By Dr. Bolz
Traditional Chinese Medicine has long used the tongue to look into the condition of the patient to see what is out of balance inside the body (humans and animals) and to assess the general health of the individual. This is quite appropriately termed tongue diagnosis in Traditional Chinese Medicine (TCM). It is very telling and one of the most reliable methods to look inside the body to assess the general condition and even the state of the different internal organs themselves.
If you have ever been to a TCM health practitioner, you most likely have experienced having to stick your tongue out at the TCM doctor. The TCM doctor or practitioner would also have told you not to drink coffee the day you come in nor scrape or brush your tongue (brushing your teeth is acceptable). The reason for this is so that the doctor can see the real you, your internal condition, to get a glimpse of what is going on inside of you that may be causing the symptoms that you are experiencing. If you scrape off or brush off the coating, the practitioner will not be able to see the state of your health. The same holds true for drinking coffee, because it has the high possibility of staining the top coating of your tongue either brown, yellow, or a combination of this.
The size, the shape, the color and thickness of the tongue body proper manifests certain aspects of your condition and the fur, or coating, of the tongue tells another aspect of what is going on inside of you.
Chinese Medicine diagnosis traditionally includes four methods described with five simple words: 1) Looking (visual diagnosis) 2) Listening (not necessarily listening to you talk, listening to your body while you are silent and not speaking, but also listening to the sound and pitch of the voice or any other sounds such as coughing, borborygmi, hiccups, groaning, sighing, and any other sound emitted by a person.) 3) Asking (the doctor asks you questions and listens to your answers) 4) Feeling (palpation of many different areas on the body, head, limbs) 5) Smelling (every person has a certain distinct smell about them, no matter how subtle).
Now you know why your TCM practitioner may also ask you to not wear perfume or perfumed deodorants or anything unnatural, as well as not drinking coffee or brushing your tongue the day you come in. This article is going to be about the first item listed here: looking. Even more specifically, we are discussing only one of the visual diagnostic methods and that is observing and reading the tongue. There are other visual diagnostic methods in this medicine, of course. Nail, skin, hair, eyes (you may have heard of iridology, which is one of the eye diagnostic methods), teeth, gums, ears, and facial diagnosis. The practitioner has learned to read these body signs.
The color of the body proper should be pale red. There are five pathological colors: purple, blue, deep red, red (meaning too red), pale. Now, being able to see these colors takes a trained eye. You are not too often going to be able to distinctly see a blue tongue unless you are trained, or any of the other colors, for that matter. A student in Oriental Medicine school must observe many models of tongues which are actual photos, colored-plates in textbooks, plastic-molded models, and of course, the actual human beings tongues in clinical internship. It is a deep, scientific and practical study. One cannot learn this overnight.
A pale tongue body color indicates a deficiency of either blood or of yang qi. Many times, if there is deficiency of Yang, the tongue will also be very puffy or slightly swollen. If there is blood deficiency, the tongue will be pale and somewhat dry. In severe cases of blood deficiency, the tongue color is very pale and even slightly orangey-colored.
An excessively red tongue body always indicates heat. Sometimes red tongues have red points or spots. These are raised papillae and always indicate heat. If these are red and excessively large, this indicates blood stasis. A deep red tongue has the same clinical significance as the red body, but it indicates that the condition is more severe.
The color purple always indicates stasis of blood. There is reddish-purple and there is bluish-purple. A reddish purple indicates heat and stasis of blood which develops from a red tongue which then leads to blood stasis. A bluish-purple tongue indicates cold and stasis of blood, and it develops from a pale tongue.
The significance of a blue tongue indicates interior cold. It will eventually lead to blood stasis if the internal condition of the person is not corrected.
The shape, not only the color, of the tongue also tells us things about the persons interior condition of health. The body shape indicates the condition of the blood and Qi and it can tell us whether the general condition is an excess (full) or deficient (empty) condition.
A thin body indicates blood deficiency if it is also pale. It indicates a Yin deficiency (somewhat like an intracellular dehydration) if it is also red and peeled (without coating).
If the tongue is stiff, it indicates Interior Wind, which is seen in conditions like Parkinsons disease, tardive dyskinesia, stroke, etc. or not yet at that level, but the beginning stage of what could develop into those diseases, if not corrected.
A flaccid tongue indicates a deficiency of body fluids.
A long tongue indicates that there is a tendency towards internal heat and in particular, heart heat.
A short tongue indicates interior cold if it is pale and wet or extreme internal dryness if it is red and peeled.
A cracked tongue (cracks appearing in different areas of the body proper), indicates either excess heat or a deficiency of body fluids. Short horizontal cracks indicate stomach dryness. A long-deep central crack, midline reaching to the tip of the tongue indicates a tendency to a heart pattern. A shallow-wide crack in the midline which is not reaching to the tip indicates a lack of stomach fluids (cannot be corrected by drinking more fluids). Short transverse cracks on the sides, in the middle section of the tongue, indicate a chronic weak digestive system. A quivering tongue indicates a weak digestive system. A deviated tongue indicates interior wind which you can see in conditions like TIAs, stroke, heart disease, tremors, etc.
The coating or fur of the tongue tells us other things. The tongue coating reflects the state of certain organs of the body, and especially of the Stomach. A normal tongue should have a thin, white coating. The tongue coating is formed from residual which is left over from the stomachs digestion and reaches the tongue upwards. A thin-white coating indicates that the stomach is digesting food properly. So if you are one of those who wake up in the morning and feel you have a thick white coating on your tongue, the problem is your stomach. This is coming from the digestive system internally. Scraping it off does not help your health. One needs to know that there is a problem with the digestion that needs to be corrected. The same is true of bad breath.
The coating tells us the presence or absence of a pathogenic factor and of its strength. A thick coating always indicates the presence of a pathogenic factor and the thicker the coating, the stronger the pathogenic factor. This pathogenic factor may be interior or exterior, such as exterior wind, dampness, or cold, retention of food, phlegm, heat or fire. No coating at all indicates a deficiency of stomach Yin or Kidney Yin (a kind of dehydration inside the cells which results in lack of normal fluid generated within the body). Drinking more water does NOT solve this problem! If the tongue is definitely red in its entirety, then specifically there is a lack of kidney-yin.
The pathological coating colors can be white, yellow, grey and black. A white coating indicates a cold pattern, unless it is thin and white, which is normal. A yellow tongue coating indicates excess heat inside the body. A gray and black coating can both indicate either extreme cold or extreme heat, according to whether the tongue is wet or dry.
The different areas of the tongue reflect the state of the internal organs. One of the common topographical methods of diagnosis in use in TCM is as follows: The far rear area of the tongue represents the kidney, bladder and intestines; in that order, beginning from the rear. The center portion relates to the spleen and stomach. The left side and edge relates to the liver and the right side and edge relates to the gallbladder. The very tip of the tongue shows the state of the heart and the area between the tip and the middle manifests the condition of the lungs.
You will not have the tools to be an expert diagnostician or Oriental Medicine doctor by simply reading this article. As mentioned before, it takes a complete study of the entire system, a universal and world view of the body, mind, and spirit of the being and how it relates to the environment. But this does help you understand more about how your TCM doctor diagnoses (one of the tools, not complete by itself by any means). This system is studied in medical schools of Traditional Chinese Medicine, which is typically a four-year academic program of post-graduate training. If the practitioner is a DAOM, then he or she has completed at least two more years beyond that.
Tongue diagnosis can give a more detailed picture of the state of the internal environment, conditions that many times would be termed subclinical in allopathic medicine. The hematology, urology, radiology studies may all look good, but still the patient does not feel well. This is where Oriental medicine can see things at a different level and in another view. While the modern medical diagnostics are important in todays Oriental medicine, as well, they are not the ONLY diagnostic tool we have.
There is a very good saying in Japanese, closely translated as this: health is obtained by what goes into the mouth and troubles are created by what comes out of the mouth. What does YOUR tongue have to say?
Please read, digest and use what you have learned from this article to create your own happiness and health. Best of health and peace, always.