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Recurrent oral ulcer (ROU) is a common disease, and seriously affects the quality of life. There are obvious advantages in improving clinical symptoms, maturity of regenerated mucosa and healing quality, and reducing recurrence rate of ROU. But there is a lack of sufficient experimental data. Tongue diagnosis is an important basis for disease differentiation, syndrome differentiation and treatment, and clinical efficacy monitoring. Tongue coating can reflect the local and global pathological state. The back of the tongue forms a relatively complete and independent microecosystem. The change of tongue body may be a colony indicator for ROU. The pathogenicity of colonized bacteria in ROU may be used as a potential diagnostic marker. Based on microecology, the author reviews the pathogenesis of ROU and the correlation between microecology and both the therapeutic effect and mechanism of ROU in traditional Chinese medicine. DOI: 10.11855/j.issn.0577-7402.2018.09.15