Diagnosis Through Tongue

When a Chinese practitioner carries our his diagnosis through tongue session, he would take notes of the following:

  • Tongue colour,
  • Tongue shape,
  • Tongue coating, and
  • Distribution of cracks or spots.

It will often be necessary to cross-reference several or all of these aspects to establish a full picture.

It is, of course, difficult to judge what is abnormal unless you know what a normal tongue looks like. A child's tongue can usually be regarded as a normal tongue: it should be fresh pink, have an even and symmetrical shape, have no cracks or spots, and should be topped with a thin coating of moisture.

Obviously every tongue is different, but there are a number of clear abnormalities which can help to pinpoint an imbalance. You will learn to recognize these symtoms by practising diagnosis through tongue.

The colour can range from the palest pink to bluish tints, while changes to the normal shape include unusual thinness, swellings, indentations or apparent tooth marks along one side.

The coating is especially important as the relative moistness or dryness of the tongue can be a good indicator of Yin or Yang dominance.

The coating can also reveal the presence of Phlegm or Dampness. Monitoring changes in the tongue's appearance over time is more effective than trying to judge your health from an occasional quick look.

The Chinese regard the tongue as an internal organ, and believe that it reflects the health of the Zang-Fu organs. Therefore, diagnosis through tongue is a important process in Chinese medicine diagnosis.

How to look at your tongue?
... Diagnosis through tongue

If you are checking your health with diagnosis through tongue, do take note of the following:

  • Observe your tongue in natural daylight to get a true picture of the colour and the coating,
  • Open your mouth wide and stick the tongue out fully, but without straining, If the tongue is not relaxed, it will change the natural shape and colour.
  • Don't rush the session of diagnosis through tongue; it takes time to study the whole tongue. Note the position of any spots or blemishes.
  • Recent food, drinks, vitamins or medicines can change the colour of the coating, so wait at least an hour after taking any of these before carry out diagnosis through tongue.
  • Perform the diagnosis through tongue first thing in the morning, before you have brushed your teeth, reveals the coating in its full glory.
  • Smoking and drinking tea may well produce marked changes in the quality of the coating.

The color of tongue
... Diagnosis through tongue

Some points to note before the carry out the diagnosis through tongue are:

  • The tongue colour needs to be carefully considered, along with its shape and coating, to come to a diagnosis.

    It is not the normal shape of an individual's tongue that is significant, but a change in the shape of the tongue.

  • The colour of a tongue can vary from light pink to darker shades of red, sometimes verging towards blue. A pale tongue generally suggests some sort of Deficiency in the body, while a red tongue implies Heatlike an erupting volcano. Blue tints indicate Stagnation and the presence of Cold.

Tongues come in many colours (some of which may sound surprising to you) depending on their state of health: pink, red, red-purple, blue-purple and blue.

This can range from a slightly paler colour than normal, to almost white. A pale tongue is lighter than the fresh pink of a normal tongue. Generally, a pale tongue indicates a Deficiency This might be a Deficiency of Qi, Yang or Blood.

This signifies Heat. The area of the redness indicates where the Heat is located in the body, and the depth of the redness shows how much Heat is present. The deeper the red, the more advanced the Heat condition. Additionally, the presence or absence of a tongue coating tells us if the Heat is due to a Full-Heat condition (Yang Excess), or an EmptyHeat condition (Yin Deficiency).

This is a stage further on from the red tongue. Purple indicates Stagnation of the Blood, usually resulting from Heat damage to the Blood.

This is a stage further on from a pale tongue. Purple indicates Stagnation of Blood, usually due to Cold from a Deficiency of something.

This is a tricky tongue to recognize. In an acute disease or a life-threatening emergency, the tongue may become blue due to a lack of oxygen, but in chronic illness the tongue may have a slight blue tinge. This indicates long-standing Cold in the body, which has damaged the Yang energy.

Tongue Shape
... Diagnosis through tongue

A tongue can be long or short, and thin or swollen. Specific areas may be indented or swollen.

Gauging the overall shape of the tongue, and noting features in specific areas, the colour diagnosis can be refined. A swollen tongue reveals Qi and Yang are blocked, as if by a dam.

Swelling usually denotes a Deficiency of either Qi or Yang, or the presence of Heat. A Yang or Qi Deficiency will cause a pale, swollen tongue. If the tongue is normal or red-coloured, it indicates Heat.

A rolled appearance to the sides of a swollen tongue can show one of two things. Symptoms such as loose stools, tiredness and bloating reveal a Deficiency of Spleen Qi or Yang. If there are symptoms such as headaches, dizziness, anger or blurred vision, then Heat in the Liver is diagnosed

If the tongue is swollen with tooth marks along the sides, this clearly shows a Deficiency of Spleen Qi.

A thin tongue appears thinner than normal and even slightly shrunken. Thinness indicates a lack of proper Body Fluids; if the tongue is pale, Blood Deficiency is the problem; a red, thin tongue discloses Yin Deficiency. The tongue may also be dry.

Swelling in a particular part of the tongue indicates a problem with the organ related to that region. Swollen edges, for example, suggests a Deficiency in the Spleen, while a swollen tip can indicate a Heart problem. Swelling between the tip and central area suggests a Lung problem.

A depression or indentation in a particular area shows a Deficiency in the related organ. A tooth-marked tongue, sometimes called a scalloped tongue, can be due to Spleen Deficiency. If it is abnormally stiff, it may suggest a Heart problem.

A long, narrow tongue can indicate Heat and is also often red in colour. This tongue shape is frequently associated with Heat in the Heart and traditional Chinese Medicine theory would suggest a constitutional tendency towards Heart disease.

The tongue coating
... Diagnosis through tongue

The coating of the tongue gives an accurate report on the state of all the organs, but particularly the organs of digestion

When observing the coating, we are looking at the colour, thickness, distribution and texture of the coat. However, the coating can be affected by consumption of certain foods, drinks or medicines, so should not be inspected shortly after taking any of these. The tongue coating may reflect the presence of a pathogen in the body, which will usually be seen as Phlegm or Dampness. A normal, healthy tongue should have a thin, white, and slightly moist coating. This is produced as a natural by-product of the digestive process.

The colour of the coating reveals the nature of the problem (if any). A white coating indicates Cold, a yellow coating indicates Heat, and a dirty grey coating indicates Dampness or Food Stagnation.

The thickness of the coating lets us know how severe the problem is: the thicker the coat, the more Dampness or Phlegm is present.

The distribution of the coating shows the location of the disharmony in the body.

An absence of coating, known as a stripped tongue, shows a lack of proper Body Fluids due to Yin Deficiency, and usually occurs on a red tongue. If there is no coating present on the entire tongue surface, it denotes a serious Yin Deficiency. More commonly, small patches of the tongue lack a coating, indicating a Yin Deficiency in the organ related to that area.

A dry coating means that either Heat, or a Deficiency of Qi or Yang, is present (differentiated by other symptoms). A wet coating, which may be greasy and sticky, proves a Dampness due to Cold.

Cracks and spots on tongue
... Diagnosis through tongue

Many types of alteration to the normal tongue surface are possible, and the significance of these is determined by their type and location.

The Chinese view of cracks on the tongue is related to the tongue as an expression of the moisture levels in the body. In the same way as the tongue swells if there is Excess Water (or Heat) present, a lack of Body Fluids may cause it to become cracked. Think of the way a dried-up river bed cracks after a drought.

Cracks are actual cuts in the tongue. (This should be distinguished from the rumpled appearance sometimes seen in a swollen tongue, resembling skin that has been in water for a long time) Cracks can be found with or without a tongue coating, and their significances are combined if both are present.

The significance of cracks is determined by their depth and location. The deeper the cracks, the more severe or long-standing the condition. The location indicates the problem organ.

  • Ceneralized small cracks over the tongue:
    Dryness of the Stomach and maybe Deficiency of Spleen Yin.
  • Severe cracking:
    Deficiency of Kidney Yin.
  • Vertical cracks on the sides of the tongue:
    Deficiency of the Spleen Qi or Yang. These will most often be found on a pale tongue.
  • A vertical crack down the centre of the tongue shows up a problem with the Stomach, or Heart and Stomach, depending on the length of the crack. A crack that does not extend to the tip (Heart area) indicates a Deficiency of the Stomach Yin. If the crack extends to the tip, and especially if there is a forking at the end of the tongue, there will be emotional problems related to the Heart.

Spots on the tongue can be found in different locations and in various colours. The location determines the organ involved; the colour reveals the problem.

Red spots indicate Heat, purple spots indicate Stagnation of Blood, and pale spots indicate Stagnation of Qi. The size and number of spots, as well as the depth of their colour, tells us the severity of the disharmony.

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