Black coated tongue in integrative medicine: An alarm signal.

introduction In integrative medicine (IM), western medicine (WM) is associated with other non-conventional medicines, provided these are based on scientific evidence.1 All events are considered as part of the individual’s health/disease process, which includes physical, mental, emotional and environmental factors. Traditional chinese medicine (TCM) includes the inspection of the tongue as an important means for diagnosis and prognosis of disease.2 In WM, black coated tongue is associated with smoking, the use of medication such as antibiotics or corticosteroids, radiotherapy, or poor oral hygiene. It is considered a benign change resulting from decreased apoptosis of the epithelium on the dorsum of the tongue, with consequent elongation of the papillae and modification of the local flora, with an increase of fungi and chromogenic bacteria.3-5 Resolution is spontaneous, or involves removal while brushing the teeth and tongue.4 In TCM, however, it has another meaning. It demonstrates a state of internal heat2 with extreme decompensation of the internal equilibrium, with a tendency towards the emergence of diseases.2,6