Many people have experienced this: when visiting a hospital, doctors often ask us to stick out our tongues. This is because tongue diagnosis is an important method in TCM observation. The five internal organs have corresponding reflection areas on the tongue, and any pathological changes in the internal organs will be directly reflected on our tongues.
Doctors observe the tongue based on two indicators: one is to look at the color of the tongue and tongue coating, and the other is to assess the thickness and shape of the tongue. You might want to stick out your tongue in front of a mirror and take a look.
Color of the Tongue
-
A normal tongue color is generally pleasing, typically pale red to light pink.
-
If it is too pale or white, it indicates cold or deficiency of Qi and blood;
-
If it is red or dark red, it indicates heat in the body;
-
If it is dark purple, it indicates blood stasis.
Color of the Tongue Coating1White Coating
White coating generally indicates the presence of cold dampness in the body, which is particularly common in modern people. Why? Because modern individuals often experience high work pressure and irregular eating and sleeping habits, leading to dampness in the spleen and stomach, which is reflected on the tongue.
White coating can be seen in healthy individuals (sub-health state) as well as in mild illnesses, early stages of diseases, and recovery periods. Early-stage diseases or localized lesions that have not affected the whole body, such as thyroid enlargement during puberty, trauma, athlete’s foot, plum pit qi, early breast cancer, cervical cancer, etc.
For example, in the case of COVID-19, it is recognized as a damp epidemic, and most patients with COVID-19 have a white greasy tongue coating, indicating a strong relationship between a white greasy tongue and internal cold dampness.
2Yellow Coating
Yellow coating generally represents heat in the body. If the tongue coating is yellow and greasy, it indicates the presence of damp-heat in the body, and at this time, one should clear heat and eliminate dampness, and regulate the spleen and stomach.
From a pathological perspective, yellow coating is often associated with inflammatory infections: various acute infectious diseases, such as meningococcal meningitis, Japanese encephalitis, leptospirosis, typhoid fever, diphtheria, and bacillary dysentery in severe stages, as well as severe pneumonia, severe hepatitis, intestinal infections, acute pyelonephritis, pelvic inflammatory disease, sepsis caused by staphylococcus and streptococcus, acute pancreatitis, appendicitis, intestinal obstruction, ruptured ectopic pregnancy, acute perforation of peptic ulcers, peritonitis, acute cholecystitis, cholelithiasis, biliary ascariasis, and urinary tract infections, can all present with yellow coating.
In cases of cold and fever, if yellow coating is observed, it may be accompanied by dry mouth, sore throat, cough, and yellow phlegm, which in TCM is referred to as a wind-heat type cold. Fever can lead to yellow coating appearing as early as 2 days, indicating a close relationship between fever and yellow coating. Therefore, treatment should focus on cooling herbs and avoid stimulating spicy foods and tonics to prevent exacerbating the condition.
3Gray-Black Coating
This is primarily caused by the proliferation of filiform papillae on the tongue turning black. The color of black coating can vary from brown-black, gray-black, charred black to pitch black. If this coating appears, it indicates a prolonged illness with a complex and serious condition.
Among patients with black coating, half of the cases are caused by various inflammatory infections, including pneumonia and pyelonephritis. Dysfunction of the central nervous system can also lead to black coating. Certain critically ill patients, such as those with end-stage liver cirrhosis with severe liver dysfunction, chronic renal failure with uremia, and various late-stage cancers, may also present with black coating, indicating a critical stage of illness.
Of course, black coating does not necessarily indicate a severe illness; poor oral hygiene and infrequent brushing can promote the growth of fungi and excessive keratinization of the tongue papillae, leading to black coating. Frequent smokers may also develop black coating due to the irritation of the tongue papillae by smoke or chemicals in tobacco. Regular consumption of Chinese herbs can also lead to black coating due to drug sedimentation and staining, which will improve after stopping the medication.
Color of the Tongue
By understanding the symbolism of the tongue and tongue coating colors, we can infer the prognosis of our health. However, in addition to color, we can also assess health status through the shape and size of the tongue.
A normal tongue has a moderate thickness and size. If the following conditions occur, attention is needed.
1Teeth-Marked Tongue
A tongue that is too thick indicates spleen deficiency; if it has teeth marks, it is an intensified version of spleen deficiency—spleen dampness; individuals with this condition are often weak, tend to speak little, feel fatigued, and have cold hands and feet.
If you notice a teeth-marked tongue, try to avoid eating raw fruits and cold drinks, as they can exacerbate dampness. It is recommended to use moxibustion for conditioning or drink a decoction of Fu Ling (Poria) and Bai Zhu (White Atractylodes).
2Thin Tongue
A tongue that is too thin indicates Qi stagnation; if it is both thin and weak, it indicates deficiency of Qi and blood;
3Stasis-Dotted Tongue
If there are spots or stasis dots on the tongue, it indicates blood stasis; TCM believes this is caused by liver Qi stagnation, leading to internal blood stasis. At this time, one can take some herbs that soothe the liver and regulate Qi, but the fundamental solution is to manage our emotions well, smile more, and the body will naturally improve.
4Cracked Tongue
Generally, most people have slight cracks in the middle of the tongue, but if there are obvious cracks, it indicates insufficient Qi of the spleen and stomach, and one should focus on improving the spleen and stomach.
5Sub-lingual Veins
There are two veins under the tongue that flow quietly; under normal circumstances, these veins are faintly visible or completely invisible. However, when there is stagnation in the body and Qi and blood circulation is poor, the veins under the tongue will become prominent, indicating a risk of cardiovascular and cerebrovascular diseases.
6Deviated Tongue
If the tongue appears crooked, and the root of the tongue feels numb, with the index and middle fingers feeling wooden, this is often a precursor to a stroke. In such cases, please seek medical attention promptly.
