Tongue Diagnosis- Lecture

Won Institute of Graduates: Acupucture Program Tongue Diagnosis-Acs 530

Dr. Cao Wei

2012

Observation of Tongue A. The Relation between Tongue and Viscera Spleen, Stomach, Kidney, Liver, Heart, and Lung Heart meridian, Spleen meridian, Kidney meridian, Liver meridian, Bladder meridian, and Triple Jiao meridian. Spleen and Stomach: liquids and essence are closely related to Spleen qi and Stomach qi Heart: blood circulation and speech communication are controlled by Heart qi Kidney: Kidney channel ascends to the tongue and ends at its root Liver: Liver channel reaches the tongue B. Significance of Tongue Inspection Tongue Body: to exhibit conditions of five zang-viscera, indicating the qi and blood of the viscera and the deficiency or excess of genuine-qi and severity of disease. (tongue body color and tongue body shape) Tongue Coating: to show conditions of six-fu-viscera, indicating the cold or heat (nature) of evils and the location (depth) of disease. Tongue Spirit (shen): to observe the tongue’s vitality, referring to the qualities of brightness, sheen and vitality. The Method of Observation of the Tongue The Topographical Tongue and the Zang-Fu Organs Root of tongue (lower-jiao), Middle of tongue (middle-jiao), Tip of tongue (upperjiao) Root of tongue –Kidney (Bladder), Middle of tongue - Spleen (Stomach), Tip of tongue – Heart (Lung), Margins of tongue – Liver (Gallbladder) Four Important Factors: Light, Posture, Diet, False Factors Normal Tongue Pale Red Color and Luster Tongue with Thin, White Coating (w/ root)

A normal tongue is of proper size, soft in quality, free in motion, slight (pale) red in color, luster, and a thin layer of white coating which is neither dry nor over moist, with root. (vein underneath the tongue are not distended). Contents of Tongue Diagnosis I.Tongue Texture (Body, Proper) Tongue Spirit: a. Flourish; b. Withered Tongue Body Color •

Pale-red

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Pale

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Red

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Crimson

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Purple

Tongue Shape and Mobility •

Rigid and tender

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Swollen and thin

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Cracked

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Tooth markings

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Thorny

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Flaccid (Atrophy) and stiff

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Quivering (Tremor)

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Deviated

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Moving

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Shortened

1.舌神 Tongue Spirit (Vitality, Shen) - A general Impression (the qualities of brightness, sheen and vitality) Flourish of Tongue - “Have spirit” Withering of Tongue - “Have no spirit”

2. 舌色 Tongue Body Color – To reflect primarily the state of the yin organs and blood, to show conditions of heat or cold and of yin and yang deficiency Pale Red Tongue - Normal - Mild disease Pale Red, w/ Pale Edges Tongue – Spleen qi deficiency, Stomach yin deficiency Pale Tongue - Deficiency (qi or blood deficiency, or yang deficiency) yang deficiency-wet qi or blood deficiency-dry - Cold Pale Withering (dry) Tongue -Blood deficiency Pale and Swollen (w/ teeth-printer) Tongue - Deficiency syndrome, especially deficiency of Spleen (Spleen qi and Spleen yang, accumulation of dampness) Pale & Thin Tongue – Spleen qi deficiency, Liver blood deficiency A pale tongue w/ normal shape & coating – slight deficiency of Lung & Spleen qi Pale Tongue (Indications)  Pale and slightly wet: yang deficiency  Pale and slightly dry: blood deficiency  Slightly pale: Qi deficiency  Pale on the slides all along edges: Liver blood deficiency  Pale on the sides in central section: Spleen (qi) & blood deficiency  Pale without coating: deficiency of qi and blood; sever Liver blood deficiency Self-study: “Atlas of Chinese Tongue Diagnosis” pp 35, pp117

Red, Crimson Tongue - Heat (exterior or interior, excess or deficiency) The deeper red is, the extreme heat is. w/ coating w/ root - Excess-heat w/o coating, or only partially, or w/ rootless coating – Deficiency-heat Red Color at the Tongue Tip - Hyperactivity of Heart fire Red Tongue in Bilateral Margins -Extreme heat in the Liver and Heart Red Points along the Edges and at the Tips –Internal Heat, Heat in the Liver & Heart Crimson Tongue with Prickles – Excess heat Deep Red Tongue No Coating: Mirror- Like Tongue - Extreme heat, consumption of yin fluid (Kidney yin deficiency) Crimson w/ Cracked Tongue Yellow, Sticky & Dry Tongue Coating - Damp-heat in the qi system - Intense heat damages body fluid Crimson Tongue w/ Gray-Black, Dry Tongue Coating - Extreme Heat - Impairment of yin Red Tongue (Indications)  Red tongue with coating: Excess-Heat  Red tongue without coating: Deficiency-Heat  Normal tongue without coating: Blood deficiency  Red points on the tongue: - Tip area: Heart fire - Both sides: Liver heat - Centre area: Stomach heat - Front sides: Lung heat

- Root area: Damp-heat in the Bladder Self-study: “Atlas of Chinese Tongue Diagnosis” pp 64, pp106, pp72, pp76,, pp125, pp126, pp158 Purple Tongue –Blood Stasis Pale Bluish Purple Tongue - Blood stasis (excess of yin due to yang deficiency, stagnation of blood) Reddish-Purple Tongue - Extreme heat in Yin & Xue stage; - Blood stasis Purple Spots Tongue - Stagnation of blood Purple Tongue (Indications)  Red Purple (reddish-purple) tongue: Extreme heat and blood stasis  Pale Purple (bluish-purple) tongue: Extreme yin cold and stagnation of blood  Purple areas on the tongue: - Both sides areas: Liver blood stasis - Tip areas: blood stasis in the Heart - Centre: blood stasis in the Stomach

Self-study: “Atlas of Chinese Tongue Diagnosis” pp193 Summary I Tongue Body Color  To Reflect primarily the state of the Yin organs and Blood 

To Show conditions of Heat or Cold and of Yin or Yang deficiency

Summary I Tongue Body Color (Continued) •

Pale-Red Tongue

Normal color of the tongue body; Mild disease

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Pale Tongue Deficiency; Cold

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Red Tongue Heat (Excess type and deficiency type)

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Crimson Tongue

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Purple Tongue Extreme Heat and blood stasis; Extreme yin cold and stagnation of blood

Extreme heat; Hyperactivity of fire due to yin deficiency

3. 舌的形 质 Tongue Shape (Form of the Tongue Proper) – To reveal primarily conditions of deficiency or excess, to add more information to that gleaned from observation of the tongue body color. A.Rigid and Tender - To differentiate the deficiency and excess Rigid Tongue – Excess; -Heat Tender Tongue – Deficiency; - Cold; B. Swollen and Thin - To indicate qi, blood and body fluid, water-dampness Swollen (Corpulent) Tongue - Retention of water-dampness; - Phlegm Thin Tongue - Deficiency syndrome (qi & blood deficiency, yin deficiency) Self-study: “Atlas of Chinese Tongue Diagnosis” pp 35, 51 C. Cracked Tongue - Insufficient yin fluid, blood deficiency, or health person - Excessive heat, consumption of yin (red tongue color) - Deficiency of blood (pale tongue color) Self-study: “Atlas of Chinese Tongue Diagnosis” pp 71, 72, 74 D. Tooth Markings - Deficiency syndrome, especially deficiency of the Spleen Swollen Tongue w/ Tooth-Print - Qi deficiency; - Yang deficiency (accumulation of dampness) No Swollen Tongue w/ Tooth-Print - Spleen deficiency; - Qi or qi & blood deficiency Self-study: “Atlas of Chinese Tongue Diagnosis” pp 30, 33

E. Thorny (Red Points & White Points) Tongue - Intense heat Red Thorny Tongue & White Star Tongue - Different heat in the different zang organs (different thorny tongue area) Self-study: “Atlas of Chinese Tongue Diagnosis” pp212, pp219,

4. 舌的 动态 Tongue Mobility – To show that the disease is rather severe (wind syndrome, heat syndrome, and severe diseases) A. Flaccid (Atrophy) Tongue: Severe disease - Deficiency of qi and blood - Yin fluid consumption due to heat, exhaustion of yin in the Liver and Kidney B. Stiff Tongue -In the febrile disease, heat into the Pericardium - A sign of windstroke, epilepsy or tetanus. C. Quivering (Tremoring) Tongue - In febrile disease, extreme heat producing wind D. Deviated Tongue - Wind syndrome, mostly seen in windstroke accompanied with deviation of the eyes and mouth E. Shortened Tongue - Critical stage (heat, cold, phlegm, deficiency) F. Playing with the Tongue: Critical Sign - In febrile disease, invasion of the Heart by evil - Heat in the Heart and Spleen - Infantile convulsion, or children with congenital mental deficiency Self-study: “Atlas of Chinese Tongue Diagnosis” pp182, pp183 5. 舌下 络脉

Sublingual Vein (Hypoglossal Vessels) – To observe deficiency or excess, cold or heat, especially in blood stasis Normal: Two veins are barely visible and have a very faint. Pale-red colour. Diameter