Input:

Input: For common mild to moderate mumps, external applications of mumps-related formulas have been widely used in various regions in recent years: ① Mix vinegar with indigo dye. ② Mix water with golden yellow powder. ③ Use Ji De Sheng Snake venom as medicine. ④ Use white pepper powder. ⑤ Use the roots of Wan Nian Qing. ⑥ Mix rice vinegar with camphor. ⑦ Use fresh fish herb. ⑧ Mix fresh earthworm paste. ⑨ Grind vinegar with Aconite, Seven-Leaf One-Tip Flower, and other herbs, etc.y X ten Then extract their bark. ⑪ Take 30g each of red adzuki beans and indigo dye, along with 15g of rhubarb, grind them into a fine powder, and mix with one egg white. ② Marinate for 1 day, then add a small amount of bitter alum, and mash thoroughly until it resembles garlic juice. 4. Add 50g of alum, 45g of realgar, and camphor.

Afterward, apply the mixture as a paste. (1) Mix 30g of indigo dye with 15g of angelica root, 20g of dandelion, and 15g of licorice, then mix with water. ⑩ Mix with stone snail vinegar. ⑦ Prepare white lead plaster. 8. Add 9g of Wu Zhu Yu, 5g of Hua Zhang.

Mix all ingredients together and apply as a paste. (1) Mix 6g of purple flower groundwort, 2g of Aconite, and mix finely, then apply with 15g of vinegar to treat the Yongquan acupoint (both sides). According to Zhu Shuguang’s report on treatment methods for 125 cases: select acupoints such as Qie Fan, Ju Feng, He Gu, Wai Guan, Qu Chi, Feng Long, etc., applying treatment to 3–4 acupoints each time, using the method of “shu” for 3–5 minutes, without leaving needles in place; for facial acupoints, use penetrating needling, directing the needle tip toward the fatty gland area, and increase bloodletting at the Gao Re acupoint; for testicular swelling and pain, add Taichong and Qu Quan; for headaches, add Xia Xi and Feng Chi; for convulsions or meningeal irritation signs, add Shui Gou. Administer once daily, with 5 treatments constituting one course of therapy. Properly combine with antibiotics and antiviral medications; for high fever, add antipyretic and analgesic drugs, or use physical cooling methods; for patients with meningitis, administer dehydrating agents. Results: all cases were cured, with 115 cases cured within 1–5 days. (Journal of Integrated Traditional Chinese and Western Medicine, 1992) Meng Qingjun treated 58 cases of epidemic parotitis using traditional Chinese medicine both internally and externally. The internal treatment formula consisted of: 20g of Ban Lan Gen, 20g of Jin Yin Hua, 15g of Lian Qiao, 10g of Niu Lu Zi, 10g of Fu Jing, 10g of Huang Qin, 10g of Chi Shu, 10g of Pu Gong Ying, 10g of Gan Cao, one dose per day. For children under 5 years old, decoct 150mL; for children aged 6–8, decoct 200mL; for those over 8 years old, decoct 250mL, dividing the liquid into two doses. The external application formula consisted of: white alum, dried alum, and Huang Yan. According to needs, grind these ingredients into a powder in a 1:1 ratio, mix well with petroleum jelly ointment, apply to the affected area, changing the dressing every other day; three treatments constitute one course of therapy. Results: in unilateral cases, 42 cases were treated, with 33 cases fully recovered; in bilateral cases, 24 cases were treated, with 18 cases fully recovered. (Journal of North China Coal Medical College, 2007, Issue 5) Zheng Jinhong et al. treated 32 cases of epidemic parotitis with a combination of cactus external application and traditional Chinese medicine for clearing heat and detoxifying, achieving satisfactory results. The treatment regimen involved taking herbal decoctions for clearing heat and detoxifying, with 25g each of Da Qing Ye and Ban Lan Gen, 20g each of Jin Yin Hua, Lian Qiao, and Pu Gong Ying. First, soak the herbs in cold water for 30 minutes, then simmer over low heat for 20 minutes to extract the juice. The dosage of the medicine was adjusted according to age, ranging from 10–40ml per dose, with 6–8 doses per day. At the same time, take an appropriate amount of fresh cactus, remove the spines, crush it into a paste-like consistency, and apply it externally to the affected area 3 times a day. When the medicinal juice evaporated and dried, promptly replace with fresh juice and reapply. Results: among the 32 cases, 27 cases had a fever that subsided within a shortest of 1 day and a longest of 6 days, with the swelling of the parotid glands resolving in a shortest of 2 days and a longest of 6 days; other symptoms also disappeared within 3 days. Based on efficacy criteria, 27 out of 32 cases were cured, accounting for 84.38%, 4 cases showed improvement, accounting for 12.50%, and 1 case remained ineffective, accounting for 3.12%. The overall effective rate was 96.87%. (Clinical Oral Medicine Journal, 2007, Issue 6) Liu Shu'e developed a modified Qing Wen Xiao Zuo Tang formula to treat 64 cases of epidemic parotitis. The basic formula included: 10g of Chao Xu, 12g of Huang Qin, 12g of Huang Lian, 10g of Chen Pi, 12g of Lian Qiao, 10g of Xuan Shen, 6g of Chai Hu, 10g of Jiang Bing, 12g of Ban Lan Gen, 10g of Bo He, 3g of Zhang Can, and 5g of Sheng Ma. In clinical practice, adjustments were made: if the fever was severe and the parotid swelling was prominent, Chen Pi, Xuan Shen, and Jiang Bing were added, along with Jin Yin Hua and Da Qing Ye, focusing on clearing heat and detoxifying; for those with headache, add Mulberry Leaves and Chrysanthemum Flowers to clear the head and eyes; for those with cough, add Apricot Kernels, Peony Root, and Zhejiang Beimu to eliminate phlegm and relieve cough; for those with yellow phlegm, add Zhimu and Gua Wei Pi to clear phlegm and heat; for sore throat and redness, pair with Mabo, Yizhi Huanghua, Niuxi, and Shan Dou Gen to detoxify and benefit the throat; for dry stools, combine with Gypsum, Peony Bark, and Zhimu to clear lung and stomach heat. One dose per day, decocted in water and taken twice a day, for 7 days constituting one course of therapy; after each course, efficacy was evaluated. 48 cases were cured, accounting for 75%; 12 cases showed marked improvement, accounting for 18%; 4 cases were effective, accounting for 6.2%; no cases were ineffective. The overall effective rate was 100%. (Hebei Traditional Chinese Medicine, 2008, Issue 7) Niu Youxian used a modified Xiaochaihu Decoction to treat 80 cases of epidemic parotitis, achieving good therapeutic effects. The drug composition included: 5–10g of Chai Hu, 5–10g of Huang Qin, 5–10g of Banxia, 15–30g of Sheng Shi, 5–10g of Xia Ku Cao, 5–10g of Zhang Can, 10–15g of Ban Lan Gen, 5–10g of Jin Yin Hua, 5–10g of Lian Qiao, 5–10g of Jiang Bing, 3–6g of Gan Cao, one dose per day, decocted in water to make 400mL, divided into four doses for oral administration. If accompanied by headache, nasal congestion, or severe fever, add 5–10g of Bo He, 10g of Chan Tui, and 5–10g of Jing Jie to promote exterior release through a pungent and cool nature; for those with constipation, add 3–6g of Sheng Da Huang and 5–10g of Zhi Shi to unblock the intestines and eliminate internal heat; for those with poor appetite, add 5–10g of Mai Ya and 5–10g of Lai Fu Zi to aid digestion and eliminate food stagnation. Results: 68 cases were cured (85%), 10 cases showed improvement (12.5%), 2 cases remained untreated (2.5%), with an overall effective rate of 97.5%. (China Community Physician, 2008, Issue 21) Four. Western Medical Treatment (1) General Nursing Care Rest in bed; when complications such as orchitis occur, lie in a semi-recumbent position to facilitate swelling reduction. Maintain oral hygiene, isolate the respiratory tract, avoid acidic or irritating foods; for those with pancreatitis, restrict diet and provide intravenous fluids to maintain nutrition, while appropriately administering vitamins B and C. (2) Medication Treatment In early stages of severe cases, try using Virozol or Interferon. For complications involving orchitis, administer 1mg of Diethylstilbestrol three times a day orally. For complications related to pancreatitis, consider using antispasmodics such as Atropine and 654-2. (3) Other Therapies Apply Wang Bu Liu Xing to both parotid glands, ear tips, and Shen Men, massaging them 4–5 times daily. Utilize near-infrared therapy, laser therapy at acupoints, cupping therapy, and magnetic therapy (targeting areas of parotid swelling). (Jo Furu, Wu Bin) Chapter Two: Infectious Diseases – Chapter Eight: Epidemic Cerebrospinal Meningitis I. Overview

Epidemic cerebrospinal meningitis (ECM), often referred to as “flow brain,” is an acute infectious disease of the central nervous system caused by Neisseria meningitidis. ECM is widespread globally, with cases occurring in many parts of the world, with Africa being a typical region prone to outbreaks. Since 1880, large-scale outbreaks have occurred regularly. According to WHO estimates, since World War II, the annual incidence has been approximately 70 per 100,000 people, with rates ranging from 1 to 10 per 100,000 across major continents. China is a region where ECM is highly prevalent; in non-outbreak years, the incidence is typically around 3–10 per 100,000, in minor outbreak years it reaches 30–50 per 100,000, and during major epidemics, the incidence can soar to 100–500 per 100,000, with a mortality rate as high as 5.49%. Historically, the highest incidence rates have been observed in central and southern China provinces, followed by northeastern and northern China. ECM occurs throughout the year, but is most common between February and April, as winter and spring weather conditions lead to increased population density and decreased respiratory resistance, making individuals more susceptible to infection. The general population is generally susceptible to this disease, with the highest incidence rates occurring in children aged 6 months to 2 years, though young and middle-aged adults in rural areas are also susceptible. Neisseria meningitidis is the sole pathogen responsible for the disease; in China, type A strains are the predominant strain circulating. The primary source of infection is carriers, with infected individuals serving as secondary sources, transmitted via droplets. The bacteria reside in the nasopharynx, where they become carriage states or cause upper respiratory tract inflammation. However, when the body's immune defenses decline, or when bacterial virulence is high and bacterial numbers are large, the bacteria can enter the bloodstream, leading to bacteremia or sepsis. During this period, the bacteria invade the inner walls of skin vessels, causing thrombosis, necrosis, hemorrhage, and cellular infiltration, resulting in petechiae or ecchymoses. Fulminant sepsis arises when bacterial lipopolysaccharide endotoxins trigger vascular spasms and increased vascular permeability, leading to microcirculatory disorders and causing endotoxin shock and disseminated intravascular coagulation. Some bacteria cross the blood-brain barrier and invade the meninges, causing purulent inflammation; the resulting cerebral edema, combined with congestion and edema in brain tissue, can lead to seizures and altered consciousness. When swollen brain tissue protrudes into the cranial foramina, it can result in brain herniation, causing respiratory and circulatory failure and rapid death. In rare cases, obstruction of the ventricular openings leads to hydrocephalus, damaging the optic nerves, auditory nerves, and facial nerves, resulting in vision loss, hearing impairment, and facial paralysis.

II. Diagnosis (1) Diagnostic Criteria The incubation period for this disease ranges from 2 to 10 days, typically 2–3 days.

1. Common Form of Mumps (1) In winter and spring, onset is often preceded by upper respiratory tract infection symptoms, including sudden high fever, headache, neck stiffness, and vomiting; some patients develop vesicles around the corners of the mouth on the 3rd–4th day of illness.

(2) Neurological signs such as neck stiffness, Kernig’s sign, and Brudzinski’s sign are positive. Most patients begin to exhibit petechiae or ecchymoses on the skin and mucous membranes within hours of onset, sometimes accompanied by maculopapular rashes that appear dark red or purplish-red, varying in size and unevenly distributed, often not blanching upon pressure.

(3) Laboratory tests: White blood cell counts often reach over 20×10^9/L, with neutrophils accounting for over 80%; smear examinations of petechiae and blood cultures may reveal Neisseria meningitidis. Cerebrospinal fluid pressure can reach up to 0.196 kPa, with a milky appearance; white blood cell counts exceed 10×10^9/L, predominantly neutrophils with segmented nuclei. Smears and cultures may show reduced numbers of bacteria, while protein levels increase, and Pandy’s test remains positive. Immunological tests may be performed when necessary to detect antibodies, providing specific diagnostic information—common methods include indirect hemagglutination assays, bactericidal assays, latex agglutination tests, enzyme-linked immunosorbent assays, and radioimmunoassays. However, antibody titers typically rise around one week after onset, making early diagnosis difficult. In recent years, to expedite diagnosis, antigen detection in blood, cerebrospinal fluid, and urine samples has become increasingly common, employing techniques such as co-agglutination assays, enzyme-linked immunosorbent assays, flow immunoelectrophoresis, gas chromatography, hemagglutination tests, reverse hemagglutination tests, radioimmunoassays, and immunofluorescence techniques.

Practical Internal Medicine in Integrated Traditional Chinese and Western Medicine

Symptoms include high fever, headache, extreme lethargy, altered consciousness, and seizures. Systemic petechiae and ecchymoses rapidly expand.

Large, even subcutaneous hemorrhages or necrosis may occur. The face becomes pale, lips turn blue, limbs grow cold, breathing becomes rapid, pulse quickens, blood pressure drops, and neurological signs are absent. Cerebrospinal fluid is mostly clear, with normal or slightly elevated white blood cell counts, and blood cultures are positive.

(2) Meningitis-type: Sudden high fever, severe headache and vomiting, restlessness, frequent convulsions and seizures, rapid progression into coma. Heart rate and respiration may slow down, blood pressure rises, pupils fluctuate in size, margins become irregular, light reflexes become sluggish or absent, and breathing becomes irregular (double breaths, sobbing, sighing, tidal breathing, etc.). Neurological signs and pyramidal signs are often pronounced, and cerebrospinal fluid may also exhibit typical changes; blood and cerebrospinal fluid cultures or smears may reveal the pathogenic bacteria.

(3) Mixed Type: Both shock-like symptoms and meningitis-type manifestations coexist.

(4) Chronic meningococcal bacteremia and atypical cases of mumps: The former presents with irregular fevers, rashes, ecchymoses, migratory joint pain, and splenomegaly; after the fever subsides, rashes often disappear. The latter does not present with obvious toxic symptoms, instead exhibiting fatigue, gastrointestinal inflammation, arthritis, pneumonia, and other symptoms—during epidemic periods in endemic areas, these conditions should be closely monitored.

(2) Differential Diagnosis

1. Epidemic encephalitis B peaks in July and September, characterized by high fever, headache, and vomiting, but the headache is not severe, and there are no petechiae or vesicles on the skin or mucous membranes. Patients often exhibit somnolence. Cerebrospinal fluid is clear, with white blood cell counts rarely exceeding 1×10^9/L, primarily consisting of lymphocytes; early-stage neutrophils may be slightly elevated, and glucose levels remain largely normal. Serum complement fixation tests, with positive IgM antibodies, can confirm the diagnosis.
2. Tuberculous meningitis develops slowly, with low-grade fever lasting 1–2 weeks before neurological signs appear—no petechiae or nasolabial vesicles. Cerebrospinal fluid appears glassy, with white blood cell counts generally below 500, mainly composed of lymphocytes; after prolonged storage, thin films may form, and culture or animal inoculation can identify Mycobacterium tuberculosis.
3. Other forms of purulent meningitis There is no fixed seasonal pattern; often, the primary focus of infection can be identified (such as otitis media or pneumonia), with few petechiae on the skin. Cerebrospinal fluid changes resemble those seen in mumps, but smear staining of cerebrospinal fluid can reveal other bacteria.
4. Hypoxic meningitis Severe systemic infections such as septicemia, typhoid fever, or pneumonia can cause neurological signs due to high levels of toxemia; cerebrospinal fluid may only show elevated pressure, and clinical symptoms and laboratory findings can help differentiate it from mumps.
5. Toxic dysentery More common in children, especially during summer and autumn. Within a short period, high fever, convulsions, coma, shock, and respiratory failure may occur—but no petechiae are present, and cerebrospinal fluid examination is normal. Cold saline enemas or anal swabs can reveal clusters of pus cells and red blood cells under the microscope; definitive diagnosis relies on bacterial culture. III. Traditional Chinese Medicine’s Understanding and Treatment of Epidemic Cerebrospinal Meningitis (1) Historical Medical Views on Similar Conditions