Acute tonsillitis is a kind non-specific acute inflammation of palatine tonsil which is often accompanied with different severities of acute inflammation of pharyngeal mucosa and lymphatic ring. It is commonly seen in people of 10-30 years old. In most cases, it usually attacks recurrently on the basis of chronic tonsillitis. This condition is rare in patients over 50 or under 3-4 years old. It occurs mostly in spring and autumn when the temperature fluctuates.

Clinical manifestation 1. Acute systemic symptoms Aversion to cold, fever with body temperature up to 39℃-40℃, which may last 3~5 days. Infants may suffer from vomiting, convulsion and lethargy due to high fever. Some patients also suffer from headache, loss of appetite, fatigue, constipation, pain in the lower back and limbs. 

2. The most common local symptom-pharyngalgia. At the initial stage, it manifests as lateral pain and then develops into bilateral pain. With the worsening of the condition, it turns to difficulty swallowing. The pain extends to ipsilateral aural region. 

3. Dyscinesia of soft palate Swelling tonsil pressing soft palate may cause transient dysfunction of soft palate and unclear speech.

4. Symptoms caused by inflammation spreading to nearby organs If the inflammation extends to laryngeal, it can cause a sensation of foreign body in the throat, hoarseness, laryngalgia, expectoration, weakness of voice, or even aphonia; if it extends to nose, it can cause nasal congestion, watery nasal discharge/thick mucosa, and headache; if it extends to nasopharyngeal region, it can spread to otosalpinx and cause ear fullness, tinnitus, earache, and hearing loss. 

Typical case A 30-year old female nurse had suffered from fever, sore throat accompanied with general soreness and weakness for 3 days. Upon examination: her body temperature was 38.2℃. The uvula was red and swelling, with one degree enlargement of bilateral tonsil. The posterior pharyngeal wall was covered by white patches. 

The patient complained that she caught a cold and then found pharyngalgia, fear of cold, fever. The duration of disease was three days. Her body temperature went up to 39℃ and was slightly relieved after taking anti-inflammation drugs. That morning, the patient had severe pain in pharyngeal and was unable to swallow saliva, so she came for medical help. Taking the above-mentioned symptoms and tongue image (yellow and slimy tongue coating) into consideration, the practitioner made the diagnosis: acute suppurative tonsillitis.

Pattern differentiation This is “Ru’e” which can be translated as tonsillitis. Wind-heat tonsillitis is mostly caused by abrupt change of climate, cold-heat disharmony, and insecure defensive qi of the lung. The yellow and slimy tongue coating is due to heat pathogen mixed with turbid phlegm. Yellow tongue coating means heat; slimy tongue coating indicates dampness, phlegm and food stagnation. Yellow and slimy coating is the manifestation of dampness-heat accumulation, phlegm and fluid retention transforming into heat, and food stagnation transforming into heat, external contraction of summer-heat, and damp warm patterns. Therapeutic methods include clearing heat, eliminating damp, and expelling phlegm. Though the disease was located in pharynx, the root cause was disorder in the lung, spleen, stomach and large intestine. In TCM, the lung and the large intestine are an interior-exterior pair, so are the spleen and the stomach. Thus, the treatment methods should be clearing the lung heat, purging the stomach heat and promoting the transformation function of the spleen. 

 Notes The downward pulling is usually performed after smearing some BB massage oil on the treated area, so as to alleviate discomfort.  

First step of treatment The practitioner pulled the#5 cups, along both sides of the cheek and bridge of the nose, from the lower jaw center to both sides. The cups were pulled until the skin turned slightly red; red spots were desired.

Second step of treatment The practitioner pulled cups along chin towards to earlobes, along throat trachea from the top to the bottom, and then from suprasternal fossa to clavicle (from inside out). Because abundant lymph are in the neck, cup-pulling this area meant to activate and reinforce the vitality of neck lymph, then enhance the capacity of immune system against inflammation and bacteria.

The third step of treatment The practitioner pulled cups along the body midline and the course of spleen and stomach meridians, which meant to pull along pharynx from top to bottom, along sternum from middle to two sides, and then along coastal arch towards two sides. This treatment could unblock the spleen and stomach meridians, relax fascia of pectoral-abdominal muscle, reinforce the functions of the spleen and stomach, soothe the liver and accelerate healing. 

Notes The stomach receives and digests food and water. The spleen governs transportation and transformation. The spleen and stomach are interiorly-exteriorly related. Both of them complete absorption and digestion of food and distribution of essence. Unblocking these two meridians can reinforce healthy qi, nutritive qi, and defensive qi, so that the body can be prevented from pathogenic factors.

The fourth step of treatment The practitioner pulled cups along the lung and large intestine meridians, that is, pulling cups from shoulders towards wrists, even to LI 4 (Hegu). Repeated pulling was performed until the skin showed red spots. Notes The lung governs breathing, skin and body hair, opens at the nose. The lung and large intestine are interiorly-exteriorly related. The lung qi descents and large intestine conduct and disperse defensive qi. Clearing lung heat is to expel pathogens and reinforce the healthy qi . 

The patient was examined in the next day and found the suppurative spots were already disappeared, swelling uvula and tonsil also became normal.

Notes Sore throat and oral ulcer are the most common symptoms in daily life and the relapse rates are among the highest. The encouraging news is that the effective rate in our clinical practice is up to 100%. The author once suffered from oral ulcer and was unable to swallow anything. After receiving the above-mention treatment, I recovered from the condition up to 80% on that day. This treatment is simple, convenient, effective and not confined by treatment environment. 

（By Shiyuan Zhong 钟士元）