(1) Physical manifestations: Facial (eyelid) swelling, oily complexion, prone to acne, diarrhea, heaviness and fatigue, dry and hard stools, irritability. (2) Causes: Qi deficiency, lack of exercise, consumption of cold drinks, leading to water dampness retention in the body. (3) Solutions: 10 grams each of Hong Dou (Red Bean) and Yi Ren (Job’s Tears), boil in water for 30 minutes, drink as tea to dispel summer heat and dampness. In winter, for cold dampness, use green Hua Jiao (Flower Pepper) to soak feet in boiled water. 
(1) Physical manifestations: Forgetfulness, dry throat, irritability, dry skin, body pain, dull complexion, dark lips, dark circles, dysmenorrhea. (2) Causes: Poor blood circulation, trauma, emotional stress (liver Qi stagnation can easily lead to blood stasis), Qi deficiency, cold exposure. (3) Solutions: 0.5 grams each of San Qi (Notoginseng) and Xi Yang Shen (American Ginseng), powdered and taken with warm water.
(1) Physical manifestations: Poor memory, poor concentration, poor sleep, easy insomnia, fatigue, sensitivity to wind and cold, warm hands and feet in hot weather, cold hands and feet in cold weather. (2) Causes: Blood loss, poor spleen and stomach function leading to nutrient absorption issues, excessive worry depleting heart and spleen blood. (3) Solutions: 30 grams of Xi Yang Shen (American Ginseng) powdered, 300 grams of Long Yan Rou (Longan Fruit), mix and steam for 4 hours, take one spoon daily with hot water.
(1) Physical manifestations: Dry eyes, dry mouth and throat, heat in palms and soles, dry stools, dizziness, tinnitus, poor sleep, rapid pulse, preference for cold drinks, irritability, and easy anger, lower back and knee soreness. (2) Causes: Insufficient body fluids, staying up late, consuming spicy and excessive heat-inducing foods, severe illness. (3) Solutions: 9 grams each of Sheng Di (Rehmannia), Sha Shen (Adenophora), Mai Dong (Ophiopogon), Gou Qi Zi (Goji Berries), 6 grams of Shi Hu (Dendrobium), 3 grams of Dang Gui (Angelica), one section of pig spine, boil into soup and consume within a week. 
(1) Physical manifestations: Sensitivity to cold, preference for hot drinks, lack of energy, excessive sleep, pale lips, hair loss, excessive sweating, loose stools, clear and frequent urination. (2) Causes: Excessive consumption of cold medicines, cold drinks, weak constitution, excessive exposure to cold environments. (3) Solutions: 20 grams of Dang Gui (Angelica), 30 grams of Sheng Jiang (Ginger), 500 grams of lamb, boil into soup and consume.(1) Physical manifestations: Depression, bitter and dry mouth, dizziness, poor appetite, alternating chills and fever, irritability, nausea, chest tightness and rib pain, insomnia with vivid dreams. (2) Causes: Excessive worry, high stress (emotional injuries: joy disperses Qi, anger raises Qi, worry gathers Qi, thinking knots Qi, sadness disperses Qi, fear lowers Qi, shock confuses Qi). (3) Solutions: 3 grams each of Deng Xin Cao (Juncus), Zhu Ye (Bamboo Leaves), steep in water and drink for 3-5 days, mainly used for sudden heat requiring liver Qi regulation. Long-term liver Qi stagnation requires adjustment of the seven emotions: joy, anger, worry, thought, sadness, fear, and shock. Compassion is the most powerful tool to control the seven emotions, as the benevolent live long.
Tongue diagnosis organ location chart
Tongue diagnosis organ location chart
(1) Tongue color
① Pale tongue: The tongue color is lighter than normal, indicating deficiency syndromes and cold syndromes, often seen in blood deficiency, representing weak Yang Qi and insufficient Qi and blood. A pale and plump tongue indicates deficiency cold; a plump tongue with teeth marks on the edges indicates Qi deficiency or Yang deficiency.
② Red tongue: The tongue color is deeper than normal, bright red, indicating heat syndromes, often due to internal heat. A red tip indicates heart fire; red edges indicate liver and gallbladder heat; a dry red tongue indicates heat injuring body fluids or Yin deficiency heat.
③ Dark red tongue: The tongue color is deep red, indicating excessive heat, often due to evil heat penetrating the nutrient level, blood level, or Yin deficiency heat.
The deeper the red or dark red tongue color, the heavier the heat evil.
④ Stasis spots on the tongue: The tongue has blue-purple stasis spots or patches, often indicating internal blood stasis accumulation.
⑤ Cyanotic tongue: The entire tongue appears blue-purple, indicating extreme heat or cold syndromes. A deep purple dry tongue indicates extreme heat, while a pale yellow-purple or cyanotic tongue that is moist indicates Yin cold syndromes.
(2) Tongue shape: Observe the tongue’s texture, thickness, and presence of prickles or cracks.
① Old and young: “Old” refers to a rough tongue texture, firm color, often indicating excess syndromes or heat syndromes; “young” refers to a delicate tongue texture, soft color, often indicating deficiency syndromes or deficiency cold syndromes.
② Thick and thin: “Thick” refers to a swollen tongue, often related to water dampness retention. A pale and thick tongue with teeth marks on the edges often indicates spleen deficiency or kidney Yang deficiency with water dampness retention; a red and swollen tongue often indicates internal damp-heat or excessive heat toxin. “Thin” refers to a small and thin tongue, often indicating deficiency syndromes. A pale and thin tongue often indicates insufficient Qi and blood; a red and dark thin tongue often indicates internal heat due to Yin deficiency.
③ Prickles: The tongue papillae are enlarged and protruding like thorns, often indicating excessive heat evil. The more severe the heat evil, the larger and more numerous the prickles. Clinically, prickles are often seen on the tongue tip and edges, with prickles on the tongue tip often indicating excessive liver and gallbladder heat.
④ Cracks: The tongue has various longitudinal or transverse cracks or wrinkles, often due to mucosal atrophy. Cracked tongues can be seen in a few normal individuals. A red cracked tongue often indicates excessive heat; a pale cracked tongue often indicates insufficient Qi and Yin.
(3) Tongue state: Observe whether the tongue trembles, is tilted, weak, or stiff.
① Trembling: The tongue trembles involuntarily, often indicating both Qi and blood deficiency or internal liver wind.
② Tilted: The tongue is tilted to one side, often indicating stroke or stroke warning signs.
③ Weak: The tongue is weak and lacks strength, often due to both Qi and blood deficiency leading to insufficient nourishment of the muscles.
④ Stiff: The tongue is not flexible, difficult to move, or cannot rotate, often indicating high fever injuring body fluids, excessive heat, or a sign of stroke.
2. Tongue coating: The tongue coating is a manifestation of the stomach’s vital energy. Zhang Xugu said: “The tongue coating arises from the stomach’s vital energy, and the stomach’s energy arises from the heart and spleen. Therefore, healthy individuals often have a thin coating, which is the stomach’s vital energy, like the fine grass on the ground; if there is no grass, the soil lacks vitality.” Wu Kun’an said: “The tongue coating is like the moss on the ground. The ground’s moss arises from the upward diffusion of moisture; the tongue’s coating arises from the stomach’s steam and spleen dampness, hence it is called coating.” Modern physicians believe that the formation of tongue coating is mainly due to the differentiation of filiform papillae. The tips of the filiform papillae differentiate into keratinized trees, and the gaps in the keratinized branches are often filled with shed keratinized epithelium, saliva, bacteria, food debris, and exuded white blood cells, forming normal tongue coating. Normal tongue coating is a thin white layer, moist and not thick, neither slippery nor dry. Observing the tongue coating involves examining the color, thickness, and moisture of the coating.
(1) Coating color: There are white, yellow, gray, and black coatings.
① White coating: White coating is the most common in clinical practice, and other colors can be considered transformations of white coating. White coating generally belongs to the lungs, indicating exterior syndromes or cold syndromes, but white coating can also be seen in internal syndromes or heat syndromes. For example, thin white and moist indicates wind-cold; thin white and dry indicates wind-heat; cold dampness in internal syndromes can show thick and greasy white coating.
② Yellow coating: There are light yellow, tender yellow, deep yellow, and scorched yellow. Generally, the deeper the yellow coating, the heavier the heat evil. Light yellow indicates mild heat; tender yellow indicates heavier heat; deep yellow indicates even heavier heat; scorched yellow indicates heat accumulation; dry yellow indicates heat injuring body fluids; greasy yellow indicates damp-heat.
③ Gray-black coating: Often indicates heat syndromes, but can also indicate cold dampness or deficiency cold syndromes. Gray-black and dry coating indicates excessive heat injuring body fluids; gray-black and moist coating often indicates Yang deficiency with excessive cold. Gray-black coating is often seen in more severe stages of illness.
(2) Thickness: There are thin coating, thick coating, sparse coating, and no coating.
Thin coating often indicates the early stage of disease, with the pathogen on the surface, and the condition is relatively mild; thick coating often indicates a stronger pathogen that has penetrated internally; or there may be gastrointestinal accumulation; or phlegm dampness. The thicker the coating, the stronger the pathogen, and the more severe the condition. However, the formation of tongue coating reflects the presence of stomach Qi; even if the coating is thick, it indicates that stomach Qi is still present, while sparse coating often indicates insufficient righteous Qi, and no coating indicates severe deficiency of stomach Qi, lacking the ability to generate. Irregular tongue coating shedding, with smooth areas without coating, is called “flowered peeling coating,” often indicating insufficient stomach Qi and Yin; if accompanied by greasy coating, it indicates phlegm dampness has not transformed and righteous Qi has been injured.
(3) Moisture and dryness: Reflects the internal fluid status. Normal tongue coating is neither dry nor wet; dry tongue without coating indicates that internal fluids have been depleted, with external pathogens often causing dry heat injuries; internal injuries often indicate Yin deficiency and insufficient fluids; moist tongue coating indicates that fluids have not been injured, while excessive moisture on the tongue surface that drips when the tongue is extended is called “slippery coating,” indicating internal dampness retention.
Greasy coating: The coating is dense and fine, like a layer of turbid, smooth mucus covering the tongue surface, difficult to wipe off, often indicating internal phlegm dampness.
Putrid coating: The coating is loose like tofu dregs, piled on the tongue surface, easy to wipe off, often indicating the transformation of food stagnation in the stomach due to excessive heat.
Tongue image atlas explanation
1. Normal tongue
Tongue image: Tongue quality is pale red, thickness is moderate, tongue coating is thin white and moist at an appropriate level.
2. Pale white tongue
Tongue image: Tongue quality is pale white, tongue body is plump, tongue coating is white and thin.
Significance: Often indicates weak stomach Qi or insufficient Qi and blood.
3. Old tongue with rough coating
Tongue image: Tongue quality is pale red, old, with white coating covering, slightly yellow, rough like sand.
Significance: Dampness obstructing the meridians, fluids not ascending, or excessive heat injuring fluids.
4. Pale white tongue with white coating
Tongue image: Tongue quality is pale white, with white coating covering, thick in the middle like accumulated powder.
Significance: Yang deficiency with heat floating, can be seen in Yang deficiency with external damp-heat.
5. Pale white tongue with black dry coating
Tongue image: Tongue quality is pale white, tongue body is plump, tongue coating is gray-black, dry and cracked.
Significance: Spleen loses healthy movement, dampness and turbidity not transformed, phlegm dampness obscuring the clear orifices.
6. Pale red mirror tongue
Tongue image: Tongue quality is pale red and tender, with cracks on the edges, tongue surface is smooth and shiny without coating.
Significance: Insufficient stomach Yin or both Qi and Yin deficiency.
7. Stasis spots on the tongue
Tongue image: Tongue quality is pale red with dark spots, edges have stasis spots, tongue coating is thin white.
Significance: Blood stasis obstructing the meridians, Qi and blood stagnation.
8. Pale red flowered peeling tongue (geographic tongue)
Tongue image: Tongue quality is pale red, tongue body is tilted, tongue coating is white and greasy with peeling, presenting a geographic pattern.
Significance: Both stomach Qi and Yin deficiency, phlegm dampness obstructing the meridians.
9. Red tongue with flowered peeling coating
Tongue image: Tongue quality is red and tender, tongue coating is white and greasy with peeling, smooth areas without coating, or covered with white transparent coating.
Significance: Damp-heat injuring Yin, damp turbidity not transformed, already injuring Yin fluids.
10. Red swollen tongue
Tongue image: Tongue quality is red, tongue body is swollen and plump, cannot retract into the mouth, tongue tip and middle have yellow coating, tongue edges and root have white coating.
Significance: Damp-heat steaming, blood heat obstructing.
11. Pale red tongue with purple spots
Tongue image: Tongue quality is pale red, tongue tip and edges have multiple blue-purple patches, tongue coating is uneven white and greasy, with less coating in the middle.
Significance: Qi stagnation and blood stasis or prolonged illness with Qi and blood not replenished.
12. Pale red tongue with thick greasy coating
Tongue image: Tongue quality is pale red, tongue coating is thick and greasy.
Significance: Qi deficiency with blood stasis, phlegm and fluid accumulation.
13. Pale red tongue with thick putrid coating
Tongue image: Tongue quality is pale red, tongue body is slightly plump, white thick putrid coating covers the tongue surface like accumulated powder, with a slight yellow hue on the surface.
Significance: Damp-heat obstructing the three burners.
14. Pale red tongue with yellow rough coating
Tongue image: Tongue quality is pale red, tongue coating is yellow and rough, like sand.
Significance: Gastrointestinal heat accumulation with dampness, damp-heat transforming into dryness.
15. Red tongue with black greasy coating
Tongue image: Tongue quality is red, coating is thick and greasy, edges are white and yellow, with black in the middle.
Significance: Deficient Yang floating upwards, damp-heat retained internally.
16. Red tongue without coating
Tongue image: Tongue quality is red and tender, with cracks in the middle, except for a small amount of residual coating on the edges, the rest is smooth and without coating.
Significance: Injury to both stomach and kidney Qi and Yin.
17. Tongue with teeth marks
Tongue image: Tongue quality is slightly red, tongue body is plump with teeth marks, with longitudinal cracks in the middle, coating is thin white and coarse.
Significance: Spleen deficiency with damp stagnation, accompanied by internal heat.
18. Cracked tongue
Tongue image: Tongue quality is slightly thin, mostly longitudinal cracks like knife cuts, tongue coating is thin white.
Significance: Pre-existing Yin deficiency, true Yin insufficient, with deficiency fire rising.
19. Cracked tongue
Tongue image: Tongue quality is pale white with a hint of cyanosis, tongue body is plump, with deep cracks in the middle, tongue edges have cracks like knife cuts, tongue coating is uneven and greasy.
Significance: Both Qi and blood are deficient, kidney Yin insufficient.
20. Red tongue with white putrid coating
Tongue image: Tongue quality is red, tongue coating is thick white, coarse and loose, like tofu dregs piled on the tongue surface.
Significance: Phlegm and food accumulation internally, damp-heat steaming.
21. Red tongue with yellow putrid coating
Tongue image: Tongue quality is red, with red spots, tongue body is old, tongue coating transitions from white to gray-yellow, thick putrid accumulation, with horizontal and vertical cracks.
Significance: Damp-heat and turbid accumulation in the interior.
22. Dark red tongue with scorched yellow coating
Tongue image: Tongue quality is red but dark, coating is scorched yellow like a pot bottom, thick and cracked.
Significance: Gastrointestinal heat accumulation, obstructing the bowels.
23. Red tongue with yellow and white coating
Tongue image: Tongue quality is red, with red spots, coating is yellow and white, thick and full, like rice flour.
Significance: Evil heat and damp toxins accumulating in the interior.
24. Dark red tongue with scorched yellow coating
Tongue image: Tongue quality is dark red and dull, tongue body is thin, tongue coating is thick and scorched yellow and cracked.
Significance: Excess heat and dryness accumulating in the stomach and intestines.
25. Red tongue with yellow and black coating
Tongue image: Tongue quality is dark red, old, tip has red spots, coating transitions from thin white to gray-yellow, root has gray-black greasy coating.
Significance: Wind-phlegm disturbing, phlegm-heat obstructing the bowels.
26. Red tongue with black rough coating
Tongue image: Tongue quality is red, with red spots, black rough cracked coating covers the tongue, thick and accumulated.
Significance: Heat toxin internally, phlegm-heat obstructing the bowels.
27. Red dotted prickly tongue
Tongue image: Tongue quality is red, with red prickly protrusions, tongue coating is white and greasy, surface slightly yellow.
Significance: Nutrient level heat stagnation.
28. Cyanotic thin tongue
Tongue image: Tongue is thin and small, appearing cyanotic and dull, tongue coating is white and thick and putrid.
Significance: Cold dampness stagnating, Qi and blood obstructing.
29. Dark purple tongue with shiny peeling coating
Tongue image: Tongue quality is dark purple and dull, tongue surface is shiny and without coating.
Significance: Heat affecting the nutrient blood, injuring Yin and obstructing the meridians.
30. Pale white tongue with slippery coating
Tongue image: Tongue is pale and plump, edges and tip covered with white slippery coating, middle root has yellow coating, thick and greasy.
Significance: Kidney Yang insufficient; damp turbidity transforming into heat.
31. Red tongue with thin stasis spots
Tongue image: Tongue quality is red, tongue body is thin, two yellow greasy coatings thickly accumulated, the rest is smooth and without coating.
Significance: Gastrointestinal heat accumulation injuring Yin and accompanied by excessive Yin deficiency fire.
32. Red plump stasis spots tongue
Tongue image: Tongue quality is red with stasis spots, tongue body is swollen, tongue surface has lesions, coating is white and slippery with some brown.
Significance: Internal dampness and toxins.
3. Considerations for tongue diagnosis
(1) The patient should naturally extend the tongue outside the mouth, fully exposing it, in a flat shape, allowing the tongue body to relax, without curling or excessive force, to avoid color changes.
When observing the tongue, try to quickly and accurately assess the tongue quality, tongue body, tongue coating, and avoid the patient extending the tongue for too long; if necessary, allow a brief rest before re-observing.
(2) The patient should face the light, allowing direct light to shine into the mouth, with sufficient light; otherwise, the colors of the tongue quality and coating may be difficult to distinguish.
(3) Pay attention to the impact of diet on tongue diagnosis: For example, after eating, food friction may cause the tongue coating to thin; drinking may cause the tongue coating to become moist; consuming warm or spicy foods may cause the tongue quality to become red or dark. Therefore, it is generally not advisable to perform tongue diagnosis immediately after the patient has eaten or rinsed their mouth.
(4) Be aware of staining: For example, drinking milk may cause the coating to appear white; eating black plums, bayberries, coffee, dried plums, olives, etc., may stain the tongue coating black or brown; eating broad beans, oranges, persimmons, and yellow rinds may cause the tongue coating to turn yellow. These temporary external stains should not be mistaken for pathological tongue coatings.
Appendix: Brief Introduction to Modern Research on Tongue Diagnosis
The tongue is one of the main organs in the oral cavity, composed of many transverse striated muscles, covered by a special mucosa, especially the dorsal mucosa, which is the main component of the tongue coating. The tongue has a rich distribution of blood vessels and nerves, and its mucosal epithelium is thin and transparent, thus it can sensitively reflect changes in the body, digestive system, and body fluids. In recent years, there has been an increasing use of modern knowledge and methods to study traditional Chinese tongue diagnosis, summarized as follows:
(1) Normal tongue image:
Pale red tongue quality: Due to the rich blood vessels and blood circulation in the submucosa and muscular layer, the tongue muscle appears red, seen through a layer of white keratinized mucosal surface, forming the normal pale red tongue quality.
Thin white coating: Formed by the differentiation of the tips of the filiform papillae and the shed keratinized epithelium, saliva, bacteria, food debris, and exuded cells.
(2) Changes in tongue image:
① Changes in tongue quality are closely related to blood circulation, body fluid status, and physiological disorders, as well as metabolic disorders of tissue cells; for example, when the body’s compensatory function is disordered or insufficient, a Qi deficiency tongue image may appear; when the body is excessively consumed, leading to a lack of certain important substances, a Yin deficiency tongue image may appear.
Pale white tongue is often related to tissue edema, capillary contraction, reduced blood volume, and slow blood flow, commonly seen in anemia or protein deficiency, especially albumin deficiency; it can also be seen in digestive system dysfunction or endocrine dysfunction, such as adrenal cortex insufficiency; red tongue is often related to capillary dilation, increased blood volume, and blood concentration, commonly seen in fever, especially acute infectious diseases, dehydration, vitamin deficiency, post-surgery, water balance disorders, and coma patients; cyanotic tongue may be closely related to venous stasis or hypoxia leading to increased reduced hemoglobin, commonly seen in liver disease, heart disease, and cancer patients.
The plump and tender tongue is mainly due to reduced plasma protein, tongue tissue edema, and may present teeth marks on the edges due to edema, tongue enlargement, or reduced muscle tone and relaxation; cracks are caused by the fusion and separation of tongue papillae, possibly related to mucosal atrophy; prickles are due to the transformation of filiform papillae into fungiform papillae, while the blood vessels in the mucosal stroma become congested and dilated, causing the fungiform papillae to swell and become congested.
A dry tongue quality is due to reduced saliva secretion or decreased water content in saliva. In dehydrated patients, blood viscosity increases, and saliva secretion decreases, leading to a dry tongue surface, making dry tongue surface the best indicator of clinical dehydration, being the earliest manifestation of any cause of dehydration.
② Changes in tongue coating are related to the proliferation of filiform papillae, increased keratinization, bacterial action, the amount of moisture in the oral cavity, and the nutritional status of the body, as well as organ diseases: white coating is often due to reduced oxygen exchange or anemia, leading to decreased oxygen transport, causing metabolic disorders of the tongue mucosa and increased metabolic products; yellow coating is due to the stimulation of inflammatory factors and metabolic products, leading to the proliferation of filiform papillae, diffuse keratinization of the mucosal surface, and excessive keratinization, along with keratin debris and the action of yellow microorganisms, as well as local inflammatory exudates on the tongue, thus often seen in infectious diseases, febrile illnesses, and some malignant tumors; black coating is due to more severe proliferation of filiform papillae, the appearance of brown keratinized cells and black mold growth, or putrefactive bacteria acting on necrotic substances on the tongue mucosa, or forming black substances with iron-containing microorganisms, thus considered to be caused by chronic infections, toxic stimulation, gastrointestinal dysfunction, fungal infections, long-term antibiotic use, and deterioration of oral health due to malignant diseases, and can also be seen in excessive smoking and poor oral hygiene.
Thick and greasy tongue coating is often due to reduced appetite or consumption of soft food, liquids, reduced mechanical friction on the tongue, or due to fever and dehydration, reduced saliva secretion, and decreased cleaning action, affecting the tongue’s self-cleaning ability, leading to the elongation of filiform papillae, along with the accumulation of keratin debris and exudates.
Based on current research data, changes in tongue images are related to the following points:
① Related to nutritional deficiencies: Patients with chronic gastric diseases or chronic diarrhea may exhibit yellow or gray tongue coatings due to poor digestion and absorption. Excessive consumption and metabolic disorders can also lead to significant changes in tongue coating, such as various febrile patients initially showing thin white coating, transitioning to dry yellow coating in the mid-stage, and diabetic patients may show dry red coating.
② Related to the quality and quantity of the circulatory system and blood: Patients with severe anemia often have pale white tongues, with atrophy of tongue papillae; dehydration, acidosis, blood concentration, and hypoxia often present with bright red or purple tongues; thrombocytopenia may show purple spots on the tongue; pernicious anemia may present with a smooth tongue.
③ Related to bacterial and viral infections and the body’s resistance: During the onset of epidemics, white greasy coating is common, while more severe or serious cases may present with red tongues; sepsis caused by Pseudomonas aeruginosa often shows smooth tongues without coating, while sepsis caused by Streptococcus and Staphylococcus often shows yellow coating. This indicates that changes in tongue images are not only related to the type of bacteria but may also be related to the body’s resistance and reactivity. Generally, sepsis caused by Pseudomonas aeruginosa often occurs in conditions of extremely poor human resistance, with insufficient righteous Qi, thus showing smooth tongues, while sepsis caused by Streptococcus and Staphylococcus infections often presents with heat syndrome, thus mostly showing yellow coating.
④ Related to saliva: Patients with high fever, such as those with toxic pneumonia and acute enteritis, often have dry tongues and lack moisture in the oral cavity. This is due to increased blood viscosity and decreased watery saliva secretion. Similarly, patients with Yin deficiency often have increased sympathetic nervous tension and decreased parasympathetic nervous tension, leading to reduced serous saliva secretion, replaced by mucous secretion, resulting in changes in saliva quality and dry tongue surfaces.
⑤ Related to endocrine: Patients with endocrine disorders may show abnormal tongue images, such as those with adrenal insufficiency may have brown raised or depressed pigment spots on the tongue surface.
(3) Clinical significance of changes in tongue images:
① Changes in tongue images can reflect the severity and progression of diseases: For example, pale red tongue quality, thin white, moist coating indicates a milder condition; red, dark red, blue-purple tongue, yellow thick, gray-black coating, or smooth tongues without coating indicate a more severe condition; pale white tongues often belong to chronic diseases, with slow changes and longer courses, such as anemia, protein deficiency, or adrenal insufficiency; red tongues are often seen in fever, dehydration, and water balance disorders, such as burn patients, the larger the burn area, the faster and more obvious the tongue quality changes to red; if complicated by sepsis, the tongue quality often becomes red, dark, and dry; if a liver cirrhosis patient originally has a pale red tongue with thin white or thin yellow coating, once it changes to red and smooth, it often indicates liver function deterioration; acute appendicitis often shows greasy coating, during treatment, if thick greasy coating transitions to thin white coating, it often indicates improvement, but if pain decreases while greasy coating does not retreat, it indicates that the condition has not improved, and may even worsen.
② Changes in tongue images have certain diagnostic significance for some diseases: Sepsis caused by Pseudomonas aeruginosa often shows smooth tongues without coating, while sepsis caused by Streptococcus and Staphylococcus often shows yellow coating; severe infectious diseases, malignant tumors, hyperthyroidism, and severe diseases of solid organs such as the lungs, liver, and kidneys often present with red, dark red tongues, thin tongues, dry tongues with cracks, and other Yin deficiency tongue images; some tongues may show smooth tongues with red prickles on the edges, while in later stages, the tongue surface may become smooth like a mirror; severe hepatitis patients often have red, dark tongues, dry with little moisture, and when the condition worsens, it becomes more obvious, with thick greasy or dry coating, yellow or black, and sometimes smooth tongues without coating; late-stage tumor patients may present with red and shiny tongue images.
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