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(1) Physiology of the Tongue
1. Tongue Body: The muscular tissue of the tongue, nourished by blood.
2. Tongue Coating: The white, semi-transparent mucous membrane on the surface of the tongue, generated by the stomach qi.
(2) Relationship Between the Tongue and Organs
1. Physiological Connection: The tongue has direct or indirect connections with all five zang and six fu organs, particularly closely related to the heart, spleen, and stomach.
2. There are two methods to divide the tongue surface according to organ locations:
(1) Based on the Stomach Meridian: The tip of the tongue corresponds to the upper jiao, the middle part corresponds to the middle jiao, and the root corresponds to the lower jiao.
(2) Based on the Five Zang: The tip corresponds to the heart and lungs, the sides correspond to the liver and gallbladder, the middle corresponds to the spleen and stomach, the left side corresponds to the liver, the right side corresponds to the gallbladder, and the root corresponds to the kidneys (see Figure 5).
(3) Principles of Tongue Diagnosis
1. The tongue can reflect the function of the heart: The heart governs blood, and the tongue body is nourished by blood; the tongue regulates speech, while the heart governs the spirit, “speech is the voice of the heart.”
2. The tongue can reflect changes in the qi and blood of the organs: In addition to the direct or indirect connections between the organs and the tongue, the heart is the master of all organs, governing the qi and blood functions of the entire body.
3. The taste sensation of the tongue affects the function of the spleen and stomach: The spleen and stomach are the foundation of postnatal life and the source of qi and blood production; the kidney meridian is connected to the tongue, and the essence of all organs is stored in the kidneys, thus the essence of the body is closely related to the spleen, stomach, kidneys, and tongue. Therefore, observing the tongue can reveal changes in the organs.
(4) Methods and Considerations for Tongue Observation
1. Lighting: Sufficient and soft natural light.
2. Position: The patient should sit upright, mouth open, and extend the tongue naturally.
3. Sequence: First observe the tongue coating, then the tongue body, observing from the tip to the root.
4. Other factors: The influence of diet, season, time, age, constitution, and tongue scraping or wiping.
(5) Clinical Significance of Tongue Diagnosis
1. Assessing the vitality of the body’s qi: Observing the tongue can reveal the presence or absence of qi.
2. Differentiating the depth of disease: A thin coating indicates a superficial condition, while a thick coating indicates a deeper condition; a crimson tongue body indicates heat entering the blood, suggesting a severe condition.
3. Distinguishing the nature of pathogenic factors: A yellow coating indicates heat, a white slippery coating indicates cold, a putrid coating indicates food stagnation and phlegm, and a thick yellow coating indicates damp-heat. A deviated tongue indicates wind pathogen, while spots on the tongue indicate blood stasis.
4. Inferring the progression of the disease: A coating changing from white to yellow, then to gray-black indicates the progression of the disease from superficial to deep, and the transformation of cold to heat; a coating changing from moist to dry indicates increasing heat and decreasing fluids; a coating changing from dry to moist indicates the retreat of pathogenic factors and the recovery of fluids.
(6) Main Content of Tongue Observation
1. Tongue Body: Spirit, color, shape, and state.
2. Tongue Coating: Quality and color of the coating.
(7) Normal Tongue Appearance
Light red tongue with a thin white coating.
(8) Clinical Manifestations and Significance of Pathological Tongue Appearance
1. Tongue Body
[Clinical Manifestations] Tongue spirit:
(1) Tongue spirit: There are two types, with spirit and without spirit. The presence or absence of spirit is primarily determined by color, luster, and tongue movement.
A tongue with spirit is red, lustrous, and dynamic (i.e., flexible and soft).
A tongue without spirit is dull, dry, and lacks vitality (i.e., the tongue body is stiff and inflexible).
(2) Tongue Color: The main tongue colors are five types: pale white, red, crimson, purple, and blue.
(3) Tongue Shape: Includes thickness, youthfulness, swelling, and some special pathological shapes.
Youthfulness is determined by the texture of the tongue body. A mature tongue has rough texture and appears firm and old; a youthful tongue has delicate texture and appears swollen and tender.
Swollen: The tongue body is significantly larger than a normal tongue, filling the mouth.
Swollen and bloated: The tongue body is enlarged, filling the mouth, and in severe cases, cannot be closed or retracted.
Thin: The tongue body is noticeably smaller and thinner than normal.
Spots: Spots refer to raised red, white, or black dots on the tongue surface (red star tongue); prickles refer to soft spikes and granules on the tongue surface, which not only enlarge but gradually form sharp peaks, rising like thorns (thorny tongue); stasis spots appear as flat spots that do not rise above the tongue surface and are blue-purple or purple-black.
Cracks: The tongue surface has varying numbers of deep and shallow cracks, referred to as cracked tongue.
Smooth: The tongue surface has no coating and is as smooth as a mirror, referred to as smooth tongue, also known as “mirror tongue” or “glossy tongue.”
Teeth marks: The edges of the tongue show teeth marks, referred to as teeth-marked tongue, also known as “tooth imprint tongue,” often seen with a swollen tongue.
Heavy tongue: The blood vessels under the tongue are swollen, resembling a small tongue growing again, hence called heavy tongue. If multiple areas are swollen, it is referred to as “lotus tongue.”
Bleeding tongue: Bleeding from the tongue is referred to as bleeding tongue.
Abscessed tongue: An abscess on the tongue, red, swollen, hard, and painful, often affecting the chin.
Boil on the tongue: A purple blood blister the size of a bean on the tongue, with a hard base, accompanied by severe pain, referred to as boil on the tongue.
Ulcerated tongue: Ulcers on the tongue, the size of corn, scattered around the tongue, painful, referred to as ulcerated tongue.
Fleshy tongue: The tongue grows flesh-like tissue, initially the size of a bean, gradually enlarging with a small base, resembling “floating lotus,” “vegetable flower,” or “cockscomb,” with a red, rotten surface, producing extremely foul saliva, and severe pain making it impossible to eat.
Sub-lingual vessels: Normal sub-lingual vessels are faintly visible on both sides of the lingual frenulum, at the Jin Jin and Yu Ye points, with two thicker blue-purple vessels faintly visible. Pathological sub-lingual vessels are thick and swollen, or branched, with blue-purple or purple-black stasis spots.
(4) Tongue State: Tongue state refers to the dynamic state of the tongue body, including soft, hard, trembling, elongated; crooked, retracted, protruding, etc.
Stiff: The tongue body is hard and rigid, moving inflexibly, leading to slurred speech, referred to as “stiff tongue.”
Flaccid: The tongue body is weak, unable to flex and extend, referred to as “flaccid tongue.”
Trembling: The tongue body trembles and shakes involuntarily, referred to as “trembling tongue,” also known as “quivering” or “tongue battle.”
Crooked: The tongue body is deviated to one side, referred to as “crooked tongue.”
Protruding: The tongue extends outside the mouth, referred to as “protruding tongue”; if the tongue slightly shows outside the mouth and is immediately retracted, or licks the lips up and down or side to side, continuously moving, it is called “playing tongue.”
Shortened: The tongue body is contracted and cannot extend, referred to as “shortened tongue.”
Elongated: The tongue extends beyond the mouth, unable to retract, referred to as “elongated tongue.”
Numb tongue: The tongue feels numb and moves ineffectively, referred to as “numb tongue.”
[Clinical Significance] Observing the tongue body is crucial for diagnosing the vitality of the organs and assessing the prognosis of diseases.
(1) Tongue spirit: A tongue with spirit indicates a better prognosis, while a tongue without spirit indicates a poor prognosis.
(2) Tongue color: The clinical significance of tongue color must be closely combined with luster for assessment.
Pale white tongue: Generally indicates deficiency or cold syndrome. However, in special cases, it can also indicate heat syndrome, seen in epidemics or internal abscesses as “accumulated powder coating” or “powder white coating,” and can also be seen in rapidly transforming warm diseases or mistakenly taking warming tonics as “rough, cracked coating.”
Red tongue: Indicates heat syndrome, with distinctions between deficiency and excess. If red with prickles, or accompanied by a thick yellow coating, it generally indicates excess heat syndrome; if the coating is red with little coating, or has cracks or is smooth and red without coating, it indicates deficiency heat syndrome.
Crimson tongue: Indicates differentiation between external and internal injuries. An external injury tongue is crimson, indicating warm disease heat entering the blood, often with red spots and prickles; an internal injury tongue is bright red, indicating yin deficiency and excess fire, usually with little coating and dryness; if it is bright red and moist, it indicates blood stasis.
Purple tongue: Indicates differentiation between cold and heat diseases. In heat syndrome, it is purple and crimson, dry and lacking fluids; in cold syndrome, it is light purple or blue-purple and moist.
Blue tongue: Indicates cold stagnation and blood stasis. A completely blue tongue indicates cold in the liver and kidneys, while a blue tongue on the sides indicates internal blood stasis.
(3) Tongue shape: The shape of the tongue indicates complex diseases and must be assessed based on specific conditions.
Youthfulness: A mature tongue indicates excess syndrome, while a youthful tongue indicates deficiency syndrome.
Swollen: Generally caused by water dampness and phlegm obstruction, but varies between excess and deficiency. In excess cases, the disease is in the spleen and stomach with damp-heat and phlegm obstruction, resulting in a red and swollen tongue; in deficiency cases, the disease is in the spleen and kidney with yang deficiency, resulting in a pale and swollen tongue.
Swelling: A bright red tongue indicates heart and spleen heat; a purple tongue indicates heat combined with alcohol toxicity or congenital tongue hemangioma.
Thin: Indicates deficiency of qi and blood, with a pale white color; indicates excess fire due to yin deficiency, with a red and crimson color.
Spots: Red, black, or white spots indicate excessive heat toxins in the blood. Red spots are often seen in heat toxins, damp-heat accumulation in the blood, or heat toxins attacking the heart. White spots often result from insufficient qi, while black spots are usually due to blood heat and qi stagnation.
Stasis spots: In external heat diseases, they indicate heat entering the blood, while in internal injuries, they indicate blood stasis.
Prickles: Indicate excessive heat. If accompanied by a yellow coating, it indicates heat in the qi level; if without coating, it indicates heat entering the blood. Prickles at the tip of the tongue indicate excessive heart fire; prickles in the middle indicate extreme stomach and intestinal heat.
Cracks: Indicate three diseases: one is heat damaging yin (red and crimson), the second is blood deficiency leading to lack of nourishment (pale white), and the third is spleen deficiency with dampness (pale white, thick, and with teeth marks).
Smooth: Indicates impending danger of stomach qi exhaustion. If pale white and lustrous, it indicates extreme deficiency of qi and blood, with severe damage to the spleen and stomach; if red and lustrous, it indicates excessive fire and depletion of fluids, leading to exhaustion of stomach and kidney yin.
Teeth marks: Indicate spleen deficiency with excessive dampness. If pale white and moist, it indicates internal cold dampness; if pale red, it indicates spleen deficiency and qi deficiency.
Heavy tongue: Indicates heart fire syndrome, often seen in children.
Bleeding tongue: Indicates heart fire, stomach heat, liver fire, or spleen deficiency.
Abscessed tongue: Indicates heart fire or accumulated heat in the spleen and kidneys.
Boil on the tongue: Indicates heart and spleen fire toxicity.
Ulcerated tongue: Indicates heat toxin in the heart or excessive fire due to yin deficiency.
Fleshy tongue: Indicates heart and spleen heat, qi stagnation, and fire inflammation.
Sub-lingual vessels: Blue-purple and swollen indicate qi stagnation and blood stasis.
(4) Tongue state: Refers to the dynamic state of the tongue body, including soft, hard, trembling, elongated, crooked, retracted, protruding, etc.
Stiff: Also known as “stiff tongue.” Indicates heat entering the pericardium, high fever injuring fluids, phlegm obstruction, stroke, and stroke precursors.
Flaccid: Also known as “flaccid tongue.” Indicates prolonged illness with deficiency of both qi and blood, or extreme yin deficiency with new heat injuring fluids.
Trembling: Also known as “trembling tongue” or “tongue battle.” Indicates three conditions: one is deficiency syndrome, seen in qi, blood, and fluid deficiency and yang deficiency; the second is extreme heat generating wind; the third is alcohol toxicity.
Crooked: Indicates stroke or stroke precursors. In chronic cases, it often indicates stroke sequelae; in acute cases, it often indicates liver wind spasms.
Protruding: A protruding tongue indicates heat in the heart and spleen. Protruding tongues are often seen in heart and spleen heat, with impending qi exhaustion; playing tongues are often seen in wind precursors or congenital low intelligence in children.
Shortened: Indicates impending danger. Can be seen in cold obstructing the meridians, phlegm obstruction, extreme heat generating wind, or extreme deficiency of qi and blood.
Elongated: A tongue that cannot retract and is dry without coating indicates impending danger. If it can retract and is moist, the condition is less severe. Can be seen in phlegm-fire disturbing the heart and prolonged qi deficiency.
Numb tongue: Indicates wind qi with phlegm obstructing blood vessels, blood deficiency leading to wind movement, and failure to nourish the blood.
2. Tongue Coating
[Clinical Manifestations] Mainly observe changes in coating color and quality.
(1) Coating Color: The main coating colors are white, yellow, gray, and black. Additionally, it is important to distinguish between moist and dry qualities and the transformation relationships between colors.
(2) Coating Quality: Refers to the shape and quality changes of the tongue coating. It is divided into thickness, partial or full, peeling, and changes in moistness and dryness, as well as true and false manifestations.
[Clinical Significance] The significance of coating color and quality is as follows:
(1) Coating Color:
White coating: Generally indicates exterior syndrome or cold syndrome. However, in special cases, it can also indicate heat syndrome, seen in epidemics or internal abscesses as “accumulated powder coating” or “powder white coating,” and can also be seen in rapidly transforming warm diseases or mistakenly taking warming tonics as “rough, cracked coating.”
Yellow coating: Generally indicates interior syndrome or heat syndrome. However, it is important to note the changes in coating color and the transformation between yellow and white coatings, as well as the moistness and dryness of the coating.
Changes in the depth of yellow coating generally parallel the development of heat pathogens, indicating that as the coating changes from light yellow to deep yellow, the heat pathogen is becoming more severe, while a gradual lightening of the yellow coating indicates a reduction in heat severity.
Transformation between yellow and white coatings: A gradual transition from white to yellow indicates that an exterior syndrome has entered the interior and transformed into heat. Wind-heat exterior syndrome at the onset can also present as a thin yellow coating.
Moist and dry yellow coating: A yellow coating that is dry indicates excessive heat injuring fluids, while a yellow coating that is moist indicates yang deficiency with water dampness not transforming.
Gray coating: Indicates interior syndrome, but can be differentiated between cold and heat: in interior heat syndrome, the coating is gray and dry, seen in external heat diseases or internal injuries with yin deficiency and excessive fire; in interior cold syndrome, the coating is gray and moist, seen in phlegm retention or cold dampness obstruction.
Black coating: Often seen in severe epidemic diseases, indicating interior syndrome, with differentiation between cold and heat: a black and dry coating indicates extreme heat; a black and moist coating indicates extreme cold syndrome.
Additionally, there are green coatings and moldy coatings.
Green coating: Transforms from white coating, indicating similar diseases to gray and black coatings, but does not indicate cold syndrome, seen in epidemics and damp-warm diseases.
Moldy coating: Indicates prolonged damp-heat or internal heat stagnation, seen in damp-heat summer heat or damp-heat cold damage.
(2) Coating Quality:
Thickness: Indicates the depth of pathogenic factors. A thin coating indicates exterior syndrome or light internal injury; a thick coating indicates interior syndrome with severe pathogenic factors, often caused by phlegm, dampness, or food stagnation.
Dynamic significance of coating thickness: A coating changing from thin to thick indicates that an exterior syndrome has entered the interior, and the pathogenic factors have intensified; a coating changing from thick to thin indicates that the pathogenic factors are lightening, and the interior syndrome is resolving.
Partial or full: Can indicate the location of the disease. A full coating indicates scattered pathogenic factors, seen in phlegm dampness obstruction. Localized tongue coatings can be divided into inner, outer, middle, and bilateral conditions:
Outer coating (tip of the tongue): Indicates that the pathogenic factors have not deeply entered the interior, but the stomach qi has been injured; inner coating (root of the tongue) indicates stagnation in the stomach; middle tongue coating indicates phlegm dampness or gastrointestinal stagnation; a sparse coating indicates insufficient stomach yang and kidney yin, with both yin and qi injured. Bilateral tongue coatings, seen on either the left or right side, indicate half exterior and half interior syndrome, or liver-gallbladder damp-heat disease.
Peeling: Depending on the different forms of peeling, there are various names such as “smooth peeling tongue” (mirror tongue), “flower peeling tongue,” “map tongue,” and “similar peeling tongue.” The clinical significance mainly lies in assessing the existence of stomach qi and stomach yin and the prognosis of the disease.
Smooth peeling tongue indicates severe damage to stomach qi and yin; flower peeling tongue indicates unresolved phlegm dampness, with injury to the righteous qi, and the coating must be greasy; similar peeling tongue indicates prolonged illness with injury to qi and blood; thick coating with peeling indicates dryness; and signs of liquid depletion.
Growth and decline: Mainly observe the struggle between righteous and evil, assessing changes in prognosis. Clinically, in addition to observing the transformation of growth and decline, it is especially important to note the timing of transformations.
Timing of coating transformation: Gradual changes indicate a favorable prognosis; sudden changes indicate an unfavorable prognosis, with sudden thickening indicating a rapid decline in righteous qi and a rapid increase in pathogenic factors, while sudden disappearance indicates a complete exhaustion of stomach qi.
Changes in retreating coating: If the coating does not reappear, it becomes a “mirror tongue,” indicating severe exhaustion of stomach qi and yin, with multiple areas peeling, leading to flower coating, which also indicates an unfavorable prognosis; if the coating suddenly retreats but the tongue surface remains dirty and greasy, or shows red spots or lines, and thick coating reappears within a day or two, it indicates excessive dampness and stagnation of righteous and evil.
Moisture and dryness: Depending on the moisture of the fluids, it can be divided into “slippery coating,” “dry and bitter coating,” “powder coating,” and “dry and cracked coating.” The clinical significance lies in understanding the existence of fluids.
Moist coating indicates that fluids are not injured; slippery coating indicates yang deficiency with phlegm dampness retention; dry coating indicates excessive heat injuring fluids, deficiency of yin fluids, or yang deficiency failing to transform fluids, with excessive cases of heat injuring fluids.
Special diseases indicated by moist and dry coatings: Moist coatings indicate heat syndrome, seen in heat pathogens entering the blood, with yang pathogens steaming yin qi; dry coatings indicate dampness, seen in damp pathogens entering the qi level, with qi failing to transform fluids.
Putrid coatings: Clinically, there are various types such as “putrid coating,” “floating dirt coating,” “pus putrid coating,” “moldy coating,” “greasy coating,” “sticky coating,” and “dirty coating (turbid coating).” They indicate the changes in yang qi and dampness.
Putrid coating indicates excess yang heat, steaming and rising dampness; seen in food stagnation, phlegm dampness, internal abscesses, and damp-heat oral ulcers.
As the coating changes from stagnation to putrid, and gradually retreats, it becomes a thin floating coating, indicating that the righteous qi is overcoming the evil, suggesting that the disease is retreating.
Pus putrid coating indicates severe evil and serious disease, seen in lung abscesses, stomach abscesses, liver abscesses, and toxic sores.
Moldy coating indicates the transformation of stomach yin fluids into putrid substances.
Greasy coating indicates the accumulation of evil, with yang qi being obstructed. Seen in dampness, phlegm, food stagnation, damp-heat, and stubborn phlegm.
Greasy coatings should also be noted for changes in yellow and white colors: yellow greasy indicates heat (phlegm heat, damp heat, summer heat, damp warmth), food stagnation, and obstruction of the bowel qi; white greasy indicates moistness and dryness: slippery and moist indicates cold dampness; if it is powdery, it indicates seasonal evil with dampness; if it is not dry, it indicates spleen deficiency with excessive dampness; sticky indicates damp-heat in the spleen and stomach.
True and false: True coating is also known as “rooted coating,” while false coating is known as “unrooted coating.” The clinical significance lies in assessing the severity of the disease and prognosis.
True coating is seen in the early and middle stages of disease, indicating deep and severe evil; in the later stages, it indicates a favorable prognosis; thick coating covering new coating indicates a sign of recovery.
False coating varies based on its growth state and color, with false coating not being unrooted, as it is normal, seen in morning coating or after meals, while if the coating retreats less or not at all, it indicates interior deficiency. Thick coating without roots and new coating not growing indicates damage to stomach qi, seen in excessive consumption of cold items harming yang, or damp-heat yang medications harming yin. Coating color easily retreats (observed by scraping or wiping), indicating light and shallow pathogenic factors.
(9) Clinical Manifestations and Significance of Tongue Body and Coating Combined
[Clinical Manifestations] Changes in tongue body and coating are generally consistent, but there are often inconsistencies or even completely opposite manifestations.
[Clinical Significance] Whether consistent or contradictory, the clinical manifestations of tongue body and coating do not present false appearances, thus the disease is generally a comprehensive result of both.
Pale white coating combined with various colored tongue coatings: Indicates that the basic pathological change is the deficiency of yang qi in the pale white tongue, combined with the various colors of yellow, white, gray, black, and the moistness and dryness of each, collectively indicating the main disease of pale white tongue combined with various colored coatings.
Pale white tongue with transparent coating: Indicates spleen and stomach deficiency and cold.
Pale white tongue with dry white coating: Indicates spleen and stomach yang deficiency, with heat accumulation.
Pale white tongue with yellow cracked coating: Indicates qi deficiency with little fluid and dampness.
Pale white tongue with black dry coating: Indicates yang deficiency with excessive cold.
Light red tongue combined with various colored coatings: Indicates that the basic pathological change is the sufficient yin blood in the light red tongue, combined with the various colors of white, yellow, gray, black, and the moistness and dryness of each, collectively indicating the main disease of light red tongue combined with various colored coatings.
Light red lustrous tongue: Indicates deficiency of stomach and kidney yin, with deficiency of both qi and blood.
Light red tongue with pale white slippery coating: Indicates half exterior and half interior syndrome, with liver-gallbladder damp-heat injuring yin, and yin deficiency with stagnant food.
Light red tongue with white thick dry coating and red spots: Indicates wind-cold exterior binding, heat medications injuring the blood, excessive heat injuring fluids, and stagnation in the spleen and stomach.
Light red tongue with white tip and yellow coating at the root: Indicates heat syndrome, either heat in the upper jiao or wind-heat exterior syndrome, or wind-cold entering the interior transforming into heat.
Light red tongue with yellow-black coating: Indicates phlegm dampness with heat, transforming into dryness and injuring fluids, with damp-heat accumulation in the spleen and stomach.
Crimson tongue combined with various colored coatings: Indicates that the basic pathological change is heat entering the blood or excessive fire due to yin deficiency, combined with the various colors of white, yellow, gray, black, and the moistness and dryness of each, collectively indicating the main disease of crimson tongue combined with various colored coatings.
Red tongue with floating dirt coating: Indicates deficiency of righteousness, with lingering damp-heat.
Red tongue with white slippery coating: If the texture is old, it indicates interior heat with dampness; if the texture is tender, it indicates yang deficiency with excessive dampness.
Red tongue with black (gray) slippery coating: Indicates deficiency cold syndrome.
Red tongue with red edges and black moist coating: Indicates mixed cold and heat syndrome, seen in interior cold and exterior heat, external heat in summer, and cold food retention.
Red tongue with yellow tip and black coating: Indicates internal heat.
Red thin tongue with black coating: Indicates dryness of fluids and blood.
Crimson tongue with thin white coating: Indicates a tendency to wind-cold, with the crimson tongue appearing before the exterior syndrome; or indicates that the exterior syndrome has not resolved, penetrating into the blood (the tongue gradually becomes crimson).
Crimson tongue with sticky coating: Indicates heat evil entering the blood, with insufficient fluids, combined with damp phlegm and turbid qi.
Crimson tongue with yellow-white coating: Indicates both qi and blood are burning.
Crimson tongue with yellow moist coating: Indicates heat evil combined with dampness, seen in individuals with yin deficiency, with damp-heat in the stomach and intestines, and alcohol dampness transforming into heat, penetrating into the blood; with heat evil heavily present, indicating that the heat evil has just entered the blood.
Crimson tongue with yellow sticky coating: Indicates yin deficiency with heat evil combined with phlegm dampness.
Red crimson tongue with yellow petal coating: Indicates heat accumulation in the stomach and intestines.
Red crimson tongue with thick sticky coating: Indicates damp-heat injuring fluids, while a light red tongue with thin coating indicates qi deficiency with dampness.
Blue-purple tongue combined with various colored coatings: Indicates that the basic pathological change is either cold or heat, combined with the various colors of yellow, gray, black, and the different moistness, collectively indicating the main disease of blue-purple tongue combined with various colored coatings.
Purple tongue with white sticky coating: Indicates internal heat from alcohol toxicity, wind-cold entering the interior, or internal heat accumulation.
Blue-purple tongue with yellow slippery coating: Indicates cold stagnation in the blood vessels, with food retention in the stomach.
Light purple tongue with gray coating: Indicates deficiency of righteousness, with damp-heat entering the blood.
Blue tongue with yellow coating: Indicates excessive internal cold dampness.
Grape epidemic tongue: The tongue body is mixed blue-purple, with yellow and black coatings, with blisters on the tongue resembling grapes, containing water, or blue or purple, hence the name. Seen in epidemic diseases (grape epidemic).
(10) Clinical Manifestations and Significance of Critical Tongue Appearance
The tongue is bright and without coating, resembling a pig’s kidney: Indicates impending exhaustion of stomach qi and yin.
The tongue is dry, cracked, and prickly, resembling fish skin: Indicates severe depletion of fluids.
The tongue is contracted and dry, resembling dried lychee flesh: Indicates extreme heat and fluid depletion.
The tongue is the color of pig liver or persimmon: Indicates destruction of qi and blood.
The tongue is short and contracted: Indicates impending exhaustion of liver qi.
The tongue is reddish-black: Indicates impending exhaustion of kidney yin.
The tongue is as white as snow: Indicates impending exhaustion of spleen yang.
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How Do Old TCM Practitioners Feel the Pulse?
Thinking Process of TCM Pulse Diagnosis – Teaching You How to Feel the Pulse
What Is It Like to Feel the Pulse? Teacher Dan Fuzai Shares His Insights on Pulse Diagnosis
My Pulse Diagnosis Experience: Ten Symptoms That Reveal Cold Damage Pulse Methods (Recommended Reading)
Common Symptoms of Ten Types of Classical Pulse Diagnosis
[Zou Mengcheng] Experience in Learning to Observe the Pulse and Pulse Diagnosis
Pulse Diagnosis Basics (Includes: Differentiation of Similar Pulses, Seven Absolute Pulses)
Pulse Diagnosis for Pregnancy to Differentiate Between Genders Is a Masterable Skill
Pulse Diagnosis Techniques
TCM Secret Skills: The Pulse Diagnosis That Can Predict Diseases!
Senior TCM Practitioners Discuss Pulse Diagnosis – Teaching You to Quickly Master Pulse Diagnosis!
Pulse Diagnosis Basics, Learn to Feel the Pulse in Ten Minutes!
Introduction to TCM Pulse Diagnosis | Understand Pulse Diagnosis in Ten Minutes!
He Lost His Sight at 9, After 40 Years of Feeling Hundreds of Thousands of Pulses, He Explains the Scientific Nature of Pulse Diagnosis with Mathematics and Fluid Mechanics