Amebic enteritis

　　The pathogenicity of Amoeba is a complex process involving the interaction between the parasite and the host, influenced by various factors. The invasive power of Entamoeba histolytica mainly manifests in its ability to dissolve and destroy host tissues.

　　The strains of Entamoeba histolytica with a high incidence in tropical areas have a strong virulence due to long-term adaptation to intracellular parasitism. While the strains in cold and temperate zones have weaker virulence and more carriers. However, the virulence of the strain is not fixed and can be enhanced through animal passage or weakened after long-term in vitro culture, but it can be increased again after animal inoculation. The virulence is closely related to the bacteria present in the intestinal lumen. Someone once conducted an experiment on themselves, showing that simply ingesting clean Entamoeba histolytica cysts only results in carrier status, but after ingesting the intestinal cells of patients, dysentery occurs. This synergistic effect that promotes disease is likely due to the bacteria providing the physical and chemical conditions for the growth and activity of the amoeba, such as creating suitable redox potential and hydrogen ion concentration, and the bacteria may also weaken the host's systemic or local resistance, even directly damaging the intestinal mucosa, providing an opportunity for the amoeba to invade the tissue.

　　The host's immune status plays a significant role in whether Amoeba can invade tissues. To invade and reproduce in tissues, the amoeba must break through the host's defense barrier. Clinical and experimental data indicate that malnutrition, infection, intestinal dysfunction, and mucosal damage can lead to decreased immune function in the host, which is favorable for the amoeba to invade tissues. In populations with low nutritional standards or experimental animals, the incidence and pathogenic index of amebiasis are significantly higher than those of balanced diet groups, and it is not easy to control with medication; patients with enteric or systemic infections such as typhoid, schistosomiasis, and tuberculosis are prone to amebiasis, and it is also difficult to cure after infection.

　　The large trophozoites of Entamoeba histolytica invade the intestinal wall, causing amebiasis. The common sites are the cecum, followed by the rectum, sigmoid colon, and appendix. The transverse and descending colon are less frequently involved, and sometimes the entire or part of the ileum can be affected.

　　一、肠道并发症：

　　1、肠穿孔：急性肠穿孔多发生于严重的阿米巴肠病患者，此系肠阿米巴病威胁生命最严重的并发症，穿孔可因肠壁病变使肠腔内容物入腹腔酿成局限性或弥漫性腹膜炎，穿孔部位多见于盲肠、阑尾和升结肠。慢性穿孔先形成肠粘连，尔后常形成局部脓肿或穿入附近器官形成内瘘。

　　2、肠出血：发生率少于1％，一般可发生于阿米巴痢疾或肉芽肿患者，因溃疡侵及肠壁血管所致。大量出血每因溃疡达于粘膜下层，侵袭大血管，或肉芽肿破坏所致。大量出血虽少见，但一旦发生，病情危急，常因出血而致休克。小量出血多由于浅表溃疡渗血所致。

　　3、阑尾炎：因阿米巴肠病好好于盲肠部位，故累及阑尾的机会较多，结肠阿米巴病尸检中发现6.2％～40.9％有阑尾炎，中国报告，累及阑尾者仅0.9％。其症状与细菌性阑尾炎相似，亦有急、慢性等表现，但若有阿米巴痢疾病史并有明显右下腹压痛者，应考虑本病。

　　4、阿米巴瘤：肠壁产生大量肉芽组织，形成可触及的肿块。多发生在盲肠，亦见于横结肠、直肠及肛门，常伴疼痛，极似肿瘤，不易与肠癌区别。瘤体增大时可引起肠梗阻。

　　5、肠腔狭窄：慢性患者，肠道溃疡的纤维组织修复，可形成疤痕性狭窄，并出现腹部绞痛、呕吐、腹胀及梗阻症状。

　　6、肛门周围阿米巴病：该病较少见，在临床上常误诊。当有皮肤损伤或肛裂、肛管炎及隐窝炎等病变时，阿米巴滋养体即可直接侵入皮肤内而引起肛门周围阿米巴病，有时病变可继发于挂线法治疗痔瘘之后，阿米巴滋养体偶可通过血行感染肛门周围组织，出现粟粒样大小棕色皮疹，其疹扁平隆起，边缘不清，最后形成溃疡或脓肿，破裂后排出脓液及分泌物。易被误诊为直肠肛管癌、基底细胞癌或皮肤结核等。

　　二、肠外并发症：阿米巴滋养体可自肠道经血流一淋巴蔓延远处器官而引起各种肠外并发症，其中以肝脓肿为是常见，其次如肺、胸膜、心包、脑、腹膜、胃、胆囊、皮肤、泌尿系统、女性生殖系统等均可侵及。

　　阿米巴肠病潜伏期长短不一，自1～2周至数月以上不等，虽然患者早已受到溶组织内阿米巴包囊感染，仅以共栖生存，当宿主抵抗力减弱以及肠道内感染等，临床上始出现症状，根据临床表现不同，分为以下类型：

　　1. Asymptomatic carriers:Although patients are infected with Entamoeba histolytica, the amoebae only exist as commensals, and more than 90% of people do not produce symptoms and become cyst carriers. Under appropriate conditions, they can invade tissues, cause lesions, and appear symptoms. Therefore, from the perspective of controlling the source of infection and preventing pathogenicity, cyst carriers should be paid enough attention and must be treated.

　　2. Acute atypical amoebic enteritis:The onset is relatively slow, with no obvious systemic symptoms, with only loose stools, sometimes diarrhea, several times a day, but without typical dysentery-like stool, similar to general enteritis. Trophozoites can be found in stool examination.

　　3. Acute typical amoebic enteritis:The onset is often slow, starting with abdominal pain and diarrhea, with the frequency of defecation gradually increasing to 10 to 15 times a day. There is varying degrees of abdominal pain and tenesmus during defecation, indicating that the lesion has spread to the rectum. The stool is bloody and mucous, often dark red or purple, paste-like, with a foul smell. In severe cases, it can be bloody stool, or a little fresh red blood on the white mucous membrane. The general systemic symptoms of the patient are usually mild, and in the early stage, the body temperature and white blood cell count may increase, and trophozoites can be found in the stool.

　　4. Acute fulminant amoebic enteritis:The onset is acute, with poor overall nutritional status, a serious appearance, and significant toxic symptoms, such as high fever, chills, delirium, abdominal pain, and severe tenesmus. The stool is purulent and bloody, with a foul odor, and can also be watery or jelly-like, with more than 20 times a day. It is accompanied by vomiting, fainting, varying degrees of dehydration and electrolyte disorder, neutrophilia in blood tests, and is prone to intestinal hemorrhage or perforation. If not treated in time, death can occur due to sepsis within 1 to 2 weeks.

　　5. Chronic persistent amoebic enteritis:It is usually a continuation of acute infection, with diarrhea and constipation alternating, and the course of the disease may last for several months or even years without cure. During the intervals, one can be healthy as usual, and recurrence is often caused by improper diet, overeating, drinking, catching a cold, fatigue, and other factors. Daily diarrhea occurs 3 to 5 times, and the stool is yellow paste-like, and trophozoites or cysts can be found. Patients often have umbilical or dull pain in the lower abdomen, varying degrees of anemia, emaciation, malnutrition, and other symptoms.

　　Amoebiasis is prevalent worldwide, mostly in tropical and subtropical regions, but even in relatively cold areas, even within the Arctic Circle, there are amoebic infections and outbreaks. The infection rate is closely related to environmental hygiene, economic conditions, and dietary habits in various regions. It is estimated that about 10% of the world's population is infected, and in some places, the infection rate can reach up to 50%. In China, the distribution is generally higher in rural areas than in urban areas. In recent years, due to the improvement of health conditions and living standards in China, acute amoebic dysentery and abscess cases have become rare except in some areas, and most are scattered chronic persistent cases, typical cases, and carriers.

　　1. Source of infection:Chronic patients, convalescent patients, and healthy carriers are the sources of infection for this disease. Cysts have strong resistance, and can survive for more than 12 days in a humid and cold environment, and for 9-30 days in water. However, cysts have weak resistance to dryness, high temperature, and chemical drugs. At 50°C, they will die quickly, and their survival time in a dry environment is only a few minutes. They cannot survive for a long time in 0.2% hydrochloric acid, 10%-20% saltwater, and soy sauce, vinegar, and other condiments. 50% alcohol can kill them quickly.

　　2. Transmission routes:The transmission modes of Entamoeba histolytica include the following: ① Cyst contamination of water sources can cause outbreaks in the area; ② Unwashed and uncooked vegetables used as fertilizer are also important factors for transmission; ③ Cysts can be transmitted by hands, food, or utensils; ④ Flies and cockroaches can contact feces, carry cysts on their bodies, and vomit them, thereby becoming important vectors for transmission.

　　3. Epidemic characteristics:Entamoeba histolytica is widely distributed. In temperate regions, the disease can occur occasionally, and in tropical and subtropical regions, the situation is particularly serious. Since the liberation of China, the infection rate of amebas in various places has decreased significantly. For example, from 1973 to 1978, the Capital Hospital of Beijing examined a total of 38,075 cases, with a positive rate of 0.52%; in 1976, 216 children were examined in Huian, Fujian Medical University, with a positive rate of 4.63%; in 1980, the Northeastern Medical College reported that 487 middle school students in the suburbs were examined, with a positive rate of only 0.4%; in 1979, a general survey of 557 farmers in Leqing, Zhejiang Province, showed a positive rate of 3.2%. The incidence varies from time to time, with autumn being the most common, followed by summer. The incidence is higher in men than in women, and in adults than in children, which may be related to eating food containing cysts or age immunity.

　　1. Pathogenic examination

　　1. Feces examination:

　　(1) Live trophozoite examination method: The direct smear method with physiological saline is commonly used to examine active trophozoites, such as purulent and bloody stools in acute dysentery patients or loose stools in amebic colitis patients. It is required that the container be clean, the feces fresh, and the sooner the inspection is sent, the better. In cold seasons, attention should also be paid to insulation during transportation and examination. During the examination, take a clean glass slide, add one drop of physiological saline, use a bamboo stick to take a small amount of fecal material, spread it in the physiological saline, cover with a glass slide, and then examine it under a microscope. The typical amebic dysentery feces is dark red jelly-like, with a special smell, and the microscope examination shows that the mucus contains a large number of clumped red blood cells and fewer white blood cells. Sometimes, Schistosomiasis-Leyden crystals (Charcot-Leyden crystals) and active trophozoites can be seen, which can be distinguished from the feces of bacterial dysentery.

　　(2) Cyst examination method: The iodine film method is commonly used in clinical practice, which is simple and easy to operate. Take a clean glass slide, add one drop of iodine solution, then use a bamboo stick to take a small amount of feces and spread it into a thin film in the iodine solution, cover with a glass slide, and then examine it under a microscope to identify the characteristics and number of cell nuclei.

　　2. Amebic culture: There are various improved artificial culture media, commonly used ones such as洛克氏液, eggs, serum culture medium, nutrient agar serum saline culture medium, agar protein peptone biphase culture medium, etc., but the technical operation is complex, requires certain equipment, and amebic artificial culture has a low positive rate in most subacute or chronic cases, so it is not advisable to use it as a routine examination for amebic diagnosis.

　　3. Tissue examination: Directly observe mucosal ulcers through sigmoidoscopy or colonoscopy, and perform tissue biopsy or scraping smear. The detection rate is the highest. It is reported that about 2/3 of the cases with lesions in the sigmoid colon and rectum are symptomatic patients. Therefore, all suspected patients whose conditions allow it should strive to undergo colonoscopy, scraping smear, or tissue biopsy. The sampling of trophozoites must be from the edge of the ulcer, and it is preferable for slight bleeding to occur after the clamp is removed. The examination of pus cavity puncture fluid should pay attention to the morphological characteristics, and the sampling should be taken from the wall of the pus cavity, which is easier to develop trophozoites.

　　II. Immunological Diagnosis

　　In recent years, various serological diagnostic methods have been reported in China, among which indirect hemagglutination (IHA), indirect fluorescent antibody (IFAT), and enzyme-linked immunosorbent assay (ELISA) have been studied more. However, the sensitivity varies among different types of cases, with IHA having higher sensitivity, the positive rate for intestinal amebiasis reaching 98%, and the positive rate for extra-intestinal amebiasis reaching 95%. For asymptomatic carriers, it is only 10%-40%. The sensitivity of IFA is slightly lower than that of IHA, EALSA has strong sensitivity and high specificity, and has a promising future. Complement fixation test has a certain trap significance for the diagnosis of extra-intestinal amebiasis, with a positive rate of more than 80%. Other tests such as gel diffusion precipitation test, intradermal test, and others have the value of auxiliary diagnosis. In recent years, there have been reports of the successful application of sensitive immunological techniques in the detection of amebic specific antigens in feces and pus. Especially the application of monoclonal antibodies against amebic rhinosclerosis provides a reliable, sensitive, and anti-interference tracer for detecting pathogenic substances in host excretions.

　　III. Diagnostic Treatment

　　If, after high clinical suspicion and still unable to make a definitive diagnosis with the above examinations, a sufficient dose of santonin injection or oral Anlitiping, metronidazole, and other treatments can be given. If the effect is significant, a preliminary diagnosis can also be made.

　　I. Dietary therapy for amebic dysentery

　　1. Prescription One

　　Medicines: Flesh of Chinese prune 20-30 grams, ginger 5-10 grams, green tea leaves 3-5 grams, brown sugar in appropriate amount.

　　Usage: Crumble the flesh of Chinese prune, and slice ginger. Put the flesh of Chinese prune, ginger, and green tea leaves into the pot, boil for 5 minutes, and stir in brown sugar. Take 1 dose daily, divided into 2 servings, taken warm.

　　Indications: Used as an auxiliary treatment for amebic dysentery and bacterial dysentery.

　　2. Prescription Two

　　Medicines: Herba Siegesbeckiae (without lotus root) 25 grams, Liquorice 6 grams,芍药 6 grams.

　　Usage: Place Herba Siegesbeckiae, Liquorice, and芍药 in a sand pot, add an appropriate amount of water, boil, remove the residue, and drink the juice. Take 1 dose daily, divided into 2 servings.

　　Indications: Used as an adjuvant treatment for amebic dysentery.

　　2. Food therapy recipes:

　　1. Green tea leaves 30g, steeped in a bowl of boiling water to taste, taken two to three times a day.

　　2. Fungus 5g, brown sugar 60g, add half a bowl of water, cook until done, take the decoction with the residue, once a day or in two doses.

　　3. Chrysanthemum flowers 30g, brown sugar 60g, scalded and cooked until soft, eat once a day or in two doses.

　　4. Fresh Portulaca oleracea 60g, crushed, add 4 bowls of water and appropriate amount of brown sugar, boil to 3 bowls, take 1 bowl each time, three times a day.

　　3. Simple recipes:

　　1. Duck galls: Shell and take the kernel, adults take 15-20 seeds each time, three times a day; in capsules, taken after meals. For 7-10 days as one course. Duck galls have a killing effect on amebic trophozoites and the cure rate for amebic dysentery is 50%, symptoms disappear in 2-7 days, negative microscopy in 3-5 days, and recurrence rate is about 6%.

　　2. Bai Tou Weng: Take the rhizome 15-30g per day, decocted and taken in three divided doses. 7-10 days is one course, or it can be used in decoction. For severe cases, 30-50g can be decocted to 100ml for retention enema, once a day. High doses of Bai Tou Weng can inhibit the growth of amebae and have a astringent effect on the intestinal mucosa, so it can stop diarrhea and stop bleeding.

　　3. Garlic: Purple garlic, one clove per day (about 6g), for 10 days as one course. 10% garlic extract can be used for retention enema, suitable for chronic amebic dysentery.

　　4.石榴皮: Dry product 60g, add 200ml of water, decoct to 100ml, filter and remove the residue to obtain 60%石榴皮 decoction. Adults take 20ml each time, three times a day. For chronic amebic dysentery, 6 days is one course of treatment. If it is ineffective, continue for another course. The cure rate for one course is 90%.

　　5. Tianxianglu (Jinjinxiang): Use 30-60g, decocted for oral administration, take one dose per day, once in the morning and once in the evening on an empty stomach, for 3-5 days in a row. Avoid eating tofu and eggs during the medication period. It has a good effect on amebic dysentery.

　　6. Iron wire grass: 60g, wind tail grass 60g, garlic 30g, decocted for oral administration. It has a certain therapeutic effect on amebic dysentery.

　　What should amebic dysentery patients eat:

　　To reduce intestinal irritation and allow the intestines to rest and recover, fasting should be the first measure for 1-2 days after onset of the disease, and intravenous fluid replacement may be necessary. If symptoms are severe, the fasting period should be extended to allow complete rest of the intestines. After symptoms subside, start with clear liquid food, with the best option being rice gruel and thin lotus root starch. This can be consumed 6-7 times a day, and it is also appropriate to drink salted water. If the frequency of bowel movements decreases, you can switch to liquid food. Besides rice gruel and lotus root starch, you can add steamed egg custard, egg flower soup, juice, strained vegetable juice, and almond cream, among others. As the condition improves further, you can switch to low-fat, low-fiber semi-liquid food. Foods should be easy to digest and absorb, and avoid gas-forming and strongly刺激性 seasonings. White rice porridge, thin noodles, thin noodles, toasted bread, toasted steamed buns, and a small amount of easily digestible protein foods such as minced fish and chicken can be used. During the recovery period, soft rice with few residues can be consumed. However, coarse grains, beans, and vegetables and fruits with high fiber content should not be used before the patient's bowel movements return to normal. If desired, they can be made into purees, fruit purees, and juices. Milk should not be used.

　　First, differential diagnosis and treatment:

　　1. Damp-heat dysentery:

　　Treatment method: Clear heat, transform dampness, and detoxify, supplemented with regulating Qi, promoting blood circulation, and promoting defecation.

　　Herbal medicine: Modified Ge Gen Huang Qin Huang Lian Decoction: Ge Gen 15g, Licorice 3g, Scutellaria 9g, Coptis 9g; decocted in water for oral administration. Modified Bai Tou Weng Decoction: Bai Tou Weng 15g, Phellodendron 12g, Coptis 6g, Qin Pi 12g; decocted in water, add Moschus, Qingpi, and White Peony for severe abdominal pain; add Diyu, Huaihua, and Danggui for abundant fresh blood in stools. Add Xiangru, Dandoukou for exterior symptoms, add Zhike, Baima, and Houpu for retained food.

　　2. Epidemic toxicity dysentery:

　　Treatment method: Clear heat, cool blood, and detoxify.

　　Herbal medicine: Bai Tou Weng Decoction: (Bai Tou Weng, Qin Pi, Coptis, Phellodendron) add Lonicera. Diyu, Chishao, Danpi, Zhike, Moschus, etc. If symptoms include high fever, delirium, even convulsions, red tongue with deep purple coating. Yellow and dry coating, thready rapid pulse, it indicates deep invasion of heat-toxin into the heart, use Shen Xi Dan: Rhinoceros horn, Acorus calamus, Scutellaria, fresh Rehmannia, Lonicera, Jinjiu, Forsythia, Isatis, Xiangdou, Astragalus, Flos Lonicerae, Flos Chrysanthemi, Huashi, Shuishi, Shiliu, Cimicifuga, Rhizoma Atractylodis Macrocephalae, Fructus Amomi, Atractylodes, Paeonia lactiflora, Fructus Amomi, Shexiang. To clear heat and detoxify, and ventilate the orifices and relieve convulsions. If symptoms include sweating, cold limbs, thready and rapid pulse, coma, it indicates internal closure and external exudation, use Shenfu Decoction or Dushen Decoction to rescue the Yang.

　　3. Cold-damp dysentery:

　　Treatment method: Warm the middle-jiao, transform dampness, and regulate Qi.

　　Herbal medicine: ① Fu Gui Li Zhong Decoction: Codonopsis 12g, Dried Ginger 9g, White Atractylodes 12g, Prepared Licorice 6g; decocted in water for oral administration. Add Angelica Sinensis, Moschus, and White Peony. ② Mugwort 3g, Dried Ginger 3g, Raphanus sativus seed 4.5g; decocted in water, take three doses a day.

　　4. Deficient-cold dysentery (protracted dysentery):

　　Treatment method: Tonify the middle and reinforce the Qi, clear the intestines and astringe.

　　Herbal medicine: Bu Zhong Yi Qi Decoction: Astragalus 15g, Licorice 6g, Codonopsis 12g, Angelica Sinensis 10g, Tangerine Peel 6g, Cimicifuga 3g, Bupleurum 3g, White Atractylodes 9g; decocted in water for oral administration. He Taohua Decoction: Red Ochre 24g, Dried Ginger 6g, Glutinous Rice 30g; decocted in water for oral administration. If acute dysentery symptoms are present, it indicates uncleaned damp-heat, remove astringents such as Red Ochre and Dried Ginger, and add herbs for clearing heat, transforming dampness, and detoxifying. If chronic dysentery does not heal, it耗伤 Yin and blood, presents with purulent dysentery with red and white sticky mucus, weakness, fatigue, abdominal pain, slight fever, red tongue with little saliva, and thready rapid pulse, it is Yin deficiency dysentery. Use Huanglian Ejiao Decoction combined with Zhucheng Wan (Coptis, Ejiao, Scutellaria, chicken egg yolk, Peony, Angelica Sinensis, Dried Ginger) for modification.

　　5, Rest dysentery:

　　Treatment method: Warm the middle energizer and harmonize the blood, bitter and acrid to descend.

　　Prescription: Xiang Sha Liu Jun Zi decoction: Ren Shen, Bai Zhu, Fu Ling, Gan Cao, Ban Xia, Chen Pi, Mu Xiang, Sha Ren. Or Lian Li decoction: Ren Shen, Bai Zhu, Gan Jiang, Zhì Cao, Huang Lian, Fu Ling, add or subtract. If the symptoms are that the disease occurs when exposed to cold, with white diarrhea, lack of appetite, pale tongue with white fur, deep pulse, it indicates extreme spleen Yang deficiency, cold accumulation in the intestines that does not dissolve, use Wen Pi decoction: Ren Shen, Gui Xin, Gan Jiang, Fu Zi, Da Huang, add or subtract.

　　6, Lockjaw dysentery:

　　Treatment method: Clear heat and dampness, harmonize the stomach and reduce turbidity.

　　Prescription: Use Kai Jin San: Ren Shen, Huang Lian, Shi Gao Pu, Dan Shen, Shi Liu Zi, Fu Ling, Chen Pi, Dong Gua Zi, Chen Mi, He Ye Ti. Combine with Xie Xin decoction: Da Huang, Huang Qin, Huang Lian. Add or subtract. If the decoction is not acceptable, use Yu Zhu Dan first: Shan Ci Gu, Xu Sui Zi, Da Ji, She Xiang, Yao Huang, Zhu Sha, Wu Bai Zi. Take in small quantities. If the tongue is red and dry, and the pulse is fine, it indicates that the stomach yin is greatly injured, and Shu Di, Mai Dong, Sha Shen, Sheng Di should be added to nourish the stomach and moisten the yin.

　　Two, Treatment with traditional Chinese medicine formulas:

　　1, Bai Tou Weng decoction combined with Ge Gen Qin Lian decoction:30g of Bai Tou Weng, 15g of Huang Qin, 9g of Hua Ji Zi, 9g of Hou Po, 9g of Huoxiang. For those with aversion to cold and high fever, add 12g of Ge Gen, 15g of Shuang Hua; for those with more red stools, add 15g of Sheng Di Yu; for those with nausea and vomiting, add 9g of Ban Xia; for those with abdominal pain, add 10g of Bai Shao; for those with injury of fluid, appropriate fluid replacement should be done.

　　2, Prescriptions:50g of Danggui, 50g of Fangfeng carbon, 15g of Bai Tou Weng, 15g of Bei Qinpi, 15g of Stir-fried Huang Bai, 25g of Sheng Di Huang, 5g of Braised ginger carbon, 15g of Chi Shao, decocted in water.

　　3, Prescriptions:10g of Danshen, 10g of Stir-fried Baizhu, 3g of Cimicifuga, 3g of Braised ginger, 10g of Bai Shao, 5g of Braised Muxiang, 10g of Stir-fried Shaocarbol, 5g of Wumei carbon, 3g of Prepared Liquorice, 5g of Guang Chenpi, 10g of Shiliu. Decocted in water. Western medical treatment methods for amebic colitis

　　Three, General treatment:During the acute stage, bed rest is required, and intravenous fluid therapy may be given if necessary. Depending on the condition, a liquid or semi-liquid diet should be provided. Chronic patients should enhance nutrition to strengthen their physical fitness.

　　Four, Pathogenetic treatment:

　　1, Metronidazole, also known as metronidazole (metronidazole):It has a strong killing effect on amebic trophozoites and is relatively safe, suitable for all types of amebiasis both inside and outside the intestines, and is currently the first-line drug for the treatment of amebiasis. The dose is 400 to 800mg, taken orally, three times a day for 5 to 10 consecutive days; for children, it is 50mg per kilogram of body weight per day, taken in three divided doses, for a continuous period of 7 days. Nausea, abdominal pain, dizziness, and palpitations may occur occasionally during the medication period, which do not require special treatment. It is contraindicated for pregnant women within the first three months of pregnancy and lactating women. The efficacy reaches 100%.

　　2, Tinidazole:It is a derivative of nitroimidazole compounds. The dose is 2g per day; for children, it is 50mg per kilogram of body weight per day, taken once in the morning, for 3 to 5 consecutive days. Occasional symptoms may include anorexia, abdominal discomfort, constipation, diarrhea, nausea, itching, etc. The efficacy is similar to or better than that of metronidazole.

　　III. Ipecac Alkaloid:Has a high killing effect on the trophozoites in the tissue, but is ineffective against the amoebae in the intestinal lumen. This drug is extremely effective in controlling acute symptoms, but the cure rate is low, and it needs to be combined with halogenated quinolone drugs and other drugs. The dose is calculated at 1mg per kilogram per day, not exceeding 60mg per day for adults, usually 30mg per dose, twice a day, deep subcutaneous or intramuscular injection, for 6 consecutive days.

　　This drug has a high toxicity, and bed rest should be taken before each injection, and blood pressure and pulse should be measured, with attention to heart rate and blood pressure drop. Toxic reactions include vomiting, diarrhea, abdominal绞痛, weakness, muscle pain, tachycardia, hypotension, precordial pain, and abnormal electrocardiogram, occasionally arrhythmia. Contraindicated for children, pregnant women, and those with cardiovascular and renal diseases. If repeated treatment is needed, at least 6 weeks should be separated.

　　IV. Halogenated Quinolones:Primarily acts on the amoebae in the intestinal lumen rather than the tissue. Effective for mild cases and those excreting cysts, often combined with ipecac alkaloid or metronidazole for severe or chronic patients. Iodophor solution 100-150ml for retention enema. The main side effects are diarrhea, occasional nausea, vomiting, and abdominal discomfort. Contraindicated for those allergic to iodine and those with thyroid disease.

　　V. Other:Anteridine, oral, 0.5g, 3 times a day, for 10 consecutive days; paromomycin, 15-20mg per kilogram of body weight per day, taken in divided doses, for 5-7 days; antidiarrheal, oral, 0.1g, 3 times a day, for 10 consecutive days. The above three drugs all act on the amoebae in the intestinal lumen.

　　In addition to metronidazole, most of the above drugs often require the combined use of 2 or more drugs to achieve a better effect.

　　V. Treatment of complications:Under the active and effective treatment of metronidazole and ipecac alkaloid, all intestinal complications can be alleviated. Patients with fulminant type have mixed bacterial infections and should be given antibiotics. Large amounts of intestinal hemorrhage can be treated with blood transfusion. Patients who must undergo surgical treatment for intestinal perforation, peritonitis, and other conditions should be treated under metronidazole and antibiotic therapy.

　　Amoebiasis of the intestines has a good prognosis if treated promptly. If complications such as intestinal hemorrhage, intestinal perforation, and diffuse peritonitis occur, or if there are liver, lung, or brain metastatic abscesses, the prognosis is poor. After treatment, the original parasites in the stool should be tested for about half a year to detect possible recurrence early.