bubble_chart Concept

The incomplete shedding of the tongue coating, where the shed area is smooth and without coating, is referred to as tongue peeling.

The erosion of the tongue coating is different from the "worm-eaten tongue," which resembles the appearance of being eaten by insects. The former is described as "a piece of the tongue coating peeling off like a coin, or several pieces peeling off, or the entire tongue peeling like a map" ("Clinical Essentials of Chinese Medicine"); the latter is described as "the tongue having red spots, pits, and ulcers, with protrusions resembling insect-eaten grass" ("National Medicine Tongue Inspection Studies"). The different forms have different clinical significances: tongue peeling often indicates yin deficiency, while the "worm-eaten tongue" indicates excessive fire toxin. Therefore, the two should be distinguished.

Based on the degree of tongue coating shedding, there are also terms like "mottled peeling" and "complete peeling," but they all fall within the category of tongue peeling.

bubble_chart Pattern Analysis

1. Stomach Yin Deficiency︰A red tongue with peeling coating, dry mouth with little saliva, poor appetite, inability to taste food, postprandial fullness, retching or hiccups, or even dysphagia and regurgitation, dry and difficult bowel movements, and a thin, rapid, and weak pulse. This is often caused by residual heat in the stomach during the late stage of an external-contraction febrile disease (third stage), which consumes stomach yin; or due to prolonged stomach disorders or other chronic illnesses that deplete yin fluids over time, depriving the stomach of nourishment and moisture. This leads to peeling of the tongue coating, and in severe cases, a smooth, glossy tongue surface known as a "mirror tongue," indicating severe damage to stomach yin. There is concern that stomach yin may be exhausted, leading to a poor prognosis. The tongue texture is deep red or glossy crimson with cracks, accompanied by symptoms of impaired stomach descending function (poor appetite, postprandial fullness, retching, or hiccups).
2. Deficiency of Both Qi and Yin︰The tongue is pale red with peeled coating, shortness of breath, lack of strength, fatigue, vexing heat in the chest, palms, and soles, night sweat, dry mouth and throat, and a thin rapid pulse. This mostly occurs in the late stage of external-contraction febrile disease [third stage], where prolonged pathogenic heat damages yin and consumes qi, leading to deficiency of both qi and yin; or due to excessive sweating in summer, resulting in fluid depletion; certain chronic sexually transmitted diseases in advanced stages may also cause prolonged illness to deplete both qi and yin, leading to a peeled tongue.

   Key points of pattern identification: The tongue texture is pale red, accompanied by symptoms of qi deficiency (shortness of breath, reluctance to speak, mental fatigue, lack of strength, spontaneous sweating) and yin depletion (vexing heat in the chest, palms, and soles, night sweat, dry mouth, and constipation).

The treatment principle for stomach yin deficiency with peeled tongue is to nourish stomach yin, commonly using Stomach-Tonifying Decoction, Adenophora and Ophiopogon Decoction, and other formulas; the treatment principle for deficiency of both qi and yin with peeled tongue is to tonify qi and nourish yin, commonly using Pulse-Reinforcing Powder and other formulas.

bubble_chart Documentation

1. 《Traditional Chinese Medicine Tongue Inspection》: "Erosion in the center of the tongue with a greasy coating on the edges indicates the accumulation of damp phlegm."
2. 《Diagnostics of Chinese Medicine》: "If the tongue coating suddenly disappears and does not regenerate, or if it appears as if it has been peeled off, leaving patchy remnants like scattered bean curd residue on the tongue, scattered and discontinuous, these are all signs of an unfavorable pattern. This is often due to the misuse of digestant and evacuant, food-stagnation-removing medicinals, or the misuse of exterior-releasing medicinals, which damage the stomach qi and stomach fluids, thus presenting this condition."