🌿 Folk Prescriptions

Abnormal tongue sensation refers to subjective abnormalities in the tongue, including chemical sensations (bitter, sweet, salty, etc.) and physical sensations (pain, cold, greasiness, etc.). TCM mainly includes altered taste perception and abnormal feelings such as cold, heat, pain, or itching on the tongue. Recognizing these abnormalities aids clinical diagnosis. I have treated several cases of fatty liver based on abnormal tongue sensations, gaining some insights.
1. Tongue Bitterness
Patients feel bitter taste on the tongue. Among 36 cases, all had elevated lipids and ultrasound confirmation of fatty liver. Clinically, they often present with abdominal distension, rib pain, dizziness, tinnitus, constipation, dry mouth, white or yellow greasy tongue coating, and wiry, slippery pulse—but most only report bitterness and constipation, lacking other symptoms. Bitterness belongs to the gallbladder, linked to liver function; bitter is fire, and excessive fire causes bitterness. As stated in *Su Wen·Wei Lun*: "Liver heat causes gallbladder leakage, resulting in bitter mouth..." and *Ling Shu·Zhang Lun*: "Gallbladder distention causes rib pain and bitter mouth." Treatment should clear liver and gallbladder heat, soothe liver, and relieve depression. Use Long Dan Xie Gan Tang with modifications: Chai Hu, Dang Gui, Ze Xie, Huang Qin, Zhi Zi, Cao Jue Ming, Da Huang, Bai Shao, Yu Jin, Chuan Lian Zi, Gong Ying, Bai Jiang Cao, Shan Zha, Lai Fu Zi. After treatment, symptoms improved slightly; all were cured after 2–4 months.
2. Tongue Sweetness
Patients perceive sweetness on the tongue. 29 cases confirmed by lipid tests and ultrasound. Clinically, they often have epigastric and abdominal distension, poor appetite, nausea, vomiting, sallow complexion, loose stools, fatigue, white or thick greasy tongue coating, and slow or soft pulse—some show no other symptoms except the sweet taste. Sweetness on the tongue often results from dampness rising upward, closely related to the spleen. The spleen prefers dryness and dislikes dampness; dampness easily impairs spleen function, obstructing qi movement, disrupting normal lipid metabolism, leading to phlegm and blood stasis accumulating in the liver, causing fatty liver. Treatment should invigorate the spleen and transform dampness. Use modified San Ren Tang and Yin Chen Hao Tang: Xing Ren, Yi Ren, Bai Dou Kou Ren, Hou Po, Ban Xia, Yun Ling, Pei Lan, Yin Chen, Hua Shi, Da Huang, Dang Gui, Cao Jue Ming, Yu Jin, Chi Shao, Tong Cao, Dou Juan, Heo Xiang. Treatment lasted 2–3 months; all were cured.
3. Tongue Paleness
Patients feel tasteless or diminished taste perception, often due to spleen-stomach dysfunction. As stated in *Ling Shu·Mai Du*: "Spleen governs the mouth; when spleen is harmonious, one can discern five grains." *Zhong Yi Lin Zheng Bei Yao·Oral and Lip Symptoms* notes: "Tasteless mouth, poor appetite." Clinically seen: rib and epigastric fullness, poor appetite, nausea or diarrhea, fatigue, frequent belching, white or greasy tongue coating, slow or weak pulse. 31 cases confirmed by lipid and ultrasound exams. Treatment should strengthen the spleen and boost qi. Use modified Shen Ling Bai Zhu San and Yi Gong San: Dang Shen, Fu Ling, Bai Zhu, Chen Pi, Shan Yao, Bian Dou, Yi Ren, Sha Ren, Mu Xiang, Dang Gui, Cao Jue Ming, Shan Zha, Lai Fu Zi, Zhi Shi, He Ye. After 2–4 months, 27 were cured, 4 improved.
4. Tongue Sourness
Patients feel sourness on the tongue and in the mouth, though no sour fluid is regurgitated. 18 cases diagnosed via lipid levels and ultrasound. Caused by impaired spleen function, food stagnation, overeating damaging the spleen, food accumulation in the intestines, liver-spleen disharmony, and turbid qi rising. Yu Tuan’s *Yi Xue Zheng Chuan* says: "Some have sour mouth due to weak spleen and liver overstepping the spleen." Liver-stomach disharmony, qi stagnation, dampness obstruction, phlegm retention, and blood stasis block liver meridians, manifesting as epigastric pain, rib distension, nausea, belching, irregular bowel movements, or diarrhea with foul-smelling stool, thick greasy or yellow tongue coating, wiry, slippery, or deep, forceful pulse. Treatment should eliminate food stagnation, guide digestion, regulate qi, and remove stagnation. Use modified Zhi Shi Dao Zhi Wan and Mu Xiang Bin Lang Wan: Da Huang, Zhi Shi, Shen Qu, Mai Ya, Shan Zha, Yun Ling, Mu Xiang, Bin Lang, Chen Pi, Huang Qin, Ze Xie, Huang Lian, E Zhu, San Leng, Sha Ren, Dang Gui, Cao Jue Ming, He Ye, Xiang Fu, Yu Jin. All cases cured within 1–3 months.
5. Tongue Saltiness
Patients feel saltiness on the tongue, sometimes even expelling salty phlegm. 23 cases treated. Saltiness relates to the kidneys; generally, tongue saltiness links to kidney deficiency or cold water rising. As *Tong Su Shang Han Lun* states: "Salty mouth with white foam indicates kidney water rising." *Zhang Shi Yi Tong* believes: "Salt taste means kidney fluid ascending." Saltiness also relates to emotional stress and excessive intake of flavors: "Various mouth ailments... may manifest as acid, bitter, sweet, pungent, or salty tastes—originally due to emotional disturbance and overindulgence in flavors" (*Yi Xue Zheng Chuan·Kou Bing*). Fatty liver commonly affects middle-aged and elderly individuals, often in physiological kidney deficiency, or due to mental exhaustion, disordered lifestyle, and organ damage—eventually affecting the kidneys. Kidney essence deficiency leads to yin-yang imbalance, failure of water to nourish wood and warm earth, disrupting lipid metabolism, causing hyperlipidemia, obstructing the liver. Common symptoms include sore waist and knees, insomnia, forgetfulness, tinnitus, rib and epigastric fullness. If kidney yang deficiency, symptoms include cold limbs, seminal emission, premature ejaculation, decreased libido, or facial edema. Treatment should warm yang and supplement the kidneys. Use modified You Gui Wan: Shu Di, Tu Si Zi, Du Zhong, Rou Gui, Zhi Fu Zi, Shan Yao, Gou Qi Zi, Shan Yu Rou, Zhi Shou Wu, Xiang Fu, Zhi Shi, Shan Zha, He Ye, Sang Ji Sheng, Nv Zhen Zi, Lu Jiao Jiao. For kidney yin deficiency with symptoms like restlessness, insomnia, night sweats, dry mouth and throat, red tongue with little coating, fine or rapid pulse, treatment should nourish kidney yin. Use modified Zuo Gui Wan: Shu Di, Dan Pi, Shan Yu Rou, Shan Yao, Ze Xie, Shan Zha, Gui Jiao, Tu Si Zi, Nv Zhen Zi, Zao Lian Cao, Tian Dong, Lai Fu Zi, Dang Gui, Zhi Shi, He Ye. All cases cured within 2–4 months.
6. Tongue Pungency
Patients feel spicy, burning, or fishy taste on the tongue—clinically rare. 4 cases confirmed by lipid and ultrasound. Primarily due to heart-gallbladder unrest, with qi-fire and phlegm-dampness. Matches fatty liver pathogenesis. *Tong Su Shang Han Lun* says: "Spicy mouth indicates lung heat entering the stomach." Zhu Danxi stated: "Lung heat causes spicy mouth; use Gan Ju Tang or Xie Bai San." Clinically seen: epigastric fullness, chest tightness, shortness of breath, copious phlegm, inability to lie flat, facial edema, loose stools, dark tongue with thin greasy coating, wiry, slippery pulse. Treatment should clear lung heat, soothe liver, harmonize stomach. Use modified Xie Bai San and Chai Hu Shu Gan San: Huang Qin, Ban Xia, Sang Bai Pi, Di Gu Pi, Chen Pi, Lai Fu Zi, Bai Jie Zi, Xiang Fu, Yu Jin, Chuan Lian Zi, Cao Jue Ming, Ze Xie, Shan Zha. All 4 cases cured within 1–3 months.
7. Burning Pain on the Tongue
Patients feel a burning sensation like fire on the tongue. 6 cases treated. Often due to internal fire. Frequently accompanies red tip of the tongue, mouth sores. Alcohol-induced fatty liver often presents this tongue sensation. Accompanied by chest and epigastric heat, nausea, poor appetite, constipation, red eyes, dizziness, red tongue with little coating or dryness, fine, wiry, or large pulse. Treatment should clear heat and toxins, soothe liver and relieve stagnation. Use modified Bai Hu Tang and Liang Ge San: Sheng Shi Gao, Zhi Mu, Sheng Di, Bai Shao, Da Huang, Zhi Zi, Ze Xie, Chi Shao, Dan Pi. Adjustments made accordingly; 5 cases cured within 2 months, 1 improved after 3 months.
8. Tongue Numbness
Patients feel numbness and reduced sensation on the tongue, even scratching or poking fails to relieve it. 7 cases treated. Tongue numbness often results from blood deficiency, liver wind, or phlegm obstruction. *Bian She Zhi Nan* states: "Tongue numbness indicates blood deficiency. If numbness prevents tongue extension, it indicates internal wind with phlegm... all require moistening, nourishing blood, calming wind. For phlegm involvement, also expect to resolve phlegm and promote dispersion." If fatty liver involves blood deficiency, it results from emotional agitation, worry, anger, and hidden blood depletion. Common symptoms include dizziness, blurred vision, palpitations, forgetfulness, night sweats, feverish heat, sallow complexion, thin white tongue coating, pale tongue or tooth marks, fine, slow, or rapid pulse. Treatment should nourish blood and activate collaterals. Use modified Si Wu Tang and Er Zhi Wan: Shu Di, Dang Di, Bai Shao, Chuan Xiong, Nv Zhen Zi, Zao Lian Cao, Zhi Shou Wu, Cao Jue Ming, Zhi Shi, Ze Xie, Shan Yu Rou, Shan Zha. If phlegm is involved, symptoms include fatigue, epigastric fullness, nausea, poor sleep, thin greasy tongue coating, wiry, slippery pulse. Treatment should resolve phlegm and relieve depression. Use modified Xiao Yao San and Wen Yang Tang: Chai Hu, Dang Gui, Yun Ling, Bai Zhu, Yu Jin, Ban Xia, Zhu Ru, Zhi Shi, Chen Pi, Huang Qin, Lai Fu Zi, Bai Jie Zi, Shan Zha, Da Huang, Xiang Fu, Cao Jue Ming, Bin Lang.
9. Tongue Swelling
Patients feel tongue swelling, though not necessarily enlarged visibly. 9 cases treated. Fatty liver patients often have liver qi stagnation, which over time transforms into fire, causing upward flaming of liver fire—hence the sensation of tongue swelling. Often accompanied by insomnia, palpitations, chest and rib fullness, epigastric hardness, frequent belching, pale tongue with thin coating, wiry, forceful pulse. Treatment should soothe liver, regulate qi, clear heat, and resolve stagnation. Use modified Da Chai Hu Tang and Chai Hu Shu Gan San: Chai Hu, Huang Qin, Bai Shao, Ban Xia, Zhi Shi, Da Huang, Xiang Fu, Yu Jin, Chuan Xiong, Chen Pi, Huang Lian, Lian Qiao, Lai Fu Zi, Cao Jue Ming, Shan Zha. All 9 cases cured within 1–4 months.
10. Tongue Dryness
Patients feel a sensation like eating raw persimmons, often accompanied by dryness. Mainly due to dry-heat injuring body fluids. 14 cases treated. Excess yang-heat in zang-fu organs, upward surge of qi-fire, or dry-heat injuring body fluids. Chen Wu Zhe’s *San Yin Fang·Kou Bing Zheng Zhi* says: "Irritability and dryness cause dryness." Qing Dynasty’s Tang Rongchuan in *Xue Zheng Lun·Kou She* notes: "Tongue dryness indicates wind-heat; treat with Tong Sheng San minus Mang Xiao and Da Huang." Tongue dryness in fatty liver relates to kidney deficiency disrupting water regulation and transformation functions. Water fails to nourish wood, spleen loses transport function, body fluids fail to distribute, leading to phlegm-dampness and blood stasis obstructing vessels. Common symptoms include dry throat, dry mouth, rib distension and pain, afternoon fever, tinnitus, constipation, red tongue with little coating or central fissuring (map-like tongue), fine or wiry pulse. Treatment should nourish yin, moisten dryness, resolve phlegm, and relieve depression. Use modified Zeng Ye Tang and Xiao Yao San: Xuan Shen, Sheng Di, Mai Dong, Shi Hu, Bei Sha Shen, Dang Gui, Bai Shao, Chai Hu, Zhi Zi, Tian Dong, Chen Pi, Xiang Fu, Yu Jin, Cao Jue Ming, He Ye, Zhu Ye. All cases improved or cured within 1–4 months.