【评按】口臭多因胃火所致。例一病已数月，服药无效，采用升清降浊清胃之法。方中生石膏清胃热，泻胃火，细辛性散而升，两药相伍，散胃经伏火；升麻升阳明之清阳，又有解毒之功；自芍平肝益脾；黄柏清热燥湿，诸药配合，使清气上升，浊气下降。则口臭可除。例二病程20余年，证属虚阳上越，正治不效，反佐而取胜。此案辨证、用药微细之处，发人深思。
（二十）口疮
例一刘××，女，33岁，初诊日期：1979年10月8日。唇舌溃烂十余载，反复发作，缠绵不愈，此次发病已半月，纳呆食少，呃逆暖气，大便秘结，苔灰黄而浮，脉滑。系湿浊为患、拟七味白术散为法。方药：自术6克霍香10克葛根10克木香3克枳壳10克佩兰10克茯苓10克代储石10克旋复花6克神曲川克莱菔子10克服5剂而愈，随访一年未发。
（段荣书整理：董德懋医疗经验琐谈《中医杂志》2：10，1981）
例二程××，男，50岁。舌尖碎痛，唇颊糜烂，3～4年来反复发作，口干燥，常鼻衄，龈衄，夜寐不安，脉细无力，苔薄。此虚阳上越也。夫阳火可泻，阴火不可泻，故前医投养阴、清热、泻火之剂少效。应反佐以取之。仿费伯雄潜龙汤意，导阳归肾。一味肉桂，处于群阴药之中，引导肾火下降。方药：龙齿9克龟板24克生地15克知母3克黄柏2．4克潞党参4．5克麦冬4．5克牡蛎9克肉桂粉0．6克（吞服）云茯苓6克生甘草3克服上方3剂，口舌糜痛显著减轻，原方续服20剂，症状消失。
（邹云翔经验，黄新吾整理：反佐疗法在临床上的运用，《新医药杂志》6：11，1978）
例三龚、男，38岁，初诊日期：1954年4月28日。患者口腔溃疡数年，反复发作，久治不愈。局部剧痛，伴有口干。下唇内有一卵圆形豆大溃疡，舌尖红，苔薄白，脉沉细。辨证：脾肾阴虚，虚火上炎。治法：滋肾养阴，清热降火。方药：生菟丝子18克黄精12克天门冬15克黄柏（盐炒）12克知母12克金银花9克天花粉9克甘草6克淡竹叶9克5月1日
（二诊）：服上方3剂，溃疡较前缩小，疼痛减轻，仍口干。舌苔脉象同前。前方加玄参12克，麦门冬15克，生石膏24克。5月14日
（三诊）：服药六剂，溃疡愈合。后曾复发，但症状较轻，服上药仍有良效。（《刘惠民医案》）
【评按】口疮系指口舌糜烂生疮。《素问·至真要大论》云：“火气内发，上为口糜”。《诸病源候论·唇口病诸候》云：“脏气热盛，热乘心脾，气冲于口与舌，故今口舌生疮也。”而且对其反复发作的临床特点也有所描写，如《外台秘要》所述：“心脾中热，常患口疮，乍发乍瘥。”概言之，本病多因心脾两经火热所致。一般均以养阴降火为大法。
例一曾按常规久治不愈。董氏审视其病机，诊为脾失健运，湿浊内生，浊气不降，逆而上升，浸淫唇舌而溃。故融燥湿健脾与调理升降于一方，主次兼顾，切中病机。
例二口疮伴有衄血，病期已久。脉证所示，为虚阳上越所致，按一般养阴清热泻火法治之实难取效。盖阳火可泻而阴火不可泻，故于养阴之中反佐肉桂一味，引导肾火下降，其妙用寓意颇深。临床口糜患者不少，若遇常法治之无效时，此二例治法可资借鉴。
例三反复发作已数年，久治不愈，证属脾肾阴虚，虚火上炎，治以滋肾养阴，清热降火，并重用滋阴补肾之品，使虚火下降而阳归于阴，即所谓“壮水之主，以制阳光”。
（二十一）声带麻痹徐××，男，54岁。初诊日期：1978年8月19日。患者两个多月前因行甲状腺手术后）声音突然嘶哑，说不出话。初起两天，饮水呛，咽喉部有阻塞感，而且发紧，外院诊为“声带麻痹”。给予中西医药治疗后，饮水已不呛，但声哑不愈，麻痹未恢复。现症：声哑，咽喉发紧，说话时喉部费力，疲劳感，纳可，二便正常。脉弦细，舌苔薄白。局部检查：咽后壁淋巴滤泡增殖，声带轻度充血，右侧声带轻度外展位，左侧声带发音时代偿。诊断为声带麻痹。辨证：咽喉者，肺胃之所系，术后气阴两伤，肺胃两虚，津液不得上承，血气凝滞于咽喉，浊气不化，故致此症。治法：益气和血，清理咽喉。方药：玉竹1O克太子参10克当归须10克橘络10克麦冬10克鸡血藤20克，菖蒲10克射干10克杷叶10克诃子10克血余炭10克甘草3克水煎服。二诊：上方服15剂后，声嘶哑明显好转，声音较前洪亮，说话亦不费力、多说话亦不觉累。诊脉细，舌苔薄白，大使稀，日2～3次。局部检查：声带右侧已可活动，发音时右侧声带为中间位。症已好转，仍以原方去玉竹、太子参、橘络、麦冬、鸡血藤、菖蒲，加桔梗、荷叶边、苡仁、荧实，再服12剂。患者前后共服药27剂，右侧声带恢复正常，声音恢复而告愈。
（耿鉴庭主治，李书良整理：中医药治愈声带麻痹一例，《中医杂志》2：72，198Q）
【评按】声带麻痹的临床证候，大致属于中医“喉喑”范畴。患者于甲状腺手术后突然发病，中医名为“暴暗”。暴喑以实证居多，本案则因术后气阴耗伤、肺胃。两虚，影响津液上承和血气的流布，故而虚实互见，而又以虚证较为突出。治以益气阴、和血脉为主，兼以清咽、通痹、缓急法，方药标本兼顾，配伍亦较活泼可取。
【评按】口臭多因胃火所致。例一病已数月，服药无效，采用升清降浊清胃之法。方中生石膏清胃热，泻胃火，细辛性散而升，两药相伍，散胃经伏火；升麻升阳明之清阳，又有解毒之功；白芍平肝益脾；黄柏清热燥湿，诸药配合，使清气上升，浊气下降。则口臭可除。例二病程20余年，证属虚阳上越，正治不效，反佐而取胜。此案辨证、用药微细之处，发人深思。
（二十）口疮
例一刘××，女，33岁，初诊日期：1979年10月8日。唇舌溃烂十余载，反复发作，缠绵不愈，此次发病已半月，纳呆食少，呃逆暖气，大便秘结，苔灰黄而浮，脉滑。系湿浊为患、拟七味白术散为法。方药：白术6克藿香10克葛根10克木香3克枳壳10克佩兰10克茯苓10克代赭石10克旋覆花6克神曲、麦芽、莱菔子各适量，服5剂而愈，随访一年未发。
（段荣书整理：董德懋医疗经验琐谈《中医杂志》2：10，1981）
例二程××，男，50岁。舌尖碎痛，唇颊糜烂，3～4年来反复发作，口干燥，常鼻衄，龈衄，夜寐不安，脉细无力，苔薄。此虚阳上越也。夫阳火可泻，阴火不可泻，故前医投养阴、清热、泻火之剂少效。应反佐以取之。仿费伯雄潜龙汤意，导阳归肾。一味肉桂，处于群阴药之中，引导肾火下降。方药：龙齿9克龟板24克生地15克知母3克黄柏2.4克潞党参4.5克麦冬4.5克牡蛎9克肉桂粉0.6克（吞服）云茯苓6克生甘草3克服上方3剂，口舌糜痛显著减轻，原方续服20剂，症状消失。
（邹云翔经验，黄新吾整理：反佐疗法在临床上的运用，《新医药杂志》6：11，1978）
例三龚、男，38岁，初诊日期：1954年4月28日。患者口腔溃疡数年，反复发作，久治不愈。局部剧痛，伴有口干。下唇内有一卵圆形豆大溃疡，舌尖红，苔薄白，脉沉细。辨证：脾肾阴虚，虚火上炎。治法：滋肾养阴，清热降火。方药：生菟丝子18克黄精12克天门冬15克黄柏（盐炒）12克知母12克金银花9克天花粉9克甘草6克淡竹叶9克5月1日
（二诊）：服上方3剂，溃疡较前缩小，疼痛减轻，仍口干。舌苔脉象同前。前方加玄参12克，麦门冬15克，生石膏24克。5月14日
（三诊）：服药六剂，溃疡愈合。后曾复发，但症状较轻，服上药仍有良效。（《刘惠民医案》）
【评按】口疮系指口舌糜烂生疮。《素问·至真要大论》云：“火气内发，上为口糜”。《诸病源候论·唇口病诸候》云：“脏气热盛，热乘心脾，气冲于口与舌，故今口舌生疮也。”而且对其反复发作的临床特点也有所描写，如《外台秘要》所述：“心脾中热，常患口疮，乍发乍瘥。”概言之，本病多因心脾两经火热所致。一般均以养阴降火为大法。
例一曾按常规久治不愈。董氏审视其病机，诊为脾失健运，湿浊内生，浊气不降，逆而上升，浸淫唇舌而溃。故融燥湿健脾与调理升降于一方，主次兼顾，切中病机。
例二口疮伴有衄血，病期已久。脉证所示，为虚阳上越所致，按一般养阴清热泻火法治之实难取效。盖阳火可泻而阴火不可泻，故于养阴之中反佐肉桂一味，引导肾火下降，其妙用寓意颇深。临床口糜患者不少，若遇常法治之无效时，此二例治法可资借鉴。
例三反复发作已数年，久治不愈，证属脾肾阴虚，虚火上炎，治以滋肾养阴，清热降火，并重用滋阴补肾之品，使虚火下降而阳归于阴，即所谓“壮水之主，以制阳光”。
（二十一）声带麻痹徐××，男，54岁。初诊日期：1978年8月19日。患者两个多月前因行甲状腺手术后声音突然嘶哑，说不出话。初起两天，饮水呛，咽喉部有阻塞感，而且发紧，外院诊为“声带麻痹”。给予中西医药治疗后，饮水已不呛，但声哑不愈，麻痹未恢复。现症：声哑，咽喉发紧，说话时喉部费力，疲劳感，纳可，二便正常。脉弦细，舌苔薄白。局部检查：咽后壁淋巴滤泡增殖，声带轻度充血，右侧声带轻度外展位，左侧声带发音时代偿。诊断为声带麻痹。辨证：咽喉者，肺胃之所系，术后气阴两伤，肺胃两虚，津液不得上承，血气凝滞于咽喉，浊气不化，故致此症。治法：益气和血，清理咽喉。方药：玉竹10克太子参10克当归须10克橘络10克麦冬10克鸡血藤20克，菖蒲10克射干10克杷叶10克诃子10克血余炭10克甘草3克水煎服。二诊：上方服15剂后，声嘶哑明显好转，声音较前洪亮，说话亦不费力、多说话亦不觉累。诊脉细，舌苔薄白，大便稀，日2～3次。局部检查：声带右侧已可活动，发音时右侧声带为中间位。症已好转，仍以原方去玉竹、太子参、橘络、麦冬、鸡血藤、菖蒲，加桔梗、荷叶边、苡仁、芡实，再服12剂。患者前后共服药27剂，右侧声带恢复正常，声音恢复而告愈。
（耿鉴庭主治，李书良整理：中医药治愈声带麻痹一例，《中医杂志》2：72，1980）
【评按】声带麻痹的临床证候，大致属于中医“喉喑”范畴。患者于甲状腺手术后突然发病，中医名为“暴暗”。暴喑以实证居多，本案则因术后气阴耗伤、肺胃两虚，影响津液上承和血气的流布，故而虚实互见，而又以虚证较为突出。治以益气阴、和血脉为主，兼以清咽、通痹、缓急法，方药标本兼顾，配伍亦较活泼可取。
[Commentary] Halitosis is mostly caused by Stomach Fire (Wei Huo, stomach fire). In Case 1, the illness had persisted for several months without effect from medication; thus, a method of ascending the clear and descending the turbid to clear the Stomach was adopted. In the prescription, Shigao (Gypsum Fibrosum) clears Stomach heat and drains Stomach fire; Xixin (Asari Radix et Rhizoma), with its dispersing and ascending nature, combined with Gypsum, disperses latent fire in the Stomach meridian; Shengma ( Cimicifugae Rhizoma) ascends the clear Yang of the Yangming channel and also possesses detoxifying properties; Baishao (Paeoniae Radix Alba) soothes the Liver and benefits the Spleen; Huangbai (Phellodendri Cortex) clears heat and dries dampness. The coordination of these herbs causes the clear Qi to ascend and the turbid Qi to descend, thereby eliminating halitosis. In Case 2, the disease course exceeded 20 years, and the pattern belonged to Deficient Yang floating upward. Standard treatment was ineffective, but counter-assistance (Fan Zuo, using a small amount of warming herb in a cooling formula) achieved success. The subtle aspects of syndrome differentiation and medication in this case are thought-provoking.
(XX) Mouth Ulcers
Case 1: Liu XX, female, 33 years old. First visit date: October 8, 1979. Ulceration of the lips and tongue for over ten years, recurring repeatedly and lingering without healing. This episode has lasted half a month. Symptoms include poor appetite and reduced food intake, hiccups and belching, constipation, gray-yellow floating coating, and slippery pulse. The pathology is attributed to Damp-Turbidity (Shi Zhuo, damp-turbid pathogenic factors). The Seven-Ingredient Baidu Powder (Qiwai Baizhu San) method was proposed. Prescription: Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Huoxiang (Agastaches Herba) 10g, Gegen (Puerariae Lobatae Radix) 10g, Muxiang (Aucklandiae Radix) 3g, Zhike (Aurantii Fructus Immaturus) 10g, Peilan (Eupatorii Herba) 10g, Fuling (Poria) 10g, Daizheshi (Ochra) 10g, Xuanfuhua (Inulae Flos) 6g, Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Laifuzi (Raphini Semen) [dosages implied as appropriate]. After taking 5 doses, the patient recovered; follow-up for one year showed no recurrence.
(Collected by Duan Rongshu: Brief Talk on Medical Experience of Dong Demao, *Journal of Traditional Chinese Medicine* 2:10, 1981)
Case 2: Cheng XX, male, 50 years old. Fragmented pain at the tip of the tongue, erosion of lips and cheeks, recurring repeatedly for 3–4 years. Dry mouth, frequent epistaxis (nosebleed) and gingival bleeding, restless sleep at night, fine and weak pulse, thin coating. This is Deficient Yang floating upward. While Yang Fire can be drained, Yin Fire cannot be drained; therefore, previous prescriptions of nourishing Yin, clearing heat, and draining fire yielded little effect. Counter-assistance should be employed. Following the intent of Fe Boxiong's Qianlong Tang (Hidden Dragon Decoction), guide Yang back to the Kidney. A single dose of Rougui (Cinnamomi Cortex) amidst a group of Yin-nourishing herbs guides Kidney Fire downward. Prescription: Longchi (Dentis Mammoth) 9g, Guiban (Testudinis Carapax et Plastrum) 24g, Shengdi (Rehmanniae Radix) 15g, Zhimu (Anemarrhenae Rhizoma) 3g, Huangbai (Phellodendri Cortex) 2.4g, Lushen (Codonopsis Radix) 4.5g, Maidong (Ophiopogonis Radix) 4.5g, Muli (Concha Ostreae) 9g, Rougui powder 0.6g (swallowed), Yunfuling (Poria) 6g, Shenggancao (Glycyrrhizae Radix et Rhizoma) 3g. After taking 3 doses of the above prescription, oral and lingual erosion and pain significantly decreased; continuing the original prescription for 20 doses resulted in symptom disappearance.
(Experience of Zou Yunxiang, collected by Huang Xinwu: Application of Counter-Assistance Therapy in Clinical Practice, *New Medical Journal* 6:11, 1978)
Case 3: Gong, male, 38 years old. First visit date: April 28, 1954. The patient suffered from oral ulcers for several years, recurring repeatedly and resistant to long-term treatment. Severe local pain accompanied by dry mouth. An oval, bean-sized ulcer on the inner lower lip; red tongue tip, thin white coating, deep and fine pulse. Syndrome Differentiation: Yin deficiency of Spleen and Kidney with Deficient Fire flaming upward. Therapeutic Method: Nourish Kidney and Yin, clear heat and drain fire. Prescription: Shengtiansizi (Cuscutae Semen) 18g, Huangjing (Polygonati Rhizoma) 12g, Tianmendong (Asparagi Radix) 15g, Huangbai (Phellodendri Cortex, salt-fried) 12g, Zhimu (Anemarrhenae Rhizoma) 12g, Jinyinhua (Lonicerae Japonicae Flos) 9g, Tianhuafen (Trichosanthis Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Danzhuye (Lophatheri Herba) 9g. May 1st
(Second Visit): After taking 3 doses of the above prescription, the ulcer shrank compared to before, pain decreased, but dry mouth persisted. Tongue coating and pulse remained the same. Added Xuanshen (Scrophulariae Radix) 12g, Maimendong (Ophiopogonis Radix) 15g, Shigao (Gypsum Fibrosum) 24g to the previous formula. May 14th
(Third Visit): After taking six doses, the ulcer healed. It recurred later, but symptoms were milder, and the aforementioned medicine still proved effective. (*Medical Cases of Liu Huimin*)
[Commentary] Mouth ulcers refer to erosion and ulceration of the mouth and tongue. The *Suwen: Zhi Zhen Yao Da Lun* states: "When Fire Qi erupts internally, it manifests as oral erosion." The *Zhubing Yuanhou Lun: Disorders of Lips and Mouth* states: "When organ Qi is excessively hot, heat affects the Heart and Spleen, and Qi rushes to the mouth and tongue, causing mouth and tongue ulcers." It also describes the clinical characteristic of recurrence, as stated in the *Waitai Miyao*: "Heat in the Heart and Spleen often leads to mouth ulcers, which appear and disappear intermittently." In summary, this disease is mostly caused by Fire-Heat in the Heart and Spleen meridians. Generally, nourishing Yin and lowering Fire is the major principle.
Case 1 had not healed despite conventional long-term treatment. Dr. Dong examined the pathology and diagnosed Spleen failing to transport and transform, leading to internal generation of Damp-Turbidity. Turbid Qi failed to descend and reversed upward, infiltrating the lips and tongue causing ulceration. Thus, drying dampness and strengthening the Spleen were integrated with regulating ascending and descending functions in one formula, addressing both primary and secondary aspects and hitting the pathology accurately.
Case 2 involved mouth ulcers accompanied by bleeding, with a long disease duration. The pulse and symptoms indicated Deficient Yang floating upward. Treating with general methods of nourishing Yin, clearing heat, and draining fire would hardly be effective. Since Yang Fire can be drained but Yin Fire cannot, adding a single dose of Rougui (Cinnamon Twig) among Yin-nourishing herbs guides Kidney Fire downward; its subtle application holds profound meaning. There are many patients with oral erosion in clinical practice; if standard treatments fail, these two cases offer reference for therapeutic approaches.
Case 3 had been recurring for several years and resistant to treatment. The pattern belonged to Yin deficiency of Spleen and Kidney with Deficient Fire flaming upward. Treatment focused on nourishing Kidney and Yin, clearing heat and draining fire, heavily using Yin-nourishing and Kidney-tonifying substances to cause Deficient Fire to descend and Yang to return to Yin, known as "strengthening the master of Water to control the sunlight."
(XXI) Vocal Cord Paralysis
Xu XX, male, 54 years old. First visit date: August 19, 1978. More than two months prior, due to thyroid surgery, the patient's voice suddenly became hoarse, unable to speak. For the first two days, drinking water caused choking, and there was a sense of obstruction and tightness in the throat. An external hospital diagnosed "Vocal Cord Paralysis." After Western and Chinese medical treatment, drinking no longer caused choking, but hoarseness persisted, and paralysis did not recover. Current symptoms: Hoarseness, tightness in the throat, effort when speaking, fatigue sensation, normal appetite, normal urination and defecation. String-like and fine pulse, thin white coating. Local examination: Proliferation of lymphoid follicles on the posterior pharyngeal wall, mild congestion of vocal cords, slight abduction position of the right vocal cord, compensatory phonation of the left vocal cord. Diagnosis: Vocal Cord Paralysis. Syndrome Differentiation: The throat is connected to the Lung and Stomach. Post-surgery, both Qi and Yin were damaged, resulting in deficiency of Lung and Stomach. Fluids could not ascend, and Blood-Qi stagnated in the throat, failing to transform turbid Qi, thus causing this condition. Therapeutic Method: Benefit Qi and harmonize Blood, clear and purify the throat. Prescription: Yuzhu (Polygonati Odorati Rhizoma) 10g, Taizishen (Pseudostellariae Radix) 10g, Dangguixu (Angelicae Sinensis Radix) 10g, Juluo (Citri Reticulatae Pericarpium Retinervum) 10g, Maidong (Ophiopogonis Radix) 10g, Jixueteng (Spatholobi Caulis) 20g, Changpu (Acori Tatarinowii Rhizoma) 10g, Shegan (Belamcandae Rhizoma) 10g, Paye (Eriobotryae Folium) 10g, Hezi (Terminalia Chebulae Fructus) 10g, Xuyutan (Capillis Carbonisatus) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g. Decoct in water and take orally. Second Visit: After taking 15 doses of the above prescription, hoarseness improved significantly, voice became louder, speaking required less effort, and talking more did not cause fatigue. Pulse was fine, tongue coating thin white, stool loose, 2–3 times daily. Local examination: Right vocal cord could now move; during phonation, the right vocal cord was in the mid-position. Symptoms had improved. Still using the original formula, remove Yuzhu, Taizishen, Juluo, Maidong, Jixueteng, Changpu; add Jiegeng (Platycodonis Radix), Heyebian (Nelumbinis Folium), Yiren (Coicis Semen), Qianshi (Euryales Semen). Take another 12 doses. The patient took a total of 27 doses. The right vocal cord returned to normal, voice recovered, and the case was cured.
(Mainly treated by Geng Jianting, collected by Li Shuliang: One Case of Vocal Cord Paralysis Cured by Chinese and Western Medicine, *Journal of Traditional Chinese Medicine* 2:72, 1980)
[Commentary] The clinical manifestations of vocal cord paralysis roughly belong to the category of "Hou Yin" (Throat Aphonia) in Traditional Chinese Medicine. The sudden onset after thyroid surgery is named "Bao Yin" (Sudden Aphonia) in TCM. Bao Yin is mostly excess patterns; however, this case was due to consumption of Qi and Yin post-surgery, deficiency of Lung and Stomach, affecting the ascent of fluids and distribution of Blood-Qi, presenting both excess and deficiency, with deficiency being more prominent. Treatment primarily focused on benefiting Qi and Yin, harmonizing blood vessels, supplemented by clearing the throat, unblocking obstructions, and relieving spasms. The prescription addressed both root and branch, and the compatibility was flexible and commendable.