When the tongue trembles uncontrollably while extended, it is called tongue tremor.

Tongue tremor is also known as "tongue battle" or "battle tongue." The "Inspection Classic: Outline of Tongue Inspection Methods" states: "Those whose tongues tremble in battle have illness in the spleen."

This condition is different from "waggling tongue." "Waggling tongue" refers to the tongue frequently and involuntarily extending out of the mouth and then retracting. In children, waggling tongue is often associated with infantile malnutrition with accumulation or stomach heat, while in adults, it can occur alongside tongue tremor, such as in individuals with alcohol toxicity.

bubble_chart Pattern Analysis

1. Internal Stirring of Liver Wind︰There are three types of tongue tremors: First, when the tongue is extended, it flaps like wings, accompanied by high fever, dysphoria, unconsciousness, convulsive syncope, a red or deep purple tongue texture, a charred black tongue coating, and a mostly wiry and rapid pulse. Second, tongue tremors are accompanied by trembling and rigidity of the limbs, unsteady gait, or headache and vertigo, even sudden fainting. Third, the tongue trembles and appears atrophied, with flaccid and atrophied limbs, localized muscle wasting, and in severe cases, stiffness of the tongue making speech difficult. 1. Caused by high fever damaging yin and extreme heat generating wind. This is due to pathogenic heat scorching and wind-fire stirring each other, leading to malnourishment of the sinews and vessels. Thus, tongue tremors appear alongside high fever, dysphoria, unconsciousness, and convulsions, often with a rapid onset. Treatment should focus on clearing heat, pacifying the liver, and extinguishing wind, using modified Antelope Horn and Uncaria Decoction. 2. Caused by liver yang transforming into wind, seen in individuals with chronic liver and kidney yin deficiency, where yang transforms into wind. Symptoms include numbness of the limbs or trembling, unsteady gait. Treatment should focus on nourishing the liver and kidney, using modified Three-Carapace Pulse-Restoring Decoction. 3. Caused by internal damage to the liver and kidney leading to atrophy-flaccidity, affecting the extraordinary vessels. The condition is difficult to cure quickly. Treatment should include Rehmannia Decoction and Hidden Tiger Pill, among others.
2. Blood Deficiency︰The main manifestations include a pale-red tongue, slight wriggling of the tongue when extended, palpitation, severe palpitation, insomnia, dreamfulness, forgetfulness, reduced appetite, fatigue, lack of strength, and a thin, weak pulse. These symptoms are mostly caused by prolonged illness leading to depletion and blood deficiency, resulting in malnourishment. Zhang Jing-yue said: "Dryness of blood causes tendon spasms." The liver governs the tendons, follows the genitalia, and connects to the tongue. The spleen controls blood and connects to the root of the tongue, while the heart governs blood and opens its orifice at the tongue. Blood deficiency in the heart and spleen leads to malnourishment of the tendons and vessels, hence causing tongue tremors. The characteristics are: it is often seen in individuals with prolonged blood deficiency, with slight trembling of the tongue and a pale-red tongue color, unlike the tongue tremors caused by liver wind, which are marked by a red tongue color and vigorous, fluttering movements. The treatment focuses on nourishing blood and relaxing the tendons, as well as tonifying and replenishing the heart and spleen, using Returning to Spleen Decoction with the addition of Donkey-hide Gelatin, Peony Root, and Floweringquince Fruit.
3. Alcohol Toxicity︰The main manifestations include a purplish-red tongue color, the tongue protruding and trembling, hand tremors, hallucinations, forgetfulness, a preference for drinking water, a purplish-red face, a thick tongue coating, and a slippery, rapid pulse. These symptoms are caused by excessive alcohol consumption, lack of restraint, and prolonged indulgence, leading to alcohol toxins penetrating the meridians and scorching yin essence. The purplish-red tongue color indicates internal accumulation of alcohol toxins, while the protruding and trembling tongue and numb, trembling hands are signs of fluid depletion and sinew injury. Patients are often habitual drinkers. Treatment should combine alcohol abstinence with medication, using Pueraria Flower Sobering-Up Decoction.

bubble_chart Documentation

1. 《Four Examinations Juwei．Inspection》: "A red tongue that trembles and makes speech difficult indicates a deficiency of the heart and spleen, and may be seen in cases of excessive sweating and yang exhaustion."
2. 《Inspection Zunjing．Tongue Inspection Method Outline》: "Rebing Difficulty in extending the tongue, and unclear speech when extended, is a dangerous sign of weak healthy qi."
3. Xingse Waizhen Jianmo．Color Diagnosis: "A tongue that does not protrude and trembles is a sign of death."