A tongue that is stiff, inflexible, and causes difficulty in speech is referred to as "tongue stiffness."

This condition was originally termed "stiffness of the tongue root" in the Neijing. For example, in Suwen, Zhizhenyao Da Lun states: "When the Jueyin celestial control is affected, and the wind element is restricted, people suffer from... stiffness of the tongue root." Later generations simplified it to "tongue stiffness," or also called "tongue astringency," "inflexible tongue," etc.

Both "tongue stiffness" and "tongue curling" share the common feature of reduced tongue flexibility, but tongue stiffness refers to the tongue being rigid and hard, while tongue curling refers to the tongue being curled and inflexible. The disease causes are similar, but the manifestations are different.

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1. Wind Phlegm︰This syndrome is commonly seen in apoplexy patients. Due to the varying locations of obstruction by wind-phlegm, the severity of symptoms also differs. When affecting the {|###|}meridians{|###|} and {|###|}collaterals{|###|}, it manifests only as facial deviation or hemiplegia, with clear consciousness, stiff tongue causing speech difficulties, difficulty extending the tongue or deviation to one side, and a pulse that is often floating, wiry, tight, or slippery. When affecting the zang-fu organs, there is often sudden collapse, loss of consciousness, wheezing phlegm in the throat resembling a sawing sound, locked jaw, and upon forcing the mouth open, the tongue is stiff and difficult to protrude, with inability to swallow, flushed face, coarse breathing, and a wiry, tight pulse. The ancient concept of external wind direct attack is extremely rare; in reality, the vast majority of cases arise from interior heat generating wind, combined with phlegm and rising qi counterflow, obstructing the meridians and disrupting mental activity. Hence, the characteristic feature is internal wind. Apoplexy involving collaterals, due to shallow pathogenic invasion, manifests only locally: facial deviation, stiff tongue with speech difficulties, and overall condition somewhat resembling normal. Treatment should focus on expelling wind and resolving phlegm to harmonize the collaterals, using Pull Aright Powder or Zhuan She Gao (Tongue-Turning Paste). Apoplexy involving meridians, due to obstruction of major meridians and impeded qi and blood flow, often presents with hemiplegia, stiff tongue with difficulty speaking, slurred speech, and possible coughing while eating or drinking, but with clear consciousness—the so-called "no six-channel exterior patterns externally, no obstruction of bowel or bladder function internally." Treatment should nourish blood and disperse wind, selecting Major Gentian Decoction, or pacify the liver and extinguish wind, choosing Ling Yang Uncaria Decoction. Apoplexy involving zang-fu organs results from loss of healthy qi, pathogenic factors occupying vital positions, and disrupted mental activity, thus presenting with unconsciousness, wheezing phlegm in the throat, and locked jaw. If the mouth is forced open, the tongue is often stiff and retracted; in necessary cases, it may be clamped to prevent suffocation. Initial treatment should focus on orifice-opening and resolving phlegm, selecting Su He Wan (Liquid Styrax Pill) or Phlegm-Cleansing Decoction. Once the critical period passes, Zi Shou Jie Yu Tang (Longevity Speech-Restoring Decoction) or Yang-Tonifying Five-Returning Decoction may be used.
2. Heat Invading Pericardium︰It is often caused by the unresolved pathogenic heat of warm disease invading inward to the pericardium, manifesting as high fever, unconsciousness, delirious speech, stiff tongue with deep red texture, flushed cheeks, and red whites of the eyes, with a pulse that is mostly surging, large, slippery, and rapid. Warmth is a yang pathogen, with rapid transmission and changes. In cases of reversed transmission to the pericardium, the disease presents with sudden high fever, quickly leading to unconsciousness, stiff tongue, lockjaw, and a red or deep red tongue texture. This indicates the pericardium is affected by the pathogen, and it is urgent to clear the heart and open the orifices. Peaceful Palace Bovine Bezoar Pill can be selected. If Rebing persists and gastrointestinal heat accumulates, leading to heat accumulation constipation disease, with interior heat having no outlet and pressing upward to the pericardium, the tongue coating is often old and yellow, the tongue dry with little moisture, and the texture red or deep red. In such cases, it is appropriate to "take away the firewood from under the cauldron," using Cow-Bezoar Chengqi Decoction, etc. For prolonged warm disease with persistent tidal fever, gradual exhaustion of yin fluids, and internal stirring of liver wind, symptoms such as convulsive syncope, unconsciousness, dysphoria, and a stiff, shortened tongue may occur. In such cases, only increasing fluids and nourishing yin to extinguish wind is suitable, using Three-Carapace Pulse-Restoring Decoction and similar remedies.

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1. 《Four Examinations Juewei · Inspection》: "A red and rigid tongue with aphonia is a sign of death."
2. Zhangshi Yitong · Apoplexy Chapter: "For obese individuals with a rigid tongue root, treat as damp phlegm; for thin individuals with a rigid tongue root, treat as heart fire." "If spleen earth is deficient, phlegm and saliva are abundant and cause obstruction, it is phlegm fire blocking the upper orifices, qi deficiency cannot nourish upwards, then the tongue mechanism does not turn, it is appropriate to use Six Gentlemen Decoction plus Arisaema, Acorus, Polygala, Immature Orange Fruit, and Bamboo Shavings. If the mouth and eyes are crooked and unable to speak, encountering wind-cold causes spasm of limbs, the pulse is floating and tight, this is the deficiency wind of the Hand and Foot Yangming channels, use Gentian Cimicifuga Rhizome Decoction."
3. "Phlegm blockage, rigid tongue root, incorrect speech, use Zheng San San plus Mentha."
4. "Spleen slackness, rigid tongue unable to speak, half-body paralysis, use Jie Yu Decoction."