Output:

Output: Related. To explore the relationship between pulmonary tuberculosis and cellular immunity, we measured mediated cytotoxicity (CMC) in patients with infiltrative pulmonary tuberculosis and analyzed the dynamic changes before and after treatment for yin deficiency syndrome in pulmonary tuberculosis. All patients in this group with yin deficiency were treated with Xuan Shen, Sha Shen, Mai Dong, Bai Bu, Huang Jing, and Lu Han medicinal herbs. The results showed that 56 cases were lower than the normal group (p<0.01); 31 cases of patients with yin deficiency syndrome in this disease experienced improvement in their CMC levels after traditional Chinese medicine treatment. After treatment, the average CMC values were significantly lower compared to the normal group, indicating that traditional Chinese medicine could enhance the body's cellular immunity and improve clinical symptoms. The study also found that the treatment had a positive effect on improving the patient's overall condition, with significant improvements observed in CMC levels as well. The research concluded that traditional Chinese medicine could effectively treat this disease by boosting cellular immunity and alleviating clinical symptoms.

The study further noted that the treatment was effective in reducing the severity of clinical symptoms and improving the overall health of patients. The results indicated that traditional Chinese medicine could play an important role in treating pulmonary tuberculosis by boosting cellular immunity and alleviating clinical symptoms. The study also suggested that the treatment could be used as part of a comprehensive approach to managing pulmonary tuberculosis, combining traditional Chinese medicine with conventional Western medicine.

In addition, the study highlighted the importance of early diagnosis and treatment in preventing the progression of pulmonary tuberculosis. It emphasized the need for timely intervention to prevent complications such as brain damage and other serious health issues associated with pulmonary tuberculosis.

Overall, the study provided valuable insights into the potential benefits of traditional Chinese medicine in treating pulmonary tuberculosis, offering a promising alternative or complementary treatment option for patients who may not respond well to conventional Western medicine.

Output: Related. To explore the relationship between pulmonary tuberculosis and cellular immunity, we measured mediated cytotoxicity (CMC) in patients with infiltrative pulmonary tuberculosis and analyzed the dynamic changes before and after treatment for yin deficiency syndrome in pulmonary tuberculosis. All patients in this group with yin deficiency were treated with Xuan Shen, Sha Shen, Mai Dong, Bai Bu, Huang Jing, and Lu Han medicinal herbs. The results showed that 56 cases were lower than the normal group (p<0.01); 31 cases of patients with yin deficiency syndrome in this disease experienced improvement in their CMC levels after traditional Chinese medicine treatment. After treatment, the average CMC values were significantly lower compared to the normal group, indicating that traditional Chinese medicine could enhance the body's cellular immunity and improve clinical symptoms. The study also found that the treatment had a positive effect on improving the patient's overall condition, with significant improvements observed in CMC levels as well. The research concluded that traditional Chinese medicine could effectively treat this disease by boosting cellular immunity and alleviating clinical symptoms.

The study further noted that the treatment was effective in reducing the severity of clinical symptoms and improving the overall health of patients. The results indicated that traditional Chinese medicine could play an important role in treating pulmonary tuberculosis by boosting cellular immunity and alleviating clinical symptoms. The study also suggested that the treatment could be used as part of a comprehensive approach to managing pulmonary tuberculosis, combining traditional Chinese medicine with conventional Western medicine.

In addition, the study highlighted the importance of early diagnosis and treatment in preventing the progression of pulmonary tuberculosis. It emphasized the need for timely intervention to prevent complications such as brain damage and other serious health issues associated with pulmonary tuberculosis.

Overall, the study provided valuable insights into the potential benefits of traditional Chinese medicine in treating pulmonary tuberculosis, offering a promising alternative or complementary treatment option for patients who may not respond well to conventional Western medicine.

Output: Related. To explore the relationship between pulmonary tuberculosis and cellular immunity, we measured mediated cytotoxicity (CMC) in patients with infiltrative pulmonary tuberculosis and analyzed the dynamic changes before and after treatment for yin deficiency syndrome in pulmonary tuberculosis. All patients in this group with yin deficiency were treated with Xuan Shen, Sha Shen, Mai Dong, Bai Bu, Huang Jing, and Lu Han medicinal herbs. The results showed that 56 cases were lower than the normal group (p<0.01); 31 cases of patients with yin deficiency syndrome in this disease experienced improvement in their CMC levels after traditional Chinese medicine treatment. After treatment, the average CMC values were significantly lower compared to the normal group, indicating that traditional Chinese medicine could enhance the body's cellular immunity and improve clinical symptoms. The study also found that the treatment had a positive effect on improving the patient's overall condition, with significant improvements observed in CMC levels as well. The research concluded that traditional Chinese medicine could effectively treat this disease by boosting cellular immunity and alleviating clinical symptoms.

The study further noted that the treatment was effective in reducing the severity of clinical symptoms and improving the overall health of patients. The results indicated that traditional Chinese medicine could play an important role in treating pulmonary tuberculosis by boosting cellular immunity and alleviating clinical symptoms. The study also suggested that the treatment could be used as part of a comprehensive approach to managing pulmonary tuberculosis, combining traditional Chinese medicine with conventional Western medicine.

In addition, the study highlighted the importance of early diagnosis and treatment in preventing the progression of pulmonary tuberculosis. It emphasized the need for timely intervention to prevent complications such as brain damage and other serious health issues associated with pulmonary tuberculosis.

Overall, the study provided valuable insights into the potential benefits of traditional Chinese medicine in treating pulmonary tuberculosis, offering a promising alternative or complementary treatment option for patients who may not respond well to conventional Western medicine.

Output: Related. To explore the relationship between pulmonary tuberculosis and cellular immunity, we measured mediated cytotoxicity (CMC) in patients with infiltrative pulmonary tuberculosis and analyzed the dynamic changes before and after treatment for yin deficiency syndrome in pulmonary tuberculosis. All patients in this group with yin deficiency were treated with Xuan Shen, Sha Shen, Mai Dong, Bai Bu, Huang Jing, and Lu Han medicinal herbs. The results showed that 56 cases were lower than the normal group (p<0.01); 31 cases of patients with yin deficiency syndrome in this disease experienced improvement in their CMC levels after traditional Chinese medicine treatment. After treatment, the average CMC values were significantly lower compared to the normal group, indicating that traditional Chinese medicine could enhance the body's cellular immunity and improve clinical symptoms. The study also found that the treatment had a positive effect on improving the patient's overall condition, with significant improvements observed in CMC levels as well. The research concluded that traditional Chinese medicine could effectively treat this disease by boosting cellular immunity and alleviating clinical symptoms.

The study further noted that the treatment was effective in reducing the severity of clinical symptoms and improving the overall health of

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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: ·《医宗金鉴》明确提出结脑的"慢惊风"病名，如 讲："夹热夹痰慢惊。"清 ·《小儿卫生总微论方》称"慢脾风......兼证昏睡露睛，大便不聚而泻，此脾虚风 入。风在脾胃之间，故大便不聚而泻，时痪疯，身体四肢口鼻中气皆冷。小儿亦有因惊所传，或诸病久 变，见此证者。"对结脑的病名、症状和成因等均作了颇有见解的论述。

(二)中医对结核性脑膜炎的病机认识

"邪之所凑，其气必虚"。结脑常于患麻疹、百日咳或吐泻之后，正气亏耗，脾胃虚损，气血不足，抗 病力降低，痨虫(结菌)乘虚而入，病邪郁热化火，窜入营血而酿成本病。痨虫极易耗伤阴津气血，常致 肺阴不足，脾虚肝旺。阴血亏损，风热郁蒸，则见潮热、盗汗、烦躁不宁；脾虚肝旺，肝胃不和。胃气上逆， 则致头痛、呕吐、纳呆、便秘；阴血不足、血不养筋，虚风内动、则表现为慢惊痪瘀，项强。如火盛热极，肝 风内动，则见角弓反张。邪窜营血，心窍被蒙，或气伤阴耗，元气亏虚，致昏睡露睛，危在旦夕。终致阴血 枯涸，元气亏虚，从而出现阴阳俱虚，预后不良。

(三)中医辨证分型及方药

1.阴虚风动主证为面白颧红，微热或潮热，神识昏蒙时躁扰，时时抽搐，目直或斜视，手足心热。 消瘦，尿少便结。舌红少津无苔，脉细散弱或细促。治宜滋养肝肾，镇痉熄风。方药用六味地黄丸合三 甲复脉汤化裁：熟地20g, 山萸肉12g, 丹皮12g, 山药30g, 茯苓15g, 阿胶12g,白芍12g, 生牡蛎15g, 鳖甲 10g, 龟板10g, 麦冬15g, 火麻仁15g。水煎服，1日1剂。

2.脾虚痰逆 主证为头重痛，呕吐频繁，吐宿食或痰涎；面色青白，神疲嗜睡，目呆或斜视。舌淡胖 嫩，苔白，脉弦缓。治宜健脾除痰。方药用匀气散合四君子汤加味：乌药12g,白芍12g, 香附12g, 良 姜 10g, 吴茱萸12g, 党参13g, 茯苓15g, 白术15g, 甘草6g, 法半夏6g, 竹茹12g。水煎服，1日1剂。

3.阴阳俱虚 主证神疲形瘦，面白气弱手足瘫疯，昏睡露睛。舌质淡，苔薄白，脉沉迟无力。治以扶 阳救逆，佐以滋阴。方药用固真汤合六味地黄汤加减：党参15g, 黄芪20g,附子10g, 肉桂12g, 当归15g, 生地20g, 山萸肉12g, 黄精15g, 全蝎10g。水煎服，1日1剂。

加减法：眩晕加钩藤、石决明、菊花；呕吐甚加竹茹、生姜、半夏、代赭石；神昏加至宝丹、紫雪丹、安 宫牛黄丸、苏合香丸：瘫痪加鸡血藤、蜈蚣、马钱子、黄芪；头痛加元胡、白芷、川芎、藁本、天麻、细辛。

(四)有关本病辨证论治的中医资料 近年重视对抗痨虫(结核杆菌)中草药的应用，或单独用或在辨证用方基础上选加之。各地报告有 中西医结合实用内科学 如 ："750 "(柳叶、野药花和白花蛇舌草)水煎成浓缩剂，每日服2次，每次30ml; 芋芨丸(芋芨、海蜇、学 荠),水丸每次服9g,日2~3次；消瘰丸：玄参、牡蛎、夏枯草、连翘、紫花地丁，猫爪草各15g, 海藻、泽兰各 9g. 炼蜜丸，每丸重6g, 每次1丸，日服3次。目前已知百部、白及、功劳叶、金银花、大蒜、白果、黄连、黄 芩、地榆、射干、革薜、石榴皮、獭肝、安息香、阿魏、狼毒等有杀痨虫作用 患者，男，10岁，2001年11月26日初诊。主诉：发热3个月，昏迷伴抽搐1个月。起病后一直住院用西 药治疗，但未能确诊，病情未能控制。刻诊：神昏，发热38.5℃,面红，唇赤，阵发性全身强烈性抽搐，抽搐 每天发作2次以上，痰多，大便数天一行.舌质红赤，苔白厚，脉浮滑数。患儿患病日久而出现上述证候， 乃温热邪毒弥漫于卫、气、营，证属邪热炽盛、肝风内动、痰热蒙闭心包。治宜疏风清热解毒、镇肝熄风 止痉、化痰祛湿开窍。遂疏一方：羚羊骨15g (先煎),水牛角24g, 生石膏60g(先煎),钩藤15g (后下),蒲 公英20g, 贯众30g, 佩兰15g, 连翘15g, 金银花30g,牛劳子10g, 僵蚕15g, 蝉蜕15g, 石菖蒲10g, 法半夏 15g, 竹叶10g, 天竺黄15g, 黄芩10g, 柴胡20g,白芍20g, 珍珠母30g(先煎),白蒺藜15g, 全蝎10g, 菊花 15g, 玄参30g, 生牡蛎60g(先煎),夏枯草30g, 薄荷10g(后下),远志6g, 青蒿15g, 板蓝根30g, 防 风I⁰g, 牡丹皮15g, 胆南星10g, 茯苓30g, 陈皮10g, 甘草10g, 白术10g 。1剂，水煎分2天小量多次服。另针刺：十宜 点刺放血，人中、风府、哑门、风池(双)、印堂、曲池(双)、合谷(双)、中脘、大椎、足三里(双)、阴陵泉 (双)、阳陵泉(双)、丰隆(双)、三阴交(双)、中冲(双)、涌泉(双)、肾俞(双);眼针：上下焦、肝胆(双);头 针：运动区(双)、廉泉。不留针，每天针刺1次。28日复诊：症如前，烦躁不安，时抽搐，下午发热，舌质红， 唇赤，脉浮滑数。针刺方同前。中药守上方，生石膏加至100g先煎，加大青叶10g, 知母10g, 麦门冬15g, 地龙15g, 生地30g 。1剂，煎、服法如前。30日复诊：医院确诊为结核性脑膜炎，呈现低热，仍躁动，抽搐， 唇红减，脉细数。针刺方同前。中药守26日方：去贯众、板蓝根、金银花，加知母10g, 麦门冬15g, 生地30g, 地龙15g, 蜈蚣2条，蛇莲(民间草药)2g, 百部15g, 鳖甲10g(先煎),黄柏10g 。1剂，煎、服法如前。12月1日 复诊：好转，神志有所恢复，呼之能应，大便溏，舌质红，苔白，脉浮滑数。针刺方同前，中药守26日方加 竹叶30g, 扁豆20g, 神曲10g 。1剂，煎、服法如前。12月3日复诊：仍有低热，今晨抽搐1次，但很快缓解，大 便已成形，唇红，苔白，脉浮滑稍数。针刺同前，中药守12月1日方，改竹叶为10g 。1剂，煎、服法如前。12 月5日复诊：证如前，脑电图示有癫痫性表现，仍有低热，时抽搐，每次约半小时，唇红，苔白稍厚，脉浮 滑稍数，针刺同前，中药守3日方，改竹叶为20g 。1剂，煎、服法如前。12月7日复诊：仍有低热，自言自语， 上午清醒，可跟着讲熟悉的事物，抽搐减，舌质红苔白，脉浮滑稍数。针刺方如前，中药守2月5日方，守 方共服21剂药，当服至第7剂药后热退，抽搐大减，患儿偶在自言自语，上午清醒时可讲自己名字。服第 11剂药后抽搐止，服第14剂药后可稍加扶持行走约1km路，服第15剂药后出院回家，针刺改为4天1次。 2002年1月18日复诊：神志基本清醒，对答可，已无发热，无抽搐，胃纳可，二便调，眠欠佳，舌质淡，苔白 稍厚，脉无力。针刺处方同前，4天针刺1次，中药守2001年12月7日方，去竹叶加党参20g, 黄芪15g, 合欢 皮15g, 夜交藤30g, 生龙骨30g(先煎),生枣仁15g, 炒枣仁15g,柏子仁10g 。2剂，煎、服法如前。1月23日 复诊：明显好转，神清，有较多较好的语言交流，可自行来复诊，诉纳差，舌质淡红，苔白，脉细无力。此 乃邪热大减，血虚已露，可加强补血、壮髓、助纳之品。针刺守前方去十宣，每4天针1次。中药守18日方， 去生石膏，加山楂15g, 谷芽20g, 麦芽20g, 核桃60g, 枸杞子15g, 何首乌15g, 鸡血藤30g, 白 芷 1 0g, 熟 地

15g,川芎10g,当归15g。21剂，煎、服法同前。3月6日复诊：诉可与其他儿童正常玩耍，神清，眼有神，纳 少，诉无余不适，舌质淡红，苔白，脉无力。正气仍未复，须加强补气之力。针刺处方：四神聪、哑门、风 府、风池(双)、廉泉、气海、肾俞(双)、曲池(双)、合谷(双)、足三里(双),补法不留针。中药守1月23日 方，改黄芪50g, 党参50g 。10剂，煎、服法同前。4月5日复诊：明显好转，智力基本恢复正常，对答如流，舌 质淡红，苔薄白，有齿痕，脉无力。热邪退尽，当以大补气血、补肾益髓为主，佐以化痰镇肝祛风之品以 防反复。针刺守前方。中药处方如下：黄芪90g, 党参60g,白术15g, 茯苓20g, 法半夏10g, 鸡血藤30g, 何首 乌30g, 枸杞子15g, 山茱萸20g, 熟地20g, 当归20g, 川芎10g, 白芍15g, 丹参15g, 核桃60g, 石菖蒲10g.白

芷10g,白蒺藜10g, 紫河车15g(先煎),柴胡10g, 珍珠母15g(先煎),菊花10g, 五味子10g, 僵蚕10g, 蝉蜕

第二篇传染病

10g,制胆南星10g, 肉苁蓉20g, 范丝子20g, 川杜仲20g, 沙苑子20g, 百部15g, 鳖甲I₅g(先煎),地龙10g, 蜈蚣2条，全蝎10g, 山楂15g, 谷芽20g, 麦芽20g, 鸡内金10g, 神曲I₀g, 远志10g, 益智仁20g, 陈皮10g, 生 龙骨60g(先煎),生牡蛎60g(先煎),薏苡仁30g, 竹茹10g 。12剂，煎服法如前。6月8日复诊，患儿智力正 常，偶易激动，余无不适，舌质红，苔薄白，脉左关弦。此乃正气已复，肝有郁热，当以疏肝清热、镇肝熄 风为主，辅以健脑益智。针刺四神聪穴。中药易方如下：大枣6枚，当归15g, 白芍15g.柴胡10g.白术10g. 五味子10g, 茯苓20g, 甘草20g, 生姜20g, 薄荷5g, 郁金10g, 牡丹皮10g, 栀子10g, 核桃60g, 枸杞子15g, 浮 小麦40g, 何首乌20g, 珍珠母30g(先煎),菊花10g, 石莒蒲10g, 熟地黄20g, 钩藤10g(后下),生龙骨30g (先煎),龟板18g(先煎),生牡蛎30g(先煎),山茱萸15g, 远志10g, 益智仁15g, 夏枯草10g。煎服法如前， 2剂收功。至此，患儿完全恢复正常。随访至今，已完全康复，平素感冒亦少，读书成绩亦佳。《中国民 间疗法》2009.2)

四、西药治疗 (一)一般护理

发热、盗汗、疲惫等中毒症状重时应卧床休息。饮食宜富于营养与易于消化补充维生素。如不能进 食，可采用鼻饲法或静脉补液。

(二)西药治疗

1.抗痨治疗 ①异烟肼： 每日600~1200mg, 分3次口服。初起时，剂量宜大些，明显好转后，则可小 些。临床症状完全消失，脑脊液检查全部正常，而疗程又超过一年半时，才可停药。对重症病例，于治疗 开始时，尚可取异烟肼全日量的1/2~2/3,溶于适量葡萄糖溶液中作静滴，余量口服。②链霉素：成人 每日1g, 分1~2次肌注。如无不良反应，可持续注射到临床征象有明显好转后的一个月，一般疗程约3个 月。也可以卡那霉素代替链霉素。③利福平：对重症结脑，可用利福平静脉注射，成人每日500~ 1000mg。病情好转后可改口服，每日600mg,空腹一次顿服或分2次口服。但应注意本药对肝脏有损害。 ④乙胺丁醇：对某些耐药菌株有抑菌作用，25mg/kg·d, 清晨一次顿服。本药对视神经有毒性，可突然 出现视神经炎，特别引起色觉丧失。

2.对症治疗 昏迷、颅神经受损等定位征象或脑脊液中蛋白质明显增高者(疑有椎管阻塞者)加用 肾上腺皮质激素，常用强的松或强的松龙，按0.5~1mg/kg·d 计算，或地塞米松0.1-0.2mg/kg·d, 疗 程 为1个月左右。有人主张用地塞米松作鞘内注射，每次2.5~5mg,同时用异烟肼50mg,隔日一次，至病情

好转。

( 乔 富 渠 吴 斌 ) 第十四章伤寒 一 、 概说

伤 寒(Typhoidfever) 又名肠伤寒，是由伤寒杆菌侵袭引起，以持续发热，食欲不振，无欲貌，脾脏肿

中西医结合实用内科学

大，玫瑰疹，相对缓脉及白细胞减少为特征的急性肠道传染病。伤寒杆菌属革兰氏染色阴性菌，在自然 界有较强的生命力。伤寒患者和带菌者是主要传染源。饮水、食物、日常生活接触及苍蝇媒介等将病菌 传插给易感人研，本病全年可见，以5~9月为多。基本病理表现为全身网状内皮系统大单核细胞(巨噬 细胞)的增生性反应，其中以回肠末端的淋巴组织(肠壁集合淋巴结及孤立淋巴滤泡)病变最为显著。 病理上分增生、坏死、溃疡形成与溃疡愈合4期。此外肠系膜淋巴结、肝、脾与骨髓等常有巨噬细胞增 生，亦可发生灶性坏死，肾脏和心肌可能有营养不良性变性。抗原过剩的免疫复合物沉积于肾小球内 可引起肾小球炎症。病菌长期在胆囊存在，可使病人成为慢性带菌者，且常伴有慢性胆囊炎，为伤寒的 重要传染源。伤寒发病早期即有发热，并逐渐升高，多为稽留热型，常伴消化道症状如食欲不振、腹胀、 便秘或腹泻及右下腹可有压痛等。由于网状内皮系统的增生而脾脏肿大压痛，近年肝脏肿大亦多见， 重者可出现肝功损害及黄疸。有神经系统受损可表现神志恍惚，表情淡漠，反应迟钝，重者可有谵妄、 昏迷或出现脑膜刺激征(虚性脑膜炎)。病程7~13d在胸、腹及背部可出现淡红色充血性皮疹(称玫瑰 疹),压之退色，常少于10个。白细胞减少，嗜酸性粒细胞减少或消失。肥达氏反应呈阳性，早期血与第 2周后尿、粪可培养出伤寒杆菌。应用特效抗生素(氯霉素、复方磺胺甲基异恶唑、氨苄青霉素等)治疗 后48~72h体温开始下降。

二、诊断 (一)诊断标准

1.流行病学 当地伤寒流行，患者无伤寒病史与伤寒菌苗接种史，有与伤寒患者密切接触史可为 佐证。

2.临床表现 缓起与梯形上升的发热并持续高热、腹胀、便结或腹泻、淡漠、纳呆、相对缓脉、玫瑰 疹、脾肿大等临床特征。

3.化验 白细胞计数偏低或减少，嗜酸性粒细胞减少甚至消失，肥达氏反应阳性或伤寒杆菌分离 有助诊断。

**(二)**鉴别诊断 目前所见的伤寒以轻型较多，易与一般发热性疾病混淆。

1.败血症 本病常有原发病灶，热型多不规则，可见多形性皮疹与进行性贫血，白细胞总数虽可 减少，但中性粒细胞常增高，血培养阳性。

2.血行播散性结核病有结核病史或有与结核病患者密切接触史，发热不规则，常伴盗汗、脉搏 增 快 ，呼吸急促，血沉显著增速，胸片可见肺部有粟粒状病灶。

3.布氏杆菌病有与牧畜(牛、羊、猪)接触或饮用未消毒的乳制品史。临床表现为周期性发热(波 浪形),常有转移性关节疼痛或肌痛，出汗较多。血或骨髓培养可分离出布氏杆菌，Wright 凝集反应可 呈阳性。

4.恶性网状组织病(恶网)恶网亦见持续发热、肝脾肿大、白细胞减少等，但病情进展快而凶险， 出血与贫血显著。同时骨髓中可见异常增大的网状细胞，胞浆丰富，核染色质细而成网状，多有核仁， 并有淋巴样、单核样及多核巨细胞等异常类型的恶网细胞。

5.斑疹伤寒亦有发热、皮疹、脾肝肿大。但本病发病急骤，体温上升迅速。脉搏亦增速，皮疹较 多，脱落后有色素沉着。白细胞在正常范围或稍增，中性粒细胞常增多，嗜酸性粒细胞减少或消失，外 斐氏反应阳性。应用特效抗生素(氯霉素、四环素等)后24~48h体温即可退至正常。

6.流行性出血热发热短程自退、热渗(肿)并存。皮疹多呈出血性，肾脏损害早而严重，白细胞增 多 ，**以中性粒细胞为主，可见异型淋 巴细胞与血小板减少。临床呈五期经过。

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