Geographical tongue?

October 27, 2004

Hi, Somewhere deep inside my memory files I recall hearing about

the " geographical tongue " , but the memory isn't clear. Anyone heard

of this? I'm pretty sure that I read that this type of tongue is

misleading because it looks like massive yin deficiency but it is

actually something they are born with that does not indicate yin

deficiency. Anyone else heard of this and know anything?

I have a patient with kidney deficient low back pain that has a very

red tongue with lots and lots of cracks all over it and no coating,

but he doesn't really seem that yin deficient otherwise. He's a bit

on the chubby side and his low back feels cool to the touch and his

personality is very laid back (not at all a yin deficient type of

personality). However, he does have red cheeks and he does report

being bothered by heat and not bothered by cold...but that may be

from dampheat rather than yin xu heat--he has some dampheat

symptoms. His low back pain is clearly kidney deficient, but I'm

thinking SI 3/UB 62 would be better for him than Lu 7/K 6...but by

looking at his tongue I'd focus on tonifying kidney yin.

Thanks for any thoughts on this---

Laura

October 28, 2004

So no one has heard of this? Hmmm??? Anyone?

Laura

, " heylaurag "

<heylaurag@h...> wrote:

>

> Hi, Somewhere deep inside my memory files I recall hearing about

> the " geographical tongue " , but the memory isn't clear. Anyone

heard

> of this? I'm pretty sure that I read that this type of tongue is

> misleading because it looks like massive yin deficiency but it is

> actually something they are born with that does not indicate yin

> deficiency. Anyone else heard of this and know anything?

>

> I have a patient with kidney deficient low back pain that has a

very

> red tongue with lots and lots of cracks all over it and no coating,

> but he doesn't really seem that yin deficient otherwise. He's a

bit

> on the chubby side and his low back feels cool to the touch and his

> personality is very laid back (not at all a yin deficient type of

> personality). However, he does have red cheeks and he does report

> being bothered by heat and not bothered by cold...but that may be

> from dampheat rather than yin xu heat--he has some dampheat

> symptoms. His low back pain is clearly kidney deficient, but I'm

> thinking SI 3/UB 62 would be better for him than Lu 7/K 6...but by

> looking at his tongue I'd focus on tonifying kidney yin.

>

> Thanks for any thoughts on this---

>

> Laura

October 28, 2004

Geographic was defined for me as a mixture of coat and no coating, often

dramatically, as

if looking above a forest that had been cleared in patches. What you seem to be

describing

is what I have called fissured tongue (deep cracks). It does indicate yin

deficiency although

be careful because in cases where the patient is under 30 or so without

significant

illnesses the patient could have been born with the tongue looking that way.

Then I would

chalk it up to a genetic predissposition (often the patient will remember being

joked about

as a kid for having a " lizard " tongue). I'm much less inclined to call it yin

xu. You didn't say

what the age of the patient was so its hard to say in your patient.

Just for your information- the same applies for me for African Americans and

people of

color with black spots on their tongues where no other signs of severe blood

stagnation

exist. It seems to be a pigmentation issue that doesn't exist in Caucasian and

Asian

tongues.

Hope this helped... hopefully I haven't stepped on any land mines here. :- )

doug

, " heylaurag " <heylaurag@h...> wrote:

>

> So no one has heard of this? Hmmm??? Anyone?

>

> Laura

>

> , " heylaurag "

> <heylaurag@h...> wrote:

> >

> > Hi, Somewhere deep inside my memory files I recall hearing about

> > the " geographical tongue " , but the memory isn't clear. Anyone

> heard

> > of this? I'm pretty sure that I read that this type of tongue is

> > misleading because it looks like massive yin deficiency but it is

> > actually something they are born with that does not indicate yin

> > deficiency. Anyone else heard of this and know anything?

> >

> > I have a patient with kidney deficient low back pain that has a

> very

> > red tongue with lots and lots of cracks all over it and no coating,

> > but he doesn't really seem that yin deficient otherwise. He's a

> bit

> > on the chubby side and his low back feels cool to the touch and his

> > personality is very laid back (not at all a yin deficient type of

> > personality). However, he does have red cheeks and he does report

> > being bothered by heat and not bothered by cold...but that may be

> > from dampheat rather than yin xu heat--he has some dampheat

> > symptoms. His low back pain is clearly kidney deficient, but I'm

> > thinking SI 3/UB 62 would be better for him than Lu 7/K 6...but by

> > looking at his tongue I'd focus on tonifying kidney yin.

> >

> > Thanks for any thoughts on this---

> >

> > Laura

October 28, 2004

On Oct 28, 2004, at 11:17 AM, wrote:

> the same applies for me for African Americans and people of

> color with black spots on their tongues where no other signs of severe

> blood stagnation

> exist. It seems to be a pigmentation issue that doesn't exist in

> Caucasian and Asian

> tongues.

FYI: I just saw a tongue on a dark colored Asian indian. The

pigmentation blotches looked almost purple, but again, there was no

stagnation of blood to be found.

--

Pain is inevitable, suffering is optional.

-Adlai Stevenson

October 28, 2004

Hi Doug,

Yes, he's in his early 30's---so, yeah, I think I will disregard it.

The way his tongue looks he should be about 185 years old.

Its funny that you said, " I hope that I didn't step on any land mines

here " because I had an incident occur when I was in school regarding

this very issue. I raised my hand in class and asked whether people

of color sometimes had pigmentation spots on their tongue that did

not indicate anything clinically (because, like you, I had noticed

this to be the case). Unexpectedly, an Asian woman in the class

turned around and, with an angry, sarcastic tone of voice, said to

her friend behind her, " PEOPLE OF COLOR!!, I guess I'm a PEOPLE OF

COLOR! " . It was mortifying for me because I felt like I appeared to

be a racist to the whole class, and I am anything but a racist (and

would never want to appear to be....being the nice liberal former

social worker that I am). I was so surprised that I just sat there

and looked at her with big eyes. Everytime I saw her after that I

wanted to say something to make sure she knew I didn't mean anything

derogatory, but I was too chicken.

Anyway, thanks for the response. I can move forward and treat him

disregarding his tongue.

Wouldn't it be cool if that student happened to be a member of this

forum and she read my post and finally, after all these years, she

would know the truth?

Laura

, " "

wrote:

>

> Geographic was defined for me as a mixture of coat and no coating,

often dramatically, as

> if looking above a forest that had been cleared in patches. What

you seem to be describing

> is what I have called fissured tongue (deep cracks). It does

indicate yin deficiency although

> be careful because in cases where the patient is under 30 or so

without significant

> illnesses the patient could have been born with the tongue looking

that way. Then I would

> chalk it up to a genetic predissposition (often the patient will

remember being joked about

> as a kid for having a " lizard " tongue). I'm much less inclined to

call it yin xu. You didn't say

> what the age of the patient was so its hard to say in your patient.

>

> Just for your information- the same applies for me for African

Americans and people of

> color with black spots on their tongues where no other signs of

severe blood stagnation

> exist. It seems to be a pigmentation issue that doesn't exist in

Caucasian and Asian

> tongues.

>

> Hope this helped... hopefully I haven't stepped on any land mines

here. :- )

> doug

>

> , " heylaurag "

<heylaurag@h...> wrote:

> >

> > So no one has heard of this? Hmmm??? Anyone?

> >

> > Laura

> >

> > , " heylaurag "

> > <heylaurag@h...> wrote:

> > >

> > > Hi, Somewhere deep inside my memory files I recall hearing

about

> > > the " geographical tongue " , but the memory isn't clear. Anyone

> > heard

> > > of this? I'm pretty sure that I read that this type of tongue

is

> > > misleading because it looks like massive yin deficiency but it

is

> > > actually something they are born with that does not indicate

yin

> > > deficiency. Anyone else heard of this and know anything?

> > >

> > > I have a patient with kidney deficient low back pain that has a

> > very

> > > red tongue with lots and lots of cracks all over it and no

coating,

> > > but he doesn't really seem that yin deficient otherwise. He's

a

> > bit

> > > on the chubby side and his low back feels cool to the touch and

his

> > > personality is very laid back (not at all a yin deficient type

of

> > > personality). However, he does have red cheeks and he does

report

> > > being bothered by heat and not bothered by cold...but that may

be

> > > from dampheat rather than yin xu heat--he has some dampheat

> > > symptoms. His low back pain is clearly kidney deficient, but

I'm

> > > thinking SI 3/UB 62 would be better for him than Lu 7/K 6...but

by

> > > looking at his tongue I'd focus on tonifying kidney yin.

> > >

> > > Thanks for any thoughts on this---

> > >

> > > Laura

October 29, 2004

I have also heard of the geographic tongue as peeled in some areas and

thicker coating in others... Anyway are there 2 types of this tongue? One

that changes and one that is fixed? I have only seen the former...

-Jason

October 29, 2004

Hi Jason,

Did you hear of this tongue in the context as being non-clinically

significant? In other words, is your understanding that people with

a geographical tongue were just born with it that way and it means

nothing?

The main thing that I want to be clear on is how to approach my

patient. He doesn't seem yin deficient at all, but his tongue looks

crazily yin deficient. I know that in the past he has benefitted

from using SI 3/UB 62 to treat his back from a former acupuncturist,

so maybe I should just stick with that. But he would like to be

treated with herbs, so I need to be more clear on his diagnosis.

As we all know, sometimes the tongue and pulse can be misleading. I

have a patient I treated for infertility who successfully got

pregnant (yay!). Her diagnosis was yin deficiency, but you wouldn't

know it by the looks of her tongue (coated), nor by how she herself

looked (not at all thin, and not the least bit anxious).....until she

got pregnant. Once she was pregnant she became gaunt and her tongue

suddenly one week looked shockingly red and peeled.

There was one clue to the yin deficiency on her tongue though, and it

was a symptom that came and went. Now and then before she got

pregnant she would get this small peeled scoop in the back of her

tongue.

Anyway, I'm not sure what my point is except to say that what we do

is very challenging and we all rock, as they say.

Laura

, " "

<@c...> wrote:

> I have also heard of the geographic tongue as peeled in some areas

and

> thicker coating in others... Anyway are there 2 types of this

tongue? One

> that changes and one that is fixed? I have only seen the former...

>

> -Jason

October 29, 2004

Just to be clear, (Ha!) I use the term geographic to mean a mixture of damp and

peeled

like a partially harvested forest while I use fissured to mean deeply cracked

like the Grand

Canyon. Some people seem to have fissured tongues as a genetic component that

does

not reflect on a Yin Xu. This is my terminology (DT)... do others have a

different

vocabulary for the two tongues?

doug

, " heylaurag " <heylaurag@h...> wrote:

>

> Hi Jason,

>

> Did you hear of this tongue in the context as being non-clinically

> significant? In other words, is your understanding that people with

> a geographical tongue were just born with it that way and it means

> nothing?

>

> The main thing that I want to be clear on is how to approach my

> patient. He doesn't seem yin deficient at all, but his tongue looks

> crazily yin deficient. I know that in the past he has benefitted

> from using SI 3/UB 62 to treat his back from a former acupuncturist,

> so maybe I should just stick with that. But he would like to be

> treated with herbs, so I need to be more clear on his diagnosis.

>

> As we all know, sometimes the tongue and pulse can be misleading. I

> have a patient I treated for infertility who successfully got

> pregnant (yay!). Her diagnosis was yin deficiency, but you wouldn't

> know it by the looks of her tongue (coated), nor by how she herself

> looked (not at all thin, and not the least bit anxious).....until she

> got pregnant. Once she was pregnant she became gaunt and her tongue

> suddenly one week looked shockingly red and peeled.

>

> There was one clue to the yin deficiency on her tongue though, and it

> was a symptom that came and went. Now and then before she got

> pregnant she would get this small peeled scoop in the back of her

> tongue.

>

> Anyway, I'm not sure what my point is except to say that what we do

> is very challenging and we all rock, as they say.

>

> Laura

>

> , " "

> <@c...> wrote:

> > I have also heard of the geographic tongue as peeled in some areas

> and

> > thicker coating in others... Anyway are there 2 types of this

> tongue? One

> > that changes and one that is fixed? I have only seen the former...

> >

> > -Jason

October 29, 2004

From Dr. Greene's HouseCalls on .com

Geographic Tongue

Dr. Greene's HouseCalls have been a great help to me. Just finding out more

about

things I have questions about is informative and helpful to me with a

6-year-old, a

10-month-old, and a baby on the way. The information on ear infections has

answered lots of questions and eased concerns. Now, Dr. Greene, my daughter has

geographic tongue. What is that exactly and what causes it?

Cheryl Farrell

Clyde, North Carolina

Geographic tongue is a marvelous, descriptive name for one of the most common

medical conditions of the tongue. Parents usually are the ones to notice several

large,

red, slightly depressed, unusually smooth patches on the surface of their

child's

tongue -- when nothing was there hours before. Often the red areas are bordered

with distinct white bands. The sharp borders of these irregularly shaped lesions

give

the surface of the tongue the appearance of a map, perhaps a map of a group of

uncharted islands. The rather dramatic appearance of geographic tongue looks to

many like a burn, or like some kind of nasty infection.

How many parents must puzzle over geographic tongue? The exact prevalence varies

widely from study to study, but at any given time, somewhere between 0.1 percent

and 14.3 percent of otherwise healthy people have it. It has been found to be

present

in about 0.6 percent of Americans (Community Dental and Oral Epidemiology Aug

1994), about four percent of healthy Iraqi schoolchildren (Community Dental and

Oral

Epidemiology Aug 1982), and about 2 percent of young Finns (Oral Surgery, Oral

Medicine, and Oral Pathology, Feb 1982).

The healthy tongue is a mass of muscle fibers covered by a mucous membrane. On

the underside of the tongue, the mucous membrane is smooth. On the upper side,

the tongue is covered with many tiny protrusions called papillae. These papillae

come

in four types with different shapes. Three of these types contain taste buds;

the

fourth does not. This fourth type are called filiform papillae, and they are

packed

tightly together over the entire upper surface of the tongue.

For some reason, medical conditions of the tongue often have picturesque names

(such as " black hairy tongue " or " scrotal tongue " ). Most of these conditions are

abnormalities of the papillae, of one type or another. In geographic tongue, the

filiform papillae are missing in the reddish areas and are overcrowded in the

gray-

white borders.

We still do not know exactly what causes geographic tongue, but we do know that

it

strongly tends to run in families (Oral Surgery, Oral Medicine, and Oral

Pathology, Nov

1976). Geographic tongue has polygenic inheritance -- it is associated with

several

different genes. We also know that it is associated with a number of other

genetic

medical conditions.

It has been most closely linked to psoriasis, and is notably more common in

those

who have psoriasis (British Journal of Dermatology, Sep 1996). The two

conditions

have been linked to the same gene and are probably produced in the same manner;

nevertheless the great majority of those with geographic tongue do not go on to

develop psoriasis.

Geographic tongue is also significantly more common in people who are sensitive

to

the environment -- those with allergies, eczema, and/or asthma (Oral Surgery,

Oral

Medicine, and Oral Pathology, Aug 1984).

It is also four times more common in those with diabetes (Oral Surgery, Oral

Medicine, and Oral Pathology, Jan 1987). But a great many conditions are more

common in those with diabetes, and geographic tongue has never been noted as an

early warning of diabetes.

In young women with geographic tongue who are also taking oral contraceptives,

the

geographic tongue is worst on day 17 of the cycle (British Dental Journal, Aug

1991).

This suggests that hormone levels probably play a role. Perhaps there is even

some

truth to the unproven belief that stress can trigger geographic tongue.

Weaker links have been reported to anemia, seborrhea, and eating spicy foods.

Most people with geographic tongue are otherwise healthy. The condition is

usually

entirely painless. While it can produce a burning sensation in the mouth, this

is very

rare in children. If there is any pain or burning, this usually can be

successfully

controlled with antihistamines (Pediatric Dentistry, Nov 1992).

There is no loss of the sense of taste (hurrah for the glorious sense of

taste!), nor is

there any loss of the dexterity of the tongue. There is, however, a measurable

decrease in the tongue's sense of touch. This was studied by carefully assessing

response to mechanical vibration (Journal of Laryngology and Otology, Mar 1984).

Geographic tongue's rather spectacular appearance in the mouth has frequently

caused parents to worry. In the years since 1955, when the condition was first

described (Journal of the American Dental Association, Sep 1987), several

treatments

have been tried for geographic tongue. Topical Retin-A was the most successful

(Cutis Aug 1979). No treatment is currently recommended, however, for this

benign,

self-limited condition.

Geographic tongue heals spontaneously. The individual lesions often heal at the

same

time new ones are forming, changing the appearance of the tongue over hours or

days. This gives rise to the appearance that the map is migrating across the

face of

the tongue. Thus, geographic tongue is also called benign migratory glossitis.

Although benign, this condition may last for months -- or even longer -- and

often

recurs.

The same pattern holds true for the rare, but real variation -- geographic lip.

In the future we may know more about geographic tongue, what causes it, and why

it

recurs. In the meantime, Cheryl, you can rest assured knowing that even though

geographic tongue is spectacular in appearance, it will not harm your precious

daughter.

Alan Greene MD FAAP

January 26, 1998

Reviewed by Khanh-Van Le-Bucklin MD August 2000

> Just to be clear, (Ha!) I use the term geographic to mean a mixture of damp

and

peeled

> like a partially harvested forest while I use fissured to mean deeply cracked

like the

Grand

> Canyon. Some people seem to have fissured tongues as a genetic component that

does

> not reflect on a Yin Xu. This is my terminology (DT)... do others have a

different

> vocabulary for the two tongues?

>

> doug

>

> , " heylaurag " <heylaurag@h...>

wrote:

> >

> > Hi Jason,

> >

> > Did you hear of this tongue in the context as being non-clinically

> > significant? In other words, is your understanding that people with

> > a geographical tongue were just born with it that way and it means

> > nothing?

> >

> > The main thing that I want to be clear on is how to approach my

> > patient. He doesn't seem yin deficient at all, but his tongue looks

> > crazily yin deficient. I know that in the past he has benefitted

> > from using SI 3/UB 62 to treat his back from a former acupuncturist,

> > so maybe I should just stick with that. But he would like to be

> > treated with herbs, so I need to be more clear on his diagnosis.

> >

> > As we all know, sometimes the tongue and pulse can be misleading. I

> > have a patient I treated for infertility who successfully got

> > pregnant (yay!). Her diagnosis was yin deficiency, but you wouldn't

> > know it by the looks of her tongue (coated), nor by how she herself

> > looked (not at all thin, and not the least bit anxious).....until she

> > got pregnant. Once she was pregnant she became gaunt and her tongue

> > suddenly one week looked shockingly red and peeled.

> >

> > There was one clue to the yin deficiency on her tongue though, and it

> > was a symptom that came and went. Now and then before she got

> > pregnant she would get this small peeled scoop in the back of her

> > tongue.

> >

> > Anyway, I'm not sure what my point is except to say that what we do

> > is very challenging and we all rock, as they say.

> >

> > Laura

> >

> > , " "

> > <@c...> wrote:

> > > I have also heard of the geographic tongue as peeled in some areas

> > and

> > > thicker coating in others... Anyway are there 2 types of this

> > tongue? One

> > > that changes and one that is fixed? I have only seen the former...

> > >

> > > -Jason

October 30, 2004

Although in many TCM texts, geographical tongue is said to occur in Yin

Deficiency, especially in the aftermath of wen bing illnesses with high fever,

I've also seen it in conditions of parasites (jue-yin syndrome), in food

sensitivities/allergies, and in chemical sensitivity disorders. In cases of food

sensitivities or Food Stagnation, the geographic patches with bare tongue

coating can appear and disappear within several hours or days, depending upon

the person's diet. Also, exposure to environmental chemical toxicity can

sometimes create the same patterns on tongue.

In cases like these, it's important to do a complete health history before

jumping into herbal formulas. The TCM patterns are often complex, with multiple

syndrome combinations.

I've also seen it in people who claimed it was congenital, but in almost all of

these cases, the tongue appearance corresponded with at least several of the

factors I've mentioned above. (Perhaps an inherited susceptibility to these

factors.)

---Roger Wicke, PhD, TCM Clinical Herbalist