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Written by Scott Tamas
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Thursday, 19 March 2009 |
Observation of the Tongue
As the tongue is closely related to qi and blood of the Zang-fu, it is important to inspect the tongue for changes in the patient's health. The tongue has three main areas that need to be inspected: the lingual surface (top), the bottom of the tongue and the tongue coating.
There are two main ways of dividing the tongue for diagnosis. The first method, mostly used for diagnosing spleen diseases, is by dividing it into thirds. The front third (Shangwan), the middle third (Zhongwan) and the root of the tongue (Xiawan). The more common way to divide the tongue is by the regions that correspond to the Zang-fu organs. The tip of the tongue belongs to the heart and lung, the sides to the liver and gallbladder, the center to the spleen and stomach and the root to the kidney.
Methods for observing the tongue
Before observing the tongue make sure the room lighting is sufficient and a neutral color. Sunlight is the best for observations. It is often best to demonstrate how to stick out the tongue to a new patient who may not be familiar with the process. The patient should stick the tongue without using force. The tongue should not be held out for too long or there is a risk of the color changing.
First observer the tongue from the tip moving to the root, starting with the coating then move on to the body. Note that if the patient has eaten anything recently it may affect the tongue color. Sometimes the tongue coating will be too thick and need to be scraped off. Easily scraped off tongue coating that sits on the tongue instead of being rooted on, is an indication of deficiency of antipathogenic qi.
The normal Tongue
A healthy tongue is pale red (some might say pink) with a thin white coating and moist. It moves freely and is neither thick or thin. In smokers and drinkers the body is often slightly redder than usually and there can a slightly yellow tint to the coating.
Tongue body observations
Pale tongue -Manifestations: tongue paler than usual to very pale
-Indications: Cold syndrome and deficiency. This often occurs due to insufficient blood and qi or cold causing stagnation's in the meridians.
- qi deficiency: pale and tender tongue body with coating
- blood deficiency: pale white and slightly dry with little coating
- excess cold: pale white tongue with white, slippery, thick coating
- yang deficiency: pale often accompanied by flabby, tender body and moisture
Red tongue-Manifestations: tongue redder than usual
-Indiations: heat
- excess type heat the whole tongue is red, rigid, and corse with coating. Often seen in febrile diseases.
- deficiency type heat the tongue is red and delicate with little or no coating. Often from internal heat due to yin deficiency.
- red tip of tongue with prickles indicates heart fire
- red sides indicate liver and gallbladder heat
- often seen in drinkers
Crimson tongue-Manifestations: dark red color
-Indiations: extreme heat due to yin deficiency.
- often seen when disease penetrates he defensive qi and blood levels
- little or no coating, but glossy is called "mirror tongue" and indicates consumption of body fluids.
- dark and flaccid indicate consumption of yin fluid in the stomach and kidney.
- purple or with spots indicates stagnant heat.
Purple tongue-Manifestations: tongue is very dark red to purple color
-Indiations: Extreme heat and blood stasis or alcohol related
- deep red, dry with yellow coating indicates extreme heat
- purple and swollen tongue indicates alcoholism
- pale purple with a green-blue hue or delicate and moist indicates excess of yin cold stagnation in the blood.
Tongue shape
Rigid and tender-rigid tongue indicates excess and heat syndromes.
- pathogenic factors are hyperactive but qi doesn't decline
-markings on the sides of the tongue indicate cold and dificiency
-if flaccid must be deficiency syndrome
Swollen and thin-indicates retention of water-dampness or phlegm
-distended and large can indicate alcohol poisoning
-flabby and flaccid with tooth marks indicates spleen and kidney yang deficiency and retention of water dampness.
Thin tongue-deficiency of qi, blood or yin fluid
Cracked tongue-yin fluid, blood or qi deficiency
Tooth markings-deficiency syndrome, especially in the spleen
Thorny tongue-indicates intense heat penetrating to the defensive-qi and blood level
Tongue movement
Flaccid tongue-sever disease
-pale and flaccid indicates extreme deficiency of qi and blood
-deep red and dry indicates consumption of yin fluid by heat and exhaustion of yin in the liver and kidney.
Stiff tongue-often caused by heat in the pericardium and consumption of fluid.
-sign of windstroke, epilepsy or tetanus
Quivering tongue-often caused by exogenous pathogenic factors
-often from extreme heat producing wind
-often due to deficency of blood producing wind
Deviated tongue-wind syndrome
Shortened tongue-critical disease
-red and dry is often due to consumption of fluids or malnutrition of the meridians
-pale color with coating usually due to pathogenic cold in the muscles
-flabby with sticky coating is due to stagnancy of phlegm-dampness
Playing with the tongue-invasion of the heart by pestilence or heat in the heart and spleen
Tongue coating color
White coating-Indiations: Exterior, cold or dampness syndrome
- thin white coating is normal
- thin and dry indicates wind-cold
- thick, white and moist with pale tongue indicates excess cold
- thick, slippery and sticky indicate dampness and phlegm
Yellow coating-Indiations: Interior and heat syndromes
- the deeper the color the more sever the illness
- thin indicates exterior heat syndrome
- rigid, black-yellow and thorny indicates intense internal heat
- deep color and slipperiness indicate heat-dampness
Grey coating-Indiations: interior phlegm, cold or heat syndrome
- rough dry and thorny indicate consumption of body fluids by excessive heat
- thick, moist, slippery and sticky indicate interior cold and damp
Black coating-Indiations: Interior heat or cold syndrome
- black and moist indicate cold and edema caused by spleen and kidney deficiency
- dry and crimson tongue indicate exhaustion of body fluids due to extreme heat.
Tongue coating quality
Thick or thin-thin if can been seen through. Indicates the disease is mild
-thick if coating can't be seen through. Considered serious and interior
Dry or moist-moist tongue indicates fluids are not damaged
-dry tongue indicates body fluids are damaged by dry-ness heat.
Smooth coating-moist, has excessive fluid and has oily appearance indicates cold and dampness
Curdy coating-easily scrapped off and looks like soybean curd
-indicated undigested food or phlegm turbidity by stomach heat
Greasy coating-thick in the center, thin on the sides and hard to scrape off
-indicates retention of water, phlegm dampness, cold dampness or heat dampness
Geographic tongue-part of the center portion of the coating peels off
-indicates yin deficiency of stomach qi.
Coating without root-easily scrubbed off surface.
-indicates deficiency of antipathogenic qi and deficiency and cold syndromes
Coating with root-attached to surface and hard to scrub off
-indicates presence of stomach qi and excess syndromes Discuss Tongue Diagnosis at the Rising Phoenix forums |
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Last Updated ( Saturday, 27 February 2010 )
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