Folk remedies for treating epidemic meningitis include: ① Xing Feng Jie Xing Tang: 15g of Sheng Di, 10g of Dang Gui,

Folk remedies for treating epidemic meningitis include: ① Xing Feng Jie Xing Tang: 15g of Sheng Di, 10g of Dang Gui, 10g of Quan Xie, 10g of Diliang, 3g of Wugong, 3g of Chuan Xiong, 3g of Chang Pu, 10g of Gan Cao, 30g of Bai Mao Gen, 30g of Bai Mao Gen, 30g of Bai Mao Gen. The herbal tea was prepared by decocting and taken orally, with nasal feeding when necessary. This remedy is used for cases where the disease is characterized by extreme heat generating wind. ② Xing Di Tang: 3g of Xing Di, 30g of Sheng Di, 9g of Lian Qiao, 6g of Jin Yin Hua, 9g of Yu Jin, 1 gourd of Duck Pear Juice, 1 gourd of Fresh Bamboo Juice, 2 drops of Ginger Juice, 5g of Fresh Shizhang Pu Root, 60g of Lu Gen, 3g of Deng Xin Cao. The herbal tea was prepared and taken frequently throughout the day. This remedy is used for cases where the disease has spread to the pericardium, causing delirium and confusion. ③ Long Dan Shang Tang: 12g of Long Dan Cao, 50g of Sheng Shi, 15g of Bai Mao Gen, 15g of Da Qing Ye, 12g of Xuan Shen, 15g of Sheng Di, 15g of Jin Yin Hua, 15g of Pu Gong Ying, 10g of Gan Cao. The herbal tea was decocted and taken once daily, divided into three doses. This remedy is suitable for the phase when Qi and Ying are both severely heated. ④ Brain Membrane Inflammation Formula: 10g of Dan Zhu Ye, 12g of Sheng Di, 9g of Sheng Mai Ya, 4.5g of Hang Bai Ju, 4.5g of Bian Dou Hua, 1.5g of Su Jing, 1.5g of Bai Bi, 6g of Shihu, 6g of Gua Wei Pi, 6g of Xing Ren, 1.2g of Gan Cao, 1g of Ling Yang Jiao. Ling Yang Jiao and Dan Zhu Ye were separately decocted and taken together, while the remaining herbs were decocted in water, and an orange was taken, its juice diluted and taken daily, divided into three doses. In severe cases of meningitis, prolonged high fever persists, and the patient remains unconscious.

Chapter Two: Infectious Diseases For patients experiencing recurrent convulsions or hemiplegia, the Zhi Sheng Bao Yuan Dan formula can be used. For infants, use Jijing Fen, Angong Niuhuang Wan, Niuhuang Bao Long Jiu, Niuhuang Qing Gong Jiu, and other similar formulas. Four. Western Medical Treatment (1) General Nursing Care Isolate patients in isolation wards for respiratory infectious diseases; encourage bed rest, maintain a warm and fresh indoor air environment, and prevent... Positional therapy to prevent pressure sores and reduce the risk of aspiration pneumonia; for patients with convulsions, prevent tongue biting and falling injuries; provide semi-fluid or liquid diets.

(2) Medication Therapy

1. Antibiotics (1) Sulfonamides: SMZ-TMP Tablets (injections) are administered orally (intramuscularly), 3 tablets (1 vial) at a time, twice daily. When administering sulfonamides, it is important to supplement with sodium bicarbonate and administer sufficient fluids to ensure urine output exceeds 200–1500ml. Most patients receive 1–2 vials daily. If the condition does not improve after 1–2 vials, continue treatment for another 24 hours.

If blood in urine or renal dysfunction occurs after medication use, or if there is an allergic reaction to sulfonamides, switch to the following medications.

(2) Penicillin: Administer large doses, 4–8 million units daily for adults. For those allergic to penicillin, chloramphenicol can be used. (3) Chloramphenicol: Adults take 2–3g daily, divided into 4 oral doses or intramuscular injections, or via intravenous infusion. The course of treatment lasts 3–5 days, and attention should be paid to changes in blood counts.

2. Symptomatic Treatment: For high fever and headache, use physical cooling methods or apply analgesic drops. For nausea and vomiting, employ acupuncture therapy or inject chlorpromazine or gastric reactivation agents. During convulsions, use 0.2mg of pentylthiamine intramuscularly; or administer 5–15ml of 10% chloral hydrate via enema.

(3) Treatment of Acute Hemorrhagic Meningitis

1. Shock Type ① Anti-infection Treatment for Acute Cases: Generally, treatment is primarily administered via intravenous or intramuscular routes; at this stage, it is not advisable to use sulfonamides or other drugs that may harm the kidneys. ② Fluid Resuscitation: Initially, administer 500–1000ml of normal saline and low-molecular-weight dextran, followed by glucose and balanced salts. Monitor the degree of shock correction and urine output, adjusting fluid volume and rate as needed. ③ Acid Correction: For adults, first administer 200ml of 5% sodium bicarbonate, then adjust the dosage based on blood biochemistry tests. ④ Application of Vasoactive Drugs: Dopamine is preferred, with a dose of 2–20mg/kg per minute, adjusting the rate and concentration according to treatment response. [After the above treatments]{.underline} if shock still does not improve, add 0.5–1mg/kg of benzylamine to 100–200ml of fluid, infusing slowly over 1–2 hours, maintaining the effect for 6–8 hours, or use 1mg of benzylamine intravenously, alternating with dopamine or 20mg of isoprenaline. Alternatively, combine with cardiac stimulants to correct shock, as this disease is prone to myocarditis; rapid digitalization is recommended. Corticosteroids such as hydrocortisone 500–800mg can be administered intravenously; after shock correction, reduce the dosage and discontinue medication, generally no more than 2 days. ⑤ Anticoagulation: Use when DIC is suspected early in shock, adding 0.5–1mg/kg of heparin to 10% glucose or 20% mannitol, repeating once every 4–6 hours; for severe cases, repeat 3–4 times, with 1–2 repetitions yielding results.

2. Meningitis Type ① Dehydration Agents: 1–2g of 20% mannitol or 25% sorbitol per kg, infused intravenously within 20–30 minutes, repeated every 3–4 hours. During intervals, 60ml of 50% glucose can be infused intravenously until cranial pressure significantly decreases; generally, dehydration requires 2–4 days for high cranial pressure to resolve. ② Hypothermia Therapy: For patients with high fever, convulsions, and obvious cerebral edema or brain herniation, use chlorpromazine or promethazine at 1mg/kg each, administered intramuscularly or intravenously. Repeat every 4–6 minutes, totaling 3–4 sessions. Apply ice packs to the back of the head, neck, armpits, and groin. ③ In cases of respiratory failure, use succinate, ephedrine, nicotinic acid, or l-thyroxine intravenously or intramuscularly. If severe hypoxia or excessive respiratory secretions occur, perform tracheostomy.

(Jiang Zhongnan Qiaofu Qu, Wu Bin) Chapter Nine: Scarlet Fever – Overview Scarlet fever is caused by Group A Beta (B) group streptococcus, which produces a red rash toxin, leading to acute respiratory infections. The disease causes localized inflammation in the pharynx and tonsils, and due to the entry of exotoxins into the bloodstream, systemic toxicemia develops. Clinical characteristics include sudden onset, with fever, sore throat, or accompanied by ulceration, headache, vomiting, widespread scarlet rash all over the body, and noticeable scaling after the rash subsides. Severe cases may present with heart, kidney, and joint involvement. This disease is commonly prevalent in northern China, while sporadic cases are more common in the Yangtze River Basin. In recent years, there has been an increasing trend in some cities in South China, but overall the disease tends to become milder. The incidence is higher in winter and spring, with children being the primary susceptible population, especially those aged 2–8 years; in recent years, adult cases have been on the rise. Group A beta streptococcus is the primary cause of scarlet fever. The source of infection is mainly patients and carriers; bacterial secretions from the nasopharynx of patients and carriers enter the respiratory tract of susceptible individuals via droplets. When human immunity to the bacteria is weakened, or when the toxin potency is high, bacteria invade the pharynx or tonsils, causing inflammatory exudation and ulcers, resulting in pharyngitis and tonsillitis. In severe cases, bacteria can travel through local passages or lymphatic vessels to neighboring tissues, leading to peritonsillar abscesses, sinusitis, otitis media, mastoiditis, cervical lymphadenitis, and cellulitis. In rare cases, bacteria can enter the bloodstream, forming septicemia and chronic purulent lesions; in severe cases, they may cause fever, systemic symptoms, and skin rashes. Skin lesions show congestion, edema, and leukocytosis, forming typical rashes, eventually leading to epidermal death and shedding. Mucous membranes become congested, sometimes presenting with pinpoint hemorrhages, forming mucosal rashes. Mononuclear cells infiltrate the interstitial vessels of the liver, spleen, and lymph nodes, with varying degrees of congestion and cellular fatty degeneration. The heart may show turbidity, swelling, and degeneration; in severe cases, necrosis may occur. The kidneys exhibit interstitial inflammation, manifesting as non-purulent inflammation in the renal membrane tissue. Renal tissue shows pathological changes characteristic of glomerulonephritis, while synovial membranes of the joints exhibit inflammatory changes. Damage to the heart, kidneys, and joints is associated with immune responses. Blood tests reveal a significant increase in total white blood cell count and neutrophil percentage. II. Diagnosis (1) Diagnostic Criteria The incubation period ranges from 1–2 days, with an average duration of 2–5 days.

1. Epidemiology: There is a history of contact with patients suffering from scarlet fever, pharyngitis, or tonsillitis.
2. Early in winter and spring, the onset is sudden, with a sudden high fever. The rash appears within 12–36 minutes, initially appearing on the neck, chest, and back, then rapidly spreading to the head, face, and limbs—but without rash around the mouth, forming a pale ring around the lips. The rash is bright red, small and dense, resembling chicken skin, slightly raised above the skin; the skin between the rashes remains red, without normal skin. The rash is concentrated in skin folds and areas like the elbow creases and wrists, often accompanied by subcutaneous hemorrhaging, forming deep red lines (Pap's lines) that do not fade when pressed, with itching.
3. During the recovery phase, the pharynx becomes markedly congested, the tonsils swell, and white or grayish-white exudate may appear on their surface. Often accompanied by sore throat, with enlarged and tender submandibular lymph nodes. Initially, the coating is thick and white, the lingual papillae are red and swollen, particularly prominent at the tip of the tongue and the anterior edge of the tongue, known as "strawberry tongue"; later, the coating diminishes, though the papillae remain swollen, leading to what is called "bayberry tongue."
4. During the regression phase, the fever subsides, and the rash gradually fades. When the rash disappears, the skin may show flaky, scaly patches; in cases where the rash is severe, large areas of peeling may occur, most notably on the palms and soles.
5. Laboratory tests reveal elevated white blood cell counts to (10–20) × 10/L, with neutrophils accounting for over 80%, and toxic granules visible in the cytoplasm. Bacterial cultures (pharyngeal swabs, blood, or pus) can isolate Group A beta streptococcus. (2) Differential Diagnosis
6. Measles initially presents with obvious upper respiratory tract catarrhal symptoms and Korsakoff spots visible on the oral mucosa. The rash appears on the 4th day of illness, varying in size and shape, consisting of dark red maculopapular rashes with normal skin between them; facial rashes are particularly common.
7. Diphtheria: The pharyngitis in diphtheria is milder than in scarlet fever, but the pseudomembranes are tougher and harder to remove.
8. Acute Tonsillitis: Patients with high fever and relatively mild toxic symptoms find it difficult to distinguish pharyngitis from scarlet fever, but the absence of systemic rash can aid in differentiation.
9. Drug-induced rashes: Patients often have a history of medication use, and the rash may present in diverse forms, including both scarlet fever-like rashes and urticarial rashes. The rash distribution is uneven, and the order of rash appearance is not as consistent as in scarlet fever—rising from the trunk to the limbs—and the itching is more intense. There is no bayberry tongue, nor any pharyngitis symptoms.
10. Staphylococcal Infections: Staphylococcal infections progress quickly, with severe toxic symptoms, and can also cause scarlet fever-like rashes, but patients often have skin infections and trauma.

Chapter Two: Infectious Diseases III. Traditional Chinese Medicine’s Understanding and Treatment of Scarlet Fever (1) Historical Medical Records on Similar Conditions to Scarlet Fever

Scarlet fever falls under the category of warm diseases in traditional Chinese medicine—a very ancient disease with early records in Chinese medical literature, yet it long remained difficult to distinguish from other rash-causing conditions. As early as the Golden Cabinet Essentials and the Standard Treatise on Cold Damage, it was referred to as “yang poison,” representing one of the earliest descriptions of this disease. For example, Zhang Zhongjing’s Golden Cabinet Essentials recorded: “Yang poison manifests as redness of the face, with patches resembling soft patterns. The throat is painful, with pus and blood discharged…”, although the disease was not named specifically, its symptoms closely resembled this condition. Medical practitioners during the Tang, Song, and Ming dynasties also documented the clinical manifestations and treatments of this disease, though these records were scattered. It wasn’t until the Qing Dynasty, with the rapid development of warm disease theory, that detailed accounts began to emerge. For instance, the Qing Dynasty’s… ·“Secret Methods for Treating Rotten Throat,” stated: “There is a condition called rotten throat, which arises in winter and spring, affecting both young and old alike; when it occurs, the patient experiences high fever, thirst, thick redness of the skin, resembling soft patterns, sore throat, and a burning sensation in the throat, with intense heat inside.” This description closely resembles scarlet fever, and it highlighted the disease’s strong contagious nature—such as the Qing Dynasty’s… Chen Gengdao’s “Herbal Remedies for Epidemic Throat” stated: “The poison of epidemic throat can be transmitted through contact, or it can be contracted through infection… Those who absorb the poison through the mouth and nose develop ‘contact’; when a household is infected with epidemic throat, people absorb the poison from a sick person and contract the disease.” This text explained that the disease originates from the inhalation of pathogenic toxins through the mouth and nose, accumulating in the throat. When climatic conditions are cold or unbalanced, when the body’s righteous qi is deficient while the pathogenic forces are strong, the pathogenic toxins rapidly transform, leading to high fever, irritability, delirium, and widespread scarlet rashes across the body. After the mid-Qing Dynasty, this disease became increasingly prevalent, allowing physicians of the time to accumulate rich clinical experience and write numerous specialized books, such as Jin Dejian’s “Essentials of Rotten Throat and Diarrhea,” Chen Gengdao’s “Herbal Remedies for Epidemic Throat,” and Cao Xinyi’s “Correct Understanding of Throat,” all of which made significant contributions to the diagnosis and treatment of this disease.

(2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of Scarlet Fever Exogenous warm and pathogenic toxins are the primary causes of scarlet fever; when climatic conditions are cold or unbalanced, and the body’s righteous qi is deficient, this leads to the onset of the disease.

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Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Purulent or turbid fluid in the vesicles; or accompanied by sores on the mouth and tongue, swollen and painful gums, constipation, short yellow urine, a pulse that is洪 (hong) and rapid or deep and solid, a red or purplish tongue, with a yellow, dry tongue coating and little saliva. Treatment should focus on clearing heat and detoxifying, cooling the blood and nourishing yin. The formula should be a modified Qingying Decoction combined with Qingwei Powder; use 10g of Water Buffalo Horn, 15g of Rehmannia Root, 10g of Salvia Miltiorrhiza, 10g of Scrophularia Ningpoensis, 12g of Ophiopogon japonicus, 6g of Coptis chinensis, 15g of Honeysuckle Flower, 12g of Forsythia Suspensa, 12g of Angelica sinensis, 15g of Paeonia lactiflora. Brew the herbs in water and take one dose per day. If the rash appears a deep red color, add Purple Flowered Groundsel, Purple Herb, or Gardenia Fruit to clear heat and cool the blood; if yin and liquid are severely depleted and the mouth is dry, add Pollen, Ophiopogon japonicus, and Reed Root to nourish yin and generate fluids; for those with swollen and painful gums, sores on the mouth and tongue, and dry stools, add Shuixiang Powder or Rhubarb, Citrus Aurantium, and other herbs to clear fire and promote bowel movements.

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

Wang Junhua conducted a literature review on traditional Chinese medicine formulas, patent medicines, and integrated Chinese-Western medicine treatments for varicella between 2003 and 2006 as follows: