Aphtha is a small white or yellowish ulcer in the mouth, which is surrounded by
redness. It is commonly seen in young children and during the late stage of
febrile diseases. Acute ulcerative stomatitis and herpetic stomatitis may be
differentiated and treated with the principles mentioned in this section.
Etiology and Pathogenesis
A. Asthenic heat: The heat accumulated in the spleen and stomach or the fire
coming from the heart meridian act with the evil derived from the dirty or
injured buccal mucosa to cause local erosions.
B. Asthenic fire: A constitution of yin deficiency or febrile disease or
longstanding diarrhea may lead to consumption of body fluids with a failure to
control fire. An upward attack of asthenic fire results and causes erosions of
Syndrome Differentiation and Therapeutic Principles
A. Syndrome differentiation
(a) In cases caused by the retention of heat in the spleen and stomach or upward
attack of heart-fire, the aphthae are multiple in number, the surrounding mucosa
is bright red in color and the lesion is painful and scorching so that the child
may refuse to eat. It may be accompanied by flushed cheeks, red lips,
salivation, halitosis, fever, thirst, oliguria and constipation.
(b) In cases due to the flaming-up of asthenic fire, the aphthae are fewer, the
surrounding mucosa is reddish in color and the pain is milder. It is accompanied
by normal body temperature or occasionally low fever, restlessness, flushed
cheeks, fatigue and insomnia.
B. Therapeutic principles
For cases attributed to sthenic heat, the therapies of clearing away heat and
toxic materials, purging fire and promoting bowel movement are recommended; for
those attributed to asthenic fire, the therapies of tonifying yin and
suppressing fire are advisable. In addition, external treatment may be
supplemented to reduce swelling, relieve pain and accelerate the healing of
Classification and Treatment
A. Retention of heat in the spleen and stomach
Manifestations: Multiple painful ulcers or widely-spread erosions in the mouth,
redness of the surrounding mucosa, restlessness, thirst, salivation, halitosis,
oliguria with deep-colored urine, constipation, fever, flushed face, red tongue
with yellow coating and rapid pulse.
Therapeutic principles: Clear away heat and toxic materials, purge fire, and
promote bowel movement.
Prescription: The Modification of Powder for Clearing Away Heat in the Upper- or
Fructus Gardeniae 6 g
Fructus Forsythiae 10 g
Radix Scutellariae 6 g
Herba Menthae 3 g
Herba Lophatheri 10 g
Radix et Rhizoma Rhei 3 g
Natrii Sulfas 6 g
Radix Glycyrrhizae 3 g
Remarks: Add Caulis Akebiae (3 g) and Radix Rehmanniae (10 g) for cases with
oliguria and discharge of deep-colored urine. Add Gypsum Fibrosum (30 g,
decocted) and Calcitum (30 g) for those with thirst and predomination of heat.
Omit Natrii Sulfas and Rhei for those with loose stool.
B. Upward attack of heart fire
Manifestations: Multiple ulcers on the tongue surrounded by red mucosa,
restlessness, crying, dryness of the mouth with desire for drinking, oliguria
with deep-colored urine, red tongue tip with yellow coating and rapid pulse.
Therapeutic principles: Clear heart-fire.
Prescription: Decoction for Purging Stomach-Fire and Treating Dark Urine
Rhizoma Coptidis 3 g
Radix Rehmanniae 10 g
Caulis Akebiae 3 g
Medulla Junci 1.5 g
Radix Glycyrrhizae 3 g
Remarks: Add Radix Ophiopogonis (10 g) for cases with dryness of the mouth and
C. Flaming-up of asthenic fire
Manifestations: Few ulcers in the mouth with reddish surrounding mucosa, mild
pain, flushed cheeks, mental fatigue, dryness of the mouth without desire for
drinking, red tongue with little coating and thready and rapid pulse.
Therapeutic principles: Nourish yin, and suppress fire.
Prescription: Decoction of Anemarrhenae, Phellodendri and Rehmanniae
Radix Rehmanniae Praeparata 10 g
Remarks: Add Fructus Ligustri Lucidi (10 g), Semen Cuscutae (10 g) and Herba
Cistanchis (10 g) for cases with frequent recurrence of aphtha. Add Cortex
Cinnamomi (3 g) for those with longstanding aphtha.
Fructus Corni 10 g
Rhizoma Dioscoreae 10 g
Poria 10 g
Rhizoma Alismatis 6 g
Cortex Moutan Radicis 10 g
Rhizoma Anemarrhenae 6 g
Cortex Phellodendri 6 g
Xileisan for widely-spread erosions and Bingpengsan Powder of Dryobalanops
Aromatica Geertn and Borax for the initial stage of sthenia-syndrome.
A. Radix Isatidis (15-30 g) or Folium Isatidis (15-30 g) prepared as decoction;
one dose daily; suitable for cases due to sthenic fire.
B. Fructus Evodiae; prepared as powder; applied on the middle of the sole of the
foot at night and removed the next morning; applicable to cases of asthenic and
Copyright 1995 Hopkins Technology