bubble_chart Concept

When opening the mouth or extending the tongue, the tongue deviates to one side, known as tongue deviation. It is often seen together with "facial and eye deviation" or "hemiplegia".

Tongue deviation is also known as "tongue deviation", "tongue tilt", "deviated tongue", etc. According to the "Inspection Classic, Diagnosis of Tongue Form": "Tongue deviation with speech difficulty, facial and eye deviation, and limb paralysis is hemiplegia. In tongue deviation, the tongue leans to the left in left paralysis and to the right in right paralysis."

bubble_chart Pattern Analysis

1. External Wind︰In mild cases, the tongue deviates to one side only when extended, without systemic symptoms such as facial distortion or hemiplegia. In severe cases, tongue deviation is accompanied by facial distortion, numbness and discomfort in the flaccid facial muscles, and difficulties in speech and eating. There may also be symptoms such as chills or fever, a white or greasy tongue coating, and a floating, wiry, or slippery pulse. **External Wind-Induced Tongue Deviation vs. Internal Wind-Induced Tongue Deviation** External wind-induced tongue deviation occurs due to exposure to wind and cold, such as sweating in the wind or improper resting postures, allowing wind-cold pathogens to invade through open striae and interstices or weakened defensive qi. This obstructs the meridians and stagnates qi and blood. As the affected muscles lose nourishment and become flaccid, they lose balance with the healthy side, causing the tongue to deviate. The condition arises suddenly in previously healthy individuals, as described in *The Three-Word Medical Classic*: "Among a hundred diseases, apoplexy is foremost; it strikes suddenly, with wind from all directions." Internal wind-induced tongue deviation results from chronic poor self-care, gradual depletion of yin fluids, and internal heat accumulation, which may scorch fluids into phlegm. When extreme anger causes qi to rebel upward with phlegm, or excessive fire pathogens force phlegm to disturb the upper body, the tongue collaterals become obstructed, impairing tongue movement and causing deviation. Patients with internal wind often exhibit the following characteristics: - **Wind-phlegm type**: Typically overweight with excessive phlegm, dizziness, and head distension. After onset, tongue deviation is accompanied by a thick, greasy tongue coating, stiffness, and difficulty moving the tongue, with a wiry, slippery, and rapid pulse. - **Yin deficiency with stirring wind type**: Caused by yin damage and fire-induced wind, often seen in thin, fire-prone individuals. Wind-yang disturbs the upper body, leading to daily symptoms like dizziness, tinnitus, bitter taste in the mouth, and limb numbness. Onset may be sudden or gradual; sudden cases often involve tongue deviation, facial distortion, and hemiplegia, such as collapsing suddenly and waking with paralysis and tongue deviation.
2. Internal Wind︰It can be mainly divided into two types: wind-phlegm apoplexy involving meridians and collaterals, and stirring wind due to yin deficiency. In the case of wind-phlegm apoplexy involving meridians and collaterals, the onset is sudden, with symptoms such as vertigo, deviated tongue, facial deviation, hemiplegia on one side, a white and greasy tongue coating, and a slippery, forceful pulse. For stirring wind due to yin deficiency, symptoms include vertigo, tinnitus, deviated tongue, facial deviation, stiff and deviated tongue, slurred speech, hemiplegia, a red or dry tongue with little moisture, and a wiry, slippery, and rapid pulse. Deviated tongue caused by external wind versus deviated tongue caused by internal wind: Deviated tongue due to external wind occurs when wind-cold pathogens invade due to exposure to wind while sweating, improper posture during rest, or exposure to cold, leading to obstruction of the meridians and stagnation of qi and blood. The affected muscles lose nourishment and become slack and weak, causing imbalance with the healthy side, resulting in the tongue deviating to one side. The patient is usually healthy before the sudden onset, as described in *The Three-Character Classic of Medicine*: "Among the myriad diseases, apoplexy comes first, striking suddenly, with pathways from all directions." Deviated tongue due to internal wind arises from chronic neglect of health maintenance, gradual depletion of yin fluids, and accumulation of internal heat, which may scorch fluids into phlegm. When combined with qi counterflow due to rage or excessive fire pathogens forcing phlegm upward, it obstructs the tongue collaterals and impairs tongue movement, leading to deviation. Patients with internal wind often exhibit the following characteristics: - Those with wind-phlegm are typically obese with abundant phlegm, experiencing vertigo, head distension, and post-onset symptoms such as deviated tongue, thick and greasy tongue coating, stiff tongue, and a wiry, slippery, rapid pulse. - Those with stirring wind due to yin deficiency, caused by yin deficiency and fire generating wind, are often thin and prone to excessive internal heat. Wind-yang disturbs the upper body, leading to daily symptoms like vertigo, tinnitus, bitter taste in the mouth, and limb numbness. The onset may be sudden or gradual, with sudden cases often presenting deviated tongue, facial deviation, and hemiplegia, such as sudden collapse followed by paralysis and deviated tongue upon regaining consciousness.

In treatment, those affected by external wind should disperse wind and unblock the collaterals, using Major Gentian Decoction with modifications; for those with internal wind and a deviated tongue, if it is due to wind phlegm, they should expel wind and resolve phlegm, using Pull Aright Powder; if it is due to stirring wind caused by yin deficiency, they should pacify the liver and extinguish wind, using antelope horn decoction.

bubble_chart Documentation

1. "Guide to Tongue Diagnosis: Descriptions of the Tongue": "A deviated tongue refers to one that slants to one side, commonly seen in convulsions and hemiplegia. Further differentiation should be made based on its color. If the color is purplish-red and the condition is acute, it is caused by liver wind triggering convulsions, and extinguishing wind to calm convulsions is appropriate; if the color is pale red and the condition is mild, it is caused by apoplexy hemiplegia; if the tongue is deviated, speech is impaired, the mouth and eyes are askew, and there is half-body paralysis, it is hemiplegia. If the tongue deviates to the left, it is left-sided paralysis; if it deviates to the right, it is right-sided paralysis. Tonifying qi to relax the muscles and resolving phlegm to unblock the meridians is appropriate."