Chapter contents

INTRODUCTION

Observation of the tongue-body shape reveals primarily conditions of Deficiency or Excess and it adds more information to that gleaned from observation of the tongue-body colour. For example, a Pale tongue may indicate Yang deficiency, but if, in addition to being Pale, it is also very Swollen this indicates that the Yang deficiency is severe and that it has led to the accumulation of Dampness or Phlegm. In this example, the tongue-body shape reflects the Full condition generated by Dampness or Phlegm.

To give another example, if a tongue lacks coating, this indicates Yin deficiency, but if in addition it is also very thin it indicates that the Yin deficiency is quite severe. In this example, the tongue-body shape reflects the severity of a deficiency condition. To give yet another example, if the tip of the tongue is Red this indicates Heart-Heat or Heart-Fire usually deriving from emotional problems, but if the tip is also swollen it indicates that a condition of Heart-Heat or Heart-Fire is more severe.

THIN

“Thin” refers to the thickness, not the width, of the tongue. The “body” of the tongue is formed by fluids and Blood and a Thin tongue therefore always indicates a deficiency either of Blood or of Yin fluids. In the former case, it will also be Pale while in the latter case it will be Red.

A Thin tongue is actually not common, probably because Dampness and Phlegm, which make the tongue Swollen, are such common and predominant pathogenic factors. As they tend to make the tongue Swollen, even if the patient has a concurrent severe Blood deficiency, this would not manifest on the tongue-body shape. In my practice, for example, out of 2378 patients, less than 2% have a Thin tongue while nearly 37% have a Swollen tongue.

SWOLLEN

The size of the tongue body has to be related to the size of the head of the person: what might be “Swollen” for someone may be normal for another. (See Plate 25.1 on p. P23.) As the thickness of the tongue body depends on the supply of fluids and Blood, a Swollen tongue body indicates an accumulation of fluids, which may be Dampness, Phlegm or oedema. Thus a swelling of the tongue always indicates a Full condition and particularly one characterized by Dampness or Phlegm. Although Dampness and Phlegm usually arise from a Qi or a Yang deficiency, the swelling of the tongue body reflects the Full condition created by these two pathogenic factors.

PARTIALLY SWOLLEN

While a total swelling of the tongue always indicates Dampness or Phlegm, a partial swelling may indicate other pathologies such as Qi deficiency, Qi stagnation or Heat. The areas where a partial swelling is most commonly seen are the sides in the Liver or chest area, the tip and the front third.

A swelling on the sides in the Liver area (Fig. 25.1) is very common and it usually indicates Liver-Heat; it is nearly always associated with a Red colour in the same area.

A swelling on the sides in the chest/breast area (Fig. 25.2) generally indicates either retention of Phlegm in the chest or breast or Lung-Qi deficiency.

A swelling of the tip of the tongue (Fig. 25.3), usually associated with a Red colour, is very common and it indicates Heart-Heat or Heart-Fire deriving from severe emotional problems.

A swelling of the front third of the tongue (Fig. 25.4) indicates retention of Phlegm in the Lungs. (See Plate 25.2 on p. P23.)

STIFF

A Stiff tongue lacks the normal suppleness and flexibility. It looks hard and stiff. It indicates internal Wind, Blood stasis or severe Yin deficiency. (See Plate 25.3 on p. P24.)

FLACCID

A flaccid tongue is flabby and, in severe cases, it has a crumpled look. It always indicates lack of Body Fluids or Blood.

LONG

A Long tongue is rather narrow and, when extended, protrudes further than normal. Not commonly seen, it always indicates Heat.

SHORT

A Short tongue appears to be contracted and the patient is unable to extend it out of the mouth cavity. The significance of the Short tongue depends on the body colour because it can indicate two opposite conditions: if it is Pale it indicates severe internal Cold and Yang deficiency; while if it is Red and without coating it indicates severe Yin deficiency. In the first instance, the patient cannot extend the tongue enough because internal Cold contracts the muscles, while in the latter instance this happens because there are not enough fluids in the tongue.

CRACKED

Generally, cracks on the surface of the tongue indicate Yin deficiency or the tendency to it but, though this is the most common cause, there are others such as Dampness or deficiency of the Original Qi. Horizontal cracks (Fig. 25.5) indicate Yin deficiency, usually of the Stomach or Kidneys, or both, and they are more commonly seen in the elderly.

Irregular cracks (Fig. 25.6) usually indicate Stomach-Yin deficiency or the tendency to it. (See Plate 25.4 on p. P24.)

A central short crack in the midline of the tongue (Fig. 25.7) is very common and it indicates Stomach-Yin deficiency, or the tendency to it. (See Plate 25.5 on p. P24.)

A central long crack in the midline of the tongue (Fig. 25.8) is also common and its clinical significance depends on its depth and on the colour of the tongue body, especially the tip. (See Plates 25.6 and 25.7 on p. P24.)

If the Heart crack is shallow and the body colour normal, this simply indicates a constitutional tendency to Heart patterns and it does not have a specific clinical significance. However, if a person has such a crack, any emotional stress from which he or she might suffer will have deeper repercussions than for someone without a Heart crack. According to Dr J. H. F. Shen, a shallow Heart crack on a normal body colour may also indicate heart disease in the parents or even grandparents.

If the Heart crack is deep, it indicates that the person may suffer from a Heart pattern due to emotional stress, all the more so if the tip is also Red. One could describe different situations of emotional stress in order of increasing severity as manifested on the tongue as follows:

Short, transverse cracks on the sides (Fig. 25.9) are a clear sign of Spleen-Yin deficiency. This is not common and is not a common condition often described among the Spleen patterns; such cracks are the easiest way of identifying such a pattern (see Plate 25.5 on p. P24.)

Short, transverse cracks behind the tip in the Lung area (Fig. 25.10) usually indicate a past Lung pathology such as pneumonia, whooping cough or repeatedlung infections during childhood. As such cracks reflect past pathologies, they do not have a major clinical significance.

An extremely deep midline crack with other small cracks branching out from it (Fig. 25.11) is usually seen in a Red tongue without coating. It indicates a severe Kidney-Yin deficiency with Empty-Heat in the Kidneys and Heart.

DEVIATED

The Deviated tongue deviates to one side when extended (Fig. 25.12).

The most common clinical significance of a Deviated tongue is internal Wind and this type of tongue is most commonly seen in the elderly. In a young person it may be related to a Heart deficiency.

MOVING

The Moving tongue moves slowly from side to side with large-amplitude movements when it is extended and the patient cannot control its movement. It always indicates internal Wind and is usually seen in the elderly.

QUIVERING

The Quivering tongue trembles rapidly and with small-amplitude movements as it is extended. The most common clinical significance of a Quivering tongue in chronic conditions is Spleen-Qi or Spleen-Yang deficiency.

TOOTHMARKED

The tongue with teethmarks (Fig. 25.13) indicates chronic Spleen-Qi deficiency, but since a tongue with a normal body shape can have teethmarks, do not assume that the presence of teethmarks necess-arily means it is Swollen. (See Plate 25.8 on p. P24.)

Box 25.1 summarizes the patterns underlying different tongue-body shapes.