The external causative agents will take advantage of this to invade the body, giving rise to the disease. According to its pathological changes, acute tonsillitis can be divided into two types: acute catarrhal tonsillitis and acute suppurative tonsillitis. As for the former, the pathological changes are mild and the inflammation is confined to the mucous surface, without marked inflammation in tonsillar crypts and the tonsillar parenchyma; as for the latter, the inflammation originates from crypts and will further enter the tonsillar parenchyma, resulting in marked tonsillar swelling and suppuration.

The disease is called "Jiru'e" (acute tonsillitis) in TCM. When pathogenic wind and heat invade the lung and stomach, fire and heat will rise to steam the larynx and accumulate there, making meridians and collaterals obstructed. This scorches and erodes the sarolemma, makes the larynx red and swollen to cause onset of the disease. Therefore, the disease is also called "Fengre Ru'e" (tonsillitis due to wind and heat). This is the why the disease mostly occurs.