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Difference Between Tongue Body and Coating
The tongue body and tongue coating are two different aspects; the tongue body is not raised, while the coating is raised and can be scraped off. The tongue body reflects the state of internal organs, with a plump and tender appearance indicating deficiency, while a firm and withered appearance indicates excess.
Diseases are rooted in the coating; the coating is a manifestation of disease. Internal conditions must manifest externally, and observing the tongue coating can reveal the severity of the six excesses. The tongue body and coating also serve as indicators of the cold-heat and depth of the condition.
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Moisture Levels, Tongue Firmness and Shortness, Tongue Deviation
The moisture and dryness of the tongue indicate the presence or absence of fluids, regardless of color; a moist tongue indicates intact fluids, while a dry tongue indicates depleted fluids. A firm tongue body suggests an external heat condition with intense pathogenic heat entering the pericardium; various diseases may indicate a sign of stroke.
A quivering tongue indicates chronic deficiency; a new condition often suggests extreme heat generating wind. A short and retracted tongue reflects a critical condition; a red and short tongue indicates depletion of liver and kidney yin; a moist, short tongue with a bluish hue indicates cold pathogens directly affecting the jueyin.
A deviated tongue often indicates a stroke or a sign of stroke.
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White Coating
A white coating indicates an exterior pathogen; a moist white coating suggests wind-cold, which should be treated with warming dispersing methods; a dry white coating indicates a warming pathogen, which should be treated with pungent-cooling methods.
If the tongue is white with a red tip, it indicates that wind-heat has entered the qi level, affecting the hand taiyin; treatment should be light and cooling, avoiding pungent warming methods to prevent damaging lung fluids. A white coating with red edges indicates internal heat has emerged, also requiring light cooling treatment, avoiding warming dispersing methods.
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Yellow Coating
A yellow coating indicates internal heat pathogens; if the yellow coating has a hint of white, it suggests some exterior pathogen remains. Pure yellow without white indicates the pathogen has left the exterior and is now purely an internal condition (similar to cold damage and warm disease).
If yellow appears within a white coating or is slightly yellow and thin, it indicates the pathogen has just entered the yangming interior, still carrying exterior symptoms, likely accompanied by mild aversion to cold, requiring cooling treatment and not purging.
A yellow and dry coating indicates aversion to heat but not cold, suggesting the exterior pathogen has entered the yangming interior, or a hidden pathogen is about to emerge from the yangming exterior; at this time, the stomach is not yet full, requiring cooling treatment to clear and penetrate.
If the tongue is red with yellow and white colors, it indicates the pathogen is between the qi and ying levels; treatment should clear the heat in the ying level and disperse the pathogen in the qi level, harmonizing both.
If the coating is thick, yellow, dry, or has yellow edges with black spots, indicating fullness in the interior, it is appropriate to use purging methods. If the coating is yellow at the edges and black in the center, it indicates stomach heat steaming dampness, with fullness in the middle jiao, vomiting, and constipation; treatment should involve bitter and pungent methods to open and drain the middle jiao.
If the coating is slightly yellow, thin, and slippery, treatment should involve dispersing light cooling to clear the exterior, allowing the pathogen to exit without using bitter and pungent methods that would drain and stagnate the dampness.
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Sticky Coating
Any sticky coating, whether white or yellow, with no thirst indicates dampness. A white and sticky coating indicates cold dampness; a yellow and sticky coating indicates damp-heat.
Fullness, with a white sticky coating, difficulty urinating, and rapid bowel movements, indicates dampness obstructing the middle jiao, requiring bitter warming methods to open it.
If the coating is yellow and sticky, with fullness and nausea, and both urination and bowel movements are difficult, this indicates damp-heat obstructing the middle jiao, requiring bitter cold and slightly pungent methods to open and drain.
Dampness obstructing heat, with a yellow and dry coating, indicates a transformation from yin to yang. If there is pain upon palpation below the heart, it indicates heat phlegm accumulation; treatment should involve bitter and pungent methods to drain.
If there is fever or tidal heat, with unresolved exterior symptoms, it is important to recognize that heat arises from dampness; treatment should involve dispersing the qi level, allowing dampness to exit and heat to resolve.
Exposure to rain or dampness, or sitting on wet ground, leading to fever and spontaneous sweating without relief, even with body heat but no desire to remove clothing, and no thirst, with a gray-white sticky coating, treatment should involve pungent warming to disperse the exterior; dampness should be resolved without mistakenly using bitter cold methods that harm yang and stagnate dampness.
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Powdery White Coating with Red Edges
A powdery white coating with red edges indicates an epidemic pathogen entering the membranes; this condition changes rapidly and is severe, requiring bitter and pungent warming dispersing methods.
Regardless of cold damage or warm disease, if the righteous qi is deficient, the tongue will be tender and thin, either pale red or slightly white, and can be slightly assisted with tonifying herbs (referring to those that tonify qi and generate fluids), but should not be overly dispersive or purging.
If a thick yellow coating is seen with a white and greasy appearance, it indicates internal pathogens are not cleared, and tonifying herbs (referring to those that tonify qi and blood) should not be hastily administered.
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Black Coating
A black coating indicates the cold-heat of the foot taiyin; a gray-black and slippery coating, with symptoms of vomiting, diarrhea, abdominal pain, and coldness in the hands and feet, indicates taiyin cold dampness, requiring warming the spleen and draining dampness.
If cold drinks injure the spleen, treatment should involve warming the middle and harmonizing the spleen to expel fluids. If a white coating is accompanied by gray-black, slippery, and floating characteristics, this indicates dampness acquired from rain and dew, representing taiyin exterior pathogens, requiring muscle relaxation and dampness drainage.
A white coating with black spots or black stripes that are sticky indicates taiyin damp-heat accumulation; treatment should involve draining dampness and clearing heat.
If the coating is black and dry, it indicates heat pathogens in the yang channels (specifically yangming), requiring clearing fire and detoxifying while also treating yangming.
If the coating is black and firm, it indicates excessive yang and depleted yin, with both gastric juices and kidney fluids exhausted, a critical condition (historically referred to as untreatable), requiring nourishing yin and increasing fluids while also clearing heat, using large doses; if delayed, yin will deplete and lead to death.
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Red Tongue
A red tongue indicates the lurking pathogen of the shaoyang; the lurking pathogen often uses shaoyang as an exit route.
If the tongue is pale red, tender red, or white with red, it indicates a mild warming pathogen.
If the tongue is pure red or bright red with prickles, it indicates severe gallbladder fire and heat in the ying level, with the pathogen lurking in the shaoyin and manifesting on the shaoyang exterior; this condition is not mild, requiring nourishing yin and draining heat as a priority, nourishing the water of the shaoyin, allowing the fire of the shaoyang to resolve, strictly avoiding wind herbs (which are drying).
If the tongue is red and shiny, with bright color, it indicates stomach yin depletion; treatment can still nourish stomach yin, requiring sweet and cooling substances.
In cases of wind-heat, warm epidemics, etc., if the tongue is bright red, treatment should follow the hand shaoyin or hand jueyin, which is treating the heart (clearing the ying level).
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Crimson Tongue
A crimson tongue indicates the invasion of heat into the ying level.
A pure red and bright tongue indicates the invasion of the pericardium; treatment should involve clearing and opening while also using aromatic methods to penetrate the collaterals.
If there is pre-existing phlegm-heat, it will lead to phlegm and fluids obstructing internally, requiring urgent prevention of convulsions, necessitating clearing and opening while assisting in clearing fire and resolving phlegm.
A yellow coating with a crimson tongue indicates stomach fire scorching the heart, requiring methods to clear both the heart and stomach, with treatment involving bitter cold.
If the tongue tip is red with prickles, it indicates heart fire rising; treatment should involve clearing the heart and draining fire methods.
If the tongue tip is red with black prickles, it indicates a dangerous condition of heart fire self-burning, which requires clinical attention.
If the tongue edges are red with a white dry center, it indicates heat in the upper qi level without being in the blood level; treatment should involve light cooling to resolve qi level heat, slightly yellow, using slightly pungent methods to open and drain, avoiding rashly administering nourishing and greasy blood level herbs that would stagnate the pathogen.
A crimson tongue with a floating sticky coating indicates summer dampness combined with turbidity, with summer steaming dampness forming phlegm, risking obscuring the pericardium and leading to mental confusion and convulsions; urgent use of aromatic methods to disperse turbidity and open the orifices is required.
If the tongue has a white coating with a crimson base, it indicates heat being obstructed by dampness, unable to penetrate outward; treatment should involve draining dampness and penetrating heat, allowing dampness to open and heat to resolve itself.
If small red spots appear on the tongue, it indicates heat toxins invading the heart, likely leading to mental confusion, delirium, or mania; treatment should involve bitter cold to withdraw heat, assisting with aromatic methods to open the orifices.
A fragmented crimson tongue with yellow-white necrotic spots indicates damp-heat toxins, long-stagnated and steaming; if the stomach is strong enough to eat, heavy bitter cold herbs can be used for treatment.
A purple and dull crimson tongue with no moisture, with a shriveled and retracted shape that does not extend beyond the teeth, indicates liver and kidney yin depletion, which is difficult to treat; the focus should be on nourishing liver and kidney yin fluids, requiring sweet and salty methods.
If the tongue is purple and dull like pig liver with no moisture, and the tongue shape is retracted and does not extend beyond the teeth, it indicates liver and kidney failure, making it difficult to treat.
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Purple Tongue
A purple tongue indicates deficiency of the foot shaoyin kidney channel. In shaoyin disease, the pulse is weak and thin, with a desire to sleep, indicating deficiency of righteous qi.
If the tongue is purple and dry, with thirst, and dry lips, showing signs of shaoyin, this indicates kidney yin deficiency, requiring strengthening water as the main treatment.
If accompanied by mental confusion and delirium, treatment should follow the hand shaoyin and also clear phlegm-heat.
If the tongue is plump and tender with a pale red color, external symptoms will likely show agitation and restlessness, with the six pulses being slow and weak or showing internal qi movement, abdominal coldness and aversion to cold, or initial vomiting and diarrhea, with coldness in the hands and feet, or manic behavior with rapid pulses without root; all indicate severe depletion of kidney qi and weak true fire, requiring methods to enhance the source of fire to dispel yin turbidity.
If the tongue is purple and dry, with scorched lips and black teeth, and both urination and bowel movements are difficult, this indicates a combination of yin and yang; treatment should involve nourishing yin and clearing heat (nourishing shaoyin and clearing yangming), requiring bitter cold and salty cold methods.
In general, a plump, large, tender tongue, regardless of cold damage, warm disease, or miscellaneous conditions, indicates deficiency of shaoyin. If the tongue is purple like pig liver, dull and without moisture, this indicates kidney fluids have been depleted; if seen in dysentery, it indicates stomach yin has been exhausted, both of which are critical conditions.
If cold damage or warm disease occurs, and after bowel movements, the tongue coating suddenly disappears, revealing a purple tongue like pig liver, this indicates a loss of original qi, with stomach yin exhausted, making it difficult to treat; if the coating disappears and a pale red tongue with moisture is seen, this is favorable.
Scorched purple indicates a critical condition of the jueyin liver channel due to yang toxins.
In general, if the tongue coating is scorched purple with prickles, this indicates that yang pathogens and heat toxins have entered the liver channel, which is the most dangerous condition; if there is constipation, urgent use of major clearing and nourishing methods is required, avoiding purging methods that would severely deplete yin. This condition indicates yin injury and pathogen invasion, not yangming interior fullness.
If there are red-purple spots on the tongue in the liver and gallbladder areas (on both sides of the tongue), this indicates hidden fire in the liver channel, a very ominous sign, requiring urgent cooling blood and detoxifying methods.
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Green and Slippery
Green and slippery indicates a critical condition of the jueyin liver channel with yin toxins. Any green and slippery coating indicates a sign of yin cold, requiring urgent bitter warming methods.
If external symptoms include a green face, purple lips, retraction of the throat, reversal of the pulse, and tight muscles, these indicate a critical condition of jueyin yin toxins.
Jueyin cold pathogens may also present with a green and slippery tongue, but without the above external symptoms, warming will resolve it.
In tongue diagnosis, overemphasis on using the five colors to differentiate the five organs, or using locations to differentiate organs and bowels, is a mechanical application of the five-element theory.
Clinical assessment of disease mechanisms must rely on pulse diagnosis, comprehensively and meticulously integrating all specific conditions, flexibly mastering them to avoid errors; tongue diagnosis alone should not be used to determine the condition.
Clinical Application of Ascending and Descending Methods
Yiqi Congming Decoction