When you are confused between the words given by the patient, look at the tongue!
The tongue (Lingua, Glossa) is a muscular organ in the oral cavity that is associated with the function of deglutition, taste and speech. It acts as an easily accessible mirror of the health of a person and indicates the state of hydration of the body. Some characteristic changes occur on the tongue in some abnormal conditions or diseases. Hence, the examination of the tongue is essential and will provide some hints for the clinical and remedial diagnosis.
It is very easy to examine the tongue in a conscious patient. The difficulty may arise in unconscious patients and in non-cooperative patients, especially the children. Small children may cry if we forcefully open their mouth, hence it can be easily examined by gently pressing above the mental-protuberance with the index finger and gradually opening the mouth. The baby will protrude the tongue automatically. Of course, it is a knack that can be gained only by experience.
The clinical examination of the tongue should be done with consideration of the following aspects such as shape, size, colour, moisture, coating, nature of papillae and the movements.
The appearance of tongue in some abnormal conditions:
- Hemiplegia: Deviation towards the paralyzed side.
- Tremors: Nervousness, Thyrotoxicosis, Delirium tremens and Parkinsonism.
- Progressive Bulbar palsy: Wasting and paralysis of the tongue with fibrillation; eventually the tongue gets shriveled and lies functionless on the floor of the mouth.
The moistness of the tongue gives some indication of the state of hydration of the body. Water volume depletion in a person can lead to peripheral circulatory failure characterized by weakness, increased thirst, restlessness, anorexia, nausea, vomiting, dry and parched tongue.
Dryness of tongue is seen in:
- Later stages of severe illness
- Advanced uraemia (with brownish discolouration)
- Acute intestinal obstruction
- Hypovolemic shock
- Heat exhaustion
- Hyponatraemia (with hard reddish brown colour)
- Central Cyanosis – Bluish discolouration
- Jaundice –Yellowish discolouration
- Advanced uraemia – Brown colour
- Ketosis – Brown discolouration
- Riboflavin deficiency – Magenta colour
- Niacin and some other B-complex deficiency – Bright scarlet or beefy red tongue.
- Severe anemia – Pallor
- Enteric fever- Thick white coating
- Candidiasis – sloughing white lesions
- Diabetes mellitus and hypoadrenalism – Associated with white sloughing lesions.
- Secondary syphilis – Mucous patches that are painless, smooth, white, glistening, opalescent places which can’t be scraped off easily.
- Leukoplakia – Keratotic white patch
- HIV infection – Hairy leukoplakia
- Peritonitis – Furring of the tongue
- Acute illness – white furring
- Hairy tongue – Due to elongation of filiform papillae which is provoked by poor oral and general debility.
- Geographic tongue – Irregularly shaped red and white patches resembling a map on dorsal and lateral surfaces. The cause is unknown.
- Median rhomboid glossitis – Smooth nodular red area in the posterior midline of the tongue.
- Nutritional deficiency –Glossitis leading to papillary hypertrophy followed by atrophy.
- Thiamine and riboflavin deficiency – Hypertrophied filiform and fungiform papillae.
- Niacin and iron deficiency – Atrophic linguae papillae.
- Vitamin A deficiency – Furrowed tongue
- Iron deficiency and nutritional megaloblastic anaemia: Smooth tongue is encountered in both.
- Folic acid deficiency – Macrocytic megaloblastic anaemia with glossitis.
- Cyanocobalamine deficiency- Glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy.
- Scarlet fever – Bright red papillae standing out of a thick white fur, later the white coat disappears leaving enlarged papillae on a bright red surface, which is called strawberry tongue.
- Syphilis :- Syphilitic fissures are longitudinal in direction. In Primary syphilis extra-genital chancre with enlarged submandibular and submental lymph nodes. In secondary syphilis, multiple shallow ulcers on under surface and sides. Hutchinson’s wart on the middle of the dorsum of the tongue. In tertiary syphilis, Gumma is seen on the mid-line of dorsum.
- Tubercular ulcers:- Shallow ulcers, often multiple and greyish yellow with slightly undermining margin.
- Herpes Simplex:- Acute vesicular eruption.
- Carcinoma:- Ulcers with everted edges and a hard base.
In Homeopathy, we do not treat the diseases, but the diseased individuals are treated by a holistic approach. The diseases are the dynamic morbid phenomena which are not different entities, but a continuous process in the life of an individual, wherein the miasms get blended and evolved and finally affect the vital organs. The internal morbid process is expressed by means of abnormal sensations and functions followed by the appearance of structural changes. Here the peculiar signs and symptoms will characterise the individual. That is why the individualization is the sole mean for a prescription. Hence, the peculiar nature of the individual should be perceived by taking the totality by exact observation and correct interpretation. Merely looking at one pathological condition and prescription does not come under the domain of Homeopathy. However, some abnormal signs on the body can be helpful for the differential remedial diagnosis. Here the nature of tongue can be taken into consideration along with other characteristic signs. However, it should be kept in mind that over-importance to one particular sign or symptom may not be always correct. Hence, one need not expect a mapped tongue in all Natrum mur patients, and all patients with mapped tongue may not be Natrum mur!
[Synthesis Repertory>> Mouth >> Mapped tongue: Antimonium crudum, Arsenicum album, Chammomila, Dulcamara, Hydrangea, Kali bichromium, Kali muratica, Lachesis, Lilium tigrinum, Lycopodium, Merc, Merc cor, Natrum mur, Nitric acid, Oxalic acid, Phytolacca, Ran.s, Rhus tox, Sepia, Sulfuric acid, Syphilinum, TARAX, ter, thuja, tubercullinum.]
The peculiar appearance of the tongue in some important remedies
- Aconitum napellus:
- Tongue is swollen and white coated.
- Tingling on the tip.
- Dryness with intense thirst.
- Bitter taste of everything except water.
- Antimonium crudum:
- Tongue coated thick white as if white-washed.
- White-furred appearance.
- Cracks in the corners of the mouth.
- Saltish saliva, loss of appetite and absence of thirst.
- Desire for acids
- Apis mellifica:
- Tongue is fiery red, swollen, sore, raw, and with vesicles.
- Feels scalded.
- Red hot and trembling.
- Stinging and burning pain with thristlessness.
- Protrusion is difficult.
- Arsenicum album:
- Tongue is dry, clean and red.
- Vesicles with stinging and burning pain.
- Ulcerated with blue colour.
- Blackish discoloration.
- The edges and the tip has got redness.
- Shriveled appearance.
- Gangrene of tongue.
- Thirst for small quantity of cold water in shorter intervals.
- Indicated in typhoid tongue.
- Furred appearance with yellow dirty white coating.
- Tongue feels scalded.
- Red and shining edges.
- Cracked and sore surface.
- Fetid breath with bitter taste in the mouth.
- Loss of appetite, can swallow liquids only.
- Tongue is swollen and painful.
- The edges are red.
- Strawberry appearance.
- Dryness and heat in tongue.
- Erect papillae.
- Mouth dry as if glazed.
- Great thirst for cold water, but dread of drinking.
- Bryonia alba:
- Marked dryness of tongue.
- Coated dark white, yellow or dark brown.
- Lips parched dry and cracked.
- Dryness with a great thirst for cold water.
- Chelidonium :
- Yellowish tongue with the imprint of teeth.
- White furred with red edges.
- Large and flabby tongue.
- Bitter taste in the mouth.
- Nausea and vomiting ameliorated by drinking very hot water.
- Crotalus horridus:
- Tongue red and small but feels swollen.
- Fiery red appearance.
- Dryness in the centre.
- Smooth and polished appearance.
- ) Difficult to protrude.
- Cancer of tongue with hemorrhages.
- When protruding, goes to right side.
- White swollen and flabby.
- Shows imprint of teeth.
- Scalded sensation.
- Fissures in the edges.
- White-furred tongue with bitter taste.
- Tongue is red, dry and cracked.
- It is stiff and immovable.
- Protruded with difficulty.
- Impaired speech.
- Foams at mouth.
- Leather-like appearance of tongue.
- Indurated and looks like burnt.
- Tongue is swollen, red and dry.
- Cracked at tip.
- Trembling with difficulty in moving.
- It catches on teeth.
- Snake like protrusion is characteristic
- Furrow in the upper surface length-wise.
- Heavy, thick with moist coating.
- Feels as if burnt.
- Ulcers with fetid odour from mouth.
- Blackish discoloration and softness.
- Moist mouth with great thirst.
- Metallic taste in the mouth.
- Muriatic acid:
- Tongue is pale, swollen, dry and leathery.
- Deep ulcers with bluish red edges, black base.
- Feels longer.
- Paralysis of tongue.
- Hard lumps can be felt.
- Natrum mur:
- Frothy coating with bubbles on sides.
- Sense of dryness and numbness with tingling.
- Sensation of hair on the tip.
- Mapped tongue.
- Herpes on the tongue.
- Red insular patches on the surface.
- Loss of taste.
- Nitric acid:
- Painful pimples on the sides.
- Clean, red and wet with center furrow.
- Ulcers with splinter-like pains, with bleeding.
- Red shining ulcers on the edges.
- Sensitive even to soft food.
- Bloody saliva with fetor oris.
- Nux moschata:
- Very dry and adheres to the roof of mouth.
- There is no thirst.
- Saliva looks like cotton.
- Numb and paralysed.
- Nux vomica:
- First-half clean and posterior half covered with deep fur.
- White and cracked edges.
- Bitter taste in the mouth.
- Dry, red, clean, cracked.
- Smooth as if varnished.
- Breath is horrible.
- Taste terribly fetid.
- pus-like taste in mouth.
- Mapped tongue.
- Covered with a white film, which comes off in patches leaving red spots.
- Feels raw.
- Bitter taste and bilious vomiting.
- Rhus tox:
- Red and cracked.
- Coated except for red triangular space at the tip.
- Dry and red at edges.
- Fever blisters around mouth.
- Bitter taste in the mouth.
- Desire for milk.
The intention behind this article is not to make you prescribe just by looking at the tongue, but to show you the importance of appearance of the tongue in differentiating diseases and the indicated remedies. When you get confused between the words given by the patient, just look at the place from where those words come – the tongue.
© Dr Muhammed Rafeeque