Differentiation and Treatment of Recurrent Oral Ulcer from False and Real Specimens

: Recurrent oral ulcer is the most common oral mucosal disease in clinical practice. It often occurs repeatedly and has obvious local pain. Clinical treatment is difficult and difficult to find a good method Mark this virtual to real, this paper expounds the disease of this virtual pathogenesis characteristics, emphasis on traditional Chinese medicine in the treatment of recurrent aphthous should be severely, puts forward the qing xie fu fire, tonifying spleen zi kidney treatment, the accurate syndrome differentiation, flexible, providing and 1 proven cases were presented as evidence, designed to radically reduce the onset of symptoms and reduce the recurrence rate, in order to transfer the rich clinical experience in traditional Chinese medicine.


Introduction
Recurrent Oral Ulcer (ROU) is the most common Oral mucosal disease in clinical practice. The incidence of this disease in the world can reach 10%~20%, among which female patients are the majority [1]. Recurrent Oral Ulcer has localized pain and recurrence According to clinical studies on its etiology, the occurrence of recurrent oral ulcer is closely related to mechanical injury, trace elements and vitamin deficiency, food and drugs, genetic susceptibility, hormone deficiency, psychological stress, immune virus and bacterial infection, microcirculation disorders and other factors [2] Due to its pathogenic mechanism is not yet fully clear, also found no clinically cured recurrent oral ulcer treatment, western medicine there is no specific treatment or drugs for recurrent oral ulcer heal completely, the disease recurrent, illnesses out refractory characteristics, pain and inconvenience to patients, even seriously affect the patients quality of life However, Traditional Chinese medicine can use external application of Traditional Chinese medicine, gargling, oral experience effective prescription, acupoint application, acupuncture, cupping, etc. [3] Acupuncture and medicine combined with internal and external treatment can produce multiple targets The integrated effect of multiple links can improve the burning sensation and accompanying symptoms, reduce the wound surface and shorten the healing time of ulcer, which has obvious advantages in the treatment of oral ulcer.

Understanding of oral ulcers in TRADITIONAL Chinese medicine
Recurrent oral ulcer in traditional Chinese medicine belongs to the category of oral sores, mouth selection, etc Chinese medicine thinks that although the lesions of oral sores are local, but the lesions of the viscera are not single, involving many viscera [4], the main disease location in the heart, spleen, liver and kidney, etc., and the ancient doctors have long realized that the occurrence of oral sores and many viscera are closely related, such as su Ask to really big: All pain and itching sores, all belong to the heart pointed out that the occurrence of mouth sores and heart fire burning in the mouth and tongue is closely related to pu Fu Zhou medical case said: Oral ulcer disease, one by stomach fire, one by the spleen heat think aphtha happening is caused by the spleen and stomach heat deposition For cause aphtha, from hot to make a point, that most physicians believe yu fire knot in each viscera is the main pathogenesis of aphtha happening, and the medical Bian depressive fire can be divided into cold Diet phlegmy drink water wet blood stasis diseases with wind-cold 7 kinds of temper Also have their own understanding of its modern physicians, professor xing-kuan wang [5] from glove heating to make a point, summarize aphtha pathological factors are nothing more than empty wind-cold, he think aphtha day long attack, long illness into collaterals, qi and Yin, so the treatment should be in the mind have diarrhoea of spleen qi products on the basis of product, at the same time also put forward from two liver kidney syndrome differentiation, so treatment, can proper and effective Some scholars found a new way, not from the traditional hot to argue that recurrent oral ulcer is caused by spleen and kidney Yang deficiency, cold drink stops inside, Yin sheng forces Yang to rise, with warm Yang hua drink as the treatment [6] therefore, the syndrome should be carefully differentiated, the etiology and pathogenesis should be carefully observed, first of all, the cold and heat deficiency and reality, can not be generalized.

Identification and treatment of false and real specimens
Syndrome differentiation of deficiency and reality originates from syndrome differentiation of the Eight Cardinal principles. It is said in the Theory of Suwen· Regulating Classics: Born out of, there is the actual situation Five five virtual to real Can be found in the earliest theory of q, jade machine really dirty The ancient physicians know reading from the actual condition of the five internal organs, the actual situation is the evolution Outlines the disease evil wins is the change of the failure, and embodies the essence of syndrome, laid the groundwork for actual differentiation, to has important guiding significance to the clinical treatment [7] Differentiation and treatment of false and real specimens is the basic idea and method of TCM for the treatment of chronic recurrent diseases, especially for the diagnosis and treatment of various chronic refractory diseases, such as ulcerative colitis and cerebrovascular disease sequelae [8] Due to the long development and evolution of the disease, the pathogenesis of the disease changes from time to time, and the clinical syndromes are often mixed with the deficiency and reality. At this time, it is particularly important to distinguish the appearance and root of the disease, that is, the specimen of the syndrome, and then treat the disease based on syndrome differentiation So that later generations more physicians and give full play to in the actual condition on the basis of syndrome differentiation, with the actual specimens of idea and method, especially for the performance for the diagnosis and treatment of the qi to severely, tonify deficiency diarrhea is a therapeutic principle, is the so-called diseases according to the actual condition at both ends, all disease is not the filling purging method, eliminate pathogenic centralizer, adjust the viscera of Yin and Yang, evil is Ann.

Accurate syndrome differentiation and flexible treatment
For the treatment of recurrent oral ulcer, clinical specimens from the actual situation in the basic thinking of syndrome differentiation, will the pathogenesis characteristics of recurrent oral ulcer due to mark this virtual to real, with depression will become the standard fire each other, two empty as this, qi and Yin treatment to treat both for the principle, treats the key lies in the qing dynasty, facing the fire, fundamental core is stagnation and spleen kidney is zi kidney, in accordance with this treatment, the clinical for recurrent oral ulcer Can get twice the result with half the effort.

Yu fire each other become standard, treat when clear xie Fu fire
Doctors of all dynasties have unique views on the understanding of mouth sore, most of them think that the occurrence of mouth sore is mainly related to heat, and the pathogenesis of heat has carried on a full theoretical exposition, such as Ming chao Yuan fang said in the pathogenesis theory of mouth and tongue sore: The heart and qi pass through the tongue and the temper pass through the mouth, the zang fu heat sheng, heat multiply the heart and spleen, qi rush in the mouth and tongue, so the mouth and tongue sores also put forward that the occurrence of mouth sores is caused by the spleen and stomach depression fire up the fumigation of the mouth and tongue caused by depression fire For ulcers in one of the main pathological factors, the empirical frequentlyoccurring disease nasty, short course of disease, more poor due to the modern, and fire, often with obvious symptoms of real hot body and ulcer wound pain more intense, more modern and ulcers in patients depression, see more at female, irritability, liver support department, diseases with ease, endogenous heat, with clear heat purging fire, from the qing xie fu fire soup, basic group Results: Rehmannia glutinosa, Coptis chinensis, Anemae anemae, Scutellaria baicalensis, Cohosh hemp, Paeonia lactiflora, prepared glycyrrhiza decoction, rehmannia glutinosa is sweet and moist, cooling blood and nourishing Yin to make heart fire; Coptidis bitter cold, clear heart and liver two by the fire, Li Zhongzi Lei Gong processing medicine solution mentioned: coptidis bitter diarrhea heart, the treatment of heart fire diseases can not be short of, there is cold heart fire vexed heat...... Modern pharmacological studies have shown that Coptis chinensis has significant inhibitory effects on both acute and chronic inflammatory responses. Studies have shown that coptis chinensis can inhibit cell proliferation and migration by inhibiting the transcriptional activity of E2F, and exert anti-inflammatory effects by bidirectional regulation of STAT4 signaling pathway [10] Berberine in Coptis chinensis can also improve the function of mitochondrial biosynthesis and inhibit cellular inflammation, mainly through up-regulating the expression of genes related to mitochondrial biosynthesis [11]. Coptis chinensis and Shengdi are combined to nourish Yin, control fire, not love evil, and reduce fire, not hurt Yin. Radix Scutellariae can be used to clear away heat and detoxify fire, while radix scutellariae root can be used to clear away heat and detoxify fire, while radix paeoniae root can be used to nourish the liver and nourish the Yin, so that the evil will go away without damaging Yin In the end, we selected and adjusted the decoction of glycyrrhizin glycyrrhizin and the properties of all the medicines. In general, all the medicines should be used together to clear up the qi and the fire, harmonize qi and blood, and make the disease safe.

Qi and Yin deficiency, disease in the spleen and kidney
Oral sores, not healed for years, this empty fire also points out that empty is another important pathological factor of oral ulcer, fire can be divided into empty and real ends, Jingyue quanshu· fire syndrome: there are two sources of empty fire:...... One day this to the true Yin deficit, water does not make fire also; On the second day, people with Yang deficiency can also get fever, which indicates the occurrence of deficiency syndrome and spleen because yuanyang is exhausted and fire does not return to the source Renal most close relations between the two dirty, at the same time, this paper expounds the two virtual virtual pathogenesis of qi and Yin, and deficiency of the disease more emphasize on spleen, due to the upper abdomen spleen weak soil, transport is less, the postnatal spleen and stomach as, na transport department, valley is not jing, qi and blood biochemical lack source, can moisten the skin bore, in addition to taste food causes of Yang deficiency cold, cold day long phase without restriction on fire burns your breath Yin deficiency disease location mainly in the kidney, oral sores for a long time, long illness injury Yin, lower jiao Yin deficiency, Yin deficiency is Yang kang, Yin does not latent Yang, Yang floating more, inflammation on the empty fire in the mouth and tongue for oral sores deficiency syndrome onset is relatively slow, slight pain, often delayed for months, long illness into the collateral, spleen and kidney deficiency, and then lead to deficiency of Qi and blood Yin and Yang.

Treatment of the spleen and kidney, the emphasis on nourishing the kidney
Real fire Yi Qing, deficiency fire down hard, empty when its fill, empty when from the spleen and kidney, to benefit the spleen zi kidney for the solution, if only from the fire to differentiation, is only expedient, often with little success Based on the key pathogenesis of qi and Yin two virtual, if spleen-deficiency, sijunzi decoction and insurance and tonga, diarrhea with shi, aimed at replenishing qi, spleen xiaoshi qi of essential drugs: codonopsis in the party Radix Atractylodis balm and tonic, astragalus membranaceus nourish qi and nourish ying, so that the spleen of the four seasons is not affected by the heat produced by the elimination of food by the evil forsythia, pinellia scutellaria two drugs rise and fall, xin Kai bitter drop, flat regulating cold and heat, restore the function of spleen and stomach elevating qi machine stir-fry Radish seed stir-fry malt God qu chicken gold digestion to help transport, finally selected processed licorice and other drugs In his own fill line, without delay, repair, elimination fill is above The fungicides, temper rose, stomach gas filling, the spleen and stomach, nothing happens, since no harm If kidney Yin deficiency, the absorption of strong, the Lord of the water to the treatment of sunshine, cure to invigorate the kidney and nourishing Yin, party with liuwei dihuang pill increases the liquid soup as a basic side cut, with cultivated radix scrophulariae Chinese wolfberry yam Huangjing Maidong raw ground, cornus officinalis raw ground is the prescription, the cooked ground cornus officinalis raw ground fills the refined pulp, nourishing liver and kidney, because liver and kidney are homology, nourishing liver can be kidney, Radix Shariophylla Maidong sweet and cool and moist, radix scrophulariae Maidong raw ground three herbs together perform the function of nourishing Yin, producing jin and moistening drao If qi and blood deficiency is very, can be combined with eight zhen tang, treatment should be flexible treatment according to individual differences, with the syndrome to treat, yu Huo qing, kidney deficiency fill, treat both symptoms and root causes, reinforcing and reducing the same application, zang-fu qi and blood Yin and Yang harmonization, according to this treatment, clinical for the treatment of recurrent aphthous ulcer can receive twice the result with half the efforts Throughout the whole side, congenital acquired acquired, the source is not dry, acquired congenital help, long history of clinical syndrome should be flexible differentiation according to individual differences, with the syndrome treatment.

Case study
The patient, male, Ren Xx,34 years old, was first diagnosed on September 10,2018. Recurrent oral ulcer for 2 years with anorexia for 1 month Multiple erosion in oral cavity ulcer with your breath pain, anorexia, fatigue, had oral Chinese and western medicine (unknown) drug treatment, the symptoms did not see improvement, engraving: multiple erosion in oral cavity ulcer with your breath pain, anorexia, fatigue, consciously retrosternal burning discomfort, burning is aggravating, after eating spicy food after slightly swelling in the abdomen, defecate dry rare to be not moved, 3-4, a line, urine, can sleep Diagnosis of Traditional Chinese medicine: oral ulcers diagnosis of Western medicine: recurrent oral ulcer treatment: Nourishing qi and blood, digestion and stomach, nourishing Yin and nourishing muscle with Bazhen Decoction and bao he Decoction, drugs: Dangshen 15g, Poria coxa 15g, bran stir-fried Atractylodis atractylodis 10g, Astragalus membranaceus 15g, Pinxia feta 10g, tangerine peel 10g, stir-fried Shansi Shenqu 15g, stir-fried malt 15g, stir-fried chicken gold 15g, burnt hawthorn 10g, baiji 10g, forsythia 10g, stir-fried radish seed 10g, angelica 10g, licorice 6g. 7 doses, one dose a day, water decocted 300mL, morning and evening fasting warm to take a light digestible diet, free mood.
Diagnosis: the patient with oral ulcer wound narrowed, poor appetite, fatigue symptoms were improved markedly, the tongue reddish, less moss, pulse heavy fine In spleen and replenishing qi, nourish Yin fluid for the law, party with sijunzi decoction and increase fluid tonga decreases drugs: Dangshen 15g, bran Fried atractylodes 10g, Poria cocos 15g, licorice root 6g, stir-fried medicated leaven 15g, Stir-fried malt 15g, baiji 10g, stir-fried chicken gold 15g, burnt hawthorn 10g, forsythia 8g, Angelica 10g, Astragalus membranaceus 15g, Shengdi 10g, Maidong 10g, Beishashen 10g, 7 doses. one dose a day, decocted in water 300mL, taken warm in the morning and evening on an empty stomach, the patient self-reported oral ulcer wound healing, basically healed, no new symptoms, nachor, fatigue, sternal burn significantly reduced, bowel and urine tone After 7 doses, the wound healed and the uncomfortable symptoms disappeared, and there was no recurrence during follow-up.
Note: In this case, the patient is weak in spleen and stomach, with a long course of disease and body deficiency. With deficiency of viscera, qi and blood, Yin and Yang as the basic pathogenesis, qi and blood biochemical deficiency, unable to help and nourish the limbs, the deficiency of appetite can be seen, just as the treatment of Jisheng Prescription and blood loss said: Caused by, because that of long time big is deficient, fluid loss, tianjin is not blood, blood deficiency and moist, not oral multiple erosion The deficiency of qi and blood deficiency, the blue is a fire within the knot, treatment can't pure fill without elimination or pure enough, then choose eight Jane decoction and confirmed with bolus for xie, benefit qi and blood and disappear of spleen and stomach, and combined with gardenia Wormwood Chen Qing heat lishi retreat yellow, white, and the folding of the sore muscles Long illness injury Yin, qi and Yin two deficiency, so the two diagnosis of the four gentleman tang ping and tonifying qi and spleen, zengye soup to Zyin and liquid, to fill for attack, both dispelling truth, but also can prevent the deficiency in the square of Shushen Maidong gan cool quality embellish, Zyin shengjin, all drugs, drug syndrome, so all symptoms of self-healing.

Conclusions
Recurrent oral ulcer in delay refractory due to the complex dynamics of incentive, so the treatment is focused on promote ulcer healing and prevent the recurrent, since the pathogenesis is still unclear, single western medicine treatment, at present no specific medicine for different causes a variety of oral ulcer type, this paper analysis the actual specimen's train of thought, in the differentiation and treatment of recurrent oral ulcer mark This deficiency and solid treatment of the advantages, follow the treatment of both symptoms and root causes, tonifying the treatment principle of deficiency and eliminating the solid, put forward the treatment of clearing and eliminating the fire, tonifying the spleen and nourishing the kidney, dispelling evil and strengthening to adjust the viscera and Yin and Yang in addition, the occurrence of oral sores and emotional diet Irregular work and rest are closely related, so prevention is also the main aspect of its treatment. In daily life, we should keep a good mood, work and rest regularly, pay attention to oral hygiene, gargle after eating, light diet and appropriate exercise to prevent the invasion of evil spirits.