TONGUE-BODY COLOUR

Published on 22/06/2015 by admin

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Chapter 24

imageTONGUE-BODY COLOUR

TONGUE SPIRIT

The tongue “spirit” refers to the general appearance of the tongue: this is called shen in Chinese and it is much the same as the shen of the complexion and eyes, that is, referring to the qualities of brightness, sheen and vitality. One can therefore distinguish two types of tongue: one with spirit, the other without spirit.

A tongue with spirit denotes certain qualities of liveliness, suppleness, vitality and brightness of the tongue body; a tongue without spirit looks lifeless, rather stiff, rather dark and dull. One can use the analogy of a piece of meat in a butcher’s shop: the tongue with spirit looks like a fresh piece of meat, while the tongue without spirit looks like an old piece of meat which has become dark, greyish and lifeless.

The spirit should be observed in particular on the root of the tongue because the root reflects the state of the Kidneys and the spirit of this area reflects the condition of the Kidney-Essence. The Kidney-Essence is the foundation of life and the absence of spirit on the root of the tongue indicates a severe deficiency of the Kidneys and therefore the tendency to ill health. The tongue spirit is basically a prognostic sign as a tongue with spirit indicates that the patient may recover relatively easily whereas a tongue without spirit indicates that, whatever the patient may suffer from, the treatment may be prolonged.

It is important to remember that the tongue spirit has nothing to do with other pathological signs on the tongue; in other words, the patient may have a tongue that is pathological in many respects (e.g. Red with a thick coating), but if it has spirit this indicates that the Kidney-Essence is still strong and that the body can fight off pathogenic factors.

TONGUE-BODY COLOURS

The tongue-body colour reflects primarily the state of the Yin organs and Blood and it shows conditions of Heat or Cold and of Yin or Yang deficiency. The normal body colour is pale red. Traditionally five pathological colours are described, that is, Pale, Red, Dark-Red, Purple and Blue. However, the clinical significance of the Dark-Red tongue is essentially the same as that of the Red tongue and the clinical significance of the Blue tongue is essentially the same as that of the Bluish-Purple tongue: therefore, the pathological colours may be narrowed down to three: Pale, Red and Purple.

Pale

The Pale tongue is paler than normal. The pallor ranges from a very slight paleness to a paleness so extreme that the tongue is almost white. (See Plate 24.1 on p. P22)

The Pale tongue indicates either Yang deficiency or Blood deficiency; in Yang deficiency it will tend to be slightly wet, whereas in Blood deficiency it will tend to be slightly dry. The latter is much more common in women. If it is only slightly Pale this may also indicate Qi deficiency.

The tongue is often Pale only on the sides. If the pallor is all along the sides this indicates Liver-Blood deficiency; if it is only in the central section it indicates Spleen-Blood deficiency. In severe cases of Liver-Blood deficiency the sides may also become orangey.

The Pale tongue normally has a coating, and a Pale tongue without coating indicates severe Blood deficiency; this is relatively rare and it is usually seen only in women.

Box 24.1 summarizes the patterns underlying a Pale tongue.

BOX 24.1   PALE TONGUE

Red

The Red tongue is redder than the normal colour. Although traditionally two shades are described (i.e. Red or Dark-Red), the clinical significance of these two is essentially the same. (See Plate 24.2 on p. P22.)

A Red tongue always indicates Heat, which may be Full or Empty. Therefore, when we observe a Red tongue the first thing we should ask ourselves is whether it has a coating or not. If the tongue is Red with a coating with root (whatever its colour) this indicates Full-Heat; if the tongue is Red without a coating, or coated only partially, or with a rootless coating (whatever its colour), it indicates Empty-Heat.

It should be stressed that a Red tongue without coating indicates specifically Empty-Heat rather than Yin deficiency, although obviously it arises from the latter. In other words, it is the lack of coating that indicates the Yin deficiency and the redness (without coating) that indicates Empty-Heat. The implication of this is, of course, that there are many tongue types that indicate Yin deficiency while the tongue-body is not Red.

Box 24.2 summarizes the patterns underlying Red tongue and tongue coating.

BOX 24.2   RED TONGUE AND TONGUE COATING

The tongue-body may be Red in specific areas, especially the tip, the front third, the centre or the sides. A Red tip of the tongue (Fig. 24.1) indicates Heart-Heat (Full or Empty); if the tip only is Red, this indicates that the condition of Heart-Heat is slight, whereas if the whole tongue is Red and the tip redder it indicates that there is generalized Heat and severe Heart-Heat. (See Plate 24.3 on p. P22.)

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Fig. 24.1 Red tip

Red sides all along the edge indicate Liver-Heat (Fig. 24.2, see also Plate 24.4 on p. P22), while a redness on the sides only in the central section indicates either Stomach-Heat or Spleen-Heat (Fig. 24.3).

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Fig. 24.2 Liver-Heat

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Fig. 24.3 Spleen-Heat

If the tongue is Red in the centre it indicates Stomach-Heat (Fig. 24.4); if it is Red in the front third (including the tip) it indicates Lung-Heat (Fig. 24.5).

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Fig. 24.4 Stomach-Heat

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Fig. 24.5 Lung-Heat

Red points

Before defining red points, we should define the red “grains”. Ancient Chinese books on tongue diagnosis say that the physiological Minister Fire ascending to communicate with the Heart forms red grains on the surface of the tongue (bearing in mind that the tongue is the offshoot of the Heart). These red grains are normal and indicate that the physiological Minister Fire is in a healthy state, that is, it is neither excessive nor deficient. When the Minister Fire becomes pathological from various life influences, it flares upwards causing the red grains to become redder and to protrude from the surface of the tongue so that they become more visible: when this happens they are called red “points”. Therefore red points are always pathological and they indicate a pathological state of the Minister Fire flaring upwards. Red points always indicate Heat to a degree greater than when the tongue is just Red. The intensity of their colour and their distribution clearly correlate with the intensity of the Heat: the more intense the colour and the more dense the distribution, the stronger is the Heat. (See Plate 24.5 on p. P22.)

Red “spots” look the same as red points except that they are larger and they are usually seen only on the root of the tongue. Like red points, red spots also indicate Heat but with the additional component of some Blood stasis.

Red points are frequently seen on the tip, sides, centre or root of the tongue. Red points on the tip are relatively common and they indicate Heart-Fire, usually deriving from emotional stress. Red points on the sides in the Liver area indicate Liver-Heat (Liver-Fire), whereas red points in the centre indicate Stomach-Heat (Fig. 24.6). However, Stomach-Heat may also be reflected in red points on the sides but only in the middle section of the tongue and along a broader strip.

With Lung-Heat, red points may appear either in the chest area or in the whole front third of the tongue, as opposed to the very tip as in the case of Heart-Heat (Fig. 24.7).

Red points on the root indicate Heat, usually Damp-Heat, in the Bladder or Intestines.

Red points in external diseases

The significance of red points in external diseases is different from that in internal diseases. First of all, red points in acute external diseases definitely indicate an invasion of Wind-Heat as opposed to Wind-Cold.

In external diseases the density of the red points reflects not only the intensity of the pathogenic factor but also its progression towards the Interior; thus if, in the course of an acute external disease, the red points become denser this indicates not only that the pathogenic factor has become stronger but that it is beginning to penetrate into the Interior.

The distribution of the red points also reflects the stages of penetration of an external pathogenic factor. In the very beginning stages of an invasion of external Wind, the red points may be more concentrated on the front third or on the sides. In this context, these two areas correspond to the Exterior of the body while the centre of the tongue corresponds to the Interior (Fig. 24.8).

Thus if after a few days, the red points from these two areas extend towards the centre of the tongue, it indicates that a pathogenic factor is penetrating into the Interior.

Box 24.3 summarizes the patterns underlying red points on the tongue.

BOX 24.3   RED POINTS

Purple

A Purple tongue always indicates Blood stasis, which itself may derive from Cold or from Heat. (See Plates 24.6, 24.7 and 25.3 on pp. P22, P23 and P24.) Internal Cold contracts and obstructs the circulation of Blood, leading to Blood stasis; Heat leads to Blood stasis by condensing the Body Fluids and Blood. When Blood stasis derives from Cold, the tongue is Bluish-Purple while when it derives from Heat, it is Reddish-Purple. Therefore the Bluish-Purple tongue indicating Cold derives from a Pale tongue while the Reddish-Purple tongue derives from a Red tongue (Fig. 24.9).

A tongue becomes Purple only after a prolonged time, usually years: therefore it always indicates a chronic condition and for this reason it is far more common in the elderly. The Purple colour of the tongue indicates potentially serious conditions and in the presence of such tongue-body colour we should always invigorate Blood and eliminate stasis (as well as expelling internal Cold in the case of Blood stasis deriving from Cold and clearing Heat in the case of Blood stasis deriving from Heat), even in the absence of any symptom of Blood stasis. Serious conditions relating to Blood stasis in Chinese medicine include cancer, coronary heart disease, stroke and hypertension.

The tongue can be only partially Purple and the most common areas are the sides (Liver or chest area) of the tongue, the centre and the front third; the most frequent occurrence is on the sides in the Liver area. Strangely, the tongue is never Purple on the tip only and Blood stasis in the Heart usually manifests in the chest/breast area instead (see below).

A Purple colour on the sides in the Liver area (Fig. 24.10) indicates Blood stasis in the Liver, which may occur in any of the areas influenced by the Liver channel, for example Liver-Blood stasis in the hypochondrium, epigastrium, lower abdomen and Uterus. (See Plate 24.8 on p. P23.) It is interesting to note that, although the Uterus is in the Lower Burner, whose state is reflected in the back third of the tongue, Blood stasis in the Uterus is manifested with a Purple colour not on the root of the tongue but on the sides in the Liver area.

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Fig. 24.10 Liver area

A Purple colour on the sides in the chest area (Fig. 24.11) indicates Blood stasis in the chest (which may include Heart or Lungs) or, in women only, the breasts. In lung diseases, a Purple colour in the chest area is seen in chronic obstructive pulmonary disease such as chronic asthma, bronchitis or emphysema. In heart diseases, a Purple colour in the chest area is seen in coronary heart disease. In addition, in women a Purple colour in the chest/breast area may indicate a breast pathology such as breast lumps, whether benign or malignant. Observation of the breast area in women suffering from carcinoma of the breast is an important prognostic factor because if this area is clearly Purple the prognosis is poor, whereas if it is not the prognosis is good. A Purple colour in the breast area is also sometimes seen in women without any breast pathology; this may indicate the predisposition to breast lumps and one should therefore invigorate Blood and eliminate stasis in the breasts even in the absence of symptoms and signs. (See Plate 24.9 on p. P23.)

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Fig. 24.11 Breast/chest areas

A Purple colour in the centre of the tongue indicates Blood stasis in the Stomach, whereas a Purple colour in the front third indicates Blood stasis in the Lungs.

Box 24.4 summarizes patterns underlying Purple tongue areas.

BOX 24.4   PURPLE AREAS ON THE TONGUE

SUBLINGUAL VEINS

The sublingual veins should always form part of a routine examination of the tongue body. Under normal conditions, the two veins under the tongue are barely visible and they have a very faint, pale-red colour. When they become clearly visible, they are by definition pathological. (See Plate 24.10 on p. P23.) One should observe the size and the colour of the sublingual veins.

If the veins are distended but not dark, this indicates Qi deficiency, if they are too thin in relation to the sides of the tongue and the patient’s body itself, this indicates Yin deficiency.

The most important sign with regard to sublingual veins is their Purple colour. If they are distended and dark Purple, this indicates Blood stasis, usually in the Upper Burner (Lungs or Heart) but it may also refer to the Liver. Distended and dark sublingual veins are more common in the elderly and they give an early indication of Blood stasis before the rest of the tongue body becomes Purple. Observation of the sublingual veins therefore has an important preventative value. Dark and dry sublingual veins indicate severe Yin deficiency with Empty-Heat. Dark, swollen and wet veins indicate Lung, Spleen and Kidney deficiency with accumulation of fluids.

Such observation is important also in chronic Painful Obstruction Syndrome. If the sublingual veins are reddish and shiny, they indicate Damp-Heat; if they are yellowish, Dampness, while if they are white and slippery, Cold-Dampness, and if they are swollen, white and sticky, Dampness and Blood stasis.

In modern China, some doctors consider the appearance of sublingual veins as a useful prodromal sign of certain diseases.1 The main signs are as follows:

Boxes 24.5 and 24.6 summarize the conditions underlying sublingual veins in Chinese and Western medicine.

BOX 24.5   SUBLINGUAL VEINS

BOX 24.6   SUBLINGUAL VEINS IN WESTERN MEDICINE

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