bubble_chart Concept

The form of the tongue is retracted, unable to extend, retract, or move freely, and may not even extend past the teeth. This condition is called "tongue wilting" or "flaccid tongue."

This symptom originates from Lingshu．Jingmai chapter: "When the muscles are soft, the tongue wilts." It is relatively rare in clinical practice and is often a severe and difficult-to-treat condition.

This symptom shares the main feature of abnormal tongue extension and retraction with "tongue curling," but the former involves a flaccid and weak tongue that cannot move, while the latter involves a curled and retracted tongue that is difficult to extend. The two concepts are different and should be distinguished. For more details, refer to the "tongue curling" section.

bubble_chart Pattern Analysis

1. Damp Phlegm︰The tongue is soft and weak with difficulty in movement, accompanied by slurred speech, pale complexion, bluish lips, chest and gastric stuffiness, nausea with copious phlegm, heavy and fatigued limbs, palpitation and vertigo, a deep and slippery pulse, and a pale red tongue with a thick, white, greasy, and slippery coating. This condition arises from dysfunction of the lungs, spleen, and kidneys, leading to impaired {|###|}triple energizer qi transformation{|###|}, particularly the spleen’s failure in transportation and transformation. As a result, {|###|}body fluids{|###|} stagnate and fail to transform, accumulating to form dampness and congealing into phlegm. When phlegm and qi block the tongue’s collaterals, the {|###|100|}Jingmai{|###|101|} of the tongue becomes malnourished, resulting in tongue flaccidity. "Flaccid tongue due to spleen deficiency is caused by {|###|}overstrain{|###|} damaging the spleen, leading to {|###|}dysfunction of spleen in transportation{|###|}. This results in insufficient production of qi and blood, which over time depletes the heart and spleen qi and blood. Since the tongue is the orifice of the heart and the external manifestation of the spleen, {|###|}deficiency of both heart and spleen{|###|} means qi and blood are inadequate to nourish the tongue. The sinews and vessels lack the warmth of qi and the nourishment of blood, leading to tongue flaccidity. In the former case, the flaccid tongue may feel slightly stiff and is invariably accompanied by slurred speech, or even severe stuttering, with a thick and greasy tongue coating. Treatment should focus on {|###|}drying dampness and invigorating the spleen{|###|}, as well as {|###|}resolving phlegm for resuscitation{|###|}. The recommended formula is {|###|102|}Phlegm-Cleansing Decoction{|###|103|}.
2. Deficiency of Both Heart and Spleen︰The tongue is soft and weak, the complexion lacks luster, the lips and nails are pale, palpitation with severe palpitation, insomnia and forgetfulness, reduced appetite, fatigue in the limbs, a thin and weak pulse, a pale and tender tongue with thin white coating. The tongue is flaccid and weak, speech is low in volume but without impediment, and the coating must be thin and white without greasiness. There are also certain differences in complexion, lips and nails, as well as the chest, epigastrium, and phlegm-drool. The treatment should focus on nourishing the heart and spleen, using the Returning to Spleen Decoction.
3. Lung Heat Scorching︰The tongue is dry and soft, with a dry cough and no phlegm, or scant and sticky phlegm, qi counterflow leading to panting, dry throat and nasal dryness, restlessness and thirst, scanty and dark urine, dry stools or difficulty in defecation, a thin and rapid pulse, a red tongue texture, and thin, yellow coating with little moisture. This is caused by dryness-heat damaging the lungs, or residual pathogenic heat after illness, where the lungs are scorched by heat, leading to the depletion of yin fluids, and insufficient fluids and blood to nourish the tongue and vessels. Liver and kidney yin depletion with tongue withering results from prolonged retention of pathogenic heat, which scorches kidney yin, or after the loss of essence or blood, where the lower energizer's yin essence is depleted. Kidney yin depletion then fails to nourish the liver, leading to liver yin deficiency, which in turn drains kidney water. The kidney meridian passes through the throat and embraces the root of the tongue; the liver meridian runs through the throat and enters the nasopharynx. When liver and kidney yin are depleted, they cannot ascend to permeate the Jingmai, resulting in tongue withering. Both are deficiency patterns, with the former affecting the upper body. Treatment should focus on clearing lung heat, nourishing yin, and moistening dryness, using Dryness-Clearing Lung-Rescuing Decoction.
4. Exhaustion of Liver and Kidney Yin︰The tongue is withered, dull, contracted, and atrophied, with a dry mouth and parched teeth, accompanied by lethargy, mental fatigue, deafness, flushed cheeks, wriggling fingers, or even spasms and convulsions, palpitations with a sense of impending collapse, and a pulse that is faint and on the verge of disappearing. The tongue is deep purple and devoid of coating. The pathological changes lie in the lower body. Conditions in the upper body are mild, while those in the lower body are severe. In the upper body, symptoms such as dry cough, panting, and nasal dryness indicate lung heat and yin deficiency. In the lower body, signs like lethargy, wriggling of limbs, parched teeth, and a deep purple tongue without coating suggest yin exhaustion and wind stirring. As for the withered tongue, when caused by lung heat scorching, the tongue is dry and soft; when due to liver and kidney yin depletion, the tongue is withered and atrophied, resembling a peeled pig's kidney. The treatment should focus on nourishing fluids and yin, using Modified Pulse-Restoring Decoction. For pronounced internal stirring of deficient wind, Three-Carapace Pulse-Restoring Decoction may be used to enrich yin and subdue yang, or Major Wind-Stabilizing Pearl to enrich yin, subdue yang, and extinguish wind.

Tongue atrophy has distinctions of new and chronic, deficiency and excess. New disease tongue atrophy is often seen in the critical stage of acute Rebing, while chronic disease tongue atrophy is commonly found in internal damage Zabing. Among the aforementioned syndromes, tongue atrophy due to phlegm-dampness obstructing the collaterals is of excess type; tongue atrophy due to deficiency of both heart and spleen, lung heat scorching, and liver kidney yin exhaustion is of deficiency type. The treatment methods are as follows: for excess pattern, the focus is on resolving phlegm for resuscitation to eliminate pathogenic factors; for deficiency pattern, the emphasis is on tonifying and replenishing qi and blood, relieving dryness and moistening the lung, and nourishing water to moisten wood to support the body's vital energy.

bubble_chart Documentation

1. "A Guide to Tongue Diagnosis: Observing the Tongue's Appearance": "When the mind is clear but speech is hesitant, and the tongue is soft and weak, making it difficult to speak, it is due to insufficient nutrient-defense. ... A withered, soft, yellow, and dry tongue, along with abdominal distension and fullness, leading to sleeplessness, indicates the onset of jaundice. A disordered voice and hoarseness, with a withered tongue and inability to produce sound, is caused by mistakenly inducing sweating. A withered tongue, a full philtrum, and inverted lips signify the exhaustion of the spleen meridian's qi. During the period of lack of strength after an illness, if the tongue is also withered and soft, making speech difficult, nourishing the stomach and benefiting yin will naturally restore it." "A withered tongue is soft and unable to move, caused by paralysis of the tongue spirit meridian. ... Sudden withering is often due to heat scorching, thus it commonly appears on a red and dry tongue. If it is deep red, it is advisable to cool the qi and blood; if it is purplish red, it is advisable to drain liver heat and unblock the fu qi; if it is bright red, it is advisable to nourish yin and reduce fire. ... If it is pale white like cooked pork liver and withered, regardless of whether there is a coating or not, it indicates a collapse of the vital energy and is incurable."
2. "Wenbing Tiaobian" · Lower Energizer Chapter: "Rebing When the menstrual water arrives appropriately, and it does not resolve for more than ten days, with a withered tongue, a preference for cold drinks, heart vexation and heat, and a spirit that is sometimes clear and sometimes disordered, with a long pulse on the right and a deep pulse on the left, it indicates stagnant heat inside. The modified Peach Kernel Chengqi Decoction is the main treatment."