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Ma Ya Yan Fang (Empirical Formula for Horse's Tooth, from *Ci You Wai Bian*): Take the inner juice of a mulberry tree, filter it until clear, and apply it to the affected area.

Another formula (from *Bao Sheng Sui Shi*): Four pieces of *Bai Jiang Can* (White Silkworm), stir-fried and ground into powder, mixed with honey, applied to the inside of the lips; recovery will follow immediately.

*Yi Zong Xin Fa* states: Zou Ma Gan (Gangrenous stomatitis progressing rapidly like a running horse) occurs only when Pi Ji (accumulations such as phlegm or blood stasis) attack the teeth causing gan sores. It is prone to recurrence after healing, all due to accumulated fire attacking upward from time to time. The key lies in proper dietary regulation; foods such as Chinese yam, chestnuts, goose, crab, sweets, and spicy items must be strictly prohibited. Any negligence will inevitably lead to relapse.

Li Dongyuan stated: Zou Ma Gan is caused by heat-toxin attacking upward, borne by deficient zang organs. The Kidney governs the bones, and teeth are the surplus of bones. When heat rushes upward causing ulceration, the momentum is swift like a running horse, hence the name.

Kui Guang stated: Zou Ma Ya Gang may be due to fetal toxin, or following sha dou (exanthematous diseases like smallpox or measles), where toxic qi erupts and erodes the gingiva, rotting into gan sores, killing most rapidly. Red spots on the nasal bridge indicate an incurable case. The color resembles dried sauce; it rots one fen in one day, one cun in two days, hence called "running horse" to喻 its speed. Those with teeth who lose all their teeth will die. Pediatric Zou Ma Gan and adult Ya Cao Feng both require prevention of tooth loss.

The rhyme states: In examining Zou Ma Gan, regardless of age, the upper left central incisor serves as the master tooth. If this tooth falls out, the remaining teeth will all fall out; if this tooth does not fall out, even if the others do, the condition remains treatable.

It further states: Beng Sha Gan (Sandy Collapse Gan) and Kou Gan begin with swelling and redness of the upper gum below the tongue, with mouth pain feeling like scalding water, and gradual gum rot; tooth loss is also a concern.

It further states: For Zou Ma Gan, it is suitable to insufflate Kou Gan medicine (formula recorded in the Throat Section) added with Niu Huang (Calculus Bovis), doubling the dosage of Zhen Zhu (Pearl) and Long Gu (Fossilized Bones). After sha dou, Long Gu is omitted; adding Niu Huang and Zhen Zhu yields immediate results without exception.

Chen Shigong stated: Ya Gan invariably arises from residual toxins after sha dou, or from excessive internal heat following illness. The affected gums swell, break open, and flow with saliva. (*Wai Ke Zheng Zong*)

It further states: Death occurs if foul qi rushes into the person. Death occurs if erosion goes down to the throat and up to the nasal bridge. Death occurs if teeth fall out without bleeding. Death occurs if saliva flows inward. Death occurs if large muscles have wasted away. Death occurs if there is bad breath and foul saliva. Death occurs if black rot does not slough off. Death occurs if medication is ineffective. Death occurs if the cheek and lip are perforated. Death occurs if the nasal bridge turns dark. Death occurs if food and drink cannot be taken.

Feng Luzhan stated: Zou Ma Ya Gang is mostly due to Qi deficiency contracting cold, with heat stagnating internally, or consuming sweet, sour, salty, and stagnant foods. Accumulation persists for a long time, fermenting heat rushes upward, causing teeth to become scorched, black, and rotten, occasionally oozing clear blood. Blood gathers into pus, pus becomes foul and breeds worms, invading the mouth and teeth. Severe cases involve cheek perforation, difficulty in nursing or eating, panting, and fever, indicating critical danger. Treatment should involve internal administration of Qing Jie (clearing and resolving) formulas first to remove accumulated heat, external washing with warm salt water, and insufflation of drugs that remove saliva and draw out heat. One must absolutely avoid using purely cold and cooling herbs to constrain, which would prevent the stagnated heat from venting, leading to deeper ulceration. The name "running horse" likely exists because teeth belong to the Kidney; once Kidney Qi is deficient, defaming fire and evil heat rush directly to the Upper Jiao, swift as a running horse. (*Jin Nang Mi Lu*)

It further states: Children suffering from brain heat and abdominal pain, alternating chills and fever, frequent slippery diarrhea, bad breath and dry thirst, and ear sores with pus; externally, the body burns with high fever, feet are cold as ice, complexion is sallow/black, nails are black, sores itch, and muscles waste away, teeth break, and oral ulcers form—this is commonly called "running horse." Defaming fire congests in the Upper Jiao, causing bad breath, named Chou Xi (Foul Breath). Subsequently, teeth turn black, named Beng Sha (Sandy Collapse). If gums rot, named Kui Cao (Cavity Collapse). If hot blood flows backward, named Xuan Lu (Exposure). Even if teeth fall out, named Fu Gen (Rotting Roots). Once roots rot, even if the disease heals, teeth cannot regrow; this is the sign of Ji Gan (Acute Gan). Ji Gan is Shen Gan (Kidney Gan), also known as Gu Gan (Bone Gan). It results from long-term damage to the Kidney. If the patient craves salty water, urine resembles milk, teeth are scorched/black, and bones are withered, death ensues.