案例痢疾-完成已

1、 痢疾【概說】 痢疾以腹痛，里急后重，痢下赤白為特征，是夏秋季節(jié)流行的常見疾患之一。 臨床常見的有濕熱痢、寒濕痢、噤口痢、休息痢。 本病多由外受濕熱疫毒之氣，內(nèi)傷生冷不潔之物，邪積交阻，損傷腸胃而形成。 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.【病因病機(jī)】赤白痢-感受暑濕之邪，暑濕熱毒侵于腸胃，濕熱郁蒸，腸胃之氣血阻滯，氣血與暑濕熱毒搏結(jié)，化為膿血，而成痢疾。濕勝于熱，則為白痢；熱勝于濕，則為赤痢；濕熱俱盛，則為赤白痢。痢疾-嗜食肥甘厚味，素有濕熱內(nèi)結(jié)，復(fù)加飲食不節(jié)，或食不潔之品，因而濕熱蘊(yùn)結(jié)，腑氣阻滯，氣血凝滯，化為膿血，則成痢疾?！綞tiology 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.【病因病機(jī)】寒濕痢-平素恣食生冷，寒濕內(nèi)蘊(yùn)，再加飲食不慎，或食不潔之物，則寒濕傷害腸胃，大腸氣機(jī)阻滯，亦能損害營血，漸至膿血俱下，而成為寒濕痢。 上述病因雖有外邪與飲食之分，但二者實(shí)互相影響，往往內(nèi)外交感而發(fā)病。痢疾的病位在腸，但與胃密切相連，如果疫毒：濕熱之氣上攻于胃，則胃不納食，成為噤口痢。如痢疾遷延，邪戀正衰，脾氣更虛，則成久痢，或為時作時止的休息痢?！綞tiology 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.【辨證】（一）濕熱痢 主證：腹痛，里急后重，下痢赤白相雜，肛門灼熱，小便短赤，或有惡寒發(fā)熱，心煩口渴，苔多黃膩，脈滑數(shù)或濡數(shù)。 證候分析：濕熱積滯腸中，氣血因而被阻，以致傳導(dǎo)失職，所以腹痛，里急后重；濕熱之毒熏灼，損傷腸道脈絡(luò)，故

10、下痢赤白粘凍；肛門灼熱，小便短赤，都是濕熱下注的表現(xiàn)；暑濕外襲，正邪交爭，故惡寒發(fā)熱；邪熱內(nèi)盛，故心煩口渴；苔膩為濕，黃則有熱；脈滑或濡為濕，數(shù)為熱象?！綝ifferentiation】 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.【辨證】（二）寒濕痢 主證：下痢不爽，以白膩粘凍為主，喜暖畏寒，多兼有胸脘痞悶，腹中隱痛，口淡不渴，舌苔白膩，脈沉遲。 證候分析：寒濕內(nèi)蘊(yùn)，損傷脾胃，大腸氣機(jī)阻滯，寒性凝結(jié)，濕性粘滯，故胸脘痞悶，下痢不爽，以白膩粘凍為主；寒濕為陰邪，易傷

14、陽氣，陽氣被遏，不得宣達(dá)，故喜暖畏寒，腹中隱痛；口淡不渴，苔膩，為濕邪內(nèi)停之征；脈沉遲為陰寒內(nèi)盛之象?！綝ifferentiation】 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?！颈孀C】（三）噤口痢 主證：痢下赤白，飲食不進(jìn)，惡心嘔吐，舌苔黃膩，脈濡數(shù)。 證候分析：暑濕熱毒蘊(yùn)結(jié)腸中，上攻于胃，胃失和降，受納無權(quán)，故不能食；胃氣上逆，則惡心嘔吐；苔黃膩，脈濡數(shù)，均為濕熱之征?！綝ifferentiation】 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.【辨證】（四）休息痢 主證：下痢時作時止，日久難愈，倦怠怯冷，嗜臥，食欲不振，舌淡苔膩，脈濡。 證候分析：正虛邪戀，腸胃傳導(dǎo)失常，厘實(shí)夾雜，是以纏綿難愈，愈而復(fù)發(fā)；脾陽虛弱，神氣不充，所以倦怠怯冷，嗜臥；脈濡，苔膩不化，乃濕邪未盡之故。【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?！局委煛恐畏ǎ喝∈肿汴柮骷按竽c募穴、下合穴為主，以通腸導(dǎo)滯。濕熱痢針刺用瀉法；寒濕痢針灸并用；久痢針灸補(bǔ)瀉兼施。 處方：天樞(胃25) 上巨虛(胃37)。 濕熱痢：加曲池（大腸11） 合谷（大腸4）。 寒濕?。杭又须?任12) 灸氣海（任6） 陰陵

23、泉(脾9)。 噤口痢：加中脘(任12) 內(nèi)關(guān)（心包6）。 休息?。杭悠⒂?膀胱20) 胃俞（膀胱21） 關(guān)元（任4）足三里(胃36)。 隨證配穴：發(fā)熱：大椎(督14)o 里急后重：中膂俞(膀胱29)。 脫肛：百會(督20)（灸） 長強(qiáng)(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).【治療】 方義：天樞、上巨虛-天樞為大腸之募，上巨虛為大腸合穴，以通調(diào)大腸腑氣，使氣調(diào)而濕化滯行；曲池、合谷-清泄腸胃濕熱之氣；灸中脘，氣海-溫中散寒，調(diào)氣行滯；陰陵泉-健脾利濕；中脘、內(nèi)關(guān)-和胃氣，化濕降濁以治療噤口痢。

27、脾俞、胃俞、足三里-多用灸法，補(bǔ)瀉兼施，既能溫補(bǔ)脾胃，又可消除腸中積滯；關(guān)元-小腸募穴，取之以分利清濁，益氣助陽。【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