TCM Book ClubIssue 3549One issue daily, accompanying the growth of TCM practitionersIIntroduction：Traditional Chinese Medicine (TCM) believes that the tongue coating is generated by the stomach qi, and the twelve meridians also derive their qi from the stomach. Therefore, the pathogenic qi of the organs can manifest on the tongue through the meridians, resulting in a black coating. According to the “Tongue Diagnosis and Differentiation: General Discussion on Black Tongue”, it states: “Whenever the tongue coating appears black, the illness is certainly not mild, and there can be various patterns of cold, heat, deficiency, and excess.” Master Xu Jingban has unique treatment methods for black moss tongue based on dampness, which are introduced below for practitioners to reference.Click the bottom right corner of the article to 【like】【view】to establish a deep reading (friendship) relationship
Method of Aromatic Dispersion and Warming to Treat Black Moss TongueAuthor/Xu Danhua
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Qi stagnation, dampness manifesting on the tongue
Patient Ding, male, 77 years old, retired worker. Initial diagnosis date: April 17, 1989. Chief complaint: Black tongue coating for over three months.
Medical history:
The patient reports a black tongue coating, poor appetite, little drinking and eating, gradually losing weight, and a feeling of fullness in the stomach.Upon examination, he was diagnosed with chronic superficial gastritis, but after taking both Chinese and Western medicine for over three months, there was no relief in symptoms, and the black coating on the tongue did not dissipate.Previous doctors had used formulas like Pingwei and Xiangsha, which were theoretically appropriate. After much consideration, I decided to use the method of aromatic dispersion and warming.
Prescription:
Huo Xiang (Agastache rugosa) 15g, Pei Lan (Eupatorium) 10g, Chao Chen Pi (Processed Tangerine Peel) 6g, Ban Xia (Pinellia) 10g, Shi Chang Pu (Acorus) 6g, Tong Cao (Rice Paper Plant) 3g, Yun Fu Ling (Poria) 20g, Yi Zhi Ren (Alpinia) 10g, Bai Xing Ren (Apricot Kernel) 10g, Zhi Ji Nei Jin (Fried Chicken Gizzard) 8g, Shi Jian Chuan (Stone Jiao) 30g.
Instruct to take 7 doses, 1 dose per day, decocted twice.
Upon follow-up, the patient was very pleased, stating that both drinking and eating had increased, and he felt more comfortable in the stomach. Upon examining his tongue coating, the black color had reduced by about one-third. He continued with the original prescription and was instructed to take another 7 doses, and the condition remained stable.
Huo Xiang was adjusted to 10g, and after continuing with the next dose, the black coating on the tongue basically disappeared, and all symptoms improved. In elderly patients, chronic superficial gastritis is difficult to cure, but the symptoms have significantly improved, and the black coating has dissipated, indicating an effective case.
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Commentary:
It is not uncommon in clinical practice for chronic gastric diseases to present with black moss tongue. Master Xu emphasizes that first, one should inquire about any medications taken, as bismuth agents that protect the gastric mucosa can cause black coating, which is a drug-related factor that often resolves on its own after stopping the medication for a few days.
Secondly, food staining should be ruled out,as food that causes black staining will have a superficial color that can be cleaned with rinsing.
If the black coating is not due to the above two situations, it should be analyzed according to the pathogenesis. A tongue that is black and moist is often due to dampness and turbidity in the stomach, while a black and dry tongue is usually due to internal heat steaming. This is the general principle.
By correlating the patient’s other symptoms and integrating the four examinations, treatment should be based on the symptoms. The tongue is a mirror of the stomach. If the black coating on the tongue gradually thins and dissipates, it indicates improvement; if the black coating does not dissipate or becomes deeper and thicker, it indicates disease progression.
Therefore, the changes in the black coating have certain significance for diagnosis and prognosis assessment.
A black and moist tongue indicates internal damp accumulation.The formation of dampness is due to the stomach’s fluids not returning to normal transformation, and the spleen’s failure to transport and transform, leading to abnormal rising and falling, qi stagnation, and dampness manifesting on the tongue, resulting in a black tongue.
The treatment should primarily focus on resolving dampness. The herbs used are aromatic and should be warm in nature, and it is also necessary to consider dispersing qi so that dampness can be transformed with qi, and dampness can be resolved with warmth.
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Analysis of the Prescription:
Huo Xiang and Pei Lan are aromatic and resolve dampness; Chen Pi, Ban Xia, and Fu Ling are also commonly used and have been taken in multiple doses, while Ji Nei Jin is not the main herb. Xing Ren is a herb for the upper jiao, combined with the previous damp-resolving herbs, aiming to disperse qi.
Shi Chang Pu is pungent and slightly warm, with functions of opening orifices, resolving phlegm, regulating qi, and dispelling dampness. The “Bie Lu” states it “warms the intestines and stomach.” According to Master Xu’s experience, Tong Cao also has a dispersing effect. The combination of Shi Chang Pu and Tong Cao aims to open orifices and unblock channels. The “Ling Shu” has long proposed that the stomach also has orifices. These two herbs, combined with others, resolve stomach dampness, open stomach orifices, facilitate qi transformation, and promote the proper rising and falling of qi, thereby gradually eliminating damp turbidity.
Yi Zhi Ren enters the spleen, stomach, and kidney, warming the spleen and stomach while warming kidney fire, controlling saliva and eliminating fluids, and benefiting the spleen and stomach. Although it is not the main herb in this case, it can resolve dampness and eliminate fluids, preventing the source of dampness.
The entire prescription has a balanced and harmonious nature, thus achieving satisfactory results.
Recommended Reading
Wei Changchun’s Tongue Diagnosis ExperienceTongue coating can also have false appearances; one should adhere to common knowledge and changes—Copyright Statement—• Article from “Master of Traditional Chinese Medicine Xu Jingban’s Clinical Cases” | Author/Xu Danhua | Editor/Xu Jingru, Ju Ye.• This article is copyrighted by the rights holder. For learning and communication purposes only,please do not use medications indiscriminately.
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