🌿 Folk Prescriptions

Abnormal tongue sensations refer to subjective feelings from the tongue, including chemical sensations (e.g., bitter, sweet, salty) and physical sensations (e.g., pain, cold, greasiness). TCM mainly recognizes altered taste perception and abnormal sensations like heat, cold, pain, or itching on the tongue. Identifying diseases through abnormal tongue sensations holds significant clinical value. Through case studies of fatty liver based on tongue sensation abnormalities, I have gained some insights.
I. Tongue Bitterness
Patients subjectively feel bitterness on the tongue. Among 36 diagnosed cases, all had elevated lipids and confirmed fatty liver via ultrasound. Clinically, they often present with abdominal distension, rib pain, dizziness, tinnitus, or constipation, dry mouth, white or yellow greasy coating, wiry and slippery pulse—but many exhibit only bitterness and constipation, with other symptoms absent. Bitterness is the taste of gallbladder, linked to Liver function and dispersion. Bitterness belongs to fire; excessive fire causes mouth bitterness. *Suwen·Wei Lun*: "When Liver Qi is hot, bile leaks out, causing bitter mouth..." *Ling Shu·Zhang Lun*: "Gallbladder distention causes rib pain and bitter mouth." Treatment should clear Liver and Gallbladder heat, soothe Liver Qi. Use Long Dan Xie Gan Tang with modifications: Bupleuri Radix, Angelica Sinensis, Alismatis Rhizoma, Scutellariae Radix, Gardenia Fructus, Cassia Seed, Rheum Palmatum, Paeoniae Alba Radix, Curcuma Aromatica, Toosik, Taraxaci Herba, Houttuynia Cordata, Crataegi Fructus, Raphanus Sativus. After treatment, patients showed improvement; all were cured after 2–4 months.
II. Tongue Sweetness
Patients subjectively feel sweetness on the tongue. 29 cases were confirmed via lipid tests and ultrasound. Clinically, they often present with epigastric fullness and pain, poor appetite, nausea, vomiting, sallow complexion, loose stools, fatigue, white greasy or thick coating, slow or soft pulse—though some show no obvious symptoms except the sweet taste. Tongue sweetness usually indicates dampness rising upward, closely related to the Spleen. The Spleen prefers dryness and dislikes dampness; dampness easily impedes Spleen function, disrupting Qi movement, impairing normal lipid metabolism, leading to phlegm and blood stasis accumulating in the blood, blocking the Liver and causing fatty liver. Treatment should invigorate the Spleen and transform dampness. Use San Ren Tang or Yin Chen Hao Tang with modifications: Apricot Kernel, Job's Tears, Cardamom Seed, Magnolia Bark, Pinellia, Poria, Patchouli, Artemisiae Scopariae, Talc, Rheum Palmatum, Angelica Sinensis, Cassia Seed, Curcuma Aromatica, Paeoniae Rubra, Tongcao, Soybean Sprouts, Agastache. Treatment lasted 2–3 months; all were cured.
III. Tongue Tastelessness
Patients perceive no taste, i.e., diminished or dulled taste sensation, often related to impaired Spleen function. *Ling Shu·Mai Du*: "Spleen Qi connects to the mouth; when Spleen is harmonious, one can discern five grains." *Zhongyi Linzheng Bei Yao·Kou Chun Zhengzhuang*: "Tasteless mouth, poor appetite." Clinically seen: epigastric and rib distension, poor appetite, nausea or diarrhea, fatigue, belching, white or greasy coating, slow or weak pulse. 31 cases confirmed via lipid tests and ultrasound. Treatment should strengthen the Spleen and boost Qi. Use Shen Ling Bai Zhu San or Yi Gong San with modifications: Codonopsis Radix, Poria, Atractylodis Macrocephalae Rhizoma, Citrus Peel, Yam, Lablab Bean, Job's Tears, Cardamom Seed, Magnolia Bark, Angelica Sinensis, Cassia Seed, Crataegi Fructus, Raphanus Sativus, Citrus Aurantium, Lotus Leaf. After 2–4 months, 27 cases were cured, 4 improved.
IV. Tongue Sourness
Patients feel sourness on the tongue and mouth intermittently, though no sour fluid emerges. 18 cases confirmed via lipid tests and ultrasound. Caused by impaired Spleen function, undigested food stagnation, or sudden overeating damaging the Spleen, leading to food accumulation in the intestines, Liver-Spleen disharmony, and turbid Qi rising upward. Yu Tuan in *Yi Xue Zheng Chuan*: "Some have weak Spleen Qi, allowing Wood to overpower Earth, causing sour mouth." Liver-Gallbladder disharmony, Qi stagnation, dampness obstruction, phlegm accumulation, blood stasis blocking Liver channels—leading to epigastric pain, rib distension, nausea, belching, irregular bowel movements, or diarrhea with foul-smelling stool, thick greasy or yellow coating, wiry, slippery, or deep, firm pulse. Treatment should eliminate food stagnation, guide digestion, regulate Qi, and resolve masses. Use Zhi Shi Dao Zhi Wan or Mu Xiang Bin Lang Wan with modifications: Rheum Palmatum, Citrus Aurantium, Shenqu, Malt, Crataegi Fructus, Poria, Magnolia Bark, Areca Nut, Citrus Peel, Scutellariae Radix, Alismatis Rhizoma, Coptidis Rhizoma, Curcumae Radix, Rhizoma Zedoariae, Cardamom Seed, Angelica Sinensis, Cassia Seed, Lotus Leaf, Cyperus Rotundus, Curcuma Aromatica. All 18 cases cured within 1–3 months.
V. Tongue Saltiness
Patients feel saltiness on the tongue, sometimes even producing salty phlegm. 23 cases treated. Saltiness relates to the Kidneys; generally, tongue saltiness indicates Kidney deficiency or cold fluid rising. *Tong Su Shang Han Lun*: "Bitter saliva with white foam indicates Kidney fluid rising." *Zhang Shi Yi Tong*: "Salt taste means Kidney fluid ascends." Saltiness also links to emotional stress and excessive tastes: "Oral diseases... may manifest as acid, bitter, sweet, pungent, or salty tastes—originally due to emotional disturbance and excessive dietary indulgence" (*Yi Xue Zheng Chuan·Kou Bing*). Fatty liver commonly affects middle-aged and elderly individuals, often in a physiological state of Kidney deficiency. Overwork, poor lifestyle, and organ dysfunction eventually affect the Kidneys. Kidney essence deficiency disrupts Yin-Yang balance, failing to nourish Liver and Earth, impairing lipid metabolism and causing hyperlipidemia, blocking the Liver. Common symptoms: sore waist and knees, insomnia, forgetfulness, tinnitus, epigastric fullness. If Kidney Yang deficiency: cold limbs, nocturnal emission, premature ejaculation, low libido, or facial edema. Treatment should warm and tonify Kidney Yang. Use You Gui Wan with modifications: Rehmanniae Praeparata, Cuscutae Semen, Eucommiae Cortex, Cinnamomi Ramulus, Prepared Aconite Root, Yam, Lycii Fructus, Cornus Fruit, Prepared Polygonum Multijugum, Cyperus Rotundus, Citrus Aurantium, Crataegi Fructus, Lotus Leaf, Taxillus Chinensis, Ligustrum Fruit, Deer Horn Gelatin. For Kidney Yin deficiency: restlessness, insomnia, tidal fever, night sweats, dry mouth, red tongue with little coating, fine or rapid pulse. Treatment should nourish Kidney Yin. Use Zuo Gui Wan with modifications: Rehmanniae Praeparata, Moutan Cortex, Cornus Fruit, Yam, Alismatis Rhizoma, Crataegi Fructus, Turtle Shell Gelatin, Cuscutae Semen, Ligustrum Fruit, Eclipta Prostrata, Heavenly Winter, Raphanus Sativus, Angelica Sinensis, Citrus Aurantium, Lotus Leaf. All cases cured within 2–4 months.
VI. Tongue Pungency
Patients feel a spicy or burning sensation on the tongue, rarely reported. 4 cases confirmed via lipid tests and ultrasound. Primarily due to heart-bile unrest with phlegm-damp and latent fire—consistent with fatty liver pathogenesis. *Tong Su Shang Han Lun*: "Spicy mouth indicates lung heat entering the stomach." Zhu Danxi: "Lung heat causes spicy mouth; use Gan Ju Tang or Xie Bai San." Clinically: epigastric fullness, chest tightness, shortness of breath, abundant phlegm, inability to lie flat, severe facial edema, loose stools, red tongue with thin greasy coating, wiry and slippery pulse. Treatment should clear lung heat, soothe Liver, harmonize the Stomach. Use Xie Bai San and Chai Hu Shu Gan San with modifications: Scutellariae Radix, Pinellia, Mulberry Bark, Lycium Root Bark, Citrus Peel, Raphanus Sativus, White Mustard Seed, Cyperus Rotundus, Curcuma Aromatica, Toosik, Cassia Seed, Alismatis Rhizoma, Crataegi Fructus. All 4 cases cured within 1–3 months.
VII. Burning Tongue Pain
Patients feel a burning sensation on the tongue, similar to being scorched. 6 cases treated. Often due to internal fire. Frequently accompanied by red, swollen tongue tip and oral ulcers. Alcohol-related fatty liver often exhibits this sensation. Associated with chest and epigastric heat, nausea, poor appetite, constipation, red eyes, dizziness, red tongue with little coating or dryness, wiry and fine or large, rapid pulse. Treatment should clear heat and toxins, soothe Liver and relieve stagnation. Use Bai Hu Tang or Liang Ge San with modifications: Raw Gypsum, Anemarrhena Rhizoma, Raw Rehmannia, Paeoniae Alba Radix, Rheum Palmatum, Gardenia Fructus, Alismatis Rhizoma, Paeoniae Rubra, Moutan Cortex. Adjustments made accordingly; 5 cases cured after 2 months, 1 improved after 3 months.
VIII. Tongue Numbness
Refers to numbness and reduced sensation on the tongue—sometimes even scratching or poking fails to relieve the numbness. 7 cases treated. Tongue numbness often results from blood deficiency, Liver wind, or phlegm obstruction. *Bian She Zhi Nan*: "Tongue numbness indicates blood deficiency. Numbness preventing tongue extension indicates internal wind with phlegm... All require moistening, nourishing blood, calming wind. For phlegm involvement, also expect to resolve phlegm and promote its dispersion." If fatty liver accompanies blood deficiency, it results from emotional agitation, worry, or anger consuming Yin blood. Common symptoms: dizziness, blurred vision, palpitations, forgetfulness, night sweats, feverishness, sallow complexion, thin white coating, pale tongue or teeth marks, fine, slow, or rapid pulse. Treatment should nourish blood and activate collaterals. Use Si Wu Tang or Er Zhi Wan with modifications: Rehmanniae Praeparata, Angelica Sinensis, Paeoniae Alba Radix, Ligusticum Chuanxiong, Ligustrum Fruit, Eclipta Prostrata, Prepared Polygonum Multijugum, Cassia Seed, Citrus Aurantium, Alismatis Rhizoma, Cornus Fruit, Crataegi Fructus. If phlegm is involved: fatigue, epigastric fullness, nausea, poor sleep, greasy coating, wiry and slippery pulse. Treatment should resolve phlegm and relieve depression. Use Xiao Yao San or Wen Yang Tang with modifications: Bupleuri Radix, Angelica Sinensis, Poria, Atractylodis Macrocephalae Rhizoma, Curcuma Aromatica, Pinellia, Bamboo Shavings, Citrus Aurantium, Citrus Peel, Scutellariae Radix, Raphanus Sativus, White Mustard Seed, Crataegi Fructus, Rheum Palmatum, Cyperus Rotundus, Cassia Seed, Areca Nut.
IX. Tongue Swelling
Patients feel tongue swelling, though the tongue may not visibly enlarge. 9 cases treated. Fatty liver patients often have Liver Qi stagnation turning into fire over time, causing upward flaming of Liver fire—leading to tongue swelling sensation. Accompanied by insomnia, palpitations, chest and rib fullness, epigastric hardness, frequent belching, pale tongue with thin coating, wiry and strong pulse. Treatment should soothe Liver, regulate Qi, clear heat, and resolve stagnation. Use Da Chai Hu Tang or Chai Hu Shu Gan San with modifications: Bupleuri Radix, Scutellariae Radix, Paeoniae Alba Radix, Pinellia, Citrus Aurantium, Rheum Palmatum, Cyperus Rotundus, Curcuma Aromatica, Ligusticum Chuanxiong, Citrus Peel, Coptidis Rhizoma, Forsythiae Fructus, Raphanus Sativus, Cassia Seed, Crataegi Fructus. All 9 cases cured within 1–4 months.
X. Tongue Astringency
Refers to the sensation of eating raw persimmons, often occurring with dryness. Mainly due to heat injuring body fluids. 14 cases treated. Excessive yang-heat in zang-fu organs, ascending qi-fire, or dry-heat injuring fluids causing dry, astringent tongue. Chen Wu-Zhe in *San Yin Fang·Kou Bing Zheng Zhi Pian*: "Restlessness and dryness cause astringency." Qing Dynasty Tang Rongchuan in *Xue Zheng Lun·Kou She*: "Tongue astringency is due to wind-heat; treat with Tong Sheng San without Mirabilis and Rhubarb." Tongue astringency in fatty liver relates to Kidney deficiency disrupting water regulation and transformation functions. Water fails to nourish Liver, Spleen loses transport function, fluids fail to distribute, leading to phlegm-stasis obstructing vessels. Common symptoms: dry mouth, sore throat, rib distension and pain, afternoon tidal fever, tinnitus, constipation, red tongue with little coating or central peeling (geographic tongue), fine or wiry pulse. Treatment should nourish Yin, moisten dryness, resolve phlegm, and relieve depression. Use Zeng Ye Tang or Xiao Yao San with modifications: Scrophulariae Radix, Raw Rehmannia, Ophiopogonis Radix, Dendrobii Herba, Northern Sand-Participating Ginseng, Angelica Sinensis, Paeoniae Alba Radix, Bupleuri Radix, Gardenia Fructus, Heavenly Winter, Citrus Peel, Cyperus Rotundus, Curcuma Aromatica, Cassia Seed, Lotus Leaf, Bamboo Leaves. All cases improved or cured within 1–4 months.