Cheilitis is a chronic, recurrent, superficial inflammatory disease of the lip mucosa. During acute episodes, the main symptoms include redness, swelling, pain, exudation, and erosion, while the chronic phase is characterized by dryness of the lip vermilion, scabbing, cracking, and recurrent desquamation.This condition falls under the TCM categories of “lip wind” (唇风, chún fēng) and “tight lips” (紧唇, jǐn chún), withredness, swelling, dryness, and itching as the four main symptoms.“Redness” and “swelling” are attributed to dampness and heat. “Excess dampness leads to swelling,” and “all dampness belongs to the spleen.” When the spleen’s qi and yin are insufficient, yin deficiency leads to internal heat. The convergence of these two heats ascends along the meridians to the lips, causing pain due to excessive heat, resulting in red, swollen, and painful lips, with dampness manifesting externally as occasional exudation; “dampness is sticky,” hence this condition often lingers and is difficult to cure, with prolonged illness potentially leading to dark purple lips indicating blood stasis.“Itching” is attributed to wind. When wind is excessive, it causes itching; wind is a yang pathogen that transforms into heat, leading to dryness, which injures body fluids. When dryness is excessive, it results in “dryness,” and with yin deficiency failing to nourish, patients often feel itching and dryness in the lips.Using TCM theory, cheilitis can be classified into four patterns:
01 Wind-Heat Excess Commonly seen during acute onset, characterized by rapid onset, red, swollen, and painful lips, cracking with exudation, resembling skinless conditions, accompanied by itching, occasional twitching, halitosis, dry stools, yellow urine, red tongue with yellow coating or greasy yellow coating, and a slippery or rapid pulse. Treatment principle: Clear heat and cool the blood, disperse wind and eliminate pathogens.Recommended medication: Xiao Feng Zhi Yang Granules (消风止痒颗粒) Efficacy: Xiao Feng Zhi Yang Granules primarily disperse wind and clear heat, used to treat wind-heat excess type cheilitis, clearing internal heat and alleviating redness, swelling, and itching symptoms. Precautions: Not suitable for pregnant women; those with yin deficiency and blood deficiency should avoid it; during medication, a light, easily digestible diet is recommended, avoiding spicy and seafood foods.02 Spleen-Stomach Damp-Heat
Lips are swollen and red, with heat and itching, small blisters and exudation, and in severe cases, erosion and bleeding, with perioral skin redness, often accompanied by dry throat, bitter mouth, reluctance to drink, poor appetite, short and red urine, irritability, red tongue, yellow greasy coating, and a slippery rapid pulse.
Treatment principle: Clear and drain stomach heat, transform dampness and reduce turbidity.
Recommended medication: Qing Wei Huang Lian Wan (清胃黄连丸) + Si Jun Zi Wan (四君子丸)
Efficacy: Primarily using Qing Wei Huang Lian Wan, supplemented with Si Jun Zi Wan, which drains fire and detoxifies while also strengthening the spleen to eliminate dampness.
[For external use: For the above two patterns, external application can use brewed tea to mix with Ruyi Jin Huang San (如意金黄散) for topical application.]
03 Yin Deficiency and Blood Dryness
Lips are dry and desquamating, often recurrent scabbing, and in severe cases, cracking and bleeding, with rough lips and deepening folds, often accompanied by overall skin dryness, dry mouth and thirst, dry stools, pale red or red tongue with little coating, and a thin pulse.
Treatment principle: Nourish yin, generate fluids, nourish blood, and moisten dryness.
Recommended medication: Zhi Bai Di Huang Wan (知柏地黄丸) + Xuan Mai Gan Qi Granules (玄麦甘桔颗粒) + Si Wu Decoction (四物合剂)
Efficacy: Primarily using Zhi Bai Di Huang Wan and Xuan Mai Gan Qi Granules to nourish yin and generate fluids to moisten dryness, supplemented with Si Wu Decoction to tonify and nourish blood, specifically targeting the yin deficiency and blood dryness type of cheilitis.
04 Insufficient Yin Blood and Spleen Dampness
Onset is slow, with swollen, dry, burning, and painful lips, frequently moistened by licking with the tongue, desquamation at the affected area, dryness and itching or cracking with exudation or bleeding, lingering and difficult to heal. Symptoms worsen in cold seasons, with dry mouth or sticky tongue, often accompanied by insomnia, backache, and five-center heat, red tongue, white greasy coating, and a thin pulse.
Treatment principle: Nourish yin, tonify the kidneys, strengthen the spleen, and eliminate dampness.
Recommended medication: Liu Wei Di Huang Wan (六味地黄丸) + Shen Ling Bai Zhu San (参苓白术散)
Efficacy: Used to treat insufficient yin blood and spleen dampness type cheilitis.
[For external use: For the above two patterns, a suitable amount of olive oil can be applied to the affected lips, first moistening the lips with cool boiled water for a moisturizing effect without greasiness.]
TCM treatment, as mentioned above, is often based on different patterns to select corresponding treatment principles. It primarily combines internal treatment with external medications, offering unique advantages in treating difficult-to-cure and recurrent cheilitis.
