Gingival decay refers to the ulceration, erosion, and pain of the tissues surrounding the gums (including the upper and lower gums).

This condition is referred to as "gingival fistula" in Zhubing Yuanhou Lun, and later medical texts collectively call it "ulcerative gingivitis". Ulcerative gingivitis is further divided into "acute gangrenous stomatitis", "wind-heat ulcerative gingivitis", "swollen legs with suppurative gingivitis", and so on.

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1. Wind-heat︰Initially, the gums become red, swollen, and painful, with a rapid fever, or even alternating chills and fever. Within two or three days, one or multiple areas of the gingival margin may erode, leading to traumatic hemorrhage, pain, difficulty eating, and frequent discharge of thick saliva. Hard, tender lumps may appear under the jaw, sometimes accompanied by nausea, vomiting, constipation, a red tongue with a thin yellow coating, and a floating, rapid pulse. This condition arises from accumulated heat in the stomach combined with external contraction of wind-heat pathogens, which invade the gums and damage the mucous membranes. Swollen legs with suppurative gingivitis are related to regional, lifestyle, and dietary factors, often caused by prolonged exposure to cold and damp environments, leading to stagnation of cold-damp qi in the Jingmai, along with insufficient intake of fresh vegetables and fruits and excessive consumption of greasy, rich meats. This results in heat accumulation in the stomach and intestines, which rises to the mouth, causing the disease. Treatment focuses on dispersing wind, clearing heat, and removing toxins, commonly using Stomach-Clearing Decoction. For persistent cases, Ginseng and Scrophularia Root may be added. If dampness is severe, Virgate Wormwood, raw Coix Seed, and Plantain Seed can be included. For external use, Powder with Human Urine Sediment can be applied to the affected gums after rinsing and cleaning.
2. Blue Leg︰It manifests as swollen gums, ulceration with pus and blood, and in severe cases, it may penetrate the cheeks and rupture the lips. At the same time, there is pain in both legs, accompanied by lumps resembling cloud patches, with a color similar to dark green eggplants, varying in size. The muscles become stiff and inflexible, making movement difficult. If cold-dampness is severe, additional symptoms may include body pain, absence of sweating, swelling of the limbs, and scanty, clear urine. If toxic fire is intense, there may be a bitter taste in the mouth, dry mouth, foul breath, a red tongue texture, a yellow and dry tongue coating, and a slippery, rapid pulse. Besides gum ulceration, there is also pain in both legs with lumps resembling cloud patches or dark green eggplants, stiff muscles, and difficulty walking. The onset is relatively slow. Treatment involves dispelling cold and promoting dampness elimination, clearing heat, and removing toxins. Commonly used formulas include the Harmonizing Collaterals and Flowing Qi Decoction with the addition of Dandelion and Purslane Herb. For severe cold-dampness and significant leg swelling, Cassia Bark is added. For intense toxic fire causing fluid damage, the Five-Juice Decoction may be taken concurrently. Externally, Borneol and Borax Powder or Cinnabar and Yellow Powder can be applied to the ulcerated gums.
3. Running Horse︰At the onset, the gum margin or the cheek area becomes hard, swollen, and red. Within one or two days, it ulcerates, turning grayish-white and then black, oozing purplish blood with a foul odor. The ulcerated area is neither painful nor itchy. The tongue appears red with a yellow, greasy coating, and the pulse is rapid. In cases of excessive toxic fire, the black ulceration spreads rapidly. Within a few days, a bluish-brown discoloration appears around the nose, nasal wings, cheeks, or lips, indicating deep internal decay. In severe cases, the lips may rot, teeth may fall out, cheeks may perforate, and the palate may rupture, with the nasal bridge collapsing. When the decay is severe, systemic symptoms such as aversion to cold with fever, inability to eat, diarrhea, panting, and unconsciousness may occur. If the black ulceration can be easily removed, revealing red flesh and fresh bleeding, and the fever gradually subsides, there is still hope for recovery even if teeth have fallen out or cheeks have perforated, exposing bone. However, if healthy qi is severely deficient and the pathogenic toxins are overwhelming, death is often inevitable. This condition is usually caused by residual toxins from diseases such as measles, smallpox, eruptive diseases, cold-damage disease, malaria, or dysentery, leading to intense internal heat that damages the gums. It is a severe illness. Treatment focuses on removing toxins and clearing heat, often using the Detoxifying Xiaogan Decoction for internal use. For cases with deficient healthy qi, Ginseng and Astragalus Root may be added. For spleen deficiency, Ginseng and Poria Porridge can be supplemented. For prolonged heat damaging body fluids, Sweet Dew Decoction may be prescribed. Externally, Powder with Human Urine Sediment can be applied to the affected area.

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1. Yizong Jinjian-Zabing Xinfa Yaojue: "Ulcerative gingivitis is a disease that kills people the fastest. Although there are specialized treatments, they all lack the method of continuous attack. Continuous attack means attacking today and attacking again tomorrow, until the swelling and hardness subside, the black color changes, and the foul smell stops. If the patient cannot eat, attack every other day or every two to three days. After the attack, if the patient gradually can eat, there is no need to restrict the diet; let them eat whatever they want. Even if there is a large loose stool, still measure the severity of the attack, and the efficacy will be seen. If the patient has no appetite and cannot withstand the attack, then it is a fatal condition. The attacking medicine uses large-fruited elm Xiaogan Tang, which includes Realgar, large-fruited elm, raw Rhubarb Rhizoma, Aloes, Sichuan Coptis Rhizome, Neopicrorhiza, and Skullcap Root."