Cold Sores (Herpes Labialis)
Also known as: Cold sores, Herpes labialis, Fever blisters, HSV-1 infection, Recurrent herpes labialis, Oral herpes, Herpes simplex of the lip
Cold sores are recurrent blisters on or around the lips caused by herpes simplex virus, usually type 1 (HSV-1). After first infection the virus stays dormant in the trigeminal ganglion and can reactivate with triggers such as sun exposure, fever, colds, stress, menstruation, local trauma or reduced immunity. A typical recurrence starts with tingling or burning (the prodrome), followed by clustered vesicles that break, crust and heal within about 7 to 10 days without scarring [1][2]. Management is supportive, with oral or topical antivirals started early in the prodrome for frequent or severe episodes, sun protection, and measures to avoid passing the virus on, including avoiding kissing and sharing items during an outbreak and keeping lesions away from newborns [1][2][3]. Specialist care is needed for eye involvement, widespread lesions in people with eczema (eczema herpeticum), or immunocompromise. In Chinese medicine cold sores correspond to Rè Chuāng 热疮 (heat sores), most often from Wind-Heat attacking the Lung and Stomach, Spleen-Stomach Damp-Heat or Stomach Fire rising to the lips, and recurrent Yin deficiency with Empty Heat. Acupuncture and herbs are adjunctive and do not replace antiviral treatment or infection-control advice [1][2][3].
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Lifestyle & Diet
- •Use SPF 30+ lip balm, as sun exposure is a common trigger [2][3].
- •Start prescribed antiviral cream or tablets at the first tingle.
- •Avoid kissing, oral sex and sharing cups, towels or lip balm during an outbreak [2][3].
- •Keep away from newborns and people with eczema while a sore is active.
- •Wash hands after touching the sore and avoid touching the eyes.
- •Look after sleep, stress and general health, which Chinese medicine links to recurrences.
Cautions & Contraindications
- •Do not needle active lesions or apply herbal pastes near the eye.
- •Do not use acupuncture or herbs in place of urgent assessment for eye symptoms, neonatal exposure, eczema herpeticum or neurological symptoms.
- •Do not claim acupuncture or herbal medicine cures or eliminates the herpes virus.
- •Verify all herbal prescriptions against Australian TGA requirements and check interactions with antivirals or immunosuppressants.
When to reassess or seek care again
- •Initial: confirm the diagnosis is typical recurrent herpes labialis and exclude eye involvement, eczema herpeticum and immunocompromise.
- •Initial: record recurrence frequency, triggers, duration of episodes and current antiviral use.
- •Ongoing: keep an outbreak diary so frequency and duration can be judged objectively.
- •Ongoing: refer for GP review if episodes become more frequent, severe or slow to heal [1][2].
Frequently Asked Questions
Can acupuncture cure cold sores?+
No. The herpes virus stays dormant in nerves for life. Acupuncture and herbs may be used as adjunctive support between and during outbreaks, alongside antivirals where appropriate [1][2].
Which TCM patterns are most common?+
Wind-Heat attacking the Lung and Stomach, Spleen-Stomach Damp-Heat or Stomach Fire, and Yin deficiency with Empty Heat in frequent recurrences.
Is it safe to treat someone with an active cold sore?+
Yes, with distal points, gloves and strict hand hygiene. Never needle the lesion itself, and avoid facial work near the eye [2].
When does a cold sore need urgent care?+
Same day for eye pain or redness, any contact with a young baby, spreading sores over eczema, or neurological symptoms [1][2][3].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- NICE Clinical Knowledge Summaries · 2024
Diagnosis, antiviral management, referral criteria and red flags for herpes labialis.
- Healthdirect — Australian Government Department of Health · 2024
Australian public-health information on symptoms, treatment and preventing spread.
- DermNet · 2023
Paediatric advice and neonatal herpes risk.
- Eastland Press · 2009
Reference for composition and traditional indications of Yín Qiào Sǎn, Qīng Wèi Sǎn and Zhī Bǎi Dì Huáng Wán.
- Therapeutic Goods Administration · 2025
Regulatory framework for herbal ingredients and restricted substances in Australia.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.