Inspection of the Tongue

Yang syndrome

Excess syndrome

Wind edema; Acute glomerulonephritis

Presentation	Fear of cold Cold limbs Likes to lie in curled up position Likes warmth Fatigued spirit Somnolence with dislike of speaking
Primary disease diagnosis	Yang deficiency Qi deficiency
Case example	Post recovery from fever due to upper respiratory tract infection, with injury to yang by external wind cold and low grade fever due to qi deficiency.
	Difficulty maintaining support with a cane Wobbles left and right Difficulty taking steps

077 Normal tongue: Light red tongue body with thin white coat, and the presence of vitality

Liver and kidney insufficiency Injury to sinew and/or bone	Presentation
Sequelae of infantile paralysis; Damp-heat wilting syndrome Tongue diagnosis has various aspects, including inquiry of the feeling of the tongue (as in tastes and flavors), and palpation techniques-general palpation, rubbing, wiping and scraping. However, inspection of the tongue is the most important aspect to diagnosis.	Primary disease? diagnosis
Essentially there are two main parts of tongue inspection-examining	Case example

078 Light red tongue with thin white coating

the tongue body and tongue coating. While observing tongue changes in clinical practice can be an intricate and complex task, it is really only a matter of combining information from five aspects of the tongue-tongue color, shape, condition, coating color and nature of the coating. Understanding these basic conditions and their clinical significance allows one to comprehend tongue diagnosis once and for all, which thereby permits one to dynamically apply tongue diagnosis skills to any and all conditions. Ancient physicians have long said, “The more one diagnoses the pulse, the more one understands the pulse,” and “understanding the basics of disease recognition allows one to recognize disease in all its various and changed forms.” The same can be said for inspection. Through the repeated study of case images and by seizing every opportunity to practice tongue inspection, one can begin to understand

079 Thin, pale white tongue with thin white coating

how to distinguish the diagnostic criteria. With the combined use of the four examinations to summarize diagnosis, the accuracy of one’s disease differentiation will also improve.	Presentation
Light red tongue body Thin white tongue coat Moderate size and texture of the tongue body Agile in movement Tongue surface is especially supple and lustrous	Primary disease diagnosis
	Case example

080 Red tongue with thick, cracked and curd-like yellow tongue coating

Healthy persons

Beginning stage of external wind-cold contraction

Beginning stage of external wind-cold contraction, in which pathogens have not transformed into heat, and there is no injury to the right qi.

Presentation

Light red tongue body

Thin white tongue coat, slightly thick at the middle and root

Agile in movement

Tongue surface is especially supple

081 Crimson tongue with dry black-colored coat

Primar disease diagnosis

Health persons

External contractions of wind, cold and/or damp pathogens

Presentation

Case example

Exterior syndrome-exterior contraction of damp-cold, with no injury to the right qi

Pale white and thin tongue body Slightly glossy, thin white coating

Primary disease diagnosis

Yang deficiency

Case example

082 Bare and lustrous crimson-purple tongue with superficial, grimy coating

Qi and blood insufficiency; deficiency of the heart and spleen

Presentation

Kidney yang deficiency with qi and blood insufficiency; Aplastic anemia Red, aged-looking tongue body

Plentiful cracks in the center

Thick, dry and cracked white coating transforming into yellow, followed by curd-like coating

Primary disease diagnosis

Exuberant heat injuring yin

Phlegm-fire

Food accumulation

083 Blue-purple tongue with greasy white coating

Presentation

Case example

Turbid phlegm congesting the lung with exuberant heat injuring yin Pulmonary infection

Crimson tongue body

Multiple red spots at the tongue tip

Dry, charred black tongue coat

Primary disease diagnosis

Heat entering the ying and blood level with extreme heat injuring fluids

Hyperactivity of fire due to yin deficiency

Blood stasis

Case example?

084 Pale purple tongue with dry, greasy coating

Wind stroke, with phlegm-heat injuring body fluids; Acute stage of cerebrovascular accident

Presentation Delicate, tender crimson-purple tongue body Tongue appears bare and lustrous, with no coating Slight rootless, grimy, pale-yellow coating at the root (rootless, false coating)
Primary disease diagnosis	Exuberant heat injuring yin and drying yin fluids Internal obstruction due to blood stasis

085 Puffy, pale white tongue with tooth-marks and greasy white coating

	Internal accumulation of alcohol toxins Damp turbidity remaining, not yet exhausted	Presentation
Case example	Phlegm-heat injuring yin with internal obstruction from blood stasis, and exhaustion of stomach qi; Late-stage liver cancer.
	Blue-purple tongue body Plentiful cracks in the center Tongue coat is white, thick, greasy, glossy and moist	Primary disease diagnosis
	Spleen deficiency with dampness Cold-dampness blocked internally	Case example