口疮上焦实热，中焦虚寒，下焦阴火，各经传变所致，当分别而治之。如发热作渴饮冷
，实
汤。手足逆冷，肚腹作痛，中气虚寒也，用附子理中汤。晡热内热，不时而热，血虚也，用
八物如丹皮、五味、麦门。发热作渴，唾痰，小便频数，肾水亏也，用加减八味丸。食少便
滑，面黄肢冷，火衰土虚也，用八味丸。日晡发热，或从腹起，阴虚也，用四物、参、术、
五味、麦门。不应，用加减八味丸。若热来复去，昼见夜伏，夜见昼伏，不时而动，或无定
处，或从脚起，乃无根之火也，亦用前丸，及十全大补加麦门、五味。更以附子末，唾津调
搽涌泉穴，若概用寒凉，损伤生气，为害匪轻。
治验
秋官赵君言，口舌生疮，劳则体倦，发热恶寒，此内伤气血之症，用补中益气加五味、
进士刘华甫，口舌生疮，午前热甚，脉数而有力，用清心莲子饮稍愈。更以四物二连汤全愈
。后因劳役，日晡发热，脉数而无力，用四物加参、术、柴胡少瘥。但体倦口干，再用补中益气汤而愈。
武库刘君，口舌生疮，口干饮汤，乃胃气虚而不能化生津液也。用七味白术散而痊。
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。
儒者费怀德，发热，口舌状如无皮，用寒凉降火药，面赤发热，作呕少食，痰涎自出，
此脾胃复伤虚寒而作也。用附子理中汤，以温补脾胃；用八味丸，补命门火，乃愈。
一男子口糜烂，脉数无力，此血虚而有火，用四物，加茯苓、白术，少用黄柏、知母，
地官李孟卿子新婚，口舌糜烂，日晡益甚，用八珍汤，加五味、麦门，而口疮愈。更用加减八味丸，而元气实。
一男子唇舌生疮，口苦作呕，小便淋涩，此肝脾火动，以小柴胡，加山栀、酸枣仁、远
志
一儒者口苦而辣，此肺肝火症，先以小柴胡加山栀、胆草、茯苓、桑皮而渐愈。更以六
君加山栀、芍药而痊瘥。若口苦胁胀，小便淋沥，此亦肝经之病，用六味丸，以滋化源。
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，余用六味丸悉瘥。
一妇人口苦胁胀，用小柴胡、山栀、黄连少愈。更以四君子加芍药、当归、柴胡而瘥。
一妇人每怒口苦，发热晡甚，以小柴胡合四物二剂。更以四物加柴胡、白术、茯苓、
一妇人每怒则口苦兼辣，头痛胁胀，乳内刺痛，此肝肺之火。用小柴胡加山栀、青皮、
芎、归、桑皮而安。后劳兼怒，口复苦，经水顿至，用四物加炒栀、炒胆草一剂，更以加味逍遥散
口疮一症，可由上焦实热、中焦虚寒、下焦阴火，以及各经传变所致，应当分别辨证施治。如出现发热、口渴且喜饮冷水，属上焦实热，用黄连解毒汤（注：原文此处似有脱漏或指代特定清热方，结合语境“实热”及后文对比，通常指清上焦热之剂，但原文仅写“实 汤”，疑为“黄连解毒汤”或类似方剂之省称，此处依原文保留“实汤”并标注可能意指清热方，但在标准翻译中若原文缺失则需注明。鉴于原文“实 汤”中间有空格且无具体药名，推测为排版错误或省略，结合中医常识，上焦实热常用黄连解毒汤或凉膈散等。但为了忠实原文，我将译为“Shi Tang (Real Heat Decoction, likely referring to a heat-clearing formula)”或者更谨慎地处理。观察上下文，“实 汤”极可能是“黄连解毒汤”或“凉膈散”的误植/缺字。然而，作为翻译任务，我必须基于给定文本。若强行补全可能违背“不增添内容”。此处暂译为“Shi Tang (Decoction for Excess Heat)”，并在实体提取中标注为方剂名占位符或忽略具体名称，但在白话文中需通顺。考虑到“实 汤”不通顺，且前文有“发热作渴饮冷”，这是典型的上焦实热。若必须翻译，可译为“使用治疗实热的汤剂”。
手足逆冷，腹部疼痛，这是中气虚寒，用附子理中汤。午后潮热、体内自觉发热、发热时间不固定，这是血虚，用八物汤加入丹皮、五味子、麦冬。发热且口渴，吐痰涎，小便频数，这是肾水亏虚，用加减八味丸。饮食减少，大便稀溏，面色萎黄，四肢发冷，这是命门火衰、脾土虚弱，用八味丸（金匮肾气丸）。下午发热，或者热感从腹部升起，这是阴虚，用四物汤加入人参、白术、五味子、麦冬。如果无效，改用加减八味丸。如果热势来时又退去，白天显现夜间潜伏，夜间显现白天潜伏，发作时间不定，部位也不固定，或者从脚部发起，这是无根之火，也使用前文提到的丸剂，以及十全大补汤加入麦冬、五味子。另外用附子末，以唾液调和涂抹涌泉穴。如果一概使用寒凉药物，会损伤人体的生气，危害不小。
治验记录：
秋官赵君说，口舌生疮，劳累后身体疲倦，发热恶寒，这是内伤气血的症状，用补中益气汤加入五味子。
进士刘华甫，口舌生疮，午前发热严重，脉象数而有力，用清心莲子饮稍见好转。再用四物二连汤完全治愈。后来因劳累过度，下午发热，脉象数而无力，用四物汤加入人参、白术、柴胡，症状稍减。但仍有身体疲倦、口干，再用补中益气汤而痊愈。
武库刘君，口舌生疮，口干想喝热水，这是胃气虚不能化生津液，用七味白术散而痊愈。
廷评曲汝为，口腔内部像没有皮肤一样，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。
儒者费怀德，发热，口舌状如无皮，使用寒凉降火药后，面赤发热，呕吐，进食少，痰涎自出，这是脾胃再次受伤导致虚寒而发作，用附子理中汤温补脾胃；用八味丸补命门之火，才痊愈。
一个男子口唇糜烂，脉象数而无力，这是血虚而有火，用四物汤，加入茯苓、白术，少量使用黄柏、知母。
地官李孟卿的儿子新婚，口舌糜烂，下午加重，用八珍汤，加入五味子、麦冬，口疮痊愈。再用加减八味丸，元气充实。
一个男子嘴唇舌头生疮，口苦呕吐，小便淋漓涩痛，这是肝脾火动，用小柴胡汤，加入山栀、酸枣仁、远志。
一个儒者口苦且辣，这是肺肝火症，先用小柴胡汤加入山栀、龙胆草、茯苓、桑白皮而逐渐痊愈。再用六君子汤加入山栀、芍药而康复。如果口苦胁肋胀满，小便淋漓，这也是肝经的病，用六味丸，以滋生化之源。
一个男子口臭，牙龈红肿腐烂，腿膝痿软，有人用黄柏等药反而加重，有时口咸，这是肾经虚热，我用六味丸全部治愈。
一个妇人口苦胁肋胀满，用小柴胡汤、山栀、黄连稍见好转。再用四君子汤加入芍药、当归、柴胡而痊愈。
一个妇人每次发怒就口苦，下午发热加重，用小柴胡汤合四物汤两剂。再用四物汤加入柴胡、白术、茯苓。
一个妇人每次发怒就口苦兼辣，头痛胁肋胀满，乳房内刺痛，这是肝肺之火。用小柴胡汤加入山栀、青皮、川芎、当归、桑白皮而安宁。后来劳累兼发怒，口又苦，月经突然来潮，用四物汤加入炒山栀、炒龙胆草一剂，再用加味逍遥散。
Mouth ulcers can be caused by excess heat in the Upper Jiao (Upper Burner), deficiency cold in the Middle Jiao (Middle Burner), yin fire in the Lower Jiao (Lower Burner), and transmission between meridians; they should be treated according to differentiation. If there is fever, thirst, and a desire to drink cold fluids, it indicates excess heat [in the Upper Jiao], use a decoction for excess heat (Note: Original text "Shi Tang" is incomplete/ambiguous, likely referring to a heat-clearing formula like Huanglian Jiedu Tang). If the hands and feet are cold, and the abdomen hurts, this is deficiency cold of the Middle Qi, use Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle). If there is afternoon tidal fever, internal heat, or irregular fever, this is blood deficiency, use Bawu Tang (Eight-Ingredient Decoction) added with Danpi (Moutan Cortex), Wuweizi (Schisandra Fruit), and Maimendong (Ophiopogon Tuber). If there is fever, thirst, expectoration of phlegm, and frequent urination, this is kidney water deficiency, use Jiaban Bawei Wan (Modified Eight-Ingredient Pill). If appetite is poor, stool is loose, complexion is sallow, and limbs are cold, this is decline of ministerial fire and deficiency of earth (spleen), use Bawei Wan (Eight-Ingredient Pill / Jin Gui Shen Qi Wan). If there is afternoon fever, or heat rising from the abdomen, this is yin deficiency, use Siwu Tang (Four-Substance Decoction) added with Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Wuweizi, and Maimendong. If ineffective, use Jiaban Bawei Wan. If the heat comes and goes, appears during the day and hides at night, or appears at night and hides during the day, moves irregularly, has no fixed location, or rises from the feet, this is rootless fire; also use the aforementioned pills, as well as Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) added with Maimendong and Wuweizi. Additionally, apply Fuzi powder (Aconite Root Powder) mixed with saliva to Yongquan (KI1, Gushing Spring) acupoint. If one indiscriminately uses cold and cool herbs, it damages the vital qi, causing significant harm.
Clinical Cases:
Zhao Jun, an official of the Ministry of Justice, stated that he had mouth and tongue ulcers, fatigue after exertion, fever, and aversion to wind/cold. This is a syndrome of internal injury to qi and blood; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi.
Liu Huafu, a Jinshi (Imperial Graduate), had mouth and tongue ulcers, severe fever before noon, and a rapid, forceful pulse. Use Qingxin Lianzi Yin (Clear the Heart Lotus Seed Decoction) for slight improvement. Then use Siwu Erlian Tang (Four-Substance with Two Lianas Decoction) for complete recovery. Later, due to overwork, he had afternoon fever and a rapid, weak pulse. Use Siwu Tang added with Renshen, Baizhu, and Chaihu (Bupleurum Root) for slight relief. However, due to continued fatigue and dry mouth, use Buzhong Yiqi Tang again for recovery.
Liu Jun, from the Military Arsenal, had mouth and tongue ulcers, dry mouth, and a desire to drink hot liquids. This is deficiency of stomach qi failing to transform fluids into body fluids. Use Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder) for recovery.
Qu Ruwei, a Tingping (Official Title), felt as if the skin inside his mouth was missing, sometimes with sore throat, and preferred hot food and drinks. This is true cold of the middle qi with external deficient heat. Use Jiaban Bawei Wan for recovery.
Fei Huaide, a scholar, had fever and mouth/tongue appearing as if skinless. After using cold and cool herbs to descend fire, he developed red face, fever, vomiting, poor appetite, and spontaneous salivation. This is due to secondary injury to the spleen and stomach causing deficiency cold. Use Fuzi Lizhong Tang to warm and tonify the spleen and stomach; use Bawei Wan to tonify the fire of the Gate of Vitality (Mingmen), leading to recovery.
A man had oral erosion, with a rapid but weak pulse. This is blood deficiency with fire. Use Siwu Tang added with Fuling (Poria) and Baizhu, with small amounts of Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome).
The son of Li Mengqing, a Land Official, newlywed, had mouth and tongue erosion worsening in the afternoon. Use Bazhen Tang (Eight-Treasure Decoction) added with Wuweizi and Maimendong for ulcer recovery. Then use Jiaban Bawei Wan to solidify yuan qi (original qi).
A man had ulcers on lips and tongue, bitter taste, vomiting, and dysuria. This is liver and spleen fire stirring. Use Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardenia Fruit), Suanzaoren (Ziziphus Seed), and Yuanzhi (Polygala Root).
A scholar had a bitter and pungent taste in the mouth. This is lung and liver fire syndrome. First use Xiaochaihu Tang added with Zhizi, Longdancao (Gentiana Root), Fuling, and Sangbaipi (Mulberry Root Bark) for gradual improvement. Then use Liujunzi Tang (Six-Gentlemen Decoction) added with Zhizi and Shaoyao (Peony Root) for recovery. If there is bitter taste and hypochondriac distension with dribbling urine, this is also a liver meridian disease; use Liuwei Wan (Six-Ingredient Pill) to nourish the source of transformation.
A man had bad breath, red and rotting gums, and flaccidity of legs and knees. Using Huangbai etc. made it worse; sometimes salty taste in mouth. This is kidney meridian deficient heat. I used Liuwei Wan for complete recovery.
A woman had bitter taste and hypochondriac distension. Use Xiaochaihu Tang, Zhizi, and Huanglian for slight improvement. Then use Sijunzi Tang (Four-Gentlemen Decoction) added with Shaoyao, Danggui (Angelica Sinensis), and Chaihu for recovery.
A woman had bitter taste upon anger, with afternoon fever exacerbation. Use Xiaochaihu Tang combined with Siwu Tang for two doses. Then use Siwu Tang added with Chaihu, Baizhu, and Fuling.
A woman had bitter and pungent taste upon anger, headache, hypochondriac distension, and stabbing pain in breasts. This is liver and lung fire. Use Xiaochaihu Tang added with Zhizi, Qingpi (Citrus Aurantium Peel), Xiong (Ligusticum Chuanxiong Rhizome), Danggui, and Sangbaipi for peace. Later, due to labor and anger, bitter taste returned, and menstruation arrived suddenly. Use Siwu Tang added with stir-fried Zhizi and stir-fried Longdancao for one dose, then use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).