Traditional Chinese Medicine Tongue Diagnosis

The tongue has many relationships & connections in the body, both to the meridians & the internal organs. It is therefore very useful and important during inspection for confirming TCM diagnosis.

It can present strong visual indicators of a person's overall harmony or disharmony. The tongue has a special relationship with the Heart, in that the Heart opens to the tongue. The tongue is said to be an "offshoot" of the Heart, or "flowers" into the Heart. The normal tongue in Traditional Chinese Medicine has a light red or pinkish body with a thin white coating.

Connections Channels/Meridians Reaching the Tongue

Heart Channel (Hand Shaoyin) - The Luo connecting channel connects to the root of the tongue.

Spleen Channel (Foot Taiyin) - An internal branch of the primary channel spreads over the lover surface of the tongue. - The tongue is penetrated by the Spleen

Divergent channel Kidney Channel (Foot Shaoyin) - An internal branch of the primary channel terminates at the base of the tongue.

Bladder Channel (Foot Taiyang) - A branch of the muscle/sinew channel binds to the root of the tongue.

San Jiao Channel (Hand Shaoyang) - A branch of the San Jiao muscle channel links with the root of the tongue.

Tongue areas as they correspond to internal organs in Chinese Medicine

Tongue Diagnosis Method and Cautions

Lighting

Sunlight will give the most accurate colour of the tongue body and coat. If sunlight is not available, use a second light source such as a small flashlight to compare the tongue colour to the original light source.

Position

The tongue should be extended in a relaxed manner, and should not be held out for an extended duration.

Food and Drink

Food and drink, such as coffee, green tea, and candy may alter the colour of the tongue coating.

Brushed Tongue

Some patients may brush their tongue to help freshen their breath or as an Ayurvedic practice. Ask the patient not to brush their tongue, at least the day of their TCM tongue diagnosis.

Seasons of the Year

In Summer, there may be more Dampness present in the tongue coating, leaving it slightly thicker and light yellow.
In Autumn, the tongue may be thinner with a coating that is more dry.
In Winter, there may also be more moist or damp presenting in the tongue.
In Spring, the tongue should be normal.

Time of Day

The coating of the tongue usually becomes thinner as the day progresses, while the colour of the tongue body becomes more red and shiny.

Patient's Age and Body Shape

In the elderly, Qi and Blood Deficiency is more common, so the tongue may present with dryness and cracks
Infants tend to have a white thick coating that is easily removed, peeled tongues are also common
Overweight patients usually have more Damp and/or Phlegm and therefore their tongues may be larger and lighter in colour
Thin patients tend towards redder tongues.

Tongue Feature Indications

Tongue Body Colour
Tongue Body Shape
Tongue Body Features
Tongue Body Moisture
Tongue Coating
Tongue Coat Thickness
Tongue Body Cracks
Tongue Coat Root

Tongue Body Colour

Indicates the state of Blood, Yin organs, and Ying (Nutritive) Qi.

Normal Tongue Body

Pink or light red in colour

Bluish Purple or Reddish Purple Tongue Body

Purple can indicate both Heat and Cold conditions
A reddish purple tongue indicates Heat and Blood Stagnation
A dark reddish purple tongue that is dry usually indicates depleted fluids due to Excess Heat
A light purple, bluish purple, or greenish purple tongue body colour can indicate Cold and Blood Stagnation

Red Tongue Body

A red tongue body is darker than the normal red, which is pinkish in colour. It indicates either Deficient or Excess Heat
A red tongue body with a thick yellow coat or swollen buds indicates Excess Heat
A red tongue body with a bright shiny coat, little coat, or no coating indicates Deficient Heat

Red Tip

Heat in the Heart Zang

Scarlet Tongue Body

A scarlet tongue that is also peeled or shiny indicates Yin Deficiency, usually of the Heart and/or Lung depending on the area of swelling.

Dark Red Tongue Body

The red is darker and more crimson in color. This tongue body can indicate internal injuries such as trauma (De Da), invasion of external evil in the Ying (Nutritive) and Xue (blood) levels, or it can indicate Blood Stagnation
If there are red spots with a thin coat, this usually indicates damage to the Ying or Xue level
If the tongue body also has cracks and there is little or no tongue coat, this usually indicates Deficient Heat due to internal injury

Pale Tongue Body

Indicates the quality of Blood, reflecting Blood and/or Qi Deficiency or Cold
If the tongue body is also moist, tender, and swollen, this can indicate Yang Cold
A pale thin tongue body usually indicates Qi and Blood Deficiency

Green Tongue Body

A green tongue body usually indicates Excess Yin Cold or the presence of a strong Excess evil with weak Zheng Qi
The Yang is not properly moving Blood and Fluids and there is Stagnation in the body. Internal Wind may also present with a green tongue body

Tongue Body Shape

The body shape reflects the state of Blood and Ying (Nutritive) Qi and indicates Excess or Deficiency
A constitution can also affect the shape of the tongue body

Stiff

A stiff or rigid tongue is difficult to move (protrude, retract, side to side). This may cause speech abnormalities such as slurring or mumbled speech
A stiff tongue is an indication of Excess, and often one of Internal Wind
If a stiff tongue is accompanied by a bluish purple tongue body, this usually indicates potential or impending Wind-Stroke
If a stiff tongue is accompanied by a bright red tongue body, this usually indicates heat in the Heart and Pericardium disturbing the Shen (Spirit)
If a stiff tongue is accompanied by a thick sticky tongue coating, this usually indicates "Phlegm Misting the Heart"

Flaccid

The flaccid tongue is the opposite of the stiff tongue. It is weak and lacks strength. It usually indicates Deficiency
When heat has consumed and damaged body fluids, they can not rise to nourish the tongue. This can indicate Yin Deficiency, Qi Deficiency and/or Blood Deficiency
A flaccid tongue that is also pale usually indicates Qi and Blood Deficiency
A flaccid tongue that is also dark red, dry, and has cracks usually indicates extreme heat injuring fluids
A flaccid tongue body with a scarlet tongue body usually indicates Exhaustion of Yin

Swollen

This is a very large tongue body and can indicate both Excess and Deficiency
A swollen tongue that is also pale can indicate Qi Deficiency
A swollen tongue that is also bright red and painful can indicate Heart and Spleen Heat. This could also be due to excess alcohol consumption

Big or Enlarged Tongue

An enlarged tongue can indicate Phlegm, Damp, or Water Stagnation
An enlarged tongue with a pale body and a moist coat may indicate Spleen and Kidney Yang Deficiency
An enlarged tongue with a red body and a greasy yellow coat may indicate Spleen and Stomach Damp-Heat

Half the Tongue Is Swollen

A half swollen tongue may indicate a general weakness of the Channels

Hammer Shaped

This is where the front half or third of the tongue is enlarged at the sides
A hammer-shaped tongue usually indicates Spleen, Stomach, and Kidney Deficiency
This tongue is almost always indicative of a serious condition and may indicate mental illness

Local Swelling on One Side

Localized swelling of the tongue with a normal tongue body colour indicates Qi Deficiency
Localized swelling of the tongue with a red tongue body colour indicates Qi and/or Blood Stagnation

Swollen Sides

A tongue with swelling in Liver and Gallbladder area usually indicates Rising Liver Yang or Liver Fire

Swollen Between the Tip and the Central Surface

This area corresponds to the Lung area and usually presents with a normal or pale tongue body
This tongue is usually found in patients with chronic Lung and Spleen Deficiency, which tends toward Damp and Phlegm accumulation

Swollen Edges

This tongue may indicate Spleen Qi or Yang Deficiency
If Spleen Yang is Deficient, the edges will also be wet

Swollen Tip

When the very tip of the tongue is swollen, it usually indicates Heart problems
If the tongue is also deep red, this may indicate Heart Fire
If the tongue is normal in colour or pale, this may indicate Heart Qi Deficiency

Short and Contracted

When the patient can not show the entire tongue, it usually indicates a more severe disease
If the tongue is also moist and pale, this indicates stagnation of Cold (bluish/purple) in the meridians or Spleen Yang Deficiency
If a contracted tongue also has a sticky tongue coating, this may indicate Turbid-Phlegm blocking the channels
If the tongue is also deep red and dry, excessive heat has consumed Body Fluids and stirred up internal Wind
A short, swollen, tender, and pale tongue usually indicates Qi and Blood Deficiency
A short or small frenum may be inherited and is normal

Long

There is difficulty in retracting the tongue
This indicates interior Excess Heat, Heart Fire, or Phlegm-Fire Misting the Heart
There may be numbness which is associated with Front Swollen Swelling towards the front one-third of the tongue may indicate Phlegm retention in the Lungs

Thin

This can indicate that Qi and Blood are deficient and not able to properly nourish and moisturise the tongue
The tongue body will also usually be pale in color with Qi and Blood Deficiency
A thin tongue that is also dark red and dry may indicate Yin Deficient Fire

Tongue Body Features

Rough or Tender Texture

A tender tongue that appears smooth, delicate, and is possibly swollen indicates a deficiency
A rough tongue that appears wrinkled and rough indicates Excess

Red Spots

Red spots may indicate Heat Toxins in the Blood or Heat Toxins attacking the Heart
Red spots can indicate the presence of Damp-Heat in the Xue Level, where the internal organs are accumulating toxins
Red spots on the Tip (Lung/Heart area) is usually not severe and may present in the beginning stages of illness
Red spots on the entire tongue may indicate a more severe illness
Red spots on the sides of the tongue (Liver/Gallbladder area) may also indicate a more severe illness
Red spots on the back of the tongue (Kidney area) may indicate the advanced stage or chronic nature of an illness

White Spots

White spots are usually due to Spleen and Stomach Qi Deficiency together with excess heat accumulating in the body
In this case, the tongue may also have sores and pus

Black Spots

Black spots usually indicate Qi and Blood Stagnation or heat in the Blood

Ulcerated Tongue Body

There is excess Heat in the Stomach
There is excess Heat in the Heart

Deviated Tongue Body

This is where the tongue tends toward one side of the mouth
This is due to Wind, either from exterior Pathogenic Wind or internal Wind-Damp patterns

Moving, Lolling, Wagging, Playful Tongue Body

This usually indicates heat in the Heart and Spleen channels stirring up internal Wind
In children, this may indicate developmental problems

Teeth Marks on Tongue Body (Scalloped)

If the tongue body has normal color, this usually indicates Spleen Qi Deficiency
If there are teeth marks together with a swollen tongue, this may indicate Spleen Yang and/or Qi Deficiency
If the tongue is also pale and moist, it is more likely Spleen Yang Deficiency or a Cold-Damp pattern

Quivering or Trembling Tongue Body

Trembling of the tongue that can not be controlled may be due to external febrile disease or excess heat consuming Yin
The excess heat stirs up Internal Wind
The tongue body will be a deep red color and the pulse will be rapid
If the tongue body is pale and trembling, this usually indicates a chronic condition of Qi and Blood Deficiency, where the tongue is not being nourished
Side effects of some western medications (pharmaceuticals) may cause trembling of the tongue

Sore Covered Tongue Body

Excess Heat damaging Blood and Yin

Tongue Body Moisture

Reveals the state of Yin and Fluids in the body

Dry Tongue Body

Yin / Blood xu. Yin Xu/ Yang Shi

Slightly Dry Tongue Body

Blood xu Wet Tongue Body Damp /Excess Yin accumulation
Yang Xu Tongue Coating Indicates the state of the Yang organs, especially the Stomach

White Tongue Coat

A thin white tongue coating is normal
A thin white tongue coating can also indicate external
Cold patterns when the appropriate clinical symptoms are present
With a moist and pale tongue, a thicker white coating can indicate Damp-Cold
A dry white coating can indicate Cold turning to Heat and starting to dry body fluids

White Like Powder Tongue Coat

A white and thick tongue coating like powder indicates turbidity and external pathogenic heat
This coating will usually change to yellow after a short time if the patient is not treated
If the tongue body is dark red, interior toxins may be present

White Like Snow Tongue Coat

This may indicate exhaustion of Spleen yang with Damp-Cold in the Middle Jiao

Yellow Tongue Coat

A slightly yellow coating indicates Wind-Heat or Wind-Cold turning to Wind-Heat
A yellow tongue coat indicates an interior heat pattern
The deeper the color of yellow, the more severe heat
A burnt yellow indicates further accumulation of heat in the body
If the coating is yellow and moist and the tongue body is swollen and tender, this indicates interior Damp-Heat or Yang Deficiency
In the case of Yang Deficiency, the tongue is showing false heat signs, as the Yin has forced the Yang to the surface of the body

Dirty Yellow Tongue Coat

This tongue coating may indicate Stomach and Intestinal Damp-Heat

Simultaneous White and Yellow Tongue Coating

Can indicate a Shaoyang pattern Can indicate a simultaneous Heat and Cold pattern, or a Cold pattern turning to Heat
Can indicate a simultaneous Interior and Exterior pattern

Grey Tongue Coat

This tongue coating usually indicates an internal pattern of either Heat or Damp-Cold
A dry grey coating can indicate internal Excess Heat scorching Body Fluids or Yin Deficient Fire
A wet or moist grey coating usually indicates Cold-Damp Stagnation or Damp-Phlegm retention

Black Tongue Coat

Similar to the Grey coating above, but more severe
The black coating usually develops from grey or a burnt yellow coating
A dry black coating (usually with cracks) may indicate excessive Heat burning body fluids
A moist black coating and a pale tongue body may indicate Yang Deficiency, Internal Excess Cold, with or without the presence of Dampness
Both Gray and Black tongue coating can indicate extreme Cold (wet tongue) or extreme Heat (dry tongue)
Western drugs such as antibiotics can also cause a black tongue coating

Half Yellow, Half White (Longitudinally)

This coating may indicate Heat in the Liver and Gallbladder

Yellow Root With A White Tip

This may indicate that exterior Pathogenic Heat is penetrating more deeply into the interior of the body.

Black in the Centre, White and Slippery on the Sides

This may indicate Spleen Yang Deficiency with interior Damp-Cold

Tongue Coat Thickness

Thin Coating Normal

In disease, it indicates the disease is either external or an internal disease that is not severe
If the tongue coating changes from thick to thin, this indicates pathogens are moving to the exterior of the body and the disease is waning

Thick Coating

A thick coating usually indicates more of an internal disease that is more severe
It may also indicate that exterior pathogenic factors have penetrated more deeply into the body
A thick tongue coating may also indicate retention of food
If the tongue coating changes from thin to thick, this indicates pathogens are penetrating deeper into the interior of the body

Peeled, Mirrored, Shiny, No Coating

With a mirrored tongue, there is no coating on the tongue
In less severe cases, there may be a partial coating on the tongue
If the body of the tongue is also red, it usually indicates that Stomach Qi and Yin is severely damaged
If the tongue body is also light in color, this may indicate that Qi and Blood of the Spleen and Stomach is damaged and Deficient
If the tongue body is also red or dark, Stomach and Kidney Yin is damaged (body fluids dried up) due to heat

Tongue Body Cracks

Short Horizontal Cracks

Dryness in corresponding organ due to Blood or Yin Xu

Long Horizontal Cracks

More severe dryness. Blood or Yin Xu

Transverse Cracks On the Sides of the Tongue

Liver Blood Xu

Tongue Coat Root

Tongue Coat Has Root

The normal tongue coating has Root, which means that is "rooted" or attached to the surface of the tongue body
It can not be easily scraped off or removed

Tongue Coat Has No Root

A coating without root rests on the surface of the tongue, but can easily be removed or scraped off
A coating without root usually indicates impairment of Spleen, Stomach, and Kidneys

Tongue Gallery

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Example 1 - NEW

Body colour: Reddish-Purple.

Body shape: Swollen and cracked.

Coating: peeled.

A Reddish-Purple tongue body colour usually indicates Blood stasis deriving from or associated with Heat (whereas a Bluish-Purple colour generally indicates Blood stasis deriving from Cold). In this case, the tongue colour is consistent over the whole tongue so we cannot determine from the tongue alone where the Blood stasis is located. The pulse and the symptoms can tell us this. However, the most likely pattern is that of Liver-Blood stasis.

The tongue body is also Swollen which indicates the presence of Phlegm. The Lung and Heart areas of the tongue are especially swollen which points towards the fact that the Phlegm is predominantly in the Upper Burner. Phlegm and Blood stasis are often seen existing side by side, especially in older patients, as they interact with and "promote" each other. Blood stasis stops fluids from being transported around the body smoothly therefore encouraging the production of Phlegm, while Phlegm blocks the smooth flow of Qi and Blood leading to stasis.

The tongue is totally peeled (without coating) and with many cracks, both signs of chronic Yin deficiency. It is likely that the Yin deficiency preceded the Blood stasis. Chronic Yin deficiency leads to Empty-Heat and we know in this case that the Blood stasis derives from Heat as the tongue is a Reddish-Purple colour. Although we cannot tell conclusively from the tongue only, the Yin deficiency is most likely of the Stomach and Kidneys

Therefore, in conclusion, we can say that this many suffer from Yin deficiency with Empty-Heat, Blood stasis and Phlegm in the Upper Burner.

Example 2

Body colour: Reddish-Purple, Bluish-Purple in the chest area on the right.

Body shape: Stiff, slightly Swollen.

Coating: sticky coating without root.

The overall body colour of this tongue is Purple, indicating Blood stasis. It is predominantly Reddish-Purple, which indicates Blood stasis deriving from or associated with Heat but the chest area on the right of the tongue is Bluish-Purple which indicates that there is also some Cold which has lead to Blood stasis in the chest.

The tongue is also Stiff. A Stiff tongue indicates either severe Blood stasis or internal Wind. As the tongue is also Purple, in this case, it is most likely that it indicates Blood stasis.

The sticky consistency of the coating simply indicates that there is Dampness (or together with the Swollen tongue body Damp-Phlegm), but the fact that it is rootless reflects a deficiency of Stomach-Yin. A rootless coating reflects the beginning stages of Stomach-Yin deficiency.

Example 3 - NEW

Body colour: Slightly Red but Pale on the sides.

Body shape: Swelling in the Spleen area on the sides, Stomach cracks.

Coating: Peeled.

This tongue shows clearly a relatively common condition of Stomach-Yin deficiency (leading to some Heat) and Spleen-Yang deficiency. The cracks in the Stomach area indicate Stomach-Yin deficiency and the overall colour of the tongue is slightly Red showing that this Yin deficiency has lead to some Heat, but the sides of the tongue in the Spleen area are Swollen and Pale. This relects Spleen-Qi and Yang deficiency leading to Dampness.

It is important to distinguish between the Liver and the Spleen areas on the sides of the tongue. The Liver area is a longer and thinner strip, covering nearly the whole side of the tongue, whereas the Spleen area is shorter and fatter and in the middle of the side of the tongue.

In the case of this patient, it would therefore be necessary to treat both Yin deficiency (of the Stomach) and Yang deficiency (of the Spleen). Even though the Yin deficiency (and Empty-Heat) seem predominant because the main area of the tongue body is Red and it is peeled, it is likely that the Spleen deficiency came first. As the Spleen and Stomach are so closely connected, a long-standing case of Spleen-Qi and/or Yang deficiency may lead to a deficiency of the Stomach (which has a tendency to become Yin deficient). A suitable remedy for this condition might be Shen Ling Bai Zhu San (Central Mansion in the Three Treasures remedies).

Example 4 - NEW

Body colour: slightly Red.

Body shape: Swollen, especially in the chest area with a Heart crack.

Coating: sticky coating.

This tongue is slightly unusual in that it clearly shows us the exact location of a pathogenic factor. The chest area is clearly more Swollen than the rest of the tongue indicating the presence of Phlegm in the Upper Burner.

As a general rule, the tongue body shows more the presence of Phlegm and the coating reflects the presence of Dampness. When the tongue body is Swollen and the coating is sticky, as in this case, it normally indicates the presence of Damp-Phlegm, in this case clearly in the Lungs.

Example 5

Body colour: slightly Red.

Body shape: Swollen, especially in the chest area with a Heart crack.

Coating: sticky coating.

The Reddish-Purple coating is more distinct on the sides in the Liver area which points specifically towards Liver-Blood stasis. The Liver area on the sides is also Swollen which usually indicates severe or chronic Liver-Heat. The Liver area being Red and Swollen simply indicates a more severe degree of Liver-Heat than if the Liver area is just Red.

The strips of a slightly thicker, white coating on either side of the tongue indicate a Gall-Bladder pathology, most usually Dampness in the Gall-Bladder.

Although the tongue points towards the Blood stasis being especially in the Liver, treatment of this patient should focus equally on moving Blood in the Heart. The presence of a Heart crack indicates a constitutional tendency to Heart patterns.

Example 6

Body colour: pale.

Body shape: swollen, central Heart crack, transverse Spleen cracks on the sides.

Coating: thin-white (normal), slightly yellow in the centre.

The pale tongue-bicolour indicates Yang deficiency (it may also indicate Blood deficiency, but in a man, it is more likely to be Yang deficiency). It is not possible from the tongue only to establish which organ is mostly affected in this case by the Yang deficiency: however, since the tongue body is also swollen, which usually indicates Phlegm, it is more likely to be Spleen-Yang deficiency. The central crack, in this case, correlates with the Heart.

A "Heart crack" is rather thin and long, extending from near the root of the tongue to near the tip; a "Stomach crack" is rather wide and is situated only in the middle section of the tongue, in the Stomach area. What does a Heart crack indicate? It depends on its depth and on the colour of the tongue tip. Generally speaking, a Heart crack indicates a constitutional propensity to Heart patterns and to emotional problems: the deeper the crack, the stronger this propensity. If, in the presence of a Heart crack, the tongue tip is red, it indicates that there already is a Heart pattern usually from emotional problems. In other words, a change in colour of the tongue body indicates that that particular constitutional tendency to Heart patterns has manifested itself and generated an actual Heart pattern. If we compare two people both with a red tip of the tongue, one with a Heart crack and the other without, the presence of a Heart crack indicates that that person has a constitutional tendency to Heart patterns and that his or her condition is deeper and more difficult to treat than that of the person without a Heart crack.

The small, transverse cracks on the sides usually indicate severe, chronic Spleen deficiency. Thus, we can conclude that this man suffers from a chronic Spleen-Yang deficiency and Phlegm.

Example 7

Body colour: dark red, redder on the sides.

Body shape: swollen on the sides, Stomach crack.

Coating: white, rootless.

The dark red body colour clearly indicates intense Heat and the redder colour and swelling on the sides shows that the Heat is in the Liver. Thus, this patient has suffered from Liver-Fire for a long time (we can deduce it is a long time from the dark-red colour) and the intense Fire has begun to injure Yin. We know this from the fact that the coating is rootless: this indicates the beginning of Yin deficiency and, since the tongue is dark-red and there is a coating, we can deduce that it is the Fire that is injuring Yin rather than deficient Yin giving rise to Empty-Heat.

Example 8

Body colour: red slightly tending to purple, redder tip.

Body shape: swollen tip, tip curling up, Heart crack.

Coating: normal but there is a slightly peeled patch without coating on the left side towards the root.

The red body colour indicates Heat and the slightly purple colour indicates that there is some Blood stasis. The red tip indicates Heart-Fire and the swelling of the tip and its curling up confirm and reinforce this diagnosis. The presence of the Heart crack indicates that this patient had a constitutional tendency to Heart patterns and to emotional problems. The small patch without coating indicates the beginning of Stomach-Yin deficiency.

Example 9

Body colour: red, tending to purple

Body shape: very swollen, Stomach crack.

Coating: yellow, rootless, dry.

The red body colour indicates Heat while its slightly purple hue indicates that there is some Blood stasis. The very swollen body shape indicates the presence of Phlegm. The red colour, together with the Stomach crack and the yellow coating, indicates that the Heat is located in the Stomach. This is confirmed by the rootless coating which indicates the beginning of Stomach-Yin deficiency, presumably from the Heat injuring Yin. The dryness of the coating confirms both the Heat and the Yin deficiency (it could be due to either).

This tongue has a rootless but relatively thick coating: this is doubly bad. Why? The rootlessness of the coating indicates that there is the beginning of Yin deficiency but the relative thickness of it indicates that there is a pathogenic factor, in this case, Stomach-Heat: thus, this patient suffers from a Full condition occurring against a background of Stomach deficiency. In other words, it would have been better if the coating had been either rootless but thin (indicating Yin deficiency but no pathogenic factor) or thick with root (indicating the presence of a pathogenic factor but also a good state of the Stomach).

Example 10

Body colour: reddish-purple, red sides

Body shape: very swollen, swollen sides, Stomach crack

Tongue coating: sticky-yellow, sticky-dry-rough-yellow inside the Stomach crack.

The reddish-purple colour of the tongue body indicates Blood stasis deriving from or associated with Heat. The redness on the sides indicates Heat in the Spleen and/or Stomach; in this case, the redness on the sides is not related to the Liver because it occupies a wider area than the Liver are and also because it is associated with a Spleen-type of swelling on the sides. The general swelling of the tongue body indicates the presence of Phlegm, while the swelling on the sides is related to the Spleen and it indicates Dampness occurring against a background of chronic Spleen deficiency.

The sticky-yellow coating confirms the presence of Dampness while the Stomach crack, together with the sticky-dry-rough-yellow coating insides it indicates Phlegm-Heat in the Stomach.

In conclusion, the main location of the disharmony, in this case, is in the Middle Burner with Stomach and Spleen Heat, Damp-Heat and Phlegm-Heat in the Stomach. The Blood stasis probably derives partly from the Heat and partly from the chronic retention of Phlegm.

Example 11

Body colour: slightly pale, almost normal

Body shape: very swollen, more so on the (patient's) left side

Tongue coating: thick-white-rootless coating.

The swelling of the tongue body indicates Phlegm while the partial swelling on the left side often indicates a weakness of the channels on that side. Such weakness may derive either from a febrile disease with high temperature or from an accident to that side of the body.

The rootless coating indicates Stomach-Qi or Stomach-Yin deficiency, but its thickness indicates the presence of a pathogenic factor, probably Dampness. A thick-rootless coating is doubly bad because, on the one hand, Stomach-Yin is deficient, but, on the other, there is a pathogenic factor. It is better for a rootless coating to be thin (indicating Stomach-Qi deficiency but no pathogenic factor) or for a thick coating to have a root (indicating the presence of a pathogenic factor but also intact Stomach-Qi).

Example 12

Body colour: reddish-purple

Body shape: swollen sides

Tongue coating: thin-white-rootless coating, peeled in patches.

The reddish-purple colour indicates Blood stasis with Heat. The swelling on the sides indicates chronic Spleen deficiency and the rootless coating missing in patches indicates Stomach-Yin deficiency.

This patient too suffers primarily from a disharmony in the Middle Burner with chronic Spleen-Qi deficiency and Stomach-Yin deficiency. Both the swelling on the sides (related to the Spleen) and the rootless coating missing in patches (related to Stomach-Yin) indicate a chronic condition because this type of swelling and the lack of coating develop over a long period of time.

It is not possible to tell from the tongue only which other organs (apart from the Stomach), if any, is affected by the Blood stasis and the Heat.

Example 13

Body colour: red, red tip

Body shape: short.

Tongue coating: thin-white.

This slide is presented here mainly as an example of a short tongue body. The patient could not stick the tongue out more than that. The red tip indicates Heart Heat.