bubble_chart Concept

Tongue coating that is yellow and greasy refers to a layer of yellow, turbid, and greasy moss on the surface of the tongue, which is slightly thicker in the center and thinner at the edges, belonging to the category of greasy coating. Yellow greasy coating is rarely recorded in ancient medical texts. Jingui Yaolue mentions "yellow coating," but does not explicitly state "yellow and greasy." With the rise of warm disease theories in later generations, the understanding of yellow greasy coating gradually deepened. The most detailed discussion can be found in the "Guide to Tongue Differentiation." People who are fond of alcohol or long-term smokers may also exhibit yellow, greasy, and turbid moss, but the center is yellow and slightly black, which can be distinguished from the purely pathological condition through inquiry.

bubble_chart Pattern Analysis

1. Phlegm-Heat Accumulation in the Lung︰Yellow and greasy tongue coating, cough, wheezing in the throat, expectoration of thick yellow sputum or blood-streaked sputum, fullness and oppression in the chest and diaphragm, severe cases may present with dyspnea, inability to lie flat due to breathlessness, slippery and rapid pulse, and a strong and large pulse at the right cun position. The condition primarily affects the lungs, hence symptoms of impaired lung descending function are more prominent, such as cough, expectoration, chest pain, and shortness of breath.
2. Phlegm-heat Accumulation in the Chest︰The tongue coating is yellow and greasy, the face is red with body heat, thirst with a desire for cool drinks, chest and gastric stuffiness, hardness and tenderness upon pressure, nausea and vomiting, severe constipation, and a slippery, rapid pulse. When the condition is predominantly in the chest and epigastrium, it manifests as chest and gastric stuffiness, tenderness upon pressure, nausea and vomiting, and constipation. For phlegm-heat congesting the lungs, the treatment should focus on clearing the lung and resolving phlegm, using the Clearing the Lung and Resolving Phlegm Decoction with modifications. For phlegm-heat accumulation in the chest, the treatment should aim at clearing heat and resolving phlegm, broadening the chest, and relieving bind, using the Minor Chest Bind Decoction with modifications.
3. Liver-gallbladder Dampness-heat︰Yellow, sticky, and greasy tongue coating, heaviness of head, bodily fatigue, chest and hypochondriac stuffiness and fullness, abdominal distension and fullness, anorexia, aversion to greasy food, bitter taste in mouth, and in severe cases, yellowing of the face, eyes, and skin as bright as tangerine, dark urine, constipation, slippery and rapid or soggy and rapid pulse. This is often caused by excessive consumption of rich, sweet, or alcoholic foods, leading to undigested food accumulating and generating dampness and heat; or emotional depression, wood depression transforming into fire, both of which can impair the liver and gallbladder's free-flowing function. Symptoms may include yellow and greasy tongue coating, bitter taste in mouth, chest fullness, severe constipation, scanty dark urine, yellowing of the eyes and skin, abdominal distension and fullness, and anorexia. In clinical diagnosis, it is essential to differentiate whether dampness or heat predominates. In cases where heat predominates over dampness, the tongue coating is yellow, sticky, thin, and greasy, with a bright yellow hue resembling tangerine, accompanied by fever, thirst, constipation, and a slippery, rapid pulse. Treatment should focus on clearing heat and resolving dampness, with the prescription of Virgate Wormwood Decoction. In cases where dampness predominates over heat, the tongue coating is yellow, sticky, thick, and greasy, accompanied by heaviness of the head, bodily fatigue, chest and gastric stuffiness and fullness, abdominal distension and fullness, loose stools, and a soggy, rapid pulse. Treatment should emphasize resolving dampness and draining turbidity, with the prescription of Powder of Capillaris and Five Ingredients with Poria with modifications.
4. Large Intestine Dampness-heat︰The tongue coating is yellow and greasy, accompanied by abdominal pain, diarrhea, tenesmus, large purulent bloody stool, burning sensation in the anus, scanty dark urine, and a wiry, slippery, and rapid pulse. This condition arises from overeating, which damages the spleen and stomach, leading to stagnation of dampness that transforms into heat over time. Alternatively, during summer and autumn, excessive consumption of raw, cold, or unclean food injures the spleen and stomach, weakening healthy qi. Coupled with exposure to summerheat-dampness pathogens, internal and external factors combine, causing dampness-heat to pour down into the large intestine. The large intestine's transportation and transformation functions become impaired, and filthy turbidity rises upward, manifesting as a yellow, greasy tongue coating. Additional symptoms include abdominal pain, diarrhea, tenesmus, large purulent bloody stool, and possibly alternating chills and fever. Treatment should focus on {|###|}clearing heat and draining dampness{|###|}, as well as regulating qi movement. Recommended formulas are Pulsatilla Decoction and Aucklandia and Areca Pill.

A yellow and greasy tongue coating is caused by the steaming of dampness-heat, and is most closely related to the spleen, stomach, liver, and gallbladder. In clinical practice, it is necessary to distinguish the severity of dampness-heat based on the dryness or moisture and thickness of the tongue coating texture, the depth and tenderness of the tongue coating color, and in combination with systemic symptoms, to determine the zang-fu organs where dampness, heat, and phlegm turbidity accumulate, which generally are not easily confused.

bubble_chart Documentation

1. "Guide to Tongue Differentiation: Differentiation of Tongue Body Fluids": "Yellow coating without pores and greasy, water yellow coating, like the appearance of egg yolk mixed with white, this yellow and smooth coating indicates phlegm-fluid retention, a sign of dampness warm disease, or warm febrile disease with water retention, should be judged in conjunction with the pulse."
2. "Chinese Medicine Tongue Inspection: Examination of Tongue Coating": "Greasy coating... often seen in dampness turbidity, phlegm-fluid retention, food accumulation, stubborn phlegm, and other conditions where yang qi is suppressed by yin. A thick, greasy, and yellow coating indicates phlegm-heat, dampness-heat, summerheat warmth, dampness warm disease, food stagnation, and internal binding of damp phlegm, leading to unfavorable bowel qi."