诸疳口疮，因乳哺失节，或母食膏粱积热，或乳母七情郁火所致。其症口舌齿龈如生疮状。若发热作渴饮冷，额
间色赤，左寸脉洪数者，此属心经，先用导赤散，清心火；次用地黄丸，滋肾水。若寒热作渴，左颊青赤，左关脉弦洪
者，属肝经，先用柴胡栀子散，清肝火；次用六味地黄丸，生肝血。若两腮黄赤，牙龈腐烂，大便酸臭，右关脉洪数，
按之则缓者，属脾经，用四味肥儿丸，治脾火；以五味异功散，补脾气。若发热咳嗽，右腮色赤，右寸脉洪数，按之涩
者，属肺经，先用清肺饮，治肺火；用五味异功散，补脾胃。若发热作渴，两额黧色，左尺脉数者，属肾经不足，先
用六味地黄丸，以生肾水；次用补中益气汤，以生肺气。又有走马疳者，因病后脾胃气血伤损，虚火上炎，或痘疹余毒
上攻，其患甚速，急用铜碌散、大芜荑汤。轻则牙龈腐烂唇吻腮肿，重则牙龈蚀露，颊腮透烂。若饮食不入，喘促痰甚，
此脾胃虚而肺气败也。颊腮赤腐，不知痛者，此胃气虚甚而肉死也， 不治。
一小儿口疮，呕血便血，两腮微肿，唇白面青，此脾土亏损，木所乘也，朝用补中益气汤，食远用异功散而愈。
一小儿右腮鼻准微赤，此脾肺二经虚热，用四君、升麻及白术散而愈。
一小儿口疮久不愈，诊其母，右关脉弦缓，乃木克土之症，先用六君，柴胡；又用加味逍遥散，治其母，子自愈。
一小儿齿龈蚀烂，年余不愈，用大芜荑汤，治其疳邪；五味异功散，健其脾气寻愈。后复作，兼项间结核，另服败
毒药，口舌生疮，余用四味肥儿丸而愈。
一小儿患口疮，寒热嗜卧，作泻引饮，此脾疳气虚发热，而津液不足也，先用白术散，以生胃气；再用四味肥儿丸，
治以疳症，两月余，又用异功散而安。
一小儿口疮，身热如炙，肚腹胀大，此脾疳内作。朝用五味异功散，夕用四味肥儿丸，稍愈；又以地黄、虾蟆二丸，
兼服而愈。
一小儿齿龈腐烂，头面生疮，体瘦发热，此脾疳所致，先用大芦荟丸；又用四味肥儿丸、大枫膏而愈。
东垣大芜荑汤（一名栀子茯苓汤） 治黄疳土色，为湿为热，当利小便。今反利（知黄色中为燥，胃经热也。）
发黄脱落，（知膀胱肾俱受土邪，乃大湿热之症） 鼻下断作疮，（上逆行，营气伏火也）能乳，（胃中有热也，寒则食不
入。）喜食土（胃不足也。）面黑色，（为寒为痹。）大便清（寒也。）褐色，（热蓄血中，）间黄色。（肠胃有热。）
治当滋荣润燥，外致津液。
山栀仁（三分） 黄柏 甘草（炙。各二分） 大芜荑（五分） 黄连 麻黄根（各一分） 羌活（二分） 柴胡
（三分）防风（一分） 白术 茯苓（各五分） 当归（四分）
上水煎服。
葛花解醒汤 治乳母酒醉后，乳儿遗热为患。
白豆蔻 砂仁 葛花（各五钱） 干生姜 白术 泽泻 神曲（炒黄。各二钱） 白茯苓 陈皮 人参 猪苓 木
香青皮（三分）
上为末，每服二钱，白汤调服。
愚按∶前汤先哲不得已而用之。盖醉酒耗气，又服辛散，重损真阴，折人长命，可不慎哉！
大芦荟丸 治疳杀虫，和胃止泻。
胡黄连 黄连 白芜荑（去扇） 芦荟 木香 青皮 白雷丸（破开赤者不用） 鹤虱（微炒。各半两） 麝香（二
钱，另研）
上为末，粟米饭丸绿豆大。每服一二十丸，米饮下。
虾蟆丸 治无辜疳症，一服虚热退；二服烦渴止；三服渴痢住。
蟾蜍（一枚，夏月沟渠中，腹大、不跳、不鸣、身多癞 者）
上取粪蛆一杓，置桶中，以尿浸之，桶上要干，不令虫走出，却将蟾蜍扑死，投蛆中食一昼夜，以布袋盛置浸急水
中，一宿取出，瓦上焙为末，入麝一字，粳米饭揉丸，麻子大，每服二十丸，米饮下。
六味肥儿丸 消疳、化虫、退热。若脾疳，饮食少思，肌肉消瘦，肚大颈细，发稀成穗，项间结核，发热作
渴，精神怠倦，大便酸臭，嗜食泥土，或口鼻头疮，肚腹青筋，啮下痢便白，宜用此丸。即四味肥儿丸，加干蟾一两、
芜荑五钱。
四味肥儿丸（方见热毒瘰 ）
地黄丸（方见作渴不止）
诸疳口疮，是由于哺乳喂养不当，或者母亲食用肥甘厚味导致积热，或者是乳母因七情郁结化火所致。其症状表现为口腔、舌头及齿龈如同生疮一般。如果出现发热、口渴且喜饮冷水，额头颜色发红，左手寸脉洪大而数的情况，这属于心经病变，先用导赤散来清心火；接着用地黄丸来滋补肾水。如果出现寒热交替、口渴，左脸颊青红相间，左手关脉弦而洪大的情况，属于肝经病变，先用柴胡栀子散来清肝火；接着用六味地黄丸来滋养肝血。如果两腮发黄发红，牙龈腐烂，大便酸臭，右手关脉洪大数急，重按则感觉缓和的，属于脾经病变，使用四味肥儿丸治疗脾火；配合五味异功散来补益脾气。如果出现发热咳嗽，右腮颜色发红，右手寸脉洪大数急，重按感觉涩滞的，属于肺经病变，先用清肺饮治疗肺火；再用五味异功散来补益脾胃。如果出现发热口渴，两额发黑，左手尺脉数的，属于肾经不足，先用六味地黄丸以滋生肾水；接着用补中益气汤以生成肺气。又有走马疳这种病，是因为病后脾胃气血受损，虚火上炎，或者是痘疹余毒上攻所致，病情发展非常迅速，急需使用铜碌散、大芜荑汤。轻症表现为牙龈腐烂、嘴唇和腮部肿胀，重症表现为牙龈蚀烂暴露，面颊和腮部穿透腐烂。如果饮食无法进入，气喘急促痰多，这是脾胃虚弱而肺气败坏的表现。如果面颊腮部红腐，不知疼痛，这是胃气极度虚弱而肌肉坏死的表现，属于不治之症。
有一个小儿患口疮，伴有呕血便血，两腮轻微肿胀，嘴唇白色面色青暗，这是脾土亏损，被肝木所乘克（克制）的表现，早晨服用补中益气汤，饭后远处服用异功散而痊愈。
有一个小儿右腮和鼻尖微红，这是脾肺二经虚热的表现，使用四君子汤、升麻以及白术散而痊愈。
有一个小儿口疮久治不愈，诊察其母亲，发现右手关脉弦缓，这是木克土的病症，先用六君子汤加柴胡；又用加味逍遥散治疗其母亲，孩子自然痊愈。
有一个小儿齿龈蚀烂，一年多不好，使用大芜荑汤治疗疳邪；用五味异功散健运脾气，随后痊愈。后来复发，兼有颈部结核，另外服用了败毒药，导致口舌生疮，我使用四味肥儿丸而治愈。
有一个小儿患口疮，恶寒发热嗜睡，腹泻并引水自救，这是脾疳气虚发热，同时津液不足的表现，先用白术散以生成胃气；再用四味肥儿丸治疗疳症，两个多月后，又用异功散而安定。
有一个小儿患口疮，身体热得像烤炙一样，肚子胀大，这是脾疳在体内发作。早晨服用五味异功散，晚上服用四味肥儿丸，稍有好转；后来又配合服用地黄丸和虾蟆丸而痊愈。
有一个小儿齿龈腐烂，头面部生疮，身体消瘦发热，这是脾疳所致，先用大芦荟丸；又用四味肥儿丸和大枫膏而痊愈。
东垣的大芜荑汤（又名栀子茯苓汤），治疗黄疳呈现土色，由湿和热引起，应当通利小便。现在反而利尿（因为知道黄色中间代表燥，是胃经的热证）。出现发黄脱发（知道膀胱和肾都受到土邪的影响，是大湿热之症）。鼻子下方断断续续生疮（气机上逆，营气伏藏之火）。能够吃奶（说明胃中有热，如果是寒证则食物无法进入）。喜欢吃泥土（说明胃气不足）。面色黑（为寒为痹）。大便清稀（寒证）。褐色（热蓄积在血中）。间杂黄色（肠胃有热）。治疗应当滋养荣血润燥，向外布散津液。
山栀仁（三分）、黄柏、甘草（炙，各二分）、大芜荑（五分）、黄连、麻黄根（各一分）、羌活（二分）、柴胡（三分）、防风（一分）、白术、茯苓（各五分）、当归（四分）。以上药材用水煎服。
白豆蔻、砂仁、葛花（各五钱）、干生姜、白术、泽泻、神曲（炒黄，各二钱）、白茯苓、陈皮、人参、猪苓、木香、青皮（三分）。以上研为细末，每次服用二钱，用白开水调服。
我按语：前面的方剂是先哲不得已而使用的。大概是因为醉酒耗损正气，又服用辛散药物，严重损伤真阴，折损人的寿命，能不谨慎吗！
胡黄连、黄连、白芜荑（去扇状物）、芦荟、木香、青皮、白雷丸（破开，红色的不用）、鹤虱（微炒，各半两）、麝香（二钱，另研）。以上研为细末，用粟米饭做成如绿豆大小的丸药。每次服用一二十丸，米汤送下。
虾蟆丸，治疗无辜疳症，服用一次虚热退去；服用两次烦渴停止；服用三次渴痢停止。
蟾蜍（一枚，夏季在沟渠中捕获，腹部大、不跳、不叫、身上多癞疾的）。取粪蛆一杓，放入桶中，用尿液浸泡它，桶口要盖严，不让虫子跑出来，然后将蟾蜍打死，投入蛆中让其吃一个昼夜，用布袋盛装置于急流水中浸泡一夜，取出后在瓦上焙干研为细末，加入麝香一字，用粳米饭揉成如麻子大小的丸药，每次服用二十丸，米汤送下。
六味肥儿丸，消疳、化虫、退热。如果是脾疳，饮食减少不想进食，肌肉消瘦，肚子大脖子细，头发稀疏结成穗状，颈部有结核，发热口渴，精神倦怠，大便酸臭，嗜食泥土，或者口鼻头部生疮，肚腹有青筋显露，咬指甲下痢便白，适宜使用此丸。即四味肥儿丸，加入干蟾一两、芜荑五钱。
Mouth ulcers associated with various types of Gan syndrome (chronic malnutrition and digestive disorder in children) are caused by irregular breastfeeding or feeding, accumulation of heat from the mother's consumption of rich and greasy foods, or fire generated from emotional stagnation in the nursing mother. The symptoms present as ulcer-like lesions on the oral mucosa, tongue, and gingiva. If accompanied by fever, thirst with a preference for cold drinks, redness of the forehead, and a surging and rapid pulse at the left Cun position, this belongs to the Heart meridian. First, use Daochi San (Coptis Decoction) to clear Heart fire; subsequently, use Dihuang Wan (Rehmannia Pill) to nourish Kidney water. If accompanied by alternating chills and fever, thirst, bluish-red discoloration of the left cheek, and a string-taut and surging pulse at the left Guan position, this belongs to the Liver meridian. First, use Chaihu Zhizi San (Bupleurum and Gardenia Decoction) to clear Liver fire; subsequently, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to generate Liver blood. If the cheeks are yellowish-red, the gingiva is rotting, the stool is sour and foul-smelling, and the right Guan pulse is surging and rapid but feels relaxed upon deep pressure, this belongs to the Spleen meridian. Use Siwei Fei'er Wan (Four-Ingredient Stomach-Nourishing Pill) to treat Spleen fire; combine with Wumei Yigong San (Five-Ingredient Yi Gong Powder) to tonify Spleen Qi. If accompanied by fever and cough, redness of the right cheek, and a surging, rapid, and choppy pulse at the right Cun position, this belongs to the Lung meridian. First, use Qingfei Yin (Lung-Clearing Drink) to treat Lung fire; then use Wumei Yigong San to tonify the Spleen and Stomach. If accompanied by fever and thirst, darkening of both foreheads, and a rapid pulse at the left Chi position, this indicates insufficiency of the Kidney meridian. First, use Liuwei Dihuang Wan to generate Kidney water; subsequently, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to generate Lung Qi. There is also a condition known as Zouma Gan (Running Horse Gan), which develops rapidly due to damage to Spleen and Stomach Qi and Blood after illness, with deficient fire flaming upward, or due to residual toxicity from smallpox/rubella attacking upward. Mild cases present with rotting gingiva, swollen lips and cheeks; severe cases present with exposed, eroded gingiva and perforated rotting of the cheeks and malar region. If food cannot be taken in, accompanied by panting and profuse phlegm, this indicates failure of Lung Qi due to Spleen and Stomach deficiency. If the cheeks and malar region are red and rotting without sensation of pain, this indicates extreme deficiency of Stomach Qi and necrosis of flesh, which is untreatable.
One child suffered from mouth ulcers with hematemesis and hematochezia, slightly swollen cheeks, white lips, and a cyan face. This indicated deficiency of Spleen Earth being overacted upon by Wood (Liver). He was treated with Buzhong Yiqi Tang in the morning and Yigong San far from meals, resulting in recovery.
One child had slight redness of the right cheek and nose tip, indicating deficient heat in the Spleen and Lung meridians. He was treated with Sijunzi Tang (Four Gentlemen Decoction), Shengma (Cimicifugae Rhizoma), and Baizhu San (Atractylodis Macrocephalae Powder), resulting in recovery.
One child had chronic mouth ulcers unresponsive to treatment. Examination of the mother revealed a string-taut and relaxed pulse at the right Guan position, indicating Wood overacting on Earth. The mother was first treated with Liujunzi Tang (Six Gentlemen Decoction) plus Chaihu (Bupleuri Radix); subsequently, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was administered to the mother, leading to the child's spontaneous recovery.
One child had eroded and rotting gingiva persisting for over a year. He was treated with Da Wuyi Tang (Greater Trogopterorus Decoction) to address Gan pathogenic factors, and Wumei Yigong San to strengthen Spleen Qi, leading to recovery. Later, it relapsed with cervical lymphadenopathy. After taking other detoxifying drugs, he developed mouth and tongue ulcers. I treated him with Siwei Fei'er Wan, resulting in recovery.
One child suffered from mouth ulcers with chills, fever, lethargy, diarrhea with polydipsia. This indicated Spleen Gan with Qi deficiency causing fever and insufficient body fluids. First, Baizhu San was used to generate Stomach Qi; then Siwei Fei'er Wan was used to treat the Gan syndrome. After more than two months, Yigong San was used to stabilize the condition.
One child suffered from mouth ulcers with high fever like roasting, abdominal distension, and enlargement. This indicated internal onset of Spleen Gan. He was treated with Wumei Yigong San in the morning and Siwei Fei'er Wan in the evening. After slight improvement, Dihuang Wan and Xama Wan (Toad Pill) were taken concurrently, resulting in recovery.
One child had rotting gingiva, sores on the head and face, emaciation, and fever. This was caused by Spleen Gan. He was first treated with Da Lushan Wan (Greater Aloe Pill); subsequently, Siwei Fei'er Wan and Dafeng Gao (Large Maple Ointment) were used, resulting in recovery.
Da Wuyi Tang (also known as Zhizi Fuling Tang) from Dong Yuan treats Huang Gan (Yellow Gan) presenting with an earthy color, caused by dampness and heat, requiring promotion of urination. However, urination should not be promoted indiscriminately (as yellow indicates dryness and Stomach heat). Yellowing and hair loss indicate that both the Bladder and Kidney are affected by Earth pathogen, representing a severe damp-heat syndrome. Sores appearing intermittently under the nose indicate upward reversal and latent fire in Ying (Nutritive) Qi. Ability to nurse indicates heat in the Stomach (cold would prevent intake). Preference for eating dirt indicates Stomach insufficiency. Black complexion indicates cold and obstruction. Clear stool indicates cold. Brown stool indicates heat accumulating in the blood. Intermittent yellow stool indicates heat in the intestines and stomach. Treatment should focus on nourishing Ying and moistening dryness, and distributing body fluids externally.
Ingredients: Zhiren (Gardeniae Semen, 3 fen), Huangbai (Phellodendri Cortex, 2 fen), Gancao (Licorice Root, roasted, 2 fen), Dawuyi (Trogopterori Faeces, 5 fen), Huanglian (Coptidis Rhizoma, 1 fen), Mahuanggen (Ephedrae Radix et Rhizoma, 1 fen), Qianghuo (Notopterygii Rhizoma et Radix, 2 fen), Chaihu (Bupleuri Radix, 3 fen), Fangfeng (Saposhnikoviae Radix, 1 fen), Baizhu (Atractylodis Macrocephalae Rhizoma, 5 fen), Fuling (Poria, 5 fen), Danggui (Angelicae Sinensis Radix, 4 fen). Decoct in water and take orally.
Ge Hua Jie Xing Tang (Kudzu Flower Decoction to Resolve Intoxication) treats heat transmitted to the infant via milk after the nursing mother has consumed alcohol.
Ingredients: Baidoukou (Cardamomi Fructus Rotundus), Sharen (Amomi Fructus), Ge Hua (Puerariae Flos) (each 5 qian), Ganshengjiang (Zingiberis Rhizoma Recens), Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), Shenqu (Massa Medicata Fermentata, stir-fried until yellow) (each 2 qian), Bai Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium), Renshen (Ginseng Radix), Zhuling (Polyporus), Muxiang (Aucklandiae Radix), Qingpi (Citri Reticulatae Pericarpium Viride) (3 fen). Grind into powder. Take 2 qian each time, mixed with warm water.
My commentary: The aforementioned decoctions were used by past sages out of necessity. Alcohol consumption depletes Qi, and administering acrid and dispersing herbs further damages True Yin, shortening lifespan. One must be cautious!
Da Lushan Wan (Greater Aloe Pill) treats Gan syndrome by eliminating parasites, harmonizing the Stomach, and stopping diarrhea.
Ingredients: Huhuanglian (Coptidis Rhizoma alternative), Huanglian (Coptidis Rhizoma), Bai Wuyi (Trogopterori Faeces, cleaned), Lushen (Aloes), Muxiang (Aucklandiae Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Bai Leiwu (Asari Radix et Rhizoma, split open; discard red ones), Heshi (Chrysanthemi Indici Flos, lightly stir-fried) (each half liang), Shexiang (Moschus, 2 qian, separately ground). Grind into powder. Make pills using millet rice paste, sized like mung beans. Take 10-20 pills each time, washed down with rice drink.
Xama Wan (Toad Pill) treats Wugu Gan (Innocent Gan). After one dose, deficient heat subsides; after two doses, irritability and thirst cease; after three doses, dysentery stops.
Ingredients: Chan Chu (Bufo bufo gargarizans or Bufo melanostictus) (one specimen, caught in summer ditches, characterized by large abdomen, non-jumping, non-croaking, and covered in warts). Collect one scoop of maggot larvae, place them in a bucket, soak in urine. Seal the bucket tightly to prevent escape. Kill the toad and throw it into the bucket for the maggots to consume for a day and night. Place the mixture in a cloth bag and soak in running water overnight. Remove, dry on tiles, and grind into powder. Add Shexiang (Moschus, one zi). Mix with japonica rice paste to form pills sized like hemp seeds. Take 20 pills each time, washed down with rice drink.
Liushi Fei'er Wan (Six-Ingredient Stomach-Nourishing Pill) eliminates Gan, resolves parasites, and reduces fever. It is suitable for Spleen Gan characterized by poor appetite, emaciation, abdominal distension with thin neck, sparse hair forming tufts, cervical lymphadenopathy, fever with thirst, mental fatigue, sour foul-smelling stool, pica (eating dirt), sores on mouth/nose/head, visible abdominal veins, nail-biting, dysentery with white stool. It consists of Siwei Fei'er Wan plus Gan Chan (Dried Toad, 1 liang) and Wuyi (Trogopterori Faeces, 5 qian).
Siwei Fei'er Wan (Four-Ingredient Stomach-Nourishing Pill) (See formula under "Heat Toxicity Scrofula").
Dihuang Wan (Rehmannia Pill) (See formula under "Unremitting Thirst").