bubble_chart Concept

Tongue coating decay, abbreviated as tongue decay, refers to the condition where the tongue coating resembles bean dregs, with a loose and thick texture that can be wiped off easily but quickly reappears.

Tongue decay is different from "tongue greasiness." Tongue greasiness is usually thicker in the middle and root of the tongue, thinner at the edges and tip, with fine and dense particles that adhere closely to the tongue surface and are difficult to scrape off. The disease causes and mechanisms of these two conditions are different, and they should be distinguished clinically.

Tongue decay can be seen in various diseases. This section discusses certain internal diseases where tongue decay is the main symptom. For the pus-decay coating seen in sore and ulcer conditions, such as the white pus-decay coating in lung abscess and chancre, the yellow pus-decay coating in stomach abscess, and the gray-purple pus-decay coating in liver abscess, these are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Stomach Heat with Phlegm Turbidity Counterflow︰The tongue coating is loose and floating on the surface of the tongue, resembling thick, rotten bean curd residue, accompanied by nausea, bitter taste in the mouth, or coughing up yellow phlegm, or epigastric fullness with poor appetite, and a wiry, slippery, and rapid pulse. The main condition is phlegm turbidity, supplemented by Gallbladder-Warming Decoction with modifications to clear heat and resolve phlegm, as well as dispel turbidity.
2. Food Retention and Stagnation︰The tongue coating is loose in texture, floating on the surface of the tongue, thick, foul, and odorous, accompanied by dry belching with a foul smell of food, acid regurgitation, epigastric fullness, abdominal distension, borborygmus, poor appetite, and loose stools. The pulse is thin, slippery, and rapid. The primary cause is food stagnation. The distinguishing features are as follows: In cases of stomach heat with phlegm turbidity, the tongue coating resembles bean dregs—thick and foul—accompanied by nausea, vomiting of yellow phlegm, epigastric fullness, bitter taste in the mouth, sticky sensation in the mouth, and anorexia. In cases of retained food, the tongue coating is thick, foul, and odorous, accompanied by dry belching with a foul smell of food, acid regurgitation, abdominal distension and fullness, and borborygmus. The treatment principle should focus on descending counterflow and harmonizing the stomach, supplemented by promoting digestion and removing food stagnation. The formula of choice is the Immature Orange Fruit Stagnation-Removing Pill. Under no circumstances should warm-drying or diaphoretic formulas be used, as stated in the *Guide to Tongue Differentiation*: "Using them will inevitably lead to a grayish and dull coating—this must not be overlooked."

Tongue putrefaction is mostly due to excessive stomach heat, which steams stomach turbidity, causing pathogenic qi to rise. Since the stomach is the sea of water and grain, it should descend smoothly. If the stomach fails to descend, the water and grain in the stomach cannot transform into essence but instead produce phlegm turbidity, or food stagnation and qi stagnation. In individuals with a strong yang constitution, pathogenic factors transform into heat, leading to putrid tongue coating. Therefore, tongue putrefaction is mostly an excess pattern, while deficiency pattern is rare. In some patients, due to qi deficiency and inability to transform, it may manifest as a pattern of deficiency complicated by excess. Treatment should not solely rely on warm and dry methods but should focus on harmonizing the stomach and descending adverse qi, with a slight addition of qi-tonifying substances for regulation.

Additionally, tongue putrefaction has guiding significance for prognosis judgment in certain acute diseases. For example, in wind-warmth diseases, if the putrid coating is loose and not solid, and gradually gives way to a thin new coating, it is a sign of recovery. However, if the water and grain body fluids in the stomach completely transform into turbid putrefaction, steaming upward and overflowing from the esophagus to the throat, covering the entire tongue, lips, teeth, and palate, it indicates a poor prognosis. Yiyuan said: "This is due to stomach and kidney yin deficiency, with no central pillar, allowing dampness-heat to dominate and mix with steaming, making the condition difficult to treat."

bubble_chart Documentation

1. "New Methods of Tongue Diagnosis and Pattern Identification. Classification and Diagnostic Methods for White Coating": "A white and thick coating resembling tofu curd spread over the tongue indicates a phlegm-heat syndrome. A white coating like tofu dregs piled on the tongue suggests a heat syndrome mistakenly treated with drying methods, leading to food stagnation and turbidity retention in the stomach, indicating an impending diarrhea syndrome. If there is a central crack, it signifies extreme deficiency mimicking an excess syndrome, and tonifying qi is required, with differentiation based on pulse diagnosis. A white coating like tofu strands piled on the tongue, where the white coating is thick and porous, resembling cooked tofu with holes, is called 'strands.' If there are two or three white strands with the rest of the tongue being red, either round or elongated, and the tongue texture is visible, this indicates stomach heat, phlegm stagnation, turbidity, and abdominal mass due to mistaken drying treatment. It is a condition that should be treated with purgation, but if purgation is not applied, no diarrhea syndrome will manifest."