​Tip:The treatments and medications involved in this article are for the reference of fellow TCM practitioners only, and patients should not take them privately, or else they will be responsible for the consequences.
Introduction:Deconstructing the Spoon Tongue with an article. Spoon Tongue simply means that there is a pit in front of the tongue, shaped like a spoon head, and its disease mechanism is mainly: depression + atmospheric subsidence.

About the spoon tongue, I have seen in many articles and tongue diagnosis books inside, I do not know who proposed it, we do not need to care about it, although analyzing its disease mechanism is.
Spoon tongue, as the name suggests, refers to a pit in the front of the tongue, shaped like the head of a spoon, with a depression in the center surrounded by a bulge, put a picture of a spoon below:

I. Redefinition of the spoon tongue: the tongue code for deficiency and depression of the upper jiao

1. Morphological characteristics and basis for naming

• ​Morphological description: The tongue is spoon-like in its anterior depression and bulges around it, corresponding to the cardiopulmonary region of the upper jiao (with tongue image 1).
• ​core pathogenesis::
  • ​deficiency syndrome: upper jiao atmosphere sinks (zong qi deficiency) → qi and chemical imbalance in the lungs, spleen and kidneys.
  • ​concrete evidence: Stagnation and blockage (Qi, Blood, Phlegm and Stasis intermingling) → Clear Qi does not rise, Turbid Qi does not descend.

About the spoon tongue its disease mechanism say different, I read, I feel that those statements do not speak through, understanding is very difficult, so I can not go to use, so I carried out the re-graphic interpretation, clinical use is also very good, so here to share.
Spoon tongue is a pit in front of the tongue, there is a pit means that there is something missing in this place, this place corresponds to the supra-jiao, that is, the supra-jiao is insufficient, Zhang Xichun called this situation the supra-jiao atmosphere subsidence, in fact, it is the textbook Zongqi deficiency.
The heart and lungs are in the upper jiao, so the insufficiency of the atmosphere in the upper jiao directly affects the function of the heart and lungs, and the patient often manifests palpitations, shortness of breath, fatigue, malignant wind, and sweating when moving.
Affects heart function, heart qi is not enough, the heart compensatory frantic pumping blood is palpitations; affects lung function, not enough qi is short of breath. Insufficient human energy throughout the body results in weakness.
When the atmosphere of the upper Jiao is insufficient, the Wei Qi is also insufficient, and when the surface is deficient and not solid, there is bad wind and sweating when it moves.
The operation of the human body's qi follows the order: rooted in the lower jiao yuan qi - transformed in the middle jiao stomach qi - upward transmission in the upper jiao atmosphere - dispersed in the peripheral body of the Wei qi.
This underlying logic was not invented by anyone, but exists naturally in itself.

2. Theoretical traceability

• ​The Laws of Qi Operation in the Yellow Emperor's Classic of Internal Medicine"Drinking in the stomach, overflowing essence, up to the spleen, spleen qi scattered essence, up to the lungs, through the water channel, down to the bladder, water essence four cloth, five meridians in parallel." This reveals the general rule of qi operation in the human body.
  "Drink enters the stomach→spleen qi disperses essence→returns to the lungs→communicates the waterways→transfers down to the bladder" (Laws of qi operation).
• ​Zhang Xichun's "atmospheric subsidence" theory::
  "The atmosphere is originally based on Yuan Qi, with water and grains as its sustenance, and the chest as its mansion and cave" (Zhong zhong gan xi lu, The Record of Medical Compassion and Compassion).

There are also articles that say that this spoon tongue can tell if a man is a premature ejaculator, and there is a basis for this as well.
Lung and Kidney are related to each other as Jin and Water, and when Lung Qi is deficient, Kidney Water is also deficient. In addition this Heart Qi, especially this Heart Fire is to descend to the Lower Jiao to replenish Kidney Yang to warm Kidney Water, now Heart Qi is also deficient, Kidney Yang is also deficient, then Kidney Water is cold.
This spoon tongue will lead to kidney yin and yang deficiency, resulting in many male problems, impotence, premature ejaculation, spermatorrhea can be seen.
So that this spoon tongue, further down the line will inevitably appear as a Rudraksha tongue, that is, the root of the tongue that will also be concave. Take a look at this article to find out.
Technique | Deconstructing the Ruyi Tongue of Tongue Diagnosis (Lower Element Deficiency, Upper Jiao Atmosphere Sinking)

The main point of the above is that the atmosphere of the upper jiao is sinking, and according to the laws of qi operation in the human body, then we can know that theThis insufficiency of the atmosphere in the Upper Jiao may also be caused by deficiencies in the Middle and Lower Jiao, the Spleen and Kidneys, in addition to their own deficiencies.
This is from the point of view of the imaginary, thatFrom a practical point of view, it is the problem of stagnation, which is also very common, especially when liver qi is stagnant, or when phlegm and stagnation are in the upper jiao, and when the upper jiao is overrun by evil qi, the clear qi naturally cannot rise.
I have encountered this situation in the process of healing, there is a depression must be chemical depression, otherwise ascending and lifting the atmosphere, the patient will feel particularly stuffy near the Jianqutu, depression can not be opened, this gas is stuck in the vicinity of the Jianqutu, a very good image.

In general the pathogenesis of the spoon tongue is: the upper jiao atmospheric subsidence (lung, spleen and kidney deficiency), stagnation (qi, blood, phlegm, cold and heat, etc.)

In terms of medication, I commonly use Zhang Xichun's series of ascending and trapping broths, Supplementary Beneficial Qi Broth, Shengqi Drink, Blood Mansion and Blood Stasis Broth, Li Dongyuan's Semixia and Atractylodes Macrocephalae Tianma Broth, Er Chen Broth, and Warm Gallbladder Broth, and so on.

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​Second, 11 tongue mapping analysis and conditioning program

1. Classification of typical spoon tongues

The following look at the specific tongue image, limited energy, only focus on analyzing the tongue image, the next version will be considered for detailed analysis of the medication.

2. Typical spoon tongue medication logic

​Tongue Characteristics	​core pathogenesis	​Recommended Formulas
Deep pits + cracks on the front of the tongue	Stagnation and fire + deficiency of qi and yin	Hematopoeia and Blood Stasis Tang + Shengmai Drink
Anterior depression of the tongue + white and greasy base of the tongue	Atmospheric subsidence + Spleen and Kidney Yang deficiency	Tonifying the Middle Jiao Qi Tang + Right Angelica Pill
Anterior bulging of tongue + yellowish greasy moss	phlegm-heat complex (TCM)	Warm Gallbladder Soup + San Ren Soup
Ice Cap Tongue + Spoon Tongue Composite	lit. upper heat, lower cold, mixed reality and emptiness (idiom); fig. a mixture of real and imagined conditions	Semixia Diarrhea Heart Soup + Jiaotai Pill

3. Analysis of classic formulas

• ​Addition and subtraction of Sheng Sheng Tang (升陷汤)::Astragalus (elevates the atmosphere) + Radix Bupleurum Chinense (detoxifies the liver) + Platycodonis (carries herbs upward) Radix et Rhizoma Polygoni Multiflori (nourishes yin and clears heat) + Fructus Hippocastanum (elevates the yang and lifts the sun) → dual-channel regulation of Qi.
• ​Taoist water and fire elixir::
  "Xuan Shen enlightens Kidney Water → relieves Heart Fire; Dan Shen lowers Heart Fire → warms Kidney Water" (transportation of the Heart and Kidneys, cracking upper heat and lower cold).
• Here in the discussion of lifting the atmosphere with astragalus, I summarize it in three points, as follows:
  First.If the phlegm-dampness and other stagnation is particularly heavy, I usually unblock the stagnation first, and after the path is cleared, then I consider using astragalus to raise the atmosphere. Sometimes when the stagnation is opened and the Qi itself is not that weak, the Qi will rise on its own. If used at the same time, if the stagnation is not opened in time, the Qi will easily stagnate near the Jian Qiao.
  Second.If one encounters the Ruyi Tongue, there is an appearance of the Kidneys not sealing, one needs to use Cornu Cervus Pantotrichum, Sheng Long Bone, Sheng Oyster to astringe the floating yang, and I usually wait until the sealing is almost over, and those floating yang on fire, for example, after the toothache, sore throat, and mouth ulcers have been cured, and then I will consider using Astragalus to elevate the atmosphere.
  Third.If the stagnation is not that severe and the Lower Jiao is not so weak that it needs to be sealed, feel free to just use Astragalus.
  Also with astragalus, there is a well knownAstragalus and Zhimu Method, you can find out about it, go through Zhang Xichun's "Medicine Zhongzhong Ganshi Lu".

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​III. Clinical Cases and Dynamic Conditioning Guidelines

1. Analysis of typical medical cases

• ​Case 1: Male, 42 years old, with spoon tongue accompanied by chest tightness and shortness of breath, was treated with tonifying Zhong Yi Qi Tang + Danshen 15g, and the tongue flattened out after 2 weeks.
• ​Case 2: Female, 38 years old, spoon tongue + yellowish greasy moss, menstrual dribbling, use Wen Gentian Tang + Motherwort 30g, after 1 month the moss turned thin white.

2. Conditioning cycle planning

• ​Broken Depression (1-2 weeks): Chaihu Liver-Sparing Powder as a base, add yujin and xiangsui to clear the liver
• ​Sagging period (3-4 weeks): tonifying the middle and benefiting the qi soup + ascending hemp, together with breathing and exhaling exercises
• ​Sterilization period (5-6 weeks): Alternate between Gui Spleen Pill + Easy Pill, dietary treatment with yam and lotus seed