Tongue Diagnosis in TCM: Acid Reflux

0:01 hello today I would like to comment on a recent Facebook post I came across in a group dedicated to acupuncture this post describes a clinical case what compelled me to make this video is the fact that in this post a practitioner discussed all aspect of this case from the position of Western diagnosis and the use of enzymes Western drugs and many other things but very little attention was directed at differentiating this case in terms of Chinese medicine pattern diagnosis I find it very unfortunate because uh the power of Chinese medicine

0:46 lies in its ability to break down complicated syndromes into pattern diagnosis this is how we solve complicated cases we solve patterns one by one or a few at a time that's what makes Chinese medicine so unique we can use proven methods and strategies created by generations of practitioners who lived before us and we can do it with excellent results provided we have correct diagnosis any complicated disease can be broken down into pattern diagnosis and only by treating these patterns can be h to achieve meaningful uh clinical

1:33 results and so allow me to present this case to you I regrouped some of the facts um from the original post to uh make it more accessible first of all to me and hopefully to the rest of the listeners and so we're dealing here with a man whose Chief complaint is a progressively difficult swallowing over the past two years this patient has a sensation of something stuck in the throat there is a a suspicion that he has a Alp or the silent reflux uh indicated by throat inflammation coughing after eating and swallowing difficulties uh there is also shortness

2:19 of breath during eating and the patient has cold hands uh the practitioner says that the patient exhibits syndrome symp similar to raino syndrome so I presume he has cold hands and most probably feet as well I need to clarify that anyways he also has a small hiatal hernia and weakness of the epiglotis uh as observed during barium swallow test swallowing becomes difficult after three bites requiring water with every bite or um after every swallow the patient has a stutter and is

3:04 described as socially awkward which may suggest a neurological um angle medically he tried broad spectrum enzymes and specific enzymes without any noticeable results and he was also prescribed pantoprazol which helps uh to reduce shortness of breath after eating um doctor is also prescrib um to test um the assumption that um his difficult difficulty swallowing has a psychological component and this treatment did not produce good results um um he was also prescribed uh an herbal formula Bania H

3:54 poan and he tried it for one month without any noticeable change um there were also alternative therapies and relief measures um that he used sound therapy with occasional relief would definitely help with was Garling with baking soda and uh swallowing exercises did not uh produce any help now let's see what his tongue would tell us now I always follow the same protocol when I describe a Tong this protocol helps me to avoid jumping to conclusions or missing any diagnostic Clues I always start with the quoting of

4:42 the tongue then I uh describe its moisture then I uh look at the shape of the tongue its color then I look at the texture of the tongue and finally I look at the sublingual veins unfortunately in this case I don't have the image of the sublimal veins but let us take a look at the closeup of this Tong I also advise you to change the background to um this gray color because then it will help you to better understand true colors of the tongue CU in the context of uh red lips um and other things you may not notice the true colors especially when it comes

5:28 to new so uh let's take a look at the coating uh we can see that the coating is actually pale yellow it's thick and greasy we can already tell there is flam dampness accumulation but there is also an element of heat because the color of the tongue is not white it's yellowish um in terms of moisture of the tongue we can see that the body has uh uh the body of the tongue is moist especially closer to the tip and it tells us that um um this person has difficulty transforming fluids when it comes to the shape of the tongue there are four features we need

6:16 to be aware of number one this is a long tongue and so we can say that excess of Yi is thrusting up and out uh and you so from the root of the tongue which represents the bottom of the body it goes all the way up but at the same time we don't see much of the narrowing of the sides of the tongue so Yi does not burn up the fluids meaning there is no Yin deficiency however the tip of the tongue is red and therefore we are definitely dealing with heat in the heart as part of this presentation next I would like you to take a look at

7:03 the elevated edges of the tongue uh and they come with teeth marks now this is a tough call but I tend to think of this Tong as as as of this uh sign as a liver stagnation however it's not very pronounced um according to the um the this tongue image I mean the image of the tongue is not screaming at us liver stagnation uh and especially if you look at the third feature which is teeth marks on the sides of the T there is a clear indication of splin CH deficiency with dampness accumulation we can also

7:51 see uh the fourth feature which is a depression in the anterior third of the tongue a sign of Lungi or long Chi deficiency the Gathering Chi next we can look at the color of the tongue overall this is a pink tongue pink color however we have a red tip already mentioned that and also there are red edges of the tongue so there is hard fire but there is also heat in the liver that would explain the neurological component a little bit better the texture of the tongue we can see irregular creases in the middle third of the tongue and so we have

8:36 underlying stomach in deficiency these creases are send to the proximal third of the tongue meaning stomach in deficiency is drawing from the kidney resources now let's put it all together the sensation of something stuck in the throat the inability to swallow is called plumet chii this term describes a condition where a person feels a sensation of something stuck in the throat but without an actual physical abstraction the feeling can come and go and it is often associated with an

9:23 emotional stress or psychological tension in Chinese medicine plum Chi is generally considered uh a manifestation of liver Chi stagnation hence we often observe emotional components as part of this clinical case the tongue indicates uh and if you look at the tongue it indicates the presence of liver CH stagnation however in this case liver CH stagnation progresses into liver heat as the sides of the tongue are red liver stagnation can also affect the spleen and create flam which compounds the sensation in

10:09 the throat again we have evidence of splin deficiency and dampness accumulation as evidenced by teeth marks on the sides of the tongue we can also observe the evidence of flam a thick slippery greasy coating however its color is slightly yellow as sign that flam is turning into heat hence B hang that was prescribed to this patient does not work although this is the main formula to treat plumet Chi and it does not work because it's a warming formula and in a situation where heat already is building up this formula would only make things worse therefore

10:56 the first step um if I were to treat this patient I would consider releasing liver CH stagnation that turns into heat and I would start with uh with the formula if you are to um treat this person with standard prade formulas I would start with G sh ya g means um with flavors two flavors xia Yao Sun plus two extra herbs this is the formula prescribed in cases of constrained liver G with flingy deficiency that transforms into heat this formula should have a positive effect on the heart heat as well um as

11:44 the heat in the heart is most likely transferred from the uh liver and uh the herb Jud treats liver heat but it also would treat heart heat as well um now for the flam accumulation I would actually prescribe when done Tong um that would be the um formula that deals with flame heat and is specifically um it is it specifically treats stomach flam heat it would be very beneficial to treat acid V flux next I would consider addressing lung ch deficiency with

12:32 buong in the initial phases of the treatment I would focus primarily on regulating Chi and transforming flam adding only modest amounts of chi tonics because Chet tonics generally produce heat in the later stages once flam is transformed and heat is cleared I would focus my attention on building ch and also building back stomach and kidney Y and so this concludes my presentation for this case and traditionally I always say if you have uh a health issue and U I would like to send me a picture of your tongue to know what your tongue

13:19 tells and you don't hesitate to contact me I'll be very happy to speak about your tongue next thank you and I will see you next time and