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Zhang Lian's commentary: Ya gan (Gum Gangrene) is a severe complication following the recovery from measles. This content is not included in this volume but can be found in surgical texts regarding dental diseases. Bad breath and ulceration are signs of Ya gan. Treatment is primarily with Baihu Tang (White Tiger Decoction) and Qingwei San (Stomach-Clearing Powder). Dai Yuanli used Ganjie Tang (Licorice and Platycodon Decoction), Huanglian Jiedu Tang (Coptis Decoction for Detoxification), and Liangge San (Cooling the Diaphragm Powder). If accompanied by diarrhea, indicating Spleen deficiency with dampness, Jiawei Lianli Tang (Modified Coptis and Ginger Decoction) is used. Externally, Jiangbai San (Ginger and Phellodendron Powder) is applied. For Yin deficiency, Ganlu Yin (Sweet Dew Decoction) is indicated. The Classics state: Pain in the upper teeth is due to heat in the Yangming channel; pain in the lower teeth is due to Kidney deficiency failing to control fire. Generally, Stomach heat equates to blood heat; treatment should cool the blood and clear the Stomach, adding guiding herbs according to the meridians. The four central upper teeth belong to the Heart; add Huanglian (Coptis Rhizome) and Maidong (Ophiopogon Tuber). The four central lower teeth belong to the Kidney; add Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). The four lateral upper teeth belong to the Stomach; add Gegen (Pueraria Root) and Chuanxiong (Ligusticum Rhizome). The four lateral lower teeth belong to the Spleen; add Shengma (Cimicifuga Rhizome) and Baishao (White Peony Root). The leftmost upper tooth belongs to the Gallbladder; add Lianqiao (Forsythia Fruit) and Longdancao (Gentiana Root). The leftmost lower tooth belongs to the Liver; add Chaihu (Bupleurum Root) and Zhizi (Gardenia Fruit). The rightmost upper tooth belongs to the Large Intestine; add Zhike (Aurantii Fructus) and Dahuang (Rhubarb Root). The rightmost lower tooth belongs to the Lung; add Huangqin (Scutellaria Root) and Jiegeng (Platycodon Root). Swelling of the upper and lower gums is treated with Liangge San plus Shigao (Gypsum Fibrosum), Zhimu, and Shengma. The inner part is the teeth (Chi); the outer gingiva is the gum (Ya). Teeth are the external manifestation of the Kidney. If interdental spaces are wide and teeth are loose or falling out, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is indicated. Kou mi (Oral Mucosal Ulceration) refers to erosion in the mouth, sometimes with bleeding. It is appropriate to clear fire from the Heart, Spleen, and Stomach meridians and moisten the Large Intestine. Jinhua Xiaodu Yin (Golden Flower Detoxifying Decoction) is primary; Huadu Tang (Toxin-Resolving Decoction) and Qingwei San are also usable. For Yin deficiency with fire, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) added with Maidong and Xuanshen (Scrophularia Root), or Ganlu Yin, is indicated. As for weak pulse, slight fever, white lips, aversion to cold, no bad breath, diarrhea, and loss of appetite, this is caused by Spleen deficiency with floating fire. Lizhong Tang (Regulate the Middle Decoction) is suitable, with Shanggui powder (Cinnamon Twig powder) blown into the mouth externally. Ya xuan (Gum Recession) presents with bad breath, swollen gums, and bleeding from interdental spaces, progressing towards Ya gan. Treat with Qingwei Huadu Fang (Stomach-Clearing Toxin-Resolving Formulas) plus Ce bai ye (Biota Tops), or Baihu Tang plus Shengma, Qingdai (Indigo Naturalis), Zhizi, Lianqiao, Xuanshen, and Danpi (Moutan Cortex). Alternatively, Yiyuan San (Benefit Origin Powder) mixed with cold water is used. For Yin deficiency with hyperactive fire, Ganlu Yin is used. Ya gan involves rotting of the upper and lower teeth. This is caused by Yangming toxic heat; the condition is critical, with seven or eight deaths out of ten. Internal and external treatment is necessary. Internally, take Xijiao Dihuang Tang plus Gegen, Huanglian, Shigao, and Dahuang. Externally, use Yu'a San (Jade Abacus Powder) and Huanglong San (Yellow Dragon Powder). If there is high body heat, facial edema, cyanosis around the mouth, black spots appearing today leading to cheek perforation, tooth loss, nasal collapse, and lip detachment tomorrow, resulting in death from inability to eat, it is called "Zou ma" (Running Horse),喻其速也 (metaphorically describing its speed). Apply fresh pork to the external lesion, treat with Chuikou Dan (Blow-Mouth Elixir), or moxibustion at Chengjiang acupoint below the lip. Qibo said: Bad breath is treatable; bad breath from the nose is difficult to cure. Red spots on the nasal bridge like beads are untreatable. Death occurs if the upper incisors fall out. Death occurs if the root is red and swollen, making eating difficult. In summary, this condition should be treated with heavy doses of Shigao. The patient must have strong Stomach Qi and ability to eat to tolerate heavy doses; otherwise, it is difficult to treat. Bingpian (Borneol) and Shexiang (Musk) are strictly contraindicated. I had a female student, Ms. Jin, whose daughter was over twenty years old. After six or seven days of measles, the rash had mostly receded, except for one spot on the nasal bridge resembling a bead. Her upper incisors were slightly painful, and she had mild tidal fever. The previous physician treated her with Shenmai Liuwei Tang (Ginseng and Ophiopogon Six-Ingredient Decoction). After five or six days, the condition worsened. Her brother came to my study seeking a prescription. I said, "This condition is critical and will not resolve in a few days." I visited her home and palpated the pulse: the Right Cun and Guan positions were distinctly strong and wiry, while other pulses showed excess signs. I administered Baihu Chengqi Tang (White Tiger and Major Order Decoction) combined with Shengdi (Rehmannia Root), Baishao, Danpi, Huangqin, and Maidong. After sixteen large doses, the initial stool resembled diarrhea, varying in color from red to black. Eventually, she vomited several bowls of purple blood. The red spot on the nasal bridge dispersed, and tooth pain ceased. The patient was extremely fatigued, seemingly lifeless, causing panic among her family. I said, "Do not fear; the disease has resolved. Only tonify the Yuan Qi (Primal Qi)." I prescribed Liuwei Dihuang Tang plus Renshen (Ginseng Root), Maidong, Dangshen (Angelica Sinensis Root), and Baishao for several doses. When Yuan Qi slightly recovered, I removed Renshen and Maidong and administered Guixiao Liuwei Tang (Danggui and Baishao Six-Ingredient Decoction) for fifty doses until recovery. Without such heavy doses, this case would certainly have been fatal. However, given that she was my student and her family trusted me, I dared to take responsibility. Indeed, medicine is difficult! Yet, misdiagnosis and erroneous medication act as blades killing people. Feng Chuzhan stated: For weak, powerless pulse indicating Spleen deficiency and no bad breath, use Lizhong Tang type formulas. For Yin deficiency with Stomach heat, use Ganlu Yin plus Shigao. For emaciated Yin deficiency, use Liuwei Dihuang Wan plus Xijiao (Rhino Horn). Always prescribe based on the pulse; do not rigidly assume measles are always Yang Du (Yang Toxin), as all diseases differ in their beginning, middle, and end stages. Untreatable conditions include: gum rot without pus or blood; bad breath with foul saliva, cheek perforation, and lip rupture; total whiteness of the mouth; black rot not shedding, tooth loss without blood. Prognosis is good if saliva flows out after applying medicated powder; prognosis is fatal if toxic saliva retracts internally.

Qingwei San (Stomach-Clearing Powder): Treats toothache, Ya xuan, bad breath, and oral ulcers.
Ingredients: Huanglian (Coptis Rhizome), Shigao (Gypsum Fibrosum), Shengma (Cimicifuga Rhizome), Shengdi (Rehmannia Root), Danpi (Moutan Cortex), Lianqiao (Forsythia Fruit), Xuanshen (Scrophularia Root), Gancao (Licorice Root), Jingmi (Glutinous Rice).
Add Ce bai ye (Biota Tops) for bleeding.

Baihu Tang (White Tiger Decoction): Universally treats dental symptoms, see previous text.

Ganjie Tang (Licorice and Platycodon Decoction)
Ingredients: Gancao (Licorice Root), Jiegeng (Platycodon Root).

Huanglian Jiedu Tang (Coptis Decoction for Detoxification) (See previous text)

Liangge San (Cooling the Diaphragm Powder) (See previous text)

Jiawei Lianli Tang (Modified Coptis and Ginger Decoction): Treats bad breath and Spleen deficiency diarrhea after measles.
Ingredients: Huanglian (Coptis Rhizome), Ganjiang (Dried Ginger), Renshen (Ginseng Root), Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome, stir-fried).

Jiangbai San (Ginger and Phellodendron Powder)
Ingredients: Ganjiang (Dried Ginger), Huangbai (Phellodendron Bark).
Grind into equal parts powder, apply dry to the mouth, rinse with warm water.

Ganlu Yin (Sweet Dew Decoction)
Ingredients: Shengdi (Rehmannia Root), Shudi (Prepared Rehmannia Root), Tiandong (Asparagus Tuber), Maidong (Ophiopogon Tuber), Huangqin (Scutellaria Root), Gancao (Licorice Root), Shihu (Dendrobium Stem), Ychen (Artemisia Capillaris), Zhike (Aurantii Fructus), Pipaye (Loquat Leaf).

Jinhua Xiaodu Yin (Golden Flower Detoxifying Decoction): Treats Kou mi (Oral Mucosal Ulceration).
Ingredients: Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root), Huangbai (Phellodendron Bark), Dahuang (Rhubarb Root).

Qingwei Huadu Tang (Stomach-Clearing Toxin-Resolving Decoction): Treats extreme heat-induced oral gangrene after measles.
Ingredients: Shigao (Gypsum Fibrosum), Lianqiao (Forsythia Fruit), Xuanshen (Scrophularia Root), Yinhua (Honeysuckle Flower), Danpi (Moutan Cortex), Jiesui (Schizonepeta Spike), Fangfeng (Saposhnikovia Root), Huafen (Trichosanthes Root), Guangpi (Tangerine Peel), Shanzha (Hawthorn Fruit), Gancao (Licorice Root), Digupi (Wolfberry Bark).

Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction)
Ingredients: Xijiao (Rhino Horn - *Note: Substitute with Niuhuang or other alternatives in modern practice*), Shengdi (Rehmannia Root), Danpi (Moutan Cortex), Baishao (White Peony Root).
One formula adds Huanglian, Huangqin, and Dahuang.

Lizhong Tang (Regulate the Middle Decoction)
Ingredients: Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome, stir-fried), Paojiang (Prepared Ginger), Gancao (Licorice Root).

Yiyuan San (Benefit Origin Powder): Also known as Liuyi San plus Chen Sha (Cinnabar) 5 fen.

Yu'a San (Jade Abacus Powder): Treats Zou ma Ya gan (Running Horse Gum Gangrene).
Ingredients: Mao shi (Cat feces, sun-dried, rain-exposed, wind-blown until white, preserved nature, amount unspecified), paired with small amounts of Bingpian (Borneol) and Qingdai (Indigo Naturalis), ground into fine powder and applied. Highly effective. If genuine Qingdai is unavailable, substitute with Dian hua (Indigo flower water purified by sedimentation). Another formula uses Wo niu lian gu (Snail with shell, preserved nature), ground and blown onto the lesion for immediate cure.

Miao Shi Huanglong San (Miao Family Yellow Dragon Powder): Treats Zou ma Ya gan.
Ingredients: Niu huang fen jian (Tip of cow dung, male preferred), preserved nature, ground into powder. Add 1 fen of Bingpian per qian, mix well, and blow into the gum roots for self-healing.

Fresh Pork Application Method: First, decoct Huanglian in thick liquid. Slice fresh lean meat thinly and soak in the Huanglian liquid for a moment. Apply the pork to the lesion to draw out accumulated toxins. Replace when the pork turns dry and black. Repeat several times for effect.

Chruikou Dan (Blow-Mouth Elixir): Treats cheek perforation, tooth loss, nasal collapse, and lip erosion. Highly effective.
Ingredients: Cu qi cao juice (Crushed herb juice), Qingcao e'e juice (Green grass goose droppings mixed with juice).
Place both juices in a hemp clam shell, roast over charcoal fire several times, grind into powder, add Bingpian. Especially effective.

Sheng [Huangqi] Tang (Raw Astragalus Decoction): Treats cheek perforation, tooth loss, lip detachment, and nasal destruction.
Ingredients: Sheng Huangqi (Raw Astragalus Root, 3 qian), Nianzi (Adhatoda Seed, 3 qian), Jiangcan (Bombyx Batryticatus, 1.5 qian), Chantui (Cicada Slough, 1 qian), Huashi (Talcum, 3 qian), Gancao (Licorice Root, 0.5 qian).
Any number of doses. Highly effective.

Liuyi San (Six-to-One Powder)
Ingredients: Huashi (Talcum, 6 qian), Gancao (Licorice Root, 1 qian).
Grind into fine powder, mix with cold water and take. Any number of doses.

Cha Ya San (Teeth-Anointing Powder): Treats residual toxin attacking teeth, causing severe rotting.
Ingredients: Muguezi (Myristica Seed, preserved nature as Chief), Chuanbei (Fritillaria Bulb as Minister), Yueshi (Mirabilite as Assistant), Bai pi (White Arsenic, small amount processed).
Grind into fine powder. Clean the lesion with rice water and apply. Processing method for Arsenic: Place White Arsenic inside Aurantii Fructus, tie tightly with thread, boil in one cup of good wine to remove toxicity.