Recurrent aphthous ulcer (RAU) is one of the most common diseases of oral mucosa, with a prevalence of about 20%, ranking first among oral mucosa diseases. Recurrent aphthous ulcer is the most common, accounting for about 80%, and its morphology is characterized by “red, yellow, concave and painful”. Red: there is a red band of congestion about 1 mm around the periphery of the ulcer; yellow: the surface of the ulcer is covered with a light yellow pseudomembrane; concave: the central depression of the ulcer, the base is not hard; pain: there is an obvious burning sensation. It is equivalent to “mouth sores” in Chinese medicine and belongs to the categories of “mouth breakage” and “mouth ulcers” in Chinese medical literature.
The cause of the disease is still unclear and may be the result of a combination of factors.
1. Characteristics of recurrent mouth ulcers.
(1) gender characteristics: the onset, prognosis has gender differences.
(2) Age characteristics: Different types of diseases have different age groups of predilection.
(3) Site characteristics: Different parts of the oral mucosa have different perceptibility to the disease.
(4) Damage characteristics: overlap and overlap, site variability, and coexistence of damage.
(5) Diagnostic features: clinical manifestations combined with pathological examination.
(6) Characteristics of treatment: different treatment for the same disease, different treatment for different diseases, systemic treatment for local diseases, and combined treatment of Chinese and Western medicine.
(7) The characteristics of regression: most of them have good prognosis, but some damages such as precancerous lesions need attention.
2.Anatomical and structural characteristics of oral mucosa and its barrier function.
Barrier function includes physicochemical barrier, specific, nonspecific humoral and cellular immune barriers on the mucosal surface and within the mucosa.
(1) Salivary barrier: It has mechanical flushing effect, excludes toxic substances and blocks the adhesion of microorganisms. Such as mucin, lactoferrin and lysozyme all have different types of functions.
(2) Epithelial barrier: The intact epithelium has keratinized layer, granular layer, spiny layer and basal layer, which can prevent obligations and microorganisms from entering deep tissues, and the membrane is granulated to form intraepithelial barrier, and the basement membrane complex forms a filtering barrier of macromolecules with selective permeability.
(3) Immune cell barrier: including suppressor T cells, helper T cells, B lymphocytes, Langerhans cells, etc., which perform the function of cellular immunity.
(4) Immunoglobulin barrier: also known as humoral immune barrier, SIgA is the most important immunoglobulin with strong antibacterial effect and protein degradation by digestive hydrolase.
3.The general principles of recurrent oral ulcer management, commonly used drugs and treatment methods.
Treatment principles: systemic treatment to reduce the recurrence of ulcers and prolong the interval; local treatment to promote ulcer healing and shorten the ulcer period; attention to psychological guidance; active treatment of systemic diseases.
Immune-enhancing agents: Multi-anti-methotrexate, transfer factor, thymidine enteric-coated tablets.
Immunosuppressants: Prednisone, Torch root tablets, Radix polygoni.
Thalidomide (reaction stop).
Endocrine drugs/Nil estrol.
Vitamins and trace elements : VitBC, folic acid, niacin Silcon.
Chinese medicine for diagnosis and treatment: Stomatitis Ning Punch, Liu Wei Di Huang Wan, Gentian Diarrhea Liver Soup.
Topical preparations.
The four general principles are anti-inflammatory, analgesic, antiseptic, and healing promotion.
Anti-inflammation: To eliminate the inflammatory reaction caused by ulcers, adrenocorticosteroids and non-steroidal anti-inflammatory drugs such as prednisone and diclofenac sodium can be used.
Analgesia: To eliminate the sensation of pain, local anesthetic drugs such as 0.5% dacronin can be used.
Antiseptic: to prevent secondary infection, some antibiotics such as metronidazole and cephalosporin can be used appropriately.
Promote healing: promote the growth of epithelium, use epidermal growth factor and fibroblast growth factor, such as Befuzi, Jinin peptide, etc.
The treatment method requires a combination of local treatment and systemic symptoms of Chinese and Western medicine.
The signs of “chancre”, “mouth erosion” and “mouth sore” in Chinese medicine are similar to the clinical manifestations of recurrent oral ulcers.
In the Nei Jing, it is said that “all pains and ulcers belong to the heart”. The “Secret Guide to the Outer Terrace” says that “the heart and spleen often suffer from mouth sores when there is heat”. The General Record of Shengji states that “mouth sores are caused by heat in the heart and spleen, and the gas rushes to the upper jiao, fumigating the mouth and tongue.” It is believed that mouth sores are related to wind, fire, and dryness, as well as internal injuries and spicy food. The symptoms are Yin deficiency and fire, Spleen deficiency and dampness, actual heat in the spleen and stomach, heat congestion in the lung and stomach, and Qi and blood deficiency. Treatment is based on the principles of nourishing Yin and clearing fire, strengthening the spleen and relieving dampness, clearing heat and cooling the blood, clearing the stomach and purging the lung, and double tonification of Qi and Blood. It should be combined with internal treatment and external application, and the whole body and localization.
4.Efficacy observation indexes.
Primary efficacy indicators: ulcer size, number, exudation, edema, congestion, pain, burning sensation, dry mouth.
Secondary efficacy indicators: stool, urine, tongue and pulse.
5. Assessment criteria (effectiveness and safety)
(1) Efficacy.
The study conducted a comprehensive efficacy and safety evaluation of the patient’s evidence and symptoms, different degrees of changes in local lesions and systemic symptoms, the degree of pain, ulcer size, congestion and edema, healing and other relevant laboratory tests before and after treatment.
(2) Evaluation criteria.
Chinese medical evidence efficacy determination criteria.
Clinical healing: clinical symptoms and signs of TCM disappear or basically disappear, and the score of symptoms is ≥95%.
Apparently effective: Chinese medicine clinical symptoms and signs have significantly improved, and the symptom score is ≥70%.
Effective: TCM clinical symptoms and signs have improved, with a symptom score of ≥ 30%.
Ineffective: Chinese medicine clinical symptoms and signs have not improved, and the symptom score is ≤ 30%.
(3) Criteria for judging the efficacy of lesions: The evaluation standard of local lesions is based on the degree of healing of ulcers and the degree of pain and burning.
Clinical healing: The symptoms disappeared after 5 days of medication, the signs basically disappeared, the ulcer lesions were all healed, and the main index points were 0 or 1.
Effective: symptoms disappeared after 5 days, signs were significantly improved, ulcers healed up to 2/3 or ulcers became shallow and shrunken, the main index points were 1 and two were 2.
Effective: symptoms disappeared after 5 days of medication, signs improved, ulcers healed up to 1/3 or ulcers became shallow and shrunken, main index points were 2, two were 3.
Ineffective: The main symptoms and signs do not improve significantly after 5 days of medication, the ulcer basically does not change, and the points of main indexes are 3 or 4.
(4) Long-term efficacy determination criteria.
Recurrent oral ulcers are mainly characterized by recurrent attacks, self-limiting and self-healing. Therefore, the control of recurrence is of great importance for the treatment of this disease.