Amebic cervicitis

　　One, Etiology

　　Caused by Entamoeba histolytica. Most amebas in the reproductive tract come from the trophozoites in the intestinal tract, and a very small number are transmitted through sexual contact. Not everyone who is infected with amebas develops the disease; whether or not the disease occurs depends on the individual's resistance, the number of trophozoites, and the virulence of the strain.

　　Two, Pathogenesis

　　The pathogenic ameba that can cause disease in humans is Entamoeba histolytica, which has a life cycle with two stages: trophozoite stage and cyst stage. The trophozoite can cause damage to the body's tissues, while the cyst can cause infection between individuals. Infections between humans and animals are rare. After the ameba invades the mucous membrane of the reproductive tract, it relies on the tissue lysin secreted by it to dissolve the surrounding tissue, causing damage to the mucosa, leading to ulcers. The virulent strains can even invade the submucosal tissue. Therefore, the ulcers are usually large and deep, and scars often remain after healing.

　　It is often accompanied by amebic vaginitis. Amebic vaginitis (Amebic vaginitis) often secondary to intestinal infection, the amebae trophozoites (Amebictrophozoite) in the patient's stool are excreted with stool mucus, directly spreading to the vulva and vaginal orifice.

　　Since the disease is relatively rare, it may sometimes be ignored by clinical doctors, but a diagnosis can be made according to the history of diarrhea or dysentery and relevant tests. The most reliable diagnosis is to find amebae trophozoites in the vaginal secretion (simultaneously examine the patient's feces). Direct smear method or culture method can be used to find entamoeba histolytica, as well as pathological examination of the lesion. For cases of chronic vaginal ulcer with negative secretion examination, it is more necessary to perform histological examination.

　　The main manifestations are increased vaginal discharge,呈脓性, purulent or serous, with a foul smell, accompanied by vaginal inflammation, often with vaginal pain and burning sensation, without pruritus vulvae. Gynecological examination and vaginal speculum examination show that the cervix is deformed with worm-eaten ulcers and necrotic tissue, the edge of the ulcer is convex like a volcanic crater, covered with dirty grayish yellow secretion, the leukorrhea is yellowish purulent or bloody mucus, easy to bleed on palpation, and easy to be misdiagnosed as cervical cancer.

      Daily care points for chronic cervicitis:

　　1. Fumigation and washing:30 grams of Cnidium monnieri, 30 grams of ku shen, 15 grams of calomel, 10 grams of Phellodendron amurense, decocted, first fumigate and wash the genital area, then sit in the bath, suitable for damp-heat syndrome.

　　2. Massage:First, warm your palms, then rub the lower abdomen several times with your palms facing down, and then massage the inner side of the thighs several times with your palms. Apply more techniques to the painful areas to the extent of feeling warmth. Finally, rub the lumbar sacral area several times and then change to the friction method for 2-3 minutes to make the warmth spread to the lower abdomen.

　　3. Fomentation:① Ku shen suppository, each tablet weighing 1.2 grams, one tablet each night, inserted deeply into the vagina. ② Funing suppository, each tablet weighing 1.6 grams. Before going to bed, rinse the vagina, insert one Funing suppository into the deep part of the vagina, and then use a sterile cotton ball the size of a walnut to insert into the vaginal orifice to prevent the drug from flowing out. These methods are suitable for damp-heat syndrome. ③ 3 grams of calomel, 6 grams of Cnidium monnieri, finely ground together, mixed with wax to form pills the size of a bullet, wrapped with disinfected gauze and inserted into the vagina, changed once a day until cured. Used for deficiency syndrome.

　　1. Secretion smear:Search for amebae trophozoites, tumor marker examination, take a living tissue section from the edge of the ulcer for pathological examination, where amebae trophozoites can be seen. Clinically, it is highly suspected that vaginal secretion can be cultured, but the culture of amebas requires high conditions and complex technology, which is generally difficult to perform in general hospitals.

　　2. Peripheral blood:Present with normocytic, normochromic anemia, normal platelets, and normal or elevated white blood cells.

　　3. Pregnancy test:Positive.

　　4. Gynecological examination:The uterine cervix is enlarged, with very obvious coloration, soft texture, the cervical os can be dilated, and sometimes dark red or purple tissue can be seen, and there seems to be tissue impacted in the cervical os. However, when trying to separate and extract the tissue and cervix with fingers, a large amount of bleeding may occur. The most characteristic change is that the uterus is葫芦-shaped during gynecological three-point examination, with a small uterus body, slightly hard, a large cervix, soft, and sometimes the uterine artery pulse can be felt, which is a typical manifestation of cervical pregnancy.

　　Detection of blood β-hCG. The development of blood β-hCG detection technology and ultrasound has made early diagnosis of cervical pregnancy possible.

　　5. Ultrasound examination:The manifestations under abdominal or vaginal ultrasound:

　　(1) The cervical canal is dilated.

　　(2) There is a complete gestational sac in the cervical canal, and sometimes the germ or fetal heart can be seen.

　　(3) Closure of the cervical internal os.

　　(4) Cavity of the uterus. Color Doppler ultrasound is used to investigate the situation of trophoblast infiltration into the uterine cervix stroma, as well as the position of the uterine artery. The uterine artery crosses the ureter at 2cm from the level of the internal os of the uterus and reaches the lateral margin of the uterus. This anatomical position can help determine whether the gestational site is below the histological internal os of the uterine cervix to help diagnose cervical pregnancy.

　　One. Amoebic cervicitis food therapy recipe:

　　1. Dandelion lean meat soup: 250g of lean pork, 30g of dandelion, and 30g of coix seed. Wash dandelion, raw coix seed, and lean pork, put them in a pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for 1-2 hours, season and serve, suitable for mealtime consumption. It has the effects of clearing heat and detoxifying, removing dampness, and stopping leukorrhea, suitable for damp-heat type acute cervicitis.

　　2. Chicken crown flower lean meat soup: 20g of chicken crown flower, 100g of lean pork, and 10 red dates. Wash the chicken crown flower, red dates (without kernel), and lean pork. Put all the ingredients in a pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for 30 minutes, season and serve, suitable for free consumption. It has the effects of clearing heat and removing dampness, and stopping leukorrhea, suitable for damp-heat type cervicitis. Chicken crown flower has two colors, white and red. The white one is mainly for infiltrating dampness and clearing heat, treating leukorrhea; the red one, in addition to clearing heat and removing dampness, can also enter the blood to treat red and white leukorrhea. When used, choose according to different symptoms.

　　3. Three Marvelous Quail Soup: 1 fat and tender quail (about 100g), 30g of coix seed, 12g of Phellodendron amurense, and 6g of Atractylodes. Slaughter the quail, remove the feathers and internal organs, wash; roast the coix seed slightly yellow, remove the fire, and set aside; wash Phellodendron amurense and Atractylodes. Put all the ingredients in the pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for about 2 hours, season and serve, suitable for mealtime consumption. It has the effects of clearing heat and detoxifying, and promoting diuresis and stopping leukorrhea, suitable for damp-heat type acute cervicitis.

　　4. Cucumber, Turmeric, and Snake Soup: 500g of cucumber, 100g of turmeric, 60g of red beans, 250g of snake, 30g of ginger, and 8 red dates. Skin the snake, remove the internal organs, boil in a pot of boiling water, remove the bones and take the meat; wash the fresh cucumber. Put the above ingredients and the snake meat in the pot, add an appropriate amount of water, boil over high heat, then simmer over low heat for 3 hours, season and serve. Take 1 dose daily, with 5-7 days as one course of treatment. It has the effects of clearing heat and detoxifying, and removing dampness, suitable for acute cervicitis.

　　5. Portulaca Oleracea Lean Pork Soup: 250 grams of lean pork, 30 grams of Portulaca Oleracea, and 30 grams of Euryale Seed. Clean the Portulaca Oleracea, Euryale Seed, and lean pork, put them in a pot, add an appropriate amount of water, bring to a boil over high heat, then simmer over low heat for 2 hours, season, and serve as a side dish. It has the effects of clearing heat and detoxifying, and stopping dampness and leukorrhea, suitable for damp-heat type acute cervicitis.

　　6. Houttuynia Cervisiae and Pig Lung Soup: 60 grams of fresh Houttuynia Cervisiae, about 200 grams of pig lung, and an appropriate amount of table salt. Cut the pig lung into pieces, squeeze and wash to remove foam, add an appropriate amount of water, and boil into soup. Add a little salt for seasoning, and drink the soup and eat the pig lung. It has the effect of clearing heat and detoxifying, and is suitable for acute cervicitis.

　　7. 6 grams of Cornu Cervi, 30 grams of Bupleurum Seed, 30 grams of Chinese yam, and one pig bladder. First, clean the pig bladder, crush the drugs, and put them into the pig bladder, tie the bladder mouth tightly, and simmer over low heat until soft. Add a little salt for seasoning, and take the medicine, meat, and soup together.

　　8. 30 grams of Eucommia Ulmoides (wrapped in cloth), 30 to 60 grams of glutinous rice, cooked into porridge, the medicinal residue removed, and the porridge eaten. Take one dose daily, for 7 to 8 doses consecutively.

　　9. 9 grams of Dolichos Lablab flower, 12 grams of Albus椿 bark, wrapped in gauze, boiled in 200 milliliters of water to 150 milliliters, taken in divided doses, usually effective in one week.

　　10. Take 30 grams of new silkworm ash (wrapped in cloth), 30 grams of Coix Seed, and boil them in a pot with an appropriate amount of water. Take one dose daily, for 5 to 7 days consecutively.

　　Secondly, foods that are good for patients with amebic cervicitis:

　　Animal liver, milk, peanuts, eggs, green leafy vegetables, and other foods rich in B vitamins.

　　Thirdly, foods that should be avoided for amebic cervicitis:

　　1. Patients with amebic cervicitis should avoid spicy, fried, and warm foods: Spicy and fried foods such as chili, fennel, Sichuan pepper, onions, mustard, roasted chicken, fried pork chops, etc.; warm foods such as beef, mutton, and dog meat can all promote heat and inflammation, worsening the condition. Avoid seafood and river products: Sea fish, crabs, shrimps, clams, hairy clam, oysters, and abalones are all irritants, which are not conducive to the regression of inflammation.

　　2. Patients with amebic cervicitis should avoid sweet and greasy foods: Foods that are too sweet and greasy, such as candies, cream cakes, eight-treasure rice, glutinous rice dumplings, lard, and fatty pork, these foods have the effect of promoting dampness and may reduce the therapeutic effect, making the condition difficult to treat. Avoid alcohol: Alcohol is a warm and stimulating food, drinking alcohol will exacerbate damp-heat, making the condition worse.

　　Firstly, the internal treatment for cervicitis in traditional Chinese medicine is as follows:

　　1. Deficiency of both the spleen and kidney:Leukorrhea in large quantity, white in color and thin in quality, with a fishy smell. Weakness in the loins and knees, poor appetite, loose stools, pain in the lower abdomen, frequent urination, pale tongue with white slippery coating, deep and slow pulse.

　　Therapeutic Method: Strengthen the spleen and kidney, transform dampness, and stop leukorrhea.

　　Prescription: 15 grams each of Codonopsis, Astragalus, Poria, Coix Seed, Osseous Odor, Cuttlefish Bone, 10 grams each of Morinda Officinalis, Euryale Seed, and 6 grams of prepared Liquorice. Patent medicine: Warming the Channels and White Leukorrhea Pill.

　　2. Downward flowing damp-heat:Leukorrhea in large quantity, yellowish or with blood streaks, thick and resembling pus, foul smell, burning and swelling in the vagina, short and yellow urine, red tongue with yellow greasy coating, slippery and rapid pulse.

　　Therapeutic Method: Clear heat, drain dampness, and stop leukorrhea.

　　Prescription: Poria, Poria cocos, red peony, Moutan bark, patrinia scabiosa, gardenia, Coptis, Platycodon grandiflorus (powder), Cynanchum wilfordii (powder), each 15 grams, safflower, atractylodes, Cuscuta reflexa (powder), each 10 grams, raw licorice 6 grams.

　　Chinese patent medicine: Anti-cervical inflammation tablets.

　　Two, the main external treatment methods in the traditional Chinese medicine treatment of cervicitis are as follows:

　　1. Vaginal lavage method:Chrysanthemum, Atractylodes, Sophora flavescens, Artemisia argyi, Cnidium monnieri, each 15 grams, stemona root, Phellodendron amurense, each 10 grams. Boil 20ml, perform vaginal lavage, once a day, 10 times as one course of treatment. Suitable for acute cervicitis.

　　2. Cervical medication method

　　① Dandelion, scutellaria baicalensis, hemerocallis, Phellodendron amurense, each 15 grams, Coptis, Scutellaria baicalensis, raw licorice, each 10 grams, borneol 0.4 grams, catechu 1 gram. Grind into fine powder, apply to the cervix affected area, once every other day. Suitable for acute cervicitis.

　　② Shuangliao Fengfeng powder: First wipe off the secretion on the surface of the cervix, then spray the medicine powder on the affected area, twice a week, 10 times as one course of treatment. Suitable for acute cervicitis and cervical erosion.

　　③ Yin nourishing and muscle building powder: Clean the cervix, spray the medicine powder on the affected area, twice a week, 10 times as one course of treatment, suitable for cervical erosion.

　　From the above introduction, it can be known that there are many traditional Chinese medical treatment methods for cervicitis. However, when patients choose to implement specific treatments and medications, they must be guided by professional doctors.

　　Three, Western Medical Treatment Methods for Amoebic Cervicitis

　　Amoebic cervicitis is mainly treated with systemic therapy and local treatment as an adjunct.

　　1. Metronidazole (Flagyl) tablets:200mg each time, 3 times/d, 10-14 days as one course of treatment, which can achieve therapeutic effects quickly.

　　2. Chloroquine tablets:0.6g/d, take for 2 days, then change to 0.3g, once/d, 2-3 weeks as one course of treatment.

　　3. Other Medications:Tetracycline and Brucea javanica have inhibitory effects on amebas and can be taken orally. Tetracycline 0.5g, 4 times/d, for 5-6 days in total. Brucea javanica seeds 10-15 grains, 3 times/d, 1 week as one course of treatment.

　　4. Local Treatment:After washing with 10% lactic acid or 1:5000 potassium permanganate and wiping clean, the above drugs are made into suppositories and placed inside the vagina. 1 time/d, 7-10 days as one course of treatment. Place metronidazole effervescent tablets inside the vagina, once a night, 10 days as one course of treatment.