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 very essential and will provide some hints for the clinical and remedial diagnosis.
It is very easy to examine the tongue in a conscious patient. 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 on the chin 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 following aspects such as shape, size, color, moisture, coating, nature of papillae and the movements.
Appearance of tongue in some abnormal conditions
1. Hemiplegia: Deviation towards the paralyzed side.
2. Tremors: Nervousness, Thyrotoxicosis, Delirium tremens and Parkinsonisum.
3. 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 about 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 discoloration)
- Acute intestinal obstruction
- Hypovolumic shock
- Heat exhaustion
- Hyponatraemia (with hard reddish brown color)
- Central Cyanosis – Bluish discoloration
- Jaundice –Yellowish discoloration
- Advanced uraemia – Brown color
- Ketosis – Brown discoloration
- Riboflavin deficiency – Magenta color
- 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 plazues 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. Cause is unknown.
- Median rhomboid glossitis – Smooth nodular red area in the posterior mid-line 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 disappear 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 dorsum of the tongue. In tertiary syphilis Gumma is seen on the mid-line of dorsum.
- Tubercular ulcers: Shallow ulcers, often multiple and grayish yellow with slightly undermining margin.
- Herpes Simplex: Acute vesicular eruption.
- Carcinoma: Ulcers with everted edges and hard base.
- The Homeopathic Perspective
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 characterize the individual. That is why the individualization is the sole mean for 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 in to consideration along with other characteristic signs.
The peculiar appearance of tongue in some important remedies is discussed here.
a) Tongue is swollen and white coated.
b) Tingling on the tip.
c) Dryness with intense thirst.
d) Bitter taste of everything except water.
2. Ant Crud:
a) Tongue coated thick white as if white washed.
b) White furred appearance.
c) Cracks in the corners of the mouth.
d) Saltish saliva, loss of appetite and absence of thirst.
e) Desire for acids.
a. Tongue is fiery red, swollen, sore, raw, and with vesicles.
b. Feels scalded.
c. Red hot and trembling.
d. Stinging and burning pain with thristlessness.
e. Protrusion is difficult.
4. Arsenic alb:
a. Tongue is dry, clean and red.
b. Vesicles with stinging and burning pain.
c. Ulcerated with blue color.
d. Blackish discoloration.
e. The edges and the tip has got redness.
f. Shriveled appearance.
g. Gangrene of tongue.
h. Thirst for small quantity of cold water in shorter intervals.
a) Indicated in typhoid tongue.
b) Furred appearance with yellow dirty white coating.
c) Tongue feels scalded.
d) Red and shining edges.
e) Cracked and sore surface.
f) Fetid breath with bitter taste in the mouth.
g. Loss of appetite, can swallow liquids only.\
a) Tongue is swollen and painful.
b) The edges are red.
c) Strawberry appearance.
d) Dryness and heat in tongue.
e) Erect papillae.
f) Mouth dry as if glazed.
g) Great thirst for cold water, but dread of drinking.
a) Marked dryness of tongue.
b) Coated dark white, yellow or dark brown.
c) Lips parched dry and cracked.
d) Dryness with great thirst for cold water.
a) Yellowish tongue with imprint of teeth.
b) White furred with red edges.
c) Large and flabby tongue.
d) Bitter taste in the mouth.
e) Nausea and vomiting ameliorated by drinking very hot water.
9. Crotalus Horridus:
a) Tongue red and small but feels swollen.
b) Fiery red appearance.
c) Dryness in the center.
d) Smooth and polished appearance.
e.) Difficult to protrude.
f) Cancer of tongue with hemorrhages.
g) When protruding, goes to right side
a) White swollen and flabby.
b) Shows imprint of teeth.
c) Scalded sensation.
d) Fissures in the edges.
e) White furred tongue with bitter taste.
a) Tongue is red, dry and cracked.
b) It is stiff and immovable.
c) Protruded with difficulty.
d) Impaired speech.
e) Foams at mouth.
f) Leather like appearance of tongue.
g) Indurated and looks like burnt.
a) Tongue is swollen, red and dry.
b) Cracked at tip.
c) Trembling with difficulty in moving.
d) It catches on teeth.
e) Snake like protrusion is characteristic
a) Furrow in the upper surface length wise.
b) Heavy, thick with moist coating.
c) Feels as if burnt.
d) Ulcers with fetid odor from mouth.
e) Blackish discoloration and softness.
f) Moist mouth with great thirst.
g) Metallic taste in the mouth.
14. Muriatic Acid:
a) Tongue is pale, swollen, dry and leathery.
b) Deep ulcers with bluish red edges.
c) Feels longer.
d) Paralysis of tongue.
e) Hard lumps can be felt.
15. Natrum mur:
a) Frothy coating with bubbles on sides.
b) Sense of dryness and numbness with tingling.
c) Sensation of hair on the tip.
d) Mapped tongue.
e) Herpes on the tongue.
f) Red insular patches on the surface.
g) Loss of taste.
16. Nitric acid:
a) Painful pimples on the sides.
b) Clean, red and wet with center furrow.
c) Ulcers with splinter like pains.
d) Red shining splinter like pain.
e) Sensitive even to soft food.
f) Bloody saliva with fetor oris.
17. Nux moschata:
a) Very dry and adheres to roof of mouth.
b) There is no thirst.
c) Saliva looks like cotton.
d) Numb and paralyzed.
18. Nux Vomica:
a) First half clean and posterior half covered with deep fur.
b) White and cracked edges.
c) Bitter taste in the mouth.
a) Dry, red, clean, cracked.
b) Smooth as if varnished.
c) Breath is horrible.
d) Taste terribly fetid.
e) pus like taste in mouth.
a) Mapped tongue.
b) Covered with a white film, which comes off in patches leaving red spots.
c) Feels raw.
d) Bitter taste and bilious vomiting.
21. Rhus tox:
a) Red and cracked.
b) Coated except red triangular space at the tip.
c) Dry and red at edges.
d) Fever blisters around mouth.
e) Bitter taste in the mouth.
f) Desire for milk.