Tongue Diagnosis

Front 1

Pale & moist tongue, with thick & white coating

Back 1

cold syndrome - cold causes blood vessels in the tongue to constrict which prevents blood from entering tongue
(excess condition cuz of thick tongue coating)

Front 2

Pale, flabby and moist tongue, with thin and white coating

Back 2

yang deficiency - deficiency of yang fails to lift qi and blood up to the tongue

Front 3

Pale, small and dry tongue, with thin and white coating

Back 3

qi and blood deficiency - deficiency of qi and blood fails to fill the tongue vessels and nourish the tongue

Front 4

Red tongue with slightly red or red tip, or red tongue edge, with thin yellow coating

Back 4

external heat - heat in the body causes qi and blood to overfill the vessels of the tongue with the fresh red color

Front 5

Red and tough tongue, with thick yellow coating

Back 5

internal heat - excess heat

Front 6

Small red tongue body with or without fissures with no coating

Back 6

internal heat - deficiency heat

Front 7

Crimson & dry, with dry tongue coating

Back 7

exogenous febrile disease - pathogenic heat invades the nutritive and blood levels, consumes the blood & body fluids, which concentrates the blood leading to a darker color.

Front 8

Crimson, dry & small, with no coating

Back 8

internal disease - yin deficiency or exhaustion

Front 9

Crimson, with purple hue, tongue coating is thin and moist

Back 9

blood stagnation

Front 10

Blue purple (pale purple) tongue with moist & white tongue coating

Back 10

blood deficiency or internal cold

Front 11

Blue purple (pale purple) tongue with tongue coating that can be dry

Back 11

blood stagnation

Front 12

Dark red purple tongue with dry yellow coating

Back 12

extreme heat

Front 13

Dark red purple tongue with glossy or greasy tongue coating

Back 13

phlegm damp

Front 14

Dark red purple tongue with no coating

Back 14

yin exhaustion

Front 15

Dark red purple tongue with dry coating

Back 15

alcohol intoxication

Front 16

Entire tongue body is blue with glossy tongue coating

Back 16

cold accumulation

Front 17

Tongue is blue on the sides of the tongue, may include a dry mouth with a dislike of swallowing water and may have dry coating

Back 17

blood stagnation

Front 18

What does a change in shape of the tongue body indicate?

Back 18

Indicates a more severe condition

Front 19

red and tough tongue body

Back 19

excess heat

Front 20

purple and tough tongue body

Back 20

excess syndrome - blood stagnation

Front 21

tender and dry tongue body

Back 21

deficiency syndrome - qi & blood deficiency

Front 22

tender and glossy tongue body

Back 22

deficiency syndrome - yang qi deficiency

Front 23

What does the tongue size reflect?

Back 23

person's constitution; if person has no signs or symptoms, not pathological

Front 24

Flabby & red tongue

Back 24

damp heat or phlegm heat accumulation

Front 25

Flabby, pale, tender with teethmarks

Back 25

Spleen or Kidney yang deficiency with accumulation of dampness

Front 26

True or False:
A flabby tongue can appear in a healthy person.

Back 26

TRUE
especially in absence of any other symptoms

Front 27

What does a swollen tongue generally indicate?

Back 27

The swollen tongue is a toxic enlargement of the tongue.

Front 28

Swollen, bright red tongue body, possibly with pain

Back 28

pathogenic heat invades the Heart and Spleen

Front 29

Swollen & purple tongue

Back 29

alcohol poisoning

Front 30

Swollen, dark blue purple or pale blue purple tongue

Back 30

blood stagnation due to chemical toxicity

Front 31

True or False:
A swollen tongue can be found in a healthy person.

Back 31

False: The swollen tongue always indicates a pathology.

Front 32

Pale & moist tongue, with teethmarks

Back 32

dampness

Front 33

Slightly pale tongue with teethmarks

Back 33

Spleen deficiency

Front 34

pale & thin body, with thin coating

Back 34

qi and blood deficiency

Front 35

red & thin, small body with little or no coating

Back 35

yin deficiency with heat

Front 36

Deep red tongue with cracks, with dry coating

Back 36

excess heat

Front 37

red body with cracks, with no tongue coating

Back 37

yin deficiency

Front 38

pale or slight red tongue with cracks, varied tongue coating

Back 38

blood deficiency

Front 39

pale, flabby, with cracks and teethmarks, with varied tongue coating

Back 39

Spleen qi deficiency with dampness

Front 40

bright red tongue body with speckles & prickles, with yellow coating

Back 40

toxic heat

Front 41

deep red, red, or dark purple prickles with little or no coating

Back 41

heat in the nutritive or blood level

Front 42

red prickles with thick yellow coating

Back 42

damp heat accumulation in blood

Front 43

Speckles vs. prickles:
______ are generally considered to be due to blood stagnation, while ______ are most likely due to pathogenic heat

Back 43

speckles (flat), prickles (raised)

Front 44

Tongue sores and red tongue body with yellow coating. The sores have yellow dimples, in time they erode and create ulcerations that are red and painful.

Back 44

heat toxin in the Heart channel

Front 45

Tongue sores with red tongue body with fissures, with scanty yellow coating. Sores do not protrude from the tongue. The red color and pain is relatively mild.

Back 45

deficiency heat rising up from the lower burner

Front 46

Stiff & crimson tongue, with yellow coating

Back 46

external heat invades the Pericardium

Front 47

Stiff, slightly red or green-purple tongue, with varied coating

Back 47

internal wind

Front 48

Stiff & flabby tongue, with thick and greasy coating

Back 48

turbid phlegm

Front 49

Limp & pale tongue with varied coating

Back 49

severe qi & blood deficiency

Front 50

Limp & crimson tongue, dry with no coating

Back 50

exhaustion of yin & body fluids

Front 51

Limp & red tongue, with yellow coating

Back 51

excess heat

Front 52

What causes spasms in the tongue (abnormal movement)?

Back 52

Lv controls sinews. Sp controls muscles. Spasms can be caused by:
internal wind - due to hyperactivity of the Liver or internal excessive heat
malnutrition - insufficient qi, blood, or body fluids

Front 53

Trembling; pale, or pale & limp tongue

Back 53

deficiency of qi & blood, or yang depletion causes body fluid impairment

Front 54

Trembling, red & dry tongue

Back 54

internal wind due to extreme pathogenic heat

Front 55

Trembling, deep red & swollen tongue

Back 55

alcohol intoxication

Front 56

Deviated, purple red body, acute onset

Back 56

internal wind due to Liver yang rising

Front 57

Deviated tonguewith pale tongue body, chronic onset

Back 57

internal wind due to blood deficiency

Front 58

Deviated tongue with thick coating

Back 58

internal wind due to wind phlegm

Front 59

Deviated tongue with red body

Back 59

external pathogenic wind entering collaterals

Front 60

Tongue that remains outside the mouth with red tongue body

Back 60

Protruding tongue with red body indicates pathogenic heat in the Heart channel or pathogenic heat in the Spleen channel

Front 61

Tongue sticks out momentarily then returns to the mouth with red tongue body

Back 61

"Licking" tongue with red body indicates pathogenic heat in the Heart channel or pathogenic heat in the Spleen channel

Front 62

What does the shortened tongue generally indicate?

Back 62

critical condition

Front 63

shortened & pale tongue

Back 63

excessive pathogenic cold invades tendons and channels

Front 64

shortened & flabby tongue

Back 64

turbid phlegm accumulation

Front 65

shortened & red tongue

Back 65

excessive pathogenic heat injures blood fluids

Front 66

shortened, pale, tender, flabby

Back 66

Spleen & Kidney failure, deficiency of qi & blood

Front 67

loosened tongue that is red or crimson & may be swollen

Back 67

interior excess heat or phlegm heat

Front 68

loosened tongue with flabby tongue, possibly numb

Back 68

qi deficiency

Front 69

What are the indications of hypoglossal vein abnormalities?

Back 69

qi and blood stagnation

Front 70

What is the clinical significance of tongue coating inspection?

Back 70

To determine depth of the disease; identify pathogenic factors & the thermal nature of the disease (heat/cold); assess the condition of the Stomach.

Front 71

normal tongue coating

Back 71

thin, white and slightly moist

Front 72

white thin coating

Back 72

normal, mild or early stage disease;
exterior pattern: wind cold, wind damp, cold damp

Front 73

white, thick & greasy coat

Back 73

Sp/St yang deficiency causes accumulation of food or dampness;
turbid dampness or phlegm accumulation

Front 74

white, thick, greasy & glossy

Back 74

Sp yang deficiency w/retention of cold damp phlegm;
interior cold w/phlegm & dampness

Front 75

white, dry & thin coating

Back 75

wind heat invades or dryness attacks the Lungs, yang deficiency prevents water from being transformed into body fluids and so fails to nourish the tongue

Front 76

white, dry & thick coating

Back 76

early stage of febrile disease, body fluid is injured by excess heat

Front 77

white powdery coating

Back 77

toxic heat in the interior, seen in contagious epidemic diseases

Front 78

In general, what does a white coating mean clinically?

Back 78

cold, exterior, Lu/LI disease

Front 79

In general, what does a yellow coating mean clinically?

Back 79

interior, cold, Sp/St disease

Front 80

pale yellow tongue coating

Back 80

mild heat

Front 81

dark yellow tongue coating

Back 81

severe heat

Front 82

brown yellow tongue coating

Back 82

heat accumulation

Front 83

thin & slightly yellow coating

Back 83

exterior wind heat;
or wind cold transforming into wind heat

Front 84

thick & slightly yellow coating

Back 84

damp heat accumulation with qi stagnation

Front 85

yellow & greasy coating

Back 85

damp heat or phlegm heat;
food stagnation with heat

Front 86

pale yellow, greasy & sticky coating

Back 86

more damp than heat

Front 87

dark yellow, greasy & sticky coating

Back 87

more heat than damp

Front 88

pale tongue body with yellow & glossy coating

Back 88

yang deficiency loses its function of transforming the water leading to an accumulation of water which generates heat

Front 89

tongue coating: tip is white, root is yellow

Back 89

exopathogen penetrating deeper, more interior than exterior

Front 90

tongue coating: tip yellow, root white

Back 90

heat in the upper burner

Front 91

tongue coating partially covers tongue body: double yellow strips

Back 91

exopathogen penetrating interior;
heat in the Sp/St

Front 92

dark yellow coating partially covering tongue body

Back 92

heat in Lv/GB

Front 93

In general, what does gray coating mean?

Back 93

interior pattern; heat pattern; cold dampness;

can only be seen w/interior and excess patterns, never w/exterior or deficiency cold patterns

Front 94

gray & glossy tongue coating

Back 94

cold pattern: damp or damp phlegm

Front 95

gray & dry tongue coating

Back 95

heat pattern - yin deficiency with heat

Front 96

In general what does black tongue coating mean?

Back 96

interior pattern; extreme heat; extreme cold

reflects disease of long duration and a critical condition; can also arise from use of Pepto-Bismol (not pathological);
only seen with interior patterns never with exterior patterns

Front 97

black & glossy or greasy coating

Back 97

cold pattern: excess cold damp or
yang deficiency

Front 98

black, dry & cracked coating

Back 98

heat pattern: Kidney exhaustion

Front 99

What are the categories of tongue coating quality?

Back 99

thickness; moisture; viscosity; distribution; peeled; trend; root

Front 100

thin tongue coating indications

Back 100

normal, exterior syndrome, mild, or early stage disease

Front 101

thick tongue coating indications

Back 101

retention or stagnation of damp, phlegm, food, or water;
strong pathogen strength, severe, later stage

Front 102

moist tongue coating, neither glossy nor dry

Back 102

healthy person, or body fluids have not been injured even during illness

Front 103

dry tongue coating

Back 103

external dryness invades Lung; excess heat; yin deficiency; yang deficiency

Front 104

glossy coating indications

Back 104

cold syndrome; damp, phlegm, water accumulation; yang deficiency

Front 105

rough coating indications

Back 105

severe injury to the body fluids

Front 106

moldy coating indications

Back 106

food stagnation; phlegm; internal abscess

Front 107

coating is thick & patchy with coarse granules; easily wiped or scraped off

Back 107

moldy coating

Front 108

coating is sticky and made of fine particles that are thicker in the middle and thinner on margins; difficult to wipe or scrape off

Back 108

greasy coating

Front 109

greasy coating indications

Back 109

damp; phlegm; food stagnation

Front 110

peeled coating indications

Back 110

Stomach yin and qi deficiency