厚腻苔根源大揭秘：从脾虚痰湿到五脏失调，一张图看懂舌象与调理方向

First, I will analyze the principle of thick and greasy moss, then I will analyze the pictures of the tongue, and finally, I will put one of my common prescriptions, "Huanhou Tang".

When we see thick and greasy moss, we often think of spleen deficiency and phlegm-dampness, and then we tell the patient, "Let's dissolve the phlegm-dampness!", and then Ping Stomach San, Si Jun Zi Tang, San Ren Tang and Da Yuan Drink are used. Then Ping Stomach San, Er Chen Tang, Si Jun Zi Tang, San Ren Tang, Da Yuan Drink, and all sorts of formulas are used mindlessly.

How exactly does thick greasy moss come about, I think the only way to know the whole process of how it comes about is to have a clear picture in your mind so that the treatment doesn't miss anything. Read the following article is best to read this first:Techniques | Deconstructing the Principles of Tongue Diagnosis

As mentioned above, the production of tongue moss is caused by the upward glorification of the essence of the earth's qi on the tongue, or the synergistic action of the five organs to produce the water and grain essence to be transferred to the tongue and form tongue moss. We all know that this thick and greasy moss is phlegm-dampness, and the generation of phlegm-dampness involves the entire process of the production, transportation and metabolism of the essence of water and grains.

A description of the process follows:

Diet enters the stomach, and through the grinding operation of the spleen and stomach, the warming of the heart fire and kidney yang, and the promotion of liver qi, it becomes water and grain essence.

Then the essence of water and grains can be transmitted up to the lungs through the spleen qi, and through the lungs to promote and purge, and nourish the whole body towards the hundred veins.

Diet into the body, part of the water into the grain essence, the other part of the small intestine through the secretion of turbidity function, it becomes dregs of water and grain turbid qi, grain turbidity mainly through the intestinal tract in the form of stools, water turbidity through the bladder in the form of urination. Of course, there is also a part of the turbid qi will be through the lung's XuanDa function in the form of sweat discharge.

Lungs and the large intestine are mutually exclusive, and the lungs and the bladder are not connected to the internal organs (the theory of the internal organs is not connected). Lung qi declared purge, directly affecting the excretion of water and grain dregs.

And for water turbidity to be properly drained through the bladder, there must also be the warmth of Kidney-Yang for Qi transformation.

As for liver qi it is a wood qi, the main draining and circulation, all involved in the whole process of generation, transit and metabolism, so the most common method is to soothe the liver and strengthen the spleen.

From the above analysis, it can be learned that the five viscera and six bowels in the water and grain essence throughout the production, transportation and metabolism process have corresponding participation.

Diet enters the body, and if it is not effectively transformed into water and grain essence, it becomes phlegm-dampness. Transit process, can not be properly transported, stay in the body also become phlegm-dampness, like flowing water into a foul sewer. Produced dross can not be discharged in a timely manner, accumulation in the body also becomes phlegm-dampness.

As for the function of each viscera problems how to produce phlegm-dampness, combined with the above description, analyze yourself, the following is only a simple example.

For example, the kidneys, kidney yang insufficiency, that diet without fire power to become not water grain essence, not be absorbed by the body becomes phlegm damp. The metabolism of water turbidity need to warm the kidney yang, the bladder in order to normalize the Division of open and close from the urinary discharge, otherwise it will be accumulated in the body into phlegm-damp water drink. So phlegm dampness throughout the generation, transit, metabolism of the process, and the five viscera and six bowels are closely related. Do not see the phlegm-dampness only know the spleen to remove dampness.

I. Redefinition of thick and greasy moss: not just spleen deficiency and phlegm-dampness

1. Limitations of traditional knowledge

Textbook definitions: Thick greasy moss = Spleen deficiency, phlegm-dampness, but clinical findings:
- Tongue distribution does not match the direction of the stomach meridian (e.g., more moss on the tip of the tongue reflects heart fire)
- Stomach qi may not be strong if the whole tongue is evenly coated (e.g., pale tongue with white coating in patients with yang deficiency).
Modern Verification: Tongue microecology studies have found a significant association between tongue flora and gut flora (Nature 2023 study).

2. Synergistic phlegm-dampness generation mechanism of the five organs

generating chain::Diet → spleen and stomach transportation (water and grain essence) → heart fire and kidney yang warming → liver qi draining → lung qi declaring and descending → San Jiao regulating → water and fluid metabolism
Key Targets:.inner organsDysfunctional manifestationsTongue CharacteristicsSpleen's powerlessness of transportation and digestion, thick and greasy moss in the middle of the tongue, kidney yang deficiency, water retention, white greasy moss at the root of the tongue, liver qi stagnation, blood stasis, bulging of the sides of the tongue, yellowish moss

Second, 18 tongue mapping analysis and conditioning program

1. Classification of typical tongue signs

Here's a specific look at the tongue, some of which is not exactly thick and greasy, and put up. Only a brief analysis of the tongue and brief prescription ideas.

Bulging on both sides of the tongue is Liver-Qi stagnation, and there are also two bulging protrusions in front of it, usually chest tightness and breast enlargement are present in such patients. The point of depression is that Qi is depressed and transforms into fire. Tongue root moss is relatively greasy and stagnant, there is kidney yang deficiency. If the party sees heat on the upper side, it will see cold on the lower side. One can use Si Reverse San to soothe Liver Depression, Mint and forsythia to evacuate Depressed Fire, Bitter Almonds or Semen Aristolochia to retract the dispersed Depressed Fire and descend it to the Kidneys, where the Heart and Kidneys are intertwined. Soft herbs such as Yi Zhi Ren and Ba Ji Tian are used to warm Kidney water. Other medicines for resolving phlegm are used as appropriate.

The right side of the tongue is significantly larger than the left side, for the right path is not descending (both the lungs and the large intestines may be stagnant), and liver qi stagnation is evident in the bulges on both sides. The tongue is cracked in the center, and there is Spleen deficiency and stagnation. One can use Chai Hu and Citrus aurantium to resolve Liver Depression, and Almonds, Hou Pu, Chicken Nei Jin and Fire Ma Ren to descend the right channel. In addition, add medicines that strengthen the spleen and resolve phlegm to move Qi and activate Blood.

This is a triangular tongue. When Liver Blood is deficient and the Liver body is deficient, the function of Liver use is naturally dysfunctional and prone to Liver Depression and Spleen Deficiency. Patients often show irritability, indigestion, dry stools and dizziness, all of which are caused by deficiency of Liver Blood, or loss of nourishment or stagnation and fire. To dredge the liver, nourish blood and strengthen the spleen is the main focus. The formula can be used as Easy Pill with sour jujube seed, cypress seed, flaxseed, etc.

This is a tire tongue, bulging around the periphery and sunken in the middle, for Liver Depression and Spleen Deficiency. The formula may be Four Reversals Powder + Four Gentlemen + Fried Yam to fill the deficiency.

The tongue is a bit bulging, and the tongue texture is a bit dark, so qi and blood medicines should be used at the same time. Tongue coating is a bit yellow and greasy, phlegm-dampness and fire, you can use Xiangsha Liujunwan as the base, plus Yin Chen and Zhu Ru. Alternatively, add Sihui San to Wen Gentian Tang. Add a little more red peony, danpi and other blood-activating medicines.

The tongue is blocking the mouth, the tongue is weak and soft and bulging for the turtle's back tongue, for the deficiency of the spleen and kidney, and the loss of sealing and storing. This picture is a bit blurry, the root of his tongue is actually sunken, the root of the tongue is a bit mossy, kidney yin deficiency, and the tongue is pale and tender. This one needs to regulate the Spleen and Kidneys at the same time, and also resolve Phlegm-Dampness. There are deficiencies in both yin and yang, and the use of medicines needs to be carefully scrutinized.

The tongue is thin, light and tender, with anterior depression of the tongue as a spoon tongue, deficiency of Qi and Blood, and sinking of the atmosphere in the upper Jiao. The root of the tongue is narrow and greasy moss is mainly in the middle and lower Jiao, deficiency of yang qi in the spleen and kidney. The idea is to warm the Spleen and Kidneys and elevate the atmosphere. The Spleen and Kidneys are deficient, so if one is worried about Chai Hu and Huang Qi lifting the atmosphere and extracting energy, one can first tonify the Spleen and Kidneys plus Xiang Fu, Hovenia and Chuan Xiong to open up the circulation of the Upper Jiao, and then lift the atmosphere later.

Flower peeling moss, map tongue, uneven drainage of wood qi. The tongue is also uneven and there is depression in the Blood. Idea: Sparing the Liver, strengthening the Spleen and activating Blood. Si Reverse San, Gui Zhi Fu Ling Wan plus some medicines for strengthening the spleen and resolving phlegm-dampness. This stripping of the moss is mainly due to depression and there is also a degree of yin deficiency, so some yin-supporting medicines can be added as appropriate.

This is also a tire tongue, with liver depression and spleen deficiency, no thick greasy moss, and a bit of watery dampness in the middle of the tongue. Add subtractions of Si Reverse San and Si Jun Zi plus ginger.

This is the Ruyi tongue, with the upper and lower concave shapes shaped like Ruyi. You can read this article:
Technique | Deconstructing the Ruyi Tongue of Tongue Diagnosis (Lower Element Deficiency, Upper Jiao Atmosphere Sinking)
This is a deficiency of kidney yang, the atmosphere of the upper burner is sunken, and the tongue is stiff and stagnant, so it needs to be warmed and warmed to remove cold and dampness, to elevate the atmosphere, and to promote qi and blood circulation.

No moss on the root of the tongue, deficiency of kidney yin, tongue surface is dry. To tonify Kidney-Yin and resolve Phlegm-Dampness, I usually add Six-flavored Di Huang Pill and Huan Tou Tang. The article will talk about this at the end of the article.

The tongue is pale and tender with insufficient qi and blood, and phlegm and turbidity are depressed and transformed into fire. The tongue moss is unevenly distributed, the tongue indicates unevenness, and there is depression of both Qi and Blood. This base is deficient, and there is phlegm-heat. The medication should strengthen the spleen and replenish qi and blood, and at the same time resolve phlegm, move qi and blood. The dosage of the medicine should be careful.

The root of the tongue is concave and the tongue coating is like accumulated powder, Kidney-Yang deficiency. Red spots on the tip of the tongue are caused by floating deficiency Yang, do not clear heat. Use medicine to warm and submerge yang qi, combined with the addition and subtraction of Da Yuan Drink, especially Cao GuoTo be used.

The tongue is slightly greasy and stagnant, not very severe, slightly bulging on both sides, and the tip of the tongue is flat. Patients are often accompanied by insufficiency of Blood in the Heart and Liver, such as dizziness, alopecia, panic, and poor sleep. The same can be achieved by using Prosperity Powder with Sour Zao Ren to detoxify the Liver, strengthen the Spleen and nourish Blood.

The tongue is thick and greasy, and the tongue texture is vaguely dark, so it is necessary to warm the spleen and kidney yang qi, activate blood circulation and eliminate blood stasis, and reduce turbidity through the internal organs. This can be done with the addition and subtraction of Huafu Tang.

The left side of the tongue is obviously larger than the right side, Liver-Qi stagnation. The kidney root is concave and the tongue is pale and tender, with deficiency of kidney yin and yang. Treatment: dredge the liver, tonify the kidney, strengthen the spleen and resolve phlegm.

This is a typical ice-covered tongue with moss all over the tongue surface and dark and cold color. The pathogenesis is Yang deficiency, cold and stasis. Some red spots can likewise be seen on the tip of the tongue, which is also due to Yang deficiency and floating of deficiency Yang, and should not be cleared of heat. Formulas that can be referred to include Zhen Wu Tang, Ling Gui Jiu Gan Tang, Huo Xiang Zheng Qi San, Wu Zhu Tang, Da Jian Zhong Tang, etc. Just add or subtract according to the situation.

This is also considered an ice-covered tongue, but it is not as cold as the last one, and the deficiency of qi and blood is more obvious. The root of the tongue is narrower and the moss is more greasy, so the lower element is deficient. Warming and tonifying kidney yang, strengthening the spleen and nourishing qi and blood are the mainstays. On the medication, warming the kidney yang is mainly based on eucommia, schizandra, dog's spine, which tonifies and helps the yang.

2. Medication logic

Tongue Characteristics	core pathogenesis	Recommended Formulas
The sides of the tongue are bulging and the moss is yellow and greasy	(TCM) inflammation of the liver and constipation of internal heat	Gentian Diarrhea Liver Tang + Uljin 10g
Cracks in the tongue and thick, greasy moss	deficiency of spleen and phlegm-dampness	Ginseng Ling Bai Zhu San+Sand Seed 6g
White, greasy moss at the base of the tongue like accumulated powder	Kidney-Yang deficiency, Cold-Dampness	Golden Poverty Kidney Energy Pill+Cao Guo 10g
red tongue with dark red color and scanty moss	excessive heat in the heart (TCM)	Guanchi San+Lian Zi Xin 6g

3. Essentials of the Formulation of the Turbidifying Soup

Turbidizing Soup:柴胡，枳壳，厚朴，杏仁，鸡内金，火麻仁，桂枝，党参，茯苓，白术，草果，元参，元胡，半夏，陈皮
Core Compatibility::Bupleurum Chinense + Citrus aurantium dulcis (detoxifying the liver and resolving depression) Huperzia serrata + almonds (lowering the lungs and clearing the bowels) Herba Cuscutae Fructus + Radix et Rhizoma Ginseng (aromatizing dampness and nourishing the yin) Cinnamomum Cassiaeum + Radix Codonopsis Pilosulae (warming the yang and benefiting qi)
mnemonic chant::
"Chai Hoven, Thick Apricot, Chicken, Hemp, Cinnamon, Ginseng, Poria, Herba, Yuan, Xia, Chen."
Taboo warning::
- Warming and drying medicines (e.g. Herba Fructus) are contraindicated for those with Yin deficiency and fire exuberance
- Dampness-heat congestion needs to reduce the amount of Codonopsis.

This formula is not to say that when you see phlegm-dampness, you can use it mindlessly, but it is more of a reminder. The formulae involved in this formula include Sijunzi Tang, Pingtuosan, Ercheng Tang, Sanren Tang, and Dahuan Drink, and the medicines in this formula involve a lot of treatments.

Chai Hu and Citrus aurantium detoxify the Liver to relieve stagnation on the left, while Hou Pu and Almonds descend the Qi of the Lung and Large Intestine on the right. Chicken Neijin suggests eliminating food, flaxseed suggests clearing the bowels, and Gui Zhi suggests warming the yang with ginger and cinnamon to clear the surface.

Drying dampness, aromatizing dampness, moving qi, strengthening the spleen, soothing the liver, inducing dampness, clearing the bowels, eliminating food, tonifying qi, invigorating blood, nourishing yin, and warming the yang to relieve the epidermis. These are basically the common treatments for phlegm-dampness, and it is possible that you may have forgotten one of the treatments, so memorize the song and you won't miss it. Inside the liver, strengthen the spleen, warm the heart and kidney yang qi, declaring and lowering the lung qi are involved, in addition to phlegm-dampness is mainly metabolized from the urine and feces, of course, some skin diseases are also used to sweat, the three-way subdissolution, are all included. For example, if you memorize the song to the grass fruit, that suggests aromatic dampness, according to the patient's situation to choose different dampness medicine.

With superficial symptoms use Huo Xiang and Perilla leaf, with poor digestion use Sand Ren, with cough use Perilla leaf, with heat use the pacifying and moisturizing medicine Pei Lan, with cold use Bai Kou Ren, with tongue like accumulated powder use Cao Guo, with head blindness use Acorus Calamus.

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

1. Three major misconceptions

Myth 1: If you see thick and greasy moss, use Pingtuosan.
- correct solution (a math. equation)Tongue root greasiness + lumbar soreness → Kidney deficiency with phlegm-dampness, need Jin Gui Ren Qi Wan + Cang Zhu
Myth 2: yellowish greasy tongue only clears heat
- correct solution (a math. equation)Yellowish greasy moss with pale tongue → Spleen deficiency with dampness-heat, need Si Jun Zi Tang + Yin Chen
Myth 3Fatty and large tongue = Spleen deficiency and Dampness
- correct solution (a math. equation)Pale and fat tongue + fear of cold → Yang deficiency of Spleen and Kidney, need Zhenwu Tang + Atractylodes Macrocephala

2. Conditioning cycle planning

Acute phase (1-2 weeks): San Ren Tang (Almonds + Cardamom Seeds + Coix Seeds)
Period of remission (3-4 weeks): Ginseng and Atractylodes Macrocephalae to strengthen the spleen
Consolidation period (5-6 weeks)Turtle Deer Erxian Gum to Strengthen the Essence

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.

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Analysis of the Root Cause of Ice-Covered Tongue: The Tongue Image Code of Yang Deficiency and Cold Condensation with 14 Practical Charts - TCM Global Net

April 1, 2025

[...] Technique Section | Deconstructing Thick and Greasy Tongue Coating in Tongue Diagnosis (with 18 Tong... [...]

Thick greasy moss root cause big reveal: from spleen deficiency phlegm-dampness to the five visceral disorders, a chart to understand the tongue and the direction of regulation

I. Redefinition of thick and greasy moss: not just spleen deficiency and phlegm-dampness

​Second, 18 tongue mapping analysis and conditioning program

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

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One response to "Thick greasy moss root cause big reveal: from spleen deficiency phlegm-dampness to the five visceral disorders, a chart to understand the tongue and the direction of regulation”

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Second, 18 tongue mapping analysis and conditioning program

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