口疮上焦实热，中焦虚寒，下焦阴火，各经传变所致，当分别而治之。如发热作渴饮冷
，实
汤。手足逆冷，肚腹作痛，中气虚寒也，用附子理中汤。晡热内热，不时而热，血虚也，用
八物如丹皮、五味、麦门。发热作渴，唾痰，小便频数，肾水亏也，用加减八味丸。食少便
滑，面黄肢冷，火衰土虚也，用八味丸。日晡发热，或从腹起，阴虚也，用四物、参、术、
五味、麦门。不应，用加减八味丸。若热来复去，昼见夜伏，夜见昼伏，不时而动，或无定
处，或从脚起，乃无根之火也，亦用前丸，及十全大补加麦门、五味。更以附子末，唾津调
搽涌泉穴，若概用寒凉，损伤生气，为害匪轻。
治验
秋官赵君言，口舌生疮，劳则体倦，发热恶寒，此内伤气血之症，用补中益气加五味、
进士刘华甫，口舌生疮，午前热甚，脉数而有力，用清心莲子饮稍愈。更以四物二连汤全愈
。后因劳役，日晡发热，脉数而无力，用四物加参、术、柴胡少瘥。但体倦口干，再用补中益气汤而愈。
武库刘君，口舌生疮，口干饮汤，乃胃气虚而不能化生津液也。用七味白术散而痊。
廷评曲汝为口内如无皮状，或咽喉作痛，喜热饮食，此中气真寒，而外虚热也。用加减八味丸而愈。
儒者费怀德，发热，口舌状如无皮，用寒凉降火药，面赤发热，作呕少食，痰涎自出，
此脾胃复伤虚寒而作也。用附子理中汤，以温补脾胃；用八味丸，补命门火，乃愈。
一男子口糜烂，脉数无力，此血虚而有火，用四物，加茯苓、白术，少用黄柏、知母，
地官李孟卿子新婚，口舌糜烂，日晡益甚，用八珍汤，加五味、麦门，而口疮愈。更用加减八味丸，而元气实。
一男子唇舌生疮，口苦作呕，小便淋涩，此肝脾火动，以小柴胡，加山栀、酸枣仁、远
志
一儒者口苦而辣，此肺肝火症，先以小柴胡加山栀、胆草、茯苓、桑皮而渐愈。更以六
君加山栀、芍药而痊瘥。若口苦胁胀，小便淋沥，此亦肝经之病，用六味丸，以滋化源。
一男子口臭，牙龈赤烂，腿膝痿软，或用黄柏等药益甚，时或口咸，此肾经虚热，余用六味丸悉瘥。
一妇人口苦胁胀，用小柴胡、山栀、黄连少愈。更以四君子加芍药、当归、柴胡而瘥。
一妇人每怒口苦，发热晡甚，以小柴胡合四物二剂。更以四物加柴胡、白术、茯苓、
一妇人每怒则口苦兼辣，头痛胁胀，乳内刺痛，此肝肺之火。用小柴胡加山栀、青皮、
芎、归、桑皮而安。后劳兼怒，口复苦，经水顿至，用四物加炒栀、炒胆草一剂，更以加味逍遥散
Mouth ulcers can be caused by excess heat in the Upper Jiao (Upper Burner), deficiency cold in the Middle Jiao (Middle Burner), yin fire in the Lower Jiao (Lower Burner), and transmission between meridians; they should be treated according to differentiation. If there is fever, thirst, and a desire to drink cold fluids, it indicates excess heat [in the Upper Jiao], use a decoction for excess heat (Note: Original text "Shi Tang" is incomplete/ambiguous, likely referring to a heat-clearing formula like Huanglian Jiedu Tang). If the hands and feet are cold, and the abdomen hurts, this is deficiency cold of the Middle Qi, use Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle). If there is afternoon tidal fever, internal heat, or irregular fever, this is blood deficiency, use Bawu Tang (Eight-Ingredient Decoction) added with Danpi (Moutan Cortex), Wuweizi (Schisandra Fruit), and Maimendong (Ophiopogon Tuber). If there is fever, thirst, expectoration of phlegm, and frequent urination, this is kidney water deficiency, use Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If appetite is poor, stool is loose, complexion is sallow, and limbs are cold, this is decline of ministerial fire and deficiency of earth (spleen), use Bawei Wan (Eight-Ingredient Pill / Jin Gui Shen Qi Wan). If there is afternoon fever, or heat rising from the abdomen, this is yin deficiency, use Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Wuweizi, and Maimendong. If ineffective, use Jiaban Bawei Wan. If the heat comes and goes, appears during the day and hides at night, or appears at night and hides during the day, moves irregularly, has no fixed location, or rises from the feet, this is rootless fire; also use the aforementioned pills, as well as Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) added with Maimendong and Wuweizi. Additionally, apply Fuzi powder (Aconite Root Powder) mixed with saliva to Yongquan (KI1, Gushing Spring) acupoint. If one indiscriminately uses cold and cool herbs, it damages the vital qi, causing significant harm.
Clinical Cases:
Zhao Jun, an official of the Ministry of Justice, stated that he had mouth and tongue ulcers, fatigue after exertion, fever, and aversion to wind/cold. This is a syndrome of internal injury to qi and blood; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi.
Liu Huafu, a Jinshi (Imperial Graduate), had mouth and tongue ulcers, severe fever before noon, and a rapid, forceful pulse. Use Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction) for slight improvement. Then use Siwu Erlian Tang (Four-Substance with Two Lianas Decoction) for complete recovery. Later, due to overwork, he had afternoon fever and a rapid, weak pulse. Use Siwu Tang added with Renshen, Baizhu, and Chaihu (Bupleurum Root) for slight relief. However, due to continued fatigue and dry mouth, use Buzhong Yiqi Tang again for recovery.
Liu Jun, from the Military Arsenal, had mouth and tongue ulcers, dry mouth, and a desire to drink hot liquids. This is deficiency of stomach qi failing to transform fluids into body fluids. Use Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder) for recovery.
Qu Ruwei, a Tingping (Official Title), felt as if the skin inside his mouth was missing, sometimes with sore throat, and preferred hot food and drinks. This is true cold of the middle qi with external deficient heat. Use Jiaban Bawei Wan for recovery.
Fei Huaide, a scholar, had fever and mouth/tongue appearing as if skinless. After using cold and cool herbs to descend fire, he developed red face, fever, vomiting, poor appetite, and spontaneous salivation. This is due to secondary injury to the spleen and stomach causing deficiency cold. Use Fuzi Lizhong Tang to warm and tonify the spleen and stomach; use Bawei Wan to tonify the fire of the Gate of Vitality (Mingmen), leading to recovery.
A man had oral erosion, with a rapid but weak pulse. This is blood deficiency with fire. Use Siwu Tang added with Fuling (Poria) and Baizhu, with small amounts of Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome).
The son of Li Mengqing, a Land Official, newlywed, had mouth and tongue erosion worsening in the afternoon. Use Bazhen Tang (Eight-Treasure Decoction) added with Wuweizi and Maimendong for ulcer recovery. Then use Jiaban Bawei Wan to solidify yuan qi (original qi).
A man had ulcers on lips and tongue, bitter taste, vomiting, and dysuria. This is liver and spleen fire stirring. Use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardenia Fruit), Suanzaoren (Ziziphus Seed), and Yuanzhi (Polygala Root).
A scholar had a bitter and pungent taste in the mouth. This is lung and liver fire syndrome. First use Xiaochaihu Tang added with Zhizi, Longdancao (Gentiana Root), Fuling, and Sangbaipi (Mulberry Root Bark) for gradual improvement. Then use Liujunzi Tang (Six-Gentlemen Decoction) added with Zhizi and Shaoyao (Peony Root) for recovery. If there is bitter taste and hypochondriac distension with dribbling urine, this is also a liver meridian disease; use Liuwei Wan (Six-Ingredient Pill) to nourish the source of transformation.
A man had bad breath, red and rotting gums, and flaccidity of legs and knees. Using Huangbai etc. made it worse; sometimes salty taste in mouth. This is kidney meridian deficient heat. I used Liuwei Wan for complete recovery.
A woman had bitter taste and hypochondriac distension. Use Xiaochaihu Tang, Zhizi, and Huanglian for slight improvement. Then use Sijunzi Tang (Four-Gentlemen Decoction) added with Shaoyao, Danggui (Angelica Sinensis), and Chaihu for recovery.
A woman had bitter taste upon anger, with afternoon fever exacerbation. Use Xiaochaihu Tang combined with Siwu Tang for two doses. Then use Siwu Tang added with Chaihu, Baizhu, and Fuling.
A woman had bitter and pungent taste upon anger, headache, hypochondriac distension, and stabbing pain in breasts. This is liver and lung fire. Use Xiaochaihu Tang added with Zhizi, Qingpi (Citrus Aurantium Peel), Xiong (Ligusticum Chuanxiong Rhizome), Danggui, and Sangbaipi for peace. Later, due to labor and anger, bitter taste returned, and menstruation arrived suddenly. Use Siwu Tang added with stir-fried Zhizi and stir-fried Longdancao for one dose, then use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).