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Zi Hezi treated Yue Cheng, the supervisor of Xiangtai's wine monopoly, for malaria accompanied by incessant diarrhea day and night, intestinal borborygmus, and mouth ulcers, commonly known as "Heart Labor Mouth Ulcers," which had persisted for three years without cure. He prescribed decocting long-flowing water with ginger and jujube, taking Wuling San (Five-Ingredient Powder with Poria) 5–7 qian on an empty stomach to treat the lower jiao; he also prepared a powder of equal parts Huanglian (Coptidis Rhizoma) and Baifuling (Poria Cum Radix Glycyrrhizae et Zizyphi, peeled), made into pills with wheat flour paste, taken 30–50 pills after meals with warm water to treat the upper jiao. The patient recovered in one hundred days. (Treated as damp-heat fire.)

A man suffered from mouth ulcers for several years, extending from the mouth to the throat and down to the epigastrium, causing pain that prevented him from eating hot food. After one session of emesis, one of purgation, and one of diaphoresis, nine-tenths of the disease was eliminated. Subsequently, he took Huanglian Jiedu Tang (Coptis Decoction for Detoxification), and within ten days, all symptoms resolved. (Treated as excess-fire.)

A man in his twenties exhaled breath so foul-smelling like a latrine that even relatives refused to speak with him. Zi Hezi said: Metal of the Lung naturally governs fishiness; this is metal refined by fire. Fire governs scorched odor, hence such presentation. Over time, it becomes putrefaction, which corresponds to the Kidney; this is heat extreme manifesting as water transformation. Since the disease is in the upper jiao, emesis is indicated. First, Chetiao San (Tea Regulation Powder) was used to induce emesis, expelling seven-tenths of the pathogen. At night, Zhouche Wan (Boat and Cart Pill) and Junchuan San (River-Dredging Powder) were administered to purge the five yin organs. By morning, the disease was cured. Alas! Some people suffer from halitosis throughout their lives; worldly theories attribute it to the lung meridian being oblique and connecting with the stomach, causing odor—this is a baseless speculation.

Xue Lizhai treated Qu Ruwei, a Tingping official, who felt as if the mucosa inside his mouth were missing, sometimes experiencing throat pain, yet preferring hot drinks. This was true cold in the middle jiao with exterior deficiency-heat. He was cured using Jiawei Bawei Wan (Modified Eight-Ingredient Pill). (Deficiency-cold.)

One man with weak stomach and abundant phlegm developed mouth and tongue ulcers. Taking Guntan Wan (Rolling Phlegm Pill) worsened his condition, leading to incessant diarrhea, aversion to food, and fatigue, indicating damage to stomach qi. Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) was given, bringing slight improvement after several doses. Then, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added Banxia (Pinelliae Rhizoma) and Fuling (Poria) cured him.

Xue Lizhai treated a man with halitosis, red and ulcerated gums, and flaccidity of the legs and knees. Treatment with Huangbai (Phellodendri Cortex) and similar herbs worsened the condition; occasionally he tasted saltiness in the mouth. This was deficiency-heat of the Kidney channel. Liuwei Wan (Six-Ingredient Pill with Rehmannia) completely cured him. (Deficiency-heat.)

Sun Wen Yuan treated Wang Dongzhi, whose mouth ulcers resulted from excessive mental exertion playing Go. Administration of bitter-cold medicines aggravated the ulcers for over ten days, spreading to the throat, making ingestion of medicine and food difficult. Pulse diagnosis revealed all six positions were large, hollow, and powerless. A specialist suggested applying topical medicine for oral canker, instructing the use of Jingjie (Schizonepetae Herba) decoction to wash and draw out thick saliva, yielding two or three bowls poured on the ground. Two chickens fighting over this saliva died instantly, demonstrating its toxicity—a rare case. Sun instructed that medication should only be blown into the throat until fully healed, then applied to the tongue, and finally to the lips, never broadly applied, lest the toxin have no outlet and attack the throat, causing mishap. He told the father: "This is deficiency-yang mouth ulcer; only Fuzi Lizhong Tang (Aconite Decoction to Warm the Middle) can save him." The father replied: "Ulcers are heat syndromes; besides, the upper body is hot, and it is midsummer heat. How dare we take strongly heating medicine?" Sun said: "This is Yin-rejecting-Yang syndrome. Misuse of cold medicines irritates it. Test the feet; they will be cold." Upon palpation, they were indeed cold. Thus, Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian each, Da Fuzi (Aconiti Lateralis Radix Preparata), Pa Jiang (Zingiberis Rhizoma Preparatum), and Zhi Gancao (Prepared Licorice Root) 1 qian each were decocted and taken cold. The patient slept soundly until dawn, ate half a bowl of porridge the next morning, and his feet and knees warmed up. The prescription remained unchanged. Upon returning from a noon walk, he found the family wailing. They said: "Originally a heat disease, but mistakenly given hot medicine. Now the tongue is swollen, filling the mouth, unable to speak. It is hopeless." Shocked by the sudden change, Sun re-palpated the pulse: the six pulses were gathered and spirited, complexion harmonious, except for the swollen tongue. He realized it was caused by cold topical applications. He asked: "Can topical medicine be used today?" They said: "It has been applied twice." Sun ordered immediate preparation of Guigui (Cinnamomi Ramulus) powder 5 qian, mixed with fresh ginger juice, and applied to the tongue. After application, tears and nasal discharge flowed, saliva dripped, and the tongue subsided immediately. He then had them feed him porridge to press the tongue, preventing deficiency-fire from rising again. The reason for tongue swelling was that cold topical agents closed the toxic vapors, leaving no exit. Using cinnamon and ginger juice embodies the principle of acrid dispersal.

Huang Shiwen’s father suffered from mouth ulcers. Huang Shiwen’s treatment failed, causing surprise. Secret inquiries among maidservants revealed the father had cohabited with a maid during the day; the next day, the ulcers flared. Huang Shiwen noted the timing. The following day, at the same hour, he had the father wash his feet thoroughly and apply the medicine to the soles. The father recovered. (The formula likely contained Wu Zhu Yu (Evodiae Fructus) and Sheng Fuzi (Raw Aconiti Lateralis Radix). *Beichuang Jiu*.)

Lu Bu Yuan treated Li Mou, who had mouth and tongue ulcers for nearly three years. The pulse was floating, fine, rapid, and tense, empty upon pressure, especially at the chi position. Applying Xue Lizhai’s method for deficiency-fire not returning to its source, Jiawei Bawei Wan (Modified Eight-Ingredient Pill) ingredients were used. Recovery occurred in two doses.

Chai Yu Qing treated Min, nephew of Wu Ying’an, a Shaotingwei official, aged thirty. He presented with mouth and tongue ulcers and lower-body diarrhea. The chi pulse was weak and powerless, while cun and guan positions were large and hollow. This indicated Yin excess in the lower jiao forcing Yang upward. Cooling herbs would harm the Spleen; drying herbs would harm the tongue. Only the method of guiding fire back to its source was suitable. Fuzi Lizhong Tang (Aconite Decoction to Warm the Middle) was prepared as a frozen drink, followed by Liuwei Wan (Six-Ingredient Pill with Rehmannia) 3 qian. Two doses resulted in immediate recovery.

Madam Li Ying, wife of Guangluqing, suffered from mouth ulcers. Physicians repeatedly prescribed cooling and cold-clearing herbs without effect. She also had diarrhea and poor appetite. Upon initial examination, her right guan pulse was weak and faint, indicating Stomach deficiency and insufficient grain intake, further damaged by cold medicines. This forced the deficient fire of the Spleen and Stomach to flare upward, causing mouth ulcers, while the primal storehouse deficiency-cold caused diarrhea. Only by tonifying fire and dispersing cold could the fire be assisted and retreat. The formula included Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuzi (Aconiti Lateralis Radix Preparata), Pa Jiang (Zingiberis Rhizoma Preparatum), and Zhi Gancao (Prepared Licorice Root). Mr. Li feared to administer it and hesitated for days as the condition worsened. Several doses of the previous formula brought relief. Mouth ulcers arise from various causes: upper jiao excess-heat, middle jiao deficiency-cold, lower jiao yin-fire, and transmission between meridians. Each must be differentiated and treated individually; one must not be rigid.

Lu Yang Yu treated Yao Mingshui, who was constitutionally weak with dual deficiency of Spleen and Kidney. Fortunately, he practiced moderation and took warming-tonic herbs, enjoying good health and appetite in middle age. However, acquiring a concubine due to lack of heirs led to mouth ulcers and toothache. Initially, Liangge San (Cooling the Diaphragm Powder) cured him. Recurrent use over half a year led to full-mouth rotting and inability to eat. Pulse diagnosis showed floating, rapid, and faint cun positions, and floating, weak, and choppy guan and chi positions. Lu stated: "Though the form appears sufficient, essence remains deficient. Strict taboos must be observed, and tonic herbs taken. Cooling herbs must not be used again." Bayi Tang (Eight-Ingredient Decoction) with doubled Dihuang (Rehmanniae Radix Preparata) was used to vigorously tonify Kidney water, plus Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Preparata) 1 fen each to guide fire back to its source. As the classics state: "If suppression fails, seek the root to diminish it." Taken cold, ten doses eliminated the ailment.

Xue Lizhai treated Liu Yongong, a scholar, who was robust, drank water in winter, and prided himself on his strength. Xue said: "This is Yin deficiency." Liu did not believe him. One day, mouth and tongue ulcers appeared. Use of cold-clearing herbs caused limb fatigue, fever, and aversion to wind. Xue prescribed Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi), resulting in recovery.

Wang Kentang treated Yan Yangweng, a high-ranking official from Changshu. Due to advanced age, he sought rich, tonic foods, exacerbating Stomach fire. Qingwei San (Clear the Stomach Powder) was ineffective; adding Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), and Lianhua (Flos Loranthi) worsened it. Wang considered cooling incorrect and suspected the need for tonification. Hearing of Wang’s skill with Renshen (Ginseng Radix), he consulted him. Upon arrival, foul odor permeated the room, and the patient felt nauseous—classic Qingwei San indication. However, the heat was severe, requiring "following" treatment. Since the opportunity was missed, direct following was impossible; instead, seeking the root to diminish it was necessary. Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Sheng Dihuang (Rehmanniae Radix), Shu Dihuang (Rehmanniae Radix Preparata), Shihu (Dendrobii Caulis), Shengma (Cimicifugae Rhizoma), Xijiao (Rhinocerotis Cornu - now substituted), and Lanxiang (Agastaches Herba) were used in large doses. Within days, the odor ceased. The classics state: "For diseases that become hotter when cooled, treat the Yin." This is seeking the root. Fire declines at Xu hour; thus, vigorously tonifying Yin resolves the heat. Later, failing to avoid meat, Stomach fire recurred, causing constipation, eye opacity, tinnitus, and unbearable discomfort. Miscellaneous cold-clearing herbs were administered intermittently, leading to death. Alas! If knowing heat simply required cooling, anyone could be a Lu or Bian; why study medicine? (*Yugang Zhai Bichen*.)

Xu Shaowei, a county magistrate, suffered from oral thrush. Wang Kentang said: "Only Ganjiang (Zingiberis Rhizoma) can cure this." Xu doubted but eventually complied and recovered. His nephew Xu Mao also suffered severely, craving cold water due to intense heat. Wang prescribed Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Ganjiang (Zingiberis Rhizoma) 2 qian each, Fuling (Poria) and Gancao (Licorice Root) 1 qian each, decocted and taken cold. Several doses resolved the condition. Alas! How can this be explained to those rigidly adhering to formulas?

For mouth ulcers, old or new, at bedtime, grasp both testicles tightly and rub left and right 30–50 times with hands. Doing this nightly cures faster than medicine. (*Su Tan*.)

Xue Lizhai treated a man with mouth and tongue ulcers worsening with cold herbs; Lizhong Tang (Middle-Warming Decoction) cured him. Another man with mouth and tongue ulcers, poor taste in food, worsening with fatigue, also recovered quickly with the same formula.

A man with oral erosion worsened by cold herbs had a rapid but powerless pulse. Siwu Tang (Four-Substance Decoction) added Jiu Chao Zhizi (Wine-fried Gardeniae Fructus), Huangbai (Phellodendri Cortex), and Yuanshen (Scrophulariae Radix) reduced symptoms in one dose and cured in four.

A man with mouth and tongue ulcers had a floating and slow pulse. Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) added Pa Jiang (Zingiberis Rhizoma Preparatum), with Guixin (Cinnamomi Cortex) powder held in the mouth, cured him. Another man, worsening with fatigue, took the previous formula plus three slices of Fuzi (Aconiti Lateralis Radix Preparata), recovering in three doses. Danxi said: "When mouth ulcers do not respond to cold herbs, it is due to insufficiency of Qi in the middle jiao, allowing deficiency-fire to float upward uncontrolled. Use Lizhong Tang; if severe, add Fuzi."

A woman frequently suffered oral erosion, red cheeks, dry lips, dry eyes, thirst, rapid pulse, and choppy upon pressure. This was heat congestion in Heart and Lung damaging Qi and Blood, named "Heat Labor Syndrome." She should have taken more Yin-nourishing and Blood-tonifying herbs. Desiring quick results, she used toxic cold-clearing herbs, later developing consumption and dying. *Funren Liangfang* states: "Women's Heat Labor arises from Lung heat congestion damaging Qi and Blood, leading to disharmony, organ stagnation, internal accumulation of heat-toxin, and failure to diffuse. Symptoms include mental restlessness, red cheeks, headache, dry eyes/lips, strong heat in limbs, incessant thirst, mouth/tongue ulcers, drowsiness, insomnia, loss of appetite, body aches, palpitations, night sweats, and gradual emaciation, hence named Heat Labor."

Jiao Xiucai suffered from bitter taste in the mouth. Luo Qianfu prescribed Longdan Xiegan Tang (Gentian Decoction to Drain the Liver), which was effective. The classics state: "Bitter taste in the mouth is called Dan Dan (Gall Bladder Heat)." Liver governs planning; Gallbladder governs decision-making. They are the pure and clear organs. Liver decisions depend on the Gallbladder. If the Gallbladder hesitates, anger arises. Anger causes Qi reversal, gallbladder juice overflows upward, causing bitter taste, or results from excess heat. (*Baojian*.)

Luo Qianfu treated Liang Qimin, who consumed rich foods and alcohol excessively. Mental overwork injured Lung Metal, causing fishy-smelling breath, thick sticky sputum, throat obstruction, and dry mouth/tongue. Jiawei Xiebai San (Modified Draining White Powder) was the primary treatment. *Nanjing* states: "The Heart governs the five odors; entering the Lung, it becomes fishy odor." This injury stems from excessive drinking and heat, where Heart Fire insults Lung Metal. Sangbai Pi (Morus Cortex) and Digupi (Lycii Cortex) are slightly cold and bitter, descending latent Lung fire and tonifying Qi as sovereigns; Huangqin (Scutellariae Radix) and Zhimu (Anemarrhenae Rhizoma) are cold and bitter, treating fishy odor and clearing Lung Qi as ministers. The Lung desires astringency; sour foods should be eaten urgently to astringe it. Wuweizi (Schisandrae Fructus) is sour and warm, astringing Lung Qi; Maidong (Ophiopogonis Radix) is sweet and cold, treating thick sputum and bitter/dry mouth as assistants; Jiegeng (Platycodonis Radix) is acrid and warm, light and floating, treating phlegm reversal and benefiting the throat as envoys. Several doses cured the condition.

You Zaijing commented: Wang Kentang treated Xu Shaowei’s oral thrush, stating only Ganjiang (Zingiberis Rhizoma) could cure it, which proved true. His nephew Xu Mao also suffered severely, craving cold water. Wang prescribed Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Ganjiang (Zingiberis Rhizoma) 2 qian each, Fuling (Poria) and Gancao (Licorice Root) 1 qian each, decocted as a frozen drink, taken several times daily until resolved. Earth dampness causes fire to敛 (gather/contain); few understand this. The reason is Stomach deficiency and low food intake allow Kidney Water Qi to reverse and invade, causing Cold Center. The deficient fire of Spleen and Stomach is forced upward, manifesting as mouth ulcers. Symptoms include poor appetite, loose stools, cold extremities, and abdominal pain.