Dysentery

Dysentery (Lì Jí)
Characterized by frequent diarrhea accompanied by tenesmus, abdominal pain, and stool mixed with mucus, pus and blood. Often occurs in the summer and fall. Contagious varieties in certain parts of the world account for epidemic outbreaks.

Relevant Biomedical Diseases
-Bacillary dysentery -Amoebic dysentery -Viral dysentery -Food poisoning -IBD

TCM Etiology and Pathology
-Epidemic pestilential Toxin attacks the intestines -> impaired Qi and Blood flow and tissue destruction -> diarrhea with mucus/pus and blood, abdominal pain and tenesmus -Exogenous Damp-Heat attacks intestines -> impaired Qi and Blood flow and tissue destruction -> diarrhea with mucus/pus and blood, abdominal pain and tenesmus -Improper diet -> injury of the intestines by Damp-Heat or Cold and Damp -> impaired Qi and Blood flow and tissue destruction -> diarrhea with mucus/pus and blood, abdominal pain and tenesmus

Differential Diagnosis of Similar Disorders

 * Bloody Stool:** Hematochezia is a common symptom of many disorders, including dysentery. However, in the case of dysentery, hematochezia will be accompanied by tenesmus and abdominal pain.


 * Warm-febrile disease:** Loss of consciousness with convulsions can be caused by acute Heat Toxicity consuming the Yin and generating internal Wind in Epidemic Toxic Dysentery, or caused by Summer Heat harassing the Heart/Spirit in Warm-febrile disease. However, Summer Heat harassing the Heart/Spirit usually does not manifest with diarrhea.

Herbs
damp-heat+ no Yin xu -> Shi Liu Pi (pomegranate skin), Chi Shi Zhi damp-heat + Yin xu -> Bai Bian Dou, Shan Yao Yang Qi xu -> Chi Shi Zhi, Rou Dou Kou, Pao Jiang

In general all of the following components should be addressed:
 * Clear Pathogens:** Jin Yin Hua, "Huang" herbs
 * Move Qi & Blood:** Mu Xiang, Bing Lang, (San Lan, E Zhu)
 * Bloody Stool (often w/ heat):** Di Yu, Qiao Cao Gen, Da Huang, San Qi, Dan Shen
 * Mucus clearing:** + Er Chen Tang

(1) Tongue coat is clear (2) Abdomen is soft (3) No Fever (4) Urination is normal
 * When use of astringent herbs is appropriate:**

Damp-Heat Dysentery
[Bai Shao (15g), Dang Gui (6g), Mu Xiang (10g), Bing Lang (10g), Da Huang (10g), Huang Qin (15g), Huang Lian (6g), Rou Gui (4g), Gan Cao (6g)]
 * Signs:** abdominal pain, tenesmus, stools mixed with mucous/pus and blood
 * Symptoms:** burning sensation around the anus, dark scanty urine, thirst, fever
 * Tongue:** yellow, greasy coat
 * Pulse:** slippery and rapid
 * Treatment Principle:** Clear Heat, transform Dampness,
 * Acupuncture Treatment:** [ST-25, ST-37] +LI-4, LI-11, SP-9
 * Herbal Treatment:** Shao Yao Tang (Peony Decoction)

Epidemic Toxic Dysentery
[Bai Tou Weng (30g), Qin Pi (15g.), Huang Lian (15g.), Huang Bai (15g.)]
 * Signs:** acute onset with severe abdominal pain and tenesmus, frequent diarrhea with more blood than mucous/pus
 * Symptoms:** high fever, significant thirst, severe headache, irritability, loss of consciousness with convulsions in severe cases
 * Tongue:** dark red with dry yellow coating
 * Pulse:** rapid, slippery
 * Treatment Principles:** Clear Heat, cool the Blood, resolve toxins
 * Acupuncture Treatment:** [ST-25, ST-37] +LI-4, GV-14, Shixuan (bleed)
 * Herbal Treatment:** Bai Tou Weng Tang (Pulsatilla Decoction)

Cold-Dampness Dysentery
[Cang Zhu (10g.), Hou Po (15g.), Bai Zhu (10g.) Fu Ling (15g.), Zhu Ling (10g.), Chen Pi (10g.), Gui Zhi (10g.), Ze Xie (10g.), Zhi Gan Cao (4g.)]
 * Signs:** diarrhea or sticky stools with mucous/pus and blood (mucous/pus more predominant than blood) abdominal pain, tenesmus
 * Symptoms:** poor appetite, abdominal and epigastric distention, heaviness in the head and body, fullness in abdomen
 * Tongue:** pale with white, greasy coating
 * Pulse:** soft and moderate
 * Treatment Principles:** Warm and dissipate Cold-Dampness, strengthen the Spleen, rectify Qi and Blood
 * Acupuncture Treatment:** [ST-25, ST-37] + LI-4, SP-9, CV-12, CV-6
 * Herbal Treatment:** Wei Ling Tang

Yin Vacuity Dysentery
[Huang Lian (9g,), Dang Gui (6g.), E Jiao (6g.), Pao Jiang (1.5g)]
 * Signs:** chronic diarrhea with thick mucous/pus and blood or diarrhea with only bright blood, burning pain around the umbilicus, straining to defecate with incomplete sensation after b.m.
 * Symptoms:** poor appetite, restlessness, dry mouth
 * Tongue:** red tongue with scanty or geographic coating
 * Pulse:** thin and rapid
 * Treatment Principles:** Nourish Yin and Clear Heat to relieve dysentery
 * Acupuncture Treatment:** [ST-25, ST-37] + KI-6, SP-6
 * Herbal Treatment:** Zhu Che Wan(Carriage-Halting Pill)

Vacuity Cold Dysentery
[Fu Zi (10g.), Ren Shen (10g.), Bai Zhu (10g.), Gan Jiang (3g.), Zhi Ga Cao (6g.)]
 * Signs:** chronic, watery diarrhea mixed with mucous, fecal incontinence in severe cases, dull abdominal pain which can be relieved by pressure and warmth
 * Symptoms:** poor appetite, fatigue, cold extremities with overall sensation of cold, weakness in low back and knees
 * Tongue:** pale tongue with thin white coating
 * Pulse:** deep, thin and weak
 * Treatment Principles:** Warm and supplement the Spleen and Kidney to dispel Cold and resolve Dampness.
 * Acupuncture Treatment:** [ST-25, ST-37] + CV-4, CV-8, BL-20, BL-23
 * Herbal Treatment:** Fu Zi Li Zhong Wan (Aconite Center-Rectifying Decoction)

Chronic Intermittent Dysentery
[Ren Shen (12g.), Bai Zhu (9g.), Huang Lian (9g.), Fu Ling (9g.), Zhi Gan Cao (6g.)]
 * Signs:** recurrent, intermittent dysentery showing no improvement over an extended time, abdominal pain, tenesmus, stools mixed with pus and blood during flare ups
 * Symptoms:** tiredness, fatigue, lethargy and loss of appetite
 * Tongue:** pale tongue with greasy coating
 * Pulse:** thin, weak
 * Treatment Principles:** Warm and strengthen Spleen, clear Heat rectify Qi, remove stagnation
 * Acupuncture Treatment:** [ST-25, ST-37] + CV-4, ST-36
 * Herbal Treatment:** Lian Li Tang (Coptis Rectifying Decoction)

Acupuncture for Dysentery

 * Primary Points:** ST 25, ST 37
 * Supplementary Points:**
 * Damp-Heat:** LI 4, LI 11, SP 9
 * Epidemic Toxic:** LI 4, GV 14, Shixuan (bleed)
 * Cold-Dampness:** LI 4, SP 9, CV 12, CV 6
 * Yin vacuity:** KI 6, SP 6
 * Vacuity Cold:** CV 4, CV 8, BL 20, BL 23
 * Chronic Intermittent:** CV 4, ST 36

Clinical Tips for Treating Dysentery
“Regulate the Qi to alleviate tenesmus; quicken the Blood to resolve pus.” Tenesmus is a subjective sensation of urgency, cramping and heaviness of the rectum. It is caused by Qi stagnation and Dampness accumulation. Therefore, by facilitating Qi flow, Dampness can be resolved and tenesmus will be alleviated. Generation of pus is a result of the decomposition of tissues due to Blood stasis and Heat accumulation. By quickening the Blood to restore proper circulation, damaged tissues can be healed.

While antibiotics have greatly decreased the incidence and severity of dysentery, long-term usage or misapplication of antibiotics may induce an imbalance of normal bacterial flora in the intestines, complicating recovery. Therefore, for chronic, stubborn, drug-resistant or complicated dysentery, herbal therapy has considerable value.

Main patterns found in clinic
(1) Damp-heat: Shao Yao Tang, Bai Tou Weng Tang, Ge Ge Qin Lian Tang (2)Spleen Qi Xu: Shen Ling Bai Zhu San, Bu Zhong Yi Qi Tang (3) Spleen Yang Xu: Fu Zi Li Zhong Wan (middle jiao), Si Shen Wan (Kidney), Huang Tu Teng (much bleeding) (4) Cold + Heat: Wu Mei Wan, Ban Xia Xie Xin Tang