Tongue Quality

Presentation

Main Disease

Tongue Shape

Swollen

Swollen tongue body, extends to fill the mouth

Spleen and Kidney Yang Deficiency, Heart and Spleen Heat Excess, Poisoning

Thin

Thin and small tongue body

Qi and Blood Deficiency, Yin Deficiency with Excess Heat

Cracked

Cracks on the tongue surface

Yin Fluid Deficiency, Excess Heat injuring Fluids, Blood Deficiency

Teeth Marks

Teeth marks on the edges of the tongue

Spleen Deficiency with Excess Dampness

Thorny

Enlarged and protruding tongue papillae, resembling thorns

Excess Heat Evil, Heat in the Blood

Tongue State

Rigid

Rigid tongue body unable to move

Heat entering the Pericardium, Phlegm-Damp obstructing, High Fever injuring Fluids, Stroke signs

Flaccid

Weak tongue body unable to extend

Extreme Qi and Blood Deficiency, Extreme Yin Deficiency

Trembling

Involuntary trembling of the tongue

Qi and Blood Deficiency, Yang Deficiency, Extreme Heat generating Wind, Internal Wind Movement

Protruding

Protruding tongue not retracting or repeatedly licking lips

Heart and Spleen Heat, Epidemic Poison attacking the Heart, Precursor to Wind Movement, or Developmental Delay in Children

Deviated

When extending the tongue, it deviates to one side

Stroke or precursor to Stroke.

Shortened

Rolled tongue unable to extend, in severe cases, tongue does not reach teeth

Reflection of critical signs, seen in Cold congealing the meridians, Phlegm-Damp obstructing, Heat disease injuring Fluids

Coating

Color

White

White coating

Exterior syndrome, Cold syndrome

White Powder Accumulation (Accumulated Powder Coating)

Excess Heat in the Interior, commonly seen in epidemics and internal abscesses

Yellow

Yellow coating

Heat syndrome, Interior syndrome

Light yellow coating on a swollen tongue

Yang Deficiency with Water Dampness not transforming

Gray-Black

Gray-black and moist

Cold Damp syndrome

Gray-black and dry

Interior Heat syndrome

Coating

Quality

Thickness

Based on whether the base is visible

Thin coating indicates lighter diseases, thick coating indicates deeper diseases

Moist

Moderately moist is considered moist

Fluids are intact, fluids are not injured

Dry

Dry without fluids is considered dry

Fluid loss or fluids cannot rise

Greasy

Greasy coating: fine coating that cannot be scraped off

Damp turbidity, Phlegm-Damp, Food accumulation

Loose coating: loose coating that can be easily scraped off

Food accumulation or Phlegm turbidity

Peeling

Partial or complete peeling of the tongue coating

Injury to both Qi and Yin of the Stomach

True and False

True coating: tightly adheres to the tongue surface, cannot be scraped off, indicating rooted coating

Stomach Qi still exists

False coating: appears to float on the tongue surface, can be scraped off easily, indicating unrooted coating.

Stomach Qi is deficient

Cold-Heat Types

Clinical Presentation

Clinical Significance

Chills and Fever

Severe chills, mild fever, no sweating, body aches, pulse floating and tight

Wind-Cold Exterior Syndrome (Exterior Cold Syndrome)

Severe fever, mild chills, thirst, red face, pulse floating and rapid

Wind-Heat Exterior Syndrome (Exterior Heat Syndrome)

Alternating Cold and Heat

Fever at irregular times, bitter mouth, dizziness, fullness in the chest and hypochondria, loss of appetite

Cold Damage Shao Yang Syndrome (Half Exterior Half Interior)

Fever at regular times, severe headache, profuse sweating, thirst

Malaria

Only Cold, No Heat

New illness suddenly feels cold, severe cold pain in the abdomen or other local areas

Excess Cold Syndrome

Chronic illness with weakness, fear of cold, pale face, cold limbs

Deficiency Cold Syndrome

Only Heat, No Cold

High Fever

High fever (T≥39℃) persists, thirst for cold drinks, profuse sweating, pulse flooding and large

Interior Excess Heat

Tidal Fever

Afternoon tidal fever: higher heat, severe heat in the afternoon + abdominal pain with tenderness, constipation

Yangming Fu Excess Syndrome

Yin Deficiency Tidal Fever: low fever in the afternoon or at night + five hearts heat, bone steaming tidal fever, night sweats, red cheeks

Yin Deficiency Syndrome

Wet-Heat Tidal Fever: body heat not rising, severe heat in the afternoon + heaviness in the head and body, chest and abdomen fullness, greasy coating

Wet-Heat Disease

Low Fever

Low-grade fever, lower heat (37-38℃)

Qi Deficiency, Yin Deficiency, Qi Stagnation, residual heat after Warm Disease

Spontaneous Sweating

Daytime sweating, especially during activity + fatigue, fear of cold

Qi Deficiency, Yang Deficiency Syndrome, Wei-Yang not secure

Night Sweats

Night sweating, stops upon waking + tidal fever, red cheeks

Yin Deficiency Syndrome

Critical Sweating

Critical illness, profuse sweating, cold limbs, pulse weak or almost absent, agitation and thirst, pulse thin and rapid

Loss of Yang, Loss of Yin Syndrome

Battle Sweating

First whole body shivering, then sweating; sweating reduces heat, pulse calm and body cool—evil departs and Zheng recovers. Sweating with persistent heat, agitation, pulse rapid—evil overcomes Zheng weakness.

Severe struggle between evil and Zheng, turning point in disease progression.

Name

Pulse Pattern

Main Disease

Floating Pulse

Floating

Light pressure yields pulse, heavy pressure slightly reduces

Mainly exterior syndrome. Strong exterior indicates excess, weak exterior indicates deficiency

Scattered

Floating, large, without root, pulse irregular

Yuan Qi scattered, organ essence about to exhaust

Hollow

Floating, large, hollow, like pressing on a scallion tube

Mainly blood loss, Yin injury

Leather

Floating, string-like, hollow, like pressing on a drum skin

Mainly blood loss, essence loss, miscarriage, excessive bleeding

Deep Pulse

Deep

Light pressure does not respond, heavy pressure is needed to feel

Mainly interior syndrome. Strong interior indicates excess, weak interior indicates deficiency

Hidden

Only felt with heavy pressure, may temporarily be hidden and not apparent

Mainly evil closure, critical conditions, extreme pain

Firm

Deep, large, string-like, only felt with deep pressure

Mainly symptoms of masses, lumps, hernias

Rapid Pulse

Rapid

Pulse comes quickly, more than five beats per breath (90 beats/min)

Heat syndrome (strong, weak)

Hasty

Pulse comes urgently, more than seven beats per breath (120 beats/min)

Extreme heat disease, Yang extreme Yin exhausted

Moving

Pulse is short, slippery, rapid, strong, feels like a bean

Shock, pain

Choppy

Rapid but stops intermittently, stops without a fixed number

Excess Yang heat, Qi stagnation, Blood stasis, Phlegm and food stagnation

Slow Pulse

Slow

Pulse comes slowly, less than four beats per breath (60 beats/min)

Cold syndrome (strong, weak)

Leisurely

Four beats per breath, pulse comes and goes slowly and weakly

Damp syndrome, Spleen deficiency

Knotted

Slow but stops intermittently, stops without a fixed number

Yin cold Qi stagnation, Cold Phlegm Blood stasis

Intermittent

Slow with a stop, stops with a fixed number, comes after a long time

Organ Qi weak, Wind syndrome, Pain syndrome, Shock

Weak Pulse

Weak

All three pulse positions are weak

Qi and Blood deficiency, especially common in Qi deficiency

Soft

Floating and soft, lightly pressed can be felt, heavily pressed is not obvious

Deficiency syndrome, Damp syndrome

Thin

Pulse comes like a thread, weak and powerless, but should be felt clearly

Qi and Blood deficiency, various deficiency syndromes, also indicates Damp syndrome

Fine

Extremely thin and soft, pressing it feels like it might disappear, barely felt

Heart and Kidney Yang deficiency and sudden collapse, deficiency of Yin, Qi, and Blood

Weak

Deep and thin, responding finger is weak

Qi and Blood deficiency syndromes

Rough

Comes and goes with difficulty, like lightly scraping bamboo

Qi stagnation, Blood stasis, Injury to essence and blood

Solid Pulse

Solid

All three pulse positions are firm and strong

Excess syndrome

Slippery

Comes and goes smoothly, like beads rolling on a plate, feels round and smooth

Phlegm-Damp, Food stagnation, Excess Heat, Pregnancy

Flooding

Pulse shape is extremely large, like a flood, comes strong and goes weak

Excess Heat Evil

String-like

Straight and long, like pressing on a guitar string

Liver and Gallbladder diseases, Pain syndromes, Phlegm-Damp

Tight

Like twisting a rope

Cold syndrome, Pain syndromes, Food stagnation

Large

Pulse shape is larger than normal pulse, but without a surging force

Strong indicates excess, weak indicates deficiency

Zang-Fu

Main Clinical Manifestations and Differentiation Points

Heart

Heart Qi Deficiency and Heart Yang Deficiency, Heart Blood Deficiency and Heart Yin Deficiency, Heart Blood Stasis and Heart Fire Excess

Lung

Lung Qi Deficiency and Lung Yin Deficiency, Wind-Cold invading the Lung and Wind-Heat invading the Lung, Dry Heat invading the Lung and Phlegm-Damp obstructing the Lung

Spleen

Spleen Qi Deficiency and Spleen Yang Deficiency, Cold-Damp obstructing the Spleen and Spleen-Stomach Damp-Heat

Liver

Liver Qi Stagnation, Liver Fire Rising, Liver Yang Rising, Internal Wind of the Liver, Liver Yin Deficiency, Liver Blood Deficiency, Liver-Gallbladder Damp-Heat, Cold Stagnation in the Liver Meridian.

Kidney

Kidney Yang Deficiency, Kidney Yin Deficiency, Kidney Essence Deficiency, Kidney Qi not securing, Kidney not receiving Qi

Six Fu Organs

Stomach Cold, Stomach Heat (Fire), Food Stagnation in the Stomach, Stomach Yin Deficiency, Large Intestine Damp-Heat, Large Intestine Fluid Deficiency, Bladder Damp-Heat Syndrome

Combined Zang-Fu Diseases

Heart and Lung Qi Deficiency, Heart and Spleen Qi Deficiency, Heart and Kidney Disharmony, Lung and Spleen Qi Deficiency, Liver Fire invading the Lung, Lung and Kidney Yin Deficiency, Liver and Spleen Disharmony, Liver and Stomach Disharmony, Spleen and Kidney Yang Deficiency with Liver and Kidney Yin Deficiency.

Type

Meaning

Characteristic Manifestations

Qi Deficiency

Insufficient Yuan Qi, dysfunction, decline of organ functions, decreased resistance to disease

Shortness of breath, fatigue, weak pulse (reduced propulsion, weakened transformation), spontaneous sweating (failure to secure), easy to catch colds (reduced defense)

Qi Stagnation

Qi running not smooth and stagnant

Distension, fullness, pain

Qi Reversal

Qi rising too much and descending insufficiently

Shortness of breath, cough, nausea, headache

Qi Sinking

Qi deficiency unable to lift

Prolapse of internal organs, chronic diarrhea, rectal prolapse

Qi Stagnation

Qi stagnation trapped inside and unable to express

Convulsions in the limbs, clenched teeth

Qi Collapse

Extreme Qi deficiency leading to risk of loss and extinction

Persistent sweating, incontinence