Second Chapter: 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 the chapter “Evaluation of Heat Disease,” it is recorded: “When a patient suffers from a warm condition, sweating often leads to recurrent fever, while the pulse is rapid and forceful—yet the fever does not subside…” Han Dynasty physician Zhang Zhongjing wrote in “Shanghan Lun”: “If a patient has a Sun Ray disease, with fever and thirst, but no aversion to cold, and feels restless and unable to eat, this is considered a warm disease.” This indicates that the disease shares characteristics of warm diseases—fever without aversion to cold, thirst, and in severe cases, delirium and loss of appetite, yet after sweating treatment, the fever still persists, indicating a different kind of cold syndrome. During the Ming Dynasty, Xu Jun and others described similar symptoms in “Dongyi Baojian”: “In spring, when a warm epidemic breaks out, patients experience fever, lower back pain that is stiff and tight, legs that cannot stretch, a feeling of fatness and bending, and blurred vision… with chills and fever,” and they pointed out: “When epidemic gases arise, they spread across the world; then they affect a single region… then they affect a particular household.” These theories highlight the contagious nature of the disease. Wu Youjin wrote in “Wen Yi Lun”: “When evil energy resides in the blood, and the qi in the interior becomes congested, the hidden evil cannot escape outward and manifests as spots,” explaining that the mechanism behind the rash in this disease is that evil energy resides in the blood, unable to escape outward, prompting the use of downward methods to allow the toxic energy to leave the body. After the downward treatment, rashes gradually appear; however, do not overuse downward therapies, as excessive removal could weaken the vital qi and lead to internal accumulation of toxins. If toxins are allowed to accumulate internally, they may penetrate the body’s organs, and if toxins penetrate deeply, the treatment must rely on the “Tuo Li Qi Ba Zhen” formula. Lin Zhi Han, in “Wen Yi Cui Yan,” noted that vomiting is caused by fire in the stomach, which is ignited by the heat of the sun. Yang Li, in the Qing Dynasty, wrote in “Shanghan Wen Yi Tiao Bian”: “The pulse is weak and faint, 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, and yang qi cannot circulate outward; the stomach is full.” He described the symptoms and pathological mechanisms of shock-type mumps. In “Yi Zhen Yi De,” it is recorded: “At the beginning of the disease, symptoms resemble those of Sun Ray or Yangming in shanghan, but the headache in sun-ray and yangming syndromes is not as severe as in broken bones; instead, the headache in mumps is like a splitting blow, deep and unable to be lifted…” This highlights 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 Chapter: Infectious Diseases (2) In modern medicine, doctors recognize the causes and mechanisms of this disease, and thus understand that the four evils first attack the body, causing obstruction in the defensive qi, hindering the opening and closing of the skin and hair, leading to lung qi deficiency and impaired lung function. Symptoms such as fever, chills, and cough may appear, but the disease progresses quickly, entering the qi division. Clinically, we often see the same symptoms as in the Wei qi—such as the Shaoyang meridian—leading to neck stiffness. However, in this disease, the Wei qi symptoms are more prominent than the Qi symptoms. For example, when the disease first breaks out, high fever appears, and the patient experiences symptoms of “heat invading the heart,” but the heat is not as severe as in the previous cases. 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 body’s qi becomes blocked and tense. The heat becomes trapped in the body, preventing the fire from escaping outward and affecting the stomach, leading to frequent vomiting, sometimes even projectile vomiting. The heat enters the Ying qi, or causes bleeding and bloody stools. This disease requires careful attention to the balance of yin and yang, as the heat and toxins intensify, and the condition progresses rapidly. The heat and toxins can block the clear channels, causing severe headaches, frequent convulsions, cold extremities, burning chest and abdomen, flushed face, and clenched teeth—all signs of severe heat and qi blockage. Alternatively, if the body’s vital qi is insufficient, the heat and toxins may penetrate inward, causing yang qi to collapse, leading to a bluish-gray complexion, profuse sweating, decreased blood pressure, weakened breathing, cold limbs, and a pulse that is weak and faint—sometimes even failing to deliver qi to the blood, causing 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, lack of sweat or only slight sweating, irritability, bitter taste in the mouth with thirst, vomiting, neck pain and stiffness, muscle soreness, infrequent urination with red urine, red tongue with yellow coating and little saliva, and a wiry, rapid pulse. The treatment focuses on releasing the exterior and clearing the interior, detoxifying and calming convulsions. A formula combining Baihu Tang with 30g of Jin Yin Hua, 30g of Lian Qiao, 15g of Lu Gen, 15g of Chan Yi, 15g of Gao Qing Ye, 9g of Jiang Can, and 15g of Long Dan Cao, prepared by boiling in water, is used once daily. Those with dampness can use Ganlu Disinfection Drink; for those with significant thirst, add 30g of flower pollen.
2. Qi-Ying Type The main symptoms include high fever, particularly worse at night, dry throat and thirst, irritability and restlessness, occasional delirium, headache like a splitting blow, vomiting, frequent convulsions, and cold extremities. The treatment aims to clear the Qi and cool the Ying, calming the wind and calming the spirit. A formula like Qing Ying Tang or Qing Wen Baidu Yin, with 15g of Gao Teng, 9g of Jiang Can, 30g of Sang Zhi, is used, prepared by boiling in water, once daily. For those with yin deficiency and wind movement, use Dajing Feng Zhi; for those with excessive fire and hyperactivity, use Huang Lian A Jiao Tang for insomnia; for those with heat and fever in the evening and cool in the morning, when the fever subsides without sweating, use Qing Hao Bie Jia Tang.
3. Blood-Ying Type: The main symptoms include headache and vomiting, intense heat in the body, restlessness and agitation, delirium and mania, purplish-black rashes or vomiting and bloody stools, a deep red tongue, and a rapid pulse. The treatment focuses on clearing the Ying and cooling the Blood, calming the wind and stopping convulsions. A formula combining Xijiao Dihuang Tang with 30g of Jin Yin Hua, 30g of Sheng Shi Jue Ming, 10g of Quan Xie, 20g of Gao Qing Ye, and 12g of Huang Lian is used, prepared by boiling in water, once daily. If there is significant bleeding, or if the patient is deficient in qi and tired, or if there is fear that heat will penetrate inward, quickly administer Ren Shen Tang to help move the evil energy outward.
4. Qi-Blocking Type The main symptoms include high fever and cold extremities, delirium and mania, or sleepiness and confusion, and a tongue that is stiff and unable to speak. The treatment focuses on clearing the heart, opening the orifices, cooling the Blood, and calming the wind. A formula combining Qing Ying Tang with An Gong Niu Huang Wan, Zi Xue Dan, and Zhi Bao Dan is used. For those with abundant phlegm, add 15g of Zhu Li, 30g of Gua Lou Pi; for those with severe heat and toxins, add 10g of Jin Zhi; for those with qi blocking, add 9g of Shi Tiao, 9g of Yu Jin, and other herbs.

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5. The primary symptoms of the "Jue Tuo" type include pale complexion, cyanosis, cold and clammy sweat, a depressed or irritable mental state, even loss of consciousness, and a weak, rapid pulse.

The condition may progress to a state of extreme exhaustion or confusion, with rigid limbs and shortness of breath. Treatment should focus on both yin and yang tonification to restore both deficiency and collapse, and to counteract the "jue tao" phenomenon. The treatment regimen involves combining yin and yang tonification with the use of Shenfu Longmu Decoction combined with Shengmai Powder. If blood heat is observed, when internal obstruction occurs, accompanied by thirst, irritability, burning sensation in the chest and abdomen, red urine, constipation, foul-smelling stools, yellow and dry tongue coating, and a rapid, thin pulse, then the treatment should involve using Xijiao Dihuang Decoction combined with Shengmai Powder.

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

In the early stages of epidemic meningitis, when the pathogen resides in the Wei Qi, the primary goal is to clear the pathogen and promote its expulsion through clearing and penetrating the pathogen. Once the pathogen has spread to the Ying Qi, the focus shifts to clearing the Ying Qi and cooling the blood, as well as clearing the epidemic and detoxifying the body. As the disease progresses toward recovery, it is important to eliminate residual pathogens while supporting the body's righteous qi. It is also possible to perform differential diagnosis and select appropriate formulas. ① When Wei Qi is affected simultaneously, the treatment approach is to clear heat and detoxify, and to disperse and expel the pathogen. Formulation: Yin Qiao San combined with Baihu Tang, modified: 25g of Sheng Shi Gao, 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 are more inclined toward the Qi portion, add Jiang Can and Chan Yi; for severe headaches, add Ju Hua, Gou Teng, and Long Dan Cao; for severe vomiting, add Zhu Ru. ② When Qi and Ying are both damaged, the treatment approach is to release heat and detoxify, clearing the Qi and cooling the Ying. Formulation: Qingwen Baidu Yin, modified: 20g of Sheng Shi Gao, 15g each of Jin Yin Hua, Zhi Mu, Lian Qiao, Da Qing Ye, and Ban Lan Gen, along with Dan Pi,

Sheng Di, Chi. For cases where there is significant heat accumulation in the Ying Qi, add Zi Cao and Qian Cao; for patients experiencing delirium and convulsions, add Gou Teng and Ling Yang Jiao Fen. ③ When heat penetrates the Ying Qi, the treatment approach is to clear the Ying Qi, release heat, cool the blood, and resolve the issue. Formulation: Qingying Tang, modified: 30g of Shui Niu Jiao, 15g each of Jin Yin Hua, Lian Qiao, Da Qing Ye, and Ban Lan Gen, along with Sheng Di, Dan Shen, Mai, each 10g, and Huang for convulsions, add Gou Teng and Quan Xie; for bleeding, add Qing Dai, Qian Cao, and Shu Pei; for high fever, add Angong Niuhuang Wan. ④ When both internal and external organs are compromised, the treatment approach is to restore yang and solidify the collapse. Formulation: Shenfu Longgu Mu Liang Tang combined with Shengmai Powder, modified: 20g each of Long Gu and Mu Liang, along with 10g each of Ren Shen and Dong, 10g each of Yu Fu Pian and Wu

Practical Internal Medicine in Integrated Chinese and Western Medicine

6g each of Zhi Mao, and 5g of Gan Cai. For severely ill patients, add Du Shaan Tang for enema; for severe heat and severe limb convulsions, add Angong Niuhuang Wan and Zhi Bao Dan. ⑤ When Qi and Yin are both deficient, the treatment approach is to replenish Qi and clear residual pathogenic factors. Formulation: San Jia Fu Mai 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 limited movement of the limbs, 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 and 2 deaths. Liu’s treatment...

of 133 cases, 118 were cured, 6 died, 6 improved, and 2 remained ineffective. 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 representative for Wei Qi syndrome, and Bai Hu Tang representing Qi syndrome—these approaches are similar. In Yunnan, Guangdong, and other regions, 100 cases of this disease were treated, with 98 cured. These authors classified the disease into four types: Wei Qi, Ying Qi, Secretion Obstruction, and Collapse. All patients received Qingwen Baidu Yin and Qingnao Yan (with 50–150g of wild chrysanthemum, 50–100g of wild chrysanthemum flowers, 9–21g of Herba Cirsii), but different dosages and administration methods were used depending on the specific syndrome and patient age. 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 categorized the disease into two types: Collapse and Obstruction. For Collapse, treatment focused on restoring yang and consolidating collapse, using Shenfu Longmu Tang; for Obstruction, treatment aimed to clear heat and cool the blood, open the orifices, and calm the wind, with Qingwen Baidu Yin as the main formula (Jin Yin Hua 30g, Lian Qiao 20g, Zhi Cao 30g, Sheng Shi Gao 60g, Zhi Mu, Xuan Shen, Dan Pi each 15g, Shan Zhi 15g, Gou Teng 20g, Da Qing Ye 30g, Sheng Da Huang 20g, Xijiao Fen 0.6g, taken orally). Additionally, 10–15 needles of Danshen were administered intravenously daily, and 20–30 ml of Xingnao Jing were infused intravenously for comatose patients, all mixed with 250–500ml of 10% glucose solution. Sun’s treatment method was applied to 12 cases of acute brain injury, resulting in 4 deaths, with the mortality rate dropping from 70% to 19%. ③ Single-Formula Treatments: 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 Gao, 20–50g of Dang Gui, 20g of Xuan Shen, 10g of Chishao, 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 Cai, 10g of Zhizi,

15g of Dan Dou Chi, and one dose of Zhi Bao Dan. Liu’s treatment of 70 cases all yielded complete cure, with most symptoms and signs disappearing within 2–5 days. The formula consisted of 10g of Mu Xiang, 17.5g of Ya Shao, 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, 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, treating 84 cases with 100% cure rates. Injection dosage: For those over 10 years old, the first injection was 20ml, followed by 20ml every 6 hours. (Medical Translation Selection, April 1980)

Ma Jian from Nanjing College of Traditional Chinese Medicine summarized the dynamic developments in TCM treatment of meningitis over the past decade. According to his findings, many people consider this disease to fall under the category of winter-heat, wind-heat, spring-heat, or warm epidemic in traditional Chinese medicine. The progression and pathological changes following the onset of the disease align with the principles of Wei Qi, Ying Qi, and Blood transmission. The disease typically begins suddenly, spreads rapidly, and easily leads to infiltration of Ying Qi and blood, or even internal penetration of the Jue Yin, which is characteristic of warm epidemic transmission. Ma believed that 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 warm diseases as described in the Golden Cabinet Essentials (Chinese Medicine Information, March 1989).