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Source｜China Traditional Chinese Medicine News
Written by｜Wang Yusheng, Dezhou Hospital of Traditional Chinese Medicine, Shandong Province; Qiu Yifei, Hongyitang Hospital of Traditional Chinese Medicine, Beijing
In clinical practice, it is common to encounter patients with dry mouth and tongue as part of certain syndromes, and some present primarily with these symptoms. This condition often falls under the category of jinye (津液) deficiency, but it is not uncommon for it to be associated with yin deficiency (阴虚) and jin (津) deficiency. Patients frequently report severe dry mouth and tongue that cannot be alleviated by drinking water. Conditions such as liver-gallbladder fire (肝胆火盛), liver-stomach yin deficiency (肝胃阴虚), heart fire (心火盛), heart yin deficiency (心阴虚), stomach fire (胃火盛), stomach yin deficiency (胃阴亏), lung fire (肺火盛), lung yin deficiency (肺阴虚), kidney yin deficiency (肾阴虚), or external dryness evil (外感燥邪) can cause dry mouth and tongue. In these cases, while clearing fire and nourishing yin, herbs such as Mai Dong (麦冬, Ophiopogon japonicus), Sheng Di Huang (生地黄, Rehmannia glutinosa), and Sha Shen (沙参, Adenophorae Radix) can be added to nourish yin and generate fluids, alleviating dry mouth and tongue. However, if the dry mouth and tongue are caused by liver-gallbladder damp-heat (肝胆湿热), phlegm-fire (痰火内蕴), phlegm-damp obstructing the lungs (痰湿阻肺), spleen deficiency with dampness (脾虚湿盛), bladder damp-heat (膀胱湿热), or external damp evil (外感湿邪), then nourishing yin herbs should not be used, as they can have the opposite effect and worsen the condition.
Case One
Zhou, female, 58 years old. Retired from a university in Beijing, visited on November 9, 2012. She has experienced gastric burning for many years, with a history of superficial gastritis for 10 years, and has been treated with Western medicine. She has a history of hypertension and has been taking antihypertensive medication. Upon examination, gastric burning was noted, which had worsened over the past year. Her appetite was fair, but she experienced burning sensation after meals, daily dry mouth and bitter taste, occasional nausea, belching, and intermittent distension and pain in the flanks, along with neck pain. Bowel movements occurred every 2-3 days, with dry stools. The tongue was pale with a thin, gray-black greasy coating, and the pulse was wiry.
Pathogenesis: Spleen dampness transforming into heat, with stomach qi rising and not descending. Treatment should focus on strengthening the spleen, transforming dampness, clearing heat, and descending rebellious qi.
Prescription: Tai Zi Shen (太子参, Pseudostellaria heterophylla) 15g, Chao Bai Zhu (炒白术, Atractylodes macrocephala) 15g, Shan Yao (山药, Dioscorea opposita) 20g, Lian Zi Rou (莲子肉, Lotus seed) 20g, Sha Ren (砂仁, Amomum villosum) 5g, Huang Lian (黄连, Coptis chinensis) 12g, Wu Zhu Yu (吴茱萸, Evodia rutaecarpa) 2g, Qing Ban Xia (清半夏, Pinellia ternata) 10g, Chen Pi (陈皮, Citrus reticulata) 12g, Mu Xiang (木香, Saussurea costus) 10g, Duan Wa Leng Zi (煅瓦楞子) 15g, Zhu Ru (竹茹, Bamboo shavings) 10g, Fu Ling (茯苓, Poria cocos) 10g. Decoction, 7 doses.
November 19, second visit: After taking the medicine, gastric burning and dry mouth and bitter taste were significantly reduced. The previous prescription was supplemented with Xiang Fu (香附, Cyperus rotundus) 12g, decocted, 1 dose per day, for 7 doses.
November 26, third visit: After taking the medicine, all symptoms were basically eliminated. The tongue was pale, with a thin white coating, and the pulse was wiry. The previous prescription was modified by removing Qing Ban Xia and Fu Ling, adding Hua Fen (花粉, Pollen) 15g, Shi Hu (石斛, Dendrobium) 15g, and Mai Dong 12g, for 7 doses, to be taken every other day.
Case Two
Chai, female, 21 years old. Visited on November 21, 2012. Complained of gastric distension and pain for 2 years, possibly due to alcohol consumption. Symptoms had worsened in the past month, with frequent gastric distension and pain over the past 2 years. She was cautious about eating, as eating too much would cause discomfort. Daily gastric distension and pain were primarily distension with some hidden pain. Appetite was fair, but she avoided large meals and cold foods. She experienced dry mouth and bitter taste in the morning, lasting until noon, with poor sleep and vivid dreams. Menstrual cycle was normal, with breast distension and pain before menstruation. In the past six months, menstrual flow had decreased, lasting only 3 days, with normal bowel movements. The tongue coating was thin and white, and the pulse was deep and thin.
Pathogenesis: Liver qi stagnation and spleen deficiency, with disharmony of stomach qi. Treatment should focus on soothing the liver, strengthening the spleen, and harmonizing the stomach to relieve pain.
Prescription: Dang Gui (当归, Angelica sinensis) 15g, Bai Shao (白芍, Paeonia lactiflora) 15g, Chai Hu (柴胡, Bupleurum chinense) 12g, Yun Ling (云苓, Poria cocos) 15g, Chao Bai Zhu 15g, Xiang Fu 12g, Zhi Ke (枳壳, Citrus aurantium) 12g, Fo Shou (佛手, Citrus medica) 12g, Tai Zi Shen 15g, Sha Ren 5g, Chuan Xiong (川芎, Ligusticum chuanxiong) 12g, Bo He (薄荷, Mentha haplocalyx) 12g, Chen Pi 12g, Gan Cao (甘草, Glycyrrhiza uralensis) 10g. Decoction, 7 doses.
December 3, second visit: After taking the medicine, gastric distension and pain, as well as dry mouth and bitter taste, were completely resolved. The previous prescription was continued for 7 doses, to be taken every other day.
It should be noted that dry mouth and bitter taste, along with a dry tongue, can be caused not only by jinye deficiency, but also by qi and blood stagnation, which can obstruct the upward flow of fluids; internal damp phlegm and damp-heat can also obstruct the upward flow of fluids; and qi deficiency can weaken the ability to transport fluids. Therefore, when encountering dry mouth, dry tongue, and bitter taste, one must not hastily conclude that it is solely due to jinye deficiency.
To diagnose the cause of dry mouth and tongue, it is crucial to observe the tongue coating: a red tongue with little coating indicates yin deficiency with heat (阴虚有热), while a tongue with little or peeling coating indicates yin deficiency. A bare tongue with no coating indicates severe stomach yin deficiency. If the tongue is of normal color but has a yellow greasy or thin greasy coating, it indicates excess dampness or damp-heat, which is not due to jinye deficiency. Dampness and damp-heat, regardless of their origin in any organ, can lead to dry mouth and tongue. Such damp evils are often due to internal dampness, whether it is tangible phlegm-damp or intangible dampness, both can obstruct the normal flow of qi. When dry mouth and tongue are caused by such damp evils, using nourishing yin herbs would be akin to adding frost to snow. Clinically, it is common to encounter patients with a constitution of yin deficiency or with certain organs being yin deficient, while also having internal dampness obstructing the flow. This requires careful differentiation to clarify the primary and secondary conditions. Transforming dampness can harm yin, while nourishing yin can promote dampness; when both exist, one must prioritize the treatment of either dampness or yin. If both yin deficiency and dampness need treatment or if both are not severe, one can choose herbs that transform dampness without harming yin and nourish yin without promoting dampness. I often select Shan Yao and Lian Zi for this purpose.
In Case One, if one only considers gastric burning, dry mouth, and bitter taste, it could easily be misinterpreted as a case of yin deficiency with excess fire. However, the presence of a thin greasy tongue coating indicates damp-heat, thus the use of Tai Zi Shen, Bai Zhu, Fu Ling, and Ban Xia (半夏, Pinellia ternata) to strengthen the spleen and transform dampness was appropriate. The use of Zuojin Wan (左金丸) combined with Duan Wa Leng Zi to clear heat and relieve acidity; Chen Pi, Sha Ren, and Zhu Ru to harmonize the stomach and descend rebellious qi; and Shan Yao and Lian Zi as good pairs that transform dampness without harming yin and nourish yin without promoting dampness. The combination of these herbs strengthened the spleen, harmonized the stomach, and allowed fluids to ascend, thus resolving all symptoms. It is evident that the prescription did not include Mai Dong or Tian Men Dong (天门冬, Asparagus cochinchinensis), which are typically used to nourish fluids and yin, yet the dry mouth and bitter taste were completely resolved. In the third visit, after clearing dampness and heat, Shi Hu, Mai Dong, and Hua Fen could be added to protect stomach yin.
In Case Two, liver qi stagnation, spleen deficiency with excess dampness, and disharmony of stomach qi can also cause dry mouth and bitter taste. Thus, liver qi stagnation and spleen deficiency are the root causes, obstructing the upward flow of fluids, leading to dry mouth and bitter taste as the symptoms. According to the principle of treating the root cause, once the root is addressed, the symptoms will resolve. Case Two was treated appropriately, and the symptoms were resolved without the inclusion of Mai Dong or Tian Men Dong, which are typically used to nourish fluids.
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Edited by｜Xu Jing
Reviewed by｜Ma Jun Li Xiu Yun
