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

Sun Zhi et al. treated 62 cases of epidemic meningitis with Qingwen Baidu Yin, modifying the formula as follows: 80g of Sheng Shi Gao, 60g of Shui Niu Jiao, 30g of Lu Gen, 20g of Zhizi, 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, and 15g of Gan Cai. The medication was taken once daily, decocted three times with water, divided into three doses, and continued for half a month. For cases with severe heat toxicity and high fever, increase the amount of Qing Ye; for patients with severe delirium, add Angong Niuhuang Wan; for cases with abundant rash, add Side Bai Ye and Bai Mao Gen; for those with severe heat damaging true Yin, 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 was ineffective after 1 week of treatment. This demonstrated that using Qingwen Baidu Yin in combination with modifications could effectively reduce heat and toxins while clearing Qi and blood, achieving the therapeutic effect of Qingwen Baidu Yin. (Sichuan Traditional Chinese Medicine, May 2007)

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 Dili Long, 3g of Wugong, 3g of Chuan Xiong, 3g of Chang Pu, 10g of Gan Cai, 30g of Bai Mao Gen, 30g of Bai Mao Gen, 10g of Sheng Di, 15g of Jin Yin Hua, 15g of Lian Qiao. Brewed in water and taken orally, or administered via nasal feeding when necessary. This remedy is used for cases where the disease is characterized by extreme heat leading to wind. ② Xiji Tang: 3g of Xiji, 30g of Sheng Di, 9g of Lian Qiao, 6g of Jin Yin Hua, 9g of Yu Jin, 1 gourd of Ya Pear Juice, 1 gourd of Dan Zhu Li, 2 drops of Ginger Juice, 5g of Fresh Sheng Pu Gen Root, 60g of Lu Gen, 3g of Deng Xin Cao. Brewed as a tea and taken frequently throughout the day. This remedy is used for cases where the disease has invaded the pericardium, causing delirium and hallucinations. ③ Long Dan Shigao Tang: 12g of Long Dan Cao, 50g of Sheng Shi Gao, 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 Cai. Brewed in water and taken once daily, divided into three doses. This remedy is suitable for the stage when Qi and Ying are both damaged in the disease. ④ Meningitis 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 Shi Hu, 6g of Xing Ren, 1.2g of Gan Cai, 1g of Ling Yang Jiao. Ling Yang Jiao and Dan Zhu Ye can be prepared separately and taken together, while the remaining herbs are decocted in water. Additionally, take 1 orange, juice it, and mix the juice with the decoction, taking once daily in three doses. In severe cases of meningitis, if the fever persists for a long time and the patient remains unconscious,

Chapter Two: Infectious Diseases For patients with recurrent convulsions or hemiplegia, the Zhi Sheng Bao Yuan Dan can be selected. For children, use Jiao Jing Powder, Angong Niuhuang Wan, Niuhuang Bao Long Jiu, Niuhuang Qing Gong Jiu, and other similar formulations. Four, Western Medical Treatment (1) General Nursing Care Isolate patients in isolation wards for respiratory infectious diseases; ensure bed rest, maintain a warm and fresh indoor air quality, and prevent... Positional therapy to prevent upper respiratory tract infections and 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) taken orally (intramuscularly), 3 tablets (1 vial) each time, twice daily. When using sulfonamides, pay attention to administering sodium bicarbonate and ensuring adequate fluid intake, maintaining a urine output of at least 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 an allergic reaction to sulfonamides develops, 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 intravenous infusions. The course of treatment lasts 3–5 days, and regular monitoring of blood counts is essential.

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

(3) Treatment of Acute Hemorrhagic Meningitis

1. Shock Type ① Anti-infective treatment for acute cases: Generally, treatment focuses on intravenous and intramuscular administration; at this stage, avoid using 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 infusion rate as needed. ③ Acid Correction: For adults, first administer 200ml of 5% sodium bicarbonate, then adjust the dose based on blood biochemistry results. ④ Application of vasopressors: 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, completing the infusion within 1–2 hours, with continuous effects lasting 6–8 hours, or use 1mg of benzylamine intravenously, combined 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. Cortical steroid hormones can be administered via intravenous hydrocortisone 500–800mg, reducing the dose and discontinuing medication after shock correction—generally, treatment does not exceed 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 positive results.

2. Meningitis Type ① Dehydration Agents: 1–2g of 20% mannitol or 25% sorbitol per kg, administered intravenously within 20–30 minutes, repeated every 3–4 hours. During intervals, 60ml of 50% glucose can be administered intravenously until cranial pressure significantly decreases—usually, dehydration requires 2–4 days to see the reduction in high cranial pressure. ② Hypothermia therapy: For patients with high fever, convulsions, and obvious cerebral edema or herniation, use chlorpromazine and promethazine, each 1mg/kg, administered intramuscularly or intravenously. Repeat every 4–6 minutes, up to 3–4 times. Apply ice packs to the back of the head, neck, armpits, and groin. ③ In cases of respiratory failure, use re-syn, alkaloid, nicotinamide, or ritalin 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 an acute respiratory infection caused by Group A beta-hemolytic streptococcus, which produces scarlet toxin. The disease causes local inflammation in the pharyngeal region and tonsils, and due to the entry of exotoxins into the bloodstream, systemic toxicemia may develop. Clinical characteristics include sudden onset, with fever, sore throat, or accompanied by ulceration, headache, vomiting, widespread scarlet rash across the body, and noticeable desquamation after the rash subsides. Severe cases may present with heart, kidney, and joint involvement. This disease is common in northern China, while sporadic cases are prevalent in the Yangtze River Basin. In recent years, there has been an increasing trend in some cities in South China, though overall cases tend to become milder. The incidence is highest 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-hemolytic 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 pharyngeal region or tonsils, causing inflammatory exudation and ulcers, leading to pharyngitis and tonsillitis. In severe cases, bacteria can travel through local passages or lymphatic vessels to neighboring tissues, resulting in peritonsillar abscesses, sinusitis, otitis media, mastoiditis, cervical lymphadenitis, cellulitis, and other conditions. In rare cases, bacteria can enter the bloodstream, forming septicemia and chronic purulent lesions; in severe cases, they may trigger systemic symptoms such as fever and skin rashes. Skin lesions show congestion, edema, and leukocytosis, forming typical rashes, ultimately leading to epidermal death and subsequent 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 exhibit turbidity, swelling, and degeneration; in severe cases, necrosis may occur. The kidneys show interstitial inflammation, manifesting as non-purulent inflammation in the renal glomeruli and renal tubules. Renal tissue exhibits pathological changes similar to glomerulonephritis, while synovial membranes of the joints show 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. (2) Differential Diagnosis

1. Measles initially presents with obvious upper respiratory tract catarrhal symptoms and Krukenberg spots visible on the oral mucosa. The rash appears on the 4th day of illness, varying in size and shape, appearing as dark red maculopapular rashes, with normal skin between the rashes—particularly prominent on the face and 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 surface, with reddened skin between the rashes, lacking normal skin texture. The rash is concentrated in skin folds and areas like the elbow creases and wrists, often accompanied by subcutaneous hemorrhaging, forming deep red lines (Papp's lines) that do not fade upon pressure, and are accompanied by itching.
2. During the incubation period, the pharyngeal region becomes markedly congested, the tonsils swell, and white or grayish-white exudate may appear on their surfaces. Often accompanied by sore throat, with enlarged and tender submandibular lymph nodes. Initially, the tongue is coated thickly with white coating, with red, swollen papillae, particularly prominent at the tip and edges of the tongue, known as "strawberry tongue"; later, the coating diminishes, but the papillae remain swollen, leading to the term "bayberry tongue."
3. During the resolution phase, the fever subsides and the rash gradually fades. When the rash disappears, the skin may show flaky, scaly desquamation; in cases where the rash is extensive, large patches of skin may peel off, most notably on the palms and soles.
4. Blood tests reveal a white blood cell count reaching (10–20) × 10/L, with neutrophils accounting for over 80%, showing toxic granules within the cytoplasm. Bacterial cultures (pharyngeal swabs, blood, or pus) can isolate Group A beta-hemolytic streptococcus. (2) Diagnostic Criteria The incubation period for this disease ranges from 1–2 days, with an average duration of 2–5 days.
5. Epidemiology: There is a history of contact with patients suffering from scarlet fever, pharyngitis, or tonsillitis.
6. In winter and spring, the onset is sudden, with a sudden high fever. The rash appears within 12–36 minutes, first affecting the neck, chest, and back, then rapidly spreading to the head, face, and limbs—but without rash around the mouth, instead forming a pale circle around the lips. The rash is bright red, small and dense, resembling chicken skin, slightly raised above the skin surface, with reddened skin between the rashes, lacking normal skin texture. The rash is concentrated in skin folds and areas like the elbow creases and wrists, often accompanied by subcutaneous hemorrhaging, forming deep red lines (Papp's lines) that do not fade upon pressure, and are accompanied by itching.
7. During the active phase, the pharyngeal region is markedly congested, the tonsils are swollen, and white or grayish-white exudate may appear on their surfaces. Often accompanied by sore throat, with enlarged and tender submandibular lymph nodes. Initially, the tongue is coated thickly with white coating, with red, swollen papillae, particularly prominent at the tip and edges of the tongue, known as "strawberry tongue," followed by a decrease in coating, but the papillae remain swollen, leading to the term "bayberry tongue."
8. During the regression phase, the fever subsides and the rash gradually fades. When the rash disappears, the skin may show flaky, scaly desquamation; in cases where the rash is extensive, large patches of skin may peel off, most notably on the palms and soles.
9. Blood tests reveal a white blood cell count reaching (10–20) × 10/L, with neutrophils accounting for over 80%, showing toxic granules within the cytoplasm. Bacterial cultures (pharyngeal swabs, blood, or pus) can isolate Group A beta-hemolytic streptococcus. (2) Differential Diagnosis
10. Measles initially presents with obvious upper respiratory tract catarrhal symptoms and Krukenberg spots visible on the oral mucosa. The rash appears on the 4th day of illness, varying in size and shape, appearing as dark red maculopapular rashes, with normal skin between the rashes—particularly prominent on the face and around the mouth, forming a pale circle around the lips. The rash is bright red, small and dense, resembling chicken skin, slightly raised above the skin surface, with reddened skin between the rashes, lacking normal skin texture. The rash is concentrated in skin folds and areas like the elbow creases and wrists, often accompanied by subcutaneous hemorrhaging, forming deep red lines (Papp's lines) that do not fade upon pressure, and are accompanied by itching.
11. Diphtheria: The pharyngitis in diphtheria is generally milder than that in scarlet fever, but the pseudomembranes are tougher and harder to remove.
12. Acute tonsillitis: Patients with higher body temperatures and less severe systemic symptoms find it difficult to distinguish pharyngitis from scarlet fever, but the absence of systemic rash can aid in differentiation.
13. Drug-induced rashes: Patients often have a history of medication use, and the rash may sometimes 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 relatively severe. There is no bayberry tongue, nor any symptoms of pharyngitis.
14. Staphylococcal infections: Staphylococcal infections progress quickly, with severe systemic 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