Hi friends!
Have you seen someone suffering from recurrent or severe mouth ulcers? Understanding the key characteristics of each TCM diagnosis for mouth ulcers can help you find the right and fastest way to heal your patients!
Mouth ulcers, also known as oral ulcers or canker sores, are shallow, painful lesions that can develop on the mucous membranes of the mouth, including the inner cheeks, gums, tongue, and lips. These ulcers can vary in size and typically have a white or yellowish center surrounded by a red border.
Traditional Chinese Medicine (TCM) Perspective:
In TCM, mouth ulcers are often categorized based on patterns of disharmony in the body's energetic pathways. The diagnosis is made through observation of symptoms like the location, color, and characteristics of the ulcers, as well as tongue and pulse diagnostics.
Diagnosis by observation
🔴 Ulcers on gums, red rims, very painful: This indicates Stomach Full Heat.
🔴 Ulcer on gums, pale rims: Points to Stomach Empty Heat.
🔴 Ulcer on tip of tongue: Suggests Heart Fire or Heart Empty Heat.
🔴 Ulcers on inside of cheeks: Indicates Stomach Heat.
🔴 Ulcers during pregnancy: May indicate a disharmony of Ren Mai.
🔴 Ulcers with pale rims, aggravated by overwork: Could be due to Kidney Yin Deficiency or Yuan Qi Deficiency.
(🙋🏻♀️Personal experience: Memorizing the differential diagnosis observation section really helped me ace the NCCAOM Foundations of Oriental Medicine exam and made a big difference in how I treat my patients!)
Pattern differentiation and treatments:
🔑 Key Differentiation:
Ulcer on cheeks or tongue, red ulcers with yellow rim
✅ General Symptoms:
Feeling of heat, thirst with desire to drink cold fluids, dry mouth, constipation
👅📈 Tongue and Pulse:
Red Thick Yellow
Flooding Rapid
📌Acupuncture Points:
PC 8, HT 8, SP 2, SP 6
🌿Herbal Formula:
Liang Ge San
🔑 Key Differentiation:
Ulcer on gums, red ulcers with yellow rim
✅ General Symptoms:
Feeling of heat, thirst with desire to drink cold fluids, dry mouth, constipation
👅📈 Tongue and Pulse:
Red Thick Yellow
Flooding Rapid
📌Acupuncture Points:
ST 44, LI 11, LI 4, SP 6
🌿Herbal Formula:
Qing Wei San
🔑 Key Differentiation:
Ulcers with deep red edges and yellow center
✅ General Symptoms:
Swollen gums, thirst, restlessness, dark urination, dry stools
👅📈 Tongue and Pulse:
Red Thick Yellow
Flooding Rapid
📌Acupuncture Points:
ST 44, LI 11, LI 4, PC 8, SP 6, REN 12, ST 40
🌿Herbal Formula:
Wu Wei Xiao Du Yin
🔑 Key Differentiation:
Chronic mouth ulcers on gums and cheeks, pale red with white rims
✅ General Symptoms:
Dry mouth with desire to drink in small sips
👅📈 Tongue and Pulse:
Red Sparse
Superficial Deficient
📌Acupuncture Points:
ST 44, LI 4, REN 12, ST 36, SP 6
🌿Herbal Formula:
Qing Wei San
🔑 Key Differentiation:
Ulcers on cheeks and/or tongue, shallow red ulcers with white rims
✅ General Symptoms:
Dry mouth with desire to drink in small sips, night sweating, Five Heart Heat, feeling of heat in the evening, insomnia, restlessness, dizziness, tinnitus
👅📈 Tongue and Pulse:
Red Sparse
Superficial Deficient Rapid
📌Acupuncture Points:
HT 6, PC 7, HT 7, KD 3, REN 4, SP 6
🌿Herbal Formula:
Tian Wang Bu Xin Dan
🔑 Key Differentiation:
Ulcers on cheeks and/or tongue, shallow pale red ulcers with white rims, recurring when tired
✅ General Symptoms:
Feeling of heat on face, chills, cold limbs, dizziness, fatigue, restlessness, insomnia, loose stools, poor appetite, headache, thirst
👅📈 Tongue and Pulse:
Pale
Weak Deficient
📌Acupuncture Points:
REN 4, ST 36, SP 6, REN 12, UB 20, UB 21, HT 6, PC 7, SJ 5
🌿Herbal Formula:
Bu Zhong Yi Qi Tang
Dietary Recommendations:
- Emphasize cooling and soothing foods such as mung beans, lotus root, and cucumber.
- Avoid spicy, greasy, and irritating foods that may aggravate heat or inflammation.
Western Medical Perspective:
- Local Trauma: Minor injuries such as accidental bites, dental work, or aggressive tooth brushing can lead to the formation of mouth ulcers.
- Inflammatory Conditions: Inflammatory diseases like Crohn's disease, ulcerative colitis, and Behçet's disease are known to increase the likelihood of developing mouth ulcers.
- Immune System Dysfunction: Disorders that affect the immune system, such as HIV/AIDS or autoimmune diseases like lupus, can predispose individuals to recurrent mouth ulcers.
- Nutritional Deficiencies: Deficiencies in essential nutrients such as vitamin B12, iron, folic acid, and zinc have been linked to the occurrence of mouth ulcers.
- Allergic Reactions: Some individuals may develop mouth ulcers as a result of allergic reactions to certain foods, oral hygiene products, or medications.
- Stress and Hormonal Changes: Psychological stress, hormonal fluctuations, and certain medications can disrupt the normal immune response and contribute to the formation of mouth ulcers.
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