Mouth Ulcers

Excess ulcers are characterized by symptoms such as redness, swelling, pain, and a yellow or white coating on the ulcer itself. These ulcers are often caused by external pathogens invading the body, such as wind-heat or damp-heat. Treatment focuses on expelling the pathogen and resolving the heat.

Deficient ulcers, on the other hand, are characterized by symptoms such as pale or bluish color, slow healing, and a thin or absent coating on the ulcer. These ulcers are often caused by internal imbalances, such as deficiency of qi, blood, or yin. Treatment focuses on tonifying the deficient organs and nourishing the blood and yin.

In general, treatment of mouth ulcers with Chinese medicine aims to address the underlying imbalance and remove any external pathogens, in order to promote healing and prevent recurrence. This may involve the use of acupuncture, herbal medicine, and dietary and lifestyle recommendations.


External Pathogens

Heat and other external pathogens can cause acute mouth ulcers. If these external causes are not properly treated, they can lead to chronic, recurrent mouth ulcers.


The most common cause of recurrent mouth ulcers is persistent low-grade heat in the heart and stomach/spleen, which can irritate and sensitize the tissues of the mouth, making them more susceptible to ulceration. This heat can be triggered by a heating diet, which includes overeating and the consumption of heating or irritant substances, such as chiles, alcohol, sugar and chocolate, spicy food, stimulant drugs (including recreational and prescription), coffee, and tobacco. Emotional stress can also contribute to the generation and perpetuation of this heat, making mouth ulcers more likely to occur. In some cases, no obvious trigger for the ulcers may be evident.

Emotional Factors

Prolonged emotional stress and turmoil can impair the movement of liver qi, leading to its accumulation and the generation of heat or fire. This mix of pathologies can cause recurrent mouth ulcers that arise in response to increasing stress. In addition, stress can cause constraint of liver qi, which can over-control the spleen and stomach and/or generate heat. This can also result in the development of mouth ulcers.

Furthermore, anxiety, depression, and sudden shock can hinder the movement of heart qi, causing its accumulation and the generation of heat or fire. This type of qi accumulation is different from liver qi constraint in that the focus of liver qi constraint is typically below the diaphragm, although its effects may be systemic. Heat or fire can also be transmitted from the liver to the heart, leading to heart fire, which is more likely to occur in individuals who already have some preexisting heat, whether from diet, emotional factors, or congenital factors.

Overuse, Exhaustion, Habits

Excessive work, stress, and poor nutrition can damage the Spleen's ability to produce qi and blood, leading to deficiency. This can manifest as mouth ulcers, as the Spleen is unable to generate enough blood to nourish the Heart. Qi and blood deficiency can also occur following severe illness, hemorrhage, difficult pregnancy or labor, and in women who do not fully recover their qi and blood before returning to work. Prolonged breastfeeding or working while caring for demanding children can also deplete qi and blood.

Spleen yang can be damaged by prolonged illness, starvation, or digestive problems, such as those experienced by people with anorexia or bulimia. Kidney and Heart yin can be damaged by overwork, excessive sexual activity, lack of rest, aging, and drug use, leading to a breakdown in the relationship between the Heart and Kidneys. This can cause Kidney water to no longer keep Heart fire in check, further consuming yin.

Sudden disruption of the Heart-Kidney axis can follow a major shock or trauma, and can result in ulceration, insomnia, and other symptoms. However, the damage to the yin of the organs is not as severe in these cases.


Mouth ulcers can be caused by mechanical trauma from chewing, dentures, sharp tooth surfaces, or certain foods. Gastric or abdominal surgery can also sometimes damage the Spleen's ability to produce yang.