Diagnostics based on examination of condition of tongue:

General:

Heart, lungs Spleen, stomach Kidneys Liver, gallbladder

 

Colour and form of the tongue:

Light pink	Affection by cold, vacuity of qi of blood
Light pink and wet	Affection by cold, vacuity of YANG qi
Red	Heat
Dark red	Heat, vacuity of YANG qi
Violet	Heat
Cyanotic	Affection of liver by cold
Large, thick	Vacuity of the qi of spleen, affection by cold
Plump, bloated	Excess of qi, heat of heart and spleen
Thin and dry	Stagnation of blood, stagnation of protective qi, heat
Smooth, mirror-like	Vacuity of the qi of stomach and spleen, vacuity of YIN qi of kidneys
Thick and wet	Excess of the qi of lungs

Color and form of the fur:

White	Affection by cold
Yellow	Heat
Grey	Heat
Dark	Affection by cold or heat
Red	Vacuity of YIN qi of kidneys
Greenish	Heat
Dark red with yellow	Heat of stomach, small and large intestines
Thick, thin	Heat of stomach
Humid, dry	Heat of lungs
Thick, dense	Heat, vacuity of YANG qi
All over the tongue	Heat of the Triple warmer in the middle part

Colour of tongue and fur:

Light pink with white fur	Affection by cold of stomach and spleen
Light pink with dry fur	Heat of stomach, spleen
Pale with yellow fur	Heat, vacuity of qi
Red with dark fur	Affection by cold, vacuity of YANG qi
Red with white fur	Heat, vacuity of YANG qi
Red with yellow fur	Heat, vacuity of the qi of: blood, stomach, small and large intestines
Red with dry fur	Heat, vacuity of qi
Pale - red with dark yellow fur	Excess of qi of spleen and stomach

Zone:

1 - gray fur
2 - red fur
3 - dark fur	Excess of the qi of heart

Zone:

1 - scarlet fur	Heat of liver, heat, affection by cold
2 - dark fur	Heat of gallbladder
4 - red fur	Affection by cold of stomach, small and large intestines

Zone:

1 - yellow fur
3 - red fur	Heat of the Triple warmer in the upper part

Zone:

1 - white dry fur
4 - red fur	Affection by cold of spleen, stomach, vacuity of qi
Affection by cold of spleen, stomach, vacuity of qi	Heat of liver and gallbladder
Light-blue fur with blue-yellow spots	Heat, affection by cold
Light-blue fur with white spots	Heat, affection by cold
Light-blue fur with blue stripe and yellow fur	Affection by cold of spleen, stomach, vacuity of qi of blood
Light-blue/grey fur, zone 1 and 4 are pale blue	Heat, stagnation of blood
Light-blue with blue spots, yellow fur with dark spots, transparent bubbles	Heat

Other symptoms:

White spots	Heat of spleen and stomach
Dark spots	Heat, stagnation of blood
Scratches with capillary haematoma	Heat of stomach, small and large intestines
Pattern of cracks ("geographical tongue")	Heat of spleen
Ulcers	heat of the Triple warmer in upper and lower parts
Pustulous constellations	Excess of qi of heart, heat of spleen
Rigid tongue	Excess of qi of heart, heat
Limp powerless tongue	Vacuity of YIN qi, affection by cold
Limited mobility of tongue	Vacuity of qi of heart, affection by cold
Numbness of tongue	Vacuity of qi of blood, affection of liver by cold
Trembling of tongue	Vacuity of YANG qi, affection by cold

Details:

We classify all modern symptoms connected with the tongue into the following groups:

1. Tongue body: it enlarges in case of protein insufficiency, cardiac/pulmonary diseases; it shrinks with age, in case of dehydration, etc.
2. Fur on the tongue: thickens in case of infections, especially of the gastro-intestinal tract; dries up in case of dehydration, taking medicines; fur is absent in case of serious diseases, in such cases the tongue may become smooth and mirror-like, its surface is similar to the surface of mucous cover of the gastro-intestinal tract.
3. Veins of the tongue (under the tip of the tongue): stagnation in case of cardiac insufficiency.
4. Topography of the tongue: certain zones of the tongue surface may indicate the presence of diseases of certain organs, first of all of the gastro-intestinal tract.

Normal tongue:

Tongue body:

1. Colour: pink, not too red, not too pale.
2. Form: normal size, soft, without tooth prints.
3. Function: mobile, can be put out.

Fur on the tongue:

1. Colour: whitish.
2. Form: thin, it is not too thick but not completely absent.
3. Humidity: it is not too dry but not too wet.

Doctors in China distinguish also "young" and "old" tongues, the latter for physiological reasons becomes harder and less mobile.

Diagnostics by the tongue body

Pink tongue:

Affection caused by fire rises up. It corresponds to surface syndrome and affection of the three Yang channels. It may be a sign of an internal syndrome, as well as of the syndrome of vacuity, the syndrome of excess, the syndrome of heat. It is never is a sign of the syndrome of cold.

Western interpretation: Normal color of the tongue. It may be present at initial stage of illness or in case of minor chronic disease.

Red tongue:

Affection caused by heat. The fire is in pericardium, in respiratory tracts.

Western interpretation: pyaemia and toxaemia, high body temperature. Serious pneumonia or another infectious disease is possible.

Dark red tongue:

Affection caused by heat. The fire is in pericardium, the fire of heart rises up. Internal heat, Yin -fire or fire caused by vacuity.

Western interpretation: high body temperature. Dangerous for life pyaemia, toxaemia, pneumonia and other infectious diseases.

Violet tongue:

Intense fire, stagnation of blood, fire is in the channel of heart. The damaging poison has penetrated lungs. Phlegm and fire in the upper part of the channel of the Triple warmer. Corresponds to the surface/internal syndrome of excess and heat.

Western interpretation: dangerous stage of an illness. Impairment of breathing and blood circulation.

Cyanotic tongue:

Heavy affection caused by dampness and fire, stagnation of phlegm in the body. Impairment of the liver. Corresponds to affection caused by cold damaging kidneys and liver. Epidemic character of disease is possible.

Western interpretation: very dangerous stage of illness. Serious impairment of breathing and blood circulation.

Very cyanotic tongue:

A sign of close death.

Very pale tongue:

Syndrome of vacuity of qi and blood.

Western interpretation: exhaustion, anemia.

Shining mirror-like tongue:

Too profuse sweating, exhaustion of juices and qi of stomach; Yin or qi in the channel of stomach are exhausted even more, it is a sign of serious illness.

Western interpretation: pernicious anemia.

Cyanotic: especially in spots - stagnation of blood

Dark red and cyanotic spots: threat of cerebral-coronary insult.

Too pale: cold of qi or deficiency of Yang.

Too red: heat caused by deficiency or excess (additional data is necessary).

Purple: probably stagnation of blood (blood letting is possible).

Toothprints on the edge: deficiency of spleen or deficiency of qi.

Too large, limp tongue body: deficiency of Yang.

Too thin, atrophied tongue body: deficiency of Yin in blood.

Cracks on the tongue: intense heat, deficiency of Yin in the kidneys and spleen; the fire is caused by deficiency of Yin;

Pimply, granular tongue: very intense heat (as in the previous case).

The tongue can be stuck out too far: over excitation, intense reducing is necessary.

The tongue can not be stuck out far: the symptom of deficiency (xu), mild activation is necessary.

Laboured mobility (hard or trembling tongue): external or internal heat, damp heat, the central nervous system is affected (an attack of aggressive wind).

Shortening of the tongue: a sign of a serious illness.

Curved tongue: an attack of aggressive wind, apoplexy.

Diagnostics by the tongue fur condition

In Chinese the character for the "tongue fur" consists of two parts meaning "grass" and "mushroom". Interestingly enough, the histological examination shows that the fur consist of thread-like papillae ("grass") and fungi ("mushroom"), bacteria, residuals of cells.

Fur is considered "thin" when the tongue body is still visible under the whitish cover, and "thick" when it is not.

The humidity of the fur is an indication of water balance of the body, and absence of fur is a sign of weakness of Yin, or exhaustion of qi in the channel of stomach.

Yellow and yellowish - brown fur:

An internal syndrome, the affection is connected to heat; it will penetrate deeper into the body. Corresponds to the syndromes of excess and heat.

Western interpretation: heavy impairment of function of the digestive tract.

Black fur:

An internal syndrome. The syndrome of the three Yin channels, decrease of blood volume.

Western interpretation: heavy chronic forms of functional disorder of digestive tract with dehydration of the body, acidosis.

Thick fur:

An internal syndrome with affection of digestion; constipations,

Western interpretation: serious disorder of digestive function, poisoning is possible.

Dry fur:

The juices of the body are exhausted; serious affection caused by heat, decrease of blood volume.

Western interpretation: high body temperature, dehydration; acidosis.

Fur is too white: "cold (han), wind (feng), moisture (shi)";

Dark - brown fur: vacuity (xu) of Yin, Yin - fire;

Brown - black fur: extreme fire – Yin.

Very thick and white fur: internal cold, heat is not present.

Thick and yellow fur: internal heat.

Fur is absent: vacuity, i.e. exhaustion of Yin or Qi in the channel of stomach; it is a sign of a serious desease.

Tongue and fur are too wet: pathological dampness.

Too dry tongue and fur: heat and deficiency of Yin or liquids.

Sticky fur: heat in intestines.

Floury -dry fur: exhaustion of Yin.

General:

• The more yellow the tongue fur, the more fire is present; the lighter the color of the tongue fur, the better is the prognosis for treatment;
• The thicker the layer on the tongue, the more possibility of penetration of the pathological bioclimatic energy deep inside the body.
• Excessive dryness owing to either taking medicines (psychotropics, diuretics) or hampered nose breathing is not an indication of illness.

Diagnostics by the veins of the tongue

The veins of the tongue are visible when the tip of the tongue is raised. If the veins look too long, curved or black, it is a sign of circulation impairment or stagnation of blood in the heart, i.e. a brain blood vessels disease or a heart disease. Clinical research results obtained in various clinics of China show correlation (more than 85 %) between condition of the tongue veins and processes in the blood vessels of heart and brain.

Examination of the tongue veins:

• Ask the patient to raise the tongue trying to relax it at the same time.
• Normally the veins are only slightly prominent and do not extend beyond the middle of the space between the frenum and the tip of the tongue.
• There might be parts of varicose distension on the veins that are curved. Such veins are closer to the tip of the tongue. Some veins might be like small pears clusters. These pathological changes are the signs of increased viscosity of blood which, according to the traditional Chinese medicine may lead to the full stop of blood circulation.

Zones of the tongue

The traditional Chinese medicine divides the human body into three cavities (jiao) – the upper, the middle and the lower.

The upper cavity includes lungs (fei), heart (xin) and pericardium (xin bao). In the tongue diagnostics pericardium plays subordinate role and may be omitted from our discourse.

The middle cavity includes liver (gan) and spleen (pi).

The lower cavity includes kidneys (shen) and urinary bladder (dan).

Similarly, the tongue is subdivided in three parts: the anterior, the middle and the posterior zones. The anterior zone corresponds to the upper cavity, the middle and the posterior – to the middle and lower cavities accordingly.

The specific condition of the tongue body or fur in each zone is a sign of the condition of the corresponding part (cavity) of the body.

The tip of the tongue corresponds to heart, the part behind it up to the middle zone corresponds to lungs.

 The middle third, especially parts close to the middle, corresponds to stomach. If some abnormal signs are located on the sides of the tongue, they map changes in the liver and gallbladder.

 

The condition of the back third of the tongue reflects processes in kidneys or in the urinary bladder as well as in the rectum.

The toothprints on the sides of the tongue do not correspond to the function of liver, but are the sign of pathological accumulation of dampness. Any increase of the amount of liquids is the consequence of vacuity of spleen.

In addition:

Noticeable reddening of the tip of the tongue points out on dominance of Yang in the functional cycle of heart. Symptoms associated with this are sensation of palpitation or tachycardia, propensity to profuse sweating, logorrhea, absent-mindedness and sleep disorders. The therapy is aimed at expelling heat (Yang) from the heart and cleansing the spirit (thoughts).  Since the dominance of Yang in the heart is often caused by weakness of kidneys (which could be often recognized by heaviness in the sacrum, cold legs, noise in the ears etc.).

If not only the tip of the tongue is red, but also the first third of it [thick yellowish fur covering the whole zone is often present also], it is a sign of presence of heat in lungs. Other symptoms of this condition are yellowish phlegm, yellowish slime excreted from nose, cough, fever, dryness in the mouth and throat, thirst, small amount and dark colour of urine etc. 

Thick yellowish fur on the middle third corresponding with stomach is a sign of disease connected with the heat in stomach. The other symptoms of it are burning pain in the upper part of the stomach, thirst, craving for cold drinks, swelled gums.

Thick whitish fur on the anterior third of the tongue means presence of chronic disease connected with cold. Other indications of this condition: intolerance for cold, sensation of cold, noise in the ears, drop of hearing ability, sensation of heaviness or constant pain in sacrum, weakness of lower limbs, frequent urination, abundant light urine, reduction of keenness of observation.

The reddening on the sides of the tongue is a sign of heat in the liver. In this case patients usually complain on bitter taste in the mouth (which says of overexcitation of liver), constipation or dry stool, growing sensation of heat, irritability.

The weakness of spleen results in accumulation of dampness (liquid) which manifests in toothprints on the sides of the tongue. Sometimes toothprints could be seen on the mucous cover of cheeks. Such weakness of spleen is often combined with stagnation of qi in liver which leads to hiccups, detention of food in the stomach, winds (first of all in the upper part of stomach), general fatigue.