bubble_chart Concept

When the tongue is curled and retracted, inflexible in movement, and speech is unclear, it is referred to as "tongue curling." This condition may be accompanied by unconsciousness, scrotal retraction, and other phenomena.

The condition of tongue curling was first mentioned in Neijing, believed to be caused by disorders in the heart and liver meridians, Suwen. "Diagnostic Essentials" Jingluo Lun: "At the end of the Jueyin, there is internal heat, dry throat, frequent urination, and heart vexation; in severe cases, the tongue curls and the testicles retract upward, leading to death." Suwen. Maiyao Jingwei Lun: "When the heart pulse is strong and long, it indicates illness with tongue curling and inability to speak."

Both tongue curling and "tongue stiffness" involve inflexibility of the tongue, but the latter is characterized by a stiff and straight tongue that can slightly protrude from the mouth, whereas the former involves the tongue curling and retracting backward, often unable to protrude from the mouth. Tongue curling is more commonly seen in acute and critically ill patients, while tongue stiffness is less severe.

bubble_chart Pattern Analysis

1. Exhaustion of Liver Meridian Qi︰The tongue is curled, the tongue texture is crimson and dry, the scrotum is retracted (testicular retraction, scrotal retraction), there is restlessness and fullness in the chest, lips are cyanotic, unconsciousness, and the pulse is wiry and rapid. The main distinguishing feature is the simultaneous occurrence of a curled tongue and retracted scrotum, which differentiates it from heart disease-related tongue curling. Wenbing Tiaobian states that although curled tongue and retracted testicles both pertain to the Jueyin channel, it points out that "the tongue belongs to the hand [channel], while the scrotum belongs to the foot [channel]. The tongue is the orifice of the heart, and the pericardium acts on behalf of the heart. The scrotum is traversed by the liver meridian both anteriorly and posteriorly, so the two types of Jueyin must not be confused as one." This syndrome is often caused by extreme interior heat and exhaustion of liver yin, leading to the collapse of liver meridian qi. The liver governs the tendons, and when meridian qi collapses, the tendons also fail, resulting in symptoms such as a curled tongue, crimson and dry tongue texture, scrotal retraction, cyanotic lips, spasms, and unconsciousness. It can be treated with Uncaria Decoction combined with raw abalone shell, raw turtle carapace, hawksbill shell, and other ingredients.
2. Warm Pathogen Invading the Pericardium︰The tongue is curled and short, the tongue color is crimson, the cheeks are red, high fever with unconsciousness, reversal cold of limbs, severe constipation, a pulse that is surging and rapid or wiry, slippery, and rapid, etc. The pericardium acts on behalf of the heart, and the small intestine's collaterals connect to the cheeks and have an exterior-interior relationship with the heart. Therefore, the characteristic of heart disease with a curled tongue is a short, curled tongue and red cheeks, which can be seen in cases of warm pathogens invading the pericardium. Among these, cases where the pathogen reverses transmission from the upper energizer (lung) to the pericardium have a sudden onset and rapid progression, often quickly manifesting high fever, unconsciousness, red cheeks, and lockjaw. Treatment should focus on resuscitation with aromatics, clearing heat, and removing toxins, using Peaceful Palace Bovine Bezoar Pill or Purple Snow Bolus. For cases where pathogens enter the middle energizer and stagnant heat surges upward to the pericardium, common symptoms include constipation, red face and eyes, a crimson tongue with yellow coating, and in severe cases, cold limbs. Treatment should involve Cow-Bezoar Chengqi Decoction to open the orifices and drain heat. If the tongue is dry with prickles, it indicates severe heat damaging fluids, and Liquid-Increasing Purgative Decoction should be used to nourish yin and moisten for purgation. Acupuncture can also be applied to points such as Fuliu (KI7), Yemen (TE2), and Erjian (LI2).

The symptom of curled tongue is often seen in critical illnesses, particularly in cases of liver meridian qi exhaustion and warm pathogens invading the pericardium. The former is characterized by retraction of the scrotum, while the latter is marked by high fever and unconsciousness, making them relatively easy to distinguish in clinical practice. Additionally, in cases where phlegm-heat obstructs the heart orifices, the upward surge of phlegm-heat can block the heart orifices, leading to symptoms such as unconsciousness and slurred speech, and may also manifest as a curled tongue, which can serve as a reference for differentiation.

bubble_chart Documentation

1. Zhengyin Maizhi．External contraction, unclear tongue sound: "Wind in the Jueyin, then the tongue curls and speech becomes difficult,... the left guan pulse is stringy and tight,...Liver-Tonifying Powder."
2. 《Inspection, following the classics．Diagnosis form of tongue, appearance entry》: "Pharyngitis, curled tongue, dry mouth, vexation, heart pain, pain in the inner side of the arm, unable to reach the head,Xieke is in the hand Shaoyang's collateral." "Speech sounds anxious and fearful, the root of the tongue curls and shrinks, anger and joy without measure, dizziness, trance, distension, and oppression, spleen cold affected by wind."