2 Traditional Chinese Medicine’s Understanding of the Pathogenesis of Epidemic Parotitis

(1) Historical Medical Views: Terms like “bursting parotitis,” “parotitis with swollen glands,” “beard-like parotitis,” “toad plague,” “swan plague,” “parotitis with swelling,” “ulcerated parotitis,” “ear swelling,” “big-head plague,” “big-mouth plague,” and others all refer to this disease. Notably, records of “making the waist” clearly indicate this condition; as early as over two thousand years ago, the ancient Chinese medical text “Suwen · Zhi Zhen Yao Da Lun” contained similar descriptions of this disease. The Sui Dynasty’s “Zu Bing Yuan Hou Lun” stated: “Wind-heat toxins invade the throat, jaw, and cheeks, colliding with qi and blood, causing swelling and pain.” In 1020 AD, the disease was already prevalent in the capital city of Kyoto. Li Shizhen’s “Ben Cao Gang Mu” recorded in Zhu’s collection of verified prescriptions: “When Emperor Renzong was still in the Eastern Palace, he suffered from parotitis and ordered Taoist priest Zhan Ning to treat him. He used 70 grains of red adzuki beans, ground them into powder, and applied it to the affected area, which healed him.” Later Ming and Qing dynasty physicians further clarified the disease’s prevalence and seasonal patterns. The “Yi Xue Xin Zhi” provided a particularly vivid description of the disease: “Due to sudden wind-heat attacks, the Shaoyang meridian becomes imbalanced… swelling and pain arise under the ears, sometimes on the left, sometimes on the right, or both sides simultaneously. Initially, the lesions resemble chicken eggs, their color resembling a leaking swelling, appearing as if pus has formed, but they do not cause sharp pain when pressed, only a slight discomfort, with a mild chill and fever. In severe cases, the patient feels cold and fever, with dry mouth and greasy coating—this disease never forms pus, and the lesions naturally resolve over time.” This clearly distinguishes it from suppurative parotitis, benign or malignant parotid diseases. Chen Shigong’s “Wai Ke Zheng Zong” noted: “When the weather is unfavorable, infection occurs due to exposure to pathogenic factors.” “Parotitis arises from wind-heat and damp-phlegm, often arising after winter’s cold and unfavorable weather, with the onset of fever and chills.” The disease’s prevalence and clinical symptoms, as well as its progression, were all described in great detail. “In the Cold Pavilion’s Medical Talks,” there was a clear record of parotitis complicating into orchitis: “As parotitis progresses, the swelling and pain subside, but the testes suddenly become distended—this indicates that the toxin has entered the interior, spreading to the Jueyin meridian, causing testicular swelling and pain.” “In the Warm Heat Essentials,” it was also stated: “…after recovery, men experience testicular swelling, with abdominal cramps that are unbearable.” These cases all involved testicular inflammation. “In the Surgical Standard,” it was noted: “If people living in the same room frequently sniffle, there is no need to worry—ten days later, the condition will naturally resolve on its own.” Li Dongyuan and Wu Jutong even recommended using the “Pujie Duxiao Yin,” a time-honored prescription for treating this disease: “Warm toxins, sore throat, throat swelling, swelling in front and behind the ears, cheek swelling, with a red face. Or, if the throat does not hurt, but the swelling persists, even leading to deafness—commonly known as ‘big-head plague,’ with swollen membranes, Pujie Duxiao Yin removes Chai and Sheng.” (Wen Bing Tiao Bian)

(2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of Epidemic Parotitis

Regarding the etiology and pathology of this disease, as mentioned in “Wai Ke Zheng Zong”: “Parotitis arises from wind-heat and damp-phlegm.” Current understanding holds that this disease is caused by the invasion of wind-damp toxins. These toxins enter through the mouth and nose, affecting the Shaoyang Gallbladder Meridian; heat toxins accumulate in the meridians, becoming stagnant and obstructed, leading to qi stagnation and blood stasis. Since the Foot Shaoyang Meridian originates at the inner corner of the eye, ascends to the head, extends down to the back of the ears, and runs around the ears, we see swelling and hardness in the parotid region beneath the ears. Because the initial stage involves the invasion of lung and stomach, patients often experience chills, fever, and body aches—symptoms of lung-qi imbalance and gastric heat rising upward. The Shaoyang and Jueyin meridians are in opposition; the Foot Jueyin Liver Meridian runs downward, surrounding the genital organs. When heat toxins move from the Shaoyang to the Jueyin, testicular or ovarian swelling and pain may occur. If the heat toxins become intense and penetrate the Ying Qi, infiltrating the Pericardium and invading the Stomach and Brain, severe fever, headache, vomiting, convulsions, delirium, and limb stiffness may develop (meningitis, encephalitis). In recent years, there may also be depletion of Qi and Yin, leading to heart palpitations, chest tightness, and shortness of breath (complicating myocarditis). However, most cases are mild, with good prognoses. In summary, the basic pathogenesis of this disease can be outlined as follows: wind-heat attacking the upper layers, obstructing the Shaoyang; gallbladder heat invading the stomach, causing qi and blood stagnation; intense heat toxins affecting the Heart and Liver; qi and blood deficiency, with phlegm and blood stasis remaining; and the body’s defense weakening as toxins recede, Qi and Yin depleted.

(3) Traditional Chinese Medicine’s Differentiation and Classification of Syndrome Types and Herbal Formulas

1. Differentiation and Classification of Syndrome Types and Herbal Formulas (1) Wind-Heat Invasion of the Surface: The main symptoms include chills and fever, headache, swelling of the parotid glands, a red tongue with a thin yellow coating, and a floating, rapid pulse. Treatment focuses on dispersing wind, clearing heat, and resolving blockages and swelling. The formula is Yinqiao San with modifications: 12 g of honeysuckle, 9 g of forsythia, 9 g of citrus peel, 9 g of bitter melon, 6 g of lotus leaf, 15 g of indigo woad, 9 g of summer savory, 15 g of salvia, 9 g of scutellaria. Brew the herbs in water and take once daily.

(2) Gallbladder Heat Invading the Stomach, Qi and Blood Stagnation: The main symptoms include high fever and thirst, swelling of the parotid glands that are tender to pressure, restlessness, nausea, constipation, dry stools, a red tongue with a yellow coating, and a slippery, rapid or string-like, or even a deep, rapid pulse. Treatment aims to clear heat and detoxify, while clearing the Liver and benefiting the Gallbladder to promote blood circulation. The formula is Pujie Duxiao Yin with modifications: 6 g of bupleurum, 9 g of pinellia, 12 g of forsythia, 6 g of peppermint, 9 g of silkworm moth, 9 g of burdock, 15 g of indigo woad, 9 g of horsehair, 12 g of scutellaria, 9 g of platycodon, 15 g of salvia. Brew the herbs in water and take once daily.

(3) Remaining Toxins Unresolved, Parotid Swelling Still Present: The main symptoms include the heat subsiding while the parotid swelling gradually decreases, or testicular swelling and pain; the tongue is red with a dry coating, and the pulse is rapid. Treatment focuses on clearing residual toxins and softening and resolving blockages. The formula uses Xiaolu Wan with modifications: 12 g of summer savory, 9 g of rehmannia, 12 g of full-wrapped loquat, 12 g of fritillary bulb, 12 g of indigo woad, 15 g of forsythia, 9 g of large green leaves, 12 g of poppy seed. Brew the herbs in water and take once daily.

(4) Qi and Blood Deficiency, Phlegm and Blood Stasis: The main symptoms include sluggishness after the heat subsides, rattling phlegm, slurred speech, poor limb movement, a pale red or dark purple tongue, a stout body with moist coating, a fine, rough pulse. Treatment focuses on replenishing Qi and activating blood, transforming phlegm and opening the channels. The formula uses Changpu Yu Jin Tang with modifications: 6 g of peony, 6 g of ligusticum, 12 g of salvia, 9 g of poria, 6 g of earthworm, 3 g of star anise, 6 g of kudzu root, 12 g of astragalus, 9 g of atractylodes. Brew the herbs in water and take once daily.

Second Chapter: Infectious Diseases

Yang Jian (Spleen 5) – restoring the stomach’s function. Deficiency formulas, replenishing the Spleen: Ma’er primarily treats winter-related symptoms such as heart discomfort, irritability, poor appetite, fatigue, a red tongue with a thin yellow coating, a dry yellow coating, a fine, rapid, or even a deep, rapid pulse. Treatment focuses on replenishing Qi.

6 g of roasted mountain herb, 3 g of licorice. Brew the herbs in water and take once daily. OB, 9 g of winter, 9 g of poria, 6 g of atractylodes, 6 g of codonopsis, roasted away the buds, and the blood vessels.

Huayuan, Zhike; additionally, add kelp and seaweed; for severe heat toxins, add rhubarb and cassava; for constipation, add greater hawthorn and jujube; for brain membrane inflammation, add ginkgo and other herbs.

The treatment also includes adding medicinal herbs like mint, citronella, and other herbs; for complications like cerebral edema, add ginkgo, lychee seeds, huayuan, and zhike; for brain membrane inflammation, add ginkgo, lychee seeds, and other herbs; for neurological disorders, add ginkgo, lychee seeds, and other herbs.

IV. Relevant Traditional Chinese Medicine Data on Syndrome Differentiation and Treatment

In recent years, specialized formulas have increasingly been used to treat this disease. For example, in a study of 40 cases treated by Wen Rui, all patients took Chai Hu Ge Gen Tang with additions: Chai Hu, Huang Qin, Niu Lao Zi… 8 g each of silkworm moth, pinellia, and cicada, 6 g each of bupleurum, citronella, and cicada, 15 g of kudzu root, 10 g of pollen, 20 g of gypsum, 3 g of licorice; together with Chai Hu, Huang Qin, and other herbs. Additionally, Huang Qin, Huang Lian, Chi Shao, and other herbs were added for cases with constipation. For cases where the heat subsided but the swelling did not improve, the formula was modified to include Niu Lao Gan Ju Tang: Niu Lao Zi, Chuan Xiong, Fu Jing, Chen Pi, pollen, Huang Lian, Chi Shao, and other herbs—taking one dose daily. Results showed that all patients recovered within 1–5 doses, with an average fever reduction of 2.7 days and a 3-day disappearance of symptoms. (Shanghai Journal of Traditional Chinese Medicine, 1988.6)

Recently, scholars have explored syndrome differentiation based on liver and gallbladder types: ① When heat toxins invade the gallbladder and obstruct the meridians, treatment focuses on clearing gallbladder heat and harmonizing the stomach to descend rebellious qi, using Xiao Zhuang Hu Tang with modifications. ② When liver and gallbladder are filled with damp-heat and their functions are disrupted, treatment focuses on clearing the gallbladder and liver, using Long Dan Xie Gan Tang with modifications. ③ When liver wind is rampant and the toxin has invaded the pericardium, treatment focuses on clearing the liver and extinguishing wind, detoxifying and cooling the blood, using Ling Yang Gou Teng Tang with modifications. ④ When gallbladder heat and liver stagnation lead to phlegm and heat accumulating, treatment focuses on clearing the liver and transforming phlegm, regulating qi and dispersing blockages, using Huang Lian Wen Dan Tang combined with Hai Zao Yu Hu Tang. Wang Ruilong divided cases into mild, moderate, and severe types. Mild cases used Yin Qiao Bai Du San with modifications, moderate cases used Yin Qiao San, while severe cases used Pujie Duxiao Yin. For parotid swelling and hardness, add summer savory and kelp; for high fever and convulsions, add hook vine and whole scorpion; for testicular swelling and pain, add orange seeds, lychee seeds, Chinese plum, and other herbs. Additionally, apply topical dissolving ointments (200 g of realgar and rhubarb each, 100 g each of turmeric, chi shao, and rehmannia, 50 g each of bloodstone and camphor, finely ground and mixed with petroleum jelly to form a paste). All cases were successfully treated. The average fever reduction time was 3.1 days, and the average swelling resolution time was 6.2 days. (Yunnan Journal of Traditional Chinese Medicine, 1990.3)

Li Lihua and others reported using a specialized formula: 20–30 g of honeysuckle, 15 g each of forsythia, reed root, indigo woad, large green leaves, and summer savory, 6 g of perilla, 9 g of peppermint and burdock, 10 g of bupleurum, 10–15 g of scutellaria, taking one dose daily, brewed in water and divided into three doses. For high fever, add gypsum and morinda; for sore throat, add rehmannia and horsehair; for submandibular gland swelling, add berberine, silkworm moth, and rehmannia; for testicular redness and swelling, add gentian root, lychee seeds, and Chinese plum, and use 30 g each of realgar, dandelion, and ground ivy. Brew the herbs in water and apply locally 2–3 times daily; all cases were successfully treated. Zeng reported using a self-prepared formula—clearing heat and detoxifying drinks, taken internally combined with topical applications—to treat 98 cases of epidemic parotitis, with 75 cases cured, 21 cases improved, and 2 cases showing no improvement. This formula contained 30 g each of indigo woad and honeysuckle, 15 g each of forsythia, large green leaves, and other herbs, 12 g each of bupleurum and scutellaria, 10 g of grassy caraway. For high fever, add gypsum; for headaches, add chrysanthemum; for vomiting, add bamboo shoots; for thirst, add pollen; for loss of appetite, add hawthorn; for sore throat, add rehmannia and citronella; for cough, add Zhejiang bellflower; for neck pain, add kudzu root; for constipation, add rhubarb; for red urine, add reed root; for testicular swelling and pain, add Chinese plum and lychee seeds; for long disease courses, add danpi and pangolin. Take one dose daily, with two doses for severe cases, brewed in water and divided into two doses. For external use, add 50 g each of realgar, indigo woad, and magnesium sulfate, 3 g of camphor, finely ground and sifted, mixed with an appropriate amount of vinegar to form a paste, applied to the affected area 3–5 times daily. A course of treatment lasted 7 days, and after 2–7 days of treatment, 75 cases were cured, 21 cases improved, and 2 cases showed no improvement. (Guizhou College of Traditional Chinese Medicine Journal, 1990.4)

Cheng Quntai and others reported treating 57 cases of epidemic parotitis complicated by meningitis with Pujie Duxiao Yin: 15 g each of scutellaria and rehmannia, 8 g of citrus peel, 10 g each of licorice and horsehair, 12 g each of rehmannia and bupleurum. 6 g each of forsythia and silkworm moth, 30 g each of indigo woad and bupleurum, 3 g of peppermint. These dosages were for children aged 10; other age groups should adjust accordingly. Take one dose daily, adding 800 ml of water and simmering until 600 ml remains, dividing the liquid into three doses for oral consumption. Severe cases took two doses daily, every 6 hours; patients in a comatose state were fed via nasogastric tube, and those unable to eat were treated with supportive therapies. After 3–7 doses (with an average of 5 doses), all patients recovered. (National Forum of Traditional Chinese Medicine, 1991.2)

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Mix all ingredients together and grind into a fine powder. Then mix with water and apply as a paste. ⑤ Mix equal amounts of flower pollen and green beans, grind into powder, and mix with water. ⑩ 6g of purple flower groundwort, 2g of Tian Nan Xing, grind them into a fine powder, then mix with 15g of vinegar and apply to the Yongquan acupoint (both sides). According to Zhu Shuguang’s report on treatment methods for 125 cases: take