Tongue

P50
Why tongue can reflect
the Zang-Fu organs
 The heart opens into the tongue,
 All Zang-Fu organs are directly or
indirectly connected with the tongue
through channel-collaterals and
channel-tendon.
 The essential Qi of Zang-Fu organs
flows up nourishing and moistening the
tongue, hence, the condition of the
tongue can mirror the state of Zang-Fu
organs.
What tongue examination
can do

Tongue invariably reflects

 The state of Yin-Yang and Qi-blood.
 The nature of the pathogenic
factor
 The progression and regression of
the disease
 The degree of heat and cold
 The depth of the pathogen
penetration
Relationship between tongue and
Zang-Fu organs
Method for observing the
tongue
Natural light shining directly into
patient’s mouth.
 Because of inadequate lighting may
confuse the vision and blur color
differences
Tongue should be relaxed and natural
flat.
 Tense protraction may deepen the
color of the tongue and moisten the
tongue surface
Something affecting the tongue should
be excluded.
Content of tongue
examination

Tongue substance
Muscular body of the tongue
Tongue coat
Moss-like layer which covers the
surface of the tongue
Normal tongue
proper in size,
light red in color,
free in motion,
and with a thin
moss-like layer of
white coat over
the tongue
surface
which is neither
dry nor too moist.
Tongue substance
 Color
 Form
 Movement
Color
 Pale tongue
 Red tongue
 Crimson tongue
 Purple tongue
1.Pale tongue
a less than
normally light red
tongue,
indicates
deficiency
syndrome,
or cold syndrome
due to
insufficiency of
Yang Qi.
Because of deficiency, the
insufficiency of Qi and blood fail to
nourish the tongue, thus a pale
tongue occurs, or because the cold
stagnates the meridians, the
tongue is also pale.
The color of the tongue is just like
people's complexion, will become pale
without the supply of nutrition.
Since Yang Qi is weak and fails to
produce enough blood, it may result in
deficiency of Qi and blood, and because
of the deficiency of Qi, the warming
action is failure, so it will give rise to
cold syndrome.
2.Red tongue
An abnormally
bright red tongue
Indicated various
heat syndrome.
The color of red
tongue like the
fire, give us the
symbol of heat,
so it indicate heat
syndrome.
3.Crimson tongue
It is more red
than red tongue
Indicates a severe
stage of febrile
disease in which
pathogenic heat
factor has
intruded into
nutrient blood.
Purple tongue
Purple tongue or
tongue with
purple spots
Indicates
stagnation of Qi
and blood.
After the trauma, the purple
phenomenon will present in the body
surface, prove some blood vessel or the
tissue is damaged, and thus cause
blood not to run smoothly in the part.
And Purple tongue indicate the
circulation of Qi and blood unsmooth in
the body, so it is the stagnation of Qi
and blood.
Form
refers to the shape of the tongue
body.
 Thickness
 Tenderness
 Other morbid changes
1.Enlargement tongue
The tongue body
is enlarged and
become bigger
than normal size.
Indicated
deficiency of
spleen Yang and
kidney Yang.
In the lesson of the state of Zang-
Fu organs, we know that spleen
and kidney control water
metabolism.
If the function of spleen and kidney
are out of order, water retention
will happen in the body, and reflect
in the tongue, and make the
tongue larger than normal state.
2.Swollen red tongue
Indicates
dampness-heat
brewing, up-
flowing of blood
with cardiac heat
and splenic heat,
or toxic heat
poisoning.
Difference between Swollen
red tongue and Enlargement
tongue

Common: the size of tongue are

bigger than normal tongue
Difference----color:
 the color of Enlargement tongue
is pale, it indicate cold syndrome
 the color of Swollen red tongue is
red, it indicate heat syndrome
3.Thin and small tongue
Indicates the deficiency syndrome,
including deficiency of Qi and blood,
and deficiency of Yin.
 +pale in color: indicates deficiency of
heart and spleen, insufficiency of Qi
and blood.
 +dry tongue with dark red color:
damage to body fluids by exuberant
fire of deficiency Yin.
Without nutrition supply,
everything in the body will become
smaller than normal state
including the tongue.
It indicate the deficiency of
syndrome.
4.Fissured tongue
Indicates
deficiency Yin
Body fluid and blood are belong to
Yin humor
The fissured tongue mirror the Yin
deficiency syndrome is same to
the earth without water
supplement.
5.Prickled tongue
Indicates heat in
the relative Zang-
Fu organs.
Tip-heart and lung
Side-liver and
gallbladder
The bearing of the tongue
(movement)

 Flaccid tongue
 Stiff tongue
 Wagging tongue
 Trembling tongue
 Wry tongue
 Contraction tongue
 Numbness tongue
1.Flaccid tongue
Weak tongue
unable to
protrude and curl,
a sign of extreme
deficiency of Qi
and blood, or
consumption of
Yin fluid.
It is like the limbs
can’t move
without nutrition
supply.
2.Stiff tongue
That is difficult to
move
Seen in case of
apoplexy
3.Wagging tongue
Marked by Indicates
sticking out the excessive heat in
tongue long and the heart and
relaxed, or spleen or an
extending it out omen of
and drawing it convulsion and
back frequently, poor mental
or licking around development
the lips as in the infants
case of febrile
diseases.
4.Trembling tongue
The tongue keep
trembling
unvoluntarily.
Deficiency of both
Qi and blood
5.Wry tongue
The tongue
reclines to one
side.
Indicates
apoplexy or the
omen of
apoplexy.
6.Contraction tongue
Contraction means a retracted
tongue unable to extend is a
critical sign in most cases.
It may be caused either by a
severe damage to Yin fluid by
extreme heat, or by cold
congealing the tendons and veins,
or by stagnation of phlegm-damp.
7.Numbness tongue
Numb and not Indicates the liver
free in wind stirs and it
movement. may carry the
phlegm upward,
mostly attributed
to blood
deficiency.
Tongue coat
Health: thin and
slightly white
tongue coat.
Is due to upward
fuming of gastric
Qi
Color of tongue coat
Morbid changes of tongue coat
are categorized as
 White
 Yellow
 Grey
 Black
in color
1.White color
Exterior syndrome
Cold syndrome

the pathogenic
factor has not
entered the
interior, the coat
shows no evident
changes, it’s fairly
normal.
2.Yellow color
Interior syndrome
Heat syndrome

When the pathogenic

factor has developed
from exterior to
interior, and that it
has transformed into
heat.
As we know, the food will become
yellow when they are cooked by
fire, from this sense, yellow coat
indicate heat syndrome.
3.Grey color
Interior syndrome
Heat or cold-
damp
4.Black tongue
Interior syndrome
Extreme heat or
extreme cold
It may be
development
from grey coat or
burned yellow
coat.
Conclusion
the more color
the more interior syndrome
The form of tongue coat
 Glossy
 Dry
 Thick
 Thin
 Unclean
 Peeling
1.Thin and thick
Thin tongue coat :
the underlying
tongue surface
can be seen
faintly.
Indicates minor
case with the
pathogen in the
exterior
1.Thin and thick
Thick tongue coat:
cover the tongue
surface fully.
Indicates the
pathogen is entering
more interior, the
case more severe;
retention of phlegm-
water, or turbid
damp, or
accumulation of
indigested food.
Application
Examining the thickness of tongue coat
may help to diagnose the severity of the
primary stage, the progression or
regression of disease.
Generally speaking, at the primary
stage, the tongue coat is mostly thin,
indicates a minor case with the
pathogen in the exterior.
Whereas a thick coat indicates the
pathogen is entering more interior, the
case more severe, retention of phlegm-
water, or turbid damp, or accumulation
If the tongue coat thickens, the
morbid condition is advancing
If the tongue coat thins, the
morbid condition is improving
2.Glossy and dry
Glossy tongue
coat: surface of
tongue contains
too much water
that can even drip
down when
showing the
tongue.
Indicates damp-
phlegm retention,
or cold-damp
accumulation.
2.Glossy and dry
Dry tongue coat: the
tongue surface is dry
and looks rough.
Indicates damage to
Yin fluid by
exuberant heat as
can be seen in
exogenous heat
syndrome, or failure
of fluid to reach the
upper body because
of Yang deficiency.
Application
Glossy Dry
Because of too Because of too
much water little water

The morbid condition of body

fluid is well reflected from glossy
and dry tongue coat
3.Greasy and dreggy
Greasy tongue coat:
the tongue surface
covered with a sticky
grainy coat which is
fairy thick and
slippery and not easy
to scrub if off.
Indicates laten
phlegm-damp,
failure of Yang Qi to
disperse turbid
damp, retention of
phlegm-water,
warmth damp
3.Greasy and dreggy
Dreggy tongue coat:
more thick and soft
with bigger granular
looks like bean curd
dregs, very easy to
scrub it off.
Indicates stagnation
of food in the
stomach, turbid Qi
steaming upwards,
accumulation of
phlegm-damp.
Peeling coat
Peeling coat appears
peeling interspersed
in the tongue
surface.
Indicates both the
stomach Yin and
stomach Qi are
impaired.
The coat come from
the upward fuming
of gastric Qi.