Mumps is one of the most common childhood illnesses. In Traditional Chinese Medicine, it is commonly known as “toad plague” and is an acute, systemic infectious disease caused by the wind-heat virus. This disease can occur throughout the year, but it is more prevalent in winter and spring. The typical age range for onset is between 5 and 15 years old, while cases among adults and children under 5 are relatively rare. Individuals who have not had mumps during childhood may still become infected as adults, whereas those who have had mumps generally develop immunity and will not be reinfected.
I. Etiology and Pathogenesis of Epidemic Parotitis
This disease is caused by the wind-heat virus. The virus enters through the mouth and nose, obstructing the Shaoyang and Jueyin meridians. It travels along the collaterals of the Foot Shaoyang meridian to the ears, causing obstruction of qi and blood, disruption of meridian flow, and stagnation that fails to dissipate—resulting in diffuse swelling of the cheeks that is firm and painful; Since the Shaoyang and Jueyin meridians are paired as exterior-interior, and the Foot Jueyin meridian runs through the genitalia, if the pathogenic toxin spreads to the Jueyin meridian, mumps may be accompanied by redness, swelling, and pain in the testicles. If the warm toxin becomes intense, invades the Ying level, penetrates the pericardium, and stirs up liver wind, symptoms such as convulsions and coma may occur.
Modern medicine holds that after the mumps virus invades the nasopharynx, it replicates in local mucosal cells and enters the bloodstream, resulting in the first episode of viremia. The virus then travels through the bloodstream to the parotid glands or other glands and organs, where it replicates extensively, causing lesions, and re-enters the bloodstream, resulting in a second episode of viremia. As the virus can spread to other organs via the bloodstream, the affected glands and organs may be involved in different sequences, leading to symptoms appearing at varying times. The virus can also directly invade the parotid gland via the parotid duct from the oral cavity, causing this disease.
The mumps virus is present in the patient’s saliva, bloodstream, urine, and cerebrospinal fluid. The virus is inactivated when heated to 55–60 degrees Celsius for 20 minutes; it is rapidly inactivated under ultraviolet light; and it can be killed within a few minutes using 2% Lysol or 75% alcohol.
II. Transmission Routes of the Mumps Virus
Respiratory transmission: In the early stages, droplets from sneezing and coughing are the primary transmission routes.
Gastrointestinal transmission: Food and tableware contaminated with an infected person’s saliva can lead to infection in susceptible individuals via the oral route.
III. Clinical Manifestations
The incubation period for this disease ranges from 8 to 37 days, typically lasting 18 days. The typical onset of mumps is characterized by fever, with body temperature reaching 38 degrees Celsius or higher, accompanied by general malaise, loss of appetite, headache, vomiting, and muscle pain. After 24 hours, patients experience pain in one side of the parotid gland, particularly when opening the mouth to eat; and the pain worsens when consuming acidic foods. The surface of the swollen parotid gland is not red, its borders are indistinct, and it feels slightly warm to the touch with mild tenderness. After 1–2 days, the parotid gland on the other side swells sequentially; however, in some cases, both parotid glands may swell simultaneously, or only one side may be affected. Parotid swelling usually peaks within 2–3 days. From onset to complete resolution, the disease can last for more than a week.
IV. Manifestations Involving Other Organs
Mumps is a systemic viral infectious disease that, in addition to affecting the parotid glands, can also involve multiple organs. These are briefly described below:
Meningoencephalitis: Between 5% and 10% of patients with mumps develop symptoms of meningoencephalitis. Meningoencephalitis typically occurs 3 to 10 days after parotid swelling begins and is characterized by fever, severe headache, vomiting, neck and back muscle pain and stiffness, and drowsiness. A small number of patients experience altered consciousness and positive meningeal irritation signs. The prognosis for this condition is generally good, with fever gradually subsiding and symptoms resolving within approximately 3 to 9 days.
Orchitis and Epididymitis: Approximately 20% to 30% of male patients develop these conditions; most cases involve unilateral involvement, and bilateral orchitis and/or epididymitis are extremely rare. This condition often develops within 1 to 2 weeks of the onset of mumps. The affected testicle becomes enlarged, painful, and tender; symptoms may persist for 4 to 5 days before subsiding, and the swelling and pain eventually resolve. Approximately 1 to 2 months later, 30% to 40% of cases may experience testicular atrophy; if both testicles are affected, this can lead to infertility. Involvement of the ovaries in females is less common.
Additionally, complications may include acute pancreatitis, myocarditis, nephritis, hepatitis, interstitial pneumonia, thrombocytopenia, and polyneuropathy.
V. Treatment of Epidemic Parotitis
General Treatment: Patients with severe cases should remain on bed rest until their temperature returns to normal, symptoms disappear, and parotid swelling subsides. A light or soft diet should be provided, and acidic foods should be avoided, as they can stimulate increased parotid secretion and exacerbate pain. At the same time, attention should be paid to oral hygiene; the mouth can be rinsed with saline to prevent secondary oral infections.
Traditional Chinese Medicine (TCM) Treatment Based on Syndrome Differentiation
(1) Mild Cases: Patients present with a sensation of soreness, distension, and mild pain on one side of the parotid region below the ear, or on both sides simultaneously. They may experience slight discomfort when opening the mouth to eat, with no other symptoms. The tongue and pulse show no abnormalities. Treatment may involve Yinqiao San with appropriate modifications.
(2) Severe Cases: Patients experience chills, fever, and fatigue. The parotid glands are swollen, tender to the touch, and firm with diffuse swelling. They may also exhibit thirst, irritability, difficulty swallowing, dry stools, scanty and yellow urine, a yellow tongue coating on a red tongue, and a slippery and rapid pulse. The treatment principle is to clear heat, eliminate toxins, soften hardness, and reduce swelling. Pu Ji Disinfection Decoction with appropriate modifications may be used. For external application, mix Qing Dai powder with vinegar and apply to the affected area several times daily.
VI. Prevention
Isolate patients: Any patient diagnosed with mumps must be immediately isolated until 3 days after the parotid swelling has subsided.
Protect susceptible individuals
(1) Active immunization: Administer the live attenuated mumps vaccine to induce antibody production and achieve preventive effects.
(2) Take decoctions of traditional Chinese herbs with antiviral properties, such as Banlangen and Daqingye.
Prevent the virus from entering through the mouth and nose. Since the virus can be killed within a few minutes using 2% Lysol and 75% alcohol, air and equipment can be disinfected using these methods to prevent infection.