Oral Ulcers

Recurrent aphthous ulceration (RAU), also known as recurrent aphthous ulcers or recurrent aphthous stomatitis, is a disease of the oral mucosa that commonly affects the lips, tongue, cheeks, and soft palate. It is characterized by a cyclical, recurrent, and self-limiting course. Based on ulcer size and clinical presentation, it can be classified as minor, herpetiform, or major. Typical lesions have the features of “yellow, red, sunken, and painful.” It is the most common type of oral mucosal ulceration seen in clinical practice. In Traditional Chinese Medicine (TCM), this condition falls within the categories of “kou chuang” (oral sores) and “kou mi” (oral erosion).

TCM Pattern Identification and Medication Reference

| Common Symptoms

Clinical description:

The ulcers are irregular in shape and vary in size; they may merge with one another. The base is flat and covered with yellow exudate. The edges are mildly edematous and raised, and the surrounding area shows extensive, pronounced redness. There is a burning pain. This presentation is more common in young and middle-aged adults. It may be accompanied by facial flushing, a sensation of heat in the mouth, thirst, bad breath, red lips, a dry tongue, hard stools, scant dark-yellow urine, a reddish tongue, a yellow or thick, greasy tongue coating, and a forceful pulse.

Plain-language explanation:

  • The ulcers in the mouth are irregular in shape and vary in size; some may join together.
  • The ulcer surface is flat and covered by a layer of yellow exudate.
  • The edges are mildly swollen, with noticeable redness around the ulcers.
  • The pain can be intense and often feels burning.
  • This pattern is more common in young and middle-aged adults.
  • Facial flushing, a hot sensation in the mouth, thirst, and bad breath are often present.
  • The lips may be red and the tongue dry.
  • Stools may be hard and difficult to pass; urine may be scant and yellowish.
  • The tongue may appear red, with a yellow or thick, greasy coating.
  • The pulse may feel forceful, which in TCM is interpreted as excess internal heat.

| Treatment Approach

Clinical description:

Clear heat and drain fire; cool the blood and promote bowel movements.

Plain-language explanation:

  • Use cooling, fire-clearing methods to reduce excessive “heat” in the body and ease discomforts such as feeling hot and restless, dry mouth and thirst, a sore throat, bad breath, and a yellow, thick tongue coating.
  • At the same time, cool and nourish the blood and promote bowel movements to help relieve constipation, a burning sensation around the anus, and bloody stools or bright-red blood.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

| Common Symptoms

Clinical description:

The ulcers are small and may occur in multiples, most often at the tip, front, or sides of the tongue. They are red and painful. Symptoms may include a hot sensation in the mouth, thirst, palpitations, restlessness, irritability, scant reddish urine with painful or difficult urination, and restless sleep. The tip of the tongue may be red, with a thin yellow coating, and the pulse forceful and slightly rapid.

Plain-language explanation:

  • The mouth ulcers are small, but several may appear at the same time.
  • They commonly occur on the tip, front, or sides of the tongue.
  • The ulcer surface appears red and is noticeably painful.
  • A hot sensation in the mouth and thirst are common.
  • Palpitations, restlessness, and irritability may occur.
  • Urine may be scant and reddish, with a stinging or painful sensation.
  • Sleep may be restless, and falling asleep may be difficult.
  • The tip of the tongue may be red, with a thin yellow coating.
  • The pulse may be somewhat rapid and forceful, which in TCM is interpreted as excessive Heart Fire.

| Treatment Approach

Clinical description:

Clear Heart Fire, cool the blood, and promote bowel movements.

Plain-language explanation:

  • Use methods to calm the Heart and clear Fire, reducing “heat” associated with the Heart and easing restlessness, irritability, mouth and tongue sores, dry mouth and thirst, difficulty sleeping or vivid dreams, and a red tongue tip.
  • At the same time, cool and nourish the blood and promote bowel movements to help relieve constipation, a burning sensation around the anus, bright-red blood in the stool, or hard stools.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

| Common Symptoms

Clinical description:

This pattern is more commonly seen in women and is associated with emotional distress. It often begins or worsens with changes in mood or around the menstrual cycle. Ulcers may occur on the sides of the tongue, the lip mucosa, or other sites. They are about the size of a grain of rice and may be irregular in shape, with a yellow or gray-white base and a relatively wide red border. Associated symptoms may include distention and oppression in the chest and flanks, restlessness, irritability, bitter taste, dry throat, insomnia, premenstrual breast distention and pain, menstrual irregularity with heavy or scant flow, clots, and painful periods. The tongue tip may be red or dark red, sometimes with petechiae; the coating is thin and yellow, and the pulse is wiry and rapid.

Plain-language explanation:

  • This pattern is more commonly seen in women.
  • The ulcers often appear or worsen during emotional ups and downs or around the menstrual cycle.
  • They commonly occur on the sides of the tongue or inside the lips, are about the size of a grain of rice, and may be irregular in shape.
  • The ulcer base is yellow or gray-white, with a noticeable red border and significant pain.
  • There may be a feeling of distention and oppression in the chest and flanks, along with restlessness and irritability.
  • A bitter taste and dry throat are common.
  • Sleep may be difficult, with poor sleep quality.
  • Periods may be irregular, with heavy or scant flow, clots, and menstrual pain.
  • Breast distention and pain may occur before menstruation.
  • The tongue tip may be red or dark red, sometimes with petechiae, and the coating may be thin and yellow.
  • The pulse may feel wiry and somewhat rapid, which in TCM is interpreted as being associated with emotional factors and impaired Qi and blood circulation.

| Treatment Approach

Clinical description:

Clear Liver Fire, regulate Qi, and cool the blood.

Plain-language explanation:

  • Use methods to soothe the Liver and clear Fire, reducing stagnant heat in the Liver and easing irritability, pain and distention in the flanks, bitter taste, dry mouth, and red eyes.
  • At the same time, regulate Qi and cool and nourish the blood to support smoother Qi and blood circulation, ease upward surges of heat, and reduce facial flushing, heat in the mouth and tongue, or minor bleeding.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Longdan Xiegan Wan
Xiao Chai Hu Granules

| Common Symptoms

Clinical description:

The ulcers recur and vary in size, usually measuring a few millimeters or less, with 1–3 lesions. They are round or oval, with a shallow, saucer-shaped, flat base that is gray-yellow and has slight exudate. The edges are regular, distinct, and slightly raised, with a narrow red halo around them. There may be mild burning pain. Common accompanying symptoms include dry mouth and throat, thirst without a desire to drink, facial heat, red lips or flushed cheeks, dizziness, tinnitus, palpitations, poor memory, restlessness, irritability, heat in the palms and soles, soreness and weakness in the lower back and knees, yellow urine, dry stools, a red tongue tip or reddish tongue body, a thin yellow coating, and a deep, thready, rapid or thready, wiry, rapid pulse.

Plain-language explanation:

  • The ulcers recur and vary in size, but are generally no more than a few millimeters across.
  • Usually, 1–3 ulcers appear at a time.
  • They are usually round or oval, with a shallow, flat base.
  • The surface is gray-yellow, with a small amount of exudate.
  • The edges are regular and distinct, slightly raised, and surrounded by a narrow red halo.
  • The pain is usually mild and has a slight burning quality.
  • Dry mouth and throat are common, and there may be thirst without much desire to drink.
  • The face may feel hot; the lips may be red or the cheeks flushed.
  • Dizziness, tinnitus, palpitations, forgetfulness, restlessness, and irritability may also occur.
  • The palms and soles may feel hot, and the lower back and knees may feel sore and weak.
  • Urine may be yellow and stools hard.
  • The tip or body of the tongue may appear red, with a thin yellow coating.
  • The pulse may be thready and somewhat rapid, or thready and wiry, which in TCM is interpreted as often being associated with Yin deficiency and internal heat.

| Treatment Approach

Clinical description:

Nourish Yin and clear heat.

Plain-language explanation:

  • Use nourishing and moistening methods to replenish the body’s fluids and help relieve dry mouth and throat, dry skin, restlessness, irritability, and difficulty sleeping or vivid dreams.
  • At the same time, clear the “deficiency heat” associated with insufficient Yin fluids to ease episodes of heat in the afternoon or at night, heat in the palms and soles, night sweats, flushed cheeks, dry or sore throat, and dry cough with little phlegm.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Liu Wei Di Huang Wan
Zhi Bai Di Huang Wan

| Common Symptoms

Clinical description:

There are few ulcers, usually 1–2, and they are relatively large, often over 3 mm. The tissue around the ulcers is edematous and raised; the sores are dark red or pale red, with a gray-white, dull-looking base, and heal slowly. Accompanying symptoms may include a heavy-headed sensation, bland taste, sticky mouth without thirst, poor appetite, fullness and discomfort in the epigastrium, loose stools or diarrhea, fatigue, a pale, enlarged, tender tongue with teeth marks, a white, slippery, greasy coating, and a deep, moderate or thready pulse.

Plain-language explanation:

  • There are usually only 1–2 mouth ulcers.
  • The ulcers are relatively large, often more than 3 millimeters across.
  • The surrounding tissue is noticeably swollen; the ulcers may be dark red or pale red.
  • The ulcer base may appear gray-white or dull, and healing may be slow.
  • A heavy-headed sensation is common.
  • The mouth may taste bland, with a sticky feeling but no thirst.
  • Appetite may be poor, with little desire to eat.
  • There may be a feeling of fullness and discomfort in the stomach.
  • Stools may be loose, diarrhea may occur, and the body may feel weak.
  • The tongue may be pale and enlarged, with teeth marks along the edges.
  • The tongue coating may be white, slippery, and greasy.
  • The pulse may be deep and moderate or thready, which in TCM is interpreted as insufficient Spleen and Stomach function.

| Treatment Approach

Clinical description:

Tonify Qi and strengthen the Spleen; gently promote the drainage of dampness.

Plain-language explanation:

  • Use methods to supplement Qi and support the Spleen and Stomach, helping their “transforming and transporting” functions and supporting appetite and digestion. This approach is intended to address fatigue, bloating after meals, poor appetite, and loose stools.
  • Use gentle methods to promote urination and drain dampness, gradually helping the body eliminate excess dampness. This approach is intended to address a heavy feeling in the body, tired and heavy limbs, swelling of the face or lower legs, a sticky mouth, a thick, greasy tongue coating, and scanty urine.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Shen Ling Bai Zhu San

| Common Symptoms

Clinical description:

The mouth sores recur. There are few, small ulcers, either single or multiple. They are pale red with a pale yellow base, shallow, only mildly swollen and red, and not very painful. The condition is prolonged and healing is slow. There may also be poor appetite, loose stools, fatigue, abdominal distention, a sallow complexion, a pale tongue with a white coating, and a soggy, rapid pulse.

Plain-language explanation:

  • Mouth ulcers recur.
  • The ulcers are small and few in number; there may be one or several.
  • They are pale red, with a pale yellow base.
  • They are shallow, with little redness or swelling around them and relatively mild pain.
  • The condition may last a long time, and healing may be slow.
  • Reduced appetite and loose stools are common.
  • The body may feel easily fatigued and weak.
  • The abdomen may often feel bloated and uncomfortable.
  • The complexion may look sallow and dull.
  • The tongue may be pale, with a white coating.
  • The pulse may feel soft and somewhat rapid, which in TCM is interpreted as Spleen and Stomach weakness and insufficient Qi and blood.

| Treatment Approach

Clinical description:

Tonify the middle Qi, strengthen the Spleen, and harmonize the Stomach.

Plain-language explanation:

  • Use methods to supplement Qi in the middle burner, supporting physical energy and digestive function. This approach is intended to address easy fatigue, shortness of breath and weakness, a weak voice, and tiredness after prolonged exertion.
  • At the same time, regulate the Spleen and Stomach to support digestion and ease poor appetite, bloating after meals, upper abdominal discomfort, belching, acid reflux, nausea, and loose stools.

| Related Products

The products below are provided for information only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Bu Zhong Yi Qi Wan

References

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  14. Lai Yan, Feng Xianli. Observation of the Efficacy of Shen Ling Bai Zhu San in the Treatment of Oral Ulcers [J]. Clinical Medication Journal, 2014, 3(7): 3.
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