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