Halitosis (Bad Breath)
Overview
Halitosis (bad breath) refers to an offensive oral odor perceptible to others, falling under the TCM categories of 'kou chou' (foul mouth) and 'kou qi' (mouth qi). The disease is located at the mouth and is closely related to dysfunction of the spleen, stomach, heart, liver, and kidney. Common etiologies include blazing stomach fire, damp-heat in the spleen and stomach, food accumulation in the gastrointestinal tract, accumulated heat in the heart and spleen, yin deficiency with fire effulgence, and liver depression transforming into fire. The key pathogenesis is accumulated heat in the zang-fu organs or deficiency fire steaming upward, causing turbid qi to rise to the mouth; or food stagnation and damp-turbidity brewing internally, putrefying and producing foul odor. Pattern differentiation should distinguish excess from deficiency: excess patterns are mostly due to fire, heat, dampness, and food accumulation; deficiency patterns are mostly due to yin deficiency with fire effulgence or spleen-stomach qi deficiency. Treatment follows the principles of clearing and draining accumulated heat in the zang-fu organs, transforming dampness and resolving accumulation, and nourishing yin and descending fire, combined with oral hygiene and dietary regulation.
Pattern differentiation (clinical patterns)
Blazing Stomach Fire
Foul offensive breath, oral and tongue ulcers, swollen and painful or bleeding gums, thirst with preference for cold drinks, burning epigastric pain, dry bound stools, scanty dark urine, red tongue with yellow coating, and a slippery rapid pulse.
Clear the stomach and drain fire; aromatically transform turbidity.
Damp-Heat in the Spleen and Stomach
Foul sticky offensive breath, stuffy distension in the epigastrium and abdomen, sticky bitter taste in the mouth, poor appetite with nausea, loose sticky unsmooth stools, yellow urine, red tongue with yellow greasy coating, and a soggy rapid pulse.
Clear heat and resolve dampness, awaken the spleen and harmonize the stomach.
Food Accumulation in the Stomach and Intestines
Sour putrid offensive breath, distension and fullness in the epigastrium and abdomen, eructation with foul odor and acid regurgitation, anorexia, foul-smelling or constipated stools, thick greasy tongue coating, and a slippery pulse.
Resolve food and guide out stagnation; harmonize the stomach and descend turbidity.
Connections
Daily care & prevention
Maintain oral cleanliness by brushing teeth morning and evening and rinsing after meals, optionally with dilute salt water or Chinese herbal mouthwash. Eat a light diet, reduce pungent, greasy, fried, and sweet-rich foods, quit smoking and limit alcohol, and consume more fresh vegetables, fruits, and high-fiber foods. Keep regular hours, avoid staying up late, and maintain smooth bowel movements. Moderately drink green tea, mint tea, or huo xiang-pei lan tea to aromatically transform turbidity. Keep emotions smooth and avoid depression and anger transforming into fire. If halitosis persists, seek medical attention for pattern-based treatment.
When to seek medical care
Halitosis with gingival bleeding, loose teeth, or non-healing oral ulcers warrants investigation for periodontal disease or oral tumors. With burning epigastric pain, acid regurgitation, black stools, or weight loss, be alert to peptic ulcer or gastric cancer. With dry mouth, polydipsia, polyuria, and weight loss, screen for diabetic ketosis. With fever, cough with purulent sputum, or hemoptysis, consider lung abscess or bronchiectasis. With altered consciousness and a rotten-apple odor, it is an emergency—seek immediate medical care.