Cheek ulceration refers to the symptom of erosion and ulceration on the lateral walls of the oral vestibule.

This condition is recorded in ancient medical texts as "infantile malnutrition with aphthae," "spleen heat disease," "maxillary osteomyelitis," and "ding ma gan."

Thrush occurring in the cheeks of children is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Exuberant Fire Flaring Upward︰Ulcers and erosions appear on the cheeks, with a bright red color, and severe cases may lead to cheek swelling. Dry and bitter mouth, headache, red eyes, thirst with a preference for cold drinks, severe constipation, scanty and dark urine, red tongue texture, dry yellow coating, and a rapid, forceful pulse. Excess fire is caused by excessive consumption of rich, greasy foods, alcohol, spicy, fried, or roasted foods, leading to accumulated heat in the spleen and stomach. The key diagnostic points are: red ulcers and erosions on the cheeks, with severe cases leading to cheek swelling, headache, red eyes, dark urine, constipation, red tongue texture, dry yellow coating, and a rapid, forceful pulse. Treatment should focus on cooling the diaphragm and clearing heat, promoting bowel movement, and detoxifying. The recommended formula is Diaphragm-Cooling Powder; for external use, Borneol and Borax Powder and Indigo Powder can be applied.
2. Deficiency Fire Flaming Upward︰White erosive patches and white spots appear on the cheeks, with a faint red periphery, and in severe cases, cracked patterns may be exposed. Symptoms include dry and sore throat, dizziness, tinnitus, restlessness and insomnia, feverish feeling in palms and soles, a tender red tongue texture, and a thin, rapid pulse. Deficiency fire is often caused by kidney yin deficiency, where water fails to restrain fire, leading to flaring of deficient fire. The key diagnostic points are: white erosive patches and decaying spots on the cheeks with a faint red periphery, in severe cases exposing cracked patterns, dizziness, a tender red tongue texture, and a deficient, rapid pulse. Treatment should focus on nourishing yin and reducing fire, with the prescription choice being Anemarrhena, Phelloendron and Rehmannia Pill; externally, apply Granulation-Promoting Powder to nourish yin.
3. Wind-heat and Phlegm Exuberance︰Initially, the cheeks become swollen, hard, and flushed, followed by ulceration and perforation of the cheek, with thick, yellow pus that gradually thins and drips continuously, eventually leading to the shedding of necrotic bone and healing. Systemic symptoms may include fever, nausea, vomiting, constipation, a yellow and greasy tongue coating, and a floating, rapid pulse. This condition is caused by wind pathogens combined with heat, affecting the intestines and stomach; it often arises when externally contracted wind-heat pathogens clash with accumulated heat in the Yangming channel, scorching fluids to form phlegm. The excessive heat and phlegm stagnate and steam upward, leading to qi and blood stagnation. The key diagnostic points are: initial cheek swelling with redness, followed by ulceration and perforation, thick yellow pus that gradually thins and drips, a yellow and greasy tongue coating, and a floating, rapid pulse. Treatment should focus on dispelling wind, clearing heat, resolving phlegm, reducing swelling, and regulating and tonifying qi and blood. The recommended formula is Burdock Muscle-Relieving Decoction combined with Eight Precious Ingredients Decoction. For external treatment: use Five-to-Five Powder for abundant pus, Nine-to-One Powder for scant pus, and apply Granulation-Promoting Powder after pus is drained and necrotic bone is shed, followed by external application of Granulation-Promoting Jade and Red Paste.
4. Wind-coldkidney Deficiency︰The cheek ulcer penetrates the cheek, with persistent swelling and hardness, prolonged pus discharge, and failure of necrotic bone to detach, accompanied by alternating chills and fever, thin white tongue coating, and a deep, tight pulse. This is due to the binding of wind-cold, with the disease rooted in the kidneys. It often arises from constitutional kidney deficiency, allowing wind-cold to invade and take advantage of the deficiency. The key diagnostic points include: hard swelling of the cheek, prolonged pus discharge, delayed detachment of necrotic bone, systemic manifestations of alternating chills and fever, thin white tongue coating, and a deep, tight pulse. Treatment should focus on nourishing water to moisten wood, dispersing cold and transforming stasis, tonifying qi and nourishing blood. The recommended formulas are Yang-Harmonizing Decoction combined with Ginseng Nutrient-Nourishing Decoction, or supplemented with Minor Golden Pill. For external treatment: first use the Five-Five Vermilion Pill thread to draw out toxins and remove decay, then apply Granulation-Promoting Powder to close the wound. If the ulcer opening is too small and pus drainage is poor, the Seven Immortals Stick can be attached to a medicated thread and inserted into the ulcer to resolve putridity and erode the tract, or debridement may be performed.
5. Upward Attack of Residual Toxin︰It commonly occurs in children. The cheeks are ulcerated and swollen, penetrating the cheeks and rupturing the lips, with a collapsed nose and lost teeth, leading to facial deformity. Symptoms include aversion to cold with fever, unconsciousness delirium, refusal to eat, constipation or loose stools, a red-crimson tongue texture, yellow and rough tongue coating, and a rapid, flooding pulse. It is often caused by residual toxins ascending after diseases such as malaria, dysentery, cold-damage disease, measles, or smallpox, leading to deficiency of lung and kidney yin and excessive fire in the liver and stomach. Key diagnostic points: initial ulceration of the gums, rapidly progressing to ulceration and swelling of the cheeks, penetrating the cheeks and rupturing the lips, a collapsed nose and lost teeth, accompanied by systemic symptoms such as aversion to cold with fever, unconsciousness delirium, a red-crimson tongue texture, yellow and rough tongue coating, and a rapid, flooding pulse. Treatment should focus on cooling blood, clearing heat, and removing toxins. Prescriptions include Rhinoceros Horn and Rehmannia Decoction, Coptis Detoxification Decoction, and Five-Ingredient Toxin-Eliminating Decoction. For severe constipation, add raw Rhubarb Rhizome and Natrii Sulfas to purge fire and clear heat. For severe loose stools, add Sanguisorba charcoal and prepared Rhubarb Rhizome to clear the intestines and stomach. For unconsciousness delirium, additional administration of Peaceful Palace Bovine Bezoar Pill or Purple Snow Bolus may be considered. External treatments are the same as for wind-heat and phlegm excess.

bubble_chart Documentation

1. "The Origin and Flow of Diseases: The Origin of Oral and Dental Diseases" states: "Mouth ulcers in humans are all caused by fire, and fire must be distinguished between deficiency and excess, and between pale and red colors. Deficiency fire results in pale white blood color, fine sunken spots, revealing turtle patterns, a weak pulse without thirst. This is due to excessive worry and overthinking, being awake more and sleeping less, causing deficiency fire to stir and manifest. It is advisable to use Four Ingredients Decoction with Anemarrhena, Phellodendron, Moutan, and Cassia Bark as a guide. Excess fire results in a red color, with ulcerated spots all over the mouth, and in severe cases, swelling of the cheeks and tongue, a strong pulse, and dry mouth. This is due to drinking alcohol and consuming rich flavors, causing the heart fire to stir excessively and manifest. It is advisable to use Diaphragm-Cooling Powder, and externally apply Fu Yan San."