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Arrowhead Tongue (Triangle Tongue): A Guide to Chinese Medicine from Liver Deficiency and Depressed Heat to Neck and Shoulder Discomfort

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 Arrowhead Tongue (also known as Triangular Tongue), the tongue is shaped like an arrowhead, gradually narrowing and sharpening from the root of the tongue to the tip of the tongue, and spitting out the tongue as if shooting an arrow 🏹. Its basic pathogenesis: Liver deficiency, Liver depression, Liver impulse. Tongue diagnosis skills are attached at the end of the article.

I. Analysis of the pathological core and pathogenesis of the arrowhead tongue​

​1. Characteristics of the tongue

  • ​morphological: The body of the tongue gradually becomes narrower and more pointed from the root to the tip of the tongue, resembling an arrow or triangle. A tongue that becomes pointed is like a tongue that is stretched out like an arrow.
  • ​concomitant trait: Thick and greasy tongue coating, dark red or light tender tongue texture, and common depressed spots or petechiae along the edge of the tongue.

​2. Core pathologies​

  • deficiency of liver blood: Liver body yin and use yang, yin and blood deficiency is liver qi stagnation, qi stagnation turns into fire.
  • ​depressive of the liver and weak spleen (TCM): The liver loses its detachment and crosses over to the spleen, leading to indigestion and poor bowel movements.
  • ​excessive heat (TCM): Liver-Yin deficiency and deficiency fire disturbing the heart, triggering insomnia and irritability.
  • The basic pathology of the arrowhead tongue is really just one ie:deficiency of liver bloodThe latter are all extended disease mechanisms. Liver body yin and use yang, liver blood insufficiency will inevitably affect the use of liver stagnation and qi stagnation. If Liver Yin is insufficient, then the deficiency fire will be inflamed. When Liver Qi is stagnant, it is easy for fire to rise upwards and to attack the Spleen and Earth. Liver-wood generates heart-fire, and when Liver-Blood is insufficient, Heart-Blood is insufficient.
  • So when analyzed, the pathogenesis of the arrowhead tongue should be:Heart, Liver and Blood deficiency, Liver Depression and Spleen Deficiency, Liver Flame upward inflammation or upward impulse.
  • Too few words are not enough hints, and too many words are too much to remember. In order to be more clinically relevant, I directly simplify this disease mechanism as:Liver Deficiency, Liver Depression, Liver FlushIt's easy to remember and the tips are very comprehensive and practical, so I'm sharing it.

​classical theoretical support::
The Clinical Guide to Medical Cases says: "The liver body is yin and uses yang, if the blood is deficient, the liver will be out of duty, which will result in the disorder of the qi mechanism."

​Second, the common symptoms of the arrowhead tongue and corresponding conditioning​

As for the frequently occurring symptoms, they are also analyzed here, generally from bottom to top as:Poor bowel movement, indigestion, neck and shoulder discomfort, irritability, dizziness, headache and insomnia. These symptoms are usually bound to occur 2-3 times, especially the first three with high frequency.

Liver and the large intestine are connected (the theory of viscera and bowels), insufficient liver yin is intestinal nourishment, liver qi stagnation is visceral qi, so the arrow tongue of the patient is very easy to constipation.

Note that the liver and the large intestine are directly connected at the level of qi, and this is the reason why many patients with hepatitis can be relieved if their bowels are clear.

Liver depression multiplies the spleen, and when the spleen loses transportation, indigestion occurs, which needs no further explanation. From the holographic view of the tongue, the neck and shoulder area corresponds to the tip of the tongue and the lateral edge of the tip of the tongue, and if this area becomes narrow, then the lack of qi and blood can't moisturize the tendons and veins, and then the neck and shoulder will be uncomfortable. The corresponding area can be found in a book.

Whether it is deficiency fire from insufficient Liver-Yin or solid fire from stagnant Liver-Qi, it can lead to heat disturbing the mind, irritability and insomnia. Liver-Qi upstroke leads to dizziness and headache.

The most commonly used formula is the addition and subtraction of the Free and Easy San.

​symptom cluster​​Breakdown of disease mechanism​​Conditioning program​​Representative Remedies/Ingredients​
​Constipation + Bloating​Liver Depression and Spleen, Intestinal Loss of MoistureMoistening the intestines and relaxing the bowels, easing the liver and strengthening the spleenMa Zi Ren Wan + Sheng Bai Shao 18g
​Neck and shoulder pain + headaches​Qi and blood do not glorify the tendons and veins, and liver yang is overactivePromoting Blood circulation, calming the Liver and submerging YangSiwei San + Tablet Turmeric 15g
​Insomnia + irritability​Empty fire disturbs the heart and makes the mind restlessNourishing Yin and lowering fire, calming the mindSour date seed soup + Nightshade 30g
​Thick and greasy tongue + sticky mouth​phlegm-dampness and congestion of the qi system (TCM)Resolving turbidity and clearing collaterals, strengthening the spleen and dispelling dampness.Er Chen Tang + Fried Chicken Nei Jin 12g

​III. Tongue Diagnostic Techniques and Diagrams for the Arrowhead Tongue​

​1. Key points of tongue observation​

  • ​tip of tongue: Sharp redness of the tip suggests liver depression and fire; light tenderness is deficiency of qi and blood.
  • ​tongue: Bulging or depressed points suggest Liver-Qi stagnation; depressions are Yin-Blood deficiencies.
  • ​tongue: Thick and greasy with much phlegm-dampness, peeling off to see Yin deficiency.

​2. Typical tongue analysis

Below to see the specific tongue, above the arrow tongue pathogenesis and symptom analysis is very detailed, the following also do not repeat, only on the need to pay attention to the place to do the analysis, the tongue is not a full explanation. If you are interested, take a look at myTongue Diagnosis ColumnThe article in.

This arrow tongue is more typical, the tip of the tongue is sharp and red, the two sides of the tongue are obviously narrow, bulging and depressed, the middle of the tongue has depression, the tongue coating is greasy. The disease mechanism is liver blood insufficiency, liver depression fire, liver depression spleen deficiency phlegm dampness, can use dan gardenia free pill + sour jujube kernel, and then according to other symptoms to add and subtract.
This is a pediatric Tourette's patient with wheezing, stomach sucking, blinking, and vertical noses evident. You can see that both sides of the tongue are concave inward, and the tongue seems to be divided into two layers. The child was also suffering from prolonged bowel problems, and his bowel movements were normalized after using Sheng Bai Shao (白芍) 18, Dang Gui (当归15), Ji Nei Jin (鸡内金) 9, and Ji Shitou (鸡屎藤) 9. This treatment is mainly to harmonize the liver and spleen, and to support Jin and Ping Mu.
This one is a triangular tongue with a peeling tongue, so you can look up that previous post on deconstructing the peeling tongue to see it.Technique | Deconstructing the Mossy Tongue of Tongue Diagnosis (Depression and Yin Deficiency, Spleen Doesn't Rise and Clear, with 12 Illustrations of Tongue Pictures and Mossy Moss Dan)
Liver-Qi stagnation means that the flow of wood-qi is not smooth, and it cannot distribute the water and liquids evenly, resulting in the tongue coating being more in some places and less in others.
This is also an arrowhead tongue, which is lighter and more tender, and the deficiency of Qi and Blood is a little more pronounced, so it should be favored to tonify Qi and Blood more on the basis of Prosperity Powder.
With this arrowhead tongue, there seems to be a piece missing on the left side of the tongue, and the discomfort on the left shoulder is obvious. The tongue texture also looks stiff, and the stasis under his tongue is very thick. Treatment should focus on soothing Liver-Blood and Liver-Qi, with Si-Reverse-San plus Yuan-Hu to unblock the left path. Of course, specialized medicines for shoulder pain like Katsuji-Turmeric + Qiang-Hu can also be used.
This is an Ice-covered Tongue plus Arrowhead Tongue, with the entire surface of the tongue covered by tongue moss, the disease mechanism of Yang Deficiency and Cold Condensation, and the Liver Depression bulging on both sides of the tongue is also evident. The tip of this tongue is not sharp enough, and it is still on its way to forming an arrow tongue. The tip of the tongue is red and tender, and usually prone to fire, this fire is not necessarily Liver Depression fire, it may be Yang deficiency, deficiency Yang floating caused by floating fire. Previous articles:Analysis of the root cause of the ice-covered tongue: the tongue code of Yang deficiency and cold condensation with 14 practical diagrams
This person's shoulder discomfort and constipation were obvious, and could also be seen on the tongue, which was very narrowly concave on both sides, and the tongue coating was thick and greasy, with phlegm-dampness blocking the qi. The medicine must be used to open up the intestines, and the phlegm-dampness will go down quickly. Many times patients say that the stool is not formed, sticky toilet, and then do not use laxative medicine, to warm the yang. In fact, the stool is sticky, which is the body wants to discharge the evil from the stool, you can follow its momentum to laxative. Sometimes just dry dampness, facilitate urination this thick greasy moss can not go down.
This is also an ice cap tongue with an arrowhead tongue, this arrowhead tongue is a little more pronounced and has a sharper tip. Refer to the previous picture for analysis.
This is also a typical arrowhead tongue, the whole tongue image of tight qi, liver depression is very obvious, a longitudinal groove in the center, the tongue coating is relatively thick and greasy, spleen deficiency phlegm-dampness image. For treatment, we can consider Free San plus Xiang Sha Liu Jun Wan.
In this arrowhead tongue, the entire tongue is dark and there are many petechiae on both sides of the tongue; bruising is obvious, and Blood activating medicines such as red peony, danpi, and yuan hu must be used. Moreover, the tongue is thick and greasy, and phlegm-dampness is also very heavy, so we can use the Shanghai Hua Turbid Tang (see the end of the article on Deconstructing Thick and Greasy Moss).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

​IV. Tongue diagnostic techniquesand daily conditioning​

1. Sharing of tongue diagnosis skills

Tongue diagnosis is very good to use, so to speak, and with a better study of tongue diagnosis, the odds are that if a patient asks you to analyze their tongue, they will stay for treatment. Learning it well is going to make a difference.
When I looked at the tongue at the initial stage, I found that after the patient stretched out the tongue, I was nervous because I had to grasp all the information in a few seconds, and as a result, after looking at the tongue, I could only see that the tongue coating was thick and greasy, but nothing else.
Then again ask the patient to extend the tongue, three times. Some patients get impatient, and even then, several details are missed. So I began to think about how I could grasp all the information about the tongue and reduce the number of times the patient stretched his tongue.
Here to share a tongue diagnosis tips, everyone tongue diagnosis, the patient stretched out the tongue within 5 seconds to grasp all the information, which is very difficult to do, even if skilled can not do. At this time I will let the patient first tongue, cell phone photos, and then analyze the tongue, analysis is complete and then let the patient tongue verification. The whole process of the patient only need to stretch the tongue twice, very short patients are easy to accept. You also have enough time to fully and carefully analyze the tongue.
I think tongue diagnosis, like pulse diagnosis, should have enough time to analyze, at least 1-2 minutes, never instantly look at it, especially if you rely on the tongue diagnosis of the doctor, you should leave enough time to analyze the tongue.

2.Food Therapy Program​

  • ​constipation due to liver depression: Black Sesame Walnut Porridge (30g black sesame + 15g walnut kernel + round-grained rice)
  • ​deficiency of qi and blood (TCM): Astragalus and Wolfberry Chicken Soup (Astragalus 15g + Wolfberry 10g + Half Chicken)

​3. Taboos for good health​

  • ​abstain from certain food (as when ill): Spicy (chili peppers, alcohol), greasy (fried food), cold (ice drinks).
  • ​work and rest: Go to sleep before Ohio time (21-23 pm) to take care of the liver and gallbladder meridians.

V. Modern research and classical verification​

  • ​Research support: Acupuncture at Taichong point reduces serum IL-6 levels in patients with liver depression (Chinese Acupuncture and Moxibustion, 2023).
  • ​Verification of tongue diagnosis: Bulging on the side of the tongue is significantly associated with abnormal hepatobiliary ultrasound (thickening of the gallbladder wall) (Journal of Traditional Chinese Medicine, 2022).

​classifier for sums of money: The formulae described in this article need to be adjusted by a Chinese medicine practitioner for evidence-based adjustment, and pregnant women and patients with chronic diseases should be cautious about using drugs that activate blood circulation and remove blood stasis.

We will learn and improve together by writing!

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