Tongue Diagnosis

Front 1

Pale tongue

Back 1

Color of tongue is lighter than that of normal people.

Clinical meaning:

yang deficiency, blood deficiency, qi deficiency

Maciocia:

Pale and slightly wet: Yang deficiency

Pale and slightly dry: blood deficiency

Slightly pale: qi deficiency

Pale on the sides all along edges: Liver-blood deficiency.

Pale on all the sides in the central section: Spleen-blood deficiency.

Pale-orangey or pale without coating: severe Liver-blood deficiency.

Front 2

Red tongue

Back 2

The color of the tongue is heavier than that of normal people.

Clinical Meaning:

Internal heat including excess heat and deficiency heat.

Maciocia:

Red tongue with coating: Full-heat

Red tongue without coating: Empty-heat

Normal tongue without coating: Yin deficiency

Red points (dots):

Red points: heat

Red spots (larger and seen at the root of the tongue): heat with some blood stasis

Red points on the tip: heart fire

Red points on the sides: Liver-heat

Red points in the center: Stomach-heat

Red points on the sides in central section: Stomach heat

Red points on the sides in the chest (lung) area: Lung heat

Red spots on the root: Damp heat in the lower burner

Red points in the external diseases (fig. 24.8 page. 212 in Maciocia's Dx book): Wind heat

Front 3

Crimson tongue

Back 3

The color of the tongue is heavier and darker than red

Clinical Meaning:

Nutrient (ying) phase syndrome, yin deficiency, and blood stasis.

Front 4

Purple tongue

Back 4

When the tongue body is purple, it is called purple tongue.

Clinical Meaning:

Dark purple tongue without fluid extreme heat; Bluish purple tongue with fluid extreme cold; Purplish spots on the tongue--blood stasis.

Maciocia:

Liver areas: Liver-blood stasis or Blood stasis in the uterus

Breast/Chest areas: Blood statis in the Heart or breast

Center: Blood stasis in the Stomach

Front 5

Blue tongue

Back 5

When the tongue is blue without any red color, it is called a blue tongue or Buffalo tongue.

Clinical Meaning:

Cold and blood stasis.

Front 6

Tenderness

Back 6

The striae of the tongue are delicate, fine, and smooth.

Clinical Meaning:

Deficiency

Front 7

Toughness

Back 7

The striae of the tongue are rough and sturdy.

Clinic meaning:

Excess

Front 8

Swollen tongue

Back 8

Swollen tongue is large than normal.

Clinic meaning:

If a swollen tongue is delicate and pale, with

tooth mark; spleen and kidney yang
deficiency.

If a swollen tongue is deep red in color

occupying the entire space of the mouth;
excess heat in the heart and spleen.

If a swollen tongue is blue purplish and

dark; toxicity.

Front 9

Thin tongue

Back 9

The small and emaciated tongue body is
called a thin tongue.

Clinic meaning: deficiency.

Pale thin tongue; qi and blood deficiency or

deficiency of both heart and spleen; dry
and thin tongue in red or crimson;
deficiency heat; withering thin tongue in
dark color is due to exhaustion of both qi
and yin.

Front 10

Crack tongue

Back 10

If there are cracks on tongue surface, it is called a crack tongue.

Clinic meaning: excess heat, deficient heat,

blood deficiency, and normal person.

Crack tongue with deep red color- excess

heat consuming body fluid.

Crack tongue with pale color-blood deficiency; all time unchanged--normal

person

Front 11

Thorny tongue

Back 11

The papillary buds over the surface of the tongue swell up like thorny.

Clinic meaning:

Heat accumulation in interior.

Front 12

Smooth tongue

Back 12

The smooth tongue surface without coating is called a smooth tongue

Clinic meaning:

Stomach exhaustion.

Front 13

Teeth marks

Back 13

The pressing marks of the teeth on lateral sides of the tongue are called teeth marks.

Clinic meaning:

In pale and moist tongue-internal cold
dampness.

In pink tongue-spleen deficiency, or qi
deficiency.

Front 14

Stiff tongue

Back 14

It is an inflexible tongue with difficulty in moving or inability of turning

Clinic meaning:

Heat, phlegm, and wind.

Front 15

Flaccid tongue

Back 15

The tongue is flaccid (flabby) and weak, and inability to move.

Clinic meaning:

Heat, deficiency of both qi and blood,

and liver and kidney yin deficiency.

Front 16

Tremor tongue

Back 16

It refers to shivering and swaying which can not be controlled by the patient oneself.

Clinic meaning:

Liver wind. Due to: Extreme heat,

Liver yang arising,

Blood deficiency,

or Yin deficiency.

Front 17

Deviated tongue

Back 17

When tongue protruding out of mouth, it is inclined to one side.

Clinic meaning:

Liver wind and wind stroke.

Front 18

Short tongue

Back 18

The tongue contracts and shortens, and is inability to stretch.

Clinic meaning:

Born with this--harmless.

Heat, cold, phlegm, or deficiency.

Front 19

White coating

Back 19

Clinic meaning:

Exterior and cold.

Front 20

Yellow coating

Back 20

Clinic meaning:

Heat.

Front 21

Grey coating

Back 21

Clinic meaning:

Without moist-interior heat.

With moist-interior cold.

Front 22

Black coating

Back 22

Clinic meaning:

Without moisture- interior extreme heat.

With moisture - interior extreme cold.

Front 23

Thick and thin coating

Back 23

The bottom can not be seen-thick.

The bottom can be seen-thin.

Clinic meaning:

Thin coating-exterior and mild.

Thick coating-interior and more severe.

Front 24

Moist and dry coating

Back 24

Clinic meaning:

Moist tongue coating- cold or dampness.

Dry tongue coating- heat, including excess heat and deficiency heat.

Front 25

Putrid and greasy coating

Back 25

Putrid coating looks like the residue of making soy bean curds piling on tongue and is easy to be scraped off.

Greasy coating is made of fine particles and difficult to be scraped off.

Clinic meaning:

Phlegm or food retention.

Front 26

Peeled tongue coating

Back 26

The tongue with a part of coating peeling off is called peeled coating.

Clinic meaning:

Stomach qi and yin deficiency or exhaustion.

Front 27

Sublingual Vein

Back 27

Maciocia:

In modern china, some doctors consider the appearance of sublingual veins as useful prodromal sign of certain diseases. The main signs are as follows: (also used in western medicine)

Dark-purple: hardening of the brains arteries

Distended, dark and crooked: hardening of arteries, hypertension (if the veins protrude a lot and look like earthworms, the disease is severe)

Small nodules like rice or wheat grains: hardening of arteries and heart disease.

Box 24.5 Sublingual Veins

Distended (not dark): Qi deficiency

Thin: Yin deficiency

Distended and dark: Blood stasis in the upper burner

Dark and dry: Severe Yin deficiency with empty heat

Dark, swollen, and wet: Lung, Spleen, and Kidney deficency with accumulation of fluids

Reddish and shiny: Damp heat

Yellowish: Dampness

White and Slippery: Cold-dampness

Swollen, white, and sticky: Dampness and blood stasis.