Day 44: Using Tongue in Diagnosis
Odd as a tongue might seem, it has many uses and it can tell us many things. Many times a Practitioner will ask to see our tongue. Some people feel intimidated by that and barely stick it out, and others open wide and push it out as far as they can (even how they stick it out tells us something). This will be a snapshot view what the different ‘things’ on your tongue mean to us, and how we use it to figure things out. But, one thing to remember, your tongue could be a couple of days behind what’s wrong. This is just one leg of a stool, you need more evidence to make a Chinese diagnosis.
The tongue is mostly associated with the Spleen/Stomach/Digestion, and the Heart. The Kidney ends at the root of the tongue and Heart goes to the root of the tongue. The tongue shows the condition of Qi and Blood. It is written that diagnosis by inspection of the tongue, was important as far back as the Shang dynasty. In the Warring States Period (403B.C.-221 B.C.), that time period produced the major schools of Chinese philosophical thinking; Taoism, Confucianism…believing and developing in the fundamental theories of Yin-Yang and the Five Elements/Phases. They used tongue diagnosis during this time. The book, “The Yellow Emperor’s (Huangdi) Classic of Internal Medicine, or the NeiJing, was written in 2600 B.C. It says about the tongue:
“If the tongue is loose, there is drooling and the patient is irritable, choose the Leg Lesser Yin.” (Kidney channel)
“When the Heart pulse is hard and long, then the tongue curls up and the patient cannot speak.”
“If the Qi of the Leg Terminal Yin is exhausted (Liver), the lips turn blue and the tongue curls.”
Tongue diagnosis has been around a long time, and is accounted for in all the dynasty time periods, and continues to this day. It’s a pretty important piece of us, and I think it belongs under Curious Organs. It can be used to see how the patient is progressing or digressing. I’m going to give you a general idea what things mean, but understand there will always be discussions on it, and what it means. It is one tool. Look at your own in the mirror, and see if you can apply what I say here, to see if it is telling you something. And, never scrape your tongue if you are going to see a Licensed Acupuncturist because that will take away truth to the story.
You need to be under proper lighting if you can’t be in the best, natural sunlight. Mostly, we are checking under ceiling or lamp lights. You can use full spectrum lighting. When a patient holds out their tongue for too long of a period, it begins to change just from the pressure of sticking it out. It is best to have the patient stick it out for a short period, which you can repeat once they put it back in their mouth to give it a rest.
Different foods and colored drinks can give a false reading because the dye of the food or drink will color your tongue. Spicy foods may make the tongue turn more red because of the peppers in the food.
The vitality of the tongue will show a healthier condition of the patient. If the tongue has a slightly red color, it is a vital sign, but if it is dark and withered, it is a sign of death. If the root of the tongue has a good and vibrant color, it is said it doesn’t matter because the prognosis is always good. But if it is dark and withered, not so good..
The body of the tongue, or sometimes said Tongue Proper, is where you observe the color and the form. A normal tongue is of proper size for the mouth, soft and free in motion, slight red color, and a thin layer of white coating with just the right amount of hydration in it, not dry, not moist.
A pale tongue, without much color indicates a deficiency type illness which can then cause cold syndromes due to insufficiency of Blood and Qi, especially Yang Qi.
A red tongue, redder than the normal red of vitality, could be called a bright tongue. This red indicates heat syndromes and can be either excess or deficient heat.
A deep red tongue indicates an extreme heat condition, febrile diseases, and that the patient is being attacked by a pathogenic heat, out to hurt you with its hyperactivity.
A blue/purple tongue is a stagnation of Hot or Cold Blood. If it is dry and has no vitality look, lack-luster, it is a heat stagnation of the Blood. If the tongue is moist, it is a cold stagnation, and it may have purplish or red dots, which means there is Blood stagnation. You need to get the Blood moving again.
If the tongue is swollen but has teeth marks on the sides, it is a Spleen and Kidney Yang Deficiency. The swollen condition is due to damp and phlegm. A deep red swollen tongue indicates excess heat in the Heart and Spleen. It could also be a cracked tongue but some people have very small cracks and its like that all the time for them, then that is probably normal. Heat cracks will be deep. If the tongue is swollen and blue, and dark, it indicates toxicosis.
A deviated tongue indicates windstroke, and it is leaning more to one side.
There are also Thorny, Rigid, and Flaccid tongue, and people may call them by a different name, but will come out with a similar diagnosis.
The coating comes from the Stomach. The color of the coat means its either a hot or cold condition, the thickness of the coat shows the intensity of the EPI. The moisture shows the condition of the Stomach, moist/wet, or dry. A white coating indicates normal to a cold condition, and its thickness of the coat tells how strong the pathogen is. A yellow coat indicates heat conditions, and the concept is the same in thickness, etc.
There is Peeled coating, or Geographical tongue. It is a sign of consumption of Qi and Yin of the Stomach. It is a sign of exhaustion and damage to the Stomach Qi.
Any of these signs can be further divided to mean different aspects of the illness, but it takes some time to gain that experience. You have to look at everyone’s tongue, every time, to gain this experience. You can take pictures that are kept in your patient’s chart to compare how treatments are working.
Looking at where on the tongue something is showing up, indicates what organ is at risk. Divide the tongue in threes from the tip to the root. the first tip is the Upper Burner, the second 1/3 is the Middle Burner, and the last third in the back is the Lower Burner. It reads like your body; Heart and Lungs in UB, Stomach and Spleen in MB, and Kidneys, Bladder, and the Intestines are in the LB. The Liver and Gall Bladder are on the sides of the tongue from the MB to the LB. Understanding the locations of the organs will help to point you in a direction that you can either back up with other types of findings during the examination, or rule things out.
Your body is speaking to you all the time because everything is recorded in your body. It is full of stories.
