🌿 Folk Prescriptions

Chronic recurrent oral ulcers are common and frequently occurring conditions, characterized by long duration and repeated episodes, causing significant physical and psychological harm to patients. Clinically, they manifest as isolated, round or oval shallow ulcers on the oral mucosa, accompanied by local burning pain.
Oral ulcers fall within the categories of "oral carbuncle" and "oral erosion" in traditional Chinese medicine. Though originating in the mouth, they are closely related to internal organs. TCM theory holds that the spleen opens to the mouth, the heart opens to the tongue, the kidney meridian connects to the throat and the root of the tongue, the cheeks and gingiva belong to the stomach and large intestine, and both the Ren and Du meridians ascend to link the mouth, lips, and tongue—indicating close ties between oral ulcers and the five zang organs. The *Huangdi Neijing* (Plain Questions, "The Great Treatise on the Essentials of Truth") states: "All pains, itching, and sores are attributed to the heart." The "fire" behind oral ulcers is not solely due to heart fire. Daily worries, anger, smoking, alcohol, coffee, and excessive consumption of rich, fatty, sweet foods can lead to heart-spleen heat accumulation, lung-stomach heat stagnation, or liver-gallbladder heat retention, resulting in ulcers typically seen as real syndromes. Kidney yin deficiency leading to false fire ascending causes ulcers usually seen as deficiency syndromes. Elderly or frail individuals with overwork and internal injury damaging the spleen and stomach may disrupt the middle burner’s function, obstructing the flow of qi between upper and lower parts, preventing the upper yang from descending and lower yin from ascending, leaving heart fire unchecked and ascending along the channels, also causing ulcers—typically deficiency syndromes. As Li Dongyuan stated in *Treatise on the Spleen and Stomach*: "When the spleen and stomach qi decline and primordial qi is insufficient, heart fire becomes dominant. Heart fire is actually a yin fire originating from the lower burner, connected to the heart. Since the heart does not govern directly, the lesser fire takes its place." "Stomach disease leads to shortness of breath, lack of spirit, and spontaneous fever. Sometimes, stomach fire ascends and burns the face alone."
Treating oral ulcers requires distinguishing between deficiency and excess, identifying involved zang-fu organs, combining disease and syndrome differentiation for optimal results. Among various clinical presentations, heart-spleen heat accumulation and false fire ascending are most common. Clinical insights are as follows:
1. Heart-Spleen Heat Accumulation Syndrome
Main symptoms: recurrent ulcers on the tip of the tongue, edges of the tongue, tongue surface, gums, or cheek areas. Ulcers have a yellowish coating on the surface, depressed base, raised margins, redness, swelling, heat, and pain. Accompanied by bitter taste, bad breath, restlessness, heat sensation, short red urine, constipation. Tongue is red with yellow coating, pulse is stringy and slippery. Diagnosis: excessive heart-spleen heat, causing tissue decay and ulcer formation. Treatment: clear heat and fire, promote tissue regeneration and healing. Formula: Self-designed Xiao Xin Liao Chuang Decoction: Scutellaria root 15g, Coptis 5g, Rhubarb 10g, red and white peony root 15g each, lotus heart 3g, raw licorice 5g, artemisia 15g, stir-fried gardenia 10g.
Case Example: Mr. He, male, 32 years old, visited our hospital on October 16, 2002. Chief complaint: recurrent oral ulcers for 3 years, worsened over the past month, severe pain preventing eating. Examination revealed three ulcers about the size of sesame seeds to green peas on the tip of the tongue and inner surfaces of upper and lower lips, intensely painful, unable to eat, bitter taste and bad breath, constipation for three days, short, hot, red urine, red tongue with yellow coating, stringy and slippery pulse. Inspection showed a 0.1×0.5cm ulcer on the tip of the tongue, red swollen margins, depressed base, covered with yellow coating. Two 0.1×0.1cm ulcers on the inner sides of the upper and lower lips. This resulted from heart fire and stomach-intestinal heat ascending along the channels, diagnosed as heart-spleen heat accumulation, scorching and forming ulcers. Treatment: clear heat and fire, relieve pain and heal ulcers. Prescription: Rhubarb 10g, Scutellaria root 15g, Coptis 5g, raw gypsum 30g, stir-fried gardenia 10g, windproof 10g, red and white peony root 15g each, raw licorice 5g, scrophularia 20g, raw rehmannia 30g, artemisia 20g, Corydalis 15g. One dose daily. Boil the herbs twice with water, collect 400ml, divide into four portions, warm and take each portion. After one dose, defecation occurred, pain reduced, allowing liquid diet. After seven doses, follow-up visit showed significantly reduced pain, ulcer size diminished, yellow coating turned white. Remove Scutellaria, Coptis, Rhubarb; add Astragalus, Angelica, and Bletilla. Continue for another seven doses until cured.
This patient often worked night shifts, smoked and drank heavily, leading to gradual accumulation of heart and spleen fire. Excessive heat ascended, scorching the oral mucosa and causing ulcers. The prescription combines Xiao Xin Tang, Zeng Ye Tang, Xie Huang San, and Chi Shao Gan Cao Tang, simultaneously replenishing fluids to extinguish fire and using bitter-cold herbs to purge heat—like removing the fuel from beneath the pot. Heart-spleen fire naturally subsides, ulcers heal. Additionally, advised to reduce smoking and drinking during night shifts, cut off the source of heat, drink more water, eat more vegetables and fruits, maintain smooth bowel and bladder movements, ensuring a pathway for internal heat elimination, thus reducing recurrence after healing.
2. False Fire Ascending Syndrome
Main symptoms: recurrent ulcers, excruciating pain, white coating on ulcer surface, depressed base, slightly raised margins, color not red, shortness of breath, fatigue, heat sensation, red cheeks, dry mouth but not thirsty, short red urine, red tip of tongue with little or cracked coating, fine and slightly rapid pulse. Diagnosis: liver-kidney deficiency, false fire disturbing upward. Treatment: nourish yin and generate body fluids, clear and reduce false fire. Formula: Self-designed Yang Yin Liao Chuang Decoction: raw and cooked rehmannia 15g each, northern sand参 15g, cornus fruit 10g, yam 10g, moutan bark 15g, alisma 15g, poria 20g, anemarrhena 10g, phellodendron 10g, ophiopogon 15g, angelica 10g, raw astragalus 15g.
Case Example: Mr. Liu, male, 50 years old. Initial consultation on March 15, 2003. Has suffered from oral ulcers for over two years, recurring intermittently, with unsatisfactory results from multiple treatments. On examination: one ulcer each on the gum and edge of the tongue, about the size of a green pea, depressed center, covered with white membrane, slightly raised margins, pale red color. Patient reports mild pain with burning sensation, dry mouth and sore throat, hot palms and soles, soreness and weakness in waist and knees, spontaneous sweating, yellow urine, dry stool. Tongue is red with little moisture, thin yellow coating, fine and slightly rapid pulse. Diagnosis: deficiency of yin fluids, false fire ascending. Treatment: nourish yin fluids, clear and reduce false fire. Prescription: raw and cooked rehmannia 15g each, yam 10g, cornus fruit 10g, alisma 15g, moutan bark 15g, poria 20g, anemarrhena 10g, phellodendron 10g, angelica 10g, northern sand参 20g, ophiopogon 15g, artemisia 20g, raw astragalus 15g. After taking the formula for 14 doses, ulcers healed, symptoms nearly disappeared. Switched to Zhi Bai Di Huang Wan for another month to consolidate results.
The ulcers appeared on the gums and tongue edges—teeth governed by the kidneys, tongue edges belong to the liver and gallbladder area. Given the recurrent nature and long duration, this is clearly due to liver-kidney yin deficiency. Repeated ulcers over time injure yin, leading to deficiency of body fluids and false fire ascending, scorching the oral mucosa and forming ulcers. Dry mouth and sore throat, hot palms and soles, red tongue with little moisture, fine and rapid pulse—all typical signs of yin deficiency with fire exuberance. The prescription selects Zhi Bai Di Huang Wan combined with Yiguan Jian, simultaneously nourishing liver and kidney yin (treatment of root cause) via Liuwei Di Huang Wan and Yiguan Jian, while using anemarrhena, phellodendron, and moutan bark to clear false heat and reduce fire. Added artemisia 20g to clear heat and promote bowel movements, giving fire a way out—this is the clever aspect of the formula. Combined use treats both root and branch, producing immediate results. After healing, continued use of Zhi Bai Di Huang Wan for one month strengthens the effect and prevents recurrence.
3. Treatment Insights
1. Oral ulcers are mostly due to fire syndromes, requiring distinction between deficiency and excess. Young patients with severe, burning pain, bitter taste, bad breath, constipation, and yellow urine indicate real heat and fire. Treatment should clear heat and fire, detoxify, and relieve pain. Elderly or weak patients with mild, persistent pain, dry mouth and throat, heat sensation or five-palm heat, red tongue with little moisture indicate deficiency heat and fire. Treatment should nourish yin, generate fluids, and clear and reduce false fire.
2. Combining local and systemic treatments enhances efficacy. Although ulcers are localized in the mouth, besides syndrome differentiation and systemic regulation, local medication is essential to deliver direct action to the ulcer site. Commonly used drugs include Plum Blossom Pill, Xihuang Qingxin Pill, and Liu Shen Wan—administered in small amounts multiple times by dissolving in the mouth to relieve local symptoms and accelerate ulcer healing, improving overall treatment effectiveness.
3. Astragalus and licorice are excellent herbs for promoting oral ulcer healing. Astragalus tonifies qi and consolidates the exterior, with effects of wound closure and tissue regeneration, ideal for treating oral ulcers. Modern pharmacological studies show astragalus enhances immune function and promotes wound healing. Raw licorice clears heat and detoxifies; modern studies confirm its steroid-like effects. Therefore, regardless of whether ulcers are due to real or false fire, adding raw astragalus and raw licorice to the prescription based on syndrome differentiation can reduce pain and promote ulcer healing.
4. Maintaining smooth bowel movements is crucial for treating oral ulcers. Oral ulcers often stem from internal organ fire ascending and scorching the oral mucosa. Treating ulcers with raw rehmannia nourishes yin and generates fluids to extinguish false fire, while artemisia clears heat and fire to extinguish real fire. Clinical studies show high-dose raw rehmannia has nourishing yin, generating fluids, and laxative effects. Pharmacological research indicates artemisia contains anthraquinones like emodin, rhein, chrysophanol, and emodin methyl ether, which have significant laxative properties. After taking medication, patients experience smooth bowel and bladder movements, allowing real and false fire to be expelled downward, naturally leading to ulcer healing. Besides medication, patients should be advised to drink plenty of plain water, eat fresh vegetables and fruits, keep bowels and bladder moving smoothly, reduce smoking and alcohol, avoid spicy and fried foods to minimize heat sources. Also, maintain good oral hygiene and engage in appropriate physical activity to strengthen the body—key measures to prevent recurrence of oral ulcers.