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Observing the tongue can provide insights into the overall health status of the body.When examining the tongue, we focus on two main aspects.First, we look at the tongue body, which is the muscular and vascular structure of the tongue; second, we examine the tongue coating, which is the layer of substance attached to the surface of the tongue.1. Observe the color of the tongue body.A white tongue body indicates cold, while a red or yellow tongue indicates heat; the color of the tongue reflects the overall condition of the body.2. Observe the age of the tongue body.An old tongue, such as a cracked tongue, may indicate obstruction due to excess pathogenic factors; a young tongue, such as a swollen tongue with teeth marks, may indicate deficiency of Qi and blood or Yang deficiency.3. Observe the state of the tongue body, which refers to the dynamic aspect of the tongue. A normal tongue state is flexible and can extend and retract appropriately; abnormal states may include a tongue that is crooked, cannot extend straight, or is tense. A common abnormality in children is the involuntary protrusion and retraction of the tongue, or licking of the lips, which may indicate heat in the heart and spleen.The tongue coating is formed by the upward steaming of stomach Qi.According to the “Tongue Diagnosis Guide”: “A thin coating indicates insufficient Qi; a thick coating indicates excess pathogenic Qi.”This means that the thickness of the tongue coating can reflect the strength of pathogenic factors; a thin coating indicates weak pathogenic factors, possibly still on the surface, while a thick coating indicates stronger pathogenic factors that have penetrated deeper into the body.
When examining the tongue coating, a thick coating indicates stagnation, while a greasy coating indicates dampness. A greasy coating feels like mud. Generally, a thick coating will also feel greasy, but there can be cases where the coating is not thick but still feels greasy.Common types of tongue coatings include: thin white coating, thin yellow coating, white greasy coating, yellow greasy coating, partial peeling coating, and total peeling coating, etc. Additionally, if you are looking at a tongue image, due to color discrepancies, it may be difficult to judge the color of the tongue body; in this case, you can compare it with the color of the lips, where a tongue that is redder than the lips is considered red. A red tongue indicates heat, but heat does not necessarily require clearing; for example, many children with food stagnation and internal heat may have a red tongue, but simply clearing heat will not resolve the root issue.There is also a three-jiao coordinate tool, where the tongue corresponds to the upper, middle, and lower jiao of the body. We should also understand this.
With this basic knowledge of tongue diagnosis, we can use it to observe the internal health status of the body.Let’s practiceobserving the tongue1
This is a generally normal tongue.We see a light red tongue body and lip colorcovered with a thin layer of frostand this layer of frost is relatively even.2
At first glance, this tongue appears normalbut the entire white coating is denseand covers the sides of the tongueThe coating is thicker than normal,indicating possible cold.The direction for warming cold is to warm up.Acupuncture can enhance Yang Qiand accelerate the circulation of Qi and bloodimproving the body’s metabolic capacity.Additionally, methods such as Nán Huái Jǐn’s navel paste, foot baths, warming the abdomen,eating warm and easily digestible foods, and running can be very helpful.3
This tongue has a greasy coating.The center is slightly yellow with some small red spots, indicating stagnant heat.However, the overall coating is primarily white and greasy,so we believe this tongue indicates cold and dampness.A greasy coating is due to dampness.We can imagine the body is filled with waste,like a muddy road after rain.This is usually due to insufficient righteous Qi or excessive pathogenic Qi.4
This image clearly shows a swollen tongue.A swollen tongue indicates dampness,and the coating is thick and greasy,indicating both dampness and cold.Case description:There is a history of many antibiotics and cold medicines suppressing symptoms.There is a history of recurrent cough.Focus of adjustment:First, stop all harmful treatments to the spleen and stomach.It is advisable to try some Chinese medicine under the guidance of a qualified practitioner.At home, use feedback-based feeding to adjust, and increase exercise.If coughing or cold occurs, handle it according to TCM principles.Remember: stopping harm to the spleen and stomach is the most basic step for recovery.5
This tongue has a slight yellow coating.The middle part of the tongue, which corresponds to the middle jiao, has a thick yellow coating.This indicates that the stomach and intestines may have waste.In many cases, children’s stagnant heat is caused by food accumulation.Symptoms such as black, foul-smelling stools or constipation, bad breath, and heat in the palms and soles confirm this.However, this stagnant heat cannot simply be treated by clearing heat; it requires digestion and guiding stagnation,which means removing waste or controlling the source of waste production.In fact, beneath this yellow coating, there is a thick white coating.Thus, this child’s basic constitution has cold and dampness.6
This tongue appears wet and slippery.There is a layer of water covering the thick white coating.A swollen tongue indicates cold and dampness obstructing the body.7
This tongue body is slightly swollen.The coating is thick and greasy,with small red spots on the tongue,indicating cold, dampness, and stagnation.Case description:There has been pneumonia once every six months, and the most recent cough has lasted nearly a month.After taking lung-clearing and some allergy medications for a month.It is important to note:If the tongue coating starts to become thick and white after treatmentand does not return to normal within a day or two,it is necessary to reconsider the treatment direction.Here we find that cold, damp, and stagnation tongue coatings can manifest in many ways.We are only presenting a broad overview here.8
This is a thick white greasy coating.The thickness of the coating represents the amount of waste in the body.Imagine the gastrointestinal tract filled with a lot of waste.The parent of this case describes the child as having adenoid hypertrophy and severe snoring.These all point to gastrointestinal stagnation.It is speculated that this is due to a long history of incorrect treatment and improper feeding.9
This tongue has peeling coating.Peeling coating indicates damage to stomach Qi.This conditionis closely related to incorrect treatment.Case description:The child is three years old and has had one intravenous treatment.However, before the age of two, they had colds and fevers, and took many heat-clearing and anti-inflammatory medications.The peeling of the tongue coating may be related to the habitual use of heat-clearing and anti-inflammatory treatments or mismanagement of colds and fevers.10
This tongue body is very pale, lacking color.We can imaginethat the circulation of Qi and blood in this body is insufficient.This child’s overall vitality is inadequate.Case description:Previously had pneumonia, and since then has remained pale.It is speculated that this may be due to improper treatment or inadequate post-illness recovery.11
This is a geographic tongue.It indicates some damage to stomach Qi.It may be due to Yin deficiency or fluid deficiency.However, the cause of fluid deficiency is often insufficient production of fluids or weak righteous Qi.Most often due to heavy pathogenic factors, which may not be suitable for heat-clearing, and may not necessarily be suitable for nourishing Yin,as nourishing Yin herbs are often not easily digestible.When righteous Qi is weak, they may not be suitable.Specific adjustments can only be handled on a case-by-case basis.12
This tongue has a thick greasy coating at the root, with some yellow.The root of the tongue represents the lower jiao,indicating severe stagnation in the lower jiao.Case description:This year has been full of illnesses.Two weeks ago, due to otitis media, the child took ceftriaxone for six days.On June 11, they took paracetamol,and from June 14, they started taking paracetamol, Pudi Blue, ceftriaxone…After the fever subsided, they experienced abdominal pain.This tongue coating indicates severe stagnation in the lower jiao, which is related to long-term incorrect treatment.Long-term and continuous incorrect treatment can lower the child’s basic constitution.The stagnation in the lower jiao is a sign of declining constitution.13
This tongue also shows peeling coating.Looking at the arrow position, there is no visible coating.Other areas appear to have peeling coating, but they actually do have a thin coating.In fact, this is the normal part,while many other areas are abnormally thick.Case description:During that time, the child often ate indiscriminately.The elderly also served them fish, meat, shrimp, and eggs every day.Then they developed food stagnation and fever.This kind of dietnot only failed to provide nutrition to the childbut also harmed the child’s spleen and stomach.14
This tongue has obvious red spots.The tip of the tongue is very red, indicating heat in the upper jiao.It can also be interpreted as fluid deficiency.The disease mechanism is Yangmingor Shaoyang.Specific diagnosis requires looking at the overall situation of eating, drinking, and excretion.15
This is also a strawberry tongue.The surface of the tongue has no coating,indicating that the stomach Qi has been burned away.In terms of treatment direction,it is necessary to carefully consider whether heat-clearing is appropriate.16
The tongue coating has cracks in the middle,indicating damage to stomach Qi.The back of the tongue is pale, and the coating is relatively thick,indicating deficiency and cold in the middle and lower jiao.Common Tongue Coating Issues Q&A1. Is the tongue coating of infants significant?Answer: The milk coating of infants does not have much reference significance; certain stagnation and cold deficiency are part of the growth and development process. If the infant is sick, tongue coating can assist in judgment, but as long as they are feeding normally, having normal bowel movements, adequate urine output, and sleeping well, there is no need to pay attention to it.2. Why does a child’s tongue coating appear normal during the day but slightly thicker at night, while everything else is fine?Answer: The tongue coating can change throughout the day based on the movement and excretion of the internal organs; this is a normal process of the body handling waste.3. When is the best time to observe the tongue coating?Answer: Avoid observing within one hour after waking, half an hour after eating, half an hour after drinking, and after consuming anything that may stain the tongue. At other times, it can be observed in natural light.Text |Yang QiandongEditor |ZhuziProofreader |YeziIllustration |Jasmine Red & ShilinRelated ReadingThe tongue is a monitor that can reveal internal abnormalities in the body.Should the whole family avoid fruits if their tongues are thick and damp?
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