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Li Dongyuan stated: Zouma gan (Running Horse Gangrene) is caused by heat-toxin in the Kidney Meridian attacking upwards. The Kidneys govern the bones, and teeth are considered the surplus of bones. When heat-toxin rushes upward causing gum ulceration, the condition progresses with the speed of a running horse, hence the name. In children, it may arise from fetal toxins, residual toxins after smallpox or measles, following typhoid fever or epidemic diseases, or condensing after malaria or dysentery. Its external manifestations include high fever, coldness in hands and feet at times, facial edema, or frequent loose stools; initially bad breath, followed by rotting gums with a color resembling dried sauce, then blackening of teeth, sometimes with bleeding gums, or pus that becomes foul-smelling and produces worm-like erosions affecting the mouth and teeth, even swelling and redness of the cheeks and jaw; on the second day the color turns purple, and by the third day it turns black; after a few more days, the teeth rot and fall out, accompanied by panting and rattling phlegm, cold sweat on the forehead, leading to death. Treatment methods: At the onset, internal administration of clearing and resolving agents is suitable, such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Yunu Jian (Jade Woman Decoction), to first remove accumulated heat, followed by applying Huadu Dan (Detoxification Pill) powder to eliminate toxins; blowing Bingqing San (Ice Green Powder) supplemented with Xihuang (Bovis Calculus/Niuhuang) and Zhenzhu (Pearl) may also result in survival. Generally, if this disease emits a foul odor that offends others, it is fatal; if it erodes downward into the throat or upward into the nasal bridge, it is fatal; if teeth fall out without bleeding, it is fatal; if saliva flows outward, it is fatal; if black necrotic tissue does not shed, it is fatal; if body heat does not subside, it is fatal; if it perforates the cheek and penetrates the lip, it is fatal; if the nasal bridge appears dark and dull, it is fatal; if Spleen failure leads to diarrhea and inability to eat or drink, it is fatal.

There is also Fengre yagan (Wind-Heat Gum Gangrene), which comes rapidly, with alternating chills and fever, developing within two or three days, occurring frequently in both adults and children. Bleeding from tooth gaps and crumbling decay of the gum roots require treatment primarily with dispersing wind-heat and clearing heat-toxins. Some cases do not present with chills or fever but arise due to Stomach fire and damp-heat steaming upward; these are treated with clearing and resolving, or bitter-cold descending methods to drain heat, such as Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins); the blowing powders mentioned above can be used, or specific anti-gangrene powders may be applied.

Yajun (Tooth Fungus) grows on the gums, appearing purple-black in color, with an uneven, mushroom-like shape. This condition results from excessive fire, blood-heat, combined with Qi stagnation. It is primarily treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder); the previously mentioned medicines may also be taken.