This disease is similar to the "throat-anus-genital syndrome" in Chinese medicine. Jingui Yaolue‧Lily Bulb erosion of throat, anus and genitalia yin and yang toxin》 first described this disease: "The disease of erosion of throat, anus and genitalia is like cold-damage disease, silently not wanting to sleep, eyes unable to close, restless in lying down and getting up, erosion in the throat causes sensation, erosion in the yin causes fox, not wanting to eat, disliking the smell of food, the face and eyes suddenly red, suddenly black, suddenly white, erosion in the upper part causes hoarseness, Licorice Heart-Draining Decoction is the main treatment." Regarding the disease cause mechanism of disease, the physician Xu Zhong-ke believed: "Erosion of throat, anus and genitalia is caused by worms, mostly due to dampness-heat toxins, when the toxins are strong in the upper part, they erode the throat causing confusion..." When the toxins are biased in the lower part, they erode the yin causing fox. The physician Qi Yi De also said: "The throat-anus-genital syndrome refers to the erosion of worms up and down... It is due to the long-standing dampness-heat, which steams and rots the qi and blood to form stasis and turbidity, and then the wind transforms into worms." Chinese medicine, based on its initial symptoms such as nodular erythema, ulcers in the mouth and genitals, red and painful eyes, slippery and rapid pulse, red tongue with yellow coating, believes that this disease is due to liver-kidney yin deficiency, affected by heat toxin dampness evil, liver failing to act freely, spleen losing its transportation and transformation, or the toxin evil flaming up, or the toxin evil pouring down, or qi and blood stagnation, meridians blocked, thus leading to the corresponding symptoms. As the disease recurs, it gradually shifts from yang pattern to pudendal coldness syndrome, the redness and pain of the ulcers in the mouth and genitals of the patient significantly reduce, fear of cold and preference for heat, often cold hands and feet, easily triggered in cold seasons, indicating that the patient has spleen-kidney yang deficiency blood stasis syndrome, so the disease in the early stage is mostly caused by yin deficiency heat toxin blood stasis, while in the advanced stage it is mostly caused by spleen-kidney yang deficiency blood stasis.

Behçet's disease is a chronic, relapsing and remitting autoimmune disease with multi-system damage. In addition to the triad of eye, mouth, and genital lesions, various skin symptoms can also be observed: erythema nodosum, nodular vasculitis, thrombophlebitis, folliculitis, polymorphic erythema-like rash, and positive pathergy test (positive isomorphic reaction). Some patients also have systemic symptoms: fever, joint pain and arthritis, increased erythrocyte sedimentation rate, gastrointestinal and nervous system or myocardial damage, and other multi-system injuries. The course of the disease can range from several years to several decades. Most patients can be cured, but a few with severe damage may suffer permanent blindness or even life-threatening conditions. In recent years, the incidence has shown an increasing trend. The cause of this disease is not yet fully understood and may be induced by a combination of multiple factors. The main causes include:

1. viral infections.
2. bacterial infections, such as staphylococcus, streptococcus, subcutaneous node bacteria, etc.
3. drug allergies (including biological agents).
4. autoimmunity: both a result and a cause of the disease.

It can be induced by the first three factors or triggered by the production of autoimmune antibodies, leading to autoimmune phenomena. Due to the above triggers, the body may produce autoantibodies against its own oral mucosa, blood, blood vessel walls, gastrointestinal mucosa, and skin, coupled with immune complex deposition, which can cause various damages to the body.

[Diagnosis]

Main features:

1. oral ulcers (aphthae).
2. uveitis (iritis, hypopyon iritis).
3. genital or genital ulcers.

Secondary features:

1. skin lesions.
   1. pyoderma.
   2. nodular sexually transmitted lesions.
2. arthritis.
   1. large joint arthritis.
   2. arthralgia.
3. vascular disease.
   1. migratory superficial phlebitis.
   2. large vein thrombosis.
   3. stirred pulse tumor.
   4. peripheral gangrene.
   5. retinal and vitreous hemorrhage, optic disc edema.
4. central nervous system lesions.
   1. brainstem syndrome.
   2. meningoencephalomyelitis.
   3. mental confusion.
5. gastrointestinal diseases.
   1. malabsorption.
   2. upper abdominal fullness and discomfort, belching.
   3. abdominal pain, indigestion.

bubble_chart Pattern Analysis

1. Exuberant Heat-toxin︰This type is commonly seen in the acute stage of attack. Symptoms include dry throat and mouth, ulcers of varying sizes on the oral mucosa with surrounding pale red mucosa and pain; red, painful eyes, photophobia, excessive tearing, and significant purulent discharge, accompanied by iritis or keratitis; genital ulcers with burning pain, while vaginal ulcers in women may present with no obvious symptoms but increased discharge. Systemic manifestations include high fever, swollen lymph nodes, prominent skin erythema, joint pain or even redness and swelling, thirst with a preference for cold drinks, scanty dark urine, dry stools, and in severe cases, difficulty due to dryness accumulation. The tongue appears red with a yellow or greasy coating, and the pulse is wiry and slippery. Treatment involves clearing heat, removing toxins, cooling the blood, and enriching yin. Modified Plague-Clear Toxin-Vanquishing Decoction combined with Universal Relief Decoction for Eliminating Toxin is used. Ingredients include Gypsum 30g, Anemarrhena 20g, buffalo horn 30g, Unprocessed Rehmannia Root 20g, Skullcap Root and Coptis Rhizome 15g each, Dried Tangerine Peel, Scrophularia Root, Bupleurum, Platycodon Root, and raw Liquorice Root 10g each, Forsythia, Isatis Root, Puff-Ball, Great Burdock Achene, and Mentha 10g each, Stiff Silkworm and Cimicifuga Rhizome 5g each, Gardenia, Moutan Bark, and Peony Root 12g each. For dry stools, add Rhubarb Rhizoma 15g (to be decocted later). For a yellow, greasy tongue coating and thirst without excessive drinking, add Gentian, Plantain Seed, and Akebia Stem 15g each. If accompanied by yin deficiency, remove Skullcap Root, Coptis Rhizome, and Gardenia, and add Prepared Rehmannia Root, Ophiopogon Tuber, and Asparagus Root.
2. Liver-kidney Yin Deficiency︰This type is primarily characterized by four types of lesions: oral, ocular, genital, and skin, accompanied by dry mouth and throat, vexing heat in the chest, palms, and soles, dry eyes, dizziness, tinnitus, insomnia, forgetfulness, night sweats, seminal emission, soreness and weakness in the lower back and knees, blurred vision, or red, swollen, and painful eyes, or mouth and tongue ulcers, or red patches and nodules on the skin. The tongue is red with scant moisture, and the pulse is thin and rapid. The treatment involves nourishing water to moisten wood and invigorating blood to remove toxins. Modified Lycium and Chrysanthemum Rehmannia Decoction is used: Barbary Wolfberry Fruit and Prepared Rehmannia Root, 20g each; Chrysanthemum Flower, Cornus, and Chinese Yam, 15g each; Alisma, Moutan Bark, and Poria, 10g each. For severe ulcer swelling and pain, add Salvia, Unprocessed Rehmannia Root, Scrophularia Root, and Chinese Angelica. For severe red, swollen, and painful eyes, add Feather Cockscomb Seed, Pale Butterflybush Flower, Prunella, and Feather Cockscomb Seed, 10g each. For severe genital ulcer swelling and pain, add Achyranthes Root, Gentian, and Tail of Chinese Angelica, 15g each. For women with menstrual irregularities, combine with Four Ingredients Decoction: Chinese Angelica, 20g; Peony Root, 15g; Sichuan Lovage Rhizome, 10g.
3. Spleen-kidney Yang Deficiency︰This type is primarily characterized by three or two of the following lesions: oral or vulvar ulcers, or painful scattered nodules on the lower legs. It is accompanied by fear of cold, cold limbs, poor appetite, loose stools, soreness and weakness in the lower back and knees, and edema of the lower limbs. The tongue is pale, swollen with tooth marks, and has a white, greasy coating; the pulse is deep and thready. Treatment involves warming and tonifying the spleen and kidney, combined with activating blood circulation. Kidney Qi Pill combined with Middle-Regulating Decoction, modified. Ingredients: Cinnamon Twig, Prepared Rehmannia Root, Chinese Yam, Cornus, and Moutan Bark, 15g each; Aconite Lateral Root, Alisma, Poria, Dried Ginger, Codonopsis, and White Atractylodes Rhizome, 10g each; Prepared Liquorice Root, 10g. For severe qi deficiency, add Astragalus Root, 30g, and Ginseng, 15g; for severe fear of cold and cold limbs, add Asarum, 3g, Chinese Angelica, and Cassia Bark, 10g each; for severe edema, add Polyporus, Rice Bean, and ginger peel, 10g each; for prolonged loose stools, add Psoralea and Nutmeg, 10g each.
4. Deficiency of Both Qi and Blood︰This type is characterized by alternating and overlapping lesions in the mouth, eyes, genitals, and skin, accompanied by dizziness, blurred vision, palpitations, insomnia, mental fatigue, lack of strength, shortness of qi, reluctance to speak, excessive sweating, poor appetite, loose stools, and recurrent episodes of the condition. The tongue is pale with a white coating, and the pulse is wiry and rapid or deep and thin. Treatment involves tonifying qi and blood, removing toxins, and promoting wound healing. Modified Eight Precious Ingredients Decoction is used, consisting of Prepared Rehmannia Root, Chinese Angelica, Peony Root, Tangshen, Indian Bread Tuckahoe, Lonicera, Scrophularia Root, and Prepared Liquorice Root, 20 grams each; Sichuan Lovage Rhizome and White Atractylodes Rhizome, 15 grams each. For severe blood deficiency, add Donkey-hide Gelatin, Chinese Date, Suberect Spatholobus Stem, and Barbary Wolfberry Fruit, 20 grams each. For severe qi deficiency, add Astragalus Root, 20 grams, and Ginseng, 10 grams. For soreness and ulceration with swelling and pain, add Dandelion and Tokyo Violet Herb, 15 grams each. For excessive sweating, add Astragalus Root, 30 grams, and raw Long Mu, 15 grams each.