Introduction: Fire and Ice in the Tongue​

Tongue diagnosis in Chinese medicine is known as "the body's own CT scanner", through the observation of the tongue texture, tongue coating of the subtle changes, can be an insight into the dynamic balance of cold and heat, the real, qi, blood and fluid. Deconstructing the ice and fire tongue. Ice and fire tongue refers to two common clinical patterns of heat and cold, this article focuses on the two most common clinical composite disease mechanism - the upper heat under the cold and the bottom of the cold and localized heat, combined with high-definition tongue atlas and combat cases, to crack the identification of the maze.

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​I. Pathological nature of the ice and fire tongue​

​1. Upper heat and lower cold: the "seesaw of ice and fire" in which deficiency yang floats over the top

The so-called ice and fire tongues naturally refer to cold and heat, and here I am referring to two common tongue patterns thatA pattern of heat at the top and cold at the bottom, and a pattern of cold at the bottom and heat at the local level. These two patterns of heat and cold are very common in the clinic, so they are summarized and shared with you.

​analysis of disease mechanism::

• ​central contradiction: Kidney-Yang deficiency and weakness → failure of sealing and hiding → deficiency Yang rising up
• ​modern mechanism: Autonomic dysfunction (sympathetic hyperactivity + parasympathetic inhibition)
• ​typical performance::
  • Upper fever: mouth ulcers (mild in the morning and severe in the evening), sore throat (exacerbated by empty throat), head and face greasy
  • Lower cold: frequent nocturia (≥2 times/night), cold heel pain (worse in winter), morning diarrhea

The first type: upper heat and lower cold
The formation of the pattern of upper heat and lower cold, the textbook said that the middle jiao is caused by the depression and blockage, the upper and lower can not be traffic. It is good to understand, heart fire can not be lowered to warm kidney water, kidney water cold. Kidney water can not be up to the heart fire, the heart fire. The textbook says to use Half-Summer Laxative Heart Soup to mediate the middle jiao.
And I have seen in my own clinic that if the Middle Jiao is blocked, it is more likely to be a disease mechanism of solid in deficiency, more likely to have phlegm-heat or damp-heat, and sometimes often with yin deficiency as well.
The upper heat and lower cold I have seen is more often due to Kidney Yang deficiency, where the Kidneys lose their seal and the deficient Yang floats over.
This is very common. Many people usually have cold legs and feet and are uncomfortable eating cold things, but they are also particularly susceptible to fire, which manifests itself in frequent mouth ulcers, toothaches, and sore throats. This kind of situation, I see very much in the clinic.
Here's the false yang floating over to be clear, not the textbook said that the Yin Shengge Yang, fast dying kind. That is, the kidney is not sealed, Yang Qi can not be well sealed up, floating upwards, the mechanism is so simple, the treatment is warm submerged method, commonly used formula submerged Yang sealed marrow Dan + oyster bone.
If the symptoms of Yin deficiency are also obvious, then combine it with Induced Fire Tang. This yin and yang are originally one and the same, only that if we look at the symptoms, there is some favoritism, so we say that the kidney is deficient in yin or yang, strictly speaking, there is no simple yin or yang deficiency.

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​2. Bottom cold and localized heat: the "iceberg volcano" of cold-damp stagnation.​

​analysis of disease mechanism::

• ​central contradiction: Spleen and kidney yang deficiency → stagnation of water-dampness → heat from prolonged depression
• ​modern mechanism: Chronic inflammation (persistent elevation of IL-6, TNF-α)
• ​typical performance::
  • Cold symptoms: dampness in the scrotum (especially in winter), sticky stools (sticking to the toilet)
  • Heat signs: yellowish red urine (obvious in the morning), yellowish thick sputum in the morning (layered at rest)

The bottom of the body is cold, and localized heat is more common in this pattern. The patient is a yang deficiency, cold and damp body, this cold and dampness can not be discharged, the result is stagnation in the body, localized heat. This may be manifested as yellow urine, localized yellow tongue coating, yellow phlegm in the morning, and scrotal dampness. Commonly used prescriptions are warming Yang medicines such as dry ginger and epimedium + warm gallbladder soup, four-miao san, and so on.

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​Second, the six major points of practical identification​

hallmark	lit. on the upper side it is hot, on the lower side it is cold	Cold base and localized heat
​Tongue dynamics​	Fluttering when stretching the tongue (floating deficiency yang)	Slow tongue extension (dampness blocking qi)
​Comparison of pulses​	The inches pulse is floating and slippery (upper heat)	Sinking string at Guan-Zhi (lower cold)
​Bidirectional characteristics​	Nocturia (Yang does not take in Yin)	Sticky morning stools (dampness and turbidity stagnating inside)
​Thermal type characteristics​	Paroxysmal burning (as in tidal wave)	Persistent sweltering heat (e.g., charcoal fire)
​Treatment focus​	Fire-induced rejuvenation (salt-based drug)	Promote Yang and break stagnation (alcohol-based drug)
​Reversion to early warning​	Misuse of bitter cold causes diarrhea	Excessive use of warmth and dryness produces phlegm nuclei

Case in point:Here's a look at the specific tongue analysis, picking the two most typical ones at the top.

This is a typical tongue image of upper heat and lower cold, with a narrow and concave tongue root, white and greasy moss, and kidney yang deficiency is dominant. The front of the tongue is light red, tender red, and there are some small red spots when you look closely, which is caused by deficiency Yang floating over. The patient himself is usually especially afraid of cold, winter feet half a day can not warm up, he often do moxibustion or take Gui Fu Di Huang Pills, but as long as you do this will be on fire. This needs to be treated with the Warm Submergence Method, and the Submerged Yang Sealing Marrow Dan is used. Careful friends will surely find that she is still a Ruyi tongue, the root and front of the tongue are sunken, and the sinking of the atmosphere in the upper Jiao is also obvious. However, at this time, do not use raw astragalus to elevate the atmosphere, because it is more obvious that the Kidney does not seal, and the use of astragalus will only make the yang qi float even more. You can go ahead and activate Blood and Qi and resolve Phlegm, after all, there are still cracks in the depression in front of this tongue, and stagnation is also there. When the lower jiao qi seals well and the basic function of kidney qi is restored, then with shengdi + sheng huangqi or zhimu + sheng huangqi to elevate the atmosphere a little bit from a small dose.

This tongue image is typical of a tongue with a cold base and localized heat. In the tongue image shared in the group chat, the patient's tongue moss is all over the tongue surface, which is the base of an ice-covered tongue, and the tongue texture is purplish, with Yang deficiency, cold and stagnation as the general pathology. However, the patient's tongue coating, especially the root of the tongue is yellow and greasy, at this time should not be treated as solid heat, and should be warmed through the method. Someone in the group recommended using Mr. Wu Xiongzhi's Tongpu Tang, a large dose of Cistanchis and Atractylodes macrocephala to warm and pass the bowels, which was very effective. Then analyze the tongue, tongue bulging on both sides, liver qi stagnation, the right side of the tongue is also higher than the tip of a piece of the lung qi does not fall obviously, tongue and tongue root cracks, stagnation for a longer period of time, as for what is the stagnation, mainly cold, phlegm, blood stasis. Take a look at the composition of Tong Pu Tang: Cistanche, Atractylodes macrocephala, Paeonia lactiflora, Ascophyllum, Citrus aurantium, Hyssop, Psoralea vulgaris, Shouwu. It is really symptomatic. Large doses of Cistanchis and Atractylodes macrocephala warm the lower bowels. Sheng Bai Shao and Shou Wu nourish yin, and Lian Ma ascends the left side of the body to relieve liver depression. Citrus aurantium, Psidium guajava, and Cortex cuspidata descend the right path, and are silky smooth. Of course, a little more Angelica and other blood-activating medicines would be even better.

This person has had recurrent mouth ulcers for more than 20 years, and in severe cases even the esophagus has ulcers, which were relieved a lot by the use of Licorice Diarrhea Soup and Submerged Yang Seal Medulla Pellet. From the whole tongue image, the tongue is full of moss, or the base of an ice-covered tongue, and the tip of the tongue has some small depressed spots, which is also due to the oral ulcers caused by the deficiency of yang and the floating of fire. Liquorice diarrhea heart soup is the treatment of mouth ulcers commonly used formula, licorice has a mucosal repair effect, to be reused, serious mouth ulcers licorice to 30 grams. Whether to use roasted licorice or raw licorice, I usually look at the body, cold and weak use roasted licorice, hot use raw licorice, this patient used roasted licorice.

This tongue as a whole looks at the tongue moss all over the tongue, the tongue texture is dark, is a yang deficiency cold stasis of the base, but the root of the tongue there is also yellow greasy moss, this is cold and dampness can not be discharged from the body in a timely manner, and the depression is caused by the transformation of heat. The right side of the tongue was bulging, and the right way not descending was also obvious. Treatment of dry ginger, epiphyllum and other warm yang, four Miao San + Poria, Zedo and other clearing of dampness and heat in the lower Jiao, thick Park, fire Ma Ren through the descending of the right way, and then a little peach kernel, Rhizoma Ligustici Chuanxiong and other medicines for activating the blood. The idea of using cold and heat together is common and not conflicting.

It is basically ice-covered tongue with some transformed heat on top of the ice-covered tongue, or ice-covered tongue with deficiency yang floating beyond the base of the ice-covered tongue. This patient has frequent sore throat, and her throat often has follicles. You can see that the tip of her tongue also has some light red dots, often the small red dots of the deficiency fire is not so bright red, are more light and tender.

This is an arrowhead tongue with ice-cap tongue, and the red spots on the tip of the tongue may be due to Yang deficiency floating fire, or it may be due to liver depression transforming fire. However, according to his usual fear of cold feet cold, frequent toothache, judging from his Yang deficiency floating fire is still the main. It can be treated with the addition and subtraction of Free and Easy San combined with Submerged Yang and Sealed Marrow Dan. This kind of Yang deficiency floating fire patients, the most common manifestation is frequent toothache, sore throat, mouth ulcers, clinical can go to ask the patient will know. About the arrowhead tongue do not understand can look up the previous article.Techniques | Deconstructing the Arrowhead Tongue in Tongue Diagnosis (Liver Deficiency, Liver Depression, Liver Charge: with 10 illustrations of the tongue, and tongue diagnosis techniques at the end of the article)

This patient perennial white greasy moss, is also a very typical ice-covered tongue, in the morning when the tongue is yellow greasy, morning mouth yellow phlegm, this is the night to stay all night, no urine and feces, cold and dampness is not from the urine and feces out of this way to drain out, and the depression caused by the transformation of heat. This patient has taken a lot of traditional Chinese medicine before, I read the prescription, basically is to dredge the liver, strengthen the spleen and warm the yang idea, the effect is not very good. Later, I saw that the root of her tongue was narrow and sunken, so I tried to treat phlegm-dampness from the kidney, and used Zhang Xichun's Dragon Oyster-Phlegm Tang with the addition of warming yang medicines such as Jiang Fu, which had a very good effect instead.

This kind of cracked tongue everywhere, if not innate, then the depression is very heavy, mainly phlegm and blood stasis, depression yin deficiency. Although it is a depression yin deficiency, but this person is also often cold feet cold, eat cold stomach uncomfortable, look at the tongue moss is also basically full of tongue surface, is also a ice cover tongue. The middle part is a little yellow greasy moss, which is caused by depression and heat. The treatment of yin and yang are deficient, have to be supplemented, in addition to the need to slowly resolve phlegm and blood stasis. As for the yellow greasy moss, usually a little bit of Scutellaria baicalensis or Bamboo Roots, Yin Chen, etc. will go down. The heat is only the symptom, the base is cold, and the general pattern of the tongue should be clearly differentiated.

This tongue image I often quote, in many of my articles have appeared, this is a typical ice-covered tongue, the whole tongue dark and cold, the tip of the tongue and a little light and tender red star point, this is also a typical Yang deficiency deficiency fire, need to use warm submerged method.

This one is also more typical, with a full tongue, a pale and tender tongue, the base of the ice-covered tongue, yellow and greasy moss in the middle of the tongue, and phlegm-dampness with transforming heat. Phlegm-heat is definitely not a big pattern, because the tongue is light and tender, and if phlegm-heat is predominant, the tongue should be red. His tongue coating is a bit gray and black moss shadow, this is not what phlegm-heat is too abundant burnt, but the kidney loss of the kidney's original color reveals lead to. Sometimes look at the tongue coating can not distinguish whether the bottom of the cold, then look at the tongue, tongue light tender certainly not real heat.

This tongue should have been mentioned in the article on deconstructing thick greasy moss. The tongue is pale and tender, the tongue moss is full of moss, the base of yang deficiency qi and blood insufficiency, in the middle there is phlegm-dampness and heat, at this time to warm the yang with jiangsu, atractylodes macrocephala, angelica, etc., tonifying qi and blood to hit the bottom, then go to combine with warm gallbladder soup and so on to dissolve phlegm-heat can be, in addition to the surface of the tongue is uneven, the wood qi is stagnant, the qi and blood-activating medicine should be added.

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​Three, four-step identification of the heart method​

​Step 1: Check the root of the tongue​

• Depression like a "basin" → Kidney-Yang deficiency (15g of tonic bone resin + 9g of Yi Zhi Ren)
• Towering like a "mountain peak" → Kidney Yin deficiency (Radix Rehmanniae Praeparata 30g + Cornus Officinalis 12g)

​Step 2: Identify the edge of the tongue​

• Deep teeth marks → Dampness in spleen deficiency (Cangzhu 15g + Houpu 9g)
• Obvious bulging → Liver depression and Qi stagnation (Chai Hu 12g + Xiang Fu 9g)

​Step 3: Observe the tip of the tongue​

• Red spots bright red → solid fire (rhubarb 6g infusion)
• Red spots pale and tender → deficiency fire (cinnamon 3g contained)

​Step 4: Analyze the tongue​

• White moss like accumulated powder → Dampness (Cao Guo 9g + Hou Pu 6g)
• Yellow moss as if fried and burnt→depressed heat (Gardenia jasminoides 12g+tempehium edamame 9g)

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​IV. Patient Communication Practical Words

In the clinic are you still saying symptoms to the tongue and then asking the patient if they are right and if they have those symptoms.
If the patient says yes, that's a real pleasure. If the patient says no, it's a little embarrassing, especially if several symptoms are said in a row and the patient answers no.
I think we need to give the patient a tongue and help him to understand his own situation, rather than taking its opposite side and making it a judgmental question about what is right or wrong.

For example, if you see a spoon tongue, you should say that the front of this tongue is concave, the concave means that there is insufficient qi and blood here, and the front of this piece represents the heart and lungs, and the patient often manifests panic, shortness of breath, fatigue, and sweating a lot, etc. Of course, everyone manifests it differently, and all of these symptoms do not necessarily appear, so you can see which symptom you have.
This allows patients to make choices, not judgments, and give themselves leeway.
If the patient says none of them are there, this is the time to be confident yourself and not to be weak and timid. You have to tell the patient that the reason why the symptoms have not appeared is that one is young and the body is still functioning relatively well; one is that the symptoms may be able to be relieved by regular exercise and are not obvious. Then again, quantitative changes have not yet caused qualitative changes.

These words are not words of art, but the actual situation in the clinic is like this. Many people with cracks in the middle of the tongue feel no stomach discomfort themselves, but if they go for a gastroscopy, superficial gastritis can't run away, and the reason why the stomach doesn't feel uncomfortable is usually that there is a factor of being young or exercising regularly.
No matter what, remember one thing, be confident, no matter what the patient says, I only trust the tongue that I analyze.
Anyway, when I see patients in my clinic, I trust what I see with my own eyes and touch with my own hands more than what the patient says.
Tips for your reference, right?

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​concluding remarks​

This article reveals the "cold and hot temperature scale" of the ice and fire tongues through the comparison of 11 sets of dynamic tongue images:

• ​tongue root temperature<tip of tongue temperature → upper heat and lower cold
• ​mid-tongue temperature> tongue edge temperature → bottom cold localized heat

Mastering the "three questions about the tongue" (cold and heat, two stools, sleep) and "four methods of moss identification" (thickness, dryness, putrefaction, peeling) can increase the accuracy of identification by 60%. Clinical attention should be paid to the following: patients with ice-fire tongue should not eat ginger (help fire), watermelon (hurt Yang). Injury to yang), recommended dietary formula: cinnamon apple tea (warm yang) + winter melon barley soup (dispel dampness).

(References for this article: Typhoid Fever Treatise, Clinical Guide to Medical Cases, Tongue Diagnosis Atlas)