《中国舌象诊断标准》

Explanation of the root cause of the moss-peeling tongue: the tongue code of depression and yin deficiency and the three ascending disorders - with 12 practical diagrams and the formula of the moss-forming elixir

Deconstructing the moss-peeling tongue, depression and yin deficiency, the spleen does not rise clear as its main disease mechanism, followed by the commonly used medication on the birth of moss Dan.

I. The redefinition of moss-peeling tongue: from "dry soil" to "blocked drains" in Chinese medicine

1. Breakthroughs in traditional theory

Let's take a look at what the 9th edition textbook Diagnostics of Traditional Chinese Medicine has to say about peeling moss:

The tongue was originally covered with tongue moss, and during the course of the disease all or part of the tongue moss fell off, and the area where it fell off was smooth and free of moss.

Depending on the size of the area and extent of tongue flaking, it can be categorized as follows.

A person whose moss flakes off the front half of the tongue is calledmossy before strippingThe

A person who has some of the moss peeling off in the middle of the tongue is calledmossyThe

A person whose moss peels off at the base of the tongue is calledlit. root peeling mossThe

A person whose tongue is peeling off in many places, with only a small amount of tongue mottling remaining on the surface of the tongue, is called amossyThe

Irregular flaking of the tongue with raised, well-defined edges, resembling a map, with occasional shifts in location, is calledtongue of atlasThe

A person whose tongue is completely stripped of its moss and whose tongue is as smooth as a mirror is calledMirror Tonguealso known assmooth tongueThe

A tongue that is not smooth at the point where the moss flakes off and still has newborn mossy particles visible is calledmoss-likeThe

Clinical significance:Mainly due to deficiency of stomach qi, damage to stomach yin, or deficiency of qi and blood.

I don't know why, but when I look at the textbook, I feel sad.
It's like when a crop field is dry and no more crops grow, and you come up and say there's no water in the pool. We people know to take a look at whether the canal is blocked, the water can not pass. Or look at the pressure pump is not the pressure is small, the water can not be pumped up.

On the subject of the tongue, we can take a look at this previously written article:The Principles of Tongue Production.Techniques | Deconstructing the Principles of Tongue Diagnosis
If we follow this analysis, I would say that all five organs and six viscera are related to the production of tongue moss, as is stripping moss. Spleen qi operates, kidney yang warms, liver qi promotes, and lung qi declares.

Then so remember, the brain feels clear, the actual use is a mess, unclear, confused. Then we directly change a minimalist thinking to see the problem. In fact, just like acupuncture, you can treat the disease from the meridian point of view, from the image of thinking about the treatment of disease is as effective, I use the five points of the five elements of the five elements of the birth of grams is also effective. For example, you are upstairs in the shower, is washing suddenly no water in the shower. Then we can consider from three aspects.
Number one that water reservoir is out of water. Secondly, the hose is clogged somewhere with hair or some kind of cloth or other debris. Thirdly, the water pressure of the upward pressure pump is too low, and the water can't be pushed up.
Corresponding to our principle of peeling moss production from this perspective, I summarize it as follows:Depression, Yin deficiency, Spleen does not promote clearing.

Depression.It can be Qi, Blood, Phlegm, Cold and Heat, i.e. Qi stagnation, Blood stasis, Phlegm, Dampness, Water and Drink, Cold and Heat.

Yin deficiency.Don't always think of raw earth, xuan shen and maitong to nourish yin. All Yin is generated by the Spleen and Stomach qi and blood, and strengthening the Spleen and Stomach is fundamental.

Spleen does not promote clearing.One is that the Spleen-Qi is weak, and the Spleen-Qi's function of ascending and clearing does not work, and it does not go upward. One is that Liver Qi doesn't rise, the wheel doesn't turn, the axle doesn't turn, and when the Liver rises, the Spleen rises. Then there is the warmth and promotion of kidney yang, and yang qi also plays a role in promoting ascension.

This sums up Depression and Yin Deficiency, Spleen Doesn't Rise and Clear (Three Liters), which is simple and easy to remember, takes better care of, and is very comfortable to use.

  • Textbook definitions: peeling moss = stomach qi deficiency/stomach yin damage, but clinical findings:
    • In patients with stripped moss, the tongue is more pale and tender (Yang deficiency) than fat and large (phlegm-damp congestion).
    • New particles can be seen on the peeled tongue (a sign of rising yang energy)
  • Modern Verification: Tongue flora assay shows reduced diversity of flora in the moss stripping region (Nature Microbiology 2023 data).

2. Three-element model of moss stripping generation

① depression (qi, blood, phlegm, cold and heat) → drain blockage
② Yin deficiency (spleen and stomach insufficient source of transformation) → barren soil
③ Spleen does not rise clear (liver and kidney yang qi propulsion weakness) → water pump failure  

Second, 12 tongue mapping analysis and conditioning program

1. Classification of typical peeling tongue

Let's look at tongue analysis again:

The surface of this tongue is mossless and cracked, with lots of phlegm and dampness between the crevices; this is a person who is constantly anxious, and who has grown up with many of life's tragedies. This mosslessness is mainly the result of depression formation. This tongue has a big crack in the center, with a perennial old stomach problem. The periphery of the tongue also has many horizontal cracks, which indicates that this person is depressed from the inside out. Prescribe medicines that break down qi and blood, and medicines that resolve phlegm and turbidity, all of which should be used, but not the energy is big, the tongue is tender, and the perennial consumption of qi and blood is also very deficient. This phlegm and stagnation, the depression are very deep, have to break slowly, can not rush.
This is a Flower Peeling Moss, and the surface of the tongue is also bumpy, with stagnation of both the Qi and Blood components. Where there is moss, it is also thick and turbid, and there is also phlegm-dampness. Sparing the Liver, strengthening the Spleen, invigorating Blood and resolving Phlegm and Turbidity. This kind of flower peeling moss, you tell the patient that "you indigestion", the patient will certainly nod, a hundred times. In fact, this is wood qi stagnation, uneven drainage caused by the tongue can not be evenly distributed.
This is a root peeling moss, you fill this lack of moss, the actual base of an ice-covered tongue. Kidney yin and yang deficiency, kidney yang insufficiency of water dampness, hindering the upward movement of fluid, or kidney yang insufficiency can not warm up the fluid, also can not be upward leading to this piece of lack of moss. The treatment is to supplement both yin and yang, in addition to resolving phlegm and turbidity. The whole tongue is a bit hard, add some blood-activating medicines.
In this tongue image we can see that the sides of the tongue are stripped of moss, and the root of the tongue also lacks moss. This is mainly caused by Liver Qi stagnation and Kidney Yang deficiency. Of course there is a pit in the upper Jiao, and there is also stagnation in the upper Jiao.
This is also a Flowering Moss, with uneven distribution of the tongue coating and many cracks on the surface of the tongue, which is also a sign of double depression of Qi and Blood. In the previous flower peeling moss, the tongue texture was uneven, while this one has more cracks, both of which represent stagnation at the tangible level. Although not necessarily caused by stasis of Blood, tangible stagnation will affect Qi and Blood, and there is no problem with the use of medicines that move Qi and activate Blood.
This is also a root peeling moss, the lack of moss in the place of tenderness, and some small blisters protruding, mainly due to kidney yang deficiency of water-dampness is not transformed. Sometimes it is directly manifested as the root of the tongue white thick greasy, water-dampness throughout the flood up. Sometimes it is this place is the water dampness depression, no moss, only visible some small blisters come out. The treatment is based on warming the Yang, transforming the Qi and inducing diuresis. As soon as the waste water is gone, new moss will be produced when Yang is added to Yin.
This look at the entire tongue dirty, turbid gas is particularly heavy, the depression is mainly in the phlegm-dampness, dredge the liver and strengthen the spleen to resolve the phlegm turbid can be.
This tongue is the middle peeling moss, tongue in the big cracks, for the spleen and stomach qi and blood deficiency, the middle jiao depression caused. In addition, the left side of the tongue bulging, tongue moss and the right side compared to the obvious less, but also a bit of qi depression into a fire like, liver qi stagnation also exists. Her tongue was taken with the front camera, and the left and right sides of the tongue are opposite.
This tongue is front peeling moss, the left side is also a little peeling moss, the tongue texture is light and tender, teeth marks obvious, spleen and stomach qi and blood is obviously insufficient. The front of the tongue peeling moss is mostly caused by a deficiency of the spleen and spleen qi does not rise, astragalus and chaihu are basically to be used, qi and blood can not rise up to lead to a lack of moss.
This tongue is also the base of an ice-covered tongue (for those who don't know about ice-covered tongues, see this article)Technique | Deconstructing the Ice-covered Tongue of Tongue Diagnosis (Yang Deficiency and Cold Condensation: With 14 Illustrations of Tongue)) the left side of the peeling moss, the other lung area also have peeling moss, you can go to ask, often the patient lungs may have some old disease depression blockage, long time not pass, it is easy to show in the corresponding area of the peeling moss. This tongue warms the yang to evacuate the liver to transform the phlegm and turbidity mainly, as for the tongue on the depression point, can use Huanglian or gardenia 3g bitter down to converge a bit or raw keel, oyster and so on submerge a bit, of course, in the middle of the jiao dry ginger or ginger is to be put, ginger and the Huanglian and gardenia of the coldness, only to take its bitter down power. Tongue tip red spot many are Yang deficiency deficiency Yang floating lead to. If it is a yellow greasy moss and there is a depression point then warm gallbladder soup plus mint, forsythia, or elevate and disperse the fire and depression of the hair.
This tongue is also a middle peeling moss, and there are some cracks on the surface of the tongue. Basically, wherever the moss is peeling off, start from there, strengthen the spleen and stomach, nourish the qi and blood, use the moss-generating elixir, and use some qi and blood-activating medicines to break up the stagnant stagnant stagnant stagnant stagnant stagnation.
This tongue is a triangular tongue with an ice-cap tongue base. With stripping of moss on both sides, the pathogenesis is Liver-Yin deficiency and Liver-Qi stagnation, which is discussed in detail in the article on Ice-covered Tongue, and is usually treated with the addition and subtraction of Puan-San. There is also stripping of moss at the base of the tongue, and kidney deficiency exists.

2. Medication logic

Tongue Characteristicscore pathogenesisRecommended Formulas
front part of the moss with tooth marksdepletion of the spleen and trapping of qi (TCM)Tonifying the middle Jiao Qi Tang + Raw Malt 15g
Root peeling moss white and greasyKidney-Yang deficiency prevents water-dampness from resolvingZhenwu Tang+Sha Ren 6g
Flower peeling moss with dark tonguelit. depression of the liver and blood stasis (idiom); venereal disease with depression and blood stasisEasy San + Peach Kernel and Safflower Decoction
Mirror tongue with cracksdeficiency of both qi and yinShengmusan+Dendrobium 15g

3. Essentials of the Formulation of San Moss Dan

  • Core Compatibility::Stir-fried Chinese yam (tonifying spleen yin) + raw malt (elevating liver qi) → invigorating the spleen and elevating Qing, breaking up depression and generating moss.
    These two herbs, one of which strengthens the spleen and stomach and replenishes qi and yin, address the source of the problem. One is raw malt, which itself has the property of ascending and developing, soothing liver qi and helping the liver wood to ascend and develop, and also helping the spleen to ascend and clear. It is included in the pathogenesis of stripping of moss, depression and yin deficiency, and the spleen's failure to elevate and clear.
  • mnemonic chant::
    "Strip the mossy tongue, three liters of tonic, yam and malt together at large;
    The stagnation is dispersed, yin fluids are born, and the tongue produces moss like a spring seedling."

Third, the common misunderstandings of modern people and crack the way

What is rigid and fixed in textbooks cannot be fully applied to clinical practice. It is like the saying in "Nezha 2: The Brain of the Devil Child": "Break it for me!" You have to keep trying to unravel what is fixed.

This era has changed, it is the era belonging to our new generation of young Chinese medicine practitioners, we have to be confident, the love of Chinese medicine will constantly give us the power to go forward, so that we shine in this era.

The last sentence:Inherit the way of healing, every person who loves Chinese medicine has the responsibility, not to carry forward, but only to pass on the essence.

It's a long way to go, and I'm going to go up and down the road.

1. Three fatal misconceptions

  • Myth 1: Use Yin-supporting medicines when you see peeling moss
    • correct solution (a math. equation): tongue pale and tender, peeling moss → spleen yang deficiency, need Li-Zhong Tang+Sha Ren
  • Myth 2: Red tongue with stripped moss = Yin deficiency and fire
    • correct solution (a math. equation)Red tongue with little moss and cold fear → upper heat and lower cold, need Jiaotai Pill + Cinnamon
  • Myth 3: Peeling moss = Stomach yin damage
    • correct solution (a math. equation): Peeling of moss with abdominal distension → Spleen deficiency and Qi stagnation, need Xiangsha Liu Junzi Tang

2. Conditioning cycle planning

  • Broken Depression (1-2 weeks)Add yu jin and xiang fu to detoxify the liver.
  • Mossy period (3-4 weeks)Ginseng Ling Bai Zhu San + Sheng Mai Zhu, strengthens the spleen and rises the Qing Dynasty.
  • Sterilization period (5-6 weeks): turtle-deer and two immortals gum to strengthen the root, with a small amount of cinnamon stick to promote Yang


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