Second Section: Infectious Diseases

This disease falls under the category of warm diseases and warm epidemics in Traditional Chinese Medicine. As early as the Inner Classic, Suwen, in “On the Evaluation of Warm Disease, Chapter 33,” it was noted: “When a patient suffers from warm disease, sweating often leads to recurrent fever, while the pulse is rapid and forceful—yet the fever does not subside…” Han Dynasty physician Zhang Zhongjing stated in “Shanghan Lun”: “If a patient has a Sun Ray disease, with fever and thirst, but no chills, and feels delirious and unable to eat, this is considered a warm disease.” This indicates that the disease shares characteristics of warm diseases—fever without chills, thirst, and in severe cases, delirium and loss of appetite—and that even after sweating treatment, if the fever persists, it is different from the superficial symptoms of a cold. During the Ming Dynasty, Xu Jun and others described similar symptoms in “Dongyi Baojian”: “In spring, when warm epidemics arise, patients experience fever, lower back pain that is stiff and tight, legs that cannot extend, a feeling of fatigue that makes one feel like breaking, and blurred vision… with chills and fever.” They also pointed out that “when epidemic qi arises, it spreads across the world; then it spreads to a single region… then it affects a single household,” highlighting the contagious nature of this disease. Wu Youjin wrote in “Wen Yi Lun”: “When evil qi resides in the blood, and the qi inside the body becomes congested, the hidden evil cannot escape outward and manifests as spots.” He explained that the mechanism behind the rash in this disease lies in the fact that evil qi resides in the blood, unable to escape outward, and suggested using methods to help the poison leave the body through the exterior—allowing the rash to gradually appear after the poison is expelled. However, if excessive expulsion occurs, the vital qi may be weakened, making it easy for the poison to penetrate inward. If the poison enters the interior, it is best to use the Tu Li Qi Ba Shang Tang formula to help the rash emerge. Lin Zhi Han, in “Wen Yi Cui Yan,” noted that vomiting is caused by fire in the stomach, which is fueled by rising fire energy. In the Qing Dynasty, Yang Lishan wrote in “Shanghan Wen Yi Tiao Bian”: “When the pulse is weak and deep, nearly extinguished, the body is cold, limbs are cold and clammy, the temperature is too low to reach the elbows or knees, half-dead, half-alive, with ice-like skin all over the body. Nine deaths, one life. This evil fire is congested, the yang qi cannot spread outward, and the stomach is full.” He described the symptoms and pathological mechanisms of shock-type mumps. In “Yi Zhen Yi De,” it was recorded: “At the onset of the disease, symptoms resemble those of a Sun Ray or Yangming syndrome, but the Sun Ray and Yangming syndromes do not cause headaches as severe as those of a broken bone; rather, the mumps headache is sharp and splitting, deep and unable to be lifted…” This illustrates the severity of the headache in this disease. In addition, several renowned warm disease experts of the Qing Dynasty, such as Wu Jutong and Wang Mengying, offered different perspectives and interpretations of this disease, greatly enriching the understanding and treatment of the condition.

Second Section: Infectious Diseases

In the past, medical practitioners recognized the causes and mechanisms of this disease, and understood that the disease originates from external evils—first, the “Wei Qi is blocked, hindering the opening and closing of the skin and hair, impeding the smooth flow of lung qi, leading to fever, chills, cough, and other lung-qi symptoms. The evil invades quickly, and in the early stages, it often manifests as a conflict between Wei Qi and the Lung Qi, leading to symptoms such as neck stiffness. However, in this disease, the Wei Qi symptoms are often overlooked, and the disease progresses rapidly. Early symptoms include high fever, but the disease is not yet fully manifested as a cold. Once the Wei Qi is resolved, the heat transforms into fire, entering the Ying Qi and Blood Qi, causing a conflict between Qi and Blood, with excess Qi and Blood, and the Qi and Blood becoming congested, constricted, and blocked—leading to a situation where the Qi cannot be released outward, the stomach is filled, and frequent vomiting occurs, sometimes even projectile vomiting. The evil enters the Ying Qi, or causes bloody vomit and bloody stools. This disease is particularly dangerous because the heat and toxins are intense, the condition progresses rapidly, and the evil and toxins obstruct the clear channels, causing severe headaches, frequent convulsions, cold extremities, burning chest and abdomen, flushed face, and clenched teeth—symptoms of severe heat and deep qi obstruction. Alternatively, if the vital qi is insufficient, the evil and toxins may penetrate inward, causing a sudden loss of yang qi, leading to a pale gray complexion, profuse sweating, a drop in blood pressure, diminished breathing, cold limbs, weak pulses, and even a lack of Qi to nourish the Blood, with rapid increases in petechiae or bleeding, nosebleeds, and other symptoms.”

(3) TCM Differentiation and Treatment Methods

1. Wei Qi Type: The main symptoms include headache, chills and fever, no sweat or little sweat, irritability, bitter taste in the mouth with thirst, vomiting, neck pain and stiffness, muscle soreness, infrequent urination with red urine, a red tongue with yellow coating and little saliva, a tense and rapid pulse. The treatment focuses on releasing the exterior, clearing the interior, and detoxifying while calming convulsions. The formula uses Bai Hu Tang with 30g of Jin Yin Hua, 30g of Lian Qiao, 15g of Lu Gen, 15g of Chan Yi, 15g of Gou Teng, 10g of Da Qing Ye, 9g of Zhang Can, and 9g of Gan Cao. Brew the herbs in water and take one dose per day. Those with dampness can use Gan Lu San; for significant thirst, add 30g of Huafen.
2. Qi and Blood Type The main symptoms include high fever, particularly worse at night, dry throat and thirst, irritability and restlessness, occasional delirium, a headache like a split, vomiting, frequent convulsions, and cold extremities. The treatment aims to clear the Qi and cool the Blood, quenching wind and calming convulsions. The formula uses Qing Ying Tang or Qing Wen Baidu Yin with 15g of Gou Teng, 9g of Zhang Can, 30g of Sang Zhi, and 15g of Da Qing Ye. Brew the herbs in water and take one dose per day. For those with yin deficiency and wind movement, use Da Ding Feng Zhi; for those with excessive fire and hyperactivity, use Huang Lian A Jiao Tang for insomnia; for those with hot fever and cool mornings, when the fever subsides without sweat, use Qing Hao Bie Jia Tang.
3. Blood Qi Type: The main symptoms include headache and vomiting, intense heat in the body, restlessness and agitation, delirium and hallucinations, purplish-black rashes or bloody vomit and bloody stools, a deep red tongue, and a rapid pulse. The treatment focuses on clearing the Blood Qi and cooling the Blood, quenching wind and calming convulsions. The formula uses Xijiao Dihuang Tang with 30g of Jin Yin Hua, 30g of Sheng Shi Jue Ming, 10g of Quan Xie, 20g of Gou Teng, 30g of Da Qing Ye, and 12g of Huang Lian. Brew the herbs in water and take one dose per day. If there is significant bleeding, if the Qi is deficient and the spirit is weary, or if there is fear that the heat will penetrate inward, quickly take a Ginseng Soup to help expel the evil.
4. Channel Obstruction Type The main symptoms include high fever and cold extremities, delirium and hallucinations, or sleepiness, confusion, and speech difficulties. The treatment focuses on clearing the heart, opening the channels, cooling the Blood, and quenching wind. The formula uses Qing Ying Tang, combined with An Gong Niu Huang Wan, Zi Xue Dan, and Zhi Bao Dan. For excessive phlegm, add 15g of Zhu Li, 30g of Gua Lou Pi; for severe heat and toxins, add 10g of Jin Zhi; for channel obstruction, add 9g of Shi Tiao, 9g of Yu Jin, and other herbs.

<!-- translated-chunk:21/261 -->

5. The primary symptoms of the cold-dry type include pale complexion, cyanosis, cold and clammy sweat, a state of apathy or irritability, even loss of consciousness, and a weak, rapid pulse.

When the condition reaches a critical stage, the patient may exhibit rigid limbs, shortness of breath, and other severe symptoms. Treatment should focus on both yin and yang tonification to restore the body's vital energy and counteract the cold-dry pattern. The treatment regimen typically involves combining yin and yang tonics with the use of Shenfu Longmu Decoction combined with Shengmai Powder. If blood heat is present, the treatment can be adjusted by adding Zhi Jiao and Dihuang Tang to the Shengmai Powder formula.

(4) Traditional Chinese Medicine Resources on the Diagnosis and Treatment of this Disease

In the early stages of epidemic meningitis, the pathogen primarily affects the Wei Qi; therefore, the focus should be on clearing the pathogen and promoting its expulsion from the body. As the disease progresses to the Ying Qi, the emphasis shifts toward clearing the Ying Qi and cooling the blood, as well as detoxifying the pathogen. When the disease begins to recover, it is important to eliminate residual pathogens while supporting the body’s righteous qi. In addition, one can employ differential diagnosis and select appropriate formulas for treatment. ① For cases where Wei Qi is affected, the treatment approach involves clearing heat and detoxifying, while also dispersing and eliminating the pathogen.

Formula: Yinqiao San combined with Baihu Tang, modified: 25g of Shengshigao, 15g each of Jin Yin Hua, Lian Qiao, and Ban Lan Gen, 10g each of Ge Gen and Zhi Mu, 5g each of Huang Lian and Gan Cai. For those who predominantly experience issues in the Qi portion, add Jiang Can and Chan Yi; if the headache is severe, add Ju Hua, Gou Teng, and Long Dan Cao; if vomiting is prominent, add Zhu Ru. ② When both Qi and Ying are affected, the treatment focuses on releasing heat, detoxifying, clearing the Qi, and cooling the Ying. Formula: Qingwen Baidu Yin, modified: 20g of Shengshigao, 15g each of Jin Yin Hua, Zhi Mu, Lian Qiao, Da Qing Ye, and Ban Lan Gen, along with Dan Pi,

Sheng Di and Chi. If there is significant heat in the Qi portion, add Zhang Cao and Chuan Yi; if the patient experiences delirium or convulsions, add Gou Teng and Ling Yang Jiao Fen. ③ When heat penetrates the Ying Qi, the treatment approach involves clearing the Ying Qi, releasing heat, cooling the blood, and resolving the obstruction. Formula: Qingying Tang, modified: 30g of Sheng Niu Jiao, 15g each of Jin Yin Hua, Lian Qiao, Da Qing Ye, and Ban Lan Gen, along with Sheng Di and Dan Can, 10g each of Huang and Mie. If convulsions occur, add Gou Teng and Quan Xie; for bleeding, add Qing Dai, Zi Cao, and Shu Cao; for high fever, add Angong Niuhuang Wan. ④ When both internal and external organs are affected, the treatment aims to restore yang and solidify the body’s vital energy. Formula: Shenfu Longguo Mu Liang Tang combined with Shengmai Powder, modified: 20g each of Long Guo and Mu Liang, along with 10g each of Ren Shen and Dong, 5g each of Long Fu Pian and Wu

Practical Internal Medicine in Integrated Chinese and Western Medicine

6g each of Zhi Zi, and 5g of Gan Cao. For patients in critical condition, add Dushen Tang for enema; for severe heat and limb convulsions, add Angong Niuhuang Wan and Zhi Bao Dan. ⑤ For cases of Qi and Yin deficiency, the treatment approach involves replenishing Qi and clearing residual pathogenic factors. Formula: San Jia Fufu Tang, modified: 12g each of Sheng Di, Bai Shao, and A Jiao, 10g each of Sheng Mu Liang, Sheng Gui Ban, and Sheng Bi Jia,

6g each of Dong and Huo Ma Ren. For low-grade fever that does not subside, add Bai Wei and Di Gu Pi; for Qi deficiency and weakness, add Huang Qi and Fu Xiao Mai; for limb stiffness, add Si Gua Luo, Ren Dong Teng, and Sheng

Branches. *The treatment methods have been summarized by scholars into three categories: ① Differential Diagnosis and Treatment: A report from Fujian indicated 178 cases, with 176 cured, 2 deaths. Liu’s treatment...

of 133 cases showed 118 cures, 6 improvements, and 2 deaths. The main classification based on the syndrome was the “Ying Qi and Blood” type. Medications were often prescribed according to the traditional Chinese medicine perspective, with Yin Qiao San being the representative formula for Wei Qi syndrome, and Baihu Tang being the representative formula for Qi syndrome—these are the common approaches. Guangdong’s Yunnan treated 100 cases, with 98 cured. They classified the disease into four types: Wei Qi, Ying Qi, Secretion Obstruction, and Dehydration Syndrome, all treated with Qingwen Baidu Yin and Qingnaoyan (50–150g of wild chrysanthemum, 50–100g of wild chrysanthemum flowers, 9–21g of Herba Cirsii), using different dosages and administration methods depending on the specific syndrome. ② Integrated Chinese and Western Medicine Treatment: This article cites Sun’s use of integrated Chinese and Western medicine to rescue patients with acute hemorrhagic meningitis, employing Western medications for infection control, shock management, fluid resuscitation, and acid-base balance adjustment. Traditional Chinese Medicine distinguished between dehydration and obstruction types, treating dehydration with Shenfu Longmu Tang, while addressing obstruction with restoring yang and consolidating the body’s vital energy—using Shenfu Longmu Tang. For obstruction, the treatment focused on clearing heat and cooling the blood, opening the orifices and calming the wind, with adjustments to Qingwen Baidu Yin (Jin Yin Hua 30g, Lian Qiao 20g, Zi Cao 30g, Sheng Shi 60g, Zhi Mu, Xuan Shen, Dan Pi each 15g, Shan Zhi 15g, Gou Teng 20g, Da Qing Ye 30g, Sheng Da Huang 20g, Zhi Jiao powder 0.6g, taken orally). Additionally, 10–15 needles of Danshen were administered intravenously daily, while comatose patients received 20–30 ml of Xingnao Jing intravenously every day, both infused in 250–500ml of 10% glucose solution. Sun used these methods to treat 12 cases of acute brain injury, with 4 deaths, reducing the mortality rate from 70% to 19%. ③ Single-Use Formulas: Zhu’s treatment of 78 cases with Qingwen An Nao Tang resulted in 70 cures and 3 deaths. The formula consisted of 20–50g of Sheng Shi, 20–50g of Dihuang, 20g of Xuan Shen, 10g of Chi Shao, 20g of Tian Dong, 20g of Mai Dong, 20g of Jin Yin Hua, 15g of Lian Qiao, 7.5g of Dan Pi, 5g of Gan Cao, 10g of Zhizi,

15g of Dan Dou Chi, one pill of Zhi Bao Dan. Liu’s treatment of 70 cases all yielded complete recovery, with most symptoms and signs disappearing within 2–5 days. The formula contained 10g of Mu Xiang, 17.5g of Ya Sha, 17.5g of Xi Xin, 12.5g of Zhu Sha, 12.5g of Xiong Huang, 15g of Bo He, 15g of Huo Xiang, 5g of Fu Fan, 5g of Bai Zhi, 10g of Cheng Bing, 15g of Chen Pi, all ground into fine powder (Zhu Sha and Ming Xiong Huang were separately ground and mixed, then stored in a magnetic bottle and sealed with wax for future use). Dosage: Adults 5–15g per dose, twice daily.

Some individuals used 10% garlic distillate for intramuscular injections, achieving 100% recovery in 84 cases, with injection doses ranging from 20ml for those over 10 years old, up to 20ml for subsequent injections every 6 hours. (Medical Translation Selection, 1980.4)

Ma Jian from Nanjing College of Traditional Chinese Medicine summarized the dynamic developments in TCM treatment of meningitis over the past decade. He believed that most people consider this disease to fall under the categories of winter-heat, wind-heat, spring-heat, or warm epidemic. The progression and pathological changes following the onset of the disease align with the principles of Wei Qi, Ying Qi, and Blood transmission. He noted that the disease develops rapidly, with a quick transition through the stages of Wei Qi, Ying Qi, and Blood, easily leading to Yin depletion and blood movement, or even internal Yin collapse—characteristic of warm epidemic transmission. According to Ma’s view, the occurrence of limb convulsions, upward gaze of the eyes, clenched teeth, neck stiffness, and even opisthotonos during the course of the disease falls within the scope of “Wen Bing” as described in the Golden Cabinet Essentials (Chinese Medicine Information, 1989.3).

Sun Zhi et al. treated 62 cases of epidemic meningitis with Qingwen Baidu Yin, modifying the formula as follows: 80g of Sheng Shi, 60g of Niu Jiao, 30g of Lu Gen, 20g of Zhi Zi, 20g of Zhi Mu, 20g of Xuan Shen, 20g of Lian Qiao, 20g of Jin Yin Hua, 20g of Dan Pi, 20g of Xian Zhu Ye, 30g of Xia Ku Cao, 20g of Han Shui Shi, 20g of Ge Gen, 15g of Gan Cao. The medication was taken once daily, decocted three times and divided into three doses, continuing for half a month. For cases with severe heat toxicity and high fever, increase the amount of Qing Ye; for patients with more severe delirium, add Angong Niuhuang Wan; for cases with abundant rash, add Ciba Ye and Bai Mao Gen; for those experiencing true Yin heat, add Huang Lian A Jiao Tang. Results: Among the 62 cases treated with Qingwen Baidu Yin, 58 were cured, 3 showed marked improvement, and 1 case remained ineffective after 1 week of treatment. This demonstrated that using Qingwen Baidu Yin in combination with modifications could effectively clear heat and toxins while cleansing the Qi and Blood, thereby achieving the goal of clearing heat and detoxifying the pathogen. (Sichuan Traditional Chinese Medicine, 2007.5)