Tongue sore refers to the ulceration of the surface of the tongue, presenting one or more small ulcers.

Tongue sore is different from "tongue pustule" and "carcinoma of tongue" (carcinoma of tongue, carcinoma of tongue), the latter refers to swollen sores or masses on the tongue, which are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Exuberance of Heart Fire︰The tongue body ulcer presents with bright red and painful surfaces, especially prominent at the tip of the tongue, accompanied by facial flushing, thirst, chest vexation and heat, restless sleep, reddish and astringent urine, a red tongue or a crimson tongue tip, and a rapid pulse or a large and rapid pulse at the left cun position. It is mostly caused by mental factors such as excessive mental exertion, resulting from the transformation of overacting of five minds. Although it is a case of excess fire, there are no signs of stagnation. Since the heart orifice opens to the tongue, up-flaming of heart fire easily leads to tongue sores. Moreover, the fire disturbs mental activity, hence symptoms like chest vexation and heat, as well as restless sleep. The Yangming meridian connects to the face, leading to facial flushing and a red tongue. As there is no internal stagnation, the tongue coating remains thin. The treatment focuses on clearing heat, using ingredients like Coptis chinensis and Acorus decoction. For cases with reddish and astringent urine, diuresis should be incorporated to guide heat downward, employing the Redness-Removing Powder supplemented with Scrophularia Root, charred Gardenia jasminoides, and Coptis chinensis.
2. Stomach Heat︰The tongue ulcer is large, accompanied by fetid mouth odor, thirst with a preference for cold drinks, epigastric upset, frequent hunger, severe constipation, a red tongue with yellow, dry, or thick tongue coating, and a slippery, rapid pulse. This condition is often caused by excessive consumption of alcohol or spicy, fried, or rich foods, leading to accumulated heat in the stomach and intestines, which transforms into fire. The stomach governs reception and descent; if its descending function is impaired, stomach heat accumulates, and fire pathogen rises to steam the tongue, resulting in ulcers. This is a sign of excess fire combined with stagnation. The key diagnostic features include severe aphtha with fetid mouth odor, constipation, and a thick, greasy tongue coating. Treatment should focus on clearing heat and removing toxin, purging heat, and promoting bowel movements. The recommended formula is Diaphragm-Cooling Powder with modifications.
3. Qi Deficiency with Heat Retention︰The tongue ulcer persists and does not heal, with a sunken sore surface, accompanied by fatigue in the limbs, shortness of breath and reluctance to speak, low-grade fever, a pale tongue with thin white coating, and a weak or large and rapid pulse. This is mainly due to deficiency of middle qi, often caused by dietary irregularities and overstrain leading to internal damage, which depletes middle qi and generates internal deficient heat. As a result, symptoms such as tongue sores, limb fatigue, shortness of breath, reluctance to speak, and sunken sores manifest as signs of middle qi deficiency. The treatment should focus on warming and nourishing middle qi, which is referred to as "relieving fever with sweet and warm." The prescription used is Middle-Tonifying Qi-Replenishing Decoction with the addition of Ophiopogon Tuber and Schisandra Fruit.
4. Blood Deficiencydryness-heat︰A persistent tongue sore accompanied by dry mouth without thirst, dizziness, blurred vision, restless sleep, feverish hands and feet, fatigue and lack of strength, throat discomfort, pale red tongue color, thin white or absent tongue coating, and a thin rapid or weak pulse. The key characteristics to focus on are blood deficiency (dry mouth without thirst, fatigue and lack of strength, pale tongue, and thin pulse) and dryness-heat (feverish hands and feet, throat discomfort, and rapid pulse). Treatment should prioritize nourishing blood while also clearing dryness-heat. Four Ingredients Decoction can be modified by adding Anemarrhena, Phelloendron Bark, Moutan Bark, Ophiopogon Tuber, Schisandra Fruit, Poria, and White Atractylodes Rhizome, or Returning to Spleen Decoction with appropriate modifications.
5. Kidney Yin Deficiency︰The ulcer on the tongue does not heal for a long time, accompanied by sore throat, dry mouth, tinnitus, dizziness, nocturnal emission, and soreness in the waist, which worsens in the afternoon. The tongue is red and dry, and the pulse is thin and rapid. In cases of kidney yin deficiency, there is a lack of yin essence, and ministerial fire is excessive. The ulcers are mostly red, and the tongue texture is also deep red, often dry without coating or with cracks. It is also accompanied by tinnitus, dizziness, sore throat, dry mouth, nocturnal emission, and soreness in the waist. For kidney yin deficiency with excessive internal fire, the treatment should focus on nourishing yin and reducing fire, using the Anemarrhena and Phellodendron Rehmannia Decoction.
6. Kidney Yang Deficiency︰The ulcerated surface of the tongue lingers unhealed, accompanied by a pale complexion, cold limbs, loose stools, impotence, frequent urination, soreness and weakness in the lower back and knees, a pale tongue with thin white coating, and a deep, slow, and weak pulse. In cases of kidney yang deficiency, the storage function is unstable, and the rootless fire drifts upward, manifesting as pale-red ulcerations and tongue texture, with a deep-slow or weak-large pulse, along with a pale face, fear of cold, or a tender-red complexion, cold limbs, loose stools, impotence, and frequent urination. Treatment should focus on warming and tonifying kidney yang and subduing the drifting fire. Internally, take Black Tin Pill or Yangzheng Dan, and externally apply Evodia Fruit mashed with vinegar as a warm compress to the soles of the feet.

Kidney yin deficiency and blood deficiency dryness-heat: The deficiency in the former lies in the depletion of yin essence, characterized by dizziness, blurred vision, tinnitus, and soreness in the waist; the deficiency in the latter lies in nutrient-blood, mainly characterized by pale lips and tongue color, fatigue, and lack of strength. The fire in the former is due to the imbalance of yin-yang and the predominance of ministerial fire, hence symptoms like sore throat, dry mouth, and nocturnal emission; the heat in the latter is due to the deficiency of nutrient-blood, leading to dryness and heat, hence poor sleep, hot hands and feet, and throat discomfort.

Qi deficiency with heat and kidney yang deficiency: The deficiency in the former lies in middle qi, while the deficiency in the latter lies in kidney yang. Therefore, those with middle qi deficiency experience fatigue in the limbs, shortness of breath, and reluctance to speak; while those with kidney yang deficiency experience impotence, frequent urination, and soreness and weakness in the waist and knees. The heat in the former is generated by middle deficiency, hence it can be alleviated with sweet and warm remedies; the fire in the latter is a floating fire, which must be treated by tonifying the kidney and calming it.

The symptom of tongue soreness can be due to both deficiency and excess. Excess pattern are mostly caused by excessive fire, with heart fire and stomach fire being the most common; deficiency pattern are mostly due to insufficient yin-blood, and yang qi deficiency is also frequently seen. For excess conditions, clearing and purging are appropriate; for deficiency conditions, nourishing and tonifying are appropriate. It is essential to recognize the characteristics and clearly distinguish between deficiency and excess, avoiding the mistake of treating excess as deficiency or vice versa.

1. Zhengzhi Zhunsheng．aphtha》: "The heart meridian spreads over the tongue. If heart fire flares upward, fumigating the mouth, it causes sores in the mouth and tongue. The spleen meridian spreads under the tongue. If spleen heat generates phlegm, and hot saliva combines, rising with ministerial fire, it also often causes sores. Both conditions can be treated with cold and cooling agents, but if there is saliva, the saliva should also be addressed." "Fire can be deficient or excessive. If it is stirred by heat in the meridians, it is called excess; if it is stirred without heat, it is called deficiency. Excess is treated directly with cold and cooling agents, while deficiency is treated indirectly, such as with warm and hot agents." "Shengji Zonglu mentions that deficiency and cold in the primordial viscera can attack aphtha."
2. 《Chinese Medical Dictionary．Tongue Afflictions》: "This condition involves sores on the tongue that protrude from the mouth, covered with a yellow scab, making it difficult to eat. It is advisable to use one part of borneol, place it inside a clam, and it will immediately turn into water. Apply it to the affected area with a goose feather, and it will heal on its own."