Tongue diagnosis, also known as observing the tongue, is an important method for understanding the physiological functions and pathological changes of the body by observing the changes in the tongue’s appearance. Traditional Chinese Medicine (TCM) believes that “what is inside must manifest outside.” By observing a child’s tongue, one can determine the cause of illness; the color, texture, and thickness of the tongue serve as a “barometer” of the child’s health. The little tongue holds great knowledge, as it can indicate the child’s health status.
What should a normal child’s tongue look like? It should be of moderate size, soft, light red, moist, and have a thin coating. In simple terms, it is a pink tongue with a thin white coating.The tongue acts as a “barometer” reflecting the child’s health, especially the digestive function of the stomach and intestines, which is vividly displayed on the tongue.If mothers can understand the changes in their child’s tongue, they can detect abnormalities early and prevent potential issues. This can help the child become healthier and reduce the likelihood of illness.
The tip of the tongue reflects the heart and lungs, the middle of the tongue reflects the spleen and stomach, the root of the tongue reflects the kidneys, and the sides of the tongue reflect the liver and gallbladder.
1. Observe the color of the tongue bodyNormal color is light red; bright red indicates heat; purple indicates stasis; blue indicates cold; pale white indicates deficiency.2. Observe the tongue coatingA thin white coating is normal; a thick white coating and moistness indicate cold; a thick yellow and dry coating indicates heat; a thick greasy and moist coating indicates damp-cold; a thick greasy and dry coating indicates damp-heat.3. Observe the shape of the tongueA tongue of moderate size is normal; a protruding enlarged tongue indicates a swollen tongue, often associated with deficiency-cold; a protruding thin tongue indicates a solid condition, often associated with internal heat.4. Observe the flexibility of the tongue bodyA tongue that moves freely is normal; a tongue that lacks strength indicates deficiency of qi and blood; a tongue that is crooked or trembles indicates signs of stroke.5. Observe the location of the tongueThe tip of the tongue is the reflection area for the heart and lungs; the middle of the tongue is the reflection area for the spleen and stomach; the root of the tongue is the reflection area for the kidneys; the sides of the tongue are the reflection area for the liver and gallbladder.6. Observe the tongue’s edge marksTeeth marks indicate deficiency; if moist, it indicates deficiency-cold; if dry, it indicates deficiency-heat.7. Observe the shedding of the tongue coatingIf the coating increases from thin to thick, it indicates worsening of pathogenic factors; if the coating decreases from thick to thin, it indicates recovery of righteous qi; if the coating suddenly increases or decreases, it often indicates a sudden change in condition.8. Observe the authenticity of the tongue coatingIf the coating adheres tightly to the tongue surface and is difficult to scrape off, it is considered true coating. If the coating is not firmly attached, like a film on the tongue surface that can be easily scraped off, it is considered false coating.
Case Study of Symptoms
Tongue Symptoms:The tongue has red spots and is dark in color. The abdomen is bloated, prone to flatulence, and the stool is dry at the front with undigested material; the child always wants to eat and feels there is always phlegm!Tongue Analysis:1. Thick coating in the middle of the tongue indicates food stagnation.2. Red spots on the tip of the tongue indicate heat from stagnation.3. Bloating indicates spleen deficiency and inability to transform.4. Always wanting to eat indicates internal heat, with a strong stomach and weak spleen.
Tongue Symptoms:
At night, the child drools while sleeping and prefers to sleep on their stomach. The complexion is slightly yellow.
Tongue Analysis:
1. Thick coating in the middle of the tongue indicates food stagnation.
2. Drooling while sleeping indicates spleen deficiency.
3. Slightly yellow complexion indicates spleen deficiency.
Tongue Symptoms:A 4-month-old boy has had this tongue coating for a while; he wakes up crying every two hours after midnight. He feels fine after breastfeeding. The stool is thin and watery, once a day, and he is very energetic, with a pointed tongue. There is a blue line between his eyes, and a purple line on his left eyelid.
Tongue Analysis:
1. Thick coating in the middle of the tongue indicates food stagnation.
2. Unstable sleep indicates food stagnation in children.
3. Watery stool indicates that children with food stagnation are prone to diarrhea or constipation.
4. Blue line between the eyes indicates insufficient lung qi.
5. Light tongue color indicates some blood deficiency.
This tongue has a red color in the heart and lung area, indicating heat in the heart and lungs, and a thick yellow coating in the middle and back of the tongue, indicating heat accumulation in the spleen and stomach. This child already shows symptoms of food stagnation and spleen and stomach weakness.
The tongue has cracks in the middle, and the tip is red, which are typical symptoms of yin deficiency, along with excess heart fire.
This tongue has a full white coating, indicating spleen deficiency and cold symptoms.
This baby has heat in the liver and gallbladder, is irritable, as indicated by the redness on both sides; there are also symptoms of food stagnation. In this state, it is crucial to resolve food stagnation; otherwise, exposure to cold may lead to colds and fevers.
This baby’s tongue coating is very good, with a pink tongue and a thin white coating.
This tongue has teeth marks on the edges, indicating spleen deficiency, a red tongue, internal heat, and excess heart and lung fire..
This tongue has a thick coating in the spleen and stomach area, but the entire tongue is moist, indicating spleen and stomach weakness with cold symptoms.
This is a strawberry tongue, with the tongue body covered in strawberry-like spots, indicating internal heat. This child is prone to respiratory diseases.
This is a swollen tongue with teeth marks, indicating internal dampness and qi deficiency. The tongue body is pale, indicating blood deficiency.
This tongue has a full white coating, indicating water dampness and cold symptoms.
Thick white coating:Children generally have irregular eating habits, and when the stomach has food stagnation, the tongue coating will become thick. Spleen and stomach yang deficiency, cold congealing damp stagnation generally leads to a thick white coating. However, those who frequently consume cold fruits and drinks or long-term eat cold substances (such as milk, eggs, soy milk, seafood, etc.) can also impair the yang qi of the spleen and stomach, leading to a thick white coating.
At this time, it is necessary to resolve food stagnation.
Thick yellow coating:Yellow indicates heat; children generally start with a thick white coating due to irregular eating habits, and after prolonged stagnation, the white coating turns yellow. Alternatively, those who frequently consume hot foods such as fish, meat, shrimp, and spicy foods can lead to thick yellow coatings due to the child’s weak spleen and stomach unable to digest. Heat in the stomach can ascend and cause lung heat, leading to sore throat and swollen tonsils; it can descend and cause dry constipation, anal pain, and dry stools.
At this time, it is necessary to resolve food stagnation and clear heat.
Thick coating with a red tip:
Heat symptoms gradually spread, like a small fire that can ignite a prairie. When the tip of the tongue starts to turn red, it indicates that heart fire is increasing. Some may even develop ulcers at the tip of the tongue, making children irritable and restless, having difficulty falling asleep, and experiencing restless nights.
At this time, in addition to resolving food stagnation, it is also necessary to clear heart fire and nourish kidney water to control fire with water, achieving harmony between water and fire.
Red tongue with little or no coating: At this time, the stomach is like a red-hot pot, with yin deficiency and excess fire, almost burning dry. Internal heat is severe, making it easy to develop sore throats, tonsillitis, mouth ulcers, repeated oral ulcers, excessive hunger, irritability, difficulty sleeping, night sweats, and hard stools like sheep droppings.
At this time, it is necessary to nourish yin and clear heat.
Geographic tongue:The tongue coating peels off in patches, resembling a map, hence the name geographic tongue. This condition is generally due to the child’s weak stomach qi, excessive and mixed diet, damaging the stomach yin and qi, leading to gastrointestinal dysfunction. Such children are also prone to irregular bowel movements, either diarrhea or constipation, or both.
At this time, it is necessary to clear heat, nourish yin, and restore stomach qi.
Methods for Observing Tongue Diagnosis
Lighting: Sufficient and soft natural indoor light; when extending the tongue, face the light source to allow direct light to shine on the tongue surface, avoiding reflections from colored walls, curtains, and other objects.Posture: The patient should sit comfortably, naturally extend the tongue, relax the tongue body, and fully expose the tongue surface without excessive force. The tongue should not be extended for too long (as it may cause the tongue body to appear red); observations can be repeated. Precautions1. Staining: Certain foods and medications can affect the color of the tongue coating, leading to misinterpretation; it is important to inquire and differentiate (eating peanuts can thicken the white coating; eating green vegetables like cucumbers and fennel can stain the coating green; oranges can stain it yellow; children eating gum, snacks, or drinks can easily stain the tongue in various colors).2. Changes in lighting can also easily affect the tongue coating and body. For example, under outdoor sunlight, yellow coatings may appear lighter, and the tongue body may change from dark red to light red, appearing fresh like bayberry; indoor fluorescent lights may make the tongue body appear light red with a slight rose color.3. Other influencing factors: The tongue appearance can vary throughout the day: — In the morning, the tongue coating may be slightly thicker and darker; — Activity and eating can restore the tongue appearance to a red, moist state. — Mouth breathing can lead to a thin, dry coating; — Excessive force can cause the tongue body to appear suddenly red;
Tongue Diagnosis Content
Tongue Body: Mainly observe the color of the tongue: pale white, light red, red, dark red, purple.Tongue Shape: Size, presence of teeth marks, cracks.Tongue Coating: Thickness, color, moisture or dryness.The tongue body reflects the body’s righteous qi, mainly the yang qi and body fluids. If qi is transformed, it is expressed through the color of the tongue. Therefore, the normal color of the tongue body is light red and glossy.The tongue shape represents the “form” and “state,” appearing moderate in size and age, and moving flexibly! The tongue coating is the result of the “qi” in the stomach being presented. It mainly reflects the type of pathogenic factors in the body and the strength of the stomach qi! The “qi” mentioned here can be divided into stomach qi and pathogenic qi, both of which can be presented and can form tongue coatings. (The tongue coating formed by stomach qi is normal, which is a thin white layer, tender and not thick, with moderate moisture, neither slippery nor dry.)Since tongue diagnosis is so important, taking tongue images is also a necessary task during the child’s conditioning period,but there are many small details to remember about how to take these tongue images.
Precautions for Taking Tongue Images
1. Do not take images immediately after waking up, after eating, or after vigorous exercise, and avoid taking images after consuming colored foods. It is recommended to take images two hours after meals.2. Do not brush the tongue coating within three days.Many friends have the habit of brushing their tongue while brushing their teeth.Friendly Reminder:If you plan to see a TCM practitioner, remember not to brush your tongue coating, and female friends should avoid wearing lipstick and makeup. TCM observation requires seeing the true condition.3. Use the rear camera of the phone to take images.Selfies use the front camera, which generally has insufficient resolution; also, avoid using beauty filters. Before taking the image, focus the camera to ensure clarity; otherwise, the image will be blurry.4. Ensure sufficient lighting. Take images during the day by a window, and at night under good lighting. If the surroundings are too dark, the phone’s automatic light compensation may distort colors. Additionally, the light should be white; yellow or other colored lights will cause color discrepancies. Avoid wearing overly bright clothing, especially bright red, as it can affect the image; if you happen to wear it, cover the collar area.5. Allow the child to fully extend their tongue gently without force or intentional retraction. Keep the camera close to ensure the entire tongue is centered in the frame. First, take images of the front, then both sides and the tip, finally capturing the underside of the tongue without biting it.6. Before taking images, ensure the child’s face is clean. For children undergoing conditioning, it is best to also capture their eyes, nose bridge, and lips.7. If taking images is difficult, consider recording a short video following this process. Whether photos or videos, review them first to check for color discrepancies, and send the original image.8. What if the baby does not cooperate and does not open their mouth? You can gently press with a spoon or distract them with a small snack; there are always more solutions than difficulties.Please share this article so more people can see it
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