Actually, you don't need to take medicine Try to adjust your diet. If your tongue coating is yellow and greasy, it is damp and hot. You can eat more foods that can get rid of damp heat, such as green leafy vegetables such as melon, and eat less peppers and meat. Fruits can be bananas and pears, and apples can be flat fruits. If the tongue coating is white and greasy, be sure to keep your appetite, and don't eat cold food such as ice cream.
If you feel indigestion after eating, or have no appetite, it means that your spleen and stomach function has been affected to some extent. You can eat some white rice porridge first, which is very nourishing!
If you still feel uncomfortable, or want to take some medicine, you can take Sijunzi Pill (Chinese patent medicine), which is also good for restoring spleen and stomach function and benefiting qi.
As a part of tongue diagnosis in traditional Chinese medicine, tongue coating has been studied for more than two thousand years. As for its mechanism, China ancient books think that "the generation of tongue coating is closely related to the function of human viscera and the changes of qi and blood", which is "disharmony between viscera and spleen and stomach fumigation". Modern medical research shows that the formation of tongue coating is related to general nutritional status, local blood flow, autonomic nerve function, saliva quality and acute inflammatory stimulation. In this paper, the modern research on several common abnormal tongue coatings is reviewed.
First, the direct factors of tongue coating.
The normal tongue coating is a thin white coating, which is composed of keratinized trees differentiated from filiform papillae, exfoliated epithelium, saliva, bacteria, food residues, oozing white blood cells and so on. (3).
(1) The imbalance between the proliferation and differentiation of tongue epithelium and keratinization;
Under normal circumstances, the metabolism, growth, proliferation, differentiation and keratinization of the tongue epithelium remain relatively balanced. Some systemic or local lesions affect the blood supply and nutrition of the tongue tissue, and the physiological characteristics of the tongue mucosa change, and the proliferation, differentiation and keratinization of the epithelium are unbalanced, resulting in pathological tongue coating.
1, thick coating: excessive hyperplasia of tongue epithelium, accumulation of keratinocyte layer. Electron microscope showed that the epithelial cells were filled with glycogen particles, indicating that the proliferation rate of epithelial cells was accelerated. Keratinocytes are connected by finger-like processes and more desmosomes, making them firmly connected; The number of spinous membrane particles and the excretion of contents increased obviously, which increased the adhesion between cells and delayed the shedding.
2, greasy fur: the density of filiform papillae increases, and the branches of keratinized trees between papillae increase, which are intertwined and not easy to fall off; All kinds of adhesion between nipple and surface, such as food residue, keratinization and shedding, increase.
3. Keratinization: With the decrease of the number of keratinized layers, the intracellular tension microfilaments in each layer of tongue epithelium are obviously reduced, and no typical granular cells are found, suggesting that the keratinization process is blocked; The decrease of membrane particles indicates the decrease of cell adhesion; The above factors lead to the atrophy and flattening of some filiform papillae of the tongue and the exposure of the tongue.
4. Yellow fur: the tongue epithelium updates slowly, the degree of incomplete keratinization increases, and the filiform papilla is prolonged.
5, black moss: black moss section can be seen that the filamentous nipple becomes longer and darker. Keratinized layers are stacked in scales or tiles, with many molds, bacteria and cell fragments in between. The unstained film shows that the filamentous papilla is loosely twisted by a large number of brown-black keratinocytes, with a wide top and a wide bottom.
(B) the spread of dominant flora
Weng Hounian and others made cytological and bacteriological observations on 566 cases of various tongue coating smears, and found that all kinds of tongue coating smears contained a large number of bacterial components except rot coating and flower coating. In contrast, cell components are not as rich as bacteria, so it is considered that various microorganisms with strong reproductive ability are the main components of tongue coating (4).
1, thick moss: bacterial content increased. Weng Hounian detected the bacterial distribution density of 107 cases of tongue coating shedding. Among them, the distribution range of G- cocci, diplococci and G- bacilli in thin white envelope, white thick envelope+,yellow thick envelope++and yellow thick envelope+++is small (4). In addition, acid-producing bacteria in the mouth can create an acidic environment and lead to the formation of thick fur.
2. Stripping: Zhang Zefang investigated 262 inpatients' tongue coating fungi, and found that the detection rate of Candida albicans in different tongue coatings was 45.46% for flower stripping and 7.89% for thin white coating, with statistical significance (5).
3. Yellow moss: Henan Medical College and other studies believe that the color of moss is related to the color of dominant colonies, and there are significant differences between gray-white and gray-yellow colonies in the formation of white moss and yellow moss. The quantitative analysis of bacterial culture of 156 cases of tongue coating in Sun Yumin showed that the second dominant flora was Carnivora carinii (33.63%) in thin coating and Pharyngococcus flavipectus (29.33%) in greasy coating. This shows that the yellow coat has a certain relationship with the pigments produced by dominant bacteria.
4. Black quilt: mostly related to mold infection. Some people think that mold produces brownish-black to black pigment, which darkens the tongue coating. Some people think that putrid bacteria act on the necrotic tissue on the tongue mucosa to produce sulfur dioxide, and then combine with hemoglobin or substances contained in iron-containing microorganisms to form FeS deposits, which make the tongue coating black.
(III) Inflammatory infiltration and exudation of white blood cells Yuan analyzed the tongue lines of 52 cases of healthy thin white fur and 135 cases of pathological tongue fur, and found that the average number of white blood cells was 4.86, 4.07, 0.79 and >: thick fur > thin white fur once. The color of moss is not only related to the colony of dominant moss, but also related to the number of white blood cells. White fur is mainly composed of lymphocytes, and yellow fur is mainly composed of neutrophils.
Systemic and local factors affecting the formation of tongue coating
Thick moss:
1. Fever infection: Fever is one of the important causes of tongue coating thickening. Dickinson believes that fever may increase the metabolism of the body, increase the blood flow of the tongue, and lead to tongue nipple hyperplasia; In addition, the body loses water, saliva decreases, and the self-purification function of the tongue disappears, forming tongue coating. Dan thinks that the optimum temperature for yeast growth is 465438 0℃. With the increase of body temperature, the propagation speed of yeast increases exponentially, and moss accumulates on the surface of tongue.
2. Autonomic nerve dysfunction: Zhou Xiaoqing et al. tested the autonomic nerve balance index of 183 cases of different tongue coatings. The results showed that thick yellow coating and thick white coating were larger than normal thin white coating, suggesting that thick coating had active sympathetic system. Its mechanism: when sympathetic nerve is excited, the viscosity of saliva increases, which leads to the thickening of tongue coating; Emotional stress increases the acidity of oral cavity and digestive tract, while Neisseria meningitidis is easy to reproduce in acidic environment; Excessive stimulation of the autonomic nervous system or the reflection of gastric dilatation can make the blood vessels of the tongue contract, and this relative ischemia flattens the epithelium on the surface of the tongue, resulting in tongue coating (1).
3. Visceral function: When the digestive system is dysfunctional or declining, the nutrition of the epithelial cells of the tongue coating is blocked and the metabolism is abnormal, resulting in changes in the tongue coating, decreased taste and thickening of the tongue coating.
4. The self-cleaning function of the tongue is weakened: the self-cleaning function of the tongue includes chewing, speaking, saliva secretion and other factors. Chewing food is accompanied by swallowing activity, which has a rubbing effect on the tongue and promotes the removal of tongue coating. Fever, dehydration and nervous disorder reduce saliva, reduce food intake or soft food after illness, reduce mechanical friction of tongue, reduce self-cleaning effect and thicken tongue coating. Tian Zhong and others studied the changes of tongue picture after operation, and found that the tongue coating did not change in those who did not have abdominal surgery and fasted for less than 1 day, and white thick greasy coating appeared in those who had abdominal surgery and fasted for more than 3 days.
5.PH change: The saliva PH value of patients with yellow or white tongue coating is significantly lower than that of normal tongue coating. Its mechanism: in acidic environment, the free increase of hydrogen ions is beneficial to the mutual attraction between positive ions in intercellular space and negative charges at the end of sugar chains on the surface of cell membrane, which increases the adhesion between cells and forms thick fur. -
6, others: smoking and drinking can make the tongue coating thicker, and drinking has a greater impact on the tongue coating than smoking. Mouth breathing often has tongue coating. It was explained that the increase of air circulation accelerated the reproduction of yeast.
(2) removing moss
1, vitamin deficiency: Many patients with lingual papilla atrophy have vitamin deficiency. As an important coenzyme of cell redox, vitamin deficiency will lead to the disorder of intracellular oxidation and energy metabolism, and make the lingual papilla atrophy. Some scholars believe that the growth of yeast needs vitamin B. Without this vitamin, yeast can't reproduce without moss. It has also been reported that vitamin E, as an antioxidant, is related to atrophy of tongue papilla.
2, the reduction of trace elements: zinc deficiency can cause atrophy of tongue papilla. Chen's detection of saliva elements of different tongue coatings showed that the contents of zinc and iron in saliva of patients with tongue coating shedding were significantly higher than those of normal patients with thin white coating. Saliva is one of the ways to excrete zinc and iron in serum. Abnormal excretion leads to the lack of zinc and iron in the body. Zinc can antagonize the increase of free iron and increase it. Zinc and iron are related to the synthesis and activity of various enzymes in the body. Lack of zinc and iron can lead to disorder of oxidative metabolism of tongue epithelium, failure to mature normally, degeneration and necrosis, and formation and shedding.
3. Mental factors: vegetative nerve balance index, light peeling, flower peeling, yellow thick coating and white thick coating are normal, suggesting sympathetic nerve activity, peeling, thick coating and thin coating.
4.ph change: The ph value of saliva of patients with exfoliation is higher than that of normal people. It may be that the alkaline environment in the mouth will weaken the adhesion between cells, which is conducive to the formation of shedding.
5. Others: Anemia affects intracellular respiration, and digestive tract dysfunction hinders the absorption and utilization of essential nutrients, leading to atrophy of tongue mucosa. Other factors such as chronic stimulation of alcohol, surgery, cardiovascular disease and tumor.
(3) Yellow moss: Various factors cause local filamentous papilla hyperplasia and local pigmentation.
1, fever, infection: fever causes dehydration of the body, the self-cleaning function of the tongue is weakened, the filiform nipple is prolonged, local inflammation exudation and the action of microorganisms form yellow fur.
2. Digestive dysfunction: it leads to abnormal metabolism of tongue epithelium and thickening of tongue coating, which becomes a good culture medium for microorganisms, and the color production of local microorganisms is also one of the reasons for yellowing of tongue coating.
3. Deposition or adsorption of reflux substances in the digestive tract: These substances are mainly digestive products of animal food, such as sulfur dioxide, products of abnormal state of the body, such as inflammatory products and metabolites of pathogenic bacteria, such as toxins. The degree of yellow fur is directly proportional to the amount of reflux.
(4) Black moss: It is generally a manifestation of aggravation and deterioration of the disease.
1. Prolongation of filiform papillae caused by various reasons: such as high fever, dehydration, acute and chronic inflammation, toxin stimulation, dysfunction of central nervous system, etc.
2, local coloring; The source of black component is ⒇, which is considered to be the proliferation and color-producing dyeing of mold or other color-producing microorganisms. Others believe that it is due to the chemical reaction of hemoglobin, protein crumbs or tobacco disintegration products.
Third, other studies on the mechanism of tongue coating:
(1) cytochemistry; Wu Zhengzhi et al. made a qualitative and quantitative study on G-6pdh, LDH \ MDH \ ANAE, ACP, -SH, RNA in 7 cases of17, and thought that the cytochemical changes of tongue coating epithelium may be the internal cause of tongue coating formation in different pathological states (2 1).
(II) Immunology: Ma Bolong et al. conducted experiments on 30 cases of normal tongue coating and 98 cases of abnormal tongue coating, showing that the lysozyme content in the abnormal tongue coating group was significantly lower than that in the normal group, while the siga and IgG contents were significantly higher than that in the normal group, indicating that the body's immunity was very active during the formation of abnormal tongue coating (22). Another scholar studied the immune response in the formation of tongue coating from the level of erythrocyte immunity.
(3) Serology: Zhang et al believe that the formation of thin yellow fur, thick yellow fur, thick white fur and greasy fur is related to the normal or low serum gastrin content (23). It is also reported that the lower the exocrine function of the pancreas, the thicker the tongue coating. Different cyclic nucleoside CAMP, CGMP and their ratios can cause different tongue coating.
Four. Tongue coating and diseases
(1) TCM syndrome differentiation observation of tongue coating: Because tongue coating is closely related to TCM syndrome differentiation theory, the appearance of a certain coating color in clinic may represent a certain syndrome type of TCM, and may also prompt a certain treatment method (1). Observing tongue coating also plays an important role in nursing medication and diet (24).
(2) Diagnosis and differentiation of diseases by combining traditional Chinese and western medicine: that is, a coating is related to a certain stage of the disease (tongue is the same as reference).
1, acute abdomen: such as intestinal obstruction, white fur shows simple incompleteness; White thick greasy fur is mostly complete; White, yellow, thick and greasy fur is mostly bizarre; Gray-black moss is mostly strangulated dehydration acidosis (1).
2, digestive tract tumors: esophageal cancer is yellow and greasy, intestinal cancer is white and greasy, and gastric cancer is mostly flower peeling (3).
3. Hepatitis: The liver function of thick greasy coating is unstable (acute hepatitis, active chronic hepatitis), but that of thin coating is relatively stable (25).
4. Cardiovascular diseases: In the early stage of acute myocardial infarction (within 24 hours), 43.98% people may have red oval or oblong flat patches in front of their tongues, which are dry and lack of body fluid (26). Hypertension is divided into stages: the first stage is thin yellow fur, the second stage is white greasy fur, and the third stage is yellow greasy fur (27).
5. Metabolic diseases: Diabetic patients (red tongue) often have thin and dry tongue coating and central atrophy of tongue nipple (3). -6, neuropsychiatric diseases: With the improvement of treatment, the thick greasy coating of schizophrenia patients can gradually turn into white thin coating (28). -7. Early pregnancy diagnosis: 88% may have slippery fur (60% tongue is dark) (29).
Verb (abbreviation of verb) conclusion
Studying tongue coating, learning from the holistic thinking of traditional Chinese medicine and combining traditional Chinese and western medicine are helpful to clinical diagnosis and treatment. The formation mechanism of tongue coating is related to many internal and external factors, and the research field is broad, and the theory needs to be further improved.