盐山李××，年六旬，于季冬患伤寒兼脑膜生炎。
病因 素有头昏证，每逢上焦有热，精神即不清爽，腊底偶冒风寒病传阳明，邪热内炽，则脑膜
生炎，累及神明失其知觉。
证候 从前医者治不如法，初得时未能解表，遂致伤寒传里，阳明腑实，舌苔黄而带黑，其干
如错，不能外伸，谵语不休，分毫不省人事，两目直视不瞬。诊其脉两手筋惕不安，脉象
似有力而不实，一息五至，大便四日未行，小便则溺时不知。
诊断 此乃病实脉虚之证，其气血亏损难抗外邪，是以有种种危
险之象。其舌苔黑而干者，阳明热实津液不上潮也；其两目
直视不瞬者，肝火上冲而目发胀也；其两手筋惕不安者，肝热血耗而内风将动也；其谵语不省
人事者，固有外感之邪热过盛，昏其神明，实亦由外感之邪热上蒸，致脑膜生炎，累
及脑髓神经也。拟用白虎加人参汤，更辅以滋补真阴之品，庶可治愈。
处方 生石膏（五两捣细） 生怀地黄（二两） 野台参（八钱） 天花粉（八钱）
北沙参（八钱） 知母（六钱） 生杭芍（六钱） 生怀山药（六钱）
甘草（四钱） 荷叶边（一钱）
共煎汤三盅，分三次温服下，每服一盅调入生鸡子黄两枚。方中不用粳米者，以生山药可代
粳米和胃也；用生鸡子黄者，以其善熄肝风之内动也；用荷叶者，以善引诸凉药之力
直达脑中以清脑膜之炎也。
再诊 将药如法煎服，翌晨下大便一次，舌苔干较愈，而仍无津液，精神较前明了而仍有谵语
之时，其目已不直视而能瞬，诊其脉筋惕已愈强半，至数较前稍缓，其浮分不若从前有
力，而重按却比从前有根底，此皆佳兆也。拟即前方略为加减，清其余热即以复其真阴，庶可全愈。
处方 生石膏（四两捣细） 生怀地黄（二钱） 野台参（八钱） 大甘枸杞（一两）
生怀山药（一两） 天花粉（八钱） 北沙参（八钱） 知母（六钱）
生杭芍（六钱） 甘草（四钱）
共煎汤三盅。为其大便已通，俾分多次徐徐温饮下，一次只饮一大口。
效果 阅十点钟将药服完，精神清爽，诸病皆愈。
帮助 按治脑膜炎证，羚羊角最佳，而以治筋惕不安亦羚羊角最效，以其上可清头脑下可熄
肝风之萌动也。然此药价太昂，僻处药局又鲜真者，是以方中未用，且此证虽兼有脑膜炎
病，实因脏腑之邪热上蒸，清其邪热则脑膜炎自愈，原不必
注重于清脑也。
Mr. Li from Yanshan County, aged sixty, contracted Cold Damage (Shanghan) accompanied by meningitis in the late winter.
Etiology: He had a history of dizziness; whenever there was heat in the Upper Jiao (Upper Burner), his mental state would become unclear. At the end of the twelfth lunar month, he was accidentally exposed to wind and cold pathogens, which transmitted to the Yangming channel. The pathogenic heat blazed internally, causing inflammation of the meninges, affecting the Shen (Spirit/Mind), thereby impairing consciousness.
Symptoms: Previous physicians treated him improperly; initially failing to release the exterior pathogens, the Cold Damage transmitted inward, resulting in Yangming Fu-organ excess syndrome. The tongue coating was yellow with black patches, dry as if scraped, unable to protrude fully. He exhibited continuous delirious speech, complete loss of consciousness, and fixed staring without blinking. His pulse showed tremors in both hands; although it appeared forceful, it was actually empty. The rate was five beats per breath cycle. He had not had a bowel movement for four days, and urination occurred without awareness.
Diagnosis: This is a pattern of excess disease with deficient pulse, where the depletion of Qi and Blood makes it difficult to resist external pathogens, leading to various critical signs. The black and dry tongue coating indicates Yangming heat excess with failure of body fluids to ascend; fixed staring without blinking indicates Liver Fire rushing upward causing eye distension; tremors in the hands indicate consumption of Liver Blood and Heat, signaling impending internal Wind; delirium and loss of consciousness are due not only to excessive external pathogenic heat clouding the Spirit, but also specifically because this pathogenic heat steams upward, causing meningitis that affects the brain marrow and nerves. It is proposed to use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) supplemented with herbs that nourish True Yin, which may lead to a cure.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 5 liang, crushed); Sheng Huai Di Huang (Raw Rehmanniae Radix, 2 liang); Ye Tai Shen (Wild Codonopsis Pilosula, 8 qian); Tian Hua Fen (Trichosanthis Radix, 8 qian); Bei Sha Shen (Glehniae Radix, 8 qian); Zhi Mu (Anemarrhenae Rhizoma, 6 qian); Sheng Hang Shao (Raw Paeoniae Radix Alba, 6 qian); Sheng Huai Shan Yao (Raw Dioscoreae Rhizoma, 6 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 4 qian); He Ye Bian (Edge of Nelumbinis Folium, 1 qian).
Decoct together to yield three bowls of liquid, taken warm in three doses. Each dose should be mixed with two raw chicken egg yolks. Rice (Jing Mi) is omitted because Raw Shan Yao can substitute for it to harmonize the Stomach; raw egg yolk is used because it effectively extinguishes internal stirring of Liver Wind; Lotus Leaf is used to guide the cooling properties of the other herbs directly to the brain to clear meningeal inflammation.
Second Visit: After decocting and taking the medicine as prescribed, he passed stool once the next morning. The dryness of the tongue coating improved slightly, though fluids were still lacking. His mental state was clearer than before, though delirious speech persisted. His eyes no longer stared fixedly and could blink. Pulse examination showed that hand tremors had decreased by more than half; the pulse rate slowed slightly compared to before; superficial pressure felt less forceful than previously, but deep pressure felt more rooted. These are all favorable omens. It is proposed to slightly modify the previous prescription to clear residual heat and restore True Yin, aiming for full recovery.
Prescription: Sheng Shi Gao (Raw Gypsum Fibrosum, 4 liang, crushed); Sheng Huai Di Huang (Raw Rehmanniae Radix, 2 qian); Ye Tai Shen (Wild Codonopsis Pilosula, 8 qian); Da Gan Gou Qi Zi (Large Lycii Fructus, 1 liang); Sheng Huai Shan Yao (Raw Dioscoreae Rhizoma, 1 liang); Tian Hua Fen (Trichosanthis Radix, 8 qian); Bei Sha Shen (Glehniae Radix, 8 qian); Zhi Mu (Anemarrhenae Rhizoma, 6 qian); Sheng Hang Shao (Raw Paeoniae Radix Alba, 6 qian); Gan Cao (Glycyrrhizae Radix et Rhizoma, 4 qian).
Decoct together to yield three bowls. Since bowel movements have resumed, instruct the patient to drink slowly in multiple small sips, one large mouthful at a time.
Outcome: The medicine was consumed within ten hours. Mental clarity returned, and all symptoms resolved.
Commentary: For treating meningitis, Ling Yang Jiao (Capri Cornu, Antelope Horn) is optimal, and it is also most effective for treating tremors, as it clears the head and brain superiorly and extinguishes emerging Liver Wind inferiorly. However, this herb is too expensive, and authentic specimens are rare in pharmacies in remote areas, so it was not included in the formula. Moreover, although this case involves meningitis, it is fundamentally caused by pathogenic heat steaming upward from the Zang-Fu organs. Clearing this pathogenic heat will naturally resolve the meningitis; thus, special emphasis on clearing the brain itself is unnecessary.