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Deeply fissured tongue


Px is 40 y.o male.

Chief complain: he suffers from R + L sided pain around his scapula, moreso L. sided along the inferior border. Px is also very "stressed"

*Levator scapula/trapezius and most of upper back is very stiff.

Very dry/red eyes He also suffers from bloating/gas that feels better after he eats something. If he does not eat the pain gets worse along the intercoastals.

Px tends to be constipated.

Tongue: red and NUMEROUS DEEP FISSUED CRACKS all over tongue.

This is a "VERY CLOSE" and accurate depiction of the tonguie.

Pulse: L sided i could not feel anything.. I don't know if there is a bifurcation etc, but was non existant. R sided that wasn't an issue.

From what i've read those fissures are yin deficiency, and upon questioning he has had this since birth.

Overall I'm thinking more of a LV/GB disharmony b/c of the above symptoms with maybe qi stagnation in the LV. Any help would be appreciated!


How is his sleep? Any heat signs at night or otherwise (sweaty palms, etc.)? The tongue at least shows strong long term yin deficiency which can, of course, be hampered by liver stagnation, etc.


Sleep is good. Dry/red eyes and "chronic stress", constipation(which he remedies by metamucil), and overall "inflammed" tight clenching muscles(feels deep in the chest) seem to be the only heat signs he is exhibiting.

Px works 5 days a week at a labor intensive job, i.e. carrying lots of items overhead, etc. My treatments have thus far been aimed at dealing with his musculature/postural problems but I would prefer a more of an approach that reflects his chronic tongue condition etc.

Thanks for your time!


Well I think if you treat him locally as you are doing along with tuina and/or cupping to release the upper body you will do well. Constitutionally you can add in KD 6 and LU 7 - maybe HT 6 as well to help build the yin. I would probably have him take Liu Wei Di Huang Wan or Suan Zao Ren for about 3 months - perhaps a dinner dose and a dose before bed. Treating more constitutionally will not only help his feelings of "stress" but will help the body to nourish the dryness in the tissues which should help the body recover quicker with the physical strain of the work he his doing leading to less recurrences of pain.


from what you have said it is clear that:

1. Px has chronic stomach yin deficiency (since early childhood)

2. dry eyes suggest Liv yin deficiency - yang rising (if complains headache)

we know that the Qi originalis goes to

a) Lungs

b) stomach

Thus the treatment must consider:

1.tonification of Kidney yin: K6, K7, K3 GV4, CV4, Ub23 tone all on water side i.e. Left.Besides Lu7 sedation on right.,SI3 tone on Left and UB62 sedate on right - (taking care of constitutional imbalance. increasing supply of Yin)

2. Tonification of St yin: St36, CV12, SP6, Sp3 tone all both sides

3. plus extra ah shi point to be located between K9 and K10 and UB54 (behind Knee) tone all and UB10 sedation.this is route of Kid divergent meridian (on water side again).

You have not mentioned of his B.P. I expect it to be on higher side (pl. confirm)

4. Sedate TW6 and Liv3

5. Sedation of GV14 and tonification of ST12 can be cosidered in isolation for immediate relief !

the Px shoulud be asked to take rest for some time after treatment.

his diet must include juices and soups



Thanks for all the input and I will let you know how this turns out.

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