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DU-4

ORAL LEUKOPLAKIA

GENERAL

Clinical Manifestations	Oral leukoplakia is a white patch or plaque that cannot be rubbed off, cannot be characterized clinically or histologically as any other condition, and is not associated with any physical or chemical causative agent except tobacco. Therefore, a process of exclusion establishes the diagnosis of the disease. In general, the term leukoplakia implies only the clinical feature of a persistent, adherent white plaque; therefore, reserve the term for idiopathic lesions when investigations fail to reveal any cause. The term carries absolutely no histologic connotation, although, inevitably, some form of disturbance of the surface epithelium is characteristic. Follow-up studies suggest that cancer is more likely to occur in individuals with idiopathic leukoplakia than in individuals who do not have this condition. Thus, idiopathic leukoplakia is considered a premalignant lesion.
Treatment Principle
Herb Formulas
Points

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	White patches on the oral mucosa which are stiff and hard with white borders A relatively disease course A bland taste in the mouth No thirst Cold body Aversion to Cold Cold extremities Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce Spleen and Kidney Yang Scatter Cold
Herb Formulas	Ba Wei Di Huang Wan modified
Points	DU-4, SP-6, ST-36, UB-18, UB-20, UB-21, UB-23 For more marked Spleen Deficiency: + SP-3 For Liver Qi Stagnation: + LI-4, LIV-3 With Blood Stagnation: + LI-4, SP-6, SP-10

QI AND YIN DEFICIENCY

Clinical Manifestations	Dry white or sticky patches on the oral mucosa Enduring disease which does not heal Pale colored or mucosa A sallow yellow facial complexion or A Pale white facial complexion with flushed cheeks Fatigue Lack of strength Maybe insomnia Profuse dreams Vexation Agitation Restlessness Dry mouth with no desire to drink Dry stools T: Pale and enlarged with a possible red tip C: White P: Thready and forceless
Treatment Principle	Strengthen the Spleen Tonify Qi Nourish Yin Generate Fluids
Herb Formulas	Yi Wei Tang modified With Fluid Dryness with Liver Qi Stagnation and Damp-Heat: Oral Leukoplakia #1
Points	KI-7, LI-4, SP-6, ST-36 With severe Spleen Qi Deficiency: + SP-3 With a restless Shen due to Deficiency: + HT-7 With a restless Shen due to Heat: + HT-8, PC-7 With Liver Qi Stagnation: + UB-17, UB-18 With lingering Damp-Heat: + SP-9 With more severe Yin Deficiency: - KI-7, + KI-6, LU-7

QI AND BLOOD STAGNATION

Clinical Manifestations	White patches on the oral mucosa which are lumpy and raised or whose surface is uneven and is hard and stiff Possible pain and itching Dry skin over the entire body Abdominal fullness and distention T: Dark C: Thin P: Wiry or Wiry and choppy
Treatment Principle	Invigorate the Blood Move Qi
Herb Formulas	Shi Xiao San modified
Points	LI-4, LIV-3, SP-6, ST-4, ST-6 With Blood Deficiency: + UB-17, UB-18 With severe Spleen Qi Deficiency: + SP-3, ST-36

DAMP-HEAT

Clinical Manifestations	White patches on the oral mucosa with red margins, and are dirty, brownish or Mixed-red and white patches Maybe ulceration Maybe burning pain Dry mouth Bitter taste in the mouth T: Red C: Greasy P: Slippery and rapid
Treatment Principle	Clear Heat Transform Dampness
Herb Formulas	Long Dan Xie Gan Tang modified With Spleen Qi Deficiency and Liver Qi Stagnation: Xiao Chai Hu Tang modified
Points	GB-34, LI-4, LIV-2, SP-9 With mouth ulcers: + ST-4, ST-6 With Stomach Heat: + ST-41, ST-44 With Excess Heat: + LI-11 With Excess Heat disturbing the Shen: + HT-8, PC-8