Zhang Zhongjing Medical PathTeaches you to differentiate syndromes and provide personalized plans.Follow

Danxi Medical PathProvides in-depth TCM content and health knowledge.Follow

Huangdi Medical PathPractical TCM knowledge shared daily.Follow

Zhongjing Medical PathZhongjing Traditional Medicine, classics endure.Follow

Elephant Medical PathGreat sounds are rare, great forms are formless. Yin and Yang complement each other, the medical path merges.Follow

Danggui Medical PathDanggui Medical Path, the way of Qi and Huang.Follow

Yuan Zhi Medical PathThose who follow this account have learned skills.Follow

Xinglin Medical Narrative PathThose who love TCM are all here.Follow

Xinglin Medical Technique PathTCM practitioners, welcome home.Follow

Click on the “Follow” above, or click on the public account name to follow.

Tongue diagnosis is a crucial part of TCM observation diagnosis, a simple and effective method to assist in diagnosis and differentiation by observing the color and shape changes of the tongue.

The tongue is the sprout of the heart, the external sign of the spleen, and the coating is produced by the stomach qi. Tongue diagnosis mainly examines the tongue’s quality and coating in terms of shape, color, moisture, and dryness to determine the nature of the disease, the severity of the condition, the abundance or deficiency of qi and blood, the balance of body fluids, and the deficiency or excess of the organs.

The tongue quality, also known as the tongue body, is the muscular and vascular tissue of the tongue.

The tongue coating is a layer of coating attached to the tongue body, produced by the stomach qi.

Three Major Tongue Qualities Indicating Possible Health Issues:

1. Fissured Tongue

The tongue surface shows various fissures of different depths and shapes, which is known as a fissured tongue.

(1) Excess Heat Injuring Yin, often presents as a red tongue with fissures; if you notice this phenomenon, seek medical attention promptly, and avoid consuming hot foods in daily life. Eat more foods that nourish Yin and reduce fire.

(2) Blood Deficiency Not Moistening, often presents as a pale tongue with fissures; this tongue quality is common in patients with anemia or those recovering from major illnesses or surgeries. It is important to consume blood-nourishing foods gradually.

(3) Spleen Deficiency with Dampness, often presents as a pale, plump tongue with teeth marks and fissures. This is common in patients with spleen deficiency and excess dampness. In daily life, consume foods like yam and coix seed to strengthen the spleen and eliminate dampness.

2. Teeth-marked Tongue

The edges of the tongue show impressions from the teeth, known as a teeth-marked tongue.

(1) A pale, moist tongue with teeth marks indicates internal cold and dampness. Patients should pay attention to warmth in daily life, avoid raw and cold foods, and try to stay away from overly humid environments.

(2) A pale red tongue with teeth marks indicates spleen deficiency or qi deficiency. In daily life, you can use Dang Shen (Codonopsis) and Fu Ling (Poria) to make tea.

(3) A red and swollen tongue with teeth marks often indicates phlegm-heat obstruction. Patients with this condition should seek medical attention promptly.

3. Swollen Tongue

The tongue body is swollen and plump, or has teeth marks, and is pale and tender, known as a swollen tongue.

(1) A plump and tender tongue, pale in color, with teeth marks, thin white coating, pale face, cold body, fatigue, poor appetite, abdominal fullness, loose stools, and a weak pulse. This often indicates spleen deficiency.

It is recommended to consume foods that strengthen the spleen, such as yam, Fu Ling (Poria), and Yi Yi Ren (Job’s Tears).

(2) A large, plump, tender tongue, pale in color, with teeth marks, and significant swelling below the waist, with scanty urination, cold limbs, a pale or dull complexion, and a weak pulse. This often indicates kidney deficiency with water retention.

It is recommended to consume foods like black beans and winter melon in daily life.

These Tongue Coatings Require Attention:

1. White Rough Coating and White Coating with Cracks

A white tongue coating can be thin or thick, with rough and loose granules, dry and hard, resembling sand or stones, and feels rough to the touch. This is known as white rough coating. If the granules are finer, the texture is hard, and there are cracks, it is called white coating with cracks.

This is commonly seen in exterior heat diseases and acute infectious diseases.

2. Yellow Greasy Coating

A yellow and greasy tongue coating, with tightly packed granules, is known as yellow greasy coating.

Yellow greasy coating indicates: damp-heat accumulation, phlegm-heat transformation, or food stagnation; it also indicates exterior heat and damp-heat.

3. Gray Coating

A gray tongue coating with a hint of black is referred to as “gray-black tongue coating.”

Gray coating is dry and indicates Yangming organ excess and injury to Yin fluids.

4. Black Coating

A black coating is darker than gray coating and often develops from gray or burnt yellow coatings.

Black coating indicates: internal heat, extreme heat, or excess cold. It often appears in severe stages of illness.

5. Burnt Yellow Coating

A burnt yellow coating is deep yellow or thick and dark yellow, especially in the center or at the root of the tongue.

Burnt yellow coating indicates stomach heat accumulation.

Every morning, take 30 seconds while brushing your teeth to observe your tongue quality and coating. If there are obvious abnormalities, timely adjustments are necessary!

If you find this article helpful, please share it with your friends and family!

If you have any questions about TCM tongue diagnosis, feel free to leave a comment below.

“TCM Tongue Diagnosis”, 23 High-Definition Case Images, Easy to Understand, Remember and You Can Be a Doctor Too!

Tongue diagnosis is part of TCM observation diagnosis and is an essential skill in TCM clinical practice.

First, Let’s Look at Tongue Color

Tongue Coating Section

The tongue image is one of the most important observation objects in TCM diagnosis and is a difficult subject to master. In the eyes of experts, the small tongue holds the key to understanding the causes and mechanisms of diseases and treatment strategies! In this regard, the famous Qing Dynasty physician Wu Kunan summarized his lifelong insights on tongue observation and syndrome differentiation in his book “Shang Han Zhi Zhang” into a verse. If you can memorize it, it will greatly benefit your diagnosis and treatment of diseases. Let’s take a look at the text.

Original Text of the Tongue Observation and Syndrome Differentiation Verse

Six excesses cause true transmission, observe the tongue method first in diagnosis.

Observe color, differentiate channels, and identify hands and feet, distinguishing between Ying and Wei, exterior and interior, and then combine with pulse symptoms for treatment.

White indicates lung and Wei, yellow belongs to the stomach, red indicates gallbladder fire, black indicates spleen channel.

Shao Yin purple color with round thickness, burnt purple liver Yang and Yin also green.

Exterior white and interior yellow, distinguish sweating and downward, red indicates Ying, white indicates Wei, treat with heaven and abyss.

Next, explore the fluids for news, moistening without injury, dryness already deficient.

White indicates lung Wei and also Qi, red indicates heart Ying blood to observe.

White with yellow still indicates Qi heat, edge red with white indicates lung fluids dry.

Wei evil can sweat, should open the lung, Qi division should clear, fierce sweating is difficult.

Enter Ying to penetrate heat, the clever use of rhino and deer, to the blood only clear earth and dan.

White and yellow Qi division flow long, still hope to fight sweat to penetrate heavy barriers.

Red tongue still with yellow and white, penetrate Ying and leak Wei, both harmonize.

White and thin moist wind cold heavy, warm dispersing is not harmful, liquid does not dry.

Dry thin white coating indicates fluids are already few, only suitable for cooling and resolving lung homeostasis.

If the coating is pure yellow with no white, exterior evil enters the interior, stomach homeostasis is dry.

Further verify old yellow with cracks, abdominal fullness and pain, downward is safe.

Tai Yin abdominal fullness, coating sticky and greasy, Chen Pi (Aged Tangerine Peel) and Fu Ling (Poria) resolve dampness.

Yellow and dry if still chest fullness and discomfort, drain heart and small trap with two formulas.

Slight yellow, greasy, and no thirst, bitter drain should not be used to open and drain safely.

Heat has not harmed fluids, yellow thin slippery, still can clear heat and penetrate muscle surface.

Dampness remains in Qi division, coating sticky and greasy, small urination like dripping, bowel movements quick to connect.

Dampness accumulates in the middle, causing fullness, Chen Pi (Aged Tangerine Peel) and Fu Ling (Poria) can cure.

Upper dampness stagnates, body feels hot, Qi division should be unblocked for self-healing.

Dampness from outside invading the muscle surface, Qin Jiao (Gentiana Macrophylla) and Gui Zhi (Cinnamon Twig) resolve the muscle first.

Damp-heat long steaming becomes internal, thick yellow vomiting and diarrhea, drain heart and control.

If accompanied by yellowish skin and eyes, Wu Ling San (Five-Ingredient Powder with Poria) and Zhi Mu (Anemarrhena) can be used together.

Red tongue must know Ying division heat, Xi Jiao (Rhino Horn) and Dan (Cinnabar) resolve it safely.

If accompanied by fresh and pure red color, evil invades the collaterals.

Fire phlegm salty internal closure, Xi Huang (Bovine Bile) and Zhi Bei Mu (Fritillaria Bulb) can be added to meals.

Heart bears the stomach burning center red, clear stomach and heart must remain.

Lord fire inflamed tip alone red, Xi Jiao (Rhino Horn) and Dao Chi San (Guide Out Red Powder) resolve it safely.

If you see edge red with dry white, upper Qi heat and blood are not dry.

Only clear the diaphragm without form heat, nourishing and greasy like throwing away the disease is difficult.

Red tongue floating sticky quality, summer heat and damp turbidity want to steam phlegm.

Fear of internal closure, fragrant chase, Xi Jiao (Rhino Horn) and Bo He (Mint) smooth the stagnation.

White coating red base due to what, heat due to dampness lurking is difficult to penetrate.

Heat poison rides the heart, red spots heavy, Huang Lian (Coptis) and Jin Zhi (Gold Juice) can calm the madness.

Red tongue fragmented with yellow and white spots, heat lust dampness wants to create sores.

Ancient names of fox and confusion are the same, mixed symptoms of cold and heat must be carefully explored.

Red tongue not fresh, dry and withered, kidney Yin has dried up, difficult to save.

Purple and withered, dim liver and kidney, red and bright, stomach fluids dry.

Thick yellow indicates evil enters the interior, black and dry pierces heat deeper.

Repeatedly clearing does not resolve, know the reason, fire dryness and fluids lost urgently save Yin.

Black slippery Tai Yin cold water insults, abdominal pain, vomiting, diarrhea, seek within.

Further accompanied by sticky and floating quality, phlegm and dampness condense, open and drain.

Tongue shows edge yellow with black greasy, heat steams spleen dampness, fullness is difficult to endure.

Vomiting, constipation due to drinking harm, open and drain the middle with heart.

Cold dampness often invades the Qi division, wind and two Qi naturally follow.

Tongue will take yellow and white shape in the middle, obtain the formula to connect pulse symptoms.

Warm evil summer heat runs in the Ying, also enters Tai Yin Qi division.

Absorb heart Ying and lung Wei, summer heat mixed with dampness, Wei and Ying communicate.

Cold damage enters the interior, Yangming is the master, heat disease Yangming first entangles.

First white then yellow, cold transforms heat, pure yellow less white heat steams.

Heat disease without cold, only strong heat, Huang Qin (Scutellaria) and Zhi Zi (Gardenia) are passed down through the ages.

Severe cold and fever, cold damage symptoms, sweating and dispersing cold exterior agents first.

Less Yangming warm disease, how to determine, red tongue must know wood fire burns.

Red eyes, deafness, severe body heat, Zhi Zi (Gardenia), Qiao (Bitter Herb), Xi Jiao (Rhino Horn), and fresh peony.

If warm evil is received from above, it first enters the lungs through the orifices.

Qin Jiao (Gentiana Macrophylla), Qin (Bitter Herb), Zhi Zi (Gardenia), Sang Ye (Mulberry Leaf), Xing Ren (Apricot Kernel), Qi dryness adds syrup to clear the lung.

Evil enters heart Ying and gallbladder, add Yuan Mai (Barley), Bo He (Mint), and fresh.

Cold and warm two Qi must be distinguished, summer heat and dampness must follow.

Dampness has already formed sticky and greasy tongue, only summer symptoms can be raised.

Summer heat injures Qi division, tongue is white, thirsty, vexed, vomiting, coughing, and wheezing.

Body heat, pulse weak, chest fullness, no form Qi division heat should be cleared.

Lou Pi (Bitter Herb), Bei Xing (Bitter Herb), Qin (Bitter Herb) smooth and slippery, Zhi Zi (Gardenia), Qiao (Bitter Herb), and bamboo leaves decoction.

Or see cough with red lotus leaf juice, fullness adds Chen Pi (Aged Tangerine Peel), Yin Jin (Golden Flower) to the river.

Summer heat enters heart Ying, tongue red, spirit dull as if asleep, ears deaf.

Urination drips, sweating is not a solution, loss of treatment, evil invades the heart palace.

Xi Jiao (Rhino Horn), slippery Qiao (Bitter Herb), Dan (Cinnabar), and silver flower bamboo leaves stone rush together.

To form internal closure, much confusion, re-enter Niu Huang (Cattle Bile) to achieve results.

Summer heat and dampness combined evil empty orifices touch, three divisions receive the disease, the situation spreads.

Abdominal fullness, head swelling, much vomiting and nausea, abdominal pain still prevents malaria and dysentery.

Zhi Zi (Gardenia), Qin (Bitter Herb), Xing Ren (Apricot Kernel), and half Chen Pi (Aged Tangerine Peel), silver flower slippery stone, Yin Jin (Golden Flower) to calm.

Damp warmth Qi division flows long, tongue red with yellow, dry and prickly.

Coughing blood does not need to nourish and greasy, deafness should not be treated as less Yang.

Three divisions and treatment smooth Xing Ren (Apricot Kernel), golden juice silver flower slippery cold.

If rashes and measles penetrate within, then clear phlegm fire and nourish Yin to calm.

Tongue shape powder white with four edges red, epidemic enters the gathering, the situation is most fierce.

Urgently use Da Yuan (Great Source) to add guiding herbs, one combined with yellow and black, quickly.

If you see bright red pure scarlet color, epidemic transmits to collaterals and Ying.

Clear evil and detoxify with silver and rhino, Bo He (Mint), Jin Zhi (Gold Juice), and warm summer heat.

Warm evil and seasonal epidemic often have spots, in clinical practice, it is necessary to know how to raise and penetrate.

Spots belong to lung home, wind and heat, spots arise from stomach heat.

Spots are white, soft on the skin surface, blood heat like red, rhino must not delay.

Tongue white, Jing Fang (Bitter Herb), Qiao (Bitter Herb), thin strength, tongue red must avoid Ge Gen (Pueraria) rising medicine.

All belong to genuine deficiency, tongue tender and thin, pale red and slightly white, supplementing rest is delayed.

Thick yellow greasy white evil within, the diagnostician must know to clear and resolve.

Interpretation

The “Tongue Observation and Syndrome Differentiation Verse” can be said to be the essence of Wu Kunan’s “Shang Han Zhi Zhang”. It is a summary of Wu’s experiences combined with his clinical practice, consisting of thirty-nine seven-character poems, totaling over one thousand two hundred words.

The verses flow smoothly, are easy to memorize, and are easy to recite.

The verse opens by indicating that the diagnosis and treatment of six excesses should first observe the tongue shape and color, differentiate between hand channels and foot channels, Ying and Wei, exterior and interior, and then combine with pulse symptoms for treatment.

It can be seen that Wu’s tongue observation is not limited to the six channels but is combined with Wei Qi and Ying blood, reflecting his dialectical thinking of cold and warmth integration. It then introduces various tongue coatings’ main symptoms, treatment principles, prognosis, and methods for observing tongue diagnosis and differentiating hidden heat diseases, summer heat, and warm epidemics.

The verses are clear in meaning, finely categorized, accurately differentiated, and orderly. They provide detailed descriptions of tongue color, coating color, shape, thickness, moisture, dryness, and multi-color combinations, as well as treatment methods, and analyze the relationship between tongue images and disease progression, which is beneficial for a comprehensive understanding of warm diseases and interrupting or reversing disease progression.

The entire text is concise, balancing comprehensiveness and practicality. For example, “White indicates lung Wei and also Qi, red indicates heart Ying blood to observe. White with yellow still indicates Qi heat, edge red with white indicates lung fluids dry.”

These eight lines basically clarify three main issues in the differentiation and treatment of warm diseases:

1. The general transmission rules of Wei Qi and Ying blood.

2. The tongue shape and color at various stages of exterior warm heat diseases.

3. The treatment principles at various stages of exterior warm heat diseases.