2. MUMPS (Epidemic parotitis) GENERAL CONSIDERATION
     Mumps is an acute contagious disease caused by a paramyxovirus that has a
predilection for glandular and nervous tissue. Mumps is characterized most commonly by enlargement of the salivary glands, particularly the parotid glands. One or more
of the following manifestations of mumps may be associated with or may occur without parotitis: meningoencephalitis, orchitis, pancreatitis, and other glandular involvement. Inapparent infection occurs in a significant percentage of persons (30
to 40).
     The disease is called "swollen cheek" in traditional Chinese medicine, and is
thought to be caused by warm-heat pathogens. The cardinal clinical manifestations
are swelling of the one or both parotid glands which are indistinctly outlined, elastic to palpation, painful and tender, and may be accompanied by fever and general
malaise.
     In traditional Chinese medicine, the condition is thought to be caused by certain seasonal wind or warm pathogens. Clinically, it is characterized by swelling of one or both parotid glands which are indistinctly outlined, elastic to palpitation, painful and tender, and may be accompanied by fever and general malaise, rapid pulse and yellow coating of the tongue.
CLINICAL MANIFESTATIONS
     For a long time the terms, mumps and epidemic parotitis, were used interchange-
ably. Mumps was recognized as primarily an infection of the salivary glands. The
isolation of the virus and the development of the specific diagnostic and immunologic
tests, however, have contributed to a better understanding of the pathogensis and a clarification of the clinical picture of the disease.
     Infection with mumps virus usually develops after an incubation period of 16 to 18 days. In approximately 30% to 40% of the patients the resulting infection is
inapparent. The remaining 60% to 70% of the patients develop an illness of variable
severity with symptoms that depend on the site or sites of infection. In the majority
of instances, clinical mumps is characterized only by parotitis, either unilateral or bilateral. Additional relatively common manifestations include submaxillary and
sublingual gland infection, orchitis and meningoencephalitis. Pancreatitis, oophoritis, thyroiditis and other glandular infections are relatively rare. These various manifestations of mumps may precede, accompany, follow or occur without parotitis.
DIAGNOSIS
     The following factors should be pointed out as a diagnostic possibility:
     A. A history of exposure to mumps 2 or 3 weeks before onset of the illness.
     B. A compatible clinical picture of parotitis or other glandular involvement.
     C. Signs of aseptic meningitis.
     In the classic case of so-called epidemic parotitis, confirmatory laboratory
procedures are usually unnecessary. In the absence of parotitis or in the presence of recurrent parotitis, however, the specific diagnostic aids whose description followed may have to be utilized.
     Isolation of causative agent. Mumps virus can be recovered from the saliva,
mouth washings, or urine during the acute phase of parotitis and from the CSF early
in the course of meningoencephalitis. The isolation may be made by inoculating the
amniotic cavities of 8-day-old chick embryos or susceptible cell cultures. The isolation of mumps virus is not a routine laboratory procedure.
     Serologic tests. There are at least three serologic tests that are used to demonstrate the development of specific mumps antibody: complement fixation, hemagglutination--inhibition (HI), and virus neutralization. The CF test is the most practical and most reliable of these diagnostic procedures. The neutralizing antibody test is a more reliable indicator of susceptibility or immunity than the CF or HI antibody test.
     The antibody becomes detectable in the blood by the end of the first week and
the end of the second week a fourfold or greater rise in antibody titer can be
demonstrated. When a diagnosis of mumps is suspected, acute and convalescent sera
should be tested simultaneously. A fourfold or greater rise in the level of antibody
confirms the diagnosis. This test is particularly useful for the diagnosis of mumps
meningoencephalitis without parotitis.
TREATMENT
I. Treatment in Western medicine.
     Mumps is a self-limited infection. The course of which is not altered by use of any of the antimicrobial drugs. Treatment is symptomatic and supportive measures
are used. Aspirin or codeine will usually control the pain caused by glandular
swelling. Warm applications seem to help some patients; others prefer cold. Topical
ointments are useless. Parenteral administration of fluids is indicated for the support of patients with persistent vomiting associated with pancreatitis or meningoencephalitis.
II. Treatment in traditional Chinese medicine.
     1. Herb therapy
     The most effective formula is Pu Ji Xiao Du Yin Jia Jian.
     Constituents:
     Skullcap  15g
     Chinese goldthread  12g
     Root of Zhejiang figwort  30g
     Weeping forsythias  30g
     Honeysuckle flower  30g
     Dyers woad root  30g
     Puff-ball 12g
     Achene of great burdock  12g
     Larva of a silkworm with batrytis  12g
     Peppermint  12g
     Chinese thorowax  30g
     Skunk bugbane  12g
     Root of balloonflower  12g
     Gypsum  30g
      Decoction and dosage. All the above herbs are put together into a boiler to be simmered twice and then the broth of each mixed, half of the mixed broth each time, twice a day. Two to four doses are prescribed.
      2. Acupuncture therapy
      Main points: $6 Jiache and LI4 Hegu.
      Auxiliary points: LI11 Quchi for fever; Liv8 Ququan, Sp6 Sanyinjiao and Liv3
Taichong for the involvement of the testis and ovaries; L11 Shaoshang picked for
severe pain.
      Method: The main points are punctured before the auxiliary ones with either
moderate or strong stimulation. The needles are retained for 20 to 30 minutes and
the therapy is given once daily.
      3. Ear-acupuncture therapy
      Points: Parotid Pt, Cheek Pt, Sympathetic Nerve Pt an