bubble_chart Concept

Tongue swelling refers to the enlargement of the tongue, which may be accompanied by stiffness and pain. In severe cases, the swelling can fill the mouth, hindering eating, speaking, and breathing.

This condition was referred to as "swollen and stiff tongue" in the Sui Dynasty's "Treatise on the Causes and Symptoms of Diseases." In the Tang Dynasty, Qianjin Fang called it "swollen tongue." After the Song Dynasty, the condition where the tongue is swollen and stiff was specifically named "wooden tongue," "swollen wooden tongue," or "wooden tongue wind."

Ancient texts also mention "carcinoma of tongue" (重, pronounced chong) or "child tongue," with varying definitions. Most describe it as a swelling under the tongue that protrudes like a small tongue, hence the name. When there are several swellings under the tongue resembling a lotus flower, it is called carcinoma of tongue. A minority refer to swelling at the base of the tongue or acute tongue swelling as carcinoma of tongue. This book adopts the first definition.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰It is caused by wind-cold injuring the heart and spleen. The main manifestations include swollen and painful tongue, aversion to cold with fever, generalized muscle pain, tastelessness in the mouth, loss of appetite, cold pain and diarrhea in the abdomen, palpitations, slurred speech, and a floating-tight pulse. $External contraction wind-cold tongue swelling differs from heart channel stagnant fire tongue swelling! Both conditions arise rapidly, but the latter, caused by sudden exuberance of heart fire, is even more acute. Records describe cases where the tongue swelled to fill the mouth overnight or even became too swollen to speak within hours. In external contraction wind-cold, external pathogens invade the heart and spleen channels. The heart opens into the tongue, and the spleen vessel connects to the tongue root. Wind, being mobile, carries cold pathogens to the tongue. Cold congeals and stagnates, leading to impeded blood flow and resulting in tongue swelling. Key diagnostic points: First, wind-cold exterior symptoms: aversion to cold with fever, muscle pain, and a floating-tight pulse. Second, blood stasis manifests as a dark purple, non-red swollen tongue that feels stiff and persistently stuffy and painful. In contrast, heart fire tongue swelling may arise from intense emotional distress or sudden upheavals, causing excessive contemplation and sudden exuberance of heart fire that attacks the tongue. Thus, the swelling is accompanied by a bitter taste in the mouth (bitterness being the flavor of fire), a bright red tongue, and pain as sharp as needles or scorching fire, making it unbearable. Treatment also differs: For wind-cold injuring the heart and spleen, disperse pathogens from these channels, Inula Herb Powder decocted in water, half gargled and half swallowed—once pathogens are expelled, swelling subsides. For heart channel stagnant fire, use bitter-cold herbs to clear and drain sudden exuberant heart fire, such as a concentrated decoction of Coptis Rhizome taken internally, with raw Typha applied externally to the tongue. For cases with fire mimicking water phenomena, add Fresh Ginger Rhizome as an adjunct treatment.
2. Heart Channel Stagnant Fire︰It often presents with sudden swelling, the tongue enlarged and filling the mouth, red in color and painful, even to the extent of being unable to eat or speak, complexion flushed... "internal dysphoria, restlessness, inability to sit or lie peacefully, disturbed sleep at night, scanty and yellow urine, bitter taste in the mouth, pulse manifestation rapid, left cun pulse surging and large. It is advisable to use bitter and cold herbs to clear and drain the suddenly excessive fire in the heart meridian. A concentrated decoction of Coptis Rhizome is taken internally, while externally, raw Typha is applied to the tongue. For cases with fire mimicking water phenomena, Fresh Ginger Rhizome is added as an adjuvant treatment.
3. Excessive Heat in Spleen︰The tongue is red, swollen, and fills the mouth, accompanied by restlessness, scorching heat in the palms and skin, a preference for coolness but little desire to drink, lethargy, reluctance to move, scanty dark urine, frequent constipation, and a slippery, rapid pulse. This is due to accumulated heat in the heart and spleen, with fire pathogens surging upward, hence the swollen and red tongue. Additionally, since the spleen governs the muscles, scorching heat is felt in the palms and skin. The spleen, being a yin earth organ, prefers dryness and dislikes dampness, which explains the intense heat yet little desire to drink.
4. Spleen Deficiency with Dampness Retention︰The tongue is swollen with tooth marks on the edges, the tongue color is dull, the complexion is pale yellow, the limbs feel heavy, there is fatigue and lack of strength, abdominal distension and fullness worsen after eating, no desire to drink water, clear and abundant urine, loose and thin stools, and the pulse manifestation is deep and slow. This indicates spleen deficiency accompanied by cold-dampness. The swollen tongue color is mostly dull, with tooth marks on the edges. The paleness is due to insufficient yang qi, the dullness indicates poor blood circulation, and the tooth marks further signify spleen qi deficiency. Hence, symptoms such as heavy limbs, fatigue and lack of strength, abdominal distension and fullness, reduced food intake, and loose, thin stools are manifestations of spleen deficiency with excessive dampness. For treatment, in cases of heart-spleen heat stagnation, external application involves fumigation with castor bean oil paper twists, while internal administration combines Redness-Removing Powder and Yellow-Draining Powder. For spleen deficiency-cold with dampness, Six Gentlemen Decoction and Middle-Regulating Decoction can be used together.

If the condition comes on suddenly, it often affects the airway and poses a risk of suffocation. Sparganium Rhizome needles can be used to prick the tip or sides of the tongue to release blood, reduce swelling, and clear the airway, allowing food and medicine to pass. Then, apply a powder made of borneol, musk, and plant soot to the tongue.

bubble_chart Documentation

1. "Yi Che. She Lun": "Excessive dampness-heat can cause the tongue to swell, and the loss of kidney fluid can also cause the tongue to swell. If it is dry and thick, making speech unclear, it is difficult to treat." "For example, if the tongue is black and withered, or swollen or thorny, many doctors cannot distinguish it, but know it is a heat syndrome. If it is not Coptis Rhizome removing toxin, then it is the purgation of Da Cheng Qi or Xiao Cheng Qi. However, they do not realize that if the pulse is weak and rapid, or faint and thin, and there is no distension in the chest and abdomen, even if the tongue is black, withered, swollen, or thorny, it is due to the exhaustion of true water, which cannot control fire. Only by taking large doses of Liu Wei Di Huang Wan. For cold deficiency, add cinnamon, aconite, and Schisandra Fruit, then the withered black swelling and thorns will dissipate like ice melting."
2. "Inspection Zun Jing. Diagnosis of Tongue Form": "Swelling of the tongue may be due to heat toxin or dermatitis medicamentosa; a purple and thick tongue is due to the upward congestion of alcohol toxin; dry ears and swollen tongue, continuous bleeding, and floating feet indicate death in six days, swollen feet indicate death in nine days, which is kidney failure."