Diagnosis: Tongue

The body is the background; the coating is what sits on top

The body colour speaks of the underlying state, which changes slowly. The coating speaks of what is happening now and changes within days. Reading both together is what dates the problem.

Red body

underlying heat

Pale body

blood or yang deficiency

No coating

fluids or Yin are short

Thick coating

something is accumulating

Common mistake: Looking only at the colour and not at whether there is a coating.

Which of these tongues points to Yin deficiency?

1. No coating
2. Thin white coating
3. Thick yellow coating

Where do you read the state of the Heart?

1. Tongue tip
2. Tongue centre
3. Lateral borders
4. Tongue root

The body colour is the underlying picture

The coating changes in days; the body colour changes in months. So the colour tells you how the person is underneath, and the coating tells you what is happening now.

Pale

blood or yang deficiency

Red

heat

Deep red with no coating

heat from yin deficiency

Purple

stagnant blood

Common mistake: Looking only at the coating, which is what catches the eye, and missing the colour underneath.

Sort each tongue by what the colour indicates.

• Pale and slightly moistBlood or yang deficiencyHeatStagnant blood
• Red with a yellow coatingBlood or yang deficiencyHeatStagnant blood
• Dark purple with thick veins underneathBlood or yang deficiencyHeatStagnant blood
• Very pale, almost whiteBlood or yang deficiencyHeatStagnant blood
• Very red tip with small spotsBlood or yang deficiencyHeatStagnant blood
• Purple only along the sidesBlood or yang deficiencyHeatStagnant blood

Pale, swollen tongue with teeth marks along the edges. What do you read?

1. Internal heat inflaming it
2. Deficiency failing to transform fluids: retained damp
3. Stagnant blood

The shape speaks of quantity and movement

After the colour and before the coating you look at the shape. It says whether there is surplus material, whether some is missing, and whether something moves that should not.

Swollen

damp or yang deficiency

Thin and small

blood or yin deficiency

Cracks

fluids consumed by heat

Trembling

internal wind or serious deficiency

Common mistake: Mistaking an old central crack, which can be constitutional, for recent dryness.

Sort each shape between the two readings.

• Swollen with teeth marksSurplus materialMissing material
• Thin and narrowSurplus materialMissing material
• Thick and large, filling the mouthSurplus materialMissing material
• With fine cracks and no shineSurplus materialMissing material
• Stiff and hard to stick outSurplus materialMissing material
• Trembling and weakSurplus materialMissing material

Match each area of the tongue with its organs.

Thick, greasy coating that is hard to scrape, on a normally coloured tongue. What does it indicate?

1. Accumulated damp or phlegm
2. Yin deficiency
3. Pure internal cold

Sort each coating by what it says.

• Thin white, slightly moistColdHeatFluid depletion
• Yellow and dryColdHeatFluid depletion
• Absent, with a shiny tongueColdHeatFluid depletion
• Thick white like snowColdHeatFluid depletion
• Yellow, thick and greasyColdHeatFluid depletion
• Peeled in patches, like a mapColdHeatFluid depletion

Which precaution changes the result most when looking at a tongue?

1. Asking them to hold it out as long as possible
2. Always using warm artificial light
3. Using daylight, briefly, and asking what they ate or drank beforehand

The patient reports a lot of heat, but the tongue is clearly pale and swollen. Which weighs more?

1. The symptoms: the patient knows what they feel
2. The tongue, which reflects the underlying state and changes slowly
3. Neither: repeat the consultation another day

Red tongue, no coating, fine cracks. Build the reading.

Slightly purple tongue sides in someone with severe period pain and clots. What does it confirm?

1. Blood stagnation, and the sides point to the Liver
2. Heart heat, because of the colour
3. Damp, because the colour is dark