经义
中央黄色，入通于脾，开窍于口。○有病口甘者，名曰脾瘅。○有病口苦者，名曰胆瘅。○膀胱移热于小肠，
隔肠不便，上为口糜。（《素问》）
胆液泄则口苦。（《灵枢》）
脾气通于口，口和则知谷味矣。（《难经》）
哲言
口之味∶热胜则苦，寒胜则咸，宿食则酸，烦躁则涩，虚则淡，瘅则甘，郁则臭，凝滞则生疮。口之津
液，通于五脏，脏气偏胜，则味应于口。（《得效方》）
口病有疮、有臭、有干、有渴，为苦、为酸，诸味不同。方书多以口病为热证，然其中亦有似热非热，及
劳伤无火等证，所当察也。○口渴、口干，大有不同。盖渴因燥火有余；干因津液不足。火有余者，当以实热论；
津不足者，当以阴虚论。二者不分，反同冰炭。○口苦、口酸等证，在《原病式》则皆指为热。谓肝热则口酸，
心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸，胃热则口淡。若据此说，则凡口之五味，悉属火证，绝
无寒病矣。岂不谬哉？如口苦者，未必尽由心火；口淡者，未必尽由胃热。盖凡思虑劳倦、色欲过度者，多有
口苦、舌燥、饮食无味之证，此其咎不在心脾，则在肝肾。心脾虚则肝胆气溢而为苦，肝肾虚则真阴不足而为
燥。即如口淡一证，凡大劳、大泻、大汗、大病之后，皆能令人口淡无味，亦岂皆胃火使然耶？凡临证察其别
无火证、火脉，则不宜妄用寒凉误治也。○口臭虽由胃火，而亦有非火之异。盖胃火之臭，其气浊秽，必兼口
热、口干，及别有阳明火证。若无火证、火脉，而臭如馊腐酸胖，及吞酸嗳滞等证，亦犹阴湿留垢之臭，自
与热臭不同。是必思虑不遂，及脾弱不能化食者多有之。此则一为阳证，宜清胃火；一为阴证，宜调补心脾。
不得谓臭必皆由于热也。（张景岳）
口疮虽由脾热，然分赤、白二种。白者肺热，赤者心热，赤白相兼者心肺俱热，不独脾病也。（《证治汇补》）
口燥者，肾热也。口噤者，风痉也。若病重见唇吻色青，环口黧黑，口张气直或如鱼口气出不返者，皆不
治。（《伤寒五法》）
补编
心热口苦，黄连泻心汤。肝热口酸，柴胡清肝汤。脾热口臭，
清胃汤。肺热口辛，泻白散。肾热口咸，滋肾丸。谋虑不决，胆虚而口苦者，用逍遥散为君，柴胡、胆草为使。
中气不足，木乘土位而口苦者，用四君子汤为君，芍药、柴胡为佐。膀胱移热，口烂、溺涩者，用导赤散专治
其下。中土虚寒，胃阳浮上者，用理中汤温补其中，而上焦自安。下焦火炎者，用八味丸温暖丹田，而火焰自
熄。（《证治汇补》）
口疮一也，心经则曰导赤，胃经则曰白虎。彼之疮连及舌，此之疮兼乎唇，气分不可与血分同治也。（程郊倩）
龙雷之火，亦能焚焦草木，岂必实热方使口舌生疮乎？盖脾胃气衰，不能按纳，下焦阴火，得以上乘，奔
溃肿烂。若一清胃，则中气愈衰、阴火愈炽。温补中、下二焦，使火有所接引而退舍矣。（冯楚瞻）
附唇
脾之合肉也，其荣唇也。○多食酸，则肉胝KT 而唇揭。○脾、胃、大肠、小肠、三焦、膀胱者，仓廪之本，
营之居也。其华在唇四白。（《素问》）
唇为飞门。（《难经》）
唇者，肌肉之本，脾之华也。故视其唇之色泽，可以知病之浅深。色红者吉，色黑者凶，赤肿者热甚也，
青黑者冷极也。（《伤寒五法》）
唇属于脾，经合于胃。脾胃受邪，则唇为之病。风胜则动，寒胜则缩，燥胜则干，热胜则裂，气郁则生
疮，血少则无色，脾冷则紫，脾败则黑，脾寒则青，脾虚则白，脾衰则黄，脾实则红。（《绳墨》）
湿病则唇肿，风病则唇 ，寒病则唇揭，热病则唇皱，燥病则唇裂，火病则唇痒，气病则唇麻，血病则唇
木。足太阴气绝则唇反，足厥阴气绝则唇青、舌卷卵缩。（《医学阶梯》）
唇口者，肉之精，脾之窍，任、督诸脉之所会也。食物从此
门飞入，内连喉舌，外接颐颊，管 之司在焉。阳明气至则啮唇，肠胃之所动也。故虫蚀脏则上唇生疮，虫蚀
肛则下唇生疮。食酸则反揭，土畏木也。与鼻孔同为灶突，中寒则寒，中热则热，如一辙焉。唇红者血盛，唇
淡者血虚，唇润者味和，唇燥裂者味变。唇口刮白则将死，唇口青黑则立死。生而缺唇者，任督二脉不相得也。（《医参》）
唇肿皱裂如蚕茧者，名曰茧唇。或因七情火动伤血，或因心火传脾，或因浓味积热伤脾。治宜清胃热、生
脾津，兼滋肾水。燥润、火降而肿自消。○唇青有二∶若唇与爪甲俱青而烦渴引饮者，为热伏厥阴，宜竹叶石
膏汤。若唇青厥冷、畏寒振振欲擗地者，为寒犯少阴，宜真武汤。唇淡为脱血，宜十全大补汤。唇赤中带黄色
者为脾热，黄芩芍药汤。唇赤而浓肿者为胃热，清胃散。（《张氏医通》）
【经文释义】
中央对应黄色，其气内通于脾，外开窍于口。○患有口中甘甜之症者，名为脾瘅（脾热导致的口甘病）。○患有口中发苦之症者，名为胆瘅（胆热导致的口苦病）。○膀胱的热邪转移至小肠，导致肠道阻隔、大便不通，热气上蒸则引起口腔糜烂。（出自《素问》）
胆液外泄则口中发苦。（出自《灵枢》）
脾气通达于口，口功能调和则能辨别五谷滋味。（出自《难经》）
【哲人言论】
口的味觉：热邪偏胜则味苦，寒邪偏胜则味咸，宿食停滞则味酸，烦躁不安则味涩，正气虚弱则味淡，脾热则味甘，气机郁结则口臭，气血凝滞则生疮。口的津液与五脏相通，脏气偏盛，则口味相应改变。（出自《得效方》）
口部疾病有溃疡、口臭、口干、口渴等表现，呈现苦、酸等各种不同味道。医书多将口病归为热证，然而其中也有看似热证而非热证，以及劳损伤正而无火邪的证候，应当仔细辨别。○口渴与口干，有很大区别。渴是因为燥火有余；干是因为津液不足。火有余者，应按实热证论治；津液不足者，应按阴虚证论治。两者若不区分，后果如同冰炭不相容。○口苦、口酸等证候，在《原病式》中均指为热证。认为肝热则口酸，心热则口苦，脾热则口甘，肺热则口辛，肾热则口咸，胃热则口淡。如果依据这种说法，那么凡是口中的五味，都属于火证，完全没有寒病了。这难道不荒谬吗？如口苦者，未必全由心火引起；口淡者，未必全由胃热引起。大凡思虑过度、劳累倦怠、房事不节的人，多有口苦、舌燥、饮食无味等症状，这过错不在心脾，而在肝肾。心脾虚则肝胆之气溢散而致口苦，肝肾虚则真阴不足而致舌燥。就像口淡一证，大凡在大劳、大泻、大汗、大病之后，都能让人口淡无味，这难道都是胃火造成的吗？凡临证时观察到患者没有其他火证和火脉，就不宜妄用寒凉药物误治。○口臭虽由胃火引起，但也有非火邪引起的特殊情况。胃火引起的口臭，气味浊秽，必然兼有口热、口干，以及其他的阳明火证。如果没有火证和火脉，而气味像馊腐酸臭，以及吞酸、嗳气阻滞等症状，这也如同阴湿留垢产生的臭味，自然与热臭不同。这多是因思虑不畅，以及脾弱不能消化食物所致。此为阳证，宜清胃火；彼为阴证，宜调补心脾。不能说口臭必定都由于热邪。（张景岳）
口疮虽然由脾热引起，但分为赤、白两种。白色属肺热，红色属心热，红白相间者心肺俱热，不仅仅只是脾的病。（出自《证治汇补》）
口干燥者是肾热。口噤（牙关紧闭）者是风痉（中风痉挛）。如果病情严重见到嘴唇颜色青紫，口周黧黑，口张气直或像鱼口出气无法收回的，都是不治之症。（出自《伤寒五法》）
【补编】
心热口苦，用黄连泻心汤。肝热口酸，用柴胡清肝汤。脾热口臭，用清胃汤。肺热口辛，用泻白散。肾热口咸，用滋肾丸。谋虑不决，胆虚而口苦者，以逍遥散为主药，柴胡、龙胆草为使药。中气不足，木乘土位（肝木克脾土）而口苦者，以四君子汤为主药，芍药、柴胡为佐药。膀胱移热，口烂、小便涩痛者，用导赤散专门治疗下焦之热。中土虚寒，胃阳浮越于上者，用理中汤温补中焦，上焦自然安宁。下焦火炎者，用八味丸温暖丹田，火焰自然熄灭。（出自《证治汇补》）
口疮这一病症，在心经称为导赤散证，在胃经称为白虎汤证。前者的疮连及舌头，后者的疮兼及嘴唇，气分病变不可与血分病变同样治疗。（程郊倩）
龙雷之火（相火），也能焚烧草木，难道只有实热才会使口舌生疮吗？这是因为脾胃气衰，不能镇纳，下焦阴火得以上乘，奔溃导致肿胀腐烂。如果一味清胃，则中气更衰，阴火更炽。应温补中、下二焦，使火有所引导而退去。（冯楚瞻）
【附：唇】
脾合肉，其荣华表现在唇。○多吃酸味食物，则肌肉皱缩且嘴唇揭起。○脾、胃、大肠、小肠、三焦、膀胱，是仓廪之本，营气所居之处。其荣华表现在口唇四周的白色肌肤。（出自《素问》）
唇是飞门（门户之意）。（出自《难经》）
唇是肌肉的根本，脾的荣华表现。所以观察唇的颜色光泽，可以知道病的深浅。色红者吉，色黑者凶，红肿者热甚，青黑者冷极。（出自《伤寒五法》）
唇属于脾，经脉合于胃。脾胃受邪，则唇为之生病。风邪偏胜则唇动，寒邪偏胜则唇缩，燥邪偏胜则唇干，热邪偏胜则唇裂，气机郁结则生疮，血少则无色，脾冷则紫，脾败则黑，脾寒则青，脾虚则白，脾衰则黄，脾实则红。（出自《绳墨》）
湿病则唇肿，风病则唇颤动，寒病则唇揭起，热病则唇皱褶，燥病则唇裂，火病则唇痒，气病则唇麻，血病则唇麻木。足太阴脾经气绝则唇反卷，足厥阴肝经气绝则唇青、舌卷、睾丸收缩。（出自《医学阶梯》）
唇口，是肉的精华，脾的外窍，任脉、督脉等经脉交会之处。食物从此门飞入，内连喉舌，外接颐颊，主管吞咽。阳明气至则咬唇，这是肠胃受到触动所致。所以虫蚀内脏则上唇生疮，虫蚀肛门则下唇生疮。吃酸味食物则唇反卷，因为土畏木也。与鼻孔同为灶突（烟囱），中寒则寒，中热则热，道理是一样的。唇红者血盛，唇淡者血虚，唇润者口味调和，唇燥裂者口味改变。唇口刮出白膜者将死，唇口青黑者立死。天生缺唇者，是任督二脉不相协调所致。（出自《医参》）
唇肿皱裂如蚕茧者，名为茧唇。或因七情化火伤血，或因心火传脾，或因浓味积热伤脾。治疗宜清胃热、生津液，兼滋肾水。燥润、火降而肿自消。○唇青有两种情况：若唇与爪甲俱青且烦渴引饮者，为热伏厥阴，宜竹叶石膏汤。若唇青厥冷、畏寒振振欲倒地者，为寒犯少阴，宜真武汤。唇淡为脱血，宜十全大补汤。唇赤中带黄色者为脾热，用黄芩芍药汤。唇赤而浓肿者为胃热，用清胃散。（出自《张氏医通》）
[Scriptural Interpretation]
The center corresponds to yellow, its qi internally connects with the Spleen (Pí Zàng), and externally opens into the mouth. ○ A person suffering from a sweet taste in the mouth is named Pi Dan (Spleen Heat causing sweet taste). ○ A person suffering from a bitter taste in the mouth is named Dan Dan (Gallbladder Heat causing bitter taste). ○ When heat from the Bladder (Páng Guāng) transfers to the Small Intestine (Xiǎo Cháng), it causes obstruction in the intestines and difficulty in defecation; the heat rises upward causing oral ulceration/maceration. (From *Su Wen*)
When gallbladder fluid leaks, the mouth tastes bitter. (From *Ling Shu*)
The Spleen's qi communicates with the mouth; when the mouth is harmonious, one can perceive the flavors of grains. (From *Nan Jing*)
[Philosophical Discourse]
Flavors of the mouth: Excess heat results in bitterness; excess cold results in saltiness; retained food results in sourness; restlessness results in astringency; deficiency results in blandness; spleen heat results in sweetness; stagnation results in foul odor; coagulation and stagnation result in sores. The fluids of the mouth connect with the Five Viscera; when the viscera's qi is excessive, the flavor responds in the mouth. (From *De Xiao Fang*)
Mouth diseases include ulcers, bad breath, dryness, and thirst, manifesting as bitter, sour, and various other flavors. Medical texts often attribute mouth diseases to heat syndromes; however, there are cases that appear like heat but are not, as well as cases of exhaustion injury without fire, which must be carefully distinguished. ○ Thirst (Kě) and dryness (Gān) are significantly different. Thirst arises from excess dryness-fire; dryness arises from insufficient body fluids. Cases with excess fire should be treated as excess heat; cases with insufficient fluids should be treated as Yin deficiency. Failing to distinguish between the two leads to disastrous consequences, like ice and charcoal. ○ Bitter or sour taste in the mouth, as described in *Yuan Bing Shi*, are all attributed to heat. It states that Liver heat causes sour taste, Heart heat causes bitter taste, Spleen heat causes sweet taste, Lung heat causes pungent taste, Kidney heat causes salty taste, and Stomach heat causes bland taste. If this theory were followed, then all five flavors in the mouth would belong to Fire syndromes, leaving no room for Cold syndromes. Would this not be absurd? For instance, a bitter taste does not necessarily stem entirely from Heart Fire; a bland taste does not necessarily stem entirely from Stomach Heat. Generally, those who overthink, labor excessively, or indulge in sexual activity often suffer from bitter taste, dry tongue, and loss of appetite. The fault lies not in the Heart and Spleen, but in the Liver and Kidneys. Deficiency of Heart and Spleen causes Liver and Gallbladder Qi to overflow, resulting in bitterness; deficiency of Liver and Kidneys causes insufficiency of True Yin, resulting in dryness. Take the case of bland taste: after severe labor, profuse diarrhea, heavy sweating, or serious illness, one may experience a bland taste. Is this always caused by Stomach Fire? In clinical practice, if no other signs of fire or pulse of fire are observed, one should not recklessly use cold-natured herbs and cause mis-treatment. ○ Bad breath is indeed caused by Stomach Fire, but there are exceptions not caused by fire. The bad breath from Stomach Fire is turbid and foul, accompanied by mouth heat, dry mouth, and other Yangming Fire signs. If there are no fire signs or fire pulse, but the odor resembles sour rot or fermented acid, accompanied by acid regurgitation and belching with stagnation, this is similar to the odor caused by damp-cold retaining filth, which is distinct from heat-induced odor. This is mostly due to unfulfilled thoughts and Spleen weakness failing to digest food. One is a Yang syndrome, suitable for clearing Stomach Fire; the other is a Yin syndrome, suitable for regulating and tonifying Heart and Spleen. One cannot claim that bad breath is always due to heat. (Zhang Jingyue)
Mouth ulcers, although caused by Spleen Heat, are divided into red and white types. White indicates Lung Heat; red indicates Heart Heat; red and white mixed indicates both Heart and Lung Heat, not merely a Spleen issue. (From *Zheng Zhi Hui Bu*)
Dry mouth indicates Kidney Heat. Lockjaw (Jin) indicates Wind-Jing (spasticity). If the disease is severe and presents with cyanotic lips, blackening around the mouth, open mouth with straight airflow, or fish-mouth breathing that does not return, these are incurable. (From *Shang Han Wu Fa*)
[Supplement]
Heart Heat with bitter taste: Huanglian Xiexin Tang (Coptis Decoction to Drain the Heart). Liver Heat with sour taste: Chaihu Qinggan Tang (Bupleurum Decoction to Clear the Liver). Spleen Heat with bad breath: Qingwei Tang (Clear the Stomach Decoction). Lung Heat with pungent taste: Xiebai San (Drain the White Powder). Kidney Heat with salty taste: Zishen Wan (Nourish the Kidney Pill). Indecisiveness with Gallbladder Deficiency causing bitter taste: Use Xiaoyao San (Free and Easy Wanderer Powder) as the sovereign herb, with Chai Hu (Bupleuri Radix) and Longdan Cao (Gentianae Radix) as ministers. Insufficiency of Middle Qi, with Wood encroaching on Earth causing bitter taste: Use Sijunzi Tang (Four Gentlemen Decoction) as the sovereign herb, with Shaoyao (Paeoniae Radix) and Chai Hu (Bupleuri Radix) as assistants. Heat transferring from the Bladder, causing oral ulcers and dysuria: Use Daochi San (Directing Flowing Powder) to specifically treat the lower jiao. Deficiency-Cold of the Middle Earth with floating Stomach Yang: Use Lizhong Tang (Regulate the Middle Decoction) to warm and tonify the middle, so the upper jiao naturally settles. Flaming Fire of the Lower Jiao: Use Bawei Wan (Eight-Ingredient Pill) to warm the Dantian, so the flames extinguish naturally. (From *Zheng Zhi Hui Bu*)
Regarding mouth ulcers: in the Heart Meridian, it is referred to as Daochi [San]; in the Stomach Meridian, it is referred to as Baihu [Tang]. The former's ulcers extend to the tongue; the latter's ulcers involve the lips. Qi-level disorders cannot be treated the same as Blood-level disorders. (Cheng Jiaoqian)
Long-Lei Fire (Ministerial Fire) can also scorch grass and trees; why must it be excess heat to cause mouth and tongue ulcers? This is because Spleen and Stomach Qi decline, failing to anchor and suppress, allowing Yin Fire from the Lower Jiao to ascend, surging and causing swelling and ulceration. If one simply clears the Stomach, the Middle Qi becomes even more depleted, and the Yin Fire becomes even more intense. One should warm and tonify the Middle and Lower Jiao, guiding the fire to retreat. (Feng Chuzhan)
[Appendix: Lips]
The Spleen governs muscles, and its luster manifests in the lips. ○ Consuming too much sour food causes muscle atrophy and peeling lips. ○ The Spleen, Stomach, Large Intestine, Small Intestine, Sanjiao (Triple Burner), and Bladder are the foundation of granaries and the residence of Ying Qi (Nutritive Qi). Their luster manifests in the four whites surrounding the lips. (From *Su Wen*)
The lips are the "Fei Men" (Flying Gate/Portal). (From *Nan Jing*)
The lips are the root of muscles and the luster of the Spleen. Therefore, observing the color and luster of the lips can reveal the depth of the disease. Red color is auspicious; black is ominous; red and swollen indicates severe heat; blue-black indicates extreme cold. (From *Shang Han Wu Fa*)
Lips belong to the Spleen and merge with the Stomach meridians. When the Spleen and Stomach are invaded by pathogens, the lips become diseased. Excess Wind causes movement/trembling; excess Cold causes retraction; excess Dryness causes dryness; excess Heat causes cracking; Qi stagnation causes sores; Blood deficiency causes lack of color; Spleen Cold causes purple; Spleen failure causes black; Spleen Cold causes green/blue; Spleen Deficiency causes pale/white; Spleen Decline causes yellow; Spleen Excess causes red. (From *Sheng Mo*)
Dampness disease causes lip swelling; Wind disease causes lip trembling; Cold disease causes lip peeling; Heat disease causes lip wrinkling; Dryness disease causes lip cracking; Fire disease causes lip itching; Qi disease causes lip numbness; Blood disease causes lip insensibility. When Foot-Taiyin Spleen Meridian Qi perishes, the lips invert; when Foot-Jueyin Liver Meridian Qi perishes, the lips turn blue, the tongue curls, and the testicles retract. (From *Yi Xue Ji Di*)
The lips and mouth are the essence of flesh and the orifice of the Spleen, where the Ren Mai (Conception Vessel), Du Mai (Governing Vessel), and other meridians converge. Food enters through this gate, connecting internally to the throat and tongue, and externally to the cheeks/jaw. The control of swallowing lies here. When Yangming Qi arrives, one bites the lips, driven by the movement of the intestines and stomach. Thus, if parasites erode the internal organs, ulcers appear on the upper lip; if they erode the anus, ulcers appear on the lower lip. Eating sour food causes lip inversion because Earth fears Wood. Like the nostrils acting as chimneys, cold invasion brings cold, heat invasion brings heat, following the same principle. Red lips indicate abundant Blood; pale lips indicate Blood deficiency; moist lips indicate harmonious taste; dry/cracked lips indicate altered taste. Scraping white coating from lips and mouth indicates impending death; blue-black lips and mouth indicate immediate death. Congenital cleft lip indicates disharmony between the Ren and Du meridians. (From *Yi Can*)
Lip swelling, wrinkling, and cracking resembling a silkworm cocoon is named Jian Chun (Silkworm Cocoon Lip). It may be caused by emotional fire injuring Blood, Heart Fire transmitting to the Spleen, or rich foods accumulating heat damaging the Spleen. Treatment should clear Stomach Heat, generate Spleen fluids, and nourish Kidney Water. Once moisture returns and fire subsides, the swelling will subside. ○ There are two types of blue lips: If lips and nails are blue accompanied by irritability, thirst, and desire to drink, it is Heat trapped in Jueyin, suitable for Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). If lips are blue with cold limbs, aversion to cold, and trembling desire to fall to the ground, it is Cold invading Shaoyin, suitable for Zhenwu Tang (True Warrior Decoction). Pale lips indicate blood loss, suitable for Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction). Red lips with yellow tint indicate Spleen Heat, suitable for Huangqin Shaoyao Tang (Scutellaria and Peony Decoction). Red and thickly swollen lips indicate Stomach Heat, suitable for Qingwei San (Clear the Stomach Powder). (From *Zhang Shi Yi Tong*)