Case ID: CHC-0085

Case Summary

This case describes a 47-year-old man suffering from a severe, five-year history of recurrent oral ulcers (aphthous stomatitis) triggered by heavy alcohol consumption. Despite numerous prior treatments with both Chinese and Western medications, the painful ulcers constantly recurred, severely impairing his ability to eat. The original report documented a conventional diagnosis of oral ulcers and a TCM assessment of Aphthous Ulcers (Kou Chuang) driven by Spleen and Stomach Damp-Heat Stagnating into Fire. He was managed by Professor Hu Shiping using his empirical Yuyang Tang (Ulcer-Healing Decoction). By strategically applying the classical principle of “venting fire stagnation” (火郁发之)—using acrid-dispersing herbs to let the trapped heat escape rather than suppressing it purely with cold herbs—the patient achieved a complete clinical recovery.

Patient Presentation

• Patient: 47-year-old male (Surname: Zhong).
• Main Complaint: Recurrent oral ulcers and erosion with severe pain for over 5 years, significantly worsening for 1 month after heavy drinking.
• History: The patient sought consultation on August 9, 2023. Five years prior, following a bout of heavy drinking, he developed painful oral ulcers. Since then, the condition would flare up whenever he drank alcohol or ate spicy food. As soon as old ulcers healed, new ones would immediately appear, making eating extremely difficult. One month prior to the visit, another episode of heavy drinking caused a severe exacerbation of the symptoms.
• Associated Symptoms: The oral ulcers were covered in a white exudate resembling snowflakes (状若雪片) and were highly ulcerated and painful. This was accompanied by systemic fatigue, lethargy, easy sweating, poor sleep with excessive dreaming, and slightly dry, difficult-to-pass stools. His urination was normal.

Examination and Diagnosis

• Conventional Diagnosis: Oral ulcers (Aphthous Stomatitis).
• TCM Tongue and Pulse: The tongue body was red with a thin, yellow coating. The pulse was stringy (脉弦).

TCM Assessment

The practitioner interpreted the presentation as Aphthous Ulcers driven by Spleen and Stomach Damp-Heat, Stagnating into Fire (口疮 – 脾胃湿热，郁而化火).

According to the holistic principles of Chinese Medicine, the patient’s long-term habit of heavy drinking severely damaged his Spleen and Stomach. The Spleen lost its transportive function, leading to the internal brewing of Damp-Heat. Over time, this Damp-Heat pathogen became trapped and stagnated, transforming into toxic Fire. This Fire followed the meridians upward, fumigating the mouth and tongue, causing the severe ulcers and pain.

Crucially, the clinical presentation was a mix of excess and deficiency: the painful, ulcerated mouth was a clear sign of intense, blazing Fire, but the severe fatigue and lethargy were signs of systemic weakness. The root cause was the trapped Damp-Heat blocking the body’s Yang Qi from properly extending to nourish the limbs. The red tongue, thin yellow coating, and stringy pulse provided objective confirmation of this trapped Damp-Heat and Fire pathology.

Treatment Approach

The primary treatment principle was to clear heat and drain fire, dry dampness and fortify the Spleen (清热泻火，燥湿健脾). The core strategy relied on Professor Hu’s empirical formula Yuyang Tang, specifically designed to treat Damp-Heat oral ulcers by adhering to the classical tenet: “When fire is stagnated, vent it” (火郁发之).

Interventions and Herbal Formulas

• Initial Herbal Formula (August 9, 2023): A 9-herb decoction modifying the empirical Yuyang Tang.
  • Clearing Heat and Draining Fire: Huang Lian (Coptis, 10g) is bitter and cold, essential for clearing Heart and Spleen fire and treating sores. Dan Zhu Ye (Lophatherum, 15g) is sweet and cooling, directing the heat downward to be excreted through the urine.
  • Venting the Stagnated Fire (The Core Strategy): Cang Zhu (Atractylodes, 15g). Utilizing its acrid, warm, and dispersing properties, Cang Zhu dries Spleen dampness while simultaneously opening the pathways to let the trapped fire “vent” out (火郁发之).
  • Resolving Phlegm and Descending Turbidity: Zhe Bei Mu (Fritillaria, 10g) clears heat and dissipates nodules. Zhi Ke (Aurantium, 15g) and Chao Lai Fu Zi (Fried Radish Seed, 30g) move Qi and aggressively drive the turbid heat downward through the bowels.
  • Cooling Blood and Astringing Sweat: Chi Shao (Red Peony, 20g) slightly cools and moves blood to stop the pain. Because intense heat damages Yin and forces sweat out, Cu Wu Wei Zi (Vinegar-baked Schisandra, 10g) and Mu Li (Oyster Shell, 20g – decocted first) are added to tightly astringe the Yin and stop the abnormal sweating.
  • Administration: 14 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (September 13, 2023): After 14 doses, no new oral ulcers had appeared. The existing ulcerated areas were nearly healed, and the pain was greatly reduced. His fatigue, appetite, and sleep had all significantly improved, and his bowel movements were normal. He still experienced some sweating, though it was better than before.
  • Formula Adjustment: The practitioner added Fu Xiao Mai (Floating Wheat, 30g) to the original formula to further boost Qi, nourish the Heart, clear residual heat, and specifically stop the remaining sweating. (7 doses prescribed).
• Third Visit (September 21, 2023): All symptoms were completely relieved. The patient was instructed to maintain a bland diet, strictly avoid spicy foods, and quit smoking and drinking to prevent relapse. Follow-up confirmed the ulcers never recurred.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Hu Shiping’s masterful application of the Huangdi Neijing (Inner Canon) principle: “When fire is stagnated, vent it” (火郁发之).

When treating severe oral ulcers, the common reflex is to overwhelm the body with heavy, bitter-cold herbs (like excessive Huang Lian or Shi Gao) to extinguish the fire. However, in this patient, the fire was trapped by thick Spleen Dampness (caused by years of drinking). If purely cold herbs were used, they would further damage the Spleen, freeze the dampness, and trap the fire even deeper, leading to endless relapses.

Instead, Professor Hu brilliantly included Cang Zhu—an acrid, warm herb. Just as you must open a window to let smoke out of a burning room, the warm, dispersing nature of Cang Zhu opened the patient’s energetic pathways, allowing the trapped Fire to safely vent outward and dissipate. By balancing cold (to clear heat) with warm (to vent stagnation), and ascending with descending, he successfully resolved a refractory 5-year illness in just three weeks.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：火郁发之治口疮，宣畅分消复升降 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 8, 2024 Original language: Chinese