Tongue pain may be of various types, including a burning pain, pricking pain or stabbing pain, and may be located in different regions of the tongue—including the tip, the middle area, the edges, the back, or even over the whole tongue. As well as the pain, other symptoms such as swelling, erosion, stiffness and ulceration can be seen in conjunction, and these may cause difficulty in swallowing, drinking or speaking. In some cases, tongue pain can also be induced by ulceration due to careless biting or chewing during eating.
In general, according to TCM, tongue pain can be caused by External invasion or by disorder of the Internal Zang-Fu organs, including invasion of Wind-Heat, hyperactivity of Excessive-Heat, hyperactivity of Deficient-Fire and accumulation of Damp in the Spleen. It may be attributed to any of the following conditions in Western medicine: lingual papillitis, lingual ulcer, hypoglossiadenitis, hypoglossitis, periglossitis, glossopyrosis, tongue abscess and even carcinoma of tongue.
Aetiology and pathology
Invasion of External factors
Invasion of External factors, especially Wind-Heat, Dryness-Heat and Wind-Cold, may cause accumulation of pathogenic factors on the tongue, resulting in stagnation of Qi and Blood and blockage of the collateral, so tongue pain follows.
Accumulation of Excessive-Heat in the Interior
Incomplete expelling of External factors in the Lung may cause disorder of the Lung so it cannot disperse Qi properly, leading to Qi stagnation in the Lung, which in turn results in the generation of Lung-Fire. The tongue is in the mouth, and the mouth is an opening to the respiratory passages, which are dominated by the Lung. If there is an uprising of Lung-Fire, the tongue will be impaired, and pain in the tongue follows.
Overeating of pungent, fatty and sweet food, and overindulgence in alcohol, may cause food to stagnate in the Spleen and Stomach, leading to the formation of Damp-Heat in the Spleen or of Stomach-Fire. The mouth is the opening passage of the Spleen, and the Stomach and Spleen form a pair of Zang-Fu organs. If there is accumulation of Damp-Heat in the Spleen, or hyperactivity of Stomach-Fire, the mouth will be affected, leading to disorders of the tongue, and so tongue pain occurs.
Accumulation of Cold-Phlegm in the Spleen
Bad eating habits, for instance, eating too much of cold and raw food, drinking too many cold drinks or taking too many cooling herbs, may damage the Yang of the Spleen, leading to poor transportation and transformation and therefore the formation of Cold-Phlegm. Once the collaterals related to the tongue are blocked by this pathogenic factor then tongue pain will follow.
Excessive emotional stimulation
Prolonged emotional disorder may cause dysfunction of the Zang-Fu organs, leading to generation of Heat or Fire in the Interior. For instance, excessive grief may cause blockage in the Lung channel, resulting in stagnation of Qi there, and gradually Lung-Fire is generated. Once this is formed, it may flow upward and cause tongue pain. Excessive thinking may cause Qi to stagnate in the Heart, leading to the formation of Heart-Fire. If there is hyperactivity of Heart-Fire, the tongue—the opening orifice of the Heart—will be burned and impaired, thus tongue pain happens.
Excessive meditation may cause stagnation of Qi in the Spleen, leading to poor transportation and transformation, and then Damp-Heat forms. When this disturbs and impairs the tongue, it causes tongue pain.
Excessive anger, stress, frustration or other emotional upset, may cause Liver-Qi to stagnate, leading to the generation of Liver-Fire. Fire is characterised by uprising and flaring; when the tongue is burned by Liver-Fire, tongue pain occurs.
Prolonged fear and fright, or sudden extreme fear and fright, may cause Qi to sink in the Kidney, leading to uprising of Kidney-Fire. The Kidney channel roots in the tongue, so this causes tongue pain.
Overstrain and prolonged sickness
Too much physical or mental work, as well as prolonged sickness, may consume the Yin of the body, leading to failure of the Fire to be controlled by Water, so hyperactivity of Deficient-Fire occurs, which ascends and bums the tongue, causing tongue pain.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
— Acute onset of tongue pain, mild in intensity, accompanied by External symptoms, such as an
aversion to cold, fever, muscle pain, runny nose, cough, or superficial pulse, is usually caused by invasion of External factors.
— A chronic history of tongue pain, mild or severe in intensity, associated with diet, emotional state and other physical conditions, is usually caused by disorder of the Internal Zang-Fu organs.
Differentiation of character of the pain
— Acute sharp tongue pain with stiffness of the tongue, together with External symptoms, such as an aversion to cold, slight fever, muscle pain or absence of thirst, is usually caused by invasion of Wind-Cold.
— Acute sharp tongue pain with a burning sensation, a thin and yellow tongue coating, together with External symptoms, is usually caused by invasion of Wind-Heat.
— Acute tongue pain with dryness on the tongue and in the mouth and throat, and thirst, together with External symptoms, is usually caused by invasion of Wind-Dryness
— Chronic sharp tongue pain, which is related to the emotional state, is usually caused by stagnation of Qi.
— Stabbing tongue pain, which worsens at night, and a purplish colour of the tongue, is usually caused by stagnation of Blood.
— Chronic tongue pain with a burning sensation, restlessness, nervousness, thirst, constipation, a red tongue with a yellow and dry coating, and a forceful and rapid pulse, is usually caused by accumulation of Excessive-Fire from the Zang-Fu organs.
— Chronic tongue pain with a slight burning sensation, thirst, night sweating, dry mouth and throat, a red tongue with a thin coating, and a deep, thready, rapid and weak pulse, is usually caused by hyperactivity of Deficient-Fire from Zang-Fu organs.
— Tongue pain with swelling and a burning sensation, a bitter taste in the mouth, constipation, a yellow and greasy tongue coating and a slippery and rapid pulse, is usually caused by hyperactivity of Phlegm-Fire.
— Tongue pain with swelling, numbness on the tongue, tastelessness or nausea, is usually caused by accumulation of Damp in the Spleen.
Differentiation of tongue colour
— If the tongue pain is caused by invasion of Wind-Cold, the tongue colour is usually slightly red, or slightly purplish-red, or there are no tongue colour changes. The tongue coating is usually thin and white.
— If the tongue pain is caused by invasion of Wind-Heat, the tongue colour is usually red, especially at the tip of the tongue, or slightly purplish-red. The tongue coating is usually thin and yellow.
— If the tongue pain is caused by invasion of Wind-Dryness, the tongue colour is usually slightly red, or there are no tongue colour changes. The tongue coating is usually thin and dry.
— If the tongue pain is caused by accumulation of Damp in the Spleen, the tongue colour is usually pale, with tooth marks. The tongue is usually swollen and big. The coating is usually white and greasy.
Treatment
INVASION OF EXTERNAL FACTORS
Symptoms and signs
Tongue pain, fever, an aversion to cold and headache are the most common symptoms where the tongue pain is caused by invasion of External factors.
If it is an invasion of Wind-Heat, there is a red and swollen tongue, erosions on the tongue, thirst, a red tongue with a thin and yellow coating and a superficial and rapid pulse.
If it is an invasion of Dryness-Heat, the throat is dry, there is thirst, and the tongue has a yellow and dr)’ coating.
If it is an invasion of Wind-Cold, the tongue is stiff, and there is a lack of thirst, spasm of the facial muscles, a thin and white tongue coating and a superficial and tight pulse.
Principle of treatment
Dispel Wind, dispel External factors and relieve the tongue pain.
HERBAL TREATMENT
a. Prescription for invasion of Wind-Heat
YIN QIAO SAN
Honeysuckle and Forsythia Powder
Jin Yin Hua Flos Lonieerae IOg
Lian Qiao Fructus Forsythiae IOg
Jie Geng Radix Platycodi 6 g
Bo He Herba Menthae 6 g
Dan Dou Chi Semen Sojae Praeparatum 10 g
Zhu Ye Herba Lophatheri 10 g Gan Cao Radix Glyeyrrhizae 6 g
Jing Jie Shui Spiea Schizonepetae 6 g
Niu Bang Zi Fructus Aretii 10 g
Lu Gen Rhizoma Phragmitis 10 g
Explanations
• Jin Yin Hua and Lian Qiao clear Heat and eliminate Toxin.
• Bo He, Jing Jie Shui and Dan Dou Chi promote sweating, release the Exterior and dispel Heat.
• Niu Bang Zi, Jie Geng and Gan Cao eliminate toxin, benefit the throat and stop the pain.
• Zhu Ye and Lu Gen clear the Heat and increase the production of Body Fluids so as to relieve the thirst.
b. Prescription for invasion of Dryness-Heat
SANG XING TANG
Mulberry Leafand Apricot Kernal Decoction
Sang Ye Folium Mori 6 g
Xing Ren Semen Armeniacae Amarum IOg
Sha Shen Radix Adenophorae 10 g
Zhe Bei Mu Bulbus Fritillariae Thunbergii IOg
Dan Dou Chi Semen Sojae Praeparatum 10 g
Zhi Zi Pi Pcricarpium Gardeniae IOg
Li Pi Exocarpium Pyrus IOg
Explanations
• Sang Ye and Zhi Zi Pi clear Dry-Heat.
• Dan Dou Chi dispels Wind and relieves Exterior syndrome.
• Sha Shen and Li Pi nourish the Lung-Yin.
• Xing Ren and Zhe Bei Mu disperse the Lung-Qi and stop the cough.
c. Prescription for invasion of Wind-Cold JING FANG BAI DU SAN
Schizonepeta and Ledebouriella Pounler to Overcome
Pathogenic Influences
Jing Jie Herba Schizonepetae 6 g
Fang Feng Radix Ledebouriellae 6 g
Ren Shen Radix Ginseng 6 g
Qiang Huo Rhizoma seu Radix Notopterygii 6 g
Du Huo Radix Angelicae Pubesecntis 6 g
Qian Hu Radix Peucedani 6 g
Chai Hu Radix Bupleuri 6 g
Jie Geng Radix Platycodi 5 g
Zhi Qiao Fruetus Aurantii 6 g
Fu Ling Poria 6 g
Chuan Xiong Rhizoma Ligustici Chuanxiong 5 g Gan Cao Radix Glycyrrhizae 5 g
Explanations
• Jiang Jie, Qiang Huo and IDu Huo are pungent and Warm herbs used to promote sweating and dispel pathogenic Wind-Cold.
• Chai Hu and Bo He are pungent and Cold herbs, used for dispersing Heat.
• Chuan Xiong invigorates the Blood circulation and promotes the Qi circulation so as to stop the pain.
• Jie Geng and Qian Hu promote the circulation of Lung-Qi and stop the cough.
• Fu Ling and Sheng Jiang resolve the Phlegm and eliminate Damp.
• Zhi Qiao promotes the Qi to relax the chest.
• Gan Cao harmonises the actions of the other herbs in the formula.
Modifications
1. If the tongue is red and swollen owing to invasion of Wind-Heat, add Pu Gong Ying Herba Taraxaci IOg and Zhu Ye Herba Lophatheri 10 g to clear the Heat and reduce the swelling.
2. If there is thirst due to invasion of Dryness-Heat, add Mai Dong Radix Ophiopogonis 10 g and Xuan Shen Radix Scrophulariae 10 g to nourish the Yin of the Lung and the Stomach and relieve the thirst.
3. If there is fever due to the predominance of Heat invasion, add Huang Qin Radix Scutellariae 10 g to clear the Heat and reduce the fever.
4. If there is headache, add Man Jing Zi Fructus Viticis 10 g to dispel the Wind-Heat and sedate the headache.
5. If there is a cough and expectoration of yellow phlegm owing to invasion of the Lung by Wind-Heat, add Qian Hu Radix Peucedani 10 g and Zhe Bei Mu Bulbus Fritillariae Thunbergii 10 g to disperse the Lung-Qi and dispel the Wind-Heat.
Patent remedy
Jing Fang Bai Du Pian Schizonepeta and Ledebouriella
Tablet to Overcome Pathogenic Influences
ACUPUNCTURE TREATMENT
Lu-7 Lieque, LI-4 Hegu, GB-20 Fengchi, TE-5 Waiguan,
GV-15 Yamen and CV-23 Lianquan. Reducing method is used on all these points.
Explanations
• Among the External factors causing tongue pain, invasion of Wind-Heat and invasion of Wind-
Diyness are the most common. All the abovementioned points have the function of dispelling external invasion; however, LU-7 is used especially when there are symptoms from the Lung, including cough, expectoration of phlegm, chest pain and throat pain.
• LI-4 is used especially to dispel Wind invasion, including Wind-Heat, Wind-Chyness and Wind-Cold, since this point has a function in opening the skin pores so as to induce sweating. Since it is also the point from the Large Intestine channel, it is able to clear Heat and reduce a fever.
• GB-20 is used to dispel the Wind and relieve the headache. When this point is punctured towards the tip of the nose, it has also the function of treating problems in the mouth, including tongue pain.
• TE-5 is applied to relieve External symptoms.
Also, this point is connected with the Yang Linking Vessel, which ends at GV-15. GV-15 is a good point to relieve stiffness of the tongue and neck. CV-23 is a good point for treating tongue problems, including tongue pain. When this point is punctured, the direction of the needle should be toward the root of the tongue to achieve the best therapeutic result.
Modifications
1. If the throat and tongue are red, with a burning feeling on the tongue due to invasion of Wind-Heat, add Ll-2, the Spring point, and LI-11, the Sea point, to clear the Heat strongly and stop the pain.
2. If there is a high fever due to predominance of Heat, add GV-14 to clear the Heat and reduce the fever.
3. If the throat and tongue are dry, with a thirst due to invasion of Wind-Dryness, add LU-8 and SP-6 to promote secretion of the Body Fluids and moisten the Dryness.
4. If there is tongue pain and spasm of the face due to invasion of Wind-Cold, add ST-6 and ST-40 to relieve the tongue pain and muscular spasm in the face.
