Chinese medicine update: tongue diagnosis in Chinese medicine

Townsend Letter for Doctors and Patients, Jan, 2004 by Bob Flaws

Keywords: Chinese medicine, pattern discrimination, tongue diagnosis

In last month's issue of The Townsend Letter, I described the role of pulse diagnosis in standard professional Chinese medicine. This month I would like to discuss tongue diagnosis or, more properly, tongue examination (she zhen) in Chinese medicine. While practitioners of acupuncture and Chinese medicine take into consideration the patient's disease diagnosis, they mainly base their treatment on the patient's individualized Chinese medical pattern or zheng. A pattern is a named and recognized standard group of signs and symptoms, and there are more than 300 such patterns in professional Chinese medicine. Each pattern is defined by a group of general signs and symptoms, tongue signs, and pulse signs. Therefore, one can say that tongue examination comprises one third of the Chinese medical process of pattern discrimination. In terms of the four examinations (si zhen) of Chinese medicine, tongue examination is a special subcategory of visual inspection (wang zhen).

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The history of tongue diagnosis in Chinese medicine

Descriptions of diagnostically significant pathological changes in the tongue and its fur in the Chinese medical literature date back to the Nei Jing (Inner Classic), the "Bible" of Chinese medicine which was compiled in the late Han dynasty (circa 200 A.D. or C.E.). Throughout the succeeding dynasties, famous Chinese doctors added more and more tongue observations to the Chinese medical literature. However, the first surviving Chinese medical text to deal exclusively with tongue examination dates from 1341 during the Yuan or Mongol dynasty. This book was written by Du Qing-bi and was based, in part, on an earlier book by a Master Ao which has not survived. This book contained 36 color illustrations of the tongue and its fur corresponding to various patterns of disharmony and their pulses. Since that time, numerous such books have been published with an ever-increasing number of illustrations until today, when we have books full of color photographs of tongues, sets of colored slides of tongues, and even sets of colored plastic tongue models to help students and practitioners learn this important diagnostic art. For instance, in 1906, Liang De-yan wrote She Jian Bian Zheng (Pattern Discrimination by Examining the Tongue). This book describes 148 tongue types and their pattern indications. Today, tongue examination is taught at all colleges of Chinese medicine in the People's Republic of China and is the frequent subject of articles published in Chinese medical journals.

The relationship of the tongue to the interior of the body

In Chinese medicine, it is believed that every part of the body contains a "holographic" image of the entire rest of the body. This holographic image is sometimes referred to in English as a homunculus or little man. Therefore, there is a "map" of the entire body on the ear, hand, foot, face, eye, and even the lateral edge of the first metacarpal bone. Sites on these maps reflect pathological changes in the corresponding body parts and, at least in some cases, stimulation of these sites can be used to treat those corresponding body parts. Anyone familiar with foot reflexology will understand this concept. Unlike the nose, hands, and feet, the tongue is an internal organ which can be seen from the outside of the body. Therefore, in Chinese medicine, the tongue is believed to be a hologram or homunculus of the organs located in the cavity of the torso. This means that Chinese medical practitioners believe that certain areas of the tongue correspond to specific viscera and bowels. Pathological changes in a given area of the tongue are thus believed to indicate pathological changes in the corresponding viscus or bowel. The accompanying diagrams show these correspondences.

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Tongue body and fur

Chinese medical practitioners look at two main things when they look at the tongue. These two things are 1) the tongue body, and 2) the tongue fur. Inspection of the tongue body is also divided into two: inspection of the tongue shape and inspection of the tongue color. Inspection of the tongue fur is divided into inspection of the thickness of the fur and consistency and inspection of its color and moisture. According to Chinese medical textbooks, the normal tongue color is pale red similar to a skinned chicken. The normal tongue body or shape is neither too thick nor too thin and is not cracked or crevassed. The normal tongue fur is thin in thickness and white in color, thus appearing almost transparent. Further, the sublingual veins are not dark, tortuous, and distended. Such a tongue indicates that qi and blood are sufficient and flowing freely, that yin and yang are in relative balance, and that, in particular, the stomach is functioning harmoniously.

In terms of deviations from this norm, a tongue which is thicker than normal indicates a yin repletion due to nonmovement and nontransportation of water fluids, while a tongue which is thinner than normal indicates an insufficiency of righteous yin, including qi and blood. A tongue which is paler than normal indicates a blood vacuity. A tongue which is redder than normal indicates heat. A tongue which is blue indicates cold, while a tongue which is purple and dark indicates blood stasis. Static speckles or spots, brownish papillae, also indicate blood stasis in the organ corresponding to their location on the tongue as do static macules, black and blue spots on the tongue. Another indication of blood stasis, this time primarily in the chest, are distended, dark, tortuous sublingual veins. If the tip of the tongue is red, this means heat specifically in the heart, but, if it is the sides of the tongue that are red, this indicates heat in the liver-gallbladder. Cracks and crevasses on the surface of the tongue can mean either of two things. If the tongue is not red, crevasses and cracks in the tongue mean longstanding spleen vacuity. If the tongue is red, then they mean chronic and enduring yin vacuity. And finally, if the tongue quivers excessively when presented, this indicates stirring of internal wind.

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Chinese medicine update: tongue diagnosis in Chinese medicine

Townsend Letter for Doctors and Patients, Jan, 2004 by Bob Flaws

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