一、口症之原因
初生小儿为纯阳之体，甚少虚症，其由胎中火旺，或胃中有热者，婴孩生下，多患口症。盖胎毒发动，
最易上攻，而胃中火邪，亦最易凌上也，惟口症发生，种类甚多，治法亦因之各异。兹将各证证状治法分志如下。
二、口症之症状
口症之最着者，有雪口、悬痈、乳蕈、牙疳、重龈、重 、重舌、木舌、弄舌、 腮、滞颐、螳螂子
等。雪口又名鹅口白屑，小儿患之最为普遍，婴孩初生百日中，口中有白点旋拭旋
生，满口缠遍，内窜入喉，甚至有啼哭不能乳者是也。悬痈一名垂痈，凡喉里上 肿起，如芦箨盛水状者是
也。乳蕈者，口中有肉肿起，高如菌状者是。马牙疳者，牙龈处生白泡者是也，又有
走马牙疳者，则牙床腐烂，崩溃甚速，若已出牙，牙齿能根据次脱落，此为险恶之症。重龈、重 ，又名龈肿、
肿，颊里及上 牙床浮肿，或肿如水泡者是也。重舌之状，为舌底作胀，如重出
一舌之状，舌根之肉，壅肿叠出，短小如舌者是也。木舌之状，舌尖肿大，塞满口中，或僵硬如木，
不能转掉者是也。弄舌之状，舌出掉弄如蛇也。 腮之状，小儿两腮肿硬有核，或在一
边，儿面常现黄色，鼻端起黑瘰，令吮乳困难，啼哭无度。滞颐者，涎自口角流出，滞于颐间，故名。螳
螂子者，月内小儿多患之，两内腮肿硬，口噤不乳，啼声难出，其状与 腮大同小异，
惟腮面部之外面高肿，而螳螂子则口内肿硬。此口症各种证象
之一斑也。
三、口症之治法
雪口多由于先天胎毒，及脾胃二经之积热，故治法宜以清热解毒为主，内服宜三黄汤及栀子、石膏、
生地之属，外治宜用甘草、黄连等分煎汤，以帛裹指轻轻拭去白屑，取桑皮中汁涂之即
愈。或用枯矾、朱砂各二钱半，马牙硝五钱，研极细，再以水搅取汁，调涂舌上颐颊内亦可。《简易方》用
鹅口中水一钟，作数次服之亦效。然未悉其何所取义也。
悬痈由胎毒而肺胃之热上蒸，故发生于喉间，治法宜以针刺破之，流出毒血，泄去毒瓦斯，即可自愈。
若一日未消，来日又刺之，不过三刺，自能消尽，若延久不刺，令毒聚而皮亦难破，故
不可姑息从事也。刺后宜用盐汤洗拭，急用如圣散或一字散掺刷之。
乳蕈、马牙疳多因肠胃之火而发生，治法宜清凉消毒，内服可用三黄汤及石膏、知母之属，外治宜
以指摘去其头，倘有血出，以帛或药棉拭去之，轻者京墨搽之即愈，重者以直僵蚕三条
去丝嘴炒，人中白四分，冰片少许，研细擦患处，略停片刻，用药棉花蘸苦茶洗净，再擦，日三四次自愈。如
未愈加硼砂、血竭、青黛各三分，儿茶分半，药珠一分为细末和入前药，每日洗擦三四次无不愈者。
《简易方》以马齿苋根瓦上焙，少加雄黄研末擦。至于走马牙疳，则其病势凶险，又迥乎不同，盖其发生
之因，由于胃中毒火燎原，而其崩溃齿落之时，每已不及救也。内服宜以绿豆煎浓汁频饮，使化毒从小便
而出，外以人中白四分，醋制铜绿、杏仁各二分，冰片少许，为细末敷患处。此症痧后余
毒不消，最易发生，即或得治，常有唇缺腮穿之祸也（参看第四章）。
重龈、重 ，由胃中有热，熏蒸而作，治宜先用针头刺破，
流去紫血，以盐汤拭净，外敷牛黄散或一字散，内服清胃散。
重舌、木舌、弄舌三者，多由心脾积热所致，重者皆能殒命，宜急治之。重舌用竹沥浸黄柏一宿点舌上，
木舌用蓖麻子油蘸纸捻，点火吹灭，以烟熏之即消。若舌下有如蝼蛄或如卧蚕，急于肿处砭去血，以盐醋调
釜底煤或井花水调釜底煤浓敷之，脱去再敷，用真蒲黄频刷舌上亦愈。弄舌轻者灯芯煎汤与服，重者
黄连煮汤与服。
腮治法，用蜒蚰一条，朱砂钱许同研烂，搽肿硬处，勿令擦去，即消，或用染坊靛青花敷之亦消。
内服初起宜柴胡葛根汤，口渴便秘者宜四顺清凉饮，势将成脓者宜托里消毒散托之。
滞颐之治法，因于脾虚不能摄津者，宜用白术、陈皮、青皮、炮姜各五分，熟半夏、丁香、木香各一钱，
为末面糊丸黍米大，一岁每下十丸服之。由于脾热津泛者，宜用白术、滑石各五
分，扁豆、茯苓、石斛各三分，黄连二分，葛根一分半，甘草一分为末，灯芯汤调下，每服一钱。
螳螂子之治法，俗尚割治，手术宜清洁灵敏，乃可无碍，然割不得其法，反致危殆。宜用青黛、硼砂各
一钱，玄明粉三钱，薄荷五分，冰片一分，同研，细擦口内两颐，一日四五次，治之
可愈。一方用斑蝥三个，蝎尾五个俱炙脆存性（不可太焦，致药无力），研极细，麻黄一钱煎汤少许去渣，
入枣肉一粒收干，麻黄汁打烂和斑、蝎末丸如桐子大，放小膏药上贴儿印堂及左右两
颐，一周时三处皆起泡，毒泄即愈。至于一般口症通治之法，内服俱宜清凉解毒如黄连、生地、木通、当归、
石膏、玄明粉、甘草、连翘、栀子、黄芩、黄柏、大黄、丹皮、赤芍之属斟酌用
之，外治则儿茶、薄荷、冰片、人中白、甘草、硼砂、青黛、马
牙硝、石膏、黄连、黄柏、犀黄、麝香之属斟酌配合为末调敷之。
附方
（一）如圣散 治小儿口症，时时掺之。
铅霜（铅合水银制成） 牛黄 太乙玄精石 朱砂（水飞曝干。各二钱五分）
研为极细末，和匀，入白龙脑五分，再研匀即成。
（二）一字散 治口内白腐。
朱砂 硼砂（各五分） 龙脑 朴硝（各少许。）
研为极细末，每用少许，蜜调，鹅翎蘸刷口内，咽下无妨。
（三）三黄汤 治三焦实热，烦躁便秘，脉浮，狐惑，疹痢。
黄连（酒煮） 黄芩（酒炒） 大黄（酒浸。各等分）
每服一钱五分，清水煎服，或不用酒制俱生用，为小儿落地常用之方，或以大黄易黄柏。
（四）牛黄散 疗口疮。
牛黄 白龙脑 朱砂（各一分） 铅霜（五钱） 太乙玄精石（一两）
研为细末，先于肿处以铍针刺出血，盐汤洗净，然后掺药。
（五）清胃散 治脾胃湿热，中脘作痛，唇口肿痛，齿龈溃烂，痛引头脑，或恶寒发热，饮冷作渴，
口舌生疮，或满面发热大痛，喜寒恶热，小儿重舌马牙，吐舌流涎。
升麻（五分） 生地黄（酒洗） 当归（酒洗。各四分） 川黄连（炒） 丹皮（各三分）
研为细末，清水煎至一半，去滓，候冷细细呷之。如痛未止，可量加石膏；若因脾胃气虚，寒凉克
伐，或虚热上行，口舌生疮，弄舌发热，饮食少思，或呕吐困睡，大便不实，流涎龈烂
者，则宜用五味异功散。虽证状相类，而虚实判然，其治法不同如此。
（六）柴胡葛根汤 治伤寒及 腮。
柴胡 葛根 石膏 天花粉 黄芩（各二钱） 生甘草（五分） 牛蒡子（炒研） 连翘（
去心） 桔梗（各一钱） 升麻（三分）
清水二钟，煎至八分，不拘时服。
（七）托里消毒散 治疮疡气血俱虚，肿不能溃，溃不能
敛。
人参 生黄 白术（炒） 茯苓 白芍 当归（酒拌） 川芎 金银花（各一钱） 白
芷甘草（炙） 连翘（各五分）
一方无川芎，一方有陈皮一钱，皂角针、桔梗各五分。此为外科内服之要方，有加减应用法甚多。
（八）四顺清凉饮 治小儿血脉壅实，脏腑蓄热，颊赤作渴，五心烦热，睡卧不安，四肢惊掣，及
肠胃不调，大小便涩，欲发惊痫，或风热结核，头面生疮，目赤咽痛，疮疹余毒，泄泻不止。
赤芍 当归 甘草（炙） 大黄（酒蒸。各一钱五分）
锉碎，加薄荷叶煎八九沸，去滓，不拘时服。
（九）当门子涂顶法 预防螳螂子。
当门子 朱砂
共研细末，用水调和，涂小儿囟门（即头顶跳跃处），惟须于产后五小时内涂用，可防螳螂子发生。
1. Causes of Oral Lesions in Infants
Newborn infants possess a "pure yang" constitution (Chunyang zhi ti, a constitution characterized by abundant yang energy and rapid growth) and rarely present with deficiency syndromes. Those caused by excessive fire within the fetus or heat in the stomach will often suffer from oral lesions after birth. This is because fetal toxins (Tai du, toxic substances retained in the fetus) tend to flare up and attack upward, and stomach fire also easily invades the upper body. However, oral lesions manifest in many varieties, and treatment methods vary accordingly. The symptoms and treatments for each type are recorded below.
2. Symptoms of Oral Lesions
The most prominent types of oral lesions include Snow Mouth (Xue kou, white patches in the mouth), Xuan Yong (suspended abscess on the soft palate), Ru Xun (mushroom-like swelling), Ya Gan (gangrenous gingivitis), Chong Yin (double gums), Chong E (swollen hard palate), Chong She (double tongue), Mu She (wooden tongue), Nong She (protruding tongue), Za Sai (mumps), Zhi Yi (drooling), and Tang Lang Zi (mantis child).
Snow Mouth, also known as Goose Tongue White Scabs, is the most common in infants. Within the first hundred days of life, white spots appear in the mouth, reappearing immediately after wiping, covering the entire mouth, and even penetrating into the throat. In severe cases, the infant cries but cannot suckle.
Xuan Yong, or Hanging Abscess, refers to a swelling at the upper part of the throat, resembling a reed tube filled with water.
Ru Xun refers to a fleshy swelling in the mouth that rises like a mushroom.
Ma Ya Gan refers to white blisters forming on the gums. A more severe form, Zou Ma Ya Gan (Running Horse Gangrene), involves rapid decay and collapse of the gum tissue; if teeth have erupted, they may fall out sequentially. This is a dangerous condition.
Chong Yin and Chong E, also called Gum Swelling and Palate Swelling, involve edema of the inner cheeks and upper gum/palate, sometimes resembling water blisters.
Chong She presents as swelling at the base of the tongue, appearing as if a second tongue has emerged, with the flesh at the root of the tongue swollen and layered, short and small like a tongue.
Mu She presents with a swollen tip of the tongue filling the mouth, or becoming stiff like wood, unable to move.
Nong She presents with the tongue protruding and flicking like a snake.
Za Sai presents with swollen, hard nodes in both cheeks, or on one side. The infant's face often appears yellow, black nodules may appear at the nose bridge, causing difficulty in suckling and incessant crying.
Zhi Yi refers to saliva flowing from the corners of the mouth and stagnating in the cheeks, hence the name.
Tang Lang Zi is common in infants within their first month. It presents with swollen, hard inner cheeks, inability to open the mouth to suckle, and difficult crying sounds. Its appearance is similar to Za Sai, except that Za Sai causes external facial swelling, while Tang Lang Zi causes internal oral swelling. These represent a general overview of various oral lesion manifestations.
3. Treatment Methods for Oral Lesions
Snow Mouth is mostly due to congenital fetal toxins and accumulated heat in the Spleen and Stomach meridians. Therefore, treatment should focus on clearing heat and detoxifying. Internally, San Huang Tang (Three Yellows Decoction) along with Zhi Zi (Gardenia), Shi Gao (Gypsum), and Sheng Di Huang (Rehmannia Root) are suitable. Externally, equal parts of Gan Cao (Licorice Root) and Huang Lian (Coptis Rhizome) are decocted; using cloth-wrapped fingers to gently wipe away the white scabs, followed by applying juice from Sang Pi (Mulberry Bark), leads to recovery. Alternatively, Ku Fan (Alum), Zhu Sha (Cinnabar) each 2.5 qian, and Ma Ya Xiao (Saltpeter) 5 qian are ground into an ultra-fine powder, mixed with water to extract juice, and applied to the tongue and inner cheeks. The *Jian Yi Fang* suggests drinking one zhong of water collected from a goose's mouth in divided doses, which is also effective, though its rationale is unclear.
Xuan Yong is caused by fetal toxins leading to heat steaming upward from the Lung and Stomach, occurring in the throat. Treatment involves puncturing it with a needle to drain toxic blood and release toxic vapors, allowing self-healing. If unresolved after one day, puncture again the next day; usually, three punctures suffice. Delaying treatment allows toxin accumulation, making the skin harder to pierce, so negligence is inadvisable. After puncturing, rinse with salt water and urgently apply Ru Sheng San or Yi Zi San.
Ru Xun and Ma Ya Gan are mostly caused by fire in the Intestines and Stomach. Treatment requires cooling and disinfecting. Internally, San Huang Tang combined with Shi Gao and Zhi Mu can be used. Externally, pick off the head of the swelling; if bleeding occurs, wipe with cloth or cotton. Mild cases heal with Jing Mo (Beijing Ink); severe cases use three dried silkworms (Chuang Can) stir-fried without silk/mouthparts, Ren Zhong Bai (Human Placenta Ash) 4 fen, and a little Bing Pian (Borneol), ground fine and applied. After a moment, rinse with cotton dipped in bitter tea, then reapply, 3-4 times daily until healed. If not healing, add Peng Sha (Borax), Xue Jie (Dragon's Blood), Qing Dai (Indigo Naturalis) each 3 fen, Er Cha (Camelia Leaf Tea) 0.5 fen, and Yao Zhu (Calculus Bovis substitute) 1 fen, ground fine and mixed with the previous powder, washing and applying 3-4 times daily ensures cure. The *Jian Yi Fang* recommends baking Ma Chi Xian (Purslane) root on tiles, adding a little Xiong Huang (Realgar), grinding, and applying.
Zou Ma Ya Gan is fierce and different. It arises from stomach fire raging like a prairie fire, and tooth loss/collapse often happens too late for rescue. Internally, drink concentrated mung bean soup frequently to transform toxins and excrete them via urine. Externally, apply a powder of Ren Zhong Bai 4 fen, vinegar-processed Tong Lv (Verdigris) and Xing Ren (Apricot Seed) each 2 fen, and a little Bing Pian. This condition often follows chickenpox/measles when residual toxins remain; even with treatment, complications like lip defects or cheek perforation may occur (see Chapter 4).
Chong Yin and Chong E are caused by stomach heat steaming upward. Treatment initially involves piercing with a needle to drain purple blood, rinsing with salt water, applying Niu Huang San externally, and taking Qing Wei San internally.
Chong She, Mu She, and Nong She are mostly caused by accumulated heat in the Heart and Spleen. Severe cases can be fatal and require urgent treatment. For Chong She, soak Huang Bo (Phellodendron Bark) in Zhu Li (Bamboo Sap) overnight and apply to the tongue. For Mu She, dip a paper wick in Bi Ma Zi You (Castor Oil), light it, blow it out, and smoke the tongue to reduce swelling. If there is a lump under the tongue resembling a mole or silkworm, urgently bleed the swollen area using Bian Fa (stone lancet), apply thick paste of Fu Di Mei (Kiln Bottom Coal) mixed with salt/vinegar or well water, reapplying after removal. Brushing Zhen Pu Huang (Polygonatum Pollen) frequently on the tongue also heals. For mild Nong She, drink Deng Xin Cao (Rush Pith) decoction; for severe cases, drink Huang Lian decoction.
For Za Sai, grind one Slime Slug (Yan You) with a coin's weight of Zhu Sha, apply to the swollen/hard area without rubbing off, and it subsides. Alternatively, apply Dian Lan Hua (Indigo Flower) from dye works. Internally, early stage uses Chai Hu Ge Gen Tang; if thirsty and constipated, use Si Shun Qing Liang Yin; if suppuration is imminent, use Tuo Li Xiao Du San to support the interior and expel toxins.
For Zhi Yi due to Spleen deficiency failing to control fluids, use Bai Zhu, Chen Pi, Qing Pi, Pao Jiang each 5 fen, Shu Ban Xia, Ding Xiang, Mu Xiang each 1 qian, made into pills with flour paste the size of millet seeds. One-year-olds take 10 pills per dose. For Spleen heat causing fluid overflow, use Bai Zhu, Hua Shi each 5 fen, Bian Dou, Fu Ling, Shi Hu each 3 fen, Huang Lian 2 fen, Ge Gen 1.5 fen, Gan Cao 1 fen, ground into powder, taken with Deng Xin Cao decoction, 1 qian per dose.
For Tang Lang Zi, folk practice favors cutting, which must be clean and skillful to avoid danger; improper cutting is hazardous. Use Qing Dai, Peng Sha each 1 qian, Xuan Ming Fen 3 qian, Bo He 5 fen, Bing Pian 1 fen, ground together and finely rubbed inside both cheeks 4-5 times daily. Another prescription uses three Ban Mao (Mylabris), five Scorpion tails (scorpio cauda), roasted until crisp but not burnt, ground ultra-fine. Decoct 1 qian Ma Huang (Ephedra) in a small amount of water, strain, add one date pulp to dry, mash with Ma Huang juice, mix with Ban Mao/Scorpion powder, make pills like mustard seeds, place on a small plaster, and apply to Yin Tang (between eyebrows) and both cheeks. Blisters form in all three places after a week; once toxins are drained, it heals.
For general oral lesions, internal treatment uses cooling/detoxifying herbs like Huang Lian, Sheng Di Huang, Mu Tong, Dang Gui, Shi Gao, Xuan Ming Fen, Gan Cao, Lian Qiao, Zhi Zi, Huang Qin, Huang Bo, Da Huang, Dan Pi, Chi Shao, selected appropriately. External treatment uses Er Cha, Bo He, Bing Pian, Ren Zhong Bai, Gan Cao, Peng Sha, Qing Dai, Ma Ya Xiao, Shi Gao, Huang Lian, Huang Bo, Xi Huang, She Xiang, selected and mixed into powder for application.
Appendix Formulas
(1) Ru Sheng San: Treats infant oral lesions, sprinkle frequently.
Qian Shuang (Lead Frost), Niu Huang (Calculus Bovis), Tai Yi Xuan Jing Shi, Zhu Sha (Water-ground and sun-dried, each 2.5 qian). Grind to ultra-fine powder, mix evenly, add Bai Long Nao (Borneol) 5 fen, grind again.
(2) Yi Zi San: Treats white rot in the mouth.
Zhu Sha, Peng Sha (each 5 fen), Long Nao, Po Xiao (each a little). Grind to ultra-fine powder. Use a little, mix with honey, dip a goose feather, brush inside the mouth. Swallowing is harmless.
(3) San Huang Tang: Treats excess heat in the Three Jiao, irritability, constipation, floating pulse, Huhuo syndrome, rash dysentery.
Huang Lian (wine-boiled), Huang Qin (wine-fried), Da Huang (wine-soaked, equal parts). Take 1.5 qian, decoct in clear water. Or use raw without wine processing. Commonly used for newborns. Da Huang can be substituted with Huang Bo.
(4) Niu Huang San: Treats mouth ulcers.
Niu Huang, Bai Long Nao, Zhu Sha (each 1 fen), Qian Shuang (5 qian), Tai Yi Xuan Jing Shi (1 liang). Grind fine. First pierce the swelling with a blade needle to bleed, wash with salt water, then apply powder.
(5) Qing Wei San: Treats Damp-Heat in Spleen/Stomach, epigastric pain, lip/mouth swelling, gum ulceration, pain radiating to head, chills/fever, thirst for cold drinks, mouth/tongue ulcers, facial heat/pain, preference for cold/dislike of heat, infant double tongue/marsh teeth, tongue protrusion/salivation.
Sheng Ma (5 fen), Sheng Di Huang (wine-washed), Dang Gui (wine-washed, each 4 fen), Chuan Huang Lian (stir-fried), Dan Pi (each 3 fen). Grind fine, decoct half volume in clear water, strain, cool, sip slowly. If pain persists, add Shi Gao appropriately. If due to Spleen/Stomach Qi deficiency, cold damaging, or deficient heat rising, causing ulcers, fever, poor appetite, vomiting, drowsiness, loose stools, salivation/gum rot, use Wu Wei Yi Gong San instead. Although symptoms are similar, deficiency/excess are distinct, and treatments differ thus.
(6) Chai Hu Ge Gen Tang: Treats Shang Han (Cold Damage) and Za Sai.
Chai Hu, Ge Gen, Shi Gao, Tian Hua Fen, Huang Qin (each 2 qian), Sheng Gan Cao (5 fen), Niu Bang Zi (stir-fried and ground), Lian Qiao (decored), Jie Geng (each 1 qian), Sheng Ma (3 fen). Decoct 2 zhong clear water to 8 fen, take anytime.
(7) Tuo Li Xiao Du San: Treats sores/ulcers with Qi and Blood deficiency, swelling unable to suppurate, or ulcer unable to heal.
Ren Shen, Sheng Huang Qi, Bai Zhu (stir-fried), Fu Ling, Bai Shao, Dang Gui (wine-mixed), Chuan Xiong, Jin Yin Hua (each 1 qian), Bai Zhi, Gan Cao (roasted), Lian Qiao (each 5 fen). One variant lacks Chuan Xiong; another adds Chen Pi 1 qian, Zao Jiao Zhen, Jie Geng each 5 fen. This is a key internal formula for surgery with many modifications.
(8) Si Shun Qing Liang Yin: Treats infant blood vessel congestion, organ heat accumulation, red cheeks/thirst, five-palm heat, restlessness, limb convulsions, gastrointestinal imbalance, difficult urination/defecation, impending epilepsy, wind-heat nodules, head/face sores, red eyes/sore throat, residual toxins from rashes, persistent diarrhea.
Chi Shao, Dang Gui, Gan Cao (roasted), Da Huang (wine-steamed, each 1.5 qian). Chop, add Bo He Ye, boil 8-9 times, strain, take anytime.
(9) Dang Men Zi Top Application Method: Prevents Tang Lang Zi.
Dang Men Zi (Muscon), Zhu Sha. Grind fine, mix with water, apply to infant Fontanelle (Xin Men, the pulsating spot on top of head). Must be applied within 5 hours postpartum to prevent Tang Lang Zi.