Won Institute of Graduates: Acupucture Program
Tongue Diagnosis-Acs 530 Dr. Cao Wei 2012
Observation of Tongue
A. The Relation between Tongue and Viscera Spleen, Stomach, Kidney, Liver, Heart, and Lung
Heart meridian, Spleen meridian, Kidney meridian, Liver meridian, Bladder meridian, and Triple Jiao meridian.
Spleen and Stomach: liquids and essence are closely related to Spleen qi and Stomach qi
Heart: blood circulation and speech communication are controlled by Heart qi Kidney: Kidney channel ascends to the tongue and ends at its root
Liver: Liver channel reaches the tongue B. Significance of Tongue Inspection
Tongue Body: to exhibit conditions of five zang-viscera, indicating the qi and blood of the viscera and the deficiency or excess of genuine-qi and severity of disease. (tongue body color and tongue body shape)
Tongue Coating: to show conditions of six-fu-viscera, indicating the cold or heat (nature) of evils and the location (depth) of disease.
Tongue Spirit (shen): to observe the tongue’s vitality, referring to the qualities of brightness, sheen and vitality.
The Method of Observation of the Tongue
The Topographical Tongue and the Zang-Fu Organs
Root of tongue (lower-jiao), Middle of tongue (middle-jiao), Tip of tongue (upper-jiao)
Root of tongue –Kidney (Bladder), Middle of tongue - Spleen (Stomach), Tip of tongue – Heart (Lung), Margins of tongue – Liver (Gallbladder)
Four Important Factors: Light, Posture, Diet, False Factors Normal Tongue
A normal tongue is of proper size, soft in quality, free in motion, slight (pale) red in color, luster, and a thin layer of white coating which is neither dry nor over moist, with root. (vein underneath the tongue are not distended).
Contents of Tongue Diagnosis I.Tongue Texture (Body, Proper)
Tongue Spirit: a. Flourish; b. Withered Tongue Body Color
• Pale-red • Pale • Red • Crimson • Purple
Tongue Shape and Mobility • Rigid and tender
• Swollen and thin • Cracked
• Tooth markings • Thorny
• Flaccid (Atrophy) and stiff • Quivering (Tremor)
• Deviated • Moving • Shortened 1.
舌神 Tongue Spirit (Vitality, Shen)
- A general Impression (the qualities of brightness, sheen and vitality) Flourish of Tongue - “Have spirit”
2.
舌色 Tongue Body Color
– To reflect primarily the state of the yin organs and blood, to show conditions of heat or cold and of yin and yang deficiency
Pale Red Tongue - Normal - Mild disease
Pale Red, w/ Pale Edges Tongue – Spleen qi deficiency, Stomach yin deficiency Pale Tongue
- Deficiency (qi or blood deficiency, or yang deficiency) yang deficiency-wet
qi or blood deficiency-dry - Cold
Pale Withering (dry) Tongue -Blood deficiency
Pale and Swollen (w/ teeth-printer) Tongue - Deficiency syndrome, especially deficiency of Spleen (Spleen qi and Spleen yang, accumulation of dampness) Pale & Thin Tongue – Spleen qi deficiency, Liver blood deficiency
A pale tongue w/ normal shape & coating – slight deficiency of Lung & Spleen qi Pale Tongue (Indications)
Pale and slightly wet: yang deficiency Pale and slightly dry: blood deficiency Slightly pale: Qi deficiency
Pale on the slides all along edges: Liver blood deficiency
Pale on the sides in central section: Spleen (qi) & blood deficiency
Pale without coating: deficiency of qi and blood; sever Liver blood deficiency Self-study: “Atlas of Chinese Tongue Diagnosis” pp 35, pp117
Red, Crimson Tongue
- Heat (exterior or interior, excess or deficiency) The deeper red is, the extreme heat is.
w/ coating w/ root - Excess-heat
w/o coating, or only partially, or w/ rootless coating – Deficiency-heat Red Color at the Tongue Tip - Hyperactivity of Heart fire
Red Tongue in Bilateral Margins -Extreme heat in the Liver and Heart
Red Points along the Edges and at the Tips –Internal Heat, Heat in the Liver & Heart
Crimson Tongue with Prickles – Excess heat
Deep Red Tongue No Coating: Mirror- Like Tongue - Extreme heat, consumption of yin fluid (Kidney yin deficiency)
Crimson w/ Cracked Tongue Yellow, Sticky & Dry Tongue Coating - Damp-heat in the qi system
- Intense heat damages body fluid
Crimson Tongue w/ Gray-Black, Dry Tongue Coating - Extreme Heat
- Impairment of yin Red Tongue (Indications)
Red tongue with coating: Excess-Heat
Red tongue without coating: Deficiency-Heat Normal tongue without coating: Blood deficiency Red points on the tongue:
- Tip area: Heart fire - Both sides: Liver heat - Centre area: Stomach heat - Front sides: Lung heat
- Root area: Damp-heat in the Bladder
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 64, pp106, pp72, pp76,, pp125, pp126, pp158
Purple Tongue –Blood Stasis Pale Bluish Purple Tongue
- Blood stasis (excess of yin due to yang deficiency, stagnation of blood) Reddish-Purple Tongue - Extreme heat in Yin & Xue stage; - Blood stasis
Purple Spots Tongue - Stagnation of blood Purple Tongue (Indications)
Red Purple (reddish-purple) tongue: Extreme heat and blood stasis
Pale Purple (bluish-purple) tongue: Extreme yin cold and stagnation of blood Purple areas on the tongue:
- Both sides areas: Liver blood stasis - Tip areas: blood stasis in the Heart - Centre: blood stasis in the Stomach
Self-study: “Atlas of Chinese Tongue Diagnosis” pp193 Summary I Tongue Body Color
To Reflect primarily the state of the Yin organs and Blood
Summary I Tongue Body Color (Continued)
• Pale-Red Tongue Normal color of the tongue body; Mild disease • Pale Tongue Deficiency; Cold
• Red Tongue Heat (Excess type and deficiency type)
• Crimson Tongue Extreme heat; Hyperactivity of fire due to yin deficiency • Purple Tongue Extreme Heat and blood stasis; Extreme yin cold and
stagnation of blood 3.
舌的形 质 Tongue Shape (Form of the Tongue Proper) – To reveal primarily conditions of deficiency or excess, to add more information to that gleaned from observation of the tongue body color.
A.Rigid and Tender - To differentiate the deficiency and excess Rigid Tongue – Excess; -Heat
Tender Tongue – Deficiency; - Cold;
B. Swollen and Thin - To indicate qi, blood and body fluid, water-dampness Swollen (Corpulent) Tongue - Retention of water-dampness; - Phlegm Thin Tongue - Deficiency syndrome (qi & blood deficiency, yin deficiency) Self-study: “Atlas of Chinese Tongue Diagnosis” pp 35, 51
C. Cracked Tongue - Insufficient yin fluid, blood deficiency, or health person - Excessive heat, consumption of yin (red tongue color)
- Deficiency of blood (pale tongue color)
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 71, 72, 74
D. Tooth Markings - Deficiency syndrome, especially deficiency of the Spleen Swollen Tongue w/ Tooth-Print - Qi deficiency; - Yang deficiency (accumulation of dampness)
No Swollen Tongue w/ Tooth-Print - Spleen deficiency;
- Qi or qi & blood deficiency
E. Thorny (Red Points & White Points) Tongue - Intense heat Red Thorny Tongue & White Star Tongue
- Different heat in the different zang organs (different thorny tongue area) Self-study: “Atlas of Chinese Tongue Diagnosis” pp212, pp219,
4.
舌的 动态 Tongue Mobility – To show that the disease is rather severe (wind syndrome, heat syndrome, and severe diseases)
A. Flaccid (Atrophy) Tongue: Severe disease - Deficiency of qi and blood
- Yin fluid consumption due to heat, exhaustion of yin in the Liver and Kidney B. Stiff Tongue
-In the febrile disease, heat into the Pericardium - A sign of windstroke, epilepsy or tetanus. C. Quivering (Tremoring) Tongue
- In febrile disease, extreme heat producing wind D. Deviated Tongue
- Wind syndrome, mostly seen in windstroke accompanied with deviation of the eyes and mouth
E. Shortened Tongue
- Critical stage (heat, cold, phlegm, deficiency) F. Playing with the Tongue: Critical Sign
- In febrile disease, invasion of the Heart by evil - Heat in the Heart and Spleen
- Infantile convulsion, or children with congenital mental deficiency Self-study: “Atlas of Chinese Tongue Diagnosis” pp182, pp183
5.
Sublingual Vein (Hypoglossal Vessels) – To observe deficiency or excess, cold or heat, especially in blood stasis
Normal:
Two veins are barely visible and have a very faint. Pale-red colour. Diameter <2.7mm. Length<3/5 of tongue tip to bottom. No spot.
Thick, Dark and Swollen & Purple Dark, Distended, and Diffuse Varicosity - Blood stasis Summary II Tongue Body Shape and Mobility
To reflect primarily conditions of Deficiency or Excess
To add more information to that gleaned from the tongue-body color Summary II Tongue Body Shape and Mobility (Continued)
Tongue Body Shape
• Rigid and tender: to differentiate of deficiency and excess • Swollen: phlegm or dampness
• Thin: deficiency syndrome • Cracked: blood or yin deficiency • Tooth markings: Spleen deficiency • Thorny: intense heat
Tongue Body Mobility
• Flaccid (Atrophy): severe disease, lack of body fluid, blood deficiency
• Stiff: mostly in febrile disease, internal wind, blood stasis, severe yin deficiency • Quivering (Tremor): deficiency (qi, blood, yang, or body-fluid) in chronic disease,
internal wind in exogenous disease or alcohol intoxication • Deviated: wind syndrome
• Moving: Liver-wind
• Shortened: critical sign, severe yang deficiency or severe yin deficiency •
II.Tongue Coating
Thick coating: Excess & Lack of coating: Deficiency---The strength of the genuine qi White coating: Cold & Yellow coating: Heat ---The nature of diseases
Tip of the tongue: Exterior of the body (Yang) & Middle and posterior third of the tongue: Interior of the body (Yin)--- The location of diseases
1.
苔色 Tongue Coating Color- To yield a differentiation of the nature and severity of a disease A. 白苔 White Coating White Coating - Exterior syndrome - Cold syndrome
- Dampness syndrome (mild)
Thin White Coating - Normal tongue coating; - Exterior syndrome Thick White Tongue
- Excess-Cold syndrome - Cold-Dampness syndrome - Phlegm
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 230, 231, 234, 237, 238 B.
黄苔 Yellow Coating Yellow Coating
- Interior syndrome - Heat syndrome Pale (Light) Yellow Coating
- Exterior Heat syndrome
- From exterior cold changes to heat, or exterior syndrome to interior syndrome The deeper yellow the color is, the more severe the pathogenic heat is.
Deep Yellow Coating - Interior heat syndrome; - Damp-Heat syndrome Black Yellow Coating (Brown Coating) - Interior intense heat syndrome
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 231, 232, 235, 236, 237, 239 C.
灰苔, 黑苔 Gray Coating, Black Coating Gray Coating
- Interior syndrome: Interior heat, Interior cold - Retention of phlegm syndrome
Black Coating: Critical sign
- Interior heat syndrome - Interior cold syndrome Gray-Black Coating
- Extreme Heat syndrome; consumption of body fluid Black, Thick, Greasy, Dry Coating (Red Tongue, Pale Sides)
– Retention of Phlegm-Heat, -Excess Heat
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 239, 240 Summary III Tongue Coating
To reflect primarily the state of the Yang organs, especially of the Stomach To reflect conditions of Deficiency and Excess
Summary III Tongue Coating (Continued) White Coating • Exterior syndrome • Cold syndrome • Dampness syndrome Yellow Coating • Interior syndrome • Heat syndrome Gray Coating
• Interior syndrome, including interior heat and interior cold • Phlegm-Retention syndrome
Black Coating
• Interior syndrome, including extreme heat or extreme cold, Critical condition 2.
质苔 Tongue Coating Quality
A. Thick or Thin - To differentiate the depth and severity of a disease Thin Coating - Mild disease; - Located superficially
Thick Coating - Serious disease; - Located in the interior B. Moist or Dry - To understand the condition of the body fluids Moist Coating - Normal tongue; - The body fluids are not damaged Slippery (Smooth, Wet) Coating
- Cold (yang deficiency) - Dampness (water retention)
Dry Coating - Insufficiency of body-fluid due to heat; - Depletion of yin C. Curdy and Greasy (Granular, Sticky Mouldy)
- To diagnose the condition of turbid dampness in the Spleen and Stomach Sticky (Greasy) Coating
- Retention of turbid damp - Phlegm
- Retention of food
Self-study: “Atlas of Chinese Tongue Diagnosis” pp 234, pp235 Granular (Putrid, Curdy, Mouldy) Coating - Tofu-Like
- Excessive yang-heat steaming the turbid qi up Mouldy-Purid Coating
- Upward of turbid qi, Stomach qi damaged - Retention of turbid phlegm
- Retention of food D. Exfoliated (Peeling) Coating
- To diagnose the condition (sign) of consumption of qi & yin of Stomach No coating: Mirror-Like (Glossy) Coating; Critical sign
- A sign of exhaustion of Stomach yin - Severe damage of Stomach qi
Peeled Off Coating in the Center of Tongue -Deficiency of Stomach qi & yin
Peeled Off Irregularly: Geographic (Map) Tongue - Deficiency of Stomach qi & yin
Summary IV Tongue Coating Quality
• Thick or thin: the depth and severity of a disease • Dry or moist: the condition of the body fluids
• Curdy and greasy (granular and sticky): the condition of turbid dampness in the Spleen and Stomach
• Exfoliated (Peeled) coating: the insufficiency of Stomach-qi or body fluid • Wax and Wane: the state of the genuine-qi and evil, and the prognosis of the
disease
Summary IV Tongue Coating Quality (Continued)
Greasy (Sticky) Coating: Dampness or Phlegm (cold or heat)
Slippery (Smooth) Coating: Cold (yang deficiency) and Dampness (water retention) Granular (Curdy, Mouldy) Coating: Retention of food, Phlegm with Stomach yin damage, Turbid qi.
Special Tongue
Black, Hairy Tongue – Retention of damp-heat, Fluids injured by antibiotics -A fungus infection
Combining Consideration of Tongue Body (Proper, Texture) and Coating The Correlation Between the Tongue Body (Proper) and the Tongue Coating
1. To combining the spirit, color, shape, and quality of the tongue body with the color and quality of the tongue coating
2. The indications are the sum of both Common Tongue Pictures and indications
Tongue Proper (Body) Tongue Coating Indications
Pale red Thin, white Wind-cold exterior syndrome
Normal tongue picture
Pale Thin, white Yang deficiency,
Deficiency of both qi and blood
Thin, white, with peeling in the center
Deficiency of both qi and blood, Insufficiency of Stomach yin
Yellow, greasy Weakness of Spleen and Stomach, Retention of damp-heat in the interior
Gray, black Internal cold due to yang
deficiency,
Retention of phlegm-dampness in the interior
Without coating Yang deficiency in chronic disease, Deficiency of both qi and blood
Pale red or red tip of the tongue (Red tip) white coating Wind-heat exterior syndrome, Hyperactivity of heart-fire
White, thin Exterior syndrome due to
exogenous pathogenic factors
White, greasy Retention of phlegm-dampness,
Retention of food
White, curdy Retention of phlegm and food,
Retention of heat in the Stomach
White, thick Damp-heat at the initial stage, or abscess of internal organs
White, dry Exhaustion of body fluids and
dryness of blood, Constipation
Red White Febrile disease penetrating
from defensive system to ying system gradually
Thin, yellow Excessive heat in the qi
Yellow, greasy Damp-heat in the qi system
Yellow, thick Inward transmission of pathogenic heat,
Formation of interior excess
Without coating Deficiency of both qi and yin
Crimson Deep yellow Heat in the stomach and Intestines,
Interior heat system of excess type
Black, dry Impairment of yin due to
extreme heat
Without coating Penetration of heat into xue system, Hyperactivity of fire due to yin deficiency
Green-blue (Purple) Yellow, dry Exhaustion of yin and blood,
Stirring up of deficiency-fire
White, moist Extremely severe internal cold, Stagnation of qi and blood
Tongue Changes in Deficiency of QI, Blood, Yin and Yang Qi Deficiency:
• General qi deficiency-pale tongue
• Spleen qi deficiency-pale tongue w/ tooth marks, or swollen/ partially swollen on sides or in the center section
Blood Deficiency:
• General blood deficiency- pale and dry • Liver blood deficiency-pale on sides Yin Deficiency:
• General yin deficiency- red tongue w/ lack of coating
• Stomach yin deficiency-red tongue w/ no coating in the center
• Lung yin deficiency-red tip tongue w/ no coating in front third section • Kidney yin deficiency- red tongue w/ no coating all over the tongue with red
tongue body Yang Deficiency:
• General yang deficiency - pale tongue w/ moist coating • Heart yang deficiency – pale tongue with white thin coating
• Spleen yang deficiency – pale and swollen, tooth marks tongue body, white and slippery tongue coating
• Kidney yang deficiency – pale, swollen tongue body w/ white/black slippery tongue coating
Tongue Changes in Four Level (Phase) Differentiation Diagnosis Wei (Defensive Phase)
Slightly red tongue on the sides/front Qi Phase
Red tongue with dark yellow coating Yin (Nutrition) Phase
Red tongue without coating Xue (Blood) Phase
