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Shen Douyuan stated: Kougan (oral ulceration) is caused by damp-heat stagnating in the stomach region. Since the mouth is the orifice of the Spleen, if not treated early, it may corrode the mouth, lips, cheeks, and parotid areas, leading to a critical condition. (From *Qixuan*)

Kui Guang stated: Mixian (mucosal erosion) causes widespread erosion throughout the mouth; its treatment is the same as that for pediatric Kougan.

He further stated: For treating Kougan, it is appropriate to use raw silk soaked in water to gently swish and clean the mouth; using cloth for wiping is contraindicated.

Empirical Prescription (From *Jinnang*):
Renzhongbai (Oxysiphonis Alba, Human Tooth Ash) [2 liang], Tongqing (Chalcocitum, Copper Green) [3 qian 5 fen], Bingpian (Borneolum Syntheticum, Borneol) [2 fen], Shexiang (Moschus, Musk) [1 fen].
Grind these into an extremely fine powder. Rinse the mouth thoroughly with cold, strong tea, then insufflate a small amount of the powder. Wait until saliva and phlegm drain completely, then insufflate one or two more times; recovery will follow. For severe cases, adding Xiniuhuang (Bovis Calculus, Indian Buffalo Stone) [1 fen] yields better results.

Another Prescription (From *Qixuan*):
Ganlanhe (Canarii Fructus Semen, Olive Pit) [1 liang], Ercha (Catechu, Catechu Extract) [5 qian], Bingpian (Borneolum Syntheticum, Borneol) [2 fen].
Grind into a fine powder and apply topically to the affected area; three applications lead to complete recovery.

Kougan (From *Jianbian*):
Burn sugarcane peel to ash, grind into powder, and apply topically; this is highly effective.

Parotid Swelling and Intractable Kougan (From *Jijiu*):
Banxia (Pinelliae Rhizoma, Pinellia Tuber) and Xiangfu (Cyperi Rhizoma, Cyperus Rhizome) in equal parts.
Mash together with egg white (Jizi Qing) until forming a paste. Apply to the Yongquan (KI-1) acupoint on the opposite side: if the left side is diseased, apply to the right Yongquan; if the right side is diseased, apply to the left Yongquan. Healing occurs immediately upon application.

Kougan:
Hongzao (Jujubae Fructus, Jujube Fruit) [10 pieces, burned until carbonized but retaining essence], Bingpian (Borneolum Syntheticum, Borneol) [2 fen].
Grind and insufflate into the lesion.

Another Prescription:
Suosharenke (Amomi Fructus Pericarpium, Shell of Amomum Fruit), grind and rub onto the affected area.

Another Prescription (From *Huoyou Xinshu*):
Jizhenpi (Galli Gigerii Endothelium Corneum, Chicken Gizzard Lining), burned until carbonized but retaining essence, applied topically; immediate effect is observed.

Pediatric Kougan and Adult Gan Chuang (Oral Ulcers):
High-quality Ercha (Catechu, Catechu Extract) [1 liang], Wubeizi (Gallae Chinensis, Chinese Gall) [stir-fried until yellow, 4 fen], Huangbai (Phellodendri Cortex, Phellodendron Bark) [honey-fried, 5 fen], Bingpian (Borneolum Syntheticum, Borneol) [2 fen].
Grind into a fine powder and insufflate or apply topically.

Feng Luzhan stated: When sores appear all over the mouth, it is named Komi (oral mucosal erosion). If small white spots appear on the upper palate, it is named Qixing Chuang (Seven-Star Ulcer). These conditions generally stem from accumulated heat in the Heart, Lung, and Stomach meridians; treatment involves clearing and draining heat according to the affected meridian. Occasionally, diarrhea accompanies the condition due to weakness of the Spleen's primordial qi, which fails to anchor the Yin fire of the lower jiao, causing it to flare upward and result in oral erosion. In such cases, cold-natured medicines must not be mistakenly administered; instead, formulas such as Liujunzi Tang (Six Gentlemen Decoction) or Lizhong Tang (Regulate the Middle Decoction) are appropriate. (From *Jinnang*)

He further stated: The mouth serves as a thoroughfare for the Qi of the five zang and six fu organs and is the orifice of the Spleen. The Qi of the organs enters and exits through it, much like a gate. If the organs harbor excess pathogenic factors, the mouth will manifest corresponding symptoms.

Chen Shigong stated: In oral ulcers caused by deficient fire, the color is pale with fine white spots; in severe cases, lesions sink and reveal crack-like patterns, accompanied by a deficient pulse and absence of thirst. This results from excessive mental worry and fatigue, characterized by being awake too much and sleeping too little. Treatment employs Zhibai Siwu Tang (Anemarrhena, Phellodendron and Four Substances Decoction) supplemented with Mudan Pi (Moutan Cortex, Tree Peony Bark) and Rougui (Cinnamomi Cortex, Cinnamon Bark). In cases of excess fire, the lesions are red with widespread erosive patches; in severe cases, the cheeks and tongue swell, accompanied by a surging pulse and dry mouth. This arises from consuming rich, greasy foods, strong alcohol, and roasted meats, causing the Heart fire to flare recklessly. Treatment employs Liangge San (Cool the Diaphragm Powder). (From *Zhengzong*)

He further stated: For oral and lingual ulcers accompanied by a dry, yellow, hard tongue and thirst, employ Jiajian Bawei Wan (Modified Eight Ingredients Pill).

He further stated: It is advisable to insufflate Fushan San (Attend Banquet Powder); healing occurs after expectoration of saliva. Water rinsing is strictly prohibited during treatment.

Kui Guang stated: For swelling and erosion of the cheeks and mouth, bind raw silk with a tendon, dip it in water, and gently swish/clean the area. If pain is felt, the condition is easy to treat; if no pain is felt, it indicates necrotic tissue (dead flesh), which is difficult to treat.

He further stated: Komi resulting from Shanghan (Cold Damage disease) is caused by heat affecting the Heart and Spleen, where stagnant fire steams upward. Treatment should regulate the Heart and Spleen; the pulse is typically surging, large, and forceful, indicating excess heat. Additionally, when deficiency of the Spleen's middle qi fails to anchor the Yin fire of the lower jiao, leading to Komi and ulcers, Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) is appropriate. This distinction must not be overlooked.