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Three days prior to onset, toothache occurs accompanied by aversion to cold and fever, with pain so severe it is unbearable. The appearance of a purple patch on the gum root indicates this disease. If not yet ulcerated, it is termed *Ding* (疔, hard boil/furuncle); if already ulcerated, it is termed *Du* (毒, toxin/ulcer).

If the color is red, it is treatable; if greenish, it is incurable.

It may arise from fetal toxins or manifest after smallpox, where toxic heat attacks the teeth, causing the gum roots to rot and form *Zouma Gan* (走马疳, gangrenous stomatitis progressing rapidly like a running horse), which kills most swiftly. The appearance of red spots on the nasal bridge resembling beads indicates an incurable condition. Only *Loulu San* (蝼蛄散, Mole Cricket Powder) can treat it. The ulcers of *Zouma Gan* are sauce-colored, rotting one fen (a unit of length) per day and another fen the next day; hence it is called "Running Horse" (*Zouma*), metaphorically indicating its rapid progression. If all teeth fall out, death ensues.

In cases of *Yacao Feng* (牙槽风, alveolar pyorrhea/gum wind), one must guard against tooth loss. The left upper central incisor is the principal tooth among the teeth; once this tooth falls out, the remaining teeth will all follow, making the condition heaviest and most difficult to treat. If this principal tooth does not fall out, even if other teeth fall out, life can be saved through treatment. Cheek perforation (*Chuan Sai*) is generally incurable, though *Loulu San* may be used. Cases presenting with bluish-black discoloration are difficult to treat. For *Gan* (疳, malnutrition/gangrene) occurring after scarlet fever/rash diseases, washing the feet with decoction of *Wutong Ye* (梧桐叶, Firmiana simplex leaf) brings immediate recovery, with efficacy as miraculous as divine intervention. [Commentary by E: For sudden onset of *Zouma Gan*, cooling herbs are appropriate. For onset following illness, *Fuzi* (Aconite Root), *Banxia* (Pinellia Tuber) mixed with scallion white, pounded into a paste and applied to the soles of the feet, can cure it. There are many legendary single-herb prescriptions, some effective and others not. In short, treating it promptly upon onset still offers a chance of cure. However, the saliva of this condition is extremely toxic; all instruments, such as tongue depressors, must be wiped clean after use to prevent transmission.]

Swelling and redness occur below the tongue and at the gum roots, with pain inside the mouth feeling like burning hot water, and the gum roots gradually rotting. This can also lead to tooth loss.

A red and swollen tongue belongs to excessive fire in the Heart Meridian. Redness and swelling in the *Di Jiao* (地角, corners under the tongue) along with painful swelling and yellow discoloration on the tongue is named *She Huang* (舌黄, yellow tongue), which also belongs to Heart Fire. [Commentary by E: These three conditions and those mentioned below should all be treated by strongly clearing Heart Heat, using formulas like *Xiling He Baidu San* (犀羚合败毒散, Rhinoceros Horn and Antelope Horn Combined Decoction to Defeat Toxins), and applying secret powders or *Mengying Xi Lei San* (孟英锡类散) via insufflation. All are excellent.]

Small tongue-like projections appear under the tongue, colored either red or purple, also known as *Que She* (雀舌, sparrow tongue). Children suffering from fetal toxins may also contract this.

This is a variation of the previous conditions. If it arises at the root of the tongue and involves swelling connected to the throat, it is named *HT She* (HT 舌, a specific type of severe lingual swelling), which is not as easy to treat as *Zhong She* (重舌, double tongue). If the treatment principle is unclear, rapid recovery is unlikely. This results from heat in the Heart Meridian, with toxic vapors emanating from beneath the tongue.