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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 buccal mucosa.

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 ulcers.

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 Middle-Jiao

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 tongue.

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
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

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.

External Therapy

Xileisan for widely-spread erosions and Bingpengsan Powder of Dryobalanops Aromatica Geertn and Borax for the initial stage of sthenia-syndrome.

Experiential Prescriptions

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 sthenic types.

Copyright 1995 Hopkins Technology


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