Mouth Ulcers, Hoarse Voice and Red Eyes?
Search terms: sores in the mouth / mouth ulcers / canker sores / hoarse voice / red eyes / inflamed eyelid margins / genital ulcers / vexation and restlessness / diarrhea
Medical terms for this condition: huhuo disease · Behcet’s syndrome · damp-heat accumulation · heat above and cold below · spleen-stomach weakness
Opening scene: taking refuge for the night, he heard a painful moaning
In the Southern Song dynasty, war was never far away — the Jin armies kept pressing south and bandits roamed everywhere. Doctor Xu Shuwei, the great master of classical formulas, was fleeing the fighting. He crossed the Yangtze from the north and made his way south into Jiangnan. One evening he knocked on the door of a household and asked to stay the night. The master of the house had a kind heart and agreed.
💬 Note from Doctor Luo: Doctor Xu Shuwei was a famous physician of the Northern–Southern Song transition who studied Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage) deeply and excelled at using the classical formulas. He wrote Shang Han Jiu Shi Lun (Ninety Discussions on Cold Damage), the earliest surviving medical casebook in Chinese history. In those unstable times, he could barely manage to save himself from the war — yet his devotion to healing never wavered. That is what makes a great doctor.
That very night, Doctor Xu Shuwei heard painful groans coming from inside the house. Anyone else might have ignored them, but he was a physician — and his ears pricked up at once.
Who was the patient? No doctor in the village, and the shamans made it worse
He asked and learned: the master of the house, a Mr. Li, was a wealthy man who lived east of Jurong County. He had contracted cold damage (shang han) more than ten days earlier. But this was an out-of-the-way place — the village had no doctor at all. What could they do? They called in shamans. Over five or six days, several shamans came and went, some using the sweating method, some the purging method, throwing every trick they knew at the illness. Instead of improving, the patient only got worse — what Chinese medicine calls a “ruined case” (huai bing): the pathogen had driven deep, and the illness had become tangled and extremely hard to treat.
Doctor Xu Shuwei said: “I know medicine — let me take a look.” One look, and he drew in a sharp breath.
One look, a sharp intake of breath
He took the pulse: it was long — extending beyond the usual cun-guan-chi positions. He looked at the mouth: the lips were entirely ulcerated — the inside of the lips was covered in white sores, as if gnawed by insects. He listened to the voice: the throat was dry and the voice hoarse — so dry he could barely speak. The tongue was coated white, and the teeth had lost their luster — they had gone dull and colorless.
Doctor Xu Shuwei said it right away: this is huhuo disease (狐惑病, “fox-ghost disease”)! And this illness is no small matter — it kills swiftly. If it is not treated properly, it can take a person’s life.
💬 Note from Doctor Luo: Notice Doctor Xu Shuwei’s order of examination: pulse, lips, throat, tongue, teeth — he missed nothing. The most dangerous thing about huhuo disease is that it looks like “just some heat and ulcers,” but it is actually a serious, whole-body illness. Zhang Zhongjing had already set it out as a disease of its own in the Jingui Yaolue (Essential Prescriptions of the Golden Coffer).
What is huhuo disease? Zhang Zhongjing explained it clearly in the Jingui Yaolue
Huhuo disease comes from Zhang Zhongjing’s Jingui Yaolue (the miscellaneous-diseases portion of the Shang Han Za Bing Lun, Treatise on Cold Damage and Miscellaneous Diseases). Zhang Zhongjing wrote: “Huhuo disease behaves like cold damage” — the patient feels chills and fear of wind, as if catching a cold, and may even run a fever. The patient is “drowsy and wants to sleep, yet cannot close the eyes” — listless and sleepy all day, but the eyes cannot shut, because there is inflammation in them (reddened, ulcerating eyelid margins, red conjunctiva). And the patient is “restless, unable to sit or lie still” — mentally agitated and fidgety.
The two characters of the disease name each carry a meaning: erosion at the throat is huo (惑); erosion at the genitals is hu (狐) — ulcers in the throat and mouth are called “huo,” and ulcers on the genitals are called “hu.” So the hallmark of this disease is a triad of symptoms: inflamed eyes, mouth ulcers, and genital ulcers. In addition, there is “no desire to eat and aversion to the smell of food” — the patient cannot bear the smell of cooking, which tells you the digestive system is involved as well. The face and eyes may alternately flush red, turn dark, and turn pale at different stages of the illness. And “when erosion is in the upper part, the voice becomes hoarse” — ulcers in the upper region ruin the voice.
💬 Note from Doctor Luo: Why is it called “huhuo” — “fox-ghost”? Because it is so bizarre, as if a person were possessed: confused, vexed, and agitated. There is also an old folk theory: foxes dig holes, and legend says a fox can burrow through all nine orifices of the body — the eyes, ears, nose, plus the front and rear passages. This disease looks like a fox has been drilling ulcer-holes all over the patient, which is how it got its name. The folklore is amusing; the strangeness of the disease is real.
Isn’t this today’s Behcet’s syndrome?
Does this disease still exist today? Yes — and it is not rare. Modern medicine calls it Behcet’s syndrome (Behcet’s disease), an autoimmune disorder. Its main symptoms are exactly that triad of ulcers — in the eyes, the mouth, and the genitals — and in some patients the ulcers become very severe.
💬 Note from Doctor Luo: Beyond the triad, Behcet’s can attack other systems too: the blood vessels and circulation, the digestive system (which is why patients lose their appetite), the skin (rashes and pustules), the joints (pain), and even the nervous system — abnormal sensations in the limbs, convulsions, and when the cranial nerves are involved, mental symptoms, in severe cases even brain atrophy. Both men and women get it, and severe cases can be fatal.
Modern medicine, frankly, does not understand this disease well: the cause is unknown — the immune system goes wrong, but no one can say why; treatment relies on steroids and immunosuppressants with limited results; and it is generally considered a lifelong condition that can only be endured with ups and downs. Zhang Zhongjing, in the Eastern Han dynasty, had already described it clearly.
The root: damp-heat blocking the spleen-stomach “central pivot”
How does Chinese medicine see it? Through pattern differentiation, it is basically damp-heat accumulation — heat-toxin gathering in the middle burner, affecting the liver and spleen: the root lies in the spleen and stomach, closely tied to the liver and to emotions. When emotions are disturbed and liver fire flares, it stirs the body’s heat and produces this congested damp-heat situation.
💬 Note from Doctor Luo: Going one layer deeper, the mechanism is this: the spleen and stomach are weak, and when an external pathogen invades, the rising and falling of the middle burner goes wrong — spleen qi fails to send the clear upward, stomach qi fails to send the turbid downward, and qi gets stuck in the middle. The result is heat above and cold below: heart-fire poison-heat, vexation, and dry retching above; cold and diarrhea below. Huhuo disease is the classic picture of this pattern.
How did Doctor Xu Shuwei treat it? An old formula: Gancao Xiexin Tang
Doctor Xu Shuwei’s treatment was remarkably direct: first a small detoxifying pill (the transcript records its name as Xunhuang Wan, 循黄丸), then the formula Zhang Zhongjing created specifically for this disease — Gancao Xiexin Tang (甘草泻心汤, Licorice Heart-Draining Decoction). Within a few days, the patient was well.
💬 Note from Doctor Luo: Gancao Xiexin Tang is Zhang Zhongjing’s main formula for huhuo disease, and we still use it today — it works remarkably well for many kinds of mouth ulcers. The formula resembles Xiao Chaihu Tang (Minor Bupleurum Decoction), but it has no chai hu (bupleurum). Huang lian (coptis) and huang qin (scutellaria) clear heat, resolve toxin, and drain damp-heat; ren shen (ginseng) supports the upright qi — if the upright qi were not deficient, the pathogen could never have entered in the first place; ban xia (pinellia) harmonizes the middle burner, sends qi downward, and dries dampness; gan jiang (dried ginger) warms the cold below (Xiao Chaihu Tang uses fresh ginger; here it is dried ginger); da zao (jujube) rounds it out. And the licorice is used in the largest dose — it is the monarch herb, there to resolve toxin. One crucial point: it must be raw licorice (sheng gan cao) — honey-fried licorice is much weaker at resolving toxin.
Why does this formula cure a “strange disease”? — heat above, cold below, and harmonizing both
The original Shang Han Lun passage on the Gancao Xiexin Tang pattern helps us understand this disease completely: the spleen and stomach are weak, an external pathogen enters, and the middle burner’s qi movement gets blocked. Hence “hardness under the heart” — the epigastrium is hard to the touch and the belly rumbles; “thunder in the abdomen, diarrhea, food passing undigested” — loose stools with food coming through undigested, which is the cold below; while above there is “dry retching and vexation, unable to settle” — that is the heat above. A full picture of “heat above, cold below, the middle burner blocked.”
💬 Note from Doctor Luo: So the essence of Gancao Xiexin Tang is harmonizing the spleen and stomach and regulating cold and heat together: hot herbs like gan jiang warm the cold below; cool herbs like huang lian and huang qin clear the heat above and resolve damp-heat; and raw licorice resolves toxin. Put cold and hot herbs into one pot, unblock the jammed middle burner, turn the qi movement around — and the “strange disease” quietly dissolves.
Recurrent mouth ulcers in modern people? This formula is a key reference
Mouth ulcers are extremely common today, in all sorts of patterns. Doctor Luo Dalun specifically reminds us: if you belong to the heat-above-cold-below type — prone to loose stools and a cold feeling below, vexation above, many ulcers in the mouth, and a belly that always feels bloated and hard to the touch — then Gancao Xiexin Tang works very well. It is the main formula for this pattern of mouth ulcer.
💬 Note from Doctor Luo: Doctor Zhao Shaoqin, one of the earliest masters of the Shang Han Lun at Beijing University of Chinese Medicine, once said that in the typical cases he had seen of this kind, treated with Gancao Xiexin Tang, there was basically not one that failed to improve — nearly all recovered. So Chinese medicine treats this disease with real confidence. If the condition is severe, you can add herbs to cool the blood, resolve toxin, and clear heat; if yin deficiency is obvious, add yin-nourishing herbs — nourish yin for the deficient heat, drain damp-heat for the damp-heat, and adjust the combination flexibly.
Doctor Luo’s reminder: people under emotional strain are especially prone to this disease
Finally, let’s return to the root: why do the spleen and stomach become weak? One reason is poor day-to-day care; the other is emotion — liver qi transversely invading and overcoming the spleen (wood overacting on earth, 肝气横逆克脾土). In the causation of huhuo disease, constrained liver qi and disturbed emotions are a very important factor.
💬 Note from Doctor Luo: People who are emotionally strained are especially prone to Behcet’s syndrome. Western medicine cannot figure out where this disease comes from; Chinese medicine has had a detailed analysis of it since the Eastern Han. That is precisely where the wisdom of our ancestors shines. Since the pandemic we have all paid more attention to health — think about these treasures our ancestors left us, and as Chinese people we can feel truly proud. Learning a little Chinese medicine is like keeping one more road to good health open for yourself.
Compiled from Doctor Luo Dalun’s lecture on Doctor Xu Shuwei’s case, from the Shang Han Jiu Shi Lun (Ninety Discussions on Cold Damage, written by Doctor Xu Shuwei, completed c. 1132).