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.

Tongue

● Observation

Observation(Observation of the Tongue )It is believed that people’s outer appearance is closely linked with their internal organs. If there is something wrong with the internal organs, such changes will be reflected in people’s expressions and appearance. Therefore, doctors can analyze the changes of internal organs by observing the outer appearance.

● Auscultation and Olfaction

By the methods of auscultation and olfaction, doctors try to diagnose diseases by listening to the sound of the patients and smelling the odor of excreta released by the human body.

By listening to the sound of the patients, doctors cannot only detect the changes of the organs related with sound, but also changes of the other internal organs. The sounds include: speech sound, breathing, coughing, hawking (clearing the throat noisily), and belching.

Also, doctors can smell the odor released by patients. It is believed that when viruses attack the human body, people’s internal organs and blood will be affected, thus making their body fluid and excreta release a bad smell.

Pulse Diagnosis

● Interrogation

By interrogation, doctor will talk to the patients or someone who knows about the disease (to get the information about how the disease occurs, how it develops, its current symptoms, and how it is treated). This method is useful when there are no obvious symptoms from the patients’ outer appearance. In this case, interrogation will help the doctors to get the information they need. Also, by interrogating, doctors can obtain other indirect information related with the disease, such as the patients’ daily life, working environment, food preference, and marital status.

Pulse Feeling ● Pulse Feeling and Palpation

Doctors use the method of pulse feeling and palpation by touching or pressing the patient’s pulse. It is believed that changes inside the body are reflected by the changes of the pulse activity. Sometimes doctors press the skin of a certain part of the body to identify the nature and the severity of the disease inside the body part.

green-inspection of complexion

It indicates cold syndrome, pain syndrome, stagnant blood syndrome and infantile convulsion. A green-blue color signifies obstructed meridians and stagnation of qi and blood. If there is grayish blue complexion with cyanotic lips, it usually pertains to the insufficient heart yang and stasis heart blood. Infantile high fever with blue or cyanotic complexion which is especially noticeable between eyebrows or on nose and around mouth, it usually suggests the omen of convulsion.

white-inspection of complexion

It suggests cold syndrome and deficiency syndrome (loss of blood or qi). White is the manifestation of insufficient qi and blood failing to nourish the body. The pale complexion with puffiness is usually due to deficiency of yang and qi which could not enable qi and blood to go up to face. Pale complexion with emaciation is usually due to insufficiency of blood. The bluish white complexion is usually due to yang deficiency with exorbitant cold, or massive bleeding. The sudden appearance of pale complexion with profuse cold sweating is usually due to yang-qi collapse.

Inspection of complexion

It suggests heat syndrome. Red is the color of blood. Heat accelerates blood flow and makes the vessels filled up, so the skin presents red color. The excessive heat syndrome is manifested by full flushed face which generally represents the yang-qi being stagnated in the exterior. If the red complexion accompanied by tidal fever and delirium, it suggests the excessive heat accumulating in the interior. The vacuity heat is shown by hectic cheek. Postmeridian reddening of the cheeks pertains to the deficient fire flaming-up due to yin deficiency in the chronic disease.

Inspection

Inspection: Inspection is one kind of examining method which is applied to knowing the condition of disease by means of doctor’s visual sense to look over the vitality, color, figure, posture of patient’s whole or partial body and the changes of the figuration, color, texture and quality of the patient’s discharges.

Auscultation-olfaction

Auscultation-olfaction

Interrogation

Interrogation: Interrogation is to know the onset, development, treatment, present symptoms and other information of disease by questioning patient or the accompanying people for diagnosis.
Palpation

Palpation

Fright

Thought

Thought

Improper food and drink

Improper food and drink

Overstrain and over-ease

Overstrain and over-ease

Overstrain and over-ease refer to over-working and over-resting. Normal work and physical exercise can help the circulation of qi and blood, which can promote health. Necessary relaxation can dispel tiredness and restore physical and mental strength. However, excessive work or rest is not healthy. Long periods of mental or physical over-exertion, excessive sex, or living without doing any work or physical exercise can lead to diseases.

Etiology of tcm

Six excesses are a general term for six kinds of exopathogens: wind, cold, summer-heat, dampness, dry and fire. Under the normal conditions, they are called six qi. They are six different climatic changes in the natural field. Six qi is the conditions that everything grows. In general they are not harmful. The six normal qi cannot easily make man diseased. Six qi that cause man to be ill are called six excesses.

Wind

Etiology of tcm

Wind is the main qi in spring, but there is wind in four seasons. The wind in the natural field, is shapeless, light and floating, good at moving and always changing. When wind, the natural climate, causes a disease, it is termed wind evil. The external invasion of wind evil usually enters the body from skin, hair and ji-cou (interstices of the flesh), so that external wind syndrome results.

Cold

Etiology of TCM

Cold is the main qi in winter, but it can also be seen in other seasons when temperature rapidly decreases. The cold weather in the natural field is mainly manifested at cold air, storage of everything, water being difficult to evaporate, things being not easily erosive and animals rolling up and sleeping quietly with skin and hair contracted, etc. When cold, the natural climate, causes illness, it is called cold evil. The diseases caused by cold evil are divided into injury of cold and cold stroke. The one that cold evil injures skin surface and depresses defensive yang is called injury of cold; that cold evil directly attack the interior of the body and injures yang qi of the viscera is called cold stroke.

Summer-heat

Etiology of TCM

Summer-heat is the chief qi in summer and formed from fire and heat. When summer-heat (the natural weather) makes one ill, it is called summer-heat evil. Summer-heat to cause diseases is obviously seasonal, i.e., summer heat is only seen in summer, chiefly after the Summer Solstice, and before the Beginning of Autumn.

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 is 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. It 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.
Evaluation of Body Language-Styles of Movement, Posture and Self-Presentation
Seeking clues to possible Pernicious Influences, the practitioner looks for signs of heat or Cold influences, Excess or Deficiency, Yin or Yang disharmonies. If a person has a heavy-footed walk, loud voice and sits in a sloppy, spread-out posture, which may indicate Excess. If a person acts frail and weak, sits with shoulders slumped and is shy that may indicate a Deficiency. On the other hand, fast, jerky, impulsive movement and an outgoing personality indicate Heat. If combined with a full, red face, high energy and a loud voice, then both Heat and Excess may be at work. Cold, as you might suspect, is associated with slow but not sloppy movements and a pale face. When coupled with a low voice, shortness of breath, or passivity, Cold and Deficiency may be at work.

Evaluation of Facial Color

When you are feeling off-balance or have a specific disharmony, facial colors offer clues to the nature and the severity of the imbalance.
There are several different methods of facial diagnosis: Korean, Japanese, Worsley School, even macrobiotic. The following evaluation of facial colors is derived from a combination of Traditional Chinese Medicine and Five Phases principles. I have found this system provides accurate analysis.

TIP In order to obtain a clear idea of what the various facial colors look like, always use natural light when examining your face in a mirror.

The Significance of Facial Colors
If facial color is bright and fresh, then the disease is called floating and is on a superficial level.
If the color is moist, neither wet nor dry, the disease is not severe and will be easy to treat.
If the color is shallow and scattered over a large area, the number of days of the disease will be short.
If the color is dark and cloudy, then the disease is sinking into the inner organs.
If the color is dark, cloudy and dry, the disease is severe and will be difficult to cure.
If the color is deep and accumulated in one spot, the disease is a long-term one.
Reading Between the Lines

Five colors appear on the face: red, green, yellow, white and black. Depending on a person’s constitution, a healthy face may have one color that is more predominant than others, but several may be visible. To determine what colors are present in your face, always examine it in natural light. Look for the overail color tone; study the skin to see what tones appear from under the surface; look at any visible veins. For contrast, hold your hand up alongside your face.

Red is the color associated with the Heart Organ System and Xue. If the face is a fresh red, the Xue is Hot. If the face is dark red, the Xue is Stagnant. If it is light red, the Xue is Deficient.

Green is the color associated with the Liver System and circulation of the Xue. If veins on the face appear greenish purple, the Xue is Hot. If the veins appear greenish black, the Xue is Stagnant. If the condition is severe, the veins on the face appear black.

Yellow is the color associated with the Spleen System. If the face appears light yellow, then the Spleen system is Damp and Hot. If the face appears deep yellow, Heat has accumulated. If it is dark yellow, Heat is the result of Xue Stagnation. Withered yellow indicates a Heat Deficiency.

White is the color associated with the Lung System, which regulates Qi, the breathing in of oxygen, and the exhalation of carbon dioxide. If a person is not able to exhale completely-as in emphysema-his or her face will take on a grayish white color. If the person inhales inadequately, then the face will appear pale and lusterless.

Black is the color associated with the Kidney System. If the face is cold and black, the Kidney System is not filtering Xue properly. If the face color is black but bright and moist, the condition can be treated. If the face is not shining, the condition is not good. If the face is withered, the Kidney System Yin is dry. If the face is cloudy and dark, the Kidney System Yang is dying.

Occasionally, there are combitonguenations of colors. This further refines the evaluation. For example, if the color is red and white, both the Heart and Lung channels are involved.