The condition of sores in the mouth is commonly referred to as "aphtha."

This condition is described in the Neijing as "aphtha," "aphtha," or "oral ulcer." Later generations, based on its clinical manifestations and different mechanisms of disease, have also referred to it as "infantile malnutrition with aphthae," "sores on the tongue and mouth," "oral sores in children," "mouth sores," or "ulceration and decay in the mouth." However, it is generally customary to refer to localized ulcers in the mouth with milder symptoms as "aphtha"; extensive erosion and decay in the mouth with more severe symptoms are also called "aphtha"; and infantile aphtha associated with infantile malnutrition with accumulation is termed "infantile malnutrition with aphthae." Pediatric "thrush" is discussed separately in pediatrics.

Additionally, sores at the corners of the mouth are called "angular stomatitis," commonly known as "angular stomatitis," and also referred to as "angular cheilitis (tinea favosa)." Although not within the scope of this condition, its mechanism of disease is related, and it has often been categorized together by predecessors. For further details, refer to the diagnosis and treatment of this condition.

bubble_chart Pattern Analysis

1. Accumulated Heat in the Spleen and Stomach︰Ulcers appear in multiple areas of the mouth, lips, tongue, and gums, with surrounding redness and swelling. In severe cases, the cheeks and tongue may also swell, causing pain that affects eating. There is thirst with a preference for cold drinks, severe constipation, dark yellow urine, and possibly fever. The tongue texture is red, possibly with cracks, and coated with yellow fur. The pulse is rapid and forceful. This condition is often caused by dietary irregularities, such as excessive consumption of spicy foods, alcohol, or rich, fried dishes, leading to accumulated heat in the spleen and stomach. The spleen opens into the mouth, so when heat from the spleen and stomach rises to the mouth, it results in aphthae. The characteristics include severe and multiple aphthae, with red and swollen ulcers accompanied by symptoms such as thirst for cold drinks, constipation, dark urine, a red tongue with yellow coating, and other signs of excessive heat in the spleen and stomach. Treatment should focus on clearing heat and purging fire. Recommended formulas are Diaphragm-Cooling Powder and Yellow-Draining Powder.
2. Yin Deficiency︰Aphtha recurs frequently, often triggered by fatigue or poor sleep. The ulcer surface appears yellowish-white with a light red periphery, and the pain is milder during the day but worsens at night. Symptoms include dry mouth, restlessness, insomnia, a feverish sensation in the palms and soles, a red tongue with scant coating, or possibly red fissures, and a deep, thin, rapid pulse. This condition is mostly caused by overthinking, overstrain, or the gradual depletion of heart yin, or it may occur in the late stage (third stage) of Rebing, where the yin aspect is injured. Yin deficiency leads to excessive fire, which flares upward to the mouth, resulting in aphtha. Its characteristics include: aphtha that lingers and does not heal, recurs repeatedly, with ulcers appearing alternately, a light red ulcer complexion without significant swelling, milder symptoms during the day but worse at night, accompanied by restlessness, insomnia, feverish sensation in the palms and soles, a red tongue with scant coating, and other signs of yin deficiency. The treatment should focus on nourishing yin and clearing away fire, avoiding bitter-cold herbs that may damage yin. For cases偏向 heart yin deficiency, the formula Coptis Rhizome and Ass Hide Glue and Egg Yolk Decoction is recommended; for cases偏向 kidney yin deficiency, formulas such as Anemarrhena, Phellodendron, and Rehmannia Decoction may be used.
3. Spleen Qi Deficiency︰Recurrent aphthae, sometimes mild and sometimes severe, with pale ulcer complexion, mild pain, poor appetite, epigastric distension, loose stools, limb weakness, mental fatigue, shortness of breath, reluctance to speak, pale tongue texture with tooth marks on the edges, white coating, and thin weak pulse. The key mechanism of disease is qi deficiency, caused by overstrain, chronic illness damaging the spleen and stomach's middle qi, or prolonged aphthae scorching yin and consuming qi, leading to spleen and stomach qi deficiency and internal generation of yin fire, resulting in aphthae. The aphthae appear pale, without redness or swelling, with grade I pain, and although they occur singly or in small numbers, they linger and do not heal. Accompanied by symptoms of spleen and stomach qi deficiency such as poor appetite, loose stools, mental fatigue, shortness of breath, and pale tongue. Treatment should focus on Middle-Tonifying Qi-Replenishing Decoction or Astragalus Center-Fortifying Decoction; for cases of deficiency of both qi and yin, Pulse-Reinforcing Powder with modifications may be selected.

Insufficient middle qi and yin deficiency are both deficiency pattern, characterized by recurrent aphthae and flare-ups upon exertion.

The symptom of aphthae can be divided into deficiency and excess types. Sudden onset is often due to excess fire, while chronic conditions are usually due to deficiency fire, which can further be categorized into yin deficiency and qi deficiency. These three are closely related: prolonged excess fire will inevitably scorch yin and deplete qi; long-term yin deficiency will inevitably harm qi; and qi deficiency is often accompanied by yin deficiency symptoms. In treatment, excess fire can be addressed by direct repulsion with bitter cold to reduce the fire, while deficiency fire should avoid bitter cold and instead focus on nourishing yin or tonifying qi, depending on the characteristics of the symptoms and signs, and requires patient regulation. Additionally, regardless of the deficiency or excess nature, while taking internal decoctions, topical application of Zhuhuang Powder or Xilei Powder can be effective as appropriate.

bubble_chart Documentation

1. Zhengzhi Zhunsheng．aphtha: "aphtha is said to be caused by heat, as stated in the classics: when the Shaoyang celestial control is affected, the fire qi descends, and the lung qi ascends, leading to mouth sores; it is also said to be caused by cold, as stated in the classics: when the year's metal is deficient, the fire of inflammation prevails, and the return of cold rain suddenly arrives, causing cold reversal and yang qi to rise upwards, resulting in aphtha."
2. Zabing Yuanliu Xizhu．The Origin and Flow of Miscellaneous Diseases: "Accumulated heat in the organs leads to aphtha. Aphtha refers to ulceration and erosion. Heart heat also causes aphtha, often red; lung heat also causes aphtha, often white; when the bladder transfers heat to the small intestine, it also causes aphtha; excessive fire in the triple energizer also causes mouth ulcers; insufficient qi in the middle energizer and rising deficient fire also cause mouth ulcers; when cooling medicines are ineffective, yin deficiency and rising fire also cause aphtha; internal heat also causes aphtha."