Recurrent Mouth Ulcers
Overview
Kǒuchuāng (recurrent mouth ulcers) is characterized by recurrent round or oval ulcers of the oral mucosa with localized burning pain. It belongs to the TCM categories of 'mouth sore' and 'oral erosion.' The disease is located in the mouth and closely related to the heart, spleen, stomach, and kidney. Its causes include accumulated heat in the heart and spleen, yin deficiency with fire hyperactivity, or spleen deficiency with dampness retention. Clinical differentiation first distinguishes excess from deficiency: excess patterns arise from accumulated heat in the heart and spleen or exogenous pathogenic heat entering the interior and steaming the mouth and tongue; deficiency patterns arise from yin deficiency with fire hyperactivity, or spleen qi weakness with turbid dampness rising upward. Chronic recurrent cases are often mixed excess and deficiency. Treatment methods include clearing heat and draining fire, nourishing yin and descending fire, and strengthening the spleen and draining dampness; external therapies may enhance efficacy.
Pattern differentiation (clinical patterns)
Accumulated Heat in the Heart and Spleen
Multiple mouth ulcers of varying sizes with yellow-white bases and red swollen surrounding areas, burning pain, restlessness, thirst, foul breath, scanty dark urine, dry bound stool, red tongue with yellow coating, and a slippery rapid pulse.
Clear the heart and drain the spleen; cool the blood and resolve toxicity.
Yin Deficiency with Fire Hyperactivity
Recurrent ulcers, few in number, with gray-white bases and pale red surroundings, mild pain, dry mouth and throat, five-center heat, insomnia and dream-disturbed sleep, soreness and weakness of the lower back and knees, red tongue with little coating, and a thin rapid pulse.
Nourish yin and descend fire; nourish the heart and calm the spirit.
Spleen Deficiency with Dampness Retention
Recurrent ulcers that persist for a long time, with pale white bases and non-red or slightly red surroundings, mild pain, fatigue, poor appetite, loose stool, bland taste in the mouth, pale tongue with white greasy coating, and a soft weak pulse.
Strengthen the spleen and boost qi; transform dampness and astringe ulcers.
Connections
Daily care & prevention
Maintain oral hygiene by brushing morning and evening and rinsing after meals; use mild salt water or honeysuckle decoction as a mouth rinse. Eat a light diet with plenty of fresh vegetables and fruits; avoid spicy, fried, smoked, and excessively hot foods, as well as alcohol and tobacco. Ensure adequate rest, avoid staying up late, and keep a calm mood. Exercise moderately to strengthen the body. During flare-ups, apply a paste of wuzhuyu (Evodia) powder mixed with vinegar to yongquan (KI1), or use watermelon frost spray topically. For recurrent cases, record the pattern of outbreaks and identify triggers.
When to seek medical care
Ulcers persisting for more than two weeks, or ulcers that are deep and large with raised edges and indurated bases, severe pain, fever, lymph node enlargement, or weight loss should raise suspicion of oral malignancy and prompt biopsy. Ulcers accompanied by genital ulcers, uveitis, or erythema nodosum suggest Behçet's disease. High fever, generalized rash, or severe oral erosion requires exclusion of infectious diseases or drug allergy.