Published on 22/06/2015 by admin
Filed under Complementary Medicine
Last modified 22/06/2015
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Chapter 23
Chapter contents
CONDITIONS FOR EXAMINING THE TONGUE
Lighting
Techniques of observation of the tongue
External factors affecting the colour of the tongue
AREAS OF THE TONGUE
CLINICAL SIGNIFICANCE OF THE TONGUE
Tongue-body colour
Tongue-body shape
Tongue coating
Tongue spirit
Proper lighting is absolutely essential for a correct examination of the tongue and the only good lighting is natural light on a sunny day. The room where the patient is examined should have an abundant source of natural light; for example, no proper natural light can ever be achieved in a basement. Even in daylight, the colour of the tongue can be interpreted properly indoors only if the day is sunny. On a cloudy day the colour of the tongue cannot be accurately observed indoors; if the patient is examined on such a day, it is advisable when observing the tongue to ask the patient to stand next to a window or even outdoors. Obviously, it is seldom possible to achieve ideal conditions. If it is necessary to observe the tongue on a cloudy day or in the afternoon or evening, I find that the best artificial light is that of a halogen bulb and the best way to observe the tongue is by means of a table lamp fitted with one of these bulbs.
One should not ask the patient to hold the tongue out for longer than approximately 15 seconds because the longer the tongue is extended the darker it will tend to become. If we need longer than 15 seconds to observe the tongue, which we normally do, we should ask the patient to withdraw the tongue, close the mouth and extend the tongue again; this can be done several times without affecting its body colour.
It is very important to examine the tongue systematically following always the same order, which should be as follows:
• tongue-body colour
• tongue-body shape
• coating
• tongue spirit.
I would strongly recommend following this systematic order of observation of the tongue because the above order reflects the relative clinical importance of each item. For example, the tongue-body colour reflects conditions of Heat or Cold and deficiency of Yin or Yang in various organs, and especially the Yin organs; it should therefore be always the first aspect to be observed. The tongue-body shape often simply adds information to that gleaned from observation of the tongue-body colour; for example, if the tongue is Pale from Yang deficiency, its swelling will simply indicate that the Yang deficiency is particularly pronounced. The tongue coating reflects more the condition of the Yang organs and it is easily influenced by short-term factors, which makes it relatively less important than observation of the tongue-body colour in chronic conditions.
The most obvious external factors affecting the colour of the tongue are highly coloured foods, sweets, drinks or pastilles. If a patient’s tongue has a very obvious, unusual, bright colour, always ask what he or she has been eating.
Spicy foods such as cayenne pepper and curry may tend to make the tongue slightly redder soon after consumption. Tobacco smoking usually colours the coating yellow, and in regular smokers this is permanent. However, this cannot be written off as no more than a false appearance due to an external factor; in fact, tobacco, which has a hot energy, will tend to create Heat.
Diagnosis in Chinese Medicine A Comprehensive Guide
TONGUE DIAGNOSIS
