张子和治相台监酒岳成之病疟，滑泄日夜不止，肠鸣而口疮，俗呼为心劳口疮，三年不愈。令以长流水同
姜、枣煎，五苓散五七钱，空心使服之，以治其下，以宣黄连与白茯苓（去皮），二味各等分为末，以白面糊为丸，
食后温水下三五十丸，以治其上，百日而愈。（作湿火治。）
一男子病口疮数年，上至口，中至咽嗌，下至胃脘皆痛，不敢食热物。一涌一泄一汗，病去其九。次服黄
连解毒汤，不旬日皆释。（作实火治。）
一男子年二十余，病口中气出臭如发厕，虽亲戚莫肯与对语。张曰∶肺金本主腥，乃金为火所炼，火主焦
臭，故如是也。久则成腐，腐者肾也，此热极则反兼水化也。病在上，宜涌之，先以茶调散涌之，去其七分。
夜用舟车丸、浚川散下五行，比旦而断。呜呼！人有病口臭，而终其身者，世说以为肺系偏而与胃相通故臭，妄论也。
立斋治廷评曲汝为，口内如无皮状，或咽喉作痛，喜热饮食，此中气真寒而外虚热也，用加减八味丸
而愈。（虚寒。）
一人胃弱痰盛，口舌生疮，服滚痰丸愈甚，反泻不止，恶食倦怠，此胃气被伤也。与香砂六君子汤，数剂
少可。再以补中益气汤加半夏、茯苓而愈。
立斋治一男子口臭，牙龈赤烂，腿膝痿软，或用黄柏等药益甚，时或口咸，此肾经虚热，以六味丸悉愈。
（虚热。）
孙文垣治汪东之，手谈过劳，口中生疮。凡进大苦大寒之剂，十余日疮益甚，延及于喉，药食难进。脉
之，六部俱豁大无力。有专科欲敷口疳药，令以荆芥汤洗而引之，搅出稠涎二三碗倾于地。偶二鸡争啄之立毙，
其毒如此，亦症之奇者。乃嘱其用药，只可吹入喉中，必俟喉全好，然后敷舌，舌好再敷口唇，毋得概敷。令
毒无出路，反攻入喉，则误事矣。谓其父曰∶此虚阳口疮也，非附子理中汤不可救。曰∶疮乃热症，况上身已
热，又天时酷暑，大热之剂，其敢进乎？曰∶此阴盛格阳之症，误服寒凉激之，试探两足必冷，按之果然。遂
与人参、白术各三钱，大附子、炮姜、炙甘草各一钱，水煎冷服。服后即酣睡达旦，次早能食粥半盏，足膝渐
暖，药仍如旧。适散步午归，见举家号恸，曰∶本热病误服热药，今舌肿大，塞满口中，不能言语，不可为矣。
骇其骤变，再脉之，则六脉敛而有神，面色亦和，独舌胀大，心知为寒凉敷药所致也。乃诘之曰∶今日可用敷
药否？曰∶已二次矣。令急取官桂研末五钱，以生姜自然汁调涂舌上，涂讫则涕泪流出，口内涎垂，舌顿消去，
即令取粥与食，使压之，庶虚火不再升。盖舌满胀者，乃敷药寒凉，闭其毒瓦斯，毒无从出故耳。以桂调姜汁涂
之，辛散之义也。
黄师文父病口疮，师文治之不愈，心讶之，乃密访诸婢，果其父尝昼同一婢子寝，明日疮作。师文即详其
时节，明日即用其父所寝时，令其父净濯足，以其药贴脚心瘥。（不外吴茱萸、生附子等药。《北窗灸 》。）
卢不远治李某，口舌生疮，几三年矣。脉浮细急数，按之空虚，而尺尤甚。用立斋虚火不归经法，以加减
八味丸料，二剂即愈。
柴屿青治吴颖庵少廷尉甥闵，年三十，口舌生疮，下部泄泻，脉尺弱而无力，寸关豁大。此阴盛于下，逼
阳于上。若用凉药清火，则有碍于脾；用燥药治脾，则有碍于舌。惟有引火归源之法，竟用附子理中汤冷冻饮料，
送八味丸三钱，两服顿愈。
光禄卿李瀛少夫人患口疮，医屡投清火寒凉之剂无效，更兼泄泻，饮食少思。始求治，按其右关微弱，知
系胃虚谷少，复为寒凉损伤，致脾胃虚衰之火，被逼上炎，则为口疮，元藏虚寒，则为泄泻也。惟补其火散其
寒，则火得所助，接引而退舍矣。方用人参、白术、附子、炮姜、炙甘草。李君畏不敢与服，逡巡数日，势益
困勉。用前方连进数剂即安。盖口疮非止一端，有上焦实热，中焦虚寒，下焦阴火，各经传变所致，必须分别
治之，不可执也。
陆养愚治姚明水，天禀素弱，脾肾两虚，幸能节养，兼服温补之剂，中年颇健啖，因无子置外家，遂患口疮，
齿痛。初以凉膈散数钱，服之即愈。自后常发常服，至半年许满口腐烂，饮食不进。脉之，两寸浮数而微，关
尺浮弱而涩。谓形虽有余，精仍不足，当严守禁忌，服滋补药，凉剂不可再投矣。用八物汤倍地黄，以峻补肾
水，加桂、附各一分，引火归原，经谓折之不去，求其属以衰之是也。煎就凉服十剂，其患如失。
薛立斋治儒者刘允功，形体魁伟，冬日饮水，自喜壮实。薛曰∶此阴虚也。不信。一日口舌生疮，或用寒
凉之剂，肢体倦怠，发热恶寒，乃与六味地黄、补中益气而愈。
王肯堂治常熟严养翁相公，春秋高而求助于浓味补药，以致胃火久而益炽。服清胃散不效，加山栀、芩、
连而益甚。以为凉之非也，疑其当补。闻王善用人参，因延诊而决之。才及门则口中秽气达于四室，向之欲哕，
此正清胃散症也。独其热甚，当用从治。而既失之，今且欲从而不可矣，当求其属而衰之。用天冬、麦冬、生
地、熟地、石斛、升麻、犀角、兰香之类，大剂投之，数日而臭已止矣。经云∶诸病寒之而热者，取之阴，所
谓求其属也。火衰于戌，故峻补其阴而热自已。后因不屏肉食，胃火复作，大便不利，目翳耳鸣，不能自忍。
杂进寒凉，时或利之，遂致不起。嗟乎！苟知其热，凉之而已，则涂之人，皆可以为卢扁，何事医乎？（《郁岗斋
笔尘》。）
邑侯许少微患口糜，王谓非干姜不能愈。许犹疑之，后竟从王言而愈。从子懋 亦患此，甚危急，热甚惟
欲饮冷水，王用人参、白术、干姜各二钱，茯苓、甘草各一钱，煎成冷服，数服乃已。噫！此岂可与拘方者道耶？
口疮无论新旧，遇夜卧时，将自己两睾丸，以手握紧，左右以手揉之三五十遍，每夜睡觉辄行之，愈于服
药。（苏谈。）
立斋治一男子，口舌生疮，服凉药愈甚，治以理中汤而愈。又一男子，口舌生疮，饮食不甘，劳而愈甚，
亦与前汤顿愈。
一男子口糜烂，服凉药愈甚，脉数而无力，以四物加酒炒栀、柏、元参，一剂顿退，四剂而痊。
一男子口舌生疮，脉浮而缓，饮补中益气汤加炮姜，更以桂末含之即愈。又一男子患之，劳而愈盛，以前
药加附子三片，三剂即愈。丹溪云∶口疮服凉药不愈者，此中焦气不足，虚火泛上无制，用理中汤，甚则加附子。
一妇人常口舌糜烂，颊赤唇干，眼涩作渴，脉数，按之则涩，此心肺壅热，伤于气血为患，名热劳症也。
当多服滋阴养血药。彼欲速效，用败毒寒剂攻之，后变瘵症而殁。《妇人良方》云∶妇人热劳者，由肺壅热，
伤于气血，气血不调，脏腑壅滞，热毒内积，不得宣通之所致也。其候心神烦躁，颊赤头痛，眼涩唇干，四肢
壮热，烦渴不止，口舌生疮，神思昏沉，嗜卧少寐，饮食无味，举体酸疼，或时心怔，或时盗汗。肌肤日渐消
瘦，故名热劳也。
焦秀才病口苦，罗谦甫制龙胆泻肝汤，治之得效。经云∶有病口苦，名曰胆瘅。乃肝主谋虑，胆主决断，
为清净之府，肝取决于胆，胆或不决，为之恚怒，怒则气逆，胆汁上溢，故口苦，或热盛使然也。（《宝鉴》。）
罗谦甫治梁齐民，膏粱多饮，因劳心过度，肺金有伤，以致气出腥臭，涕唾稠粘，咽嗌不利，口舌干燥，
以加减泻白散主之。《难经》云∶心主五臭，入肺为腥臭，此其一也。因大饮大热之气所伤，从心火刑于肺金。
以桑皮、地骨皮苦微寒，降肺中伏火，而补气为君；以黄芩、知母苦寒治气腥臭，清利肺气为臣。肺欲收，急
食酸以收之，五味子酸温，以收肺气，麦冬甘寒，治涕唾稠粘，口苦干燥为佐；桔梗辛温，体轻浮，治痰逆，
利咽膈为使。服数剂而愈。
尤在泾曰∶王肯堂治许少薇口糜，谓非干姜不愈，卒如其言。又从子懋 亦患此，势甚危急，欲饮冷水，
与人参、白术、干姜各二钱，茯苓、甘草各一钱，煎成冷冻饮料，日数服乃已。盖土湿则火敛，人多不能知此。所
以然者，胃虚食少，肾水之气逆而乘之，则为寒中。脾胃虚衰之火，被迫上炎，作为口疮。其症饮食少思，大
便不实，或手足逆冷，肚腹作痛是也。
张子和治疗相台监酒岳成的疟疾病，伴有日夜不停的滑泄（腹泻），肠鸣且口舌生疮，俗称心劳口疮，三年未愈。让他用长流水同生姜、大枣煎煮，服用五苓散五到七钱，空腹服用以治下焦；将黄连与白茯苓（去皮）两味药各等分研为末，用白面糊做成丸剂，饭后用温水送服三五十丸，以治上焦，百日而痊愈。（按湿火证治疗。）
一个男子患口疮数年，从上至口，中至咽喉，下至胃脘都疼痛，不敢吃热食。经过一次涌吐、一次泻下、一次发汗，病去九成。随后服用黄连解毒汤，不到十天全部治愈。（按实火证治疗。）
一个二十多岁的男子，口中呼出的气臭得像厕所一样，连亲戚都不愿与他对话。张子和说：肺金本主腥味，这是金被火炼制的结果，火主焦臭味，所以像这样。时间久了会成腐败，腐败对应肾，这是热极则反兼水化的表现。病在上部，宜用涌吐法，先用茶调散涌吐，排出七分病邪。夜间用舟车丸、浚川散泻下五行，到第二天早晨病断根了。唉！人有口臭，终身不愈的，世人说是肺系偏斜而与胃相通导致口臭，这是妄论。
薛立斋治疗廷评曲汝为，口腔内好像没有皮一样，有时咽喉疼痛，喜欢热饮食，这是中气真寒而外现虚热，用加减八味丸而痊愈。（属虚寒证。）
一个人胃弱痰多，口舌生疮，服用滚痰丸后病情加重，反而腹泻不止，厌恶饮食，倦怠乏力，这是胃气受损。给予香砂六君子汤，几剂后稍有好转。再用补中益气汤加半夏、茯苓而痊愈。
薛立斋治疗一个男子口臭，牙龈红肿溃烂，腿膝痿软无力，有人用黄柏等药后病情加重，有时口中有咸味，这是肾经虚热，用六味丸全部治愈。（属虚热证。）
孙文垣治疗汪东之，因下棋过度劳累，口中生疮。凡是进服大苦大寒的药物，十多天后疮疡更严重，蔓延至喉部，药物和食物难以进入。诊脉，六部脉象都豁大无力。有专科医生想用敷口疳的药，让他用荆芥汤清洗并引导出稠痰二三十碗倒在地上。偶然两只鸡争啄这些痰立刻死亡，其毒性如此之大，也是病症中的奇特者。于是嘱咐他用药，只能吹入喉中，必须等到喉部完全好了，然后敷舌头，舌头好了再敷口唇，不得全面敷药。令毒气无路可出，反而攻入喉部，那就误事了。对他的父亲说：这是虚阳口疮，非附子理中汤不能救。他说：疮是热症，况且上身已热，又是酷暑天气，大热的药，怎么敢进服呢？我说：这是阴盛格阳的症候，误服寒凉药激惹它，试探一下双脚必定冷，按之果然。于是给人参、白术各三钱，大附子、炮姜、炙甘草各一钱，水煎后冷服。服后即酣睡到天亮，次日早上能吃半盏粥，足膝逐渐变暖，药方仍照旧。恰逢散步中午回来，看见全家痛哭，说：本是热病误服热药，现在舌头肿大，塞满口中，不能言语，没救了。惊骇于突然的变化，再诊脉，六脉收敛而有神，面色也和缓，唯独舌头胀大，心里知道是寒凉敷药所致。于是责问说：今天可以用敷药吗？说：已经用了两次了。命令急忙取官桂研末五钱，用生姜自然汁调和涂在舌上，涂完后涕泪流出，口中涎垂，舌头顿时消退，立即让人取粥喂食，使其压迫舌体，防止虚火再次上升。因为舌满胀，是由于敷药寒凉，闭阻了毒气，毒气无处排出造成的。用桂枝调姜汁涂抹，是辛散的道理。
黄师文的父亲患口疮，黄师文治疗不愈，心中惊讶，于是秘密访问各个婢女，果然发现父亲曾白天与一个婢女同寝，第二天疮发作。黄师文随即详细询问时节，第二天就用父亲睡觉的时间，让父亲洗净脚，用他的药贴脚心而痊愈。（不外乎吴茱萸、生附子等药。《北窗灸》。）
卢不远治疗李某，口舌生疮，几乎三年了。脉浮细急数，按之空虚，尺脉尤其明显。用薛立斋虚火不归经的方法，用加减八味丸料，两剂即愈。
柴屿青治疗吴颖庵少廷尉的外甥闵，年三十岁，口舌生疮，下部泄泻，脉尺弱无力，寸关脉豁大。这是阴盛于下，逼迫阳气于上。如果用凉药清火，则有碍于脾；用燥药治脾，则有碍于舌。只有引火归源的方法，竟用附子理中汤冷冻饮料，送服八味丸三钱，两服顿愈。
光禄卿李瀛少夫人患口疮，医生屡次投用清火寒凉的药剂无效，更兼泄泻，饮食减少思虑。开始求治，按其右关脉微弱，知道是胃虚谷少，又被寒凉损伤，导致脾胃虚衰之火，被逼上炎，则为口疮，元藏虚寒，则为泄泻。只有补其火散其寒，则火得所助，接引而退舍了。方用人参、白术、附子、炮姜、炙甘草。李君害怕不敢服用，犹豫数日，形势更加困窘勉强。用前方连续进服数剂即安。大概口疮不止一端，有上焦实热，中焦虚寒，下焦阴火，各经传变所致，必须分别治疗，不可固执。
陆养愚治疗姚明水，天禀素来虚弱，脾肾两虚，幸好能节制保养，兼服温补药剂，中年颇能进食，因为没有儿子置办外室家眷，于是患口疮，齿痛。起初用凉膈散数钱，服用即愈。此后常发常服，到半年左右满口腐烂，饮食不进。诊脉，两寸浮数而微，关尺浮弱而涩。说形体虽有余，精仍不足，应当严守禁忌，服用滋补药，凉剂不可再投了。用八物汤倍地黄，以峻补肾水，加桂、附各一分，引火归原，经书说折之不去，求其属以衰之是对的。煎好凉服十剂，其患如失。
薛立斋治疗儒者刘允功，形体魁伟，冬日饮水，自喜壮实。薛说：这是阴虚。不信。一天口舌生疮，有人用寒凉药剂，肢体倦怠，发热恶寒，于是给予六味地黄、补中益气而愈。
王肯堂治疗常熟严养翁相公，年纪大却求助于浓味补药，以致胃火久而益炽。服用清胃散不效，加山栀、芩、连而更甚。认为凉之不对，疑其当补。听说王善于用人参，于是延请诊治决定。才到门口则口中秽气达于四室，之前想干呕，这正是清胃散的症候。独其热甚，应当用从治。而既然失之，现在想顺从也不可了，应当求其属而衰之。用天冬、麦冬、生地、熟地、石斛、升麻、犀角、兰香之类，大剂投之，数日而臭已止矣。经云：诸病寒之而热者，取之阴，所谓求其属也。火衰于戌，故峻补其阴而热自已。后因不屏肉食，胃火复作，大便不利，目翳耳鸣，不能自忍。杂进寒凉，时或利之，遂致不起。嗟乎！苟知其热，凉之而已，则涂之人，皆可以为卢扁，何事医乎？（《郁岗斋笔尘》。）
邑侯许少微患口糜，王肯堂说非干姜不能愈。许还怀疑，后来竟听从王肯堂的话而愈。侄子许懋也患此病，非常危急，热甚只想喝冷水，王肯堂用人参、白术、干姜各二钱，茯苓、甘草各一钱，煎成冷服，数服乃止。唉！这岂可与拘泥于成方的人说道呢？
口疮无论新旧，遇到晚上睡觉时，将自己两个睾丸，用手握紧，左右用手揉搓三五十遍，每晚睡觉都这样做，比服药痊愈得快。（苏谈。）
薛立斋治疗一个男子，口舌生疮，服凉药更甚，用理中汤治疗而愈。又一个男子，口舌生疮，饮食不甘，劳累后更甚，也用前汤顿愈。
一个男子口糜烂，服凉药更甚，脉数而无力，用四物汤加酒炒栀子、黄柏、玄参，一剂顿退，四剂而痊愈。
一个男子口舌生疮，脉浮而缓，饮补中益气汤加炮姜，再用肉桂末含之即愈。又一个男子患此病，劳累后更盛，用前药加附子三片，三剂即愈。丹溪说：口疮服凉药不愈者，这是中焦气不足，虚火泛上无制，用理中汤，甚则加附子。
一个妇人常口舌糜烂，颊赤唇干，眼涩作渴，脉数，按之则涩，这是心肺壅热，伤于气血为患，名热劳症。应当多服滋阴养血药。她想要速效，用败毒寒剂攻之，后来变成瘵症而死。《妇人良方》说：妇人热劳者，由肺壅热，伤于气血，气血不调，脏腑壅滞，热毒内积，不得宣通之所致也。其候心神烦躁，颊赤头痛，眼涩唇干，四肢壮热，烦渴不止，口舌生疮，神思昏沉，嗜卧少寐，饮食无味，举体酸疼，或时心怔，或时盗汗。肌肤日渐消瘦，故名热劳也。
焦秀才病口苦，罗谦甫制龙胆泻肝汤，治疗得效。经云：有病口苦，名曰胆瘅。乃肝主谋虑，胆主决断，为清净之府，肝取决于胆，胆或不决，为之恚怒，怒则气逆，胆汁上溢，故口苦，或热盛使然也。（《宝鉴》。）
罗谦甫治疗梁齐民，膏粱多饮，因劳心过度，肺金有伤，以致气出腥臭，涕唾稠粘，咽嗌不利，口舌干燥，以加减泻白散主之。《难经》云：心主五臭，入肺为腥臭，此其一也。因大饮大热之气所伤，从心火刑于肺金。以桑皮、地骨皮苦微寒，降肺中伏火，而补气为君；以黄芩、知母苦寒治气腥臭，清利肺气为臣。肺欲收，急食酸以收之，五味子酸温，以收肺气，麦冬甘寒，治涕唾稠粘，口苦干燥为佐；桔梗辛温，体轻浮，治痰逆，利咽膈为使。服数剂而愈。
尤在泾说：王肯堂治疗许少薇口糜，说非干姜不愈，最终如其所言。又从子许懋也患此病，形势非常危急，想喝冷水，给人参、白术、干姜各二钱，茯苓、甘草各一钱，煎成冷冻饮料，每天数服乃止。大概土湿则火敛，人多不能知道这一点。之所以这样，是因为胃虚食少，肾水之气逆而乘之，则为寒中。脾胃虚衰之火，被迫上炎，作为口疮。其症饮食少思，大便不实，或手足逆冷，肚腹作痛是也。
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.