready weak pulse, etc, apply Injection of Radix Ginseng and Radix Aconiti Lateralis Praeparata for Restoring Pulse Beat and puncture the acupoints Neiguan (P. 6), Renzhong (Du 26) and Zusanli (St. 36).

C. Dysentery of asthenia-cold type

Manifestations: Repeated recurrence of dysentery with thin, bloody and mucous stools, dull pain over the lower abdomen, loss of appetite, fatigue, lumbago, coldness of limbs, prolapse of rectum, pale tongue with white, smooth coating and deep and thready pulse.

Therapeutic principles: Warm and Tonify the spleen and kidneys, and arrest bowel discharge.

Prescription: The Modified Decoction for Nourishing Viscera

Radix Codonopsis Pilosulae 12 g
Rhizoma Atractylodis Macrocephalae 10 g
Rhizoma Zingiveris Praeparata 6 g
Semen Myristicae 10 g
Radix Aucklandiae 6 g
Pericarpium Granati 15 g
Cortex Cinnamomi 5 g
Radix Aconiti Lateralis Praeparata 6 g
Pericarpium Papaveris 10 g
Fructus Chebulae 15 g
Halloysitum Rubrum 10 g
Radix Glycyrrhizae 5 g

Remarks: Add Radix Astragali, Fructus Aurantii and Rhizoma Cimicifugae, and omit Aucklandiae for cases with frequent bowel movements and prolapse of rectum due to collapse of middle-jiao qi. Add Radix et Rhizoma Rhei, Fructus Crataegi (fried) and Pericarpium Citri Reticulatae, and omit Myristicae, Chebulae and Halloysitum Rubrum for those with cold pain over the abdomen and incomplete evacuation of sticky stool.

D. Dysentery with inability to take food

Manifestations: Dysentery, nausea, inability to take food, mental fatigue, emaciation, yellow, greasy tongue coating and thready and rapid pulse.

Therapeutic principles: Regulate the stomach, keep the adverse qi downwards, eliminate dampness, and clear away heat.

Prescription: Pill of the Jade Pivot and Decoction for Purging Stomach-Fire

Pill of the Jade Pivot (mixed with the decoction) 2 pcs  

Radix et Rhizoma Rhei 10 g
Rhizoma Coptidis 5 g
Radix Scutellariae 10 g
Rhizoma Pinelliae 10 g
Poria 12 g
Pericarpium Citri Reticulatae 10 g
Folium Nelumbinis 10 g
Herba Eupatorii 10 g
Rhizoma Zingiberis Recens 10 g
Caulis Bambusae in Taeniam 10 g

Remarks: Add Herba Dendrobii, Radix Ophiopogonis and Radix Adenophorae Strictae, and omit Coptidis and Scutellariae for those with dryness of mouth and throat and red, uncoated tongue due to impairment of stomach-yin by fire.

E. Chronic dysentery

Manifestations: Repeated recurrent of dysentery induced by fatigue or improper diet and characterized by distending pain over the abdomen, discharge of thin mucous stool, pale tongue with white, greasy coating and deep, thready and weak pulse.

Therapeutic principles: Benefit spleen-yin, eliminate dampness, and arrest diarrhea.

Prescription: The Modification of Yigong Powder

Radix Codonopsis Pilosulae 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Acuklandiae 6 g
Radis Sanguisorbae 10 g
Fructus Aurantii Immaturus 10 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Coptidis 5 g
Radix Pulsatillae 10 g

Remarks: For cases with marked asthenia-cold syndrome of middle jiao during the intermittent period, the Radix Aconiti Lateralis Praeparata Bolus for regulating Middle Jiao should be taken, 5 grams twice or thrice daily. For cases without significant asthenia-cold syndrome, Bolus of Ginseng, Poria and Atractylodis Macrocephalae ought to be employed, 5 grams twice or thrice daily, to prevent the recurrence of dysentery.

Copyright 1995 Hopkins Technology