Experience Treating Acute Tonsillitis with Mahuang Tang
Acute tonsillitis is a common acute infectious disease characterized by red, swollen, painful tonsils; in severe cases the patient has difficulty swallowing, and the pain radiates to the ears. Western medicine mostly treats it with antibiotics such as penicillin, and the market also has many heat-clearing, detoxifying patent medicines for acute tonsillitis, such as Yanbian Keli and Yinhang Diwan. Most physicians consider this an acute heat pattern and do not advocate acrid-warm formulas, advising patients to avoid spicy foods such as ginger. But in fact tonsillitis may also be a cold pattern.
The author recently developed acute tonsillitis. Because he had had oral ulcers a few days earlier that had not fully healed, he initially mistook the sore throat for residual ulcer pain and paid no attention. A day later the condition progressed rapidly; using a tongue depressor he could see obvious redness and swelling of the right tonsil, and the throat pain was so severe that even drinking water was difficult. At home he had some patent medicine such as Yinhang Diwan and took some. Better not to have: after taking it, the phlegm became unmanageable, he had to swallow saliva twenty or thirty times a minute, and each swallow hurt the throat and radiated to the ear. The child's school did nucleic-acid testing daily and had reported no positive COVID cases, and the author had only had close contact with family, so COVID could basically be ruled out.
After taking some heat-clearing, detoxifying patent medicine, within only a few hours the phlegm and pain became so severe he could not lie down to sleep and had to sit propped against the headboard. In the middle of the night he suddenly felt cold aversion, no sweating, body pain, and pain in the finger joints; temperature was 37.5°C, symptoms matching the indications for Mahuang Tang (Ephedra Decoction). In recent years, thanks to regular exercise, the author's health has been good, and he had not had a fever for more than ten years. Taking his own pulse, he found it neither floating nor tight, but moderate and even. By this pulse, it seemed not to be a Mahuang Tang indication, but the author has never treated the pulse as an important criterion for medication, so he did not deliberate much and immediately took Mahuang Tang. At home he had Japanese kampo Mahuang Tang granules bought previously, so he brewed two packets.
Five minutes after taking it, phlegm decreased and the body warmed. The author then used a hair dryer on Dazhui (DU14) and Changqiang (DU1) to help induce generalized sweating. But sweating did not occur; about a quarter hour later the body felt cold again. Knowing the dose was insufficient, he brewed three more packets of Mahuang Tang; after taking them he immediately used the hair dryer on Dazhui and Changqiang to induce sweating, but still could not sweat. Twenty minutes later he took three more packets; this time he felt warm all over and continued using the hair dryer, and after about three minutes sweat appeared on the forehead, symptoms relieved greatly, then the upper body began to sweat, but the lower limbs did not. He then took two more packets and used the hair dryer specifically on Changqiang to help the lower body sweat; this time the lower body sweated slightly too.
After generalized sweating, all symptoms resolved, tonsillar pain eased greatly, and the ear no longer hurt. After staying in bed for another hour he got up, took a hot shower, then slept deeply covered up; on waking again all symptoms had disappeared.
Taking ten packets of Mahuang Tang within sixty minutes terrified the child's mother as she brewed the medicine. For according to Japanese dosage, one takes only three packets in a whole day. In fact, used that way the therapeutic effect is poor. Japanese kampo dosages are very small; one can see this in Tang Ben Qiuzhen's Koto Seigaku (Imperial Chinese Medicine): ephedra-like drugs are commonly used at 1–3g, a dose that does not achieve rapid healing. Japanese kampo granules are basically safe doses, each packet containing about the same amount as Tang Ben's dosage. Such a dose is a fraction—perhaps a few percent—of the dosage in the original Shanghan Lun; however advanced Japanese extraction technology, at Japanese doses it is hard to achieve the classic "recover as soon as the cup is set down" effect.
So when using Japanese kampo, the author often observes while treating; if there is improvement but the effect is not obvious, he immediately increases the dose. Previously when treating family members he followed this principle, and treating family's external contraction with Chinese medicine often took only one or two hours from treatment to recovery. The advantage of Japanese kampo is convenience: traditionally prepared formulas made into granules that can be dissolved at any time, so that one need not buy and decoct medicine in the middle of the night; Chinese pharmaceutical companies and drug regulators should learn from this. But one must not superstitiously follow the kampo package insert.
The essence of TCM clinical treatment is pattern differentiation and treatment—grasping the key medication indications and treating with the corresponding formula. So the author often disregards the pulse and instead values the patient's set of symptoms, judging from the symptoms which formula's indications the patient matches; this is the style of the TCM formula-pattern school.
From the writings of many veteran TCM physicians we know the pulse is not to be relied upon. For example, Professor Li Shimao in Pingmai Bianzheng (Pattern Differentiation by the Calm Pulse) also mentions that he does not care whether pulse and formula correspond, often using Mahuang Tang without a floating-tight pulse and Guizhi Tang (Cinnamon Twig Decoction) without a floating-slow pulse. As another example, when Professor Jiang Chunhua conducted a special study of pulse diagnosis, he found its reliability below 15%; such low reliability seriously affects diagnosis. So in treating his own tonsillitis, the author did not refrain from Mahuang Tang merely because his pulse was not floating-tight.
From antiquity to the present, the TCM world has greatly feared Mahuang Tang, calling it a strong sweating formula, and has not used auxiliary sweating measures. From the author's own experience with Mahuang Tang, it is really not a strong sweating formula, especially in cold climates. If rapid effect is desired, one should appropriately take auxiliary sweating measures. Acute disease must be fought quickly; delay makes it harder to treat.
Tonsillitis is not among Mahuang Tang's indications; even in the Shanghan Lun, Mahuang Tang is not recorded as treating sore throat. But the other symptoms the author presented matched Mahuang Tang indications, so in treatment he sought the root and the principal contradiction, judged from the other symptoms that this was a Mahuang Tang pattern, and after taking the medicine the sore throat also disappeared. Modern patent-medicine package inserts, medical textbooks, and online medical encyclopedias are highly misleading. If judged by patent-medicine inserts, textbooks, and encyclopedia common sense, tonsillitis must absolutely not be treated with the acrid-warm Mahuang Tang; believing this, taking heat-clearing detoxifying medicine would only worsen the condition and fail to achieve rapid healing.
So when using Chinese medicine to treat disease, one should return to the root of TCM empirical medicine and, following the principle of pattern differentiation, analyze the illness carefully. In medication one must be both cautious and bold; if the medicine matches the pattern, do not hesitate to increase the dose. The author loves Chinese medicine because he has repeatedly witnessed it treating acute disease far faster than modern medicine—not because Chinese medicine is the slow physician's art.