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:
I. Movements:
1.
Hemiplegia: Deviation towards the paralyzed side.
2.
Tremors: Nervousness, Thyrotoxicosis, Delirium tremens and Parkinsonism.
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.
II. Moistness:
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:
Diarrhea
Later stages of
severe illness
Advanced uraemia
(with brownish discoloration)
Acute intestinal
obstruction
Hypovolumic
shock
Heat exhaustion
Hyponatraemia
(with hard reddish brown color)
III. 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
IV. Coating:
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
V. Papillae:
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.
VI. Ulcers:
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.
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. However, it should be kept
in mind that over-importance to one particular sign or symptom may not be
always correct. Hence, need not expect a mapped tongue in all Natrum mur
patients, and all patients with mapped tongue may not be Natrum mur!
[Synthesis >> Mouth >>
Mapped tongue: Ant.c, ars, cham, dulc, hydr,
kali.bi, kali.m, lach, lil.t, lyc, merc, merc.c, nat.m,
nit.ac, ox.ac, phyt, ran.s, rhust, sep, sul.ac, syph, TARAX, ter,
thuj, tub.]
The
peculiar appearance of tongue in some important remedies.
1. Aconite:
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. Anti 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.
3. Apis:
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.
5. Baptisia:
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.
6. Belladonna:
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.
h)
Stammering.
7. Bryonia:
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.
8. Chelidonium :
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.
10. Hydrastis:
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.
11. Hyoscyamus:
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.
12. Lachesis:
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
13. Mercurius:
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.
19. Pyrogen:
a)
Dry, red,clean,cracked.
b)
Smooth as if varnished.
c)
Breath is horrible.
d) Taste
terribly fetid.
e) pus like
taste in mouth.
20. Taraxacum:
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. Rhustox:
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.
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