Ang chronic recurrent oral ulcer ay isang karaniwang at madalas na sakit, na may mahabang proseso at paulit-ulit na paglalabas, na nakakasira sa kalusugan ng pasyente. Ang klinikal na sintomas ay ang paulit-ulit na pagbubuo ng isolated, circular o oval na shallow ulcers sa oral mucosa, na may lokal na hot sensation at sakit.
Ang oral ulcer ay kasama sa "kou chuang" at "kou mi" sa tradisyonal na Tsino medicine. Ang kou chuang ay nangyayari sa mouth, ngunit may malapit na ugnayan sa loob ng katawan. Ayon sa medisina ng Tsino, ang spleen ay may access sa mouth, heart sa tongue, kidney meridian ay nakakabit sa throat at base ng tongue, ang cheeks at gums ay kasama sa stomach at large intestine, ang ren meridian at du meridian ay nakakabit sa oral cavity, lips, at tongue, na ipinakikita na ang pagbubuo ng kou chuang ay malapit na nauugnay sa limang organs. Ang "Su Wen · Zhen Yao Da Lun" ay nagsasabing: "Lahat ng sakit, itching, at ulcers ay nanggagaling sa heart". Ang fire ng kou chuang ay hindi lamang nanggagaling sa heart. Ang regular na stress, anger, pag-inom ng alak, coffee, sobra sa pagkain na matamis at mataba, ay maaaring magdulot ng heart-spleen heat, lung-stomach heat, liver-gallbladder heat, na nagdudulot ng kou chuang na madalas ay real condition; kung ang kidney yin ay kulang, ang virtual fire ay bumabagsak, nagdudulot ng kou chuang na madalas ay virtual condition; kung ang matanda ay may weakness, nagtrabaho nang sobra, nawalan ng energy, at nasira ang spleen, ay maaaring mabawasan ang function ng middle jiao, hindi maayon ang qi flow, ang yang sa upper jiao ay hindi bumaba, ang yin sa lower jiao ay hindi bumaba, ang heart fire ay umaabot, at nagdudulot ng kou chuang, na madalas ay virtual condition. Tulad ng sinabi ni Li Dongyuan sa "Treatise on the Spleen and Stomach": "Kung ang spleen at stomach ay weak, ang yuan qi ay kulang, ang heart fire ay labis, ang heart fire ay isang yin fire, sumisikat mula sa lower jiao, nakakabit sa heart, kung ang heart ay hindi naghahari, ang phase fire ay gagawin ito." "Kung ang stomach ay may problema, ang breath ay mahihirapan, ang spirit ay mababa, at bumabalik ang malaking init, minsan ang stomach fire ay bumaba at nag-iilaw sa mukha."
Ang paggamot ng kou chuang ay dapat basahin ang realidad at virtual, alamin ang organ, at alamin ang disease at symptom, para makakuha ng magandang resulta. May maraming sintomas sa klinika, ngunit ang pinaka-karaniwan ay ang heart-spleen heat at virtual fire rising. Ang aming karanasan sa paggamot ay sumusunod:
I. Heart-Spleen Heat
Ang pangunahing sintomas ay paulit-ulit na ulcers sa tip ng tongue, edge ng tongue, surface ng tongue, gums, o sa sides ng mouth, na may yellow pelikula sa surface, may depression sa gitna, at elevated sa paligid, red, swollen, hot, painful, bitter taste, bad breath, restlessness, hot feeling, short and red urine, constipation. Ang dila ay mapula, may yellow pelikula, at ang pulse ay string-like and slippery. Ang kondisyon ay heart-spleen heat, causing tissue decay and ulcer formation. Ang gamot ay upang alisin ang heat, clear the fire, promote healing. Gamot: Self-designed Xiao Xin Liao Chuang Tang: Huang Qin 15g, Huang Lian 5g, Da Huang 10g, Chi Bai Shao 15g, Lian Zi Xin 3g, Sheng Gan Cao 5g, Hu Zhang 15g, Chao Zhi Zi 10g.
Case example: He XX, male, 32 years old, visit sa aming ospital on October 16, 2002. Complaint: repeated oral ulcers for 3 years, worsened for 1 month, severe pain preventing eating. Symptoms: three ulcers about the size of a sesame seed to green pea on the tip of the tongue and inner lips, burning and severe pain, unable to eat, bitter taste and bad breath, no bowel movement for 3 days, short and hot urine, red tongue with yellow coating, string-like and slippery pulse. Examination revealed one ulcer measuring 0.1×0.5cm on the tip of the tongue, red and swollen around, depressed center, covered with yellow coating. One ulcer each on the inner side of the upper and lower lips, 0.1×0.1cm. This is due to heart fire and stomach heat ascending along the meridian, diagnosed as heart-spleen heat accumulation, causing ulcers. Treatment: Clear heat, reduce fire, relieve pain. Prescription: Da Huang 10g, Huang Qin 15g, Huang Lian 5g, Sheng Shi Gao 30g, Chao Shan Zhi 10g, Fang Feng 10g, Chi Bai Shao 15g, Sheng Gan Cao 5g, Xuan Shen 20g, Sheng Di 30g, Hu Zhang 20g, Yuan Hu 15g. One dose per day. The herbs are decocted twice with water, yielding 400ml, divided into four portions and taken warm. After one dose, bowel movement resumed, pain decreased, able to eat liquid food. After seven doses, follow-up showed minimal pain, reduced ulcer size, yellow coating turned white. Remove Huang Qin, Huang Lian, Da Huang, add Huang Qi, Dang Gui, Bai Ji, take another seven doses and fully recovered.
This patient often works night shifts, smokes and drinks alcohol regularly, accumulating heart and spleen fire over time, which ascends and burns the oral mucosa, causing ulcers. The prescription uses Xiao Xin Tang, Zeng Ye Tang, Xie Huang San, and Chi Shao Gan Cao Tang with modifications—first, Zeng Ye Tang replenishes fluids and extinguishes fire, second, bitter and cold agents reduce fire, removing the root cause, so heart-spleen fire naturally subsides and ulcers heal. Also advised to reduce smoking and drinking during night shifts, cutting off the source of fire, drink more water, eat more vegetables and fruits, maintain regular bowel movements, allowing internal heat to be expelled, reducing recurrence after healing.
II. Virtual Fire Rising
Ang pangunahing sintomas ay paulit-ulit na ulcers, painful, with white coating on the surface, depression in the center, slightly elevated edges, not red, short of breath, weak, feverish, flushed cheeks, dry mouth but not thirsty, short and red urine, red tip of tongue with little coating or cracks, pulse slightly fine and rapid. Ang kondisyon ay liver-kidney deficiency, virtual fire disturbing upward. Ang gamot ay upang bigyan ng lakas ang yin, produce body fluid, reduce virtual fire. Gamot: Self-designed Yang Yin Liao Chuang Tang: Sheng Shu Di 15g, Shu Shu Di 15g, Bei Sha Shen 15g, Shan Yu Rou 10g, Shan Yao 10g, Dan Pi 15g, Ze Xie 15g, Fu Ling 20g, Zhi Mu 10g, Huang Bai 10g, Mai Dong 15g, Dang Gui 10g, Sheng Huang Qi 15g.
Case example: Liu XX, male, 50 years old. Initial consultation on March 15, 2003. Has had oral ulcers for over two years, recurring intermittently, unsatisfactory treatment. At consultation: one ulcer each on gums and side of tongue, about the size of a green pea, depressed center, covered with white membrane, slightly raised edges, pale red color. Patient feels mild pain with burning sensation, dry mouth and throat, hot palms and soles, sore waist and knees, spontaneous sweating, yellow urine, dry stool. Red tongue with little moisture, thin yellow coating, fine and slightly rapid pulse. Diagnosis: insufficient yin fluid, virtual fire rising. Treatment: nourish yin fluid, clear and reduce virtual fire. Prescription: Sheng Shu Di 15g, Shan Yao 10g, Shan Yu Rou 10g, Ze Xie 15g, Dan Pi 15g, Tu Fu Ling 20g, Zhi Mu and Huang Bai each 10g, Dang Gui 10g, Bei Sha Shen 20g, Mai Dong 15g, Hu Zhang 20g, Sheng Huang Qi 15g. After taking this prescription for 14 doses, ulcers healed, symptoms mostly disappeared. Switched to Zhi Bai Di Huang Wan for one month to consolidate results.
The patient's ulcers appeared on gums and side of tongue—teeth are governed by kidney, side of tongue belongs to liver-gallbladder area. Since ulcers recur repeatedly, long-term illness leads to deficiency, hence caused by liver-kidney yin deficiency. Repeated ulcers damage yin, leading to insufficient yin fluid, virtual fire rising, burning oral mucosa and forming ulcers. Dry mouth and throat, hot palms and soles, red tongue with little moisture, fine and rapid pulse—all classic signs of yin deficiency with fire excess. The prescription combines Zhi Bai Di Huang Wan with Yi Guan Jian, first using Liu Wei Di Huang Wan and Yi Guan Jian to nourish liver-kidney yin to treat the root, then using Zhi Mu, Huang Bai, Dan Pi to clear virtual heat and reduce fire, adding Hu Zhang 20g to clear heat and promote bowel movement, giving fire an outlet—this is the clever part of the formula. Combined use treats both root and branch, effective like a drumbeat. After healing, continued taking Zhi Bai Di Huang Wan for one month to consolidate results and prevent recurrence.
III. Experience in Treatment
1. Oral ulcers are mostly due to fire, must distinguish between reality and virtuality. If the patient is young, severe pain like burning, bitter taste and bad breath, constipation, yellow urine—real heat and fire. Treatment should clear heat, detoxify, relieve pain. If the patient is elderly and weak, mild pain, dry mouth and throat, irritability or five-palm heat, red tongue with little moisture—virtual heat and fire. Treatment should nourish yin, produce body fluid, reduce virtual fire.
2. Combination of local and systemic treatment improves efficacy. Oral ulcers are located in the mouth, so apart from syndrome differentiation and systemic regulation, local medication is also needed to directly act on the ulcer site. Commonly used medicines include Mei Hua Dian She Dan, Xi Huang Qing Xing Wan, Liu Shen Wan, to be held in mouth in small amounts multiple times daily to relieve local symptoms and promote healing, improving overall effectiveness.
3. Huang Qi and Gan Cao are excellent medicines for promoting oral healing. Huang Qi tonifies qi and strengthens the exterior, has the effect of closing wounds and promoting tissue regeneration, most suitable for treating oral ulcers. Modern pharmacological studies show Huang Qi enhances immune function and promotes wound healing. Raw Gan Cao has the effect of clearing heat and detoxifying, modern research shows it has steroid-like effects. Therefore, regardless of whether the ulcer is real or virtual fire, adding raw Huang Qi and raw Gan Cao appropriately in the prescription can reduce pain and promote ulcer healing.
4. Maintaining regular bowel movements is key to treating oral ulcers. Oral ulcers are mostly due to internal fire ascending and scorching the oral mucosa. To treat ulcers, use Sheng Di to nourish yin and produce body fluid to extinguish virtual fire, use Hu Zhang to clear heat and reduce fire to extinguish real fire. Clinical studies show high-dose Sheng Di Huang has the effect of nourishing yin, producing body fluid, and lubricating the bowels. Modern pharmacology shows Hu Zhang contains anthraquinone compounds such as emodin, chrysophanol, rhein, and emodin methyl ether, which have significant laxative effects. After taking medicine, regular bowel movements allow real and virtual fire to be expelled through defecation and urination, thus ulcers naturally heal. Besides medication, patients should be advised to drink plenty of plain water, eat fresh vegetables and fruits, keep bowels open, avoid excessive smoking and drinking, reduce spicy and fried foods to minimize fire sources. Also, maintain good oral hygiene, engage in moderate physical activity, strengthen the body—these are important measures to prevent recurrence of oral ulcers.
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