bubble_chart Concept

A tongue that is puffy, enlarged, or has tooth marks on the sides, and is pale and tender in color is called a "fat tongue."

A fat tongue is also referred to as an "enlarged tongue" or "teeth-marked tongue." Some texts discuss it together with "swollen tongue" (swollen tongue), but "swollen tongue" refers to a tongue that becomes enlarged due to heat stagnation, drug-induced dermatitis, etc., often appearing dark in color, hard and aged in texture, and frequently accompanied by stiffness and pain, which is a condition of excess. On the other hand, a "fat tongue" is caused by the deficiency of spleen yang qi, or combined with cold-dampness, leading to a tongue that is enlarged, puffy, tender, pale, and often has tooth marks, which is a condition of deficiency. Although both conditions involve an increase in tongue size, their nature and disease causes are different and should be distinguished.

bubble_chart Pattern Analysis

1. Spleen Qi Deficiency︰The tongue is enlarged and tender, pale in color, with tooth marks on the edges, and a thin white tongue coating. The face is pale, the body feels cold, there is a shortage of qi, reluctance to speak, fatigue, poor appetite, abdominal distension and fullness, loose stool, and a weak, slow or feeble pulse. If accompanied by cold-dampness, the enlargement of the tongue and the pale tenderness of the tongue texture become more pronounced, and it appears more moist, with a white slippery or white greasy tongue coating, along with symptoms such as nausea, heaviness of the head, body swelling, etc., and a soggy, slow or deep, slow pulse. The focus is on spleen qi deficiency, accompanied by anorexia, abdominal distension and fullness, loose stool, nausea, and vomiting. Treatment should aim at tonifying the spleen and replenishing qi, using formulas such as Middle-Regulating Decoction or Middle-Tonifying Qi-Replenishing Decoction.
2. Kidney Yang Deficiency with Water Flooding︰The tongue is large, fat, tender, pale in color, with tooth marks on the edges. There is significant swelling below the waist, scanty urine, physical coldness, mental fatigue, cold limbs, dull or pale complexion, and a deep slow or deep thin pulse. The focus is on kidney yang deficiency, accompanied by symptoms such as soreness and weakness in the waist and limbs, cold limbs, severe swelling below the waist, and a deep slow pulse. Treatment should emphasize warming yang and excreting water, using formulas like Kidney Qi Pill or True Warrior Decoction.

The tongue is swollen and tender, as stated in "Diagnostics of Chinese Medicine‧Form of Tongue": "Tenderness refers to a tongue texture that is swollen, soft, and delicate, or with tooth marks on the edges, regardless of the color of the tongue coating. Such conditions are generally attributed to deficiency." The commonalities between the two syndromes include a swollen and tender tongue, pale color, tooth marks on the edges, as well as symptoms such as cold intolerance, mental fatigue, lack of strength, and edema. The difference lies in that the former primarily involves spleen qi deficiency, while the latter is more associated with kidney yang deficiency. In terms of differentiation, the former is accompanied by symptoms such as anorexia, abdominal distension and fullness, loose stools, nausea, and vomiting; the latter is accompanied by soreness and weakness in the lower back and limbs, cold extremities, significant swelling below the waist, and a deep, slow pulse. The former is relatively mild, while the latter is more severe. The latter often develops from the former. Although the two syndromes can be distinguished, they frequently coexist in clinical practice, so a flexible approach is necessary, and one should not be rigidly fixated on a single diagnosis.

bubble_chart Documentation

1. 《Chinese Medicine Tongue Inspection．Swollen Tongue》: "The tongue color is pale, the tongue surface is slippery, and the tongue body appears swollen as if retaining a lot of water. This is due to spleen-kidney yang deficiency, causing water dampness to rise."
2. 《Guide to Tongue Diagnosis．Identifying Tongue Coating》: "The tongue is swollen, short, and moist, occurring during fainting and cessation of breathing."