What's the cause of a "burning" sensation on my tongue?

Q. I am a 57-year-old woman and have been having a "burning" tongue for close to two months.

Initially, the "burning" sensation started at the tip of the tongue. Recently, the tip has also become dry and sticky, especially when I sleep on my back.

My urine is also warmer than usual, as if my body system has a lot of "heat". I still have bowel movements daily.

I have been going for weekly acupuncture for my stomach, which occasionally feels warm.

I also visited a doctor, who suspected my "burning" tongue may be due to gastric acid in the stomach. He prescribed me domperiodone and omeprazole.

The "burning" and stickiness have not gone away and seem to have spread slightly inwards from the tip and sides of the tongue. This problem has affected my sleep.

For breakfast, I eat two slices of oatmeal bread, oats with honey or cereal and an apple.

Lunch consists of noodle soup or porridge with green tea or herbal tea. For dinner, I eat rice with two types of vegetables and a meat dish, and drink green tea or herbal tea.

I also drink chrysanthemum tea with wolfberries daily to improve my dry eyes. My daily supplements include vitamin B complex, flaxseed oil, garlic tablets and hormonal balance capsules.

Is there anything I can do to improve my situation?

A. In traditional Chinese medicine (TCM), burning tongue syndrome is probably due to a deficiency in the heart, spleen, liver and kidneys.

In TCM, the heart controls the mind and blood. Blood and qi (energy) form the main foundation for mental activity.

If blood and qi are insufficient - due to ageing, anaemia or excessive worrying - it will create "heat" and "fire" in the heart, and trigger severe tongue pain, a dry mouth with a burning sensation, constipation with dry stool, depression and insomnia.

The spleen converts nutrients from food into blood and qi. When the spleen is weak - due to ageing, a weak constitution, chronic illnesses, a poor diet or alcohol consumption - it will convert the nutrients into phlegm and "dampness" instead.

When these accumulate in the body for a prolonged period, they will create blood stasis and "heat", blocking circulation of blood and qi.

This triggers pain and numbness on the tongue with breathlessness, palpitations, a bloated stomach, a poor appetite and fatigue.

When the spleen is weak, it can also weaken the kidneys and trigger pain at the base of the tongue, a burning sensation in the mouth, dry lips, hot flashes with night sweating and lower back ache.

The liver is responsible for the smooth flow of qi in the body. If the liver is weak - due to negative emotions, such as fear, stress, anxiety and depression - qi will stagnate in the liver and create "heat" and "fire" there.

These will trigger pain in the tongue, with bitterness in the mouth, a dry throat, distension around the ribs and a poor appetite.

Reducing 'heat'

Reducing 'heat'

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

Chinese medicine such as lophatherum herb, tree peony bark, spine date seed, golden thread, dwarf lilyturf tuber, rehmannia root, thinleaf milkwort root and red peony root dispel "fire" in the heart.

Safflower, peach seed, Chinese angelica, Sichuan lovage rhizome, milkvetch root, medicinal changium root and two tooth achyranthes root increase the amount of blood and qi, enhance blood circulation and strengthen the spleen.

Amur cork-tree, cassia bark, common anemarrhena rhizome and processed rehmannia root strengthen the kidneys.

Cape jasmine fruit, plantain seed, oriental waterplantain rhizome, baical skullcap root, Chinese gentian and Chinese thorowax root strengthen the liver and dispel its "heat" and "fire".

You should eat easily digested food, such as porridge, soup, fish, lotus seeds and vegetables to strengthen your spleen and produce more qi and blood.

Have small meals, especially at dinner time, to avoid indigestion.

Abstain from spicy and oily food, alcohol and smoking to reduce "heat" and "fire" in your body.

Avoid having negative emotions and do regular exercise - such as brisk walking, taiji and yoga - for half an hour daily to strengthen your qi and blood circulation.

Sleep early and have sufficient rest - from 10pm to 6am - to increase yin, which is linked to coldness and moisture, and reduce "heat" and "fire" in your body. Taking a short nap between 12 and 1pm will strengthen the heart and reduce "fire" there.

LIM LAY BENG
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic at The Adelphi

 Doctor says: Check for other possible causes

Doctor says: Check for other possible causes

The burning tongue condition is known in the medical field usually as burning mouth syndrome or glossodynia.

Typically the condition affects women who are close to, or have had, menopause.

Dryness in the mouth and loss of taste may be accompanying symptoms.

Like yourself, many other sufferers also experience various sensations associated with the stomach and with urination.

Other associated complaints include headaches, tiredness, irritability, anxiety and depression.

While acid regurgitation from the stomach could produce burning sensations in the chest or the throat, it is not likely to be a major factor in the burning mouth syndrome.

In any case, the fact that you did not respond to treatment with omeprazole is a point against the involvement of acidity, as the class of drugs to which omeprazole belongs, called the proton pump inhibitors, is highly effective in suppressing acid production in the stomach.

Sometimes, it is even possible that prolonged treatment with proton pump inhibitors could lead to a situation of rebound hyperacidity when this treatment is stopped.

A large number of causes have been implicated in the development of the burning mouth syndrome.

Those that are important to consider, because they have serious consequences for health, are autoimmune conditions, such as lupus, diabetes, thyroid hormone deficiency, vitamin B deficiency, and the use of certain blood pressure lowering drugs.

However, it is extremely rare to find any one of these diseases as the sole cause of the burning mouth. In the overwhelming majority, no specific cause is found.

Instead, the condition is likely to be due to a combination of factors, such as changes in the levels of certain hormones with menopause, depression, a low-grade infection in the mouth and minor nutritional deficiency.

Underlying causes

Underlying causes

I would like to share with you the experience of two patients whom I encountered.

Both are menopausal women, and both had tried proton pump inhibitor treatment to no avail.

One improved after I found that she had a mild intolerance to gluten and she stopped eating this.

The other patient had also suffered from disturbed sleep for years, and there was even a period of time when she lost her ability to taste food.

Eventually, I discovered that she had chronic hepatitis C infection which affected the liver.

After she completed her treatment and was cured of the hepatitis C infection, her burning sensation disappeared and her sleep also improved.

Understandably, patients with the burning mouth syndrome are frequently very frustrated.

Many, like yourself, turn in desperation to a wide variety of alternative therapy and health supplements.

I would expect that most sufferers already know it is best to stop smoking and drinking.

I note that your diet appears to be dominated by plant-derived food rather than meat.

For your information, vitamin B12 is found in most types of animal-derived food, but there is no reliable source of active vitamin B12 in plant-derived food.

As for your daily supplements, I would just caution that regulations for consumer products, such as food supplements, do not ensure that manufacturers have to fulfil the claimed quantity of the contents.

If you feel strongly that you may have a medical condition causing your burning tongue, then I would advise that you consult a dental surgeon first.

If there is no treatable cause found in the mouth, then you should talk to your doctor about tests to check on liver function, thyroid function and levels of female hormones, blood sugar, vitamin B12, folate and zinc. I would advise that you go for tests that are carried out at mainstream laboratories approved by the Ministry of Health.

DR GWEE KOK ANN
Gastroenterologist at the Stomach, Liver & Bowel Centre at Gleneagles Hospital and adjunct associate professor of medicine at National University of Singapore


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