Many of my new clients are a bit surprised when I ask them to stick out their tongues so I can examine it with respect to their health!  After many years of training in both naturopathy and also Chinese medicine, I have honed excellent diagnostic skills which gives me great insight as to what is going on with a patient.  While tongue diagnosis is a wonderful skill it takes many years of training and practice to master and is beyond the scope of this blog. Today, just for illustrative purpose I will discuss the most common tongue presentation and what it means.

A fissured tongue is the most common finding in an integrative examination of a client. A fissured tongue is also the most common oral finding in patients with psoriasis. Other names applied to the fissured tongue are scrotal or plicated tongue. Erythema migrans (geographic tongue) is often associated with fissured tongue as well.

Figure 1: Fissured tongue. Photo at left is courtesy of Alyse Shockey, ND, RDH. Photo at right is courtesy of Dr. Carolyn Bentley.

Additionally, certain medical disorders are associated with fissuring of the tongue such as Melkersson-Rosenthal syndrome (MRS) (consisting of a triad of components: fissuring, orofacial edema, and facial nerve palsy), Down syndrome, acromegaly, and Sjögren's syndrome. Electrolyte imbalances in saliva and mild hemolytic abnormalities have been noted as well (Eisen and Lynch, 1998). All of the above disease states can usually be eliminated as possibilities because of the strong clinical characteristics of each.

Intraoral findings: A chief complaint is that of malodor and discoloration associated with deep fissuring of the tongue due to the bacteria and food particles that become embedded in the grooves and cracks. The trapped particles may lead to inflammation and often cause discomfort/burning in the patient.

These more subtle patterns usually are noted during dental exams, and the health-care provider will offer reassurance to the patient that the condition is benign. In most cases, the tongue exhibits a central groove with smaller grooves radiating from the center line. Some practitioners view the fissuring of the tongue more as a sign of other underlying issues with the total body.

What do we know about the fissured tongue?

The literature suggests that the fissured tongue is relatively common. In fact, it's so common that it is not noted in many clinical exams. Both aging and local environmental factors may also contribute to the small and deep grooves that become noticeable.

A Holistic Approach: In Chinese medicine, the tongue is considered to be the window to total body health. A Chinese medicine practitioner will take a thorough lifestyle history, a medical history, and then the first element of the body that is examined is the tongue. Integrative medicine practitioners will link the tongue to other areas of the body such as the liver, heart, bladder, spleen, and intestines. Many such organs are associated with key areas of the tongue.

I usually advise patients regarding the status of the color, shape, thickness, and coating of the tongue with regard to their total health. I usually combine with pulse diagnosis.  A tongue details far more long term conditions than the pulse.  As with Chinese medicine and integrative approaches, the naturopathic practitioner views the tongue as exhibiting possible health issues that may need monitoring with regard to the total body.

If I encountered with a fissured tongue such as the example depicted in Figure 1. it would indicate to me that  long-term period of deficiency in the body similar to a period of drought over a mass of land had occurred. The ground will become extremely dry and start to crack. The tongue topography will look the same way. The deeper the cracks, the more chronic the condition of the tongue. The body is experiencing dehydration and long-term adrenal stress.

Typically, the tongue is swollen in this state and the pressure causes cracking. Usually swollen tongues will indicate digestive problems. Regardless, once the underlying issues have been addressed, the fissuring should begin to diminish. I have seen this often.

The color of the tongue is a useful tool for monitoring the improvements or possibly decline in a patient's condition. The tongue's body color helps determine chronic conditions, and the coating helps determine acute conditions. She correlates this with the patient who has flaming red gingiva vs. pale, pink tissue.  Flaming red tongues indicate heat in the body.  Mottled tongues will indicate which organs are being impacted by the inflammation.

I always counsel patients to address lifestyle factors that may be preventing the body's natural ability to heal itself.  pH, for one example is an important aspect in rebuilding and detoxifying the body. Since thiscondition has been chronic and has taken a long time to reach the current level found clinically, the patient must realize that the process of healing will take some time as well. She usually will suggest a "live food supplement" to make the content readily available to the body.

The most common items missing in the body are minerals, proper fats such as essential fatty acids (EFAs) and greens. The diet is extremely important, and the patient needs to increase fresh foods and water. Once the factors associated with lifestyle are addressed, the body will begin to heal on its own, and the fissuring will start to diminish.

Conclusions: Even though the fissured tongue is considered a benign condition with no treatment needed, the body is perhaps telling us something that needs to be addressed. Assisting patients in trying to determine some lifestyle changes that may be beneficial for total health is certainly something that we need to consider.

To heal conditions like this from a lifestyle perspective,  I am a firm advocate of decreasing your toxic world by cleaning up your environment and air quality. Many allergy sufferers will tell you that their health improved dramatically  when they removed carpeting, covered beds with "dust mite" proof covers, discarded old mattresses, and began to use a neti pot when needed to clear nasal passages. These factors often allow a patient to stop or reduce taking their daily allergy medications and begin to breathe clean air again. Dust and dirt need to be removed from our world, especially in areas where we sleep.

Then, fresh food sources instead of the processed foods that are commonly eaten can make a huge difference in our health. If you would not place an ingredient in your mouth, don't use it on your skin!

• If the label lists more than five ingredients, you do not need it!
• If your great grandmother would not recognize what you are about to eat, don't eat it!
• Do not buy your meals in the same place that you fuel your car!

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Taryn DeCicco, ND, LAc, LDN

Naturopath

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Arlington Heights, IL

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