Treatment of recurrent oral ulcers with the method of thick soil and restraining fire

• Post By: 汉青
• Date: 2019-11-21
• Category: Case Studies, Clinical Reflections

Oral ulcer is a common and frequently-occurring clinical disease. The conventional treatment is the fire-clearing method. Taking the patent medicine Niuhuang Shangqing Pill or Huanglian Shangqing Pill generally has good curative effect. There are also some complicated cases, such as those with mixed cold and heat in the body and recurring oral ulcers. Treatment with Licorice Xiexin Decoction often yields very good results. However, there are still some oral ulcers that are difficult to cure. During today’s teaching and research activity, a teacher mentioned the method of thickening earth to collect fire. After careful inspection, it turned out to be unusual.

This method should have come from the Qing Dynasty, especially in the treatment of epistaxis in Jing, where thick soil was used to suppress fire. It is believed that the spleen and stomach are deficient and cold, and yin fire is internally generated. Of course, when it comes to Yin Fire, Li Dongyuan naturally comes to mind, so many families choose Buzhong Yiqi Decoction as the main method of thickening the soil.

In the final analysis, the theoretical basis of this treatment method is that “spleen deficiency cannot suppress fire.” This is a very novel idea. The main manifestation of spleen deficiency should be Qi deficiency. After all, “spleen and stomach Qi deficiency cannot rise and float, because yin fire damages the Qi that grows.” However, according to Zhu Danxi, there will be no fire when Qi is insufficient, so this fire is naturally a deficient fire, not a strong fire. It is feasible to restrain it by tonifying deficiency. Otherwise, something like fire will become more and more prosperous as it is replenished.

Recently I encountered a case of recurring oral ulcers. An elderly man with a strong body had recurring ulcers for nearly ten years, almost every day, and new ones would grow immediately after they disappeared. Therefore, he took Niuhuang Jiedu Tablets all the year round, which would make him feel better, otherwise the pain would be unbearable. Upon diagnosis, the fur was thin and slightly red, the tongue was slippery, the pulse was slippery and rapid, and the blood seemed to be surging, so he was given a combination of Licorice Xiexin Decoction and Longdan Xiegan Decoction. The ulcer subsided after taking three doses, but a new one appeared 5 days later. After taking the medicine again, it subsided and reoccurred again. It seemed that it had entered an infinite loop again, and the patient did not return for follow-up visits. I think this situation should also be a symptom of spleen deficiency and turbulence, and a large number of spleen-strengthening drugs should be used on the basis of clearing fire. I guess that adding Buzhong Yiqi or Lizhong Decoction should be appropriate. It is worth trying if you encounter such situations in the future.

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口腔溃疡是临床的常见病多发病，常规治疗是清火法，服用成药牛黄上清丸或黄连上清丸一般都有良好的疗效。亦有些复杂的情况，例如身体寒热错杂，口腔溃疡反复发作的，用甘草泻心汤治疗往往收效甚佳，但是，仍有部分口腔溃疡难以治愈。今日教研活动，有老师提到了厚土敛火法，细细察看，果然不同寻常。

此法应出自清朝， 尤在泾治齿衄善用厚土敛火，认为脾胃虚寒，阴火内生，上干清窍，迫血妄行而致齿衄 。当然提到阴火，自然想到了李东垣，所以有许多一家选用补中益气汤作为厚土的主要方法。

这个治法归根结底，其理论基础是“脾虚不能敛火”，这是个很新奇的提法，脾虚主要表现还应该是气虚，毕竟“脾胃气虚不能升浮,为阴火伤其生发之气” ，然而按照朱丹溪的说法，气不足不会有火，那么这个火自然是虚火，不是旺火，通过补虚进行收敛是可行的。否则，火这种东西是越补越旺。

近期我遇到了一例反复发作的口腔溃疡。一老年男性，体壮，溃疡反复发作近十年，基本上每天都会有，消下去马上就会长出新的，所以常年服用牛黄解毒片，吃上就会好一些，否则疼痛难忍。刻诊苔薄质略红，舌水滑，脉滑数，一派气血奔腾的样子，于是给了甘草泻心汤合龙胆泻肝汤加减。吃下三副后溃疡消退，但是5天之后又新发一个，再服药再消退再发，似乎又进入了死循环，此后患者不再复诊。我想，这种情况应该也是脾虚气浮的表象，应该在清火的基础上加用大量健脾药物。我猜想，加补中益气或者理中汤应该都是合适的，日后遇到此类情况值得一试。