bubble_chart Concept

A tongue that appears rough with sharp, prickly protrusions that feel obstructive to the touch is referred to as a prickly tongue.

Generally, the presence of thorn-like protrusions on the tongue indicates a heat pattern, as Wenre Lun states: "Regardless of the color, the appearance of thorn-like protrusions on the tongue signifies extreme heat in the upper energizer." However, based on clinical observations, the specific conditions indicated by these protrusions can vary depending on the presence or absence of tongue coating, the color of the tongue coating, and the location of the protrusions. This section discusses the differentiation of symptoms and signs associated with thorn-like protrusions on the tongue, focusing primarily on the presence or absence of tongue coating and the accompanying color variations.

bubble_chart Pattern Analysis

1. Yangming Dryness Excess︰The tongue coating is scorched yellow with prickles, accompanied by high fever and sweating, dry mouth and tongue, abdominal hardness and fullness, constipation, and a rapid and slippery or deep and slow but forceful pulse. This is due to pathogenic heat entering the interior and combining with the tangible evils in the stomach, transforming into dryness and forming excess, thereby turning into a yangming fu-organ excess syndrome. The disease remains at the qi aspect, with persistent dryness-heat damaging yin fluids, hence the tongue prickles are a sign of yin exhaustion and yang hyperactivity. The tongue coating is scorched yellow, or even scorched black, dry, cracked, and prickly, with a rough tongue surface and prickles attached to the coating. As stated in *The Essence of Cold Damage Disease*: "Whenever the tongue has prickles, the coating must be scorched yellow or black; if there is no coating, the tongue must be deep crimson; if the coating is white or pale yellow, the stomach lacks severe heat, and there will be no prickles." The key points of differentiation include symptoms such as stuffiness, fullness, dryness, and excess. Emergency purgation to preserve yin is advised, using the Chengqi Decoction method. As Wu Kun-an of the Qing dynasty wrote in *Methods of Tongue Inspection and Pattern Identification*: "If the coating is thick, yellow, dry, and prickly, or yellow at the edges with a scorched black center and prickles, accompanied by umbilical abdominal distension, fullness, hardness, and pain, this is a yangming interior syndrome, and Chengqi Decoction purgation should be used." However, if "there are no symptoms of abdominal stuffiness, fullness, hardness, or pain, Chengqi Decoction should not be recklessly prescribed, as this indicates dryness and exhaustion of stomach fluids and insufficient kidney water from the shaoyin. In such cases, Large or Small Sweet Dew Decoction purgation is appropriate."
2. Yingfen Stagnant Heat︰The tongue texture is deep red with prickles, fever worsens at night, the skin feels burning to the touch, accompanied by restlessness and occasional delirious speech, faint macules and papules, and a thready, rapid pulse. This indicates rampant pathogenic heat, which has progressed from the qi aspect to the nutrient aspect and becomes trapped, manifesting as intangible pathogenic heat lingering intensely. The scorching heat toxin consumes and depletes the nutrient yin, hence the prickles on the tongue often serve as a precursor to excessive heat stirring blood or wind, leading to convulsive syncope. The tongue may lack coating or have minimal coating, appearing deep red or even purplish-black with prickles resembling Chinese wax myrtle bark, sometimes with cracks but not as rough as in Yangming dryness-excess syndrome. Key diagnostic points include blazing nutrient heat and depletion of yin fluids (manifested as fever with dysphoria, delirious speech, faint macules and papules), or even excessive heat generating wind and stirring blood (convulsions, bleeding, macules). Following Ye Tian-shi’s principle that "entering the nutrient aspect still allows for clearing heat through the qi aspect," the Nutrient-Clearing Decoction should be used to clear the nutrient aspect and expel heat, enabling the pathogenic heat in the nutrient aspect to be redirected to the qi aspect for resolution. Wu Kun-an also stated: "If the tongue is purely bright red with prickles, this indicates gallbladder fire blazing and nutrient aspect heat—promptly use Rhinoceros Horn and Forsythia Bark Elixir to clear and resolve it," and "if unresolved…quickly increase the dosage of fresh Unprocessed Rehmannia Root, Ophiopogon Tuber, and Scrophularia Root."

In general, the presence of prickly, raised projections on the tongue is a sign of pathogenic heat flaring up. The more severe the pathogenic heat, the larger and more numerous the prickles. Typically, the location of the prickles can be used to differentiate the affected zang-organs. For example, prickles on the tip of the tongue indicate heart heat, while prickles in the center of the tongue suggest heat in the spleen and stomach, and so on.

bubble_chart Documentation

1. 《Tongue Coating Comprehensive Records》: "A light red tongue with sharp, thorny protrusions indicates an upper attack of wind-warmth, and treatment should focus on clearing and dispersing; sharp red spots with gray thorns indicate that ministerial fire has taken the place of monarch fire, where ministerial fire should be suppressed and monarch fire should be cleared; sharp, bud-like thorns indicate dampness fire, Rhubarb Rhizoma Coptis Detoxification Decoction, and the thorny protrusions indicate thoracic accumulation, Minor Chest Bind Decoction. If the tongue coating is white with black thorns, dryness indicates a transformation of wind-fire, while a slippery coating indicates steaming dampness-heat, both of which should be treated with diarrhea, although such signs are often critical."
2. 《Essentials of the Four Examinations》: "A red tongue with thorns indicates internal accumulation of food, treatable with purgation using Chengqi Decoction; scraping the thorns clean indicates survival, while failure to do so indicates death."
3. 《Direct Principles of Diagnosis》: "Although a black tongue coating indicates internal heat, it does not immediately produce thorns; those with a cigarette addiction often have a dry, thorny coating, but this does not necessarily indicate true internal heat."
4. 《Guide to Tongue Differentiation》: "Red or purple thorns on the tongue indicate extreme heat in the heart meridian, exacerbated by exposure to epidemic pathogens."