②此期固宜以补养为主，然病者为系误服泻药太过致成阴虚或阳虚，则不可不分辨清楚，投以药饵。例如阴虚必有夜热晨凉、热退无汗、头眩、口干、耳聋、咽燥、二目呆直无神、舌无苔或盗汗、喘促、皮肤甲错、时欲痉脱、面目枯槁黧黑、脉细数虚弱等症，治宜滋阴，用白芍、生地、麦冬、天冬、沙参、元参等；或多汗，则用介类潜阳法，用牡蛎，鳖甲、龙骨、龟板等药品，酌量病情，再佐以丹皮、青蒿、地骨皮、知母、贝母、菖蒲、远志、竹沥、花粉、麻仁、梨汁、甘蔗汁等，均为有效治法。此时有一紧要秘诀，肆”无论患者有若何虚象，只要时时热度高升，必须注意病者之大便，倘有三五日不大便，必须酌与以缓下之品，中医用麻仁、郁李仁等，或稍稍与以西药之缓下剂，以清肠之余热。不可一味滋阴，反致腻生他变。而大便之外，尤宜注意胃气，必须设法培其胃气，使之复活，滋润鼓动则病势减退必速，用稀盐酸、橙皮酊、苦丁等，最有速效。此治温病阴虚之大法也。若阳虚者，必有自汗、神倦欲眠、二目虚朦、睡时目不尽合口气短寒、肢体微凉、舌无苔、不思饮食、不欲言、不腹痛、大便或溏、或泻清水，或完谷不化、此完谷不化，系久病虚象，若热盛之时，亦有完谷不化，不可误认。小便清白、皮肤苍白、暮热蒸蒸然、或冷汗出、或畏寒欲暖、或喘促声微、腹胀足肿、脉细微等，此时必用培补元气之药，以冀挽救，故人参、黄芪、白术、山药、茯苓等均为对症良药，甚则附子、肉桂、干姜皆所必需。然于此又应格外注意者，温病至于第三期，既现虚证，自宜补养，但温病末路患阴虚者，十之八九，患阳虚者，十之一二。且阴虚之证，虽已出现，治疗时，仍宜时时顾虑到馀热复燃，又成实热不可一味滋阴，致病又反复。若遇阳虚之症，更须慎之又慎，仔细诊断，确知其属阳虚无疑，方可稍稍试与补气及温补参、芪、桂、附等之品。无与补元气之药自然有效，至于桂附必不得已时用之可也。然于补阳之中，仍须顾及阴分，所以白芍、熟地等滋阴之药，有时仍宜兼用，且必须重用。为佐盖温热之症，津液耗尽乃成此危象，若只补阳，而忽略阴精恐又演成阳亢阴竭，骤然招致阴阳晚钮不相维系之险象，结果亦必断送人命，医者乌可不慎耶？中医书有以霍乱、痢疾、疟疾，均入温病类中，目为湿温者，荒唐不经，不值科学医之一晒。然霍乱、痢疾之后，演成虚证者极多，故余此段文字，不能不详细论列，读者须知中医所谓温病后之阳虚，强半系指温病以外之杂病而言，根本不得称为温病，与本编上段论温病阳虚之说，为截然两事，此不得不加以纠正，免误后人。又以温病患阳虚者，亦非绝对无有，故附录于此，而加以申明也。
况温症误服补阴药其祸犹小，若一误服补阳药，真如火上加油，祸不旋踵，即或误服人参一味，亦足以误人性命，愿医者三复斯言。盖温病之后，不论阴虚阳虚，皆在本病缠绵多日之后，绝无新得温病进行中即有虚证者，此层须格外注意也。
③此时病象，中医书所谓温邪逆传心包络，实为温邪粘滞膻中，气血交阻，蒙蔽清窍，为温病中最多见最危险之症象。此时治法，专解表邪，专清肺气，专攻肠胃．均非所宜，尤其攻伐肠胃太过，不但无效，而反害之，愈演愈重。所以病者此症多在八、九日之后于各种热象参看症候条外，现出种种昏迷狂妄，甚则痉厥、呕吐、头痛、内外皆闭、气涌沸腾、涌吐至滴水不受烦闷欲死。此时唯一治法，必用大剂芳香、苦降、辛开之品，分量自四、五钱至八钱例如鲜菖蒲、连翘、鲜佩兰叶、郁金此味不可太多、金银花、鲜竹叶心、鲜芦根等加以犀角、紫雪丹、二药为必用之品，但此药价太昂贵，二药分量，亦宜略重—钱左右。及安宫牛黄丸、至宝丹等，酌量何者为宜与服。一日三次或冲入煎药中亦可。均为此症极效之品，亦为医者极应采用之法也，伤寒与温病不同之点，即在于此。伤寒绝无此症，只有结胸一症，以陷胸汤治之即可，然绝非此症。余近见有一病妇（住刘海胡同二号）患此症，某医照录小陷胸汤原方与之，乌有济耶。其余橘红、蔻仁等，亦可酌用，但非必需品也。参看医验按此即西医书所称肠窒扶斯并发脑膜炎之症，考西医书载，凡此症并发肺炎、脑膜炎、肠出血等症者，预后多不良，几并发肠穿孔者，殆必死，或因心脏麻痹而死，此皆基于西医报告之确实统计，当无错误。余希望再基于中医报告统计之，则有确实之比较矣。余在实验上，亦深知西医此种记载，确实不误，然在中医之高明者，心灵手敏，一眼觇定邪在膻中，及时决定治法，如本论十之八九，尚能挽回，实较西药之效力伟大，理论明通，但遇昏庸之中医，则此亦为必死之症也。余既深知中医对此症，有此妙法，是以坦白录出，并举医验．以资证明。窃愿中西对此病症，群策群力，共同研究，除去治疗上之缺点及障碍，使芸芸众生．每遇此种危险疾患，早早脱离其病厄，渐渐减少其死亡率，实为我医者之唯一责任。明达医贤，当表同情，又何必各执门户之见，妄分中西新旧，又何必自欺欺人，谬称国粹，又何必自讳其短，尽诿其过于科学，倘能抛除成见，实事求是，集思广益，取彼所长，益我所短，使医疗上多一有效之方法，岂不甚善。余以为中西王益，殊途同归，造福干病人者，必非浅显，故敢大声疾呼，愿有志于世界医学者，共同努力也。
再论小儿温病合并症之脑膜炎，小儿脑膜炎亦同，但单纯之脑膜炎发作甚速，易于确认，及早注射脑膜炎血清，或预防（流行时）脑膜炎伐克辛，均能有效，然遇失于注射时机，或遇穷乡僻壤，无处延请西医，或缺乏血清及伐克辛时，则西医此时，即失其特长，至若泻下及消炎等法，率多无效，（参看医验）此时宁以中医治之，尚有些微希望也。盖此症即中医所称之内闭注意此二宇症候，当其尚未尽失知觉以前，必有呕吐发热各症，头痛功；有，但在小儿则不能自诉。渐次即神昏或角弓反张，二目天吊，人事不省而死。俗传以此为小儿失魂，巫觋杂进，针灸并施、无益有损，戒之戒之。此症西医除及早迟则无效施行注射血清疗法外，无他善法，中西医之泻下法，虽属合理，然据余之经验，百无一效。且有于初得尚未甚重之时，与以泻剂得下后，脑之症状，反而立时加剧者，此例亦不少。若以中医学说衡之，则为热邪盘据上焦，扰及心包络，徒以泻下之药，攻伐肠胃对于高据膻中之邪，毫不相干，且恐幼稚儿童，一受时邪灼烁，津液已有干燥胶滞内风眩动倾向，此时若再加以泻药劫夺，伤其真阴，遂致阴阳脱钮，孤阳上越，故肠胃虽通，而病势反加，余基于此种经验与理想，故每遇此症，必先注意小儿之二便，倘非确实大便闭止，绝不滥用泻药，必须灼见肠热，始与润肠药或小量之缓下药，例如中药之麻仁、郁李仁、瓜蒌仁或小量之熟大黄，西药之中小量甘汞等，然犹必须佐以养阴清热及芳香开窍之品，例如中药内之金银花、连翘、佩兰叶、香豆豉、鲜芦根、石菖蒲等，且药量均须加重，惟用甘汞时，则不可杂以中药耳。而犀角、羚羊角、牛黄、紫雪丹、至宝丹、安宫牛黄丸等药，尢为必需之品。择一用之，或以芳香药煎剂，合入服之。完全与治成年人之温症内闭，同一方法。施治若早得病二、三日以前必庆更生，中药此时比较有效。但若迟误稍久至六、七日之后昏迷太重，则此种方法，亦多无济矣。于此有应注意者，小儿体质脆弱，一得此症，传变甚速，不若成年人之温症，先在肺表，以次加重，医者要以精锐之眼光，敏速之乎段，当机立断，以资挽救，病家尤不可偏信西医除早期之注射迷信西医，坐误病机，以自杀其幼童也。中医须知急惊风，即此症别名，亦传染病也。
（医验）余治此温病之医案，殆不胜枚举，以此症流行最多，四时皆有，除冬季须与伤寒症严格鉴别外，馀时殆不难确认。兹仅举危险症候，极有研究价值之医验数则，藉供参考。所列各案，或为初期误治，迟延日久，八、九日后势将逆传之症，或为邪少虚多，第三期之肠出血期危症，或为逆传后之险症，或为西医认为不治之症，举一反三，愿读者深思焉。
魏凤瑞，四十九岁，住石虎胡同二号，于民国二十六年十月得病，第一日恶寒、身热、头奇痛、身酸痛、呕恶，某医第三日与以苏叶、羌活、白茯苓等药余药记不清楚二剂，病加重。据云未出汗又请西医诊治，服液剂未见其方三日未效。又延某中医诊治，第一方为佩兰、藿香、焦楂、枳壳、砂仁、神曲、陈皮、丝瓜络，服后头痛更甚，馀症仍然。第二方为橘络、藁本、砂仁、枳实、菊花、泽泻、陈皮、桑叶、木通、神曲、竹叶，患者曾自眼阿斯比林（三次）药片，头痛暂止仍发。诸症更甚，又加口渴、小便短赤、大便稀而呈紫黑色、舌苔边白腻、中赤，又照前方加薄荷、大黄三钱、枳实三钱，服后病更甚，已不能起床，此既往治疗之经过情形也。
十一月五日，延余诊治，认为湿温，诊得肺胃郁热内炽，灼烁阴液，原因感受时令流行不正之气，天气忽冷外束日久十日未解以致现在头痛、体痛、恶寒、壮热、呕逆特甚、胸闷、口苦咽干、舌苔燥白浊厚、小便赤少、腰腿痛、脉沉濡，势将逆传，法宜宣解，兼清肺胃，服药后，忌口避风，取微汗解。
第一方，荆芥穗钱半牛蒡子钱半淡豆豉一钱金银花三钱防风二钱炒栀子二钱连翘三钱菊花三钱杏仁泥钱半白芷二钱薄荷钱半旋复花二钱包煎竹叶一钱鲜芦根引煎服。服前药一剂，得微汗，病势稍减，头痛大减，仍有壮热、作烧、心烦口渴、咽干、泄泻、舌苔仍白厚。此肺胃湿热未净。法宜再清肺胃，化除湿温分解之。十一月六日第二方，小生地三钱薄荷一钱金银花三钱生栀子二钱滑石块二钱姜黄连八分连翘二钱姜厚朴一钱旋复花二钱包煎赤茯苓二钱黄芩三钱甘草一钱腹皮绒二钱姜引煎服。眼前药一剂，病均轻减，惟肺胃蓄热太久．上焦火盛灼阴，依前法再清肺胃，抑止上焦火热，兼以养阴之品。十—-月七日第三方，鲜石斛二钱元参二饯川连八分金银花二钱生石膏四钱川军二钱，用此药汆非常慎重薄荷一钱连翘三钱生地三钱枳实二钱旋复花三钱栀子二钱菊花三钱灯心五分引煎服。服前药一剂大效，呕止，热退，头痛身痛等症均退，以后即以竹叶等品小剂调理。又三剂而愈，始终未与西药。
此症患者体质极壮，是以迟延十日，尚未逆传，然头痛极甚，呕恶亦烈，势将内闭，转成险病。余方第一剂，昕以有效者，即能毅然断定其仍有外感也，此与占书治湿温症之说不合，其脉象、舌苔、时令，秋末湿热显然，然此症至此程度，若不急解其表，使外寒久束，内热久羁，必成逆传内外皆闭之险症。余敢决然排除成说，（温症忌汗，十馀日后．更忌发汗。）既能决定其表有实邪，内热已无出路？大胆即于清热药中，一部分加入发散之药，以驱逐其外束日久之寒邪，而开其外透之门户。第二方为之稍一千旋胃气，即便决然与以第三方之攻下，盖此时已无在表之寒邪牵制，不虑其内陷矣不使内蓄日久之湿热，再作停留，故加泻药使内热一拥而下，表里均透而病愈矣。此症在余接诊之始，煞费斟酌，最今余迷惑者，即其沉濡不扬之脉，此是湿温实与表证不符，乃经多方诊察，一眼觇定其十馀日后，外邪仍在，内热固滞，遂将一切拘板之禁忌，毅然排除，三剂中药、而能令病者脱离危境，非敢云胆大心细也。
设使此症误汗，即不当汗必一剂精神昏迷，而发谵语，促成其脑症状。内闭设使此症不先汗，即攻下，必一剂津亡阳升，四肢骤厥，甚则全体皆凉，亦必促成内外皆闭。设使此症只与清热去湿，则必愈治愈热，渐渐转戍内闭，再攻下，已无及矣，医坛师友以为然否？郭校长三十二岁，住祖家街，北京美术专科学校。于二十七年三月三日，患春温症，病象为恶寒、身痛、发热、腿痛尤甚、头痛，脉浮洪、右手脉尤洪大。延余诊治，认为春温症，当与连翘、银花、桑叶、竹叶、薄荷、荆芥穗、防风等药，令取微汗。
第二月，病势均退，已复平温，惟足痛尚未痊愈，患者自觉已愈：遂停止服药，然腿足尚痛，约二十余日．方能勉强出门，此本病已往治疗之经过情形也。
四月八日，忽又病如前状？而各症加甚，腿足均肿，舌苔白，头痛，余症与三月三日病状无异，而恶寒特甚。经诊断认为上次温邪，并未全清，酝酿多日，因天气忽凉，复感外寒，因而诱起内蕴之热，仍宜先以轻剂解表，兼清上焦，使邪有出路，再议清其内热。
②This stage is indeed suitable for primarily using nourishing and tonifying methods. However, if the patient has developed Yin deficiency or Yang deficiency due to excessive intake of purgatives by mistake, it is imperative to distinguish clearly between the two before administering medication. For instance, Yin deficiency necessarily presents with symptoms such as night fever and morning coolness, absence of sweat after fever subsides, dizziness, dry mouth, deafness, dry throat, dull and spiritless eyes, tongue without coating or spontaneous sweating during sleep (night sweats), panting, skin rough like scales (skin xerosis), frequent tendency towards spasms and collapse, withered and dark complexion, and a fine, rapid, and weak pulse. The treatment should favor nourishing Yin, using herbs such as Bai Shao (Radix Paeoniae Alba), Sheng Di Huang (Radix Rehmanniae Preparata), Mai Dong (Rhizoma Ophiopogonis), Tian Dong (Radix Asparagi), Sha Shen (Radix Glehniae seu Adenophorae), and Yuan Shen (Radix Scrophulariae). If there is excessive sweating, the method of subduing Yang using shell-type minerals should be employed, using drugs such as Mu Li (Concha Ostreae), Bie Jia (Carapax et Plastrum Testudinis), Long Gu (Os Draconis), and Gui Ban (Plastrum Testudinis). Depending on the condition, these can be supplemented with Dan Pi (Cortex Moutan), Qing Hao (Herba Artemisiae Annuae), Di Gu Pi (Cortex Lycii), Zhi Mu (Rhizoma Anemarrhenae), Bei Mu (Bulbus Fritillariae Cirrhosae), Chang Pu (Rhizoma Acori Tatarinowii), Yuan Zhi (Radix Polygalae), Zhu Li (Succus Bambusae in Taenia), Hua Fen (Radix Trichosanthis), Ma Ren (Semen Cannabisae), Pear juice, and Sugarcane juice; all are effective treatments. At this time, there is a crucial secret: regardless of what kind of deficiency signs the patient exhibits, as long as the temperature remains high at times, one must pay attention to the patient's stool. If there has been no bowel movement for three to five days, mild laxatives should be酌情 administered. In Traditional Chinese Medicine (TCM), Mahuang (Ephedrae Herba) is not used here but rather Hemp Seed (Semen Cannabisae) and Prunus Seed (Semen Armeniacae Amarum); alternatively, Western medicine mild laxatives can be slightly used to clear residual heat from the intestines. One must not solely rely on nourishing Yin, as this may lead to cloying effects and other complications. Besides the stool, particular attention should be paid to Stomach Qi (Stomach energy). Efforts must be made to cultivate Stomach Qi to restore its vitality; moistening and stimulating it will cause the disease trend to subside rapidly. Dilute hydrochloric acid, Orange Peel Tincture, and Ku Ding Cha (Ilex Kudingcha) are most effective. This is the general principle for treating Yin deficiency in Warm Diseases (Wen Bing). If Yang deficiency is present, there will necessarily be spontaneous sweating, mental fatigue and desire to sleep, hazy vision, incomplete closure of eyes during sleep, shortness of breath and cold sensation, slightly cool limbs, tongue without coating, anorexia, reluctance to speak, absence of abdominal pain, loose stools or watery diarrhea, or undigested food in stool (undigested food refers to feces containing un-digested food particles, which is a sign of chronic deficiency; however, it can also occur during intense heat, so do not misidentify it). Urine will be clear and copious, skin pale, evening fever with steaming sensation, or cold sweat, aversion to cold and desire for warmth, panting with faint voice, abdominal distension and foot swelling, and a minute and subtle pulse. At this time, medicines that tonify Original Qi (Yuan Qi) must be used to hope for rescue. Therefore, Ren Shen (Radix Ginseng), Huang Qi (Radix Astragali), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Shan Yao (Rhizoma Dioscoreae), and Fu Ling (Sclerotium Poriae Cocos) are all appropriate and effective medicines. In severe cases, Fu Zi (Radix Aconiti Lateralis Preparata), Rou Gui (Cortex Cinnamomi), and Gan Jiang (Rhizoma Zingiberis Preparatum) are necessary. However, extra caution is required here. When Warm Disease reaches the third stage and deficiency signs appear, nourishment is indeed suitable. Yet, nine out of ten patients at the end of Warm Disease suffer from Yin deficiency, while only one or two suffer from Yang deficiency. Moreover, although Yin deficiency signs have appeared, treatment must always consider the possibility of residual heat reigniting and becoming excess heat. One must not blindly nourish Yin, causing disease recurrence. If encountering Yang deficiency, even greater caution is needed. Careful diagnosis must confirm Yang deficiency beyond doubt before cautiously trying Qi-tonifying and warming medicines such as Ren Shen, Huang Qi, Rou Gui, and Fu Zi. Tonifying Original Qi medicines are naturally effective, but Rou Gui and Fu Zi should only be used when absolutely necessary. Furthermore, while tonifying Yang, one must still attend to the Yin aspect. Therefore, Yin-nourishing medicines like Bai Shao and Shu Di Huang (Radix Rehmanniae Preparata) should sometimes be used concurrently and in heavy doses as adjuvants. This is because in Warm diseases, exhaustion of body fluids leads to this critical state. If only Yang is tonified while ignoring Yin essence, it may evolve into hyperactive Yang and exhausted Yin, suddenly leading to a dangerous situation where Yin and Yang detach and fail to support each other, inevitably resulting in death. How can physicians not be cautious? Some TCM books incorrectly classify Cholera (Huo Luan), Dysentery (Li Ji), and Malaria (Nue Ji) under Warm Diseases as Damp-Warmth (Shi Wen), which is absurd and unworthy of scientific medical consideration. However, many cases develop deficiency syndromes after Cholera or Dysentery. Therefore, I discuss this section in detail. Readers must understand that the "Yang deficiency after Warm Disease" mentioned in TCM largely refers to miscellaneous diseases outside of Warm Disease, and fundamentally cannot be called Warm Disease. This is completely different from the discussion on Yang deficiency in Warm Disease in the previous section of this book, which requires correction to avoid misleading future generations. I append this because Yang deficiency in Warm Disease is not absolutely non-existent, and I clarify it here.
Moreover, mistakenly taking Yin-nourishing medicines in Warm disorders causes lesser harm. If Yang-tonifying medicines are mistakenly taken, it is like adding oil to fire, with disaster following immediately. Even mistakenly taking just one dose of Ren Shen can be fatal. Physicians should repeat these words often. After Warm Disease, whether Yin or Yang deficiency occurs, it happens after the original disease has lingered for many days. It is extremely rare to have deficiency signs during the active progression of a new Warm Disease. This point requires extra attention.
③The pathological presentation at this time, described in TCM books as "Warm pathogen counter-attacking the Pericardium Collateral," is actually Warm pathogen stagnating in the Tan Zhong (Chest Center/Pericardium region), causing obstruction of Qi and Blood, and clouding the clear orifices. This is the most common and dangerous symptom complex in Warm Disease. At this time, treatments focusing solely on releasing the exterior, clearing Lung Qi, or attacking the intestines and stomach are inappropriate. Especially excessive attack on the intestines and stomach is not only ineffective but harmful, making the condition worse. Thus, patients with this syndrome usually present various symptoms of coma and madness, even convulsions, vomiting, headache, internal and external blockage, surging Qi and boiling fluids, vomiting until nothing can be retained, and extreme restlessness wanting to die, mostly after eight or nine days, alongside various heat signs. The only treatment method at this time is to use large doses of aromatic, bitter-descending, and acrid-opening substances. Dosages range from 4-5 qian to 8 qian. Examples include fresh Chang Pu (Rhizoma Acori Tatarinowii), Lian Qiao (Fructus Forsythiae), fresh Pei Lan Ye (Herba Eupatorii), Yu Jin (Rhizoma Curcumae Longae - do not use too much), Jin Yin Hua (Flos Lonicerae Japonicae), fresh Zhu Ye Xin (Folium Bambusae), and fresh Lu Gen (Rhizoma Phragmitis). These are added with Xi Jiao (Cornu Bubali) and Zi Xue Dan (Purple Snow Pill). These two medicines are essential, but they are too expensive, and their dosage should be slightly heavier, around 1 qian. Also, An Gong Niu Huang Wan (An-Gong Niu-Huang Pills) and Zhi Bao Dan (Treasure Preservation Pill) can be chosen based on suitability. Taken three times a day, or mixed into decoctions, they are highly effective for this syndrome and a method physicians should adopt. The difference between Shang Han (Cold Damage) and Wen Bing lies here. Shang Han never has this syndrome; it only has Jie Xiong (Chest Binding), treated with Xian Xiong Tang (Trap-in-the-Chest Decoction), which is definitely not this syndrome. I recently saw a female patient (living at No. 2 Liu Hai Hutong) suffering from this. A certain doctor copied the original formula of Xiao Xian Xiong Tang for her. How could it help? Other herbs like Ju Hong (Exocarpium Citri Reticulatae) and Kou Ren (Semen Amomi Rotundum) can be used optionally but are not essential. Refer to Medical Cases: This corresponds to Typhoid Fever complicated with Meningitis in Western medicine books. According to Western records, prognosis is poor when complicated with pneumonia, meningitis, or intestinal bleeding. Complication with intestinal perforation is almost certainly fatal, or death due to cardiac paralysis. These are based on accurate Western statistics and are likely correct. I hope for accurate comparisons based on TCM statistics. Experimentally, I know Western records are accurate. However, skilled TCM physicians, with keen insight and agility, can identify the pathogen in Tan Zhong at a glance and decide treatment timely. As discussed, nine out of ten cases can be saved, which is far more effective than Western medicine, with clearer theory. But if encountered by mediocre TCM doctors, it becomes a fatal case. Knowing TCM has this wonderful method for this syndrome, I record it frankly and provide medical cases for proof. I privately hope East and West will work together to study this syndrome, remove defects and obstacles in treatment, help sentient beings escape such dangerous diseases early, gradually reduce mortality rates, which is the sole responsibility of physicians. Enlightened medical experts should sympathize. Why insist on sectarian views, arbitrarily divide East/West or old/new, deceive oneself and others, falsely claim national essence, hide shortcomings, and blame science? If prejudices are discarded, facts are sought, wisdom is gathered, strengths are borrowed, and weaknesses compensated, adding an effective method to medicine, would it not be good? I believe East and West benefit equally, reaching the same goal through different paths. Benefiting patients is significant. I dare to shout loudly, hoping those dedicated to world medicine will strive together.
Regarding pediatric Warm Disease complicated with Meningitis: Pediatric meningitis is similar, but pure meningitis develops rapidly and is easy to confirm. Early injection of meningitis serum or prevention (during epidemics) with meningitis vaccine is effective. However, if injection timing is missed, or in remote areas without access to Western doctors, or lacking serum/vaccine, Western medicine loses its advantage. Methods like purgation and anti-inflammation are mostly ineffective (see Medical Cases). At this time, TCM offers slight hope. This syndrome is known in TCM as "Internal Closure" (note these two characters). Before complete loss of consciousness, there are vomiting, fever, and headache (present, but infants cannot complain). Gradually, coma, opisthotonos (arched back), upward staring eyes, and unconsciousness leading to death occur. Folklore calls this "loss of soul." Witchcraft, mixed remedies, and acupuncture are useless and harmful. Beware! Western medicine has no better method than early serum injection. While purgation in both systems seems reasonable, my experience shows zero efficacy. Sometimes, after giving purgatives early when the condition is not severe, brain symptoms worsen immediately. There are many such cases. From a TCM perspective, heat pathogens occupy the Upper Jiao (Upper Burner), disturbing the Pericardium. Using purgatives to attack the intestines and stomach is irrelevant to pathogens high in Tan Zhong. Moreover, young children, after exposure to seasonal pathogens, already have dried and sticky body fluids with tendencies toward internal wind and vertigo. Adding purgatives to劫夺 (rob/seize) further injures True Yin, leading to detachment of Yin and Yang, floating lone Yang. Thus, although bowels open, the disease worsens. Based on this experience and theory, whenever I encounter this, I first check the child's urination and defecation. Unless constipation is definite, I never abuse purgatives. Only if intestinal heat is confirmed do I give moistening intestines medicines or small doses of mild laxatives, such as Ma Ren (Semen Cannabisae), Yu Li Ren (Semen Armeniacae Amarum), Gua Lou Ren (Semen Benincasae), or small amounts of Shu Da Huang (Rhei Radix et Rhizoma Preparatum), or small doses of Calomel (Western medicine). However, these must be supplemented with Yin-nourishing, heat-clearing, and aromatic orifice-opening agents, such as Jin Yin Hua (Flos Lonicerae Japonicae), Lian Qiao (Fructus Forsythiae), Pei Lan Ye (Herba Eupatorii), Xiang Dou Chi (Faba Fermentata Preparata), fresh Lu Gen (Rhizoma Phragmitis), Shi Chang Pu (Rhizoma Acori Tatarinowii), etc., with increased dosages. Note: Calomel should not be mixed with Chinese herbs. Xi Jiao (Cornu Bubali), Ling Yang Jiao (Cornu Saigae Tataricae), Niu Huang (Calculus Bovis), Zi Xue Dan (Purple Snow Pill), Zhi Bao Dan (Treasure Preservation Pill), and An Gong Niu Huang Wan (An-Gong Niu-Huang Pills) are especially essential. Choose one to use, or mix aromatic decoctions. The method is identical to treating Internal Closure in adult Warm Disorders. If treated early, within two or three days of onset, recovery is certain, and TCM is relatively effective then. But if delayed to six or seven days with severe coma, this method is often useless. Note: Children have fragile constitutions. Once infected, transmission is rapid, unlike adults where Warm Disorder starts in Lung Exterior and worsens gradually. Physicians must use sharp eyesight and swift actions to make decisive decisions for rescue. Families must not blindly trust Western medicine, relying only on early injections, missing opportunities, and killing their children. TCM practitioners must know that Ji Jing Feng (Acute Convulsion) is another name for this syndrome and is also infectious.
(Medical Cases) My cases of treating this Warm Disease are countless, as it is prevalent in all seasons. Except for winter requiring strict differentiation from Shang Han, confirmation is easy otherwise. Here I list only a few dangerous cases with research value for reference. The listed cases include: initial misdiagnosis leading to delay, potential counter-attack after 8-9 days; late-stage intestinal bleeding crisis with little pathogen and much deficiency; post-counter-attack critical conditions; or cases deemed incurable by Western medicine. Reflect on them deeply.
Wei Fengrui, 49 years old, living at No. 2 Shi Hu Hutong. Fell ill in October of the 26th Year of the Republic of China. Day 1: Aversion to cold, body heat, severe headache, body ache, nausea/vomiting. On Day 3, a doctor gave Su Ye (Folium Perillae), Qiang Huo (Rhizoma Notopterygii), Bai Fu Ling (Sclerotium Poriae Cocos) etc. (other meds forgotten), two doses. Condition worsened. Claimed no sweat. Then consulted a Western doctor, took liquid meds (prescription unknown), no effect after 3 days. Then consulted another TCM doctor. First prescription: Pei Lan (Herba Eupatorii), Huo Xiang (Herba Agastaches), Jiao Zha (Fritillariae Bulbus Carbonized), Zhi Ke (Fructus Aurantii Immaturus), Sha Ren (Semen Amomi), Shen Qu (Massa Medicata Fermentata), Chen Pi (Exocarpium Citri Reticulatae), Si Gua Luo (Retinervus Luffae Fructus). Headache worsened, other symptoms remained. Second prescription: Ju Luo (Medulla Citri Reticulatae), Gao Ben (Rhizoma Ligustici Chuanxiong), Sha Ren (Semen Amomi), Zhi Shi (Fructus Aurantii Immaturus), Ju Hua (Flos Chrysanthemi), Ze Xie (Rhizoma Alismatis), Chen Pi (Exocarpium Citri Reticulatae), Sang Ye (Folium Mori), Mu Tong (Caulis Akebiae), Shen Qu (Massa Medicata Fermentata), Zhu Ye (Folium Bambusae). Patient self-administered Aspirin (3 times), headache temporarily stopped but returned. Symptoms worsened, added thirst, scanty dark urine, loose purple-black stool, white greasy coating on tongue edges, red center. Added Bo He (Herba Menthae), Da Huang (Rhei Radix et Rhizoma) 3 qian, Zhi Shi (Fructus Aurantii Immaturus) 3 qian to previous formula. Condition worsened further, unable to get out of bed. This was the history of previous treatment.
On Nov 5, I consulted. Diagnosed as Damp-Warmth. Pulse and tongue indicated stagnant Heat in Lung and Stomach burning Yin fluids. Cause: contraction of abnormal seasonal qi, sudden cold constraining exterior for 10 days unresolved. Current symptoms: headache, body pain, aversion to cold, high fever, severe vomiting/reversal, chest tightness, bitter taste, dry throat, dry white turbid thick coating, scanty red urine, lower back/leg pain, deep and soggy pulse. Trend towards counter-attack. Method: Release and resolve, simultaneously clear Lung and Stomach. Take light sweat after medication, avoid wind/dietary restrictions.
First Prescription: Jing Jie Sui (Capitium Elsholtziae) 1.5 qian, Niu Bang Zi (Fructus Arctii) 1.5 qian, Dan Dou Chi (Faba Fermentata Preparata) 1 qian, Jin Yin Hua (Flos Lonicerae Japonicae) 3 qian, Fang Feng (Radix Saposhnikoviae) 2 qian, Chao Zhi Zi (Semen Gossypii Herbacei Carbonized) 2 qian, Lian Qiao (Fructus Forsythiae) 3 qian, Ju Hua (Flos Chrysanthemi) 3 qian, Xing Ren Ni (Semen Armeniacae Amarum Paste) 1.5 qian, Bai Zhi (Radix Angelicae Dahuricae) 2 qian, Bo He (Herba Menthae) 1.5 qian, Xuan Fu Hua (Flos Inulae) 2 qian (wrapped), Zhu Ye (Folium Bambusae) 1 qian, Fresh Lu Gen (Rhizoma Phragmitis) as guide. After one dose, light sweat occurred, condition slightly improved, headache greatly reduced. Still high fever, burning sensation, irritability, thirst, dry throat, diarrhea, white thick coating. Damp-Heat in Lung/Stomach not cleared. Method: Clear Lung/Stomach again, transform Damp-Warmth.
Nov 6, Second Prescription: Xiao Sheng Di (Radix Rehmanniae) 3 qian, Bo He (Herba Menthae) 1 qian, Jin Yin Hua (Flos Lonicerae Japonicae) 3 qian, Sheng Zhi Zi (Semen Gossypii Herbacei) 2 qian, Hua Shi Kuai (Mineral Hydrargyri) 2 qian, Jiang Huang Lian (Rhizoma Coptidis Gingered) 0.8 fen, Lian Qiao (Fructus Forsythiae) 2 qian, Jiang Hou Po (Cortex Magnoliae Officinalis Gingered) 1 qian, Xuan Fu Hua (Flos Inulae) 2 qian (wrapped), Chi Fu Ling (Sclerotium Poriae Cocos Rubrum) 2 qian, Huang Qin (Radix Scutellariae) 3 qian, Gan Cao (Radix Glycyrrhizae) 1 qian, Fu Pi Rong (Cortex Magnoliae Officinalis Velvet) 2 qian, Ginger as guide. After one dose, all symptoms lightened. However, Lung/Stomach heat stored too long, Upper Jiao fire blazing injuring Yin. Follow previous method to clear Lung/Stomach, suppress Upper Jiao fire, nourish Yin.
Nov 7, Third Prescription: Xian Shi Hu (Rhizoma Dendrobii) 2 qian, Yuan Shen (Radix Scrophulariae) 2 qian, Chuan Lian (Rhizoma Coptidis) 0.8 fen, Jin Yin Hua (Flos Lonicerae Japonicae) 2 qian, Sheng Shi Gao (Gypsum Fibrosum) 4 qian, Chuan Jun (Rhei Radix et Rhizoma) 2 qian. Use this medicine very cautiously. Bo He (Herba Menthae) 1 qian, Lian Qiao (Fructus Forsythiae) 3 qian, Sheng Di (Radix Rehmanniae) 3 qian, Zhi Shi (Fructus Aurantii Immaturus) 2 qian, Xuan Fu Hua (Flos Inulae) 3 qian, Zhi Zi (Semen Gossypii Herbacei) 2 qian, Ju Hua (Flos Chrysanthemi) 3 qian, Deng Xin (Medulla Junci) 0.5 fen as guide. After one dose, great effect. Vomiting stopped, fever subsided, headache/body pain resolved. Later managed with small doses of Zhu Ye etc. Three more doses led to cure. Never used Western medicine.
This patient had strong constitution, so delayed 10 days without counter-attack. However, severe headache and violent vomiting indicated impending internal closure and danger. My first dose worked because I firmly judged exterior pathogen still existed, contradicting ancient texts saying Damp-Warmth forbids sweating. Autumn end damp-heat was obvious in pulse/tongue/season. But at this stage, failing to urgently release the exterior would let exterior cold constrain and interior heat linger, causing fatal internal/external closure. I boldly excluded dogma ("Warm disorders forbid sweating, especially after 10+ days"). Determining exterior excess and interior heat having no exit, I boldly added dispersing herbs to heat-clearing formulas to drive out constrained cold and open exit portals. Second dose harmonized Stomach Qi slightly, then decisively used Third dose's purgative. With no exterior cold restricting, no fear of sinking inward. Prevented lingering damp-heat by purging, allowing interior/exterior penetration and cure. Initially, I struggled with the deep, soggy, unrevealing pulse, which didn't fit exterior syndrome. After thorough examination, seeing exterior pathogen persist after 10+ days and interior heat stagnation, I discarded rigid taboos. Three doses of TCM saved the patient from crisis. Not claiming boldness, but careful detail.
If this case was wrongly sweated (when not indicated), one dose would cause coma and delirium, triggering brain symptoms/internal closure. If not sweated first, but purged directly, one dose would cause fluid loss and Yang rising, sudden cold limbs, possibly whole body cold, also triggering internal/external closure. If only given heat-clearing and damp-draining, heat would increase, turning into internal closure, and purging later would be too late. Do colleagues agree?
Principal Guo, 32 years old, living at Zu Jia Street, Beijing Art Academy. On March 3, 27th Year of ROC, suffered Spring Warm Disorder. Symptoms: aversion to cold, body pain, fever, severe leg pain, headache. Pulse floating and洪大 (surging-large), right hand pulse especially surging-large. I diagnosed Spring Warm Disorder, prescribed Lian Qiao (Fructus Forsythiae), Yin Hua (Flos Lonicerae Japonicae), Sang Ye (Folium Mori), Zhu Ye (Folium Bambusae), Bo He (Herba Menthae), Jing Jie Sui (Capitium Elsholtziae), Fang Feng (Radix Saposhnikoviae) etc., to induce light sweat.
Next month, symptoms receded, temperature normalized, but foot pain persisted. Patient felt cured and stopped meds. Leg/foot pain continued for ~20 days before walking was possible. This was the previous treatment history.
April 8, suddenly fell ill again with same symptoms, worsened. Legs/feet swollen, white tongue coating, headache, other symptoms same as March 3 but severe aversion to cold. Diagnosis: Previous Warm pathogen not fully cleared, brewed for days. Sudden cold triggered latent heat. Method: Light exterior-releasing agent first, clear Upper Jiao, give pathogen exit, then clear interior heat.