案例痢疾-完成已

1、 痢疾【概说】 痢疾以腹痛，里急后重，痢下赤白为特征，是夏秋季节流行的常见疾患之一。 临床常见的有湿热痢、寒湿痢、噤口痢、休息痢。 本病多由外受湿热疫毒之气，内伤生冷不洁之物，邪积交阻，损伤肠胃而形成。 Dysentery【Brief Introduction】 Dysentery is characterized by abdominal pain, tenesmus and frequent stools containing blood and mucus. It is a common epidemic disease in summer and autumn. It is calle

2、d “red-white dysentery,” “bloody dysentery,” “purulent and bloody dysentery” or “heat dysentery,” and known as “persistent dysentery” if it lasts for a long time, and “intermittent dysentery” if it comes on and off. This disease is often due to the invasion by the epidemic damp heat and internal inj

3、ury by intake of raw, cold and unclean food, which hinders and damages the stomach and intestines.【病因病机】赤白痢-感受暑湿之邪，暑湿热毒侵于肠胃，湿热郁蒸，肠胃之气血阻滞，气血与暑湿热毒搏结，化为脓血，而成痢疾。湿胜于热，则为白痢；热胜于湿，则为赤痢；湿热俱盛，则为赤白痢。痢疾-嗜食肥甘厚味，素有湿热内结，复加饮食不节，或食不洁之品，因而湿热蕴结，腑气阻滞，气血凝滞，化为脓血，则成痢疾。【Etiology and Pathogenesis】 Red-white dysentery The su

4、mmer epidemic heat dampness invades the stomach and intestines, impeding the flow of their qi and blood. Pus and blood are formed from the stagnated qi and blood in struggling against heat dampness, and hence occurs dysentery. In case dampness is preponderant to heat, white dysentery results, in cas

5、e heat preponderant to dampness, red dysentery appears, and in case both dampness and heat are excessive, red-white dysentery occurs. Dysentery Preference for fatty and sweet food, internal accumulation of damp heat plus irregular diet, or intake of unclean food leads to stagnation of qi and blood i

6、n the fu organs, which turns into pus and blood in the stool and results in dysentery.【病因病机】寒湿痢-平素恣食生冷，寒湿内蕴，再加饮食不慎，或食不洁之物，则寒湿伤害肠胃，大肠气机阻滞，亦能损害营血，渐至脓血俱下，而成为寒湿痢。 上述病因虽有外邪与饮食之分，但二者实互相影响，往往内外交感而发病。痢疾的病位在肠，但与胃密切相连，如果疫毒：湿热之气上攻于胃，则胃不纳食，成为噤口痢。如痢疾迁延，邪恋正衰，脾气更虚，则成久痢，或为时作时止的休息痢。【Etiology and Pathogenesis】 Cold-d

7、amp dysentery Excessive intake of raw, cold, or dirty food leads to internal accumulation of cold dampness, impeding the stomach and intestines. The stagnated qi in the large intestine also injures the blood, leading to discharge of pus and blood and resulting in cold-damp dysentery. Although the ab

8、ove-mentioned etiological factors can be classified into the exogenous pathogenic factors and food intake, the two are usually mutually affected. The disease is in the intestine, but closely related to the stomach. If the epidemic toxic and damp heat attack the stomach, which fails to receive food,

9、food-resistant dysentery occurs. If dysentery lasts longer, the body resistance is weaker and the spleen qi es more insufficient, persistent or intermittent dysentery therefore appears.【辨证】（一）湿热痢 主证：腹痛，里急后重，下痢赤白相杂，肛门灼热，小便短赤，或有恶寒发热，心烦口渴，苔多黄腻，脉滑数或濡数。 证候分析：湿热积滞肠中，气血因而被阻，以致传导失职，所以腹痛，里急后重；湿热之毒熏灼，损伤肠道脉络，故

10、下痢赤白粘冻；肛门灼热，小便短赤，都是湿热下注的表现；暑湿外袭，正邪交争，故恶寒发热；邪热内盛，故心烦口渴；苔腻为湿，黄则有热；脉滑或濡为湿，数为热象。【Differentiation】 a）Damp-heat dysentery Main manifestations：Abdominal pain, tenesmus, mixing of pus and blood in stool, burning sensation of the anus, scanty and yellow urine, or chills, fever, restlessness, thirst, yellow,

11、sticky tongue coating, rolling, rapid or soft, rapid pulse. Analysis： In case the damp heat stagnates in the intestines, the qi and blood are blocked, leading to disturbance of transmission, so abdominal pain and tenesmus occur； When the blood vessels of the intestine are injured by damp heat, blood

12、, pus and mucus appear in stools； Burning sensation of the anus, and scanty yellow urine are also manifestations of down-pouring of damp heat； When the summer heat and dampness attack the body, the body resistance will fight against it, so there are chills and fever； In case of excess of pathogenic

13、heat, restlessness and thirst result. Sticky tongue coating indicates dampness and yellow color indicates heat； Rolling or soft pulse indicates dampness, rapid pulse indicates heat.【辨证】（二）寒湿痢 主证：下痢不爽，以白腻粘冻为主，喜暖畏寒，多兼有胸脘痞闷，腹中隐痛，口淡不渴，舌苔白腻，脉沉迟。 证候分析：寒湿内蕴，损伤脾胃，大肠气机阻滞，寒性凝结，湿性粘滞，故胸脘痞闷，下痢不爽，以白腻粘冻为主；寒湿为阴邪，易伤

14、阳气，阳气被遏，不得宣达，故喜暖畏寒，腹中隐痛；口淡不渴，苔腻，为湿邪内停之征；脉沉迟为阴寒内盛之象。【Differentiation】 b）Cold damp dysentery Main manifestations：Difficult defecation, white mucus in stools, preference for warmth and aversion to cold, mostly panied with fullness in the chest and epigastrium, lingering abdominal pain, tastelessness in

15、 the mouth, absence of thirst, white, sticky tongue coating, deep, slow pulse. Analysis： Accumulation of internal cold dampness damages the spleen and stomach and blocks the qi flow of the large intestine. Cold is characterized by causing contraction and stagnation, while dampness is characterized b

16、y turbidity, so there are fullness in the chest and epigastrium, difficult defecation, white mucus in stool； Cold dampness is a yin pathogenic factor and apt to damage yang qi. When the yang qi is blocked and fails to disperse, preference for warmth, aversion to cold and lingering abdominal pain res

17、ult； Tastelessness in the mouth, absence of thirst, sticky tongue coating are the signs of accumulation of dampness； Deep, slow pulse is the sign of excessive cold。【辨证】（三）噤口痢 主证：痢下赤白，饮食不进，恶心呕吐，舌苔黄腻，脉濡数。 证候分析：暑湿热毒蕴结肠中，上攻于胃，胃失和降，受纳无权，故不能食；胃气上逆，则恶心呕吐；苔黄腻，脉濡数，均为湿热之征。【Differentiation】 c）Food-resistant dy

18、sentery Main manifestations：Frequent stools with blood and pus, total loss of appetite, nausea, vomiting, yellow, sticky tongue coating, soft, rapid pulse. Analysis： This condition is developed from the damp-heat dysentery. The epidemic summer heat dampness, when accumulated in the intestines, may a

19、ttack the stomach and impair its function in sending its contents downwards. Thus the stomach fails to receive food, and the appetite is totally lost； The stomach qi ascends instead of descending, so nausea and vomiting occur； Yellow, sticky tongue coating, and soft, rapid pulse are the signs of dam

20、p heat.【辨证】（四）休息痢 主证：下痢时作时止，日久难愈，倦怠怯冷，嗜卧，食欲不振，舌淡苔腻，脉濡。 证候分析：正虚邪恋，肠胃传导失常，厘实夹杂，是以缠绵难愈，愈而复发；脾阳虚弱，神气不充，所以倦怠怯冷，嗜卧；脉濡，苔腻不化，乃湿邪未尽之故。【Differentiation】 d）Intermittent dysentery Main manifestations：Dysentery occurring on and off, difficult to cure, lassitude, aversion to cold, anorexia, pale tongue, sticky co

21、ating, soft pulse. Analysis： In case of the weakened body resistance with existence of the pathogenic factors impairing the transmitting function of the stomach and intestine, the condition is complicated with mixed deficiency and excess, and so the disease is lingering and recurrent； When the splee

22、n yang is weak, and the qi is deficient, there may be lassitude and aversion to cold； Soft pulse and persistent sticky coating are the signs of continuing presence of dampness。【治疗】治法：取手足阳明及大肠募穴、下合穴为主，以通肠导滞。湿热痢针刺用泻法；寒湿痢针灸并用；久痢针灸补泻兼施。 处方：天枢(胃25) 上巨虚(胃37)。 湿热痢：加曲池（大肠11） 合谷（大肠4）。 寒湿痢：加中脘(任12) 灸气海（任6） 阴陵

23、泉(脾9)。 噤口痢：加中脘(任12) 内关（心包6）。 休息痢：加脾俞(膀胱20) 胃俞（膀胱21） 关元（任4）足三里(胃36)。 随证配穴：发热：大椎(督14)o 里急后重：中膂俞(膀胱29)。 脱肛：百会(督20)（灸） 长强(督1)。【Treatment】 Method：The points of Yangming Meridians of Hand and Foot as well as the Front-(Mu) point and Lower He-(Sea) point of the large intestine are selected as the principal

24、 points to remove stagnation from the intestines. Reducing is used for the damp-heat dysentery, both acupuncture and moxibustion are used for the cold-damp dysentery, and acupuncture and moxibustion, with both reinforcing and reducing methods, are used for the persistent dysentery. Prescription：Tian

25、shu (ST 25), Shangjuxu (ST 37). Damp-heat dysentery：Quchi (LI 11), Hegu (LI 4) are added. Cold-damp dysentery：Zhongwan (CV 12) is added；Qihai (CV 6) with moxibustion and Yinlingquan (SP 9). Food-resistant dysentery：Zhongwan (CV 12) and Neiguan (PC 6) . Intermittent dysentery：Pishu (BL 20), Weishu (B

26、L 21), Guanyuan (CV 4) and Zusanli (ST 36) . Supplementary points：fever: Dazhui (GV 14); tenesmus: Zhonglushu (BL 29). Prolapse of rectum：Baihui (GV 20) with moxibustion, Changqiang (GV 1).【治疗】 方义：天枢、上巨虚-天枢为大肠之募，上巨虚为大肠合穴，以通调大肠腑气，使气调而湿化滞行；曲池、合谷-清泄肠胃湿热之气；灸中脘，气海-温中散寒，调气行滞；阴陵泉-健脾利湿；中脘、内关-和胃气，化湿降浊以治疗噤口痢。

27、脾俞、胃俞、足三里-多用灸法，补泻兼施，既能温补脾胃，又可消除肠中积滞；关元-小肠募穴，取之以分利清浊，益气助阳。【Treatment】 Explanation： Tianshu (ST 25), Shangjuxu (ST 37) Tianshu (ST 25), the Front-(Mu) point of the large intestine, and Shangjuxu (ST 37), the He-(Sea) point of the large intestine, are selected as the principal points to remove stagnation