TCM clinic: White coating on tongue may mean deficiency in the heart, liver

Q. I am a 20-year-old man. For many years, I have had a white coating on my tongue.

Every day before I sleep, I brush my teeth and sometimes use mouth wash. In the morning after I wake up, there is a white coating on my tongue.

I have bought a tongue scraper from the pharmacy to scrape away the coating. That removed some of it but my tongue is still not red or clean. When I remove the coating at the end of the day, it is sometimes yellowish.

This coating makes my tongue feel heavy, gives me bad breath and makes me feel thirsty frequently. Also, I feel that my tongue is very dry. Sometimes in the toilet, I even use my fingers to try to remove the coating but to no avail.

I have been to a traditional Chinese medicine (TCM) practitioner, who prescribed medicine for me. But I did not feel any better after I finished it.

I heard from others that the white coating is formed because of a problem with my digestive system. Is this true? How do I solve this problem?

A: In TCM, your condition is probably due to a deficiency in the heart, liver, spleen and stomach.

Observation of the tongue is part of the process of arriving at a diagnosis. Indicators include the shape, colour and features of the tongue, as well as the colour and thickness of its coating.

In TCM, a normal tongue is one that is light red or pinkish, with a thin, white and moist coating.

You have described your tongue as dry and not red, with a coating that is thicker than normal and yellowish in colour.

In TCM, good circulation of adequate blood and qi (energy) is required for good health. A pale tongue indicates insufficient qi and blood or "coldness", while a purplish tongue means poor blood circulation.

If the tongue coating is thicker than normal, it indicates external or internal pathogenic (disease-causing) factors, such as "dampness", phlegm or food accumulation, obstructing the stomach and spleen.

In TCM, the stomach receives and digests food, while the spleen transforms nutrients into blood and qi.

When both organs are weak - due to a weak constitution, tiredness and a poor diet such as that of cold, spicy and oily food - nutrients will be transformed into phlegm and "dampness" instead of qi and blood.

This will increase the stickiness of the tongue coating. The stickier the tongue coating, the "damper" the stomach and spleen.

In addition to a thick tongue coating, the patient will have white phlegm or mucus, abdominal pain, diarrhoea, a yellowish complexion and fatigue.



A yellow and dry tongue coating indicates "heat" in the body. The deeper the colour, the higher the level of body "heat".

Internal "heat" - due to keeping late nights or accumulation of "dampness", phlegm or undigested food in the body for a prolonged period - and external pathogenic factors, such as "heat" and "dryness", can dry up body fluid. This causes the yellow and dry coating on the tongue, bad breath and thirst.

In TCM, the heart is closely linked to the tongue.

When the heart is weak - due to excessive thinking, worrying and insufficient qi and blood - it will create "heat" and "fire" in the heart, which will dry up body fluids. On top of a dry and yellow tongue coating, it will also lead to a dry throat, ulcers, palpitations, insomnia and mood swings.

The liver regulates the circulation of qi. When the liver is weakened - due to negative emotions, such as anxiety, anger or depression - qi will stagnate in the liver, creating "heat" and "fire", which will dry up the body fluid and weaken blood circulation.

This will trigger a dry and yellowish coating with abdominal pain, loose stool and mood swings.


Chinese herbal medicine, acupuncture and cupping therapy (placing heated cups on the skin to enhance qi and blood circulation) can help to improve your condition by strengthening the organs and dispelling the pathogenic factors.

Chinese medicine such as cablin patchouli herb, millet sprout, germinated barley, coix seed, white hyacinth bean, Indian bread, largehead atractylodes rhizome, milkvetch root and medicinal changium root strengthen the stomach and spleen.

Lophatherum herb, spine date seed, dwarf lilyturf tuber, golden thread, thinleaf milkwort root, baical skullcap root and rehmannia root dispel "heat" and "fire" in the heart.

Tree peony bark, dried tangerine peel, villous amomum fruit, cape jasmine fruit, Chinese gentian, Chinese thorowax root, white peony root and red peony root strengthen the liver.

You should take many small meals instead of heavy ones. Abstain from alcohol, smoking, caffeinated drinks and spicy, oily, raw, cold food. Instead, take easily digested food, such as porridge, fish, barley, vegetables and fruit.

Maintain good mouth hygiene. Avoid stress and negative emotions, exercise regularly and sleep early and sufficiently, from 10pm to 6am.

Ms Lim Lay Beng
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic at The Adelphi

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