从“寒饮”论治复发性口腔溃疡临证体会

Clinical experience in the treatment of recurrent oral ulcer from‘cold fluid’

复发性口腔溃疡为临床最常见的口腔黏膜疾病,以口腔黏膜上的浅表性溃疡反复发作和灼痛为特征。传统观点认为,口腔溃疡系“上火”所致,常用苦寒药清热泻火,但临床上常见久用苦寒药清热泻火并不见效,反耗伤正气,贻误病情。笔者认为,此不效者,可能是因为脾肾阳虚,寒饮内停,阴盛逼阳上浮所致,临床以温阳化饮为法,以小青龙汤加减灵活化裁,疗效甚佳。故临证时应详察其病因病机,仔细辨证,首当辨明寒热、虚实,不能一概而论。

Recurrent oral ulcer is the most common oral mucosal disease in clinic,characterized by recurrent attacks and burning pain of superficial ulcers on oral mucosa.Traditionally,it is believed that oral ulcer is caused by‘upper fire’.Medicinals with bitter and cold properties are often used to clear away heat and purge fire.However,it is not effective to use the medicinals with bitter and cold properties that clear away heat and drain fire for a long time in clinic,and it often damage the healthy qi and delay the disease.The author believes that this ineffectiveness in the treatment of recurrent oral ulcer is mostly due to deficiency of spleen and kidney yang,generation of cold fluid,and exuberant yin forcing yang to up-float.In clinic,Xiaoqinglong Decoction is often employed to add or subtract to treat recurrent oral ulcer by warming yang and transforming fluid,which has good effects.Therefore,the etiology and pathogenesis of the disease should be carefully examined and the treatment based on syndrome differentiation should be carefully made.Firstly,we should distinguish between cold and heat,deficiency and excess syndrome,which can not be generalized.