TONGUE DIAGNOSIS

Published on 22/06/2015 by admin

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Last modified 22/04/2025

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Chapter 23

imageTONGUE DIAGNOSIS

CONDITIONS FOR EXAMINING THE TONGUE

Lighting

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.

Techniques of observation of the tongue

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:

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.

External factors affecting the colour of the tongue

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.

Medicines

Some medicines affect the appearance of the tongue and the most common ones are antibiotics. These tend to make the tongue partially peeled, that is, the loss of small patches of coating. Therefore, when I see such a tongue, the first thing I ask is whether the patient is on antibiotics or has taken them recently (Fig. 23.1). In my experience, the effect of the antibiotics on the tongue lasts for about 2 weeks after stopping the course. Judging from the effects of antibiotics on the tongue, we can deduce that they injure Stomach-Yin.

Oral corticosteroids tend to make the tongue Red and Swollen, while inhaled bronchodilators (such as salbutamol) may cause the tip of the tongue to become Red, but only after many years of use.

Anti-inflammatory drugs such as phenylbutazone paradoxically cause the tongue to develop red points.

Most cytotoxic drugs used for cancer tend to create a very thick, dark-yellow or brown coating and also to make the tongue-body Red.

AREAS OF THE TONGUE

In men and women alike, the tongue-body can be divided into three areas: the rear corresponding to the Lower Burner, the middle to the Middle Burner and the front to the Upper Burner (Fig. 23.2).

Therefore, according to this division, the front third of the tongue reflects the state of the Heart and Lungs, the middle third that of the Stomach, Spleen, Liver and Gall-Bladder and the rear third that of the Kidneys, Bladder and Intestines. Figure 23.3 illustrates the areas corresponding to the Internal Organs in detail.

The relative position of the Heart and Lung areas on the tongue should be explained in relation to redness, swelling, cracks or Purple colour.

When there is Lung-Heat, this will make the whole front of the tongue Red including the Heart area (even though the Heat is only in the Lungs and not in the Heart) (Fig. 23.4); when there is Heart-Heat only the tip of the tongue becomes Red (Fig. 23.5).

As far as swelling is concerned, a swelling of the tip itself indicates a Heart pathology, usually Heart-Heat. (Fig. 23.6). A Lung-related swelling usually appears either in the whole front third (Fig. 23.7) or on the sides between the Heart area and the Stomach and Spleen area (Fig. 23.8).

As far as cracks are concerned, Lung cracks are usually located in the area between the tip and the centre (Fig. 23.9).

image

Fig. 23.9 Lung cracks

A Purple colour on the sides of the tongue between the tip and centre may be related to the Lungs or Heart. It indicates Blood stasis and, in lung disease, it is seen in chronic asthma or emphysema, while in heart disease it is seen in coronary heart disease or angina. The Purple patch may be unilateral or bilateral (Fig. 23.10). In women, in addition, a Purple colour in that area may also indicate a breast pathology.

Although the sides of the tongue correspond to Liver and Gall-Bladder, they may also, under certain circumstances, reflect conditions of the Spleen. A pathology of the Liver, such as Heat, is reflected along the whole side of the tongue, while one of the Spleen is also reflected on the sides but only in the central section. This applies to both redness and swelling, and Figures 23.11 and 23.12 illustrate this difference.

CLINICAL SIGNIFICANCE OF THE TONGUE

The importance of tongue diagnosis lies mostly in the fact that it nearly always shows the true condition of the patient; this is, of course, most useful in complicated conditions when there may be contradictory signs of Heat and Cold or of Yin and Yang deficiency. For example, in menopausal conditions, when there is often a simultaneous deficiency of Kidney-Yin and Kidney-Yang and contradictory symptoms of Heat and Cold, the tongue clearly shows whether there is a predominance of Yin or Yang deficiency as it will be Red in the former case and Pale in the latter.

The clinical significance of the tongue must be related to its various aspects as follows.

Tongue-body colour

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 tongue body’s own colour is visible through the tongue coating and it is important not to confuse the two. Generally speaking, the tongue coating does not extend right to the edge of the tongue and therefore the sides of the tongue can show us the tongue-body colour if the coating is very thick. Observation of the tongue-body colour includes that of red points, which usually, but not always, occur on a Red tongue.

Examination of the body colour should also always include an examination of the veins under the tongue.

The normal Stomach fluids tend to make the tongue Pale whereas Heart-Blood tends to redden it; the influence of these two organs therefore causes the normal tongue to be Pale Red indicating a good state of Stomach fluids and Heart-Blood.

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