Evaluation of the Tongue

The tongue is the mirror of the body. Harmony and disharmony are reflected in the tongue’s color, moisture, size, coating and the location of abnormalities.

Healthy Organ Systems and a lack of External Pernicious Influences produce a healthy tongue, which is pinkish red, neither dry nor too wet, fits perfectly within the mouth, moves freely and has a thin white coating.

Imbalances in the Organ Systems and/or invasion by Pernicious Influences produce an unhealthy tongue. External Pernicious Influences produce changes in the tongue coating. Interior problems, such as Organ System or Essential Substance disharmonies, produce changes in the tongue body.

When examining the tongue, the Chinese medicine doctor looks at the color of the tongue body, its size and shape, the color and thickness of its coating or fur, locations of abnormalities, and moistness or dryness of the tongue body and fur. These signs reveal not only overall states of health but correlate to specific organ functions and disharmonies, especially in the digestive system. To evaluate the tongue accurately, always do the examination in natural light.

Tongue Body

The tongue body is a fleshy mass and has color, texture, and shape independent from the apparent qualities of the tongue coating. A pale tongue body indicates deficient Xue, Qi, or Yang or Excess Cold. An overly red tongue body indicates Excess Heat. A purple tongue indicates that Qi and/or Xue are not moving harmoniously and are stagnant. Pale purple means the Stagnation is related to Cold. Reddish purple is related to Stagnation of Heat. When the tongue is black or gray, it indicates extreme Stagnation; if black and dry, that indicates extreme Heat Stagnation; if black and wet, that indicates extreme Cold Stagnation. Bright red indicates Deficient Yin or Excess Heat. Dark red indicates Excess Heat. Cracks in a red tongue indicate Deficient Yin or Heat Injuring the Fluids. If the tongue is pale and cracked, there is Deficient Qi or Xue. Thorny eruptions of the buds on the tongue alert the doctor to Heat or Stagnant Xue.

Tongue Fur

The tongue’s coating is best described as moss or fur. It arises when the Spleen causes tiny amounts of impure substances to drift upward to the tongue. When the Spleen and stomach are in balance, there is a uniform density of fur, with a slightly thicker area in the center of the tongue. Thick fur indicates excess. Thin fur is related to deficiency during illness, but is normal if you are well. Fur that is wet indicates Excess Jin-Ye (fluids) and/or a Deficient Yang. Dry fur is a sign of Excess Yang or Deficient Jin-Ye. A greasy fur is a sign of mucus or dampness in the body. If the fur looks peeled off or missing, it reveals Deficient Spleen or Yin or fluids. White, moist fur indicates Cold. Yellow fur means Heat. However, white fur, resembling cottage cheese, points to heat in the Stomach. Gray/black fur with a red body is associated with extreme Heat; gray/black fur with a pale body is a sign of extreme Cold.

Size and Shape

The healthy tongue rests comfortably in the mouth. It is neither too small nor too large. If a tongue is enlarged and flabby, it indicates Deficient Qi. If, in addition to being enlarged and flabby, the tongue has scalloped (or tooth marked) edges, then it indicates dampness due to Deficient Qi or stagnation of fluids. If the tongue is enlarged and hard, it is a sign of Excess. If it swells so that it fills the mouth and is deep red, that means Excess Heat in Heart and Spleen are a problem. A small, thin tongue can indicate Deficient Yin or Xue.

Movement

A trembling, pale tongue indicates Deficient Qi. A flaccid tongue that is pale often reveals extreme Qi or Xue Deficiency. A flaccid tongue that is deep red reveals severe Yin Deficiency. A trembling, red tongue indicates interior Wind. If the tongue sits off-center in the mouth, early or full-blown Wind stroke may be present. A rigid tongue accompanies an Exterior Pernicious Influence and fever. This may indicate the invasion of the Pericardium by Heat and Mucus Obstructing the Heart Qi.

Location of Abnormalities

The location of disturbances on the tongue are vivid indications of where disharmonies in the mind/body/spirit are located. Certain organs are associated with the Upper, Middle and Lower Triple Burner, which are in turn associated with the front, middle and back sections of the tongue. For example, if there are red spots on the front third of the tongue, which is associated with the Upper Burner, this indicates that there is Heat in the Lungs. If the tip of the tongue is red, that indicates Heat in the Heart. Menstrual cramps, when associated with Stagnant Xue, are often accompanied by purple spots on the edges of the tongue in the Liver/Gallbladder area.

The Role of Tongue Diagnosis

Not all tongue irregularities are indications of disharmony, however. Food and drugs may change the coating or color of the body of the tongue. For example, coffee yellows the coating and Pepto-Bismol turns the tongue black.

Furthermore, some people have minor, unchanging cracks on their tongue, which are considered normal. Others are born with what is called a geographic tongue, which is covered with severe cracks and covered with hills and valleys. This is considered normal by some practitioners, but a sign of congenital disharmony by others.

The way a tongue appears is not an absolute indicator of the location of the disharmony, but when taken as part of an overall pattern that includes a complete evaluation, it offers strong clues to the location of disharmony.


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