Four, Western Medical Treatment

acupoints such as Qie Fan, Ju Feng, He Gu, Wai Guan, Qu Chi, Feng Long, etc., applying to 3–4 acupoints each time, using the “xie fa” method, performing needling 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 Tai Chong 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. Combine appropriately with antibiotics and antiviral drugs; for high fever, add antipyretic and analgesic medications, or use physical cooling methods; for patients with meningitis, use dehydrating agents. Results: all cases were cured, with 115 cases cured within 1–5 days. (Chinese Journal of Integrated Traditional and Western Medicine, 1992) Meng Qingjun used traditional Chinese medicine for internal and external treatment of 58 cases of epidemic mumps. ① Internal treatment formula composition: 20g of Ban Lan Gen, 20g of Jin Yin Hua, 15g of Lian Qiao, 10g of Niu La 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 decoction into two doses. ② External application formula composition: White alum, Fu Alum, Wei Huang According to needs, grind the ingredients into powder in a 1:1 ratio, mix thoroughly with petroleum jelly ointment, apply to the affected area, changing the dressing every other day; three treatments constitute one course. Results: 42 cases had unilateral onset, with 33 cases cured; 24 cases had bilateral onset, with 18 cases cured. (Journal of North China Coal Medical College, 2007.5) Zheng Jinhong et al. used cactus external application combined with traditional Chinese medicine for clearing heat and detoxifying to treat 32 cases of epidemic mumps, achieving satisfactory therapeutic effects. Treatment method: take internal herbal decoctions for clearing heat and detoxifying, using 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 varies according to age, 10–40ml per dose, 6–8 times a day. At the same time, take an appropriate amount of fresh cactus, remove the spines, mash it into a paste, and apply externally to the affected area 3 times a day; when the medicinal juice evaporates and dries, promptly replace with fresh juice and reapply. Results: among the 32 cases, those who initially had elevated body temperatures saw their fever subside in as little as 1 day, with a maximum duration of 6 days before their temperature returned to normal; the swelling of the parotid glands subsided in as little as 2 days, with a maximum duration of 6 days, and other symptoms disappeared within 3 days. Based on efficacy criteria, 27 cases were cured, accounting for 84.38%, 4 cases showed improvement, accounting for 12.50%, and 1 case was ineffective, accounting for 3.12%. The overall effective rate was 96.87%. (Clinical Oral Medicine Journal, 2007.6) Liu Shuea developed a modified Qing Wen Xiao Zuo Tang formula to treat 64 cases of epidemic mumps, with the basic formula consisting of 10g of Zao 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 Di Jing, 12g of Ban Lan Gen, 10g of Bo He, 3g of Jiang Can, and 5g of Sheng Ma. In clinical practice, adjustments were made: if fever was severe and parotid swelling was prominent, Chen Pi, Xuan Shen, and Di Jing were removed, and Jin Yin Hua and Da Qing Ye were added, focusing on clearing heat and detoxifying; for those with headache, add Mulberry Leaves and Chrysanthemum to clear the head and eyes; for those with cough, add Apricot Kernel, Qian Hu, and Zhe Bei Mu to resolve 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, combine with Mabo, Yizhi Huanghua, Niuxi, and Shan Dou Gen to detoxify and benefit the throat; for dry stools, add Gypsum, Peony Bark, and Zhimu to clear lung and stomach heat. One dose per day, decocted in water and taken twice a day, 7 days forming one course; after one 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%, and no cases were ineffective. The overall effective rate was 100%. (Hebei Traditional Chinese Medicine, 2008.7) Niu Youxian used the Xiao Chai Hu Tang formula with modifications to treat 80 cases of epidemic mumps, achieving good therapeutic results. Drug composition: 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 Jiang Can, 10–15g of Ban Lan Gen, 5–10g of Jin Yin Hua, 5–10g of Lian Qiao, 5–10g of Di Jing, 3–6g of Gan Cao, one dose per day, decocted in water to 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, 5–10g of Jing Jie to release exterior heat with a pungent and cool nature; for those with constipation, add 3–6g of Sheng Da Huang, 5–10g of Zhi Shi to promote bowel movements and eliminate internal heat; for those with poor appetite, add 5–10g of Mai Ya, 5–10g of Lai Fu Zi to aid digestion and break up stagnation. Results: 68 cases were cured (85%), 10 cases showed improvement (12.5%), 2 cases remained unresponsive (2.5%), with an overall effective rate of 97.5%. (China Community Physician, 2008.21) 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 administer intravenous fluids to maintain nutrition, while also administering vitamins B and C as needed. (2) Medication Treatment In the early stages of severe cases, try using Ribavirin or Interferon. When complications such as orchitis occur, administer 1mg of diethylstilbestrol three times a day orally. For those with pancreatitis, consider using antispasmodics such as Atropine or 654-2 as appropriate. (3) Other Therapies Use Wang Bu Liu Xing to massage both parotid glands, the ear tips, and Shen Men, massaging 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 small outbreak years it reaches 30–50 per 100,000, and during major epidemics, the incidence can soar to 100–500 per 100,000, with mortality rates reaching 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 crowded populations and reduced 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, with type A being the predominant strain in China. The primary source of infection is carriers, with infected individuals acting as secondary sources, spreading through droplets. The bacteria reside in the nasopharynx, becoming carriage states or causing upper respiratory tract inflammation. However, when the body's immune defenses decline, or when bacterial virulence is high and the number of bacteria is large, the bacteria can enter the bloodstream, leading to bacteremia or sepsis. During this period, the bacteria invade the inner walls of blood vessels, causing thrombosis, necrosis, hemorrhage, and cellular infiltration, resulting in petechiae or ecchymoses. Fulminant sepsis arises from vascular spasms and increased vascular permeability caused by lipopolysaccharide endotoxins, leading to microcirculatory disorders and ultimately 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, along with congestion and edema in brain tissue, can trigger seizures and altered mental status. When swollen brain tissue protrudes into the cranial fissures, it can lead to 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, the disease begins with 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 or 4th day of illness.

(2) Neck stiffness, plus signs such as 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 as high as 0.196 kPa, with a milky appearance, white blood cell counts exceeding 10×10^9/L, predominantly neutrophils with lobulated nuclei. Smears and cultures may show a decrease in the number of organisms, while protein levels increase, and Pandy’s test remains positive. Immunological tests may be performed when necessary to determine antibody levels, providing specific diagnostic information—common methods include indirect hemagglutination tests, 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 speed up diagnosis, antigen detection in blood, cerebrospinal fluid, and urine samples has become increasingly common, employing techniques such as co-agglutination tests, enzyme-linked immunosorbent assays, flow immunoelectrophoresis, gas chromatography, blood agglutination tests, reverse hemagglutination tests, radioimmunoassays, and immunofluorescence techniques.

Practical Internal Medicine in Integrated Traditional and Western Medicine

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

Large, even subcutaneous hemorrhages or necrosis may occur. The face appears pale, lips turn blue, limbs grow cold, breathing becomes rapid, pulse quickens, blood pressure drops, and meningeal signs are absent. Cerebrospinal fluid is mostly clear, with white blood cell counts normal or slightly elevated, and blood cultures yield positive results. (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, edges become irregular, light reflexes become sluggish or absent, and breathing becomes irregular (double breaths, sobbing, sighing, tidal breathing, etc.). Meningeal signs and pyramidal signs are usually 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 mumps: The former presents with irregular fevers, rashes, ecchymoses, migratory joint pain, and splenomegaly; after the fever subsides, the rash often resolves. 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 from July to September, characterized by high fever, headache, and vomiting, but the headache is not severe, and there are no petechiae on the skin or mucous membranes or vesicles around the corners of the mouth. Patients often exhibit somnolence. Cerebrospinal fluid is clear, with white blood cell counts rarely exceeding 1×10^9/L, primarily composed 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 meningeal signs appearing only after 1–2 weeks of low-grade fever, without petechiae or nasolabial vesicles. Cerebrospinal fluid appears glassy, with white blood cell counts generally below 500, mainly composed of lymphocytes; after prolonged storage, a thin film 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 found elsewhere—such as otitis media or pneumonia—and skin petechiae are rare. Cerebrospinal fluid changes resemble those seen in mumps, but smear staining of cerebrospinal fluid can detect other bacteria.
4. Hypoxic meningitis Severe systemic infections such as septicemia, typhoid fever, or pneumonia can cause meningeal 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, patients may experience high fever, convulsions, coma, shock, and respiratory failure—but without petechiae, and cerebrospinal fluid tests remain 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