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Bleeding on the tongue is also known as "tongue bleeding" or "bleeding at the base of the tongue," or "tongue hemorrhage." Conditions such as "tongue sore," "tongue abscess," and "tongue pustule" all present with symptoms of bleeding on the tongue. However, in the case of a "tongue sore," blood flows from the surface of the sore. In "tongue abscess" and "tongue pustule," bleeding occurs after the pus has matured and the abscess, boil, or sore ruptures, resulting in the discharge of both pus and blood. This section discusses bleeding that excludes the aforementioned factors.

bubble_chart Pattern Analysis

1. Exuberance of Heart Fire︰Persistent bleeding from the tongue, swelling of the tongue body, even pain, a crimson-red tongue tip, or prickles, or erosive spots on the tongue tip, accompanied by vexing heat in the chest, irritability, insomnia, thirst with desire to drink, reddish and rough urination, or even occasional unconsciousness and delirious speech, a rapid and forceful pulse. Persistent bleeding from the tongue, swelling of the tongue body, a crimson-red tongue tip, or prickles, accompanied by symptoms of internal blazing of heart fire (vexing heat in the chest, flushed face, thirst, reddish and rough urination, insomnia with dreamfulness, or unconsciousness and delirious speech). Treatment should focus on clearing heat and cooling blood. For mild cases, use Heart-Draining Decoction, or Coptis Detoxification Decoction with lalang grass rhizome and raw pagodatree flower bud; for severe cases, choose Rhinoceros Horn and Rehmannia Decoction with pagodatree flower bud, taken infused with infant urine. For external use, apply Typha powder to the tongue to stop bleeding.
2. Up-flaming of Liver Fire︰Bleeding from the tongue, swollen and numb tongue, yellow tongue coating, red or crimson edges of the tongue, or prickly sensations, accompanied by heat and pain in the head, feverishness, dizziness, blurred vision, flushed face, red eyes, bitter taste in the mouth, dry throat, tinnitus, deafness, pain in the hypochondriac region, irritability, tendency to anger, dark urine, dry stool, and even syncope, with a wiry and rapid pulse. Persistent bleeding from the tongue, swollen and numb tongue, yellow tongue coating, and red or crimson edges of the tongue, along with symptoms of up-flaming of liver fire (flushed face, red eyes, bitter taste in the mouth, tendency to anger, headache, vertigo, tinnitus, deafness, burning pain in the hypochondriac region). Treatment should focus on clearing and draining liver fire, cooling blood, and stopping bleeding. Select Angelica, Gentian and Aloe Pill, or use Gentian Liver-Draining Decoction with hematite and Platycladus; additionally, use Scouring Rush Herb decoction for gargling and apply fried Typha powder externally to stop bleeding.
3. Yin Deficiency︰Bleeding from the tongue, a red tongue with scant coating, or a thin and emaciated red tongue, flushed cheeks and red lips, dizziness and blurred vision, dry mouth and throat, tinnitus and forgetfulness, virtual vexation and insomnia, aching pain in the waist and knees, steaming bone fever and tidal fever, seminal emission and night sweats, a fine and rapid pulse. Suwen. Qibing Lun states: "The Shaoyin meridian connects the kidneys and binds to the root of the tongue." Insufficient kidney yin, water failing to control fire, and frenetic stirring of ministerial fire ascend along the meridian, scorching the tongue's collaterals, disturbing yin-blood, and forcing blood to overflow, resulting in tongue bleeding. Zhang Jing-yue said: "Although bleeding is mostly caused by fire, it is especially common in cases of yin deficiency." Kidney yin deficiency is often due to constitutional yin deficiency; or acute Rebing, which scorches true yin; or erroneous sweating, reckless purging, excessive sexual desire, injuring essence, loss of blood, or depletion of fluids. Clinical manifestations include emaciation, dizziness and tinnitus, insomnia and forgetfulness, aching pain in the waist and knees, a red tongue with scant coating—signs of kidney yin deficiency—as well as bleeding from the tongue, flushed cheeks and red lips, vexing heat in the chest, palms, and soles, tidal fever and night sweats, dry and sore throat, loose teeth, and a fine and rapid pulse—symptoms of deficiency fire flaming upward. This differs entirely from the excess pattern of tongue bleeding due to exuberance of heart fire, which presents with a swollen tongue body, a deep red tongue tip, vexing heat in the chest, irritability and insomnia, a rapid and forceful pulse, or even unconsciousness and delirious speech. Treatment should focus on enriching yin, downbearing fire, and stopping bleeding. Options include Six-Ingredient Rehmannia Decoction with Achyranthes Root and raw pagodatree flower bud, or Coptis and Ass Hide Glue Decoction infused with child's urine. For external use, boil Chinese gall to a concentrated liquid, soak gauze in it, and tightly pack it in the mouth, or apply powdered pagodatree flower bud and carbonized human hair to the bleeding area to stop the bleeding.
4. Spleen Failing to Control Blood︰Bleeding on the tongue, with pale and thin blood, a swollen and tender tongue, pale in color with a white coating, complexion lacking luster, pale lips and nails, reduced appetite, abdominal distension and fullness, loose stool, spontaneous sweating, shortness of breath, fatigue in the limbs, mental fatigue, reluctance to speak, or bloody stool, menorrhagia and metrostaxis, subcutaneous bleeding, etc., with a weak and thready pulse. The spleen is the organ that governs blood. When the spleen is healthy, blood is properly controlled. If a person is inherently weak, suffers from excessive worry and depression, overstrain, irregular diet, or excessive consumption of cold and cooling substances, leading to injury of the spleen and stomach, deficiency and decline of spleen qi, insufficient generation and transformation, and deficiency of middle qi, the ability to control blood is lost, resulting in bleeding from the tongue. The clinical characteristics are: bleeding on the tongue with pale red blood, a swollen and tender tongue, pale in color with a white coating, complexion lacking luster, along with reduced appetite, spontaneous sweating, shortness of breath, mental fatigue, reluctance to speak, fatigue in the limbs, and other manifestations of spleen qi deficiency and decline. This is clearly different from tongue bleeding caused by exuberance of heart fire or liver fire ascending, which is due to intense pathogenic heat forcing blood to flow recklessly. The former is often seen in cases of prolonged illness with physical weakness, elderly and frail individuals, postpartum women, and those with overstrain that depletes middle qi. The latter is more common in individuals with inherently strong yang. One is due to qi deficiency, the other to blood heat; one is a deficiency pattern, the other an excess pattern, and they should be easily distinguished. For tongue bleeding due to spleen failing to control blood, the treatment should focus on tonifying qi to control blood, using Returning to Spleen Decoction, with external application of Clam Powder to stop bleeding.

Bleeding on the tongue is mostly caused by excessive fire leading to blood movement. If tongue bleeding persists for a long time, pathogenic fire damages yin and consumes qi, often leading to the conversion of excess into deficiency, presenting symptoms of yin deficiency or qi deficiency. Suwen. Tongping Xushi Lun states: "Exuberance of pathogen causes excess syndrome, lack of essential qi causes deficiency syndrome." Therefore, exuberance of heart fire and liver fire rushing upwards causing tongue bleeding is an excess pattern; yin deficiency with flaming fire and spleen failing to control blood causing tongue bleeding is a deficiency pattern. To differentiate deficiency and excess based on tongue and pulse symptoms: exuberance of heart fire causing tongue bleeding: swollen tongue body, red and deep tongue tip, possibly with prickles, rapid and forceful pulse; liver fire rushing upwards causing tongue bleeding: swollen and stiff tongue, red and deep tongue edges, wiry and rapid pulse; yin deficiency with flaming fire causing tongue bleeding: thin and shriveled tongue body, red tongue with little coating, thin and rapid but weak pulse; spleen failing to control blood causing tongue bleeding: swollen and tender tongue body, pale tongue with white coating, deep and thin but weak pulse. For excess pattern, treatment should focus on clearing and purging, with distinctions between clearing heart and reducing fire versus clearing the liver and draining fire due to differences between heart fire and liver fire; for deficiency pattern, treatment should focus on nourishing and tonifying, with distinctions between enriching yin and cooling blood versus tonifying the spleen and controlling blood due to differences between kidney yin deficiency and spleen qi deficiency.

bubble_chart Documentation

1. Xiezheng Lun．Tongue Bleeding: "The mouth is the gateway to the stomach, and the tongue is within the mouth. When stomach fire scorches it, it can also cause bleeding... The root of the tongue is connected by the liver meridian, and bleeding under the tongue is due to pathogenic heat of the liver."
2. 《Guide to Tongue Differentiation．Differentiation and Treatment of Tongue Syndromes》: "Bleeding on the tongue is called oral and tongue bleeding, mostly caused by excessive heart and spleen heat, forcing blood to flow recklessly... For those whose condition does not stop after recovery, use one qian of calcined sediment of human urine and five li of borneol, grind into fine powder and apply, it will stop."
3. 《Internal Medicine Clinical Records．Tooth and Tongue Bleeding》: "In this case, bleeding is seen in both the tongue and between the teeth, indicating a simultaneous illness of the heart and kidney... The yang qi of the human body guides the yin blood, and the yin blood is the home of yang qi. Both heart nutrient and kidney yin are insufficient, the solitary yang has nothing to attach to, floats and rushes upwards, forcing blood to flow recklessly, leading to the problem of tooth and tongue bleeding. Therefore, it is treated with the Nourishing Yin and Restoring Yang Decoction, tonifying yin and astringing yang, returning fire to its origin."