Keywords: Chinese medicine, Chinese herbal medicine, stomatology, exfoliative inflammation of the lips
On pages 23-24 of issue #3, 2005 of Fu Jian Zhong Yi Yao (Fujian Chinese Medicine & Medicinals), Li Gong-bin et al. of the Nanjing Chinese Medicine University Affiliated Hospital published an article titled, "The Treatment of 54 Cases of Exfoliative Inflammation of the Lips with Sha Shen Mai Dong Tang Jia Jian (Glehnia & Ophiopogon Decoction with Additions & Subtractions)." A summary of that study is presented below.
Altogether, there were 94 patients enrolled in this study, all of whom were seen as out-patients in the dermatology department of the Chinese authors' hospital and all of whom met the diagnostic criteria for exfoliative inflammation of the lips set forth on page 1084 of the third edition of Zhao Bian's Lin Chuang Pi Fu Bing Xue (A Study of Clinical Dermatological Diseases, Jiangsu Science & Technology Publishing Co., Nanjing, 2001). These 94 patients were randomly divided into two groups, a treatment group of 54 and a comparison group of 40. In the treatment group, there were nine males and 45 females 8-47 years of age, with a median age of 26 " 11.03 years. These patients had suffered from this condition from one month to 14 years, with a median disease duration of 4.4 " 12.96 months. In the comparison group, there were six males and 34 females aged 7-45 years, with a median age of 27 " 9.85 years. These patients had suffered from exfoliative inflammation of the lips for from one month to 12 years, with a median disease duration of 3.9 " 14.21 months. Therefore, it was concluded that, in terms of sex, age, and disease duration, these two groups were statistically comparable (P , 0.05). In terms of characteristic symptoms, the condition started with red, swollen, itchy, painful lips and continued on to become red, dry, exfoliated, scabbed, and no longer moist and soft. When the patient opened his or her mouth wide, there was burning pain and possible cracking with bleeding that made eating difficult. In general, the disease course tended to be protracted and was insidious and difficult to heal. Accompanying signs and symptoms included a dry mouth with a desire to drink, constipation, reddish urination, a red tongue with dry, yellow fur, and a fine, rapid pulse. These signs and symptoms were thus categorized as the pattern of lung-stomach yin vacuity.
All members of the treatment group were orally administered the following modified version of
Sha Shen Mai Dong Tang (Glehnia & Ophiopogon Decoction):
Nan Sha Shen (Radix Adenophorae Strictae), 10g
Yu Zhu (Rhizoma Polygoni Odorati), 10g
uncooked Gan Cao (Radix Glycyrrhizae), 3g
Sang Ye (Folium Mori), 10g
Mai Men Dong (Tuber Ophiopogonis), 10g
Bai Bian Dou (Semen Dolichoris), 10g
Tian Hua Fen (Radix Trichosanthis), 10g
If cracked, dry lips were marked, then 10 grams each of Bei Sha Shen (Radix Glehniae), Tian Men Dong (Tuber Asparagi), Shi Hu (Herba Dendrobii), and Lu Gen (Rhizoma Phragmitis) were added.
If exfoliation and itching were more prominent, 10 grams each of Fang Feng (Radix Saposhnikoviae) and Bai Ji (Rhizome Bletillae) were added.
One packet of these medicinals was decocted in water and administered per day in two divided doses.
Members of the treatment group were treated externally with an unidentifiable Western medical topical ointment once per day. Two weeks equaled one course of treatment for both groups, and patients typically received 1-2 courses. During the course of therapy, patients in both groups were forbidden to eat scrid, peppery, stimulating foods.
Outcomes were based on a point system involving four groups of symptoms: 1) extent of redness, 2) dryness and cracking, 3) exfoliation and scabbing, and 4) itching and pain. Zero equaled no presence of the sign or symptom and three equaled the worst presence of the sign or symptom. Then the total of these points was multiplied by 100. Patients signs and symptoms were assessed before and after treatment. Cure meant that the patient's score had reduced by 95-100%. Marked effect meant that the patient's score had reduced 60-94%. Some effect meant their score had reduced by 20-59%, and no effect meant that their score had reduced less than 20% from before to after treatment. The following table shows the outcomes based on these criteria.
Therefore, it was determined that the Chinese medical protocol was markedly more effective overall than the Western medical protocol (P+ 0.01).
According to the Chinese authors, this condition is mostly due to spleen-stomach brewing heat as well as to wind evils lodged externally. In this case, heat toxins and wind mix together and harass above. In the Sui dynasty, Chao yuan-fang said, "If the spleen and stomach have heat and this qi is emitted from the lips, the lips will engender sores..." In the case of the above patients, spleen-stomach accumulation of heat had followed the channels upward to steam and burn the mouth and lips externally. Because this had gone on for some time, yin had been burned transformed dryness. Because the stomach is the mother of the lungs, disease of the mother, i.e., dryness and heat, had been transmitted to the child, the lungs. Hence the lungs were not able to spread fluids and humors correctly. Thus there was upper and middle dryness or, in other words, both the yin of the stomach and lungs had been damaged with an end result of loss of moistening and nourishment of the lips. Therefore, the main treatment principles for these patients were to enrich and nourish lung and stomach yin. Sha Shen Mai Dong Tang clears and nourishes the lungs and stomach, engenders fluids and moistens dryness. It is a main treatment for dryness damaging the lung and stomach yin aspect. Within this formula, Nan Sha Shen, Yu Zhu, and Mai Men Dong all enter both the lung and stomach channels, engender fluids and moisten dryness. When combined with Sang Ye, dryness and heat are cleared and out-thrust from lung metal. Tian Hua Fen moistens lung dryness and also recedes depressive heat of the five viscera. In addition, it scatter stasis and disperses swelling. Bai Bian Dou harmonizes the center and transforms dampness and turbidity. It thus prevents enrichment from being excessive slimy. When combined with Gan Cao, it further banks earth to engender metal. When dryness is acute, the addition of Bei Sha Shen, Tian Men Dong, Shi Hu, and Lu Gen increases the functions of nourishing yin and clearing heat and dryness. Fang Feng dispels wind and stops itching. It can also scatter deep-lying or hidden fire from the spleen and stomach. This is based on the saying, "Depressive heat should be effused." Bai Ji is able to constrain sores and engender the flesh. Thus, it promotes the healing of inflammation of the lips. When all these medicinals are used together, they address both the lung and stomach channels at the same time as well as moisten dryness and clear heat at the same time.