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Tongue coated - causes and treatment
Most people know the tongue from colds or as a side effect of eating certain foods. In addition to this temporary tongue coating, however, some people permanently develop a coated tongue. The causes can be extremely different and include some very serious diseases. The color and location of the covering can provide important information when searching for the causes.
An examination of the tongue has been an essential element in medical diagnosis in many cultures for centuries. The color, location and consistency of the tongue covering are also analyzed in order to draw conclusions about existing diseases. Changes in the tongue such as cracks, furrows, dental impressions and elevations are also used as additional diagnostic diagnostic signs. Often the tongue coating is accompanied by morbidity, which can occur as a direct result of the coating, but also independently of it.
With the tongue coating, not only can the diagnosis of diseases be confirmed, but also organic disorders can be recognized very early and under certain circumstances they can be compensated for before a (serious) disease develops.
Important: Discoloration and coating on the tongue can also be caused by food and beverages (e.g. beetroot, blueberries, wine, coffee)!
Tongue covering in western tongue diagnostics
According to western tongue diagnostics, the entire digestive tract is reflected on the tongue. Depending on where the deposit forms, you can get information on the condition of certain organs. Experience has shown that the front third indicates the esophagus and the beginning of the stomach, while the reflex zones of the stomach, duodenum, liver, bile, pancreas (left) and spleen (right) are assigned to the middle third. Finally, the rear part of the tongue is intended to provide information about the condition of the intestine.
Likewise, color deviations indicate impaired organ functions:
- With mild intestinal disorders, for example, red to brownish discolouration often appears at the tongue edges and tips.
- Yellow tongue coating is interpreted as a sign of a disturbance of the intestinal muscles, but above all as a sign of liver involvement.
- A thick coating that appears brownish-yellow is associated with disorders of the liver, gallbladder and biliary tract, but also with a possible portal congestion.
- Likewise, greenish coating on the tongue can show up in gallbladder and biliary tract diseases.
Tongue covering in Ayurveda
As in traditional western tongue diagnostics, importance is also attached to the tongue covering in Ayurveda, the traditional healing system of India. After the as Jhiva designated form of diagnosis, however, there are additional areas on the tongue that reflect organs that do not belong to the digestive system. For example, the heart is located in the middle of the front third, while the lungs extend to the left and right. In the back third, the two kidneys are shown, which "frame" the large side of the colon. Finally, in the middle third, the stomach and pancreas are shown in the middle, and the spleen and liver are shown on the side, which roughly corresponds to the Western concept. The tongue coverings, which are visible on these areas, are also based on colors according to the three energetic basic principles of Ayurveda, namely Vata, Pitta and Kaphaassigned:
- white tongue coating is considered in Ayurveda KaphaDisorder,
- red or yellow-green colored covering as an indication of a PittaDisorder,
- finally brown and black discoloration as a sign of one VataDisorder.
Taking into account the individual constitution, these disorders should be compensated for with medication, massages, asanas (physical exercises), various detoxification processes and Ayurveda's nutritional theory.
Tongue covering in traditional Chinese medicine
Tongue diagnostics is one of the most important diagnostic tools in Traditional Chinese Medicine (TCM) and has proven itself for thousands of years. The tongue covering provides essential clues for diagnosis and is closely related to many systemic diseases. In a study from 2018, the informative value of train diagnostics was checked according to the TCM approaches and the train bed was evaluated as an “objective and reproducible” indicator for existing diseases due to its relatively clear molecular basis.
Tongue coating in conventional medicine
In conventional medicine, tongue coverings and tongue diagnostics are also given importance, albeit a much smaller one. There are certain tongue coatings and discolorations that are assessed as an indication of specific diseases.
For example, the “raspberry tongue” is known as a typical symptom of scarlet fever, an infectious disease caused by streptococci. At a certain stage of the infection, the tongue stands out due to intense reddening and protruding warmth, which earned it a comparison with the raspberry fruit in the medical literature.
A heavily reddened tongue is considered a sign of iron deficiency or pernicious anemia (with vitamin B12 deficiency). In addition, if the tongue looks very smooth due to lost papillae and is accompanied by tongue burns, there is probably a severe vitamin B12 deficiency, which was caused, for example, by cirrhosis of the liver. This phenomenon is called the "tongue of paint".
If the tongue is covered with pink and red spots, it is associated as a “map tongue” with disorders of the hormonal system, but also with liver or metabolic disorders. Finally, the "hair tongue" (see below) with a black tongue coating is considered harmless and is often only considered a cosmetic problem.
Tongue covering diagnostic examples
When healthy, the tongue should be reddish, moist and shiny and surrounded by a slightly whitish coating that cannot be wiped off. A coated tongue generally indicates toxins from the digestive system. That is why cleaning the tongue with a tongue scraper is an integral part of Ayurvedic morning hygiene, for example.
There are special types of tongue coatings that are very rare and clearly related to a specific cause, such as the purple-green coating as the main symptom of poisoning with the heavy metal valadium. Other shapes such as white, brown and black tongue coverings are common and can have a variety of causes.
Important: Tongue diagnostics should never be used as the sole diagnostic method, but should rather be understood as a supplement to the findings. Some examples of their use in the various healing systems are presented in the following sections.
White tongue coating
- Thin white coating in the area of the transition between the front and middle third of the tongue can, for example, indicate a slight gastric catarrh.
- A thick, whitish coating spreading over the tongue from the middle of the tongue (connection with the stomach according to western tongue diagnostics) can indicate an acute inflammation of the stomach.
- Thick, whitish tongue coating with sore throat, fever and the development of a "raspberry tongue" after three to four days is an indication of the infectious disease scarlet fever.
- Gray-whitish coating in the middle of the train with red edges and red tongue tip is an indication of typhoid (so-called typhoid tongue).
- White tongue coating on the entire tongue and on the cheek mucosa indicates oral thrush, caused by a yeast (Candida albicans) fungal infection.
- If the tongue is bright and pale overall, this may indicate a lack of red blood cells (anemia).
Yellow tongue coating
If the tongue coating is yellow, this may indicate diseases of the liver, but may also be related to biliary disorders. In Western tongue diagnostics, this is also seen as a sign of a disturbance in the intestinal muscles.
Brown tongue covering
In western tongue diagnostics, brown tongue coating is considered a fairly certain indication of an abnormal intestinal event:
- Brown, loam-like coating on the back of the tongue: indicates intestinal ulcers.
- Dry, partly barky, dirty brown coating: often with an intestinal obstruction; further symptoms are complete absence of stool and winds, bloated stomach, hard stomach and acute abdominal pain (acute abdomen).
- Dark brown-dry tongue covering with fever and diarrhea: indication of infectious diseases such as dysentery in particular (sometimes, however, a bluish discoloration of the tongue is described).
- Brown coating in the middle of the tongue with moist, red edges: indicates an inflammatory change in the large intestine.
- Elongated brown areas to the right and left of the tip of the tongue: In the Ayurvedic view, there is a suspicion of pneumonia, which must be treated accordingly.
Black tongue coating
Usually black tongue coating occurs as black hair tongue (Lingua villosa nigra), which looks like "hairy" due to the elongation and hornification of inflamed tongue papillae. The furry, dark coating is created by pigment-forming bacteria that, when the immune system is weakened, can colonize and spread in the changed mucous membrane environment (oral flora).
In holistic medicine, a black tongue is regarded as a questionable sign not only because of its drastic appearance, but also because it suggests that the immune system's immune system is severely weakened. In conventional medicine, however, little illness value is attributed to it. Usually, the patient waits without treatment until after a few weeks or months (in some cases also after years) the covering has regressed.
The appearance of the black tongue coating can be determined, for example:
- after (immunocompromising) treatment with antibiotics or cortisone preparations,
- in the context of yeast infections,
- Vitamin deficiency states,
- excessive tobacco use,
- related to AIDS,
- after chemotherapy,
- after severe exhaustion with underweight.
In addition, some mouthwashes and disinfectants also favor the development of the black (hair) tongue.
In Ayurvedic medicine, a black tongue coating is understood as a Vata disorder and is out of balance by regulating it Doshas treated according to Ayurvedic principles. (jvs, fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
- Sun, S .; Wei, H .; Zhu, R .; Pang, B .; Jia, S .; Liu, G .; Hua, B .: Biology of the Tongue Coating and Its Value in Disease Diagnosis; in: Complementary Medicine Research; 2018; 25: 191-197, karger.com
- Jie Hu, Shuwen Han, Yan Chen, Zhaoning Ji: Variations of Tongue Coating Microbiota in Patients with Gastric Cancer; in: BioMed Research International, Volume 2015, PubMed
- S. Molineus: Tongue diagnosis for dentists - what do others see on the tongue ?; in: ZWR - Das Deutsche Zahnärzteblatt, 2016, 125 (05): 220-223, thieme-connect.com
- Ralph tax nail: tongue diagnosis in Ayurveda (jihva-pariksha); in: German alternative practitioner magazine 2016; 11 (04): 25-27, thieme-connect.com