Vous êtes sur la page 1sur 280

Atlas of Chinese

Tongue Diagnosis

Chinese cton9ue

Barbara Kirschbaum

Foreword by

Dominique Hertzer

Eastland Press
SEATTLE

Originally published in German (1998) as


Atlus und Lehrbuciz der Chiizesiscl~a~~
%~~~zge~rdi~~,giioslilc
by Verlag fur Ganzheitliche Medizin Dr. Erich Wiihr Gmbli.
English language edition 02000 by Eastland Press. Incorporated
PO. Box 99749. Seaule, WA 98139, USA.
All rights rescrvcd.
No part of this book may be reproduced or transmitted in any form or
by any means, eleclronic or mechanical, including photocopying, recording, or by any inrormation storage and retrieval system, without the
prior written permission of the publisher, except where permitted by law.
Library of Congress Catalog Card Numbel.: 99-72892
Internalional Standard Book Number. 0-939616-33-5
I'riiited in lhe Republic of Korea

English transla~iunby Barbara Kirsclibauni


Book design by Gary Niemeiel

T A B L E

O F

C O N T E N T S

ACKNOWLEDGEMENTS . . . i x
FOREWORD

... xi

INTRODUCTION

... xvii

C H A P T E R 1 The Foundations of Tongue Diagnosis


1.1

Relationship of theTongue to the Interior of the Body . . . . . . . . . . . . . .1

1 .1 .1 Channel Connections to theTongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1


.
1 .1 .2 Topography of theTongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.
1 .? General Information Regarding Inspection of the Tongue . . . . . . . . . . .3

1.2.1 Three-Step Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. .


1.2.2 Conditions for an Accurate Tongue Diagnosis . . . . . . . . . . . . . . . . . . . . . .3
1 . 2 . Tongue Body Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. .
1.2.4 Relationship Between Tongue Body Color and Shape . . . . . . . . . . . . . . .4
1.2.5

Relationship Between Tongue Body Shape and Tongue Coating . . . . . .6

1 .2.6

Observation of the SublingualVeins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6.

1.2.7 Comparison of Pulse andTongue Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 6.


1 . 3 The Normal Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. .

Examples of Normal Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9.


CHAPTER ?
2.1

Pale Tongue Signs

..
Pale and Swollen Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.2 Pale Tongues with a Depression at Their Root . . . . . . . . . . . . . . . . . . . .18


.
2.13 Pale and Thin Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
.

Table of Contents

2.4
2.4.1
2.4.2
2.4.3

Special Tongue Shapes of the Pale Tongue . . . . . . . . . . . . . . . . . . . . . . . .27


Pale and Narrow Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
.
Uneven Sides of the Tongue. or Swollen on Half of the Tongue . . . . . .29
Swollen Tongue Sides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
.

CHAPTER 3

Tongue Signs Associated with Kidney Disharmonies

3.1 Characteristics of Yin-Deficient Tongues . . . . . . . . . . . . . . . . . . . . . . . . 35


..
3.2 Red Tongues with Kidney Yin Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . .36
.i.i Scarlet Red Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
.
3.4 Red, Short Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
.
3.5 Cracked Tongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
..
.
3.6 The Tongue Coating and Kidney Yin Deficiency . . . . . . . . . . . . . . . . . . 53
3.7 Special Tongue Shapes Associated with KidneyYin Deficiency . . . . . . 57
CHAPTER 4

Tongue Signs Associated with Stomach


and Spleen Disharmonies

4.1 Tongue Signs Associated with StomachYin Deficiency . . . . . . . . . . . . .G I

4.1.1
4.1.2
4.1.3
4.2

Red Dry. and Cracked in the Center of the Tongue . . . . . . . . . . . . . . . . . 61


Vertical Midline Crack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
.
Shiny and MirrorTongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
.
Tongue Signs Associated with Spleen Yin Deficiency . . . . . . . . . . . . . . . 76

CHAPTER

s Tongue Signs Associated with Lung Disharmonies

5.1 Tongue Signs Associated with Lung Yin Deficiency . . . . . . . . . . . . . . 85


s.2 Tongue Signs Associated with Constitutional Weakness
of the Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
...
5.13 Special Tongue Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
.
CHAPTER 6

Tongue Signs Associated with Disharmonies


of the Heart

6.1 Tongues Signs Associated with Constitutional Weakness


of the Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
.
.
6.1.1 LongTongues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
6.1.2 Tongues with a Long, Vertical Crack in the Midline . . . . . . . . . . . . . . 107
6.2 Tongue Signs Associated with Heart Blood Deficiency . . . . . . . . . . . .111
6.3 Tongue Signs Associated with Heat in the Heart . . . . . . . . . . . . . . . . . 116
.
CHAPTER 7

Tongue Signs Associated with Liver Disharmonies

7.1 Tongue Signs Associated with Ascending LiverYang

..
and Liver Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
7 . 2 Tongue Signs Associated with Liver Qi Constraint and the
Development of Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Table of Corzterzts
7.3 Tongue Signs Associated with Internally-Generated Wind . . . . . . . .138
7.4 Tongue Signs Associated with Liver Blood Deficiency . . . . . . . . . . . .142
CHAPTER 8

Tongue Signs Associated with Blood Stasis

Blue or Bluish Tongue Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147


.
8.2 Partial Bluish Discoloration of the Tongue . . . . . . . . . . . . . . . . . . . . . .154
8.3 Distended SublingualVeins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
.
8.1

CHAPTER 9

Tongue Signs Associated with Heat Disorders

9.1 Red Points at the Tip of the Tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . 165


.

9.2 Red Tongue Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173


..
9.3 Tongue Signs Associated with Damp-Heat . . . . . . . . . . . . . . . . . . . . . 175
.
C H A P T E R 1o
10.1
10.2
10.2.1
10.2.2
10.2.3
10.2.4
10.2.5

Tongue Coatings

Tongue Coatings and the Eight Principles . . . . . . . . . . . . . . . . . . . . . .185


Different Aspects of the Tongue Coating . . . . . . . . . . . . . . . . . . . . . . . .187
Wet and Slippery Coatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
.
GreasyTongue Coatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
..
Dry and White orYellow Coatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
Black Coating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
..
Tofu-Like Coating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207
.

CHAPTER 11

Special Tongue Sign:


The Completely Cracked Tongue

C H A P T E R 12

Changes in the Tongue Following Treatment

Severe Exhaustion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.1 3


CASE2 Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .214
.
CASE 3 Wasting Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
.
CASE 4 Cardiac Neurosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
. .1 6
CASE 5 Feeling of Pressure and Pain under the Ribs . . . . . . . . . . . . . . . . . .2 1 8
.
CASE 6 Chronic Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219
CASE 1

A C K N O W L E D G E M E N T S

..........................................................

W H E N , I N T H E 1980s, the excellent book Tongue Diagnosis i n Chirzese

Medicirze by Giovanni Maciocia appeared, it awakened my interest in this art.


For the structured conveyance of his knowledge, I wish to thank him. Thanks
also to my first teacher, J. D. van Buren, who taught me the art of observation;
Ted Kaptchuk, who introduced me to Chinese herbalism; and Dr. Huang
Yun-Rui, of the Chengdu University of Traditional Chinese Medicine, who
taught me the practice of Chinese medicine.
To those collegues and friends who gave me the courage and support to
write this book, my hearty thanks. A very special thanks to Jeni Barnet for her
help with the English edition, and her continuing friendship. Thanks to Dr.
Dominique Hertzer for her constructive support, which was also expressed
in her excellent Foreword. I am indebted to my students and patients, as this
tongue book could not have been realized without them.
Finally, a very special thanks to Walter Geiger. Not only did he permit me
to use tongue photographs of some of his patients, but he also contributed
with his helpful observations and criticisms to the completion of this book.
Any mistakes in the book are entirely my own.

F O R E W O R D

she, the Chinese character


for 'tongue,' appeared was as a n inscription on oracle bones. Even in this
ancient context it revealed a great deal about the importance of the tongue.

ACCORDING 1'0 Cl-IlNESE sources the first time

The original representation shows a bell with a wooden clapper, which


appears to be moving to and fro. The body of the bell, which is placed
upside-down, forms the upper part of the picture, while the lower part of the
picture shows a clapper, which sticks out like a protruding tongue.'
It is interesting to note that the original symbol for 'tongue,' inscribed on
the bones, matches the style of writing of two other characters; thus, several
words with different meanings are united in the characters. Unlike modern
Chinese, which utilizes many different independent characters, ancient
Chinese used only one character which, out of necessity, needed to express
many things.
The development of the Chinese language and its writing can be clearly
marked. For instance the character she is also used to mean gao, 'to communicate with,' while yun, the Chinese character meaning 'to talk' or 'to speak
words,' also means 'a bell with a wooden clapper.' This meanin, emanates
from the oldest of traditions when the eldest of the clan wanted to communicate with his people. Because he first had to ring a bell to gather them
together, the 'ringing of the bell' was a sign of forthcoming 'communication.'

This connection can be found in the oldest Chinese dictionary, the Shuo wen
jie zi:
'She [the tongue] is that with which one talks in the mouth as well as
differentiating taste."

As the essential function of the tongue is spoken communication, the character she was already used in many classical texts to mean 'to talk' and 'to
communicate.'
In one of the chapters from the Lulz yu, Confucius in conversation with
his pupils discussed the following question:
'How is the superior man able to observe and maintain forms and rituals when he occupies lhimself, because of his being, with essential
things?'
li-Chcng said: 'The superior man is concerned with the essence,
why is it necessary for him to bother with the forms?'
Zi-Gong replied: 'Your understanding of the superior man is truly
regretful. A four-in-hand cannot catch up with Ithe speed of your1
tonguc."'
Zi-Gong, a favorite pupil of Confucius, regretted the thoughtless words
uttered by Ji-Cheng, where the character she was obviously used to mean
'verbal expression.'
The application of the character she along with further associations are
found in the Yi jing, namely in the commentaries on the trigrams where the
symbolic meaning of the eight trigrams is discussed."
Here the tongue is assigned to the trigram d ~ ~where
i,
a yin line is positioned above two yang lines. While this represents 'a lake' it is also an essential characteristic of 'the merry' or 'the joyous.' The commentary notes:
'The joyous is the lake, it is the youngest daughter, it is the magician, it
is the mouth and the tongue. It is the undoing and the destruction.
With regard to the earth it means hal-dness and saltiness. With regard
to his seraglio it is the second woman, not the first. It is the sheep.'"
Here the 'tongue' appears in the context of speaking and communicating. For example, it is a distinctive mark of the magician to give her words
and abilities a special meaning and power. If we look more closely at the funi relation to the 'the joyous,' we find, in
damental quality of the trigram d ~ lin
the context of Chinese medicine, a unison of qualities which represents the
essential qualities of the Heart. The 'talking tongue' is the off-shoot of the
Heart, and the Heart's body opening is the 'the mouth.' While its vocal manifestation is 'laughter,' its emotional expression is 'joy.'
So in every sense of the word-both
tongue has the power of expression.

literally and metaphorically-the

On one hand the tongue, as an organ, enables us to communicate with


our environment through language. It is through the tongue that thoughts
and emotions are brought from the inside to the outside; it is the connecting
link between our inner and outer worlds. On the other hand, in the context of
Chinese medicine, the tongue is a diagnostic tool. By using tongue diagnosis
an experienced practitioner can judge the exterior flow of energy in the yin

organs and the interior flow of energy in the yang organs. The tongue,
therefore, connects the 'inside' and the 'outside' of a person.
The first person who is said to have applied tongue diagnosis is Bian
Que," one of the most renowned doctors in pre-Han China. He practiced
during the Warring States period (471-221 B.C.). Before becoming a physician he worked in a boarding house in the ancient state of Cheng, which
today is the province of Hebei. One of his customers was a great physician,
Chang Sang-Jun, who traveled in cognito, and legend has it that Bian Que
became his pupil, having followed a prescription given to him by Chang.'
Bian Que took the medicine for 30 consecutive days, after which, it is
said, h e had the ability to see the 'insides' of people. Bian Que then
received all of Chang's prescriptions and studied all of his books. Using
this knowledge he traveled around from state to state practicing successfully as a doctor in many different areas of medicine, from gynecology to
pediatrics to illnesses of the ear, nose, and throat. Bian Que didn't limit
himself to tongue diagnosis; it was said that he was very proficient in the
use of herbs and acupuncture, and was highly knowledgeable in pulse
diagnosis. His fame, however, was not solely attributable to his enormous
abilities as a doctor. Against a background of competing arguments concerning the history of ideas led by different philosophical schools such as
Daoism, Confucianism, Mohism and Naturalism, Bian Que's work and abilities represented a changing view of society, namely, from a religious to a
rational conception o f t h e world.
Bian Que fought for a medicine whose success was not based on shamanistic techniques, as had been the case in the Shang (1766-1 122 B.C.) and
early Zhou eras (1122-221 B.C.). In the so-called 'demon medicine' of that
time, where the causes of illness were attributed to evil demons,"" treatment was aimed at expelling demonic spirits. Success or failure was, as a
rule, inexplicable.
At the time of the Warring States, new philosophical ideas and the move
toward rational thinking was rellected in a changing theoretical understanding as well as in the practical application of medicine. It was at this
time that Bian Que introduced an objective and comprehensive method of
diagnosis using the tongue and the pulse. If properly studied, anyone, not
just a few shamans, could observe and describe the quality of an illness by
using these methods. Bian Que demonstrated that through tongue and
pulse diagnosis it was possible to gain insight into the present condition of
a patient, as well as review their past and predict future developments.
Thus, the observation of the tongue-its shape, color, and consistency-became one of the most important aspects of Chinese medicine. By
observing the patient closely, and utilizing the senses of sight, sound,
smell, and touch, o n e could reach a comprehensive description of the
whole person.
The first differentiated and concrete statements concerning the significance of the tongue coating and its body are found in the Nei jirzg: "When
the evil qi penetrates the lesser yang channel of the hand, this will cause a
blockage in the neck, the tongue curls upward, the mouth is dry, and the
Heart is restless."

This is a commonly cited passage about tongue diagnosis, as it reflects


not only the connection of the Triple Burner channel to the tongue, but also
a pathology which appears in connection with pathogenic heat.
The next passage describes the long and soft tongue: "If the tongue is
long and protrudes, and is without strength, and if the patient is frightful,
choose the lesser yin channel of the foot."
Here the long tongue is also defined as soft, and when it is retracted it
gives the appearance of being without strength. This is a description of
Kidney yin deficiency, and the illness would be treated via the Kidney channel.
The effects of pathogenic heat on the five yin organs are discussed in
Chapter 32 of the Su wen.
Describing the effects of heat on the Lung, the tongue coating is described as follows:
"If the patient has fallen sick from heat in the Lung, he will have chills
at first.The smallest hairs are raised and hc will dislike wind and cold.

The tongue coating is yellow and the body is hot.""'


"The Lung channel begins in (he middle burner, has a connection
to the Large Intestine, and encircles the Stomach as well as the mouth.
When heat is present in the Lungs, it penetrates to the Stomach and
from there ascends; the tongue coating will be yellow and the body will
be hot."'
Even if these historical passages do not give a clearly systematized and
specific description of tongue diagnosis, we still find in the Nei jing important statements about the essential elements of tongue diagnosis, that is, the
shape and coating of the tongue.
In the framework of the general development of diagnosis and treatment
strategies, we find in many classical works of Chinese medicine, over a thousand year period, more and more specific observations in relation to tongue
diagnosis.
The first text to deal exclusively with tongue diagnosis dates from 1341
during the Yuan (Mongol) dynasty. This was published by Du Qing-Bo. His
work, entitled Ao shi shunghaiz jin jirzg lu is based upon a textbook of tongue
diagnosis from an otherwise unknown man named Ao. This book contains 12
color illustrations with descriptions of the tongue body and coating. Du
Qing-Bo added another 24 illustrations and assigned to the different tongues
their corresponding patterns and pulses."
Unfortunately, the illustrations did not survive, but the tradition of pictorial illustration of the tongue coatings and shapes continued. In a work entitled Kou chi lei yno, illustrations of different tongues were not only assigned
corresponding patterns, but a corresponding prescription as well. The following drawings are samples drawn from this work:':'

These illustrations, with their descriptions, clearly show the development of Chinese medicine in its quest toward more refined and specific
diagnostic techniques, with corresponding treatment strategies, and its
application of existing knowledge to examine and integrate new findings.
Against this background it was only a matter of time before the Chinese
absorbed Western medicine into their culture to work alongside Chinese
medicine. Western medicine has been adopted in China in part because of a
common belief that it is superior to Chinese medicine but also because it
is thought to enrich Chinese medicine, rather than competing with it. In
Chinese medicine, as in many other areas of Chinese thinking, the question
is never'eitherior' but 'as well.'
Barbara Kirschbaum stands firmly in this tradition with her Atlas of
Chinese Tongue Diugnosis. According to official sources, many diseases like
skin complaints, chronic fatigue syndrome, and AIDS are more common in
the West than in China, and as such have not been described, in detail, in the
Chinese literature. Here, Barbara Kirschbaum integrates, within the parameters of Chinese medical diagnosis, her own insights, and provides examples
of many new, or typically Western, illnesses. This is done without losing the
essential characteristics of Chinese medicine-precise observation and clear
diagnosis. Beginning with the diagnosis of individual organs, tongue signs
with their corresponding patterns are clearly explained, and documentation
of their pathogenesis, from mild to severe cases, are set forth in detailed case
histories.
This Atlas is both a reference book and a useful study guide for diagnosis,
both for the beginner as well as the advanced practitioner. It will be of invaluable help in daily clinical practice.
The quality of the tongue photographs, together with their precise
descriptions, are unique in the Western literature on Chinese medicine,
and, from own my research, in the native Chinese literature as well. I
hope this book will set a new standard for Chinese medical publications and
contribute to the wider circulation and recognition that it truly deserves.

- Dominiclue ljerlzer

Endnotes
1. Compare the represcntalion and rncaning of she on thc oraclc boncs inscription
with Xu %, ed. Jiagu wen ci dian. Chengdu: Sichuan Provincial Publishing tlouse,
1990:208.
2. Zhongzhengxin yin yi cong heda ci diun.ljipei: Zhongzheng shuju, 1990:1436.

3. Lunyu "Yunyuun"121.8 in Xinyisishu du ben.l'aipei: Sanrnin shuju, 1985: 161.


the symbolic rncaning of the trigrams, see Ilermr L). "Das alte und neue
Yijing. Ilie Wandlunges des Ruches der Wandlungen." Diederichs Gelbe Reihe
126, S. 137.143. Munchen. 1996.

4. Fur

5. Zhou yi yln de: Concordance lu Yijing. laipei: llarvard Yenching Institute

Sinological Index Scries. 1966:52.

6. Li I-W, et al. Zhongyi cla ci diarz. Beijing: Peoples Medical Publishing House,

1995:1178.
7. Chuang Y. Historical Review of the Deuelopment of Chinese A c ~ ~ p ~ ~ n c Taipei,
ture.
1978:47-49.
8. Unschuld I? Medizim in Chitza. Munich: Eine Ideengeschichte. Beck, 1980:28-48.
9. Cuo A-C, ed. Huutzg di nei jing
Publishing House, 1995:769.

SLL

weti xiao zhu. Beijing: Peoples Medical

10. lbid.. 428


11. Ibid
12. Ding F-B. Zhotzgguo li clui yiyuo shu !nu. Taipei: Nantian shuju. 1979:378
13. Chen M-L, et al. GLLj i n tc1 sl?uj i chengyi bu clchnn lu. Beijing: Peoples Medical
Publishing I-louse, 1995; 5(2):80-85.

I n t r o d u c t i o n
............................................................

T H E PURPOSE OF this book is simply to demonstrate the importance of

tongue diagnosis in Chinese medicine. Although there are several valid


diagnostic techniques in Chinese medicine, the use of tongue diagnosis,
especially in conjunction with pulse diagnosis, ranks as one of the most
important tools. Moreover, tongue diagnosis can be learned quickly, and its
tindings tend to be more objective than those of pulse diagnosis.
Like all other diagnostic methods in Chinese medicine, the knowledge,
perception, and intuition of the therapist are paramount. Clearly, an experienced practitioner will read the tongue more accurately and will be able to
interpret the findings more thoroughly. The energetic condition of a patient
can be seen in the shape and color of the tongue body, and a developing
pathology is reflected by a change in these characteristics. As a rule, this can
take weeks, months, and even years, which gives the therapist a chance to
make assumptions about the depth and length of the illness. By contrast, the
pulse is subject to fluctuations that can change within minutes.
The coating of the tongue body is probably the weakest aspect of tongue
diagnosis. Assessing the color, location, consistency, and pathological
changes in the coating are especially important in the diagnosis of acute
illness. The coating on the posterior third (root) of the tongue can reflect different aspects of dampness in the lower burner. However, it does not reveal
its precise location; the pathology can be in the Bladder, Large Intestine,
or Kidneys. This, however, can be narrowed down with the help of pulse
diagnosis.
Not until the Yuan dynasty (1279-1368 CE) was a book dealing exclusively
with tongue diagnosis published in China. Written by Ao-Shi, it was revised
by Du Qingbi in 1341. The new edition included numerous illustrations of
tongues, and various tongue shapes and coatings were discussed in detail.
Thus, an important foundation for tongue diagnosis was laid, which has
since constantly evolved and grown in importance.'

Current research is being undertaken to establish the correlation


between specific tongue signs and the appearance of particular illnesses.
Chen Zelin and Chen Meifang refer to several research studies in their book
The Essence ancl Scientific Bnckgr'o~~nd
of Torzglre Dingrzosis.As an example
of this research, they report that in a Shanghai medical college, a research
team observed that patients suffering from acute bouts of cholecystitis
(inflammation of the gallbladder) presented with a thick, greasy, yellow
tongue coating. The tongue body was frequently red, especially at the sides
and tip. This presentation was associated with the following symptoms: feeling of fullness in the chest and epigastrium, stomach and abdominal pain,
and repeated vomiting. This corresponds with the traditional Chinese medical diagnosis of retention of damp-heat in the Liver and Gallbladder, blockage of qi in the middle burner, Liver qi constraint, and the development of
heat.:' Research such as this substantiates the precise nature of tongue diagnosis and underscores its value as a prognostic tool.
Tongue diagnosis made its breakthrough in the West during the 1980s.
Giovanni Maciocia's book Tongue Diagnosis irz Clzirzese Medicine was crucial
to the in-depth study of this method.' That many practitioners in the West
now use tongue diagnosis can be attributed to his systematic presentation of
the subject
It is not the purpose of this atlas to cover the basics of tongue diagnosis;
Maciocia does a very good job of this in his book. Rather, my intention here is
to teach the reader how to observe and interpret various tongue signs. To
that end, each of the tongue photographs in this book is accompanied by an
explanation of the pathological changes to the organs.
Another recommended book from the 1980%not least for its numerous
photographs, is Atlas of Tong~rearzd Lingzlnl Contirzgs by Song Tian-Bin,"
which was published in China. However, it is important to remember that
there are differences, albeit small ones, between Chinese and Western
tongues. In that atlas, all of the photographs are of Chinese tongues, which
frequently present with a thick, greasy coating. Interestingly enough, I have
not found this type of coating, which signifies an accumulation of dampness,
to be nearly as common in my clinical experience in Europe. By way of contrast, European tongues tend to have cracks in the tongue body that are an
indication of yin deficiency associated with our hectic lifestyles and irregular
eating habits. Yet this type of tongue is not commonly seen in Chinese
tongue atlases.
By studying the tongues in this book, it is hoped that the practitioner will
learn how to go about using tongue diagnosis. Most of the photographs were
taken at the clinic which 1 share with Walter Geiger, and show mostly tongues
of German patients. The interpretations of some of the tongue signs are
based on my own observations during twenty years of clinical practice, as
they were difficult to correlate with existing references.
Chapter 1 provides a short introduction to the basics of tongue diagnosis, and discusses the topography of the tongue.
Chapter 2 discusses pale tongue bodies that reflect Spleen qi or yang
deficiency as well as deficiency of essence.
Chapters 3 through 7 look at tongue signs associated with disharmonies
of the Kidney, Stomach and Spleen, Lung, Ileart, and Liver.

Chapters 8 through 10 focus on tongue signs reflecting blood stasis, heat,


and tongue coatings.
Chapter 11 addresses a specific and unusual tongue sign: the completely
cracked tongue.
Chapter 12 discusses changes in the tongue that were observed after
treatment with acupuncture and Chinese herbs.
In some cases, a particular aspect of the tongue will be especially significant to the diagnosis of the underlying disorder. These items have been
italicized in the text.
In each chapter, the sequence of tongue photographs reflects a n increase
in energetic imbalance. The first photograph shows a slight imbalance, while
the final one in each chapter reflects a severe one. This helps to develop
a perception for the essential aspects of the tongue as well as the different
levels in severity of a pathology.
The case histories at the end of each section in the chapters are intended
to integrate the findings of tongue diagnosis with other diagnostic findings in
the case. Here, the symptoms, pulse qualities, and tongue signs are brought
together in a complete, all-embracing diagnosis.
It is my hope this book will contribute to a deeper understanding of
tongue diagnosis and its practical application in the clinic.

Endnotes
I. Maciucia G. 7b1igileDicigfiosis in Chi~?eseMedici~ze,
rev. ed. Seattle: Eastland
Press, 1995. See Chapter 1 of this book for a short introduction to the history
of tongue diagnosis.
2. Chen %, Chen M. The Esseizce nfi,clScienti/ic Background ofTo~?gueDic~g~zosis.

Long Beach, CA: Oriental Healing Arts Institute, 1989.


3. Ibid., 36

4. lbid
5. Song '7'-U. Atlas oJ'l1i.u 7'01zg~1.e
C I I ? ~LDzgual Coaliizgs if1 Chinese Meclici~le.Ueijing:
Peoples Medical Publishing I-louse and Editions Sinomedic, 1981:64.

C H A P T E R

The Foundations of
Tongue Diagnosis
I .I

1 .I .I

Relationship of the Tongue


to the Interior of the Body
Channel Connections to the Tongue
The external aspect of a person can be perceived through their vitality,
exuberance, body posture, and quality of the hair and skin, all of which
reflect on the individual's internal energetic condition. The external aspect,
along with the different tissues in the body, are supplied by qi, blood, and
body fluids, which are produced, transformed, and transported by the
organs. This is especially true for the tongue. However, unlike the skin and
hair, the tongue lies somewhere between the 'interior' and the 'exterior,' and
has an immediate connection to the interior. Because of this direct relationship to the interior, the tongue is extremely well suited for the diagnosis of
various energies and the circulation in the body.
The texture of the tongue shows the quality of the individual's energy
production and inherited constitution. The color and shape of the tongue
body reflect the quality of the circulation of qi, blood, yin, yang, fluids, and
essence. The tongue coating mirrors the condition of the body fluids, the
functioning of the organs, and the strength and depth of pathogenic factors
present in the body.
The tongue has an especially close relationship with the Stomach and
Spleen. Liquids and solids are received by the Stomach where they are transformed and transported by the power of the Spleen qi. The Stomach is
regarded as the source of fluids, and its ability to produce fluids is directly

The Fourzdations of Tongue Diuglzosis

reflected in the tongue's moisture. The quality of the nutritive qi and blood
depends on the strength of Spleen qi to extract the essence from ingested
foods, which contributes to the healthy pale-red color of the tongue body.
In its function as a sensory organ, the tongue is an 'offshoot' of the Heart,
which means that the Heart qi communicates with the tongue. The Heart
governs taste and speech. In addition, Heart qi controls blood circulation
and supplies the tongue with blood, thus giving the tongue body its pale-red
color. A direct connection from the Heart to the tongue is made through the
collateral vessels of the Heart, which reach the root of the tongue.
Fig. 2

---- ----,--______--*

All the other organs directly or indirectly supply the tongue via the channels. An internal branch of the Spleen channel ascends to the tongue and
spreads out beneath it. The Kidney channel ascends to the tongue and ends
at its root. The Liver channel and the secondary channels of the Bladder,
Stomach, and Triple Burner also reach the tongue. Only the Lung, Large
Intestine, Small Intestine, and Gallbladder channels have no direct connection to the tongue; but they do have indirect contact, either through their
coupled partner organs or through deep internal channel connections. As a
result of all these connections, the tongue can be used as a source of information about the status of qi, blood, and fluids in the body.

LU

lower burner

Fig. 3

middle burner

Fig. 1

Topography of the Tongue

'
Fig. 4

To assess an individual's general energetic condition, the entire structure of


the tongue is inspected. For a more detailed diagnosis, the tongue is divided
into three zones, or areas (Fig. 1):
1) The first (anterior) third of the tongue reflects the condition of the upper

SP

burner, which encompasses the Heart, Pericardium, and Lung.


2) The second (middle) third reflects the condition of the middle burner,
which encompasses the Spleen, Stomach, Liver, and Gallbladder.
3) The third (posterior) third reflects the condition of the lower burner,
which encompasses the Kidney, Bladder, Small Intestine, Large Intestine,
and ming Inen (gate of vitality).
In contrast to the pulse positions, which have been the subject of much discussion in the history of Chinese medicine, the topography of the tongue is
less controversial. The most common topographic representations, which
deviate only a little from each other, are shown in Figs. 2-4.'

Fig. 5

The blueprint for the tongue pictures in this book is shown in Fig. 5.

The Fourzdations of Tongue Diagnosis

1.2

1.2.1

General Information Regarding


Inspection of the Tongue
Three-StepProcedure
In the daily practice of Chinese medicine it is often difficult to synthesize a
complete picture of the patient's condition, even though all the information
has been retrieved from the history, face, pulse, and tongue. Practitioners
often ask which is the more important of the two, tongue or pulse diagnosis,
and what is the best way to evaluate the signs, symptoms, and findings. This
subject will be discussed more thoroughly in Section 1.2.7.
Tongue diagnosis represents only one aspect of the diagnostic process in
Chinese medicine. It is, therefore, extremely important to view each dia,-nostic finding in the context of the overall picture. When undertaking tongue
diagnosis, a clear understanding of the entire person and pathology is
required to evaluate either general or specific tongue signs. The process thus
involves three steps:
First, one should form a general impression. In tongue diagnosis, this
means observing the tongue's vitality.
2) Second, collect and identify the individual signs concerning the tongue's
color, shape, and coating. In order to assess these signs, a topographic
map of the tongue should be used.
3) Third, reevaluate the general impression in light of the individual signs.
Through this synthesis, a diagnosis can then be formulated.
1)

I2.2

Conditions for an Accurate Tongue Diagnosis


An accurate interpretation of the tongue color and shape is only possible
when the patient presents the tongue in a relaxed manner. If a patient is very
nervous or frightened, the tongue may be only partially extended, and then
only in a tense fashion. Wait for the patient to relax and try again. However,
even when the tongue is presented in a tensed manner, it can be used as a
diagnostic sign of the quality of the patient's energy flow. I find that this is
especially true with the appearance of curled-up tongue edges, which are
only formed when the tongue has a certain amount of muscle tension. This
often represents a condition of Liver qi constraint that is rarely visible in a
relaxed tongue.
It is recommended that the color of the tongue body be observed and
noted immediately, as it changes with activity of the tongue. It can, for example, change to a deeper red when it is extended for a long time. For this reason, the tongue should not he extended for longer than about 20 seconds,
and with as little effort as possible.
When inspecting the tongue, lighting is very important. The most objective results are achieved with daylight. Fluorescent light falsifies the color,
and the tongue body may appear to be lighter than it really is. If artificial light
must be used, halogen light is preferred, as it is closest to daylight. To avoid
confusion, always try to maintain the same position and location.
If one part of the tongue body (usually the center) is noticeably red or
discolored, ascertain when the patient last ate. Some foods discolor the

The Foundations of Tongue Diagnosis


tongue body, especially coffee, black tea, and spices like curry or cayenne
pepper. Alcohol, as well as some medicines, lead to a reddening of the
tongue body. Sucking sweets or licorice, as well as the coating of some
tablets, discolors the center of the tongue. In general, it is best to check
whether the patient is taking medication, as some medicinal substances discolor the tongue body.'
Special attention should be given to the thickness of the tongue coating.
Inspection starts at the tip and ends at the root of the tongue. In the case of a
noticeably yellow, brown, or black coating, check when the patient last ate.
Cigarettes or cigars, for example, have a drying effect upon the coating and
give the tongue a yellow discoloration. Hot spices, like curry or mustard, have
the same effect. Tea or coffee may cause the coating to develop a brownish
color, while fatty foods often give it an oily consistency. The frequent drinking of fluids, or the intake of large amounts of fluids, may lead to an increase
in tongue moisture; conversely, a small intake of fluids reduces moisture.
1.2.3

Tongue Body Color


The color of the tongue body provides information about the state and quality of the blood, yin, and fluids, as well as the yang and qi. Spleen qi deficiency may lead to a pale tongue body, since the qi, in this case, is too weak
to transport the blood to the tongue. In the case of serious qi and yang deficiency, blood is not being moved adequately, which can lead to blood stasis;
this manifests as a pale-blue tongue. In the case of blood deficiency, the
tongue body will appear noticeably pale, while yin deficiency makes it more
red.
Disorders of heat and cold also show themselves in the color of the
tongue body. When externally-contracted heat, for example, enters the
blood, the tongue body may turn dark or crimson red. If cold blocks qi and
yang in the interior, the tongue body becomes noticeably pale. As a generalization, the :ongue body color tends to reflect the state of qi, yang, blood,
and yin. In acute diseases, its color can also provide information about the
quality and depth of penetration of a pathogenic factor. Thus, a continuing
high fever lasting over a few days may change the color of the tongue body to
a dark red. In the case of a chronic disease, the tongue body can reflect longterm pathological disharmony as well as constitutional weakness.
1.2.4

Relationship Between Tongue Body Color and Shape


The color and shape of the tongue body are very closely linked to one
another and should not be considered in isolation. Together, they reflect the
strength of normal qi (ihengqi).
In general, tongue body color shows, with the exception of acute illnesses, the underlying pattern of disharmony in a person's constitution. A
pale tongue body may indicate Kidney yang deficiency, a dark-red body
Kidney yin deficiency. If there is a strong contrast in color from a healthy
pale-red tongue body, this commonly reveals the onset of a more serious illness, usually involving the internal organs. In addition, where there are contradictory symptoms-for example, a patient with all the signs of Kidney yin
deficiency but experiencing an intense internal feeling of cold ('false cold,
true heat'), or of an underlying Kidney yang deficiency but experiencing hot
flushes-the tongue body color is a reliable indicator.

The Foundations of Tongue Diagnosis


As a rule, the normal tongue shape changes only when pathology persists over a long period of time. A pale, swollen tongue body shows that the qi
in the body has been deficient for quite a while. It indicates that the qi is not
only failing to bring blood to the tongue (hence the pale color) but is also
failing to transform and transport the fluids (swollen tongue body). A red
tongue with a normal tongue body can indicate the beginning of Kidney yin
deficiency, or of the penetration of heat into the blood level. A red tongue
with a small, contracted body may reveal Kidney yin deficiency with a severe
loss of fluids. This combination of color and shape is an indication that the
yin has been exhausted over a long period of time: yin deficiency has given
rise to heat, which in turn has injured the fluids, eventually leading to the
contracted appearance of the tongue body.
Thus the combination of tongue body color and shape provides precise
information about the condition of the qi, blood, yin, yang, and fluids. In the
case of chronic illness, it is especially important to use the results of this
diagnostic procedure to assess the severity of the illness.
In relation to the eight principles, the tongue body color and shape
reflect the state of yin and yang as well as the presence of heat and cold. Yin
deficiency produces heat, which is represented by a red tongue body, and, in
severe cases, by a contracted body as well. By contrast, the internal cold that
develops with yang deficiency is reflected in a very pale, swollen tongue
body. Again, the tongue body color and shape are important indicators when
assessing chronic illness.
Cracks, depressions, and localized swellings on the tongue body reflect
energetic disharmonies in specific organs. For example, if the anterior third
of the tongue is noticeably swollen, this implies retention of phlegm in the
Lungs. If such a patient complains of a cough, it must be given immediate
attention. However, if there are no Lung symptoms, it is of no special significance, and should just be noted.
Sometimes the tongue does not reflect a pattern of disharmony. This, in
my experience, is especially true of patterns involving the Liver. For example,
it is inadvisable to differentiate a pathology caused by ascending Liver yang
or Liver fire based entirely on the appearance of a specific tongue sign,
namely, redness or red points on the side of the tongue. An accurate diagnosis is possible only by considering the pulse qualities in conjunction with the
symptoms experienced by the patient, since both of the aforementioned
tongue signs can denote ascending Liver yang as well as Liver fire.
This is also the case with skin disorders. Atopic eczema, for example,
does not always show up on the tongue. Patients who have suffered with
long-term skin disorders manifested in itchy skin, sensations of heat, and
redness of the skin will often present with a tongue that is pale, or show no
signs at all of heat in the blood. Thus, for the diagnosis and treatment of skin
disorders where the most obvious signs are skin lesions, indicators on the
tongue are of little, if any, importance and occasionally must be ignored.
These examples will serve to underscore that tongue diagnosis must be
integrated with other Chinese diagnostic techniques. It is only one aspect,
albeit a very informative and important one, of the entire diagnostic protocol
in Chinese medicine.

The Foundutiorzs of Torzgiae Diugrzosis

Relationship Between Tongue Body Shape


and Tongue Coating
While the shape and color of the tongue body are inseparably linked in
tongue diagnosis, the body and coating of the tongue are not quite so tightly
connected, and occasionally can be judged independently of each other. The
tongue coating reveals the location of an illness. According to the eight principles, it shows whether the illness is situated in the exterior (biuo) or interior
(li). The thickness of the tongue coating indicates its excessive or deficient
nature. The color and the texture of the coating reflect whether it is hot or
cold. For example, a slippery, yellow coating suggests the presence of dampheat, while a dry, yellow coating indicates the predominance of heat.
In the case of an acute illness, that is, one caused by externally-contracted cold, which is indicated by a thin, white coating, it is mainly the
tongue coating that shows the strength of the pathogenic factor and how
deeply it has penetrated into the interior. Just by observing the tongue coating, the quality of the pathogenic factor can be ascertained without necessarily having to consider the color of the tongue body. Besides changing the
tongue coating, a strong, penetrating pathogenic factor may also alter the
moisture as well as the color of the tongue. Strong heat, for example, can
cause a dry, red tongue body.
In the case of mild chronic illness, the tongue coating often reflects the
underlying pattern of disharmony. Often a swollen, pale tongue body is
accompanied by a moist, white tongue coating, while a red tongue body is
accompanied by a dry, yellow coating. However, this is not always true
because, in severe cases, a red tongue body may present with a white, powdery tongue coating, which indicates the presence of heat instead of cold.
When diagnosing acute disorders that are characterized by fever, flu
symptoms, or acute digestive problems, the tongue coating takes precedence
over the shape of the tongue body. It is especially important to note the
thickness, location, and texture of the tongue coating.

Observation of the SublingualVeins


It is always important to examine the sublingual veins and to note their color
and thickness. The patient should touch the palate with the tip of the tongue.
If the veins are clearly blue, tilled, or swollen, this may indicate the presence
of blood stasis in the body.

Comparison of Pulse and Tongue Diagnosis


Qi moves the blood. The quality and dynamics of the movement of qi reveals
itself in the pulse. The pulse mainly describes the present energetic condition of an individual. By feeling the pulse the practitioner enters into a close
relationship with the patient, perceiving the quality of the patient's pulsating
energy. An example from my own practice is illustrative. A 60-year-old
woman, who always put the needs of others before her own, complained
about intense inner tension. Her tongue was normal. The pulse was very wiry
(xian) and thin (xi).From the pulse and symptoms it was clear she had developed Liver qi constraint. In the course of treatment the woman was eventu-

The Foundations of Tongue Diagnosis


ally able to begin fulfilling her own wishes rather than those of others. Slowly,
the pulse became less wiry, and this was accompanied by a greater sense of
joy in her life.
In this case it was the pulse, much more than the tongue, that reflected
the true energetic state of the patient. The pulse, however, did not provide
any indication of the length or depth of the Liver qi stagnation. For its part,
the normalcy of her tongue did not reflect any disharmony, or might have
suggested that it was not that deep or serious. This example illustrates that
pulse diagnosis can be quite accurate when the tongue signs are inconspicuous. In this case, the pulse was given priority over the tongue.
The tongue reflects the condition of the blood, body fluids, and essence
more clearly than does the pulse. There are pulse qualiries, of course, like the
choppy (se) pulse, which indicate blood deficiency. However, the depth and
severity of such deficiency is difficult to judge from the pulse alone, and can
only be made by an experienced practitioner. Yet a thin, dry, or contracted
tongue makes the condition easy to detect, especially if the color, shape, and
texture of the tongue obviously deviate from normal. In such cases, the
tongue is given priority over the pulse.
Occasionally, the pulse and tongue signs deviate from each other. If the
tongue body, for example, is pale and swollen, the practitioner may expect a
slow (chi) or submerged (cherz) pulse. But if the pulse were fast (shuo) and
floating ( ~ L L ) this
,
could be the result of nerves (arriving late for the appointment, or fear of the consultation itself), shock, coffee, or medication. The
pulse can change very quickly in response to the most recent event in a
patient's life, while the tongue will remain unchanged.
To summarize, the qualities of the pulse accurately reflect the present
energetic condition of an individual. The qualities of the tongue-especially
its body, color, and shape-allow one to predict long-term changes in the
energetic state. The tongue coating is a very important indicator in cases of
acute illness (see Chapter 10).

I .3

The Normal Tongue


The normal tongue reflects energetic harmony within the body. The right
interplay of yin and yang, qi, blood, and fluids is reflected in the color, shape,
and coating of the tongue body. As previously mentioned, the first step in the
examination of the tongue is to gain an overall impression, especially of the
vitality of the tongue. A vital tongue has a fresh-looking body that is well supplied with blood, giving it a fresh, pale-red color. When the tongue is full of
vitality, it moves easily and can protrude from the mouth without difficulty.
The normal tongue should also be a little moist, indicating the presence of
adequate fluids.
During the second step of the examination, the following individual
aspects of the tongue should be evaluated:
a) The normal tongue color is pale red.
The red coloration indicates that the qi and yang are strong enough to transport blood to the tongue. It also reflects the quality and quantity of the blood

The Foundations of Tongue Diagnosis


circulation in the body. The tongue has a pale tinge due to the supply of fluids that ascend from the Stomach to the tongue (see Chapter 5 ) .
The clear part of the fluids jjin) also serves the function of thinning the
blood. If there is a deficiency of fluids in the body, the blood will be correspondingly less dilute. This will cause the tongue to appear redder. In a
healthy person, the pale-red tongue body color arises from the appropriate
mixture of blood and fluids. If a tongue is lighter than pale red, it is called
pale. If it is darker than pale red, it is called reddish or red.
b) The normal tongue body shape is neither too thick nor too thin.

The tongue body should move easily and look neither too soft nor too stiff.
The tongue's surface should be smooth and soft and show no cracks. The size
of the tongue body usually corresponds to the constitution of the individual,
and therefore does not necessarily imply pathology It could thus be said that
the tongue fits the body shape of the individual. A big, strong person normally has a big tongue body, while a thin, small person has a thin, smallish
tongue.
The volume of the tongue body, however, is important. It should be neither too thin nor too thick. A slight tapering toward the tip of the tongue is
also normal. The tongue body shape reflects the condition of a person in
relation to their long-term energetic development. It can, for example, take
years before a contracted or extremely swollen tongue body develops. The
formation of cracks in the tongue body may also represent a lengthy pathological process.
c) The normal tongue coating is white and thin.
A thin, white tongue coating is regarded as normal, although it can also indicate acute, externally-contracted wind-cold. If the tongue shows no coating
but is moist and of a normal color, this is also normal and does not suggest
pathology. A slightly thick, pale-yellow tongue coating at the root of the
tongue arises from the physiological activity of Stomach qi during the
process of digestion. Fermentation of the ingested liquids and solids results
in 'steam,' which materializes as a form of turbid moisture on the coating of
the tongue. This coating is thickest at the root of the tongue and steadily
thins out toward the tip of the tongue. Due to the turbidity rising up, it is normal for the tongue coating, at the root, to be of a pale-yellow color. If there is
coating in the middle and anterior parts of the tongue, but none on the posterior, this is indicative of a condition characterized by deficiency (see
Section 3.6).This so-called 'rootless' coating originates most commonly from
deficiency of Stomach qi, Stomach yin, and Kidney yin.

d) Veins underneath the tongue are not distended.


In the case of a normal tongue, the sublingual veins are either barely visible
or not visible at all. Their color should be light and not of a dark-blue or purple color. When examining the veins underneath the tongue, particular
attention should be paid to the following:
The patient should curl the tongue up lightly and gently, and rest the
tip of the tongue on the palate.

The Foundations of Tongue Diagnosis


If the patient does this more than once within a short space of time, the
veins can become an intense bluish color. Similarly, if the patient has
been talking a lot before the examination, the veins may also appear
more bluish and distended. In such cases, the practitioner must be
careful in formulating a diagnosis of blood stasis based on the changed
appearance of these veins (see Section 8.3).

Examples of Normal Tongues


Tongue 1
A 50-year-old woman who has never been seriously ill.
Occasionally, she complains about exhaustion. The
tongue body shape is normal, neither too thick nor too
thin. The tongue has a fresh appearance and is moist.
The tongue body color is pale red, which indicates a
healthy supply of qi and blood throughout the body.
The tongue coating is thin and slightly yellow at the
posterior third. At the right edge of the tongue a small,
bluish point is visible, which sometimes signifies blood
stasis. However, as the patient had no other signs or
symptoms of any kind, this particular tongue sign is not
indicative of a pathological process.

Tongue 2
A 49-year-old woman who feels healthy. The tip of the
tongue shows a few red points that reflect heat in the
Heart. This occasionally manifests as difficulty in falling
asleep. The tongue body, shape, and color, however, are
normal. The tongue is moist and has vitality. On the
posterior third of the tongue are red points that are not
considered pathological. This woman has no symptoms.

Endnotes
1. Compare Maciocia G. Tongue Diagnosis in Chinese
Medicine, rev. ed. Seattle: Eastland Press, 1995:24-26.
2. Ibid., 17-18. Maciocia describes the effects of

medication in relation to a discoloration of the tongue


coating.

C H A P T E R

Pale Tongue Signs


2.1

Pale and Swollen Tongues


A pale tongue with a normal tongue shape and coating indicates only a slight

deficiency of Lung and Spleen qi. In this case, the qi is not strong enough to
transport the blood to the tongue, resulting in a paler colol-ation of the
tongue body. The paleness of the tongue body is proportional to the degree
of the deficiency: The paler the tongue body, the more serious the qi and
yang deficiency.
A pale and swollen tongue is very common. The tongue is pale because
the yang qi is too weak to transport sufficient blood to the tongue. The
tongue is also swollen as a result of qi and yang deficiency, which results in
inadequate Huid transformation. Since the fluids are inadequately transformed, they accumulate and transform into dampness. The degree of
swelling of the tongue body is inversely related to the strength of the yang
and source qi, that is, a weak yang and source qi will result in a swollen
tongue body. Physical overwork, excessive exercise, and overconsumption of
raw foods and dairy products can cause deficiency of Spleen qi and yang. If
the pale tongue has a normal body shape, the deficiency is not as serious and
can be rectified through a proper and regular diet as well as periods of rest.

Pale and swollen tongues are orten accompanied by teeth marks. The
deeper and more distinctive the marks, the more serious the weakness of
Stomach and Spleen qi, and Spleen and Kidney yang.

Pale Tongue Signs


Tongue description

Chinese diagnosis

Slightly pale, normal shape


Red points at the tip
Slightly white-yellowish, greasy coating at the
posterior third

Slight Spleen qi and blood deficiency


Normal*
Slight food stagnation

Figure 2.1.1

Symptoms

Female
31 years old

Fatigue
Constipation
Bouts of no appetite
Epigastric fullness

Western diagnosis
None

Background to disease
Overwork
Irregular eating habits, excessive consumption of
sweets
See Section 6.2

Tongue description

Chinese diagnosis

Pale, swollen, slightly wet

Spleen qi deficiency (accumulation of dampness


and blood deficiency)

Figure 2.1.2

Symptoms

Male
50 years old

Loud gurgling in the abdomen


Soft stools
Excessive sputum
No appetite
Panic attacks
Difficulty in falling asleep, severe fatigue

Western diagnosis
None

Background to disease
Excessive consumption of raw foods
Excessive wonying
Lack of sleep due to work schedule (night shift)

Pale Tongue Signs


Tongue description

Chinese diagnosis

Slightly pale, swollen


White, thin, slippery coating
Yellow coating at the root

Spleen qi deficiency
Accumulation of dampness
Damp-heat lodges in the lower burner

Symptoms

Figure 2.1.3

Fatigue, especially after meals


Lack of concentration
Difficultyin falling asleep
Loose, smelly stools

Western diagnosis
None

Background to disease
Excessive consumption of dairy products
Long fasting periods in the past

Tongue description

Chinese diagnosis

Pale, swollen

Spleen qi deficiency (accumulation of dampness)


Damp-heat in the lower burner

Yellow, slippery coating at the posterior third

Symptoms
Frequent urination
Turbid urine
Lower back pain
Constipation
Stomach pains

Western diagnosis
Chronic prostatitis

Background to disease
Irregular eating habits

7
-

Figure 2.1 4
Male
35 years old

Pale Tongue Signs

Tongue description

Chinese diagnosis

Pale, swollen

Spleen qi deficiencywith deficiency of blood and


accumulation of dampness
Retained, externally-contracted heat
Normal

Red spots at the sides and tip


White, thin coating

Figure 2.1.5
Female

Symptoms

Fatigue
Weight gain
Bloating
No periods for 3 months
Cold extremities
Frequent sore throats

Western diagnosis

I
I

None

Background to disease
Six pregnancies
Overwork at the ofice and at home
Lack of sleep

Tongue description

Chinese diagnosis

Pale, swollen, teeth marks

Spleen yang deficiency (accumulation of


dampness)

Symptoms
33 years old

Watery stools in the morning without smell


Frequent nausea
No
~-~ drive
Intense feeling of cold
Migraines, diarrhea, and vomiting preceding
menstruation
~

Western diagnosis
None

Background to disease
Treated for along time with tetracyclines for acne
vulgaris
Frequent illnesses in childhood

Pale Tongue Signs


Tongue description

Chinese diagnosis

Pale, swollen, teeth marks


Red and slightly contracted tip

Spleen yang deficiency (accumulation of dampness)


Heart blood deficiency with heat from deficiency in
the Heart
Food stagnation, accumulation of turbid dampness

Light yellow, thin, slippery coating

Figure 2.1.7
Female

Depression, no drive
No appetite
Abdominal pain at time of ovulation
Intense feeling of cold during menstruation

37 years old

Western diagnosis
Ovarian cysts

Background to disease
Excessive worry due to unemployment
Overconsumption of sweet foods
Emotional problems

Tongue description

Chinese diagnosis

Pale, swollen
Light yellow, greasy coating

Spleen qi deficiency (accumulation of dampness)


Food stagnation, accumulation of dampness in the
middle burner, which transforms into heat

Symptoms

Figure 2.1.8

Loose stools without smell 3-4 times dailv


Abdominal distention
Flatulence
Mood swings

Female
25 years old

Western diagnosis
None

Background to disease
Irregular eating habits
Excessive consumption of dairy foods
Unhappiness

Pale Tongue Signs

Tongue description

Chinese diagnosis

Very pale, slightly bluish

Spleen qi deficiency ( blood deficiency and slight


blood stasis)
Accumulation of dampness

Swollen

Figure 2.1.9

Symptoms

Female
37 years old

Tendency to catch colds, fatigue


Sudden, severe cramping pain in the abdomen

Western diagnosis
None

Background to disease
Overwork
Lack of sleep

Tongue description

Chinese diagnosis

Pale, very swollen, wide

Spleen qi and yang deficiency (accumulation of


dampness)
Stomach qi deficiency
Normal

Small, vertical cracks in the center


White, thin coating

Figure 2.1.1 0
Female
27 years old
See
CASE HISTORY
below

Symptoms
Exhaustion
Feeling of pressure in the center of the stomach
with stress
Weight gain
Pain
Tingling and numbness in the right arm and
hand

Western diagnosis
None

Background to disease
Overwork
Irregular eating habits
Excessive consumption of raw foods and cold

Pale Tongue Signs


Tongue description

Chinese diagnosis

Pale, very swollen, teeth marks

Kidney yang, Spleen yang, and Heart yang deficiency

Symptoms

Figure 2.1.1 1

Extreme physical weakness


Cold feeling, cold extremities
Sensation of cold in the stomach
Stomach pain

Female
67 years old

Western diagnosis
Chronic gastritis

Background to disease
Chronic physical overwork

Case History
Mrs. W. had spent two years in South Africa where she followed a diet that consisted
mainly of fruits and juices. Because she felt really well on this diet regime, she maintained the diet when she returned to Germany. She started a new job as manager of a
big company, but after six months on the job she experienced exhaustion, fatigue,
and steady weight gain. She also developed an occasional pain and persistent numbness in her right arm. The pale tongue was extremely swollen. Her pulses were soggy
(rul and frail frou).

Analysis. The Spleen yang deficiency, as manifested in the pale and swollen tongue
body, was caused by an inappropriate diet for the cold, damp climate of northern
Germany, as well as the requirements of a new job that took all of her strength.
Because of the accumulation of dampness associated with the weak yang, she constantly gained weight. Her exhaustion, and the soggy, frail pulse, confirmed the diagnosis of Spleen yang deficiency. The numbness in her arm was the result of dampness
obstructing the channels and collaterals. All Western-style diagnostic procedures
failed to diagnose any disorder with this patient.

Discussion. Pale, swollen tongues are unmistakable signs of Spleen qi and yang or
Kidney yang deficiency. Foods of a cool or cold nature specifically damage Spleen qi
and yang, especially when they are consumed in cold climates. From this deficiency,
a condition of excess, namely, accumulation of dampness, can arise. This accumulation blocks the flow of qi and blood, and can cause a sensation of heaviness in the
body, that is, numbness. Patients with such tongues should be given dietary advice.

Figure 2.1.10

Pale Tongue Signs

Pale Tongues with a


Depression at Their Root
With the help of the eight principles and tongue diagnosis, acute and chronic
patterns of disease can be analyzed quite accurately. Tongue diagnosis is
used to gain insight into the "energetic present" condition of the individual.
There are also tongue signs that inform us about the person's "energetic
past." These signs may include deep cracks, dents, hollows, or crevices in the
tongue body, or a contracted tongue body. These and other changes to the
tongue body, shape, and color, plus other specific signs, are most commonly
caused by deep energetic deficiencies, for example, a chronic deficiency of
Spleen and Stomach qi or Kidney yin. Generally speaking, these deficiencies
will, over time, lead to a depletion or insufficient nourishment of the essence.
The essence is a very rarified and dense form of energy that is fluid in
nature. It has the potential for building and nourishing the body. It supplies
the energetic material for physical and mental development in childhood,
and for the development and function of the reproductive system. The quality and strength of the essence is also of great importance in the production
of marrow and in controlling the functions of the brain, bone marrow, and
spinal cord. Finally, an increased output of essence is required to offset the
shock and trauma associated with accidents.
If one follows a regular lifestyle, the essence will decrease slowly and
gradually decline in old age, accompanied by such things as the loss of acute
hearing or loose or falling teeth. Young or middle-aged individuals, however,
may also show signs of weakening essence. The most common causes are:

Chronic inadequate nutrition


Chronic overwork
Chronic lack of sleep
Too many pregnancies and births
Births that follow too closely together
Excessive loss of sperm
Extremely profuse and frequent menstrual bleeding
Serious chronic illnesses
Frequent colds and flu'
Serious shocks
Many operations
Constitutional weakness, that is, inherited illness or physical and mental disabilities
Diets that are inappropriate to the season
Irregular eating habits, often in conjunction with overwork
Insufficient rest after operations, infections, or other illnesses.

The essence is responsible for the conservation and quality of 'substance,'


and a deficiency of essence implies loss of this substance, as reflected in brittle bones or loss of teeth.
Consider the following example: A young woman had been suffering for
a long time from anorexia nervosa. Her symptoms included the cessation of
periods as well as osteoporosis. The tendency to starve herself had caused
the exhaustion of the postnatal essence, which in turn failed to replenish the
Kidney essence. The young woman's loss of substance manifested in brittle
bones.

Pale Tongue Signs


The practitioner is first alerted to a deficiency of essence by the patient's
history and corresponding symptoms, as well as through specific pulse qualities. In order to formulate an accurate diagnosis and prognosis, it is of great
importance to assess the quality and strength of the essence. Alongside all
the other collected data, the diagnosis of the tongue can contribute a great
deal of information about the quality of the essence.?
Owing to its fluid nature and substantial qualities, the essence is yin in
nature relative to the dynamic power of qi and yang; it thus has a strong
affinity to Kidney yin. Because of this, Kidney yin deficiency can lead to deficient essence. All processes in the body that lead to a loss of fluids-severe
and long-lasting diarrhea, extreme sweating, or long-lasting febrile disease-will eventually injure the yin. The loss of fluids and yin will produce dry, red
tongues (Fig. 3.6.5), which can be an indication of severe deficiency of
Kidney yin and of declining essence. In clinical practice these tongues are
most commonly found in severely ill, elderly patients, or in those who suffer
from a progressive cancerous disease. However, such tongues do occur in
young people who have been affected by a wasting disease like AIDS.
A red tongue can also reflect the development of intense heat, which can
injure the yin. The more intense the redness of the tongue body, the greater
the heat which has attacked the Kidney yin and fluids.

The interplay between Kidney yin and Kidney yang depends on the
strength and quality of the essence and source qi. The essence, through the
Kidney yang and the gate of vitality (rning menl, supplies the material necessary for the transforming and warming actions needed to produce Kidney qi.
The tongue coating is highly dependent on these actions. If the fluids are not
transformed, either because of Kidney yin or Kidney yang deficiency, then
the Kidney qi is unable to rise to moisten the tongue. In extreme cases, this
becomes visible in a very pale, swollen tongue body that is dry. Here, Kidney
yang is too weak to transform (swollen body) and transport (dry tongue) the
fluids. This is rarely seen in the clinic; more commonly, a dry tongue appears
as a result of deficient fluids, blood, and Stomach or Kidney yin.
However, as mentioned in Chapter 1, the lack of tongue coating is
primarily associated with the function of the Stomach and Spleen qi. The
fermentation of solids and liquids by the Stomach qi and the healthy, damp
climate of the Stomach contribute to a turbid 'steam' that ascends and
becomes the foundation of the tongue coating. If the energies of the middle
burner function without any problems, there will be an evenly distributed
thin coating that is closely attached to the tongue's surface. A deficiency of
Stomach qi, Stomach yin, and especially Kidney yin can lead to a coating
without a root. This coating is characterized by its uneven distribution,
which gives it an old, peeled appearance and looks as if it could be easily
scraped off (Fig. 3.6.5).
The lack of a tongue coating coupled with a pale tongue body indicates a
lack of Stomach qi. This combination plus the appearance of superficial
cracks in the center of the tongue may signal the onset of a decline in fluids
and Stomach yin.
The root of the tongue corresponds to the lower burner, especially the
Kidneys. In general, the tongue coating at the root reflects the condition of
the Large Intestine, Small Intestine, and Bladder. The complete interpretation of the coating at the root requires knowledge of the patient's symptoms.

Figure 3.6.5

Pale Tongue Signs


An absence of coating at the tongue root, or a red root, reflects deficiency of
Kidney yin and exhaustion of the body fluids (Fig. 3.6.4). A very red and dry
root signifies that Kidney fire has arisen from deficiency of the Kidney yin.

Figure 3.6.4

Figure 3.7.3

The texture and form of the root of the tongue also mirrors the condition
of the Kidneys. A contracted root (Fig. 3.7.3)or a depression at the root represents a deficiency of essence. These tongue shapes are the result of a loss of
substance or material; as a result, the tongue lacks appropriate volume or
shape. If the tongue root is of a normal color, the deficiency has not yet
advanced to the stage of internal heat.
An incipient lack of essence may also be associated with pale tongues.
The incipient deficiency of essence manifests as a pale tongue with a depression at its root; it is as if there were a lack of substance to fill the root of the
tongue. This condition is characterized by the combination of qi deficiency
symptoms (fatigue, lack of appetite, sweating upon the slightest exertion,
loose stools) as well as symptoms indicating deficiency of essence. Thus,
fatigue may evolve into exhaustion that is not alleviated by regular sleep,
there may be a lack of concentration, failure of memory, or head hair may
turn prematurely gray. In such cases, it is not enough simply to tonify the qi.
The essence as well as Kidney yin and yang must also be nourished.

The hectic lifestyle associated with modem industrialized countries can


contribute to the premature consumption of essence. The earlier this can be
detected, especially in young people, the sooner prophylactic and supporting measures, by both patient and practitioner, can be undertaken.
As the following figures illustrate, it is possible to evaluate the condition
of the essence and the extent to which substance has been lost by examining
the tongue body shape, and not just the tongue body color and coating. In
these figures, pale tongue bodies that form as a result of essence deficiency
are compared with those that result from Spleen qi or yang deficiency, or
Kidney yang deficiency.

Pale Tongue Signs


Tongue description

Chinese diagnosis

Slightly pale, slightly swollen


Slight depression at the root

Spleen and Lung qi deficiency


Slight deficiency of essence

Symptoms

Figure 2.2.1
Female

Exhaustion
Insomnia
Heavy feeling in the legs
Tendency to catch colds
Coughing

35 years old

Western diagnosis
Mononucleosis
Chronic fatigue syndrome following iduenza

Background to disease
Chronic overwork

Tongue description

Chinese diagnosis

Slightly pale, swollen


Slight protrusion at the tip of the tongue
Slight depression at the root

Spleen deficiency (accumulation of dampness]


Slight disharmony of Heart
Slight deficiency of essence

Symptoms
Exhaustion
Burning sensation after urination
Severe cramping pains before and during menstruation

Western diagnosis
Chronic cystitis
Dysmenorrhea

Background to disease
Chronic overwork
Excessive use of willpower
%eke operations in childhood and puberty

Figure 2.2.2
Female
32 years old

Pale Tongue Signs


Tongue description

Chinese diagnosis

Slightly pale, swollen


Slight teeth marks, moist
Depression at the root

Spleen qi deficiency (accumulation of dampness)


Early stage of Spleen yang deficiency
Slight deficiency of essence

Symptoms

Figure 2.2.3
Female

Exhaustion
Depression
Inability to concentrate
Feeling cold
Hair loss

38 years old
See
CASE HISTORY
below

Western diagnosis
Poisoning from amalgam in tooth fillings

Background to disease
Six pregnancies, four children
Overwork

Tongue description

Chinese diagnosis

Pale, swollen. moist

Spleen qi and yang deficiency (accumulation of


dampness]
Essence deficiency

Deep depression at the root

Figure 2.2.4

Symptoms

Female
43 years old

Exhaustion
Restlessness
Inability to fall asleep
Profuse menstrual bleeding
Prolonged red discharge after menstruation
Feeling cold

See discussion
of this case
on p. 213

Western diagnosis
None

Background to disease
Chronic overwork
Irregular eating habits
Excessive consumption of raw foods
Excessive thinking and anxiety
Lack of sleep

Pale Tongue Signs


Tongue description

Chinese diagnosis

Very pale, swollen, slight teeth marks


White coating in the center
Depression at the root

Spleen yang deficiency ( accumulation of dampness


Accumulation of cold-dampness in the Stomach
Essence deficiency

Symptoms

Figure 2.2.5

Exhaustion, fatigue
Inability to fall asleep
Epigastric pain with emotional stress
No appetite
Intense feeling of cold

Female

39 years old

Western diagnosis
No findings except underweight

Background to disease
Chronic ovenvork (works at night)
Irregular eating habits
Excessive consumption of raw foods
Infection of viral meningitis 2 years ago

Tongue description

Chinese diagnosis

Pale, swollen, big


Coating without root
Depression a1 the root

Spleen qi deficiencywith accumulation of dampness


Stomach qi and slight Stomach yin deficiency
- --ence
Slight deficiency -'

Symptoms

Figure 2.2.6

Exhaustion
Restlessness
Epigastric fullness after eating
Belching, heartburn
Loose stools

Male
28 years old

Western diagnosis
None

Background to disease
Excessive sexual activity
Irregular eating habits
Overwork

Pale Tongue Signs

Case History

Figure 2.2.3

Mrs. H, a 38-year-old mother of four, found the demands of running the home
extremely difficult owing to her continual exhaustion. She felt limited by her lack of
concentration and drive, and her depressive moods. Her hair was very thin, and she
had periods of severe hair loss and often felt cold. Her tongue body was pale and
swollen and presented a depression at the root of the tongue. Her pulse was deep
(chen) and weak (ruo).

Analysis. The many pregnancies and the demands of her family caused a severe
exhaustion of Spleen qi and yang, source qi, and essence. Her thin head hair and
hair loss showed a deficiency of blood as well as essence. Forgetfulnessand a lack of
concentration arose from the weakened essence failing to produce sufficient marrow
to fill the brain and nourish it. The depression at the root of the tongue confirmed this
finding. The source qi of the patient was likewise weakened. The feeling of cold and
the lack of drive were signs of the insufficient vitality of the yang; this was confirmed
by the pale, swollen tongue body and deep, weak pulse. Over a period of a year the
patient focused on getting more rest, and with the help of Chinese herbs, her condition improved slowly but steadily. Note that the depression at the root of her tongue
did not fill in.

Discussion. Exhaustion, which is caused by a deficiency of the essence or source


qi, is different from mere fatigue in that short periods of rest or sleep do not improve
the condition. By contrast, fatigue associated with Spleen and Lung qi deficiency
benefits greatly from short naps or a good night sleep. It is important, therefore, that
the patient be treated with Chinese herbs, take long rests, and attempt to change a
hectic lifestyle.

Pale Tongue Signs

Pale and Thin Tongues


A lack of blood and body fluids causes a decline in the volume of the tongue

body, which is manifested in a thinning, shrinking, or contracting of the


tongue body. Depending on the individual's constitution or life circumstance, Spleen qi deficiency may lead either to accumulation of dampness or
a lack of blood. Both are secondary aspects of a disharmony of Spleen qi. Any
long-term deficiency will lead to impairment in the transformation of food
into blood. Because of this, every pale tongue reflects an element of blood
deficiency. However, when blood deficiency is an important contributory
factor to an illness, it is expressed in a pale and thin tongue body. At the onset
of such a pathology, it will be pale and dry. This is especially true in women
who suffer from profuse menstrual bleeding, breast feed for long periods of
time, or follow improper dietary habits.
A thin, pale tongue is an important feature in individuals who suffer from
a lack of blood. If this condition is not treated, Kidney yin deficiency may
develop, as blood nourishes the yin. The development of this particular
pathology is visible when the pale tongue body changes its shape or takes on
an intense red or orange tinge. If the pale tongue is dry, the pathology is not
so severe, that is, the blood has lost its moistening function but the deficiency is not yet significant. Typical symptoms of blood deficiency are dry or
itchy skin, hair loss, a pale tinge to the skin, numbness in the extremities, and
dizziness.

Tongue description

Chinese diagnosis

Pale red, slightly thin


Rolled up edges
Slight depression at the root

Slight Spleen qi deficiency (blood deficiency)


Liver qi constraint
Slight essence deficiency

Symptoms
Deep exhaustion
Depression
Backache
Western diagnosis
None
Background to disease
Overwork
Hectic lifestyle
Emotional problems
Excessive sexual activity

Figure 2.3.1
Male
41 years old

Pale Tongue Signs

Tongue description

Chinese diagnosis

Pale, thin
Curled-up edges
Reddish center
Depression at the root

Spleen qi deficiency (blood deficiency)


Liver qi constraint
Heat in the Stomach
Essence deficiency

Figure 2.3.2

Symptoms

Female
38 years old

Deep exhaustion
Burning around the anus
Anal pain
Constipation
Lack of appetite
lnsomnia

Western diagnosis
Inilamed hemorrhoids

Background to disease
Suong demands at work and home
Unhappy marriage
Constant frustration
Four pregnancies
Caffeineabuse

Tongue description

Figure 2.3.3
Female
35 years old

----.---.
- - - . - -Chinese
.
diagnosis
~

Pale, thin
Pale edges
Slightly dry, thin crack in the center

Slight Spleen qi deficiency (blood deficiency)


Liver blood deficiency
Slight Stomach yin deficiency

Symptoms
Exhaustion
Acute diarrhea with blood and mucus
Hair loss
Short menstrual cycle
lntense fears

Western diagnosis
Ulcerative colitis

Background to disease
Helminthes that were improperly treated in India
Emotional problems
Vegetarian diet
Fasting

Pale Tongue Signs

2.4
2.4.1

Special Tongue Shapes of the Pale Tongue


Pale and Narrow Tongues
Pale, slightly swollen, and narrow tongue bodies may indicate deficiency of
blood and improper circulation of Liver qi. In such cases, the narrow tongue
will look slightly contracted (Fig. 2.4.1.1). This type of tongue arises from a
deficiency of Spleen qi that lacks the strength to circulate qi and produce
blood. The consequence can be an insufficient supply of qi and blood to the
channels, collaterals, and muscles, leading to weakness and pain in the
extremities.

In rare cases, only one side of the tongue is contracted or drawn in. This
change suggests Liver qi constraint and lack of Liver blood flow since the
sides of the tongue reflect the circulation of Liver and Gallbladder qi. Pain or
a sense of weakness along the Liver or Gallbladder channels can be a manifestation of this pathology. This is a common tongue sign, particularly in
women who suffer from various breast diseases. The contracted side of the
tongue does not always correspond to the side of the affected breast.

Tongue description

Chinese diagnosis

Slightly pale, swollen,teeth marks


Narrow on both sides and drawn in

Spleen qi deficiency [Liverblood deficiency)


Liver qi constraint,possibly blood stasis

Symptoms

Pain in the left thigh and shoulder


Migraines with sensitivity to light during menstruation
Western diagnosis

Organized hematoma in the thigh


Baclcground to disease

Overwork
Side effect of contraceptive pill

Figure 2.4.1 .I

Figure 2.4.1.1
Female
37 years old

Pale Tongue Signs

Tongue dewription

Chinese diagnosis

Slightly pale, swollen


Drawn in on both sides

Spleen qi deficiency (Liver blood deficiency)


Lack of nourishment of sinews and tendons due
to qi and blood deficiency

Figure 2.4.1.2

symptoms

Female
28 years old

Pain in the right arm and shoulders


Tingling and numbness of the thumb
Muscular tension
Ringing noise in the right ear

Western diagnosis
Brachial plexus neuropathy

Background to disease
Whiplash

Tongue description

Chinese diagnosis

Pale

Spleen qi deficiency (blood deficiency)


Liver qi constraint and Liver blood stasis

Strongly drawn in, especially on the left side

Symptoms
Weight loss
Fatigue
Swollen axillary lymph nodes
Pain under the right hypochondrium

Western diagnosis
Bilateral breast cancer*
Liver metastases

Background to disease
Suppressed anger
Overwork

* Patient died one year after this photo was taken.

Pale Tongue Signs

2.4.2

Uneven Sides of the Tongue, or Swollen on Half of the Tongue


The nutritive qi flows with the blood. Together they nourish the organs, muscles, tendons, and sinews and circulate and fill the channels and collaterals.
Qi and blood deficiency presents not only with a pale tongue body, but also
with uneven sides to the tongue [Fig. 2.4.2.1).In my experience this tongue
sign represents impaired circulation of qi and blood in relation to the right or
left half of the body. Again, the affected side of the tongue does not necessarily correspond to the affected side of the body.
The same interpretation obtains when only one-half of the tongue is
swollen. In this case, the swelling shifts the midline of the tongue (Fig.
2.4.2.3). Symptoms associated with this type of tongue are weakness in onehalf of the body, and lack of strength or stamina in one arm or leg. Occasionally, this type of tongue will be seen in atrophy disorders.

C
Figure 2,4,2,1

Figure 2.4.2.3

Tongue description

Chinese diagnosis

Pale
Uneven teeth marks on the left side

Spleen qi deficiency
Lack of nourishment in the channels and collaterals
due to qi and blood deficiency
Acute food stagnation

Light yellow, greasy coating


Symptoms

Figure 2.4.2.1

Sharp pains in the left hip upon exenion


Lack of mobility of the hip joint
Extreme muscular tightness of the quadriceps
Acute stomachache
Loose stools

Female
35 years old

Western diagnosis
Bilateral degenerative joint disease of the hip
Background to disease
Excessive consumption of spicy foods
Lack of exercise
Mother took opiates during pregnancy

Pale Tongue Signs

Tongue description

Chinese diagnosis

Pale, slight teeth marks

Spleen yang deficiency [accumulation of


dampness)
Phlegm obstructs the Stomach
Lack of nourishment in the channels and
wllaterals due to qi and blood deficiency

Swollen center
Uneven sides to the tongue

Figure 2.4.2.2

Symptoms
Tendency to catch colds
Fatigue
Blocked nasal passages or runny nose with copious white discharge
Fullness in the epigastrium
Feeling of weakness on the left side of the body
Feeling cold

Female
30 years old

CASE HISTORY
below

Western diagnosis
None

Background to disease
Excessive physical exercise in connection with
dancing competition
Irregular eating habits
Excessive consumption of dairy products and
chocolate

Tongue description

Chinese diagnosis

Pale red, slightly swollen


One-half of the tongue swollen, midline shifted

Spleen qi deficiency [accumulation of dampness)


Lack of nourishment in the channels and collaterals due to qi and blood deficiency
Accumulation of dampness

Thin, wet coating

Figure 2.4.2.3

Symptoms
Morning stiffness, joint pain upon exertion
Pulling sensation and weakness in the left thigh
Svasms in the calves uvon exertion
Exhaustion

Female
50 years old

Western diagnosis
Multiple degenerative joint disease

Background to disease

Injuries due to a car accident 2 years ago


Overwork

Pale Tongue Signs

Case History
This 30-year-old woman complained of persistent fatigue and constant colds that
always left her with a runny nose.The nasal discharge was copious, thin, and white.
The left half of her body felt weak. Despite all of this, she forced herself to complete
a daily exercise routine, which took up to six hours, in preparation for an important
dance competition. She took great care not to gain weight, which resulted in irregular eating habits. She felt that the food was not being digested properly, as she often
experienced fullness in the epigastric region after eating. She felt cold very easily.
The tongue body was pale and showed unevenness on the sides of the tongue. The
pulse was slippery (hua) and frail (ruo).

Figure 2.4.2.2

Analysis. The fatigue and feeling of cold were the direct result of Spleen yang deficiency caused by the excessive training routine and irregular eating habits.The pale
tongue, especially swollen in the center and sides, support this diagnosis. In general,
damp-phlegm is a result of an underlying Spleen yang deficiency, which prevents the
Spleen from properly transporting and transforming solids and liquids. The presence
of damp-phlegm here led to obstruction of the qi mechanism of the middle burner,
manifesting in epigastric fullness, and also showed itself in the copious nasal discharge and slippery pulse. Damp-phlegm blocks the circulation of qi and blood in
the channels, collaterals, and muscles, which contributed to the one-sided feeling of
weakness in the body.
Discussion. Swollen or uneven tongue sides often indicate insufficient nourishment
of the channels, collaterals, and muscles. The underlying cause for this i s a deficiency of Spleen qi and yang that gives rise to accumulation of dampness, or is
aggravated by external dampness or cold-dampness. Patients with this condition are
advised to change their diets and abstain from vigorous exercise.

2.4.3

Swollen Tongue Sides


A deficiency o f Spleen qi and yang presents with a swollen tongue body as
well as broad swelling o n b o t h sides o f the middle third o f the tongue. Note
that the sides are swollen only in the middle o f the tongue. This sign must
n o t be confused with swollen sides that extend over the entire length o f the
tongue body (Fig. 7.1.21,which signifies a disharmony o f the Liver.

Figure 7.1.2

Pale Tongue Signs


Tongue description

Chinese diagnosis

Slightly pale, swollen, especially the middle part


of the sides
Slightly dry
Depression at the root

Spleen qi deficiency (accumulation of dampness)


Blood deficiency
Essence deficiency

Symptoms

Figure 2.4.3.1

Migraines since 9 years of age


Migraines now preceding and followingmenstruation
Severe hair loss
Panic attacks since childhood

Female
40 years old

Western diagnosis
None

Figure 2.4.3.2
Female
25 years old

Background to disease
Family history of migraines
Overwork at home and on the job
Irregular eating habits

Tongue description

Chinese diagnosis

Pale, slightly thin, middle part of sides swollen


White, thin, slippery coating

Spleen qi and blood deficiency


Accumulation of cold-dampness

Symptoms
Headaches
Pain at the nape of the neck
Fatigue
Weight gain

Western diagnosis
None

Background to disease
Excessive consumption of sweet foods
Excessive worrying

Pale Tongue Signs


Endnotes
1. Frequent colds and flu must be considered within the context of weakenitlg

essence. It is often forgotten that the strength of the protective qi is not only
dependent on the Lung qi but also on tlie Kidney yin and yang, tlie essence, and
the source qi. The essence is responsible for the construction of the body while
tlie source qi is vital in supplying the body with dynamic and warming qi. The
source qi is a catalyzing force that underlies all energetic activity.
Kidney yang and the source qi supply the Bladder with qi in order to
transform the pure part of the impure fluids. The transformed fluids flow to the
skin and muscles and indirectly connect with the protective qi. If the Kidney
yang is deficient, the fluids will not be rransformed, resulting in malnourishment
of tlie protective qi.
The distribution of the protective qi throughout the body is also influsnced
by the eight extraordinary vessels, especially the Governing, Conception, and
Penetrating vessels, which partly act as a reservoir for the essence. The protective
qi is thus rooted in the Kidneys, nourished by the essence, and supported in its
circulation by the source qi. Frequent colds thus not only weaken the protective
qi, they also affect the essence and source qi.
2. IJnfortunately, whilc this is potentially a very important issue, the literalurc on

Ilic subject is limited.

C H A P T E R

Tongue Signs Associated


with Kidney Disharmonies
This chapter focuses on tongue signs associated with Kidney yin deficiency.
Tongue signs associated with Kidney yang deficiency are discussed in
Chapter 2. It should be noted that a pale, swollen, wet tongue can occur in
individuals who are either Spleen yang or Kidney yang deficient. The individual's symptoms must be investigated to distinguish between these two
deficiencies.

3.1

Characteristics of
Yin-Deficient Tongues
Everyone possesses a basic constitution that shapes and influences that individual. Assessing a patient's constitution is based on a knowledge of the
patient's previous illnesses and their course of development, as well as on
observing the individual's 'being' or 'rhythm of life.' The constitution is also
reflected in the face, pulse qualities, and tongue. In a person with a yang
constitution the tongue is often reddish, long, and big, while with a yin
constitution the tongue body tends to be pale and swollen. It is therefore
sensible to take note of the tongue, especially its shape and consistency,
when evaluating an individual's constitution.
The Kidneys house both yin and yang.Yin manifests in the body through
the fluids, substance, and structural elements. Pure fluids and blood belong
to the domain of yin. Yin nourishes and moistens all the tissues of the body.
Each of the various yin organs controls and preserves specific aspects of yin.
The nutritive qi, which nourishes the five yin organs and moistens the six
yang organs, has its root in the Spleen. Blood is stored in the Liver and produced by the Heart. The Lungs distribute fluids, which originate in the

Tongue SignsAssociated with Kidney Disharmonies


Spleen and Kidneys, and nourish the skin and hair. However, the body's yin is
rooted in the Kidneys.
Cool in nature, the yin controls and prevents the pathological ascension
of yang; it also limits the rapid buildup of heat. Together with the blood, yin
anchors the spirit, which leads to good sleep and a balanced mind.
Kidney yin and essence nourish each other and are mutually dependent,
especially in maintaining the body structures and the quality of the fluids.
The fluids and blood are yin in nature. Together, they supply the tongue with
sufficient 'substantive energy' so that the tongue body achieves its normal
volume, elasticity (softness), reddish color, and moisture. An excess of yin, in
the form of dampness, for example, inevitably leads to a swollen tongue
body.

Figure 6.1.1.6

Qi governs the movement of blood and fluids and transports them to the
tongue. Thus, the tongue body color, shape, and moisture always reflect the
condition of qi and yin in each of the yin organs. Yi deficiency has many
characteristic tongue signs: a red tip, cracks in the tongue body, and a red,
dry, stiff, or (in severe cases) even shrunken tongue body (Fig. 6.1.1.6).

Red Tongues with Kidney Yin Deficiency


A common result of Kidney yin deficiency is the development of heat from

deficiency, which, over a long period of time, will dry the fluids and injure the
blood. When this occurs the tongue appears red and dry with little coating.
The stronger the heat, the greater the injury to the blood and fluids, which in
turn leads to a redder and drier tongue body.' Symptoms associated with
Kidney yin deficiency with heat are tinnitus, night sweats, hot palms and
soles, dry mouth, and a flushed face.
In cases of constrained heat, smoldering fire or fire toxin can develop,
manifesting in an extremely red tongue that is covered with a yellow coating.
Symptoms associated with this excessive disorder include fever, irritability, a
dry mouth and throat, thirst, and mouth ulcers.
Heat and fire are capable of injuring the blood as well as the blood vessels,
leading to spontaneous bleeding. Heat in the blood is characterized by
excessive menstrual bleeding, red, itchy skin lesions, and a general feeling of
heat in the body. In this case, the tongue body is completely red, possibly a
deeper red or scarlet red. In order to evaluate the origin, degree, and intensity
of the heat or fire and the resulting injury to the yin and fluids, the practitioner
should observe not only the intensity of the red discoloration on the tongue
body, but also its shape and coating.
Heat generated by deficient yin that smolders for a long time in the body
and then becomes uncontrollable will inevitably affect the essence. This
energetic deficiency, which can develop over the course of years or be accelerated by a serious illness, may lead to a sudden collapse of the yin, which
thereby allows the yang to rise uncontrollably. The mildest expression of this
energetic imbalance is the sudden loss of hearing, while its most severe form
is cerebral stroke. In some cases, a burning-out syndrome, which is often
followed by a nervous breakdown, is subject to the same pathology. A good
visual image for what happens energetically is a candle burning at both ends.

Tongue SignsAssociated with Kidney Disharmonies


The candle wax is the substance, which corresponds to the yin and essence,
while the flame corresponds to the yang. At the end, when the wax finally
burns away, there is a short, intense flickering of the flame: the excessive
yang. This upward-blazing fire in the body vents itself in such disorders as
myocardial infarction, stroke, hypertensive crisis, or uncontrollable bleeding. The tongue body is commonly red, dry, contracted, or stiff (Fig. 3.6.6).
The heat has injured the fluids and yin so severely that the muscles, sinews,
and tendons-including those of the tongue--become malnourished. This
condition can cause the internal movement of wind (see Chapter 7 for further discussion). A deep red discoloration of the tongue also arises when heat
enters the nutritive and blood levels (see Chapter 9).

Figure 3.6.6

Surprisingly, this pathology can also produce a soft red tongue, an indication of malnourishment of the sinews and tendons due to extreme heat
(Fig. 3.7.4). Patients with this tongue type often suffer from hemiplegia (following stroke), or from atrophy disorders. The soft red tongue is, accordingly,
an unfavorable prognostic sign.
There are many levels of Kidney yin deficiency. Tongue diagnosis can be
an important tool in reaching a prognosis for the illness and in formulating
the correct treatment strategy.
The photographs in this chapter reflect tongue body colors and shapes in
relation to long-standing deficiency of yin and essence, which often occurs
in chronic diseases. The sequence of tongue photos is in order of severity of
the underlying deficiency. Thus, the first photo represents only slight deficiency while the last one reflects very severe deficiency. In addition, there are
photos that depict the mutual relationships among Kidney, Heart, Lung, and
Stomach yin deficiencies. Tongues that show specific signs of individual yin
organ deficiency will be discussed in later chapters.

Figure 3.7.4

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Red

Kidney yin deficiency


Heat in the Liver
Injury to the fluids due to heat

Red points at the sides


Dry, rough coating

Symptoms

Fig. 3.2.1
Female
36 years olo

Shortened menstrual cycle


Extremely profuse menstrual bleeding, very red
menstrual blood
Hot flushes and irritability before the onset of
menstruation
Depression

Western diagnosis
Primary infertility

Background to disease
Unhappy marriage
Frustration, suppressed anger
Excessive intake of coffee

Tongue description

Chinese diagnosis

Red, thin, cracked

Blood and Kidney yin deficiency


Stomach and Kidney yin deficiency

Coatingwithout root

Fig. 3.2.:
Female
34 years old

symptoms
Severe exhaustion
Inner restlessness
Sore throat
Numbness of the left thigh
Frequent dizzy spells
Occasional night sweats

Western diagnosis
Multiple sclerosis
Chronic tonsillitis
Blindness due to optic nerve atrophy of the left
eye

Background to disease
Irregular eating habits
Frequent bouts of influenza
Long-standing emotional problems

Tongue Signs Associated with Kidney Disharmonies


Tongue description

Chinese diagnosis

Red, slightly thin


Cracked, coating without root
Red tip

Kidney yin deficiency


Fluids and Kidney yin deficiency
Heat in the Heart

Symptoms

Fig. 3.2.3
Male
38 years old

Severe exhaustion
Depression, lacking self-worth
Night sweats
Sore throat

Western diagnosis
Chronic tonsillitis

Background to disease
Long-standing emotional problems since childhood
Suppressed anger
Overwork

Tongue description

Chinese diagnosis

Deep red

Kidney yin deficiency and heat in the blood


Fluid deficiency

No coating

Symptoms
Severe, long-lasting menstrual bleeding
Dark red, strong smelling menstrual blood
Insomnia
Inner restlessness

Western diagnosis
None

Background to disease
Deep frustration with life
Excessive consumption of meat and spicy, fried
foods

Fig. 3.2.4
Female
40 years old

Tongue SignsAssociated with Kidney Disharmonies

Fig. 3.2.5
33 yezrs old

Tongue description

Chinese diagnosis

Deep red, especially i n the center


Wide shape
Deep red tip
Whitish, slippery coating at the sides, dirty yellow
coating at the center

Kidney yin deficiency with Stomach f i e


Internal heat and toxin due to alcohol
Hean fire
Long-standingaccumulation
of phlegm (phlegm-fire]

.
I
-

Severe heartburn, stomach pains


Insomnia, nightmares
Inner restlessness, panic attacks
Excessive sexual drive

Western diagnosis
None

Background to disease
Excessive use of alcohol, coffee, and nicotine
Excessivemasturbation

Case History

Fig. 3.2.5

Mr. S, a 33-year-old social worker, complained about severe heartburn and stomach
pains. The pain became worse whenever he consumed alcohol, which he did in
large quantities on a regular basis. He also drank large amounts of coffee and
smoked more than 30 cigarettes daily. Extreme inner restlessness, insomnia, and an
excessive sexual drive led to a very unsteady lifestyle. He was exhausted, but at the
same time extremely excitable and active. His tongue was deep red. His remarkable
pulse was flooding (hong), rapid (shou), and excessive (shi).

Analysis. During the consultation the patient revealed that he masturbated at least
twice a day. Because of the frequent loss of sperm, the essence and Kidney yin were
damaged. The wide, deep red tongue body and the flooding, rapid, and strong pulse
were the result of excessive heat,This heat injured the Kidney yin, which in turn was
unable to nourish the Stomach yin.The heartburn and stomach pains were caused by
the deficient Stomach yin as well as fire in the Stomach, which resulted from a diet
of predominantly fried fatty foods, alcohol, and coffee.
The tip of the tongue was of a deep red color; in this case that pointed to Heart
fire. The weakened yin, together with Heart fire, failed to anchor the spirit, leading to
insomnia and inner restlessness.

Discussion. A red tongue always denotes the presence of heat. Depending on its
strength, the heat will eventually injure the yin. If Kidney yin deficiency is present,
the red tongue will be accompanied by a coating that i s either without root or

Tongue SignsAssociated with Kidney Disharmonies


peeled. In this situation it is very important that the yin be tonified. With excessive
heat, especially at the onset of an illness, a yellow, thick coating will often be visible.
When the illness is caused by heat, there will always be a tongue coating. In treating
such a patient, it is important to first eliminate the heat before proceeding to tonify
the yin.

Scarlet Red Tongues


This tongue body color is deep red with a slight pink hue. If the tongue is dry
or without a coating, it is an indication of Kidney yin deficiency with vigorous internal heat. Occasionally only some areas of the tongue will present
with this shade, most commonly the anterior third of the tongue. This discoloration corresponds to severe Lung yin and Stomach yin deficiency.
Scarlet red tongues with coating are characteristic of warm-febrile diseases
(see Chapter 9).

Tongue description

Chinese diagnosis

Scarlet red
Dry, rough coating
Notch at the tip

Heat in the blood, slight Kidney yin deficiency


Fluid deficiency
Slight Heart blood deficiency

Symptoms
Dry, red, itchy skin
Fits of anger
Depression

Western diagnosis
Atopic eczema
Background to disease
Lack of sleep
Irregular Lifestyle
Alcohol abuse

Fig. 3.3.1
Female
22 years old

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Scarlet red, slightly shiny


Raw, reddish area in the center
Swollen tongue sides, especially in the central part

Kidney yin deficiencywith heat from deficiency


Stomach yin deficiency
Underlying Spleen qi and yin deficiency

Western diagnosis
None

Background to disease
Pregnancy at a late age
Breastfeeding for too lonp

Fig. 3.3.3
33 years old

Tongue description

Chinese diagnosis

Scarlet red
Raised, reddish dots distributed over the entire
tongue
Long vertical crack

Kidney yin deficiency


Heat in the blood

Constitutional weakness of the Heart, heat in the


Heart

Symptoms
Inner restlessness
Tremor of the hands
Poor memory

Western diagnosis
None

Background to disease
Drug abuse (heroin, cocaine, ecstasy)
Lack of sleep
Overwork
Works with toxic substances

Tongue SignsAssociated with Kidney Disharmonies

3.4

Red, Short Tongues


This tongue type is indicative of severe exhaustion of the Kidney and Liver
yin plus the development of vigorous heat. This can lead to very serious disorders as the extreme heat consumes the fluids and yin, the most serious
being the internal movement of wind.
The tongue is short because the fluids, blood, and yin are not adequately
nourishing the tongue muscles; the tongue thereupon loses its elasticity and
its ability to move freely. If the tongue deviates to one side, this indicates the
presence of internal wind.
Although this type of tongue is the result of severe yin deficiency, treatment with pure tonification is not indicated. The internal wind must be
extinguished and the yang sedated.

Tongue description

Chinese diagnosis

Red, small, short

Kidney yin deficiency, onset of essence deficiency


Heart fire
Heat in the Liver

Very pointed, prickles at the tip


Intense red edges

:ig. 3.4.1
Lack of appetite
Constipation
Amenorrhea
Strong inner restlessness
Insomnia
Suicidal fantasies

Western diagnosis
Anorexia nervosa

Background to disease
Serious starvation
Divorce of parents

:emale
9 years old
iee
XSE HISTORY

)elow

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Deep red, thin, small, short

Kidney yin deficiency


Lung qi and yin deficiency
Heat in the Lungs

Depression in the anterior third


Redness in the anterior third

Fig. 3.4.2
Female
59 years old

r-

Symptoms
Dry cough
Dry mouth and throat
Pain in the chest
Hair loss
Lack of appetite

Western diagnosis
Metastasizing bronchial cancer

Background to disease
Possibly environmental factors
Chemotherapy

Fig. 3.4.3
Male
83 years old

Tongue description

Chinese diagnosis

Deep red, short, shiny


Dry, without coating

Stomach, Lung, and Kidney yin deficiency


Exhaustion of fluids

Symptoms
Cough with little phlegm
Night sweats
Low-grade fever, intense feeling of heat in the
body
Shortness of breath
Exhaustion

Western diagnosis
Chronic bronchitis
Emphysema

Background to disease

Smoking for 60yean

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Red, short, stiff

Severe Kidney yin deficiency, essence deficiency


Stomach and Lung yin deficiency

Dry

Symptoms

Chronic cough
Dry mouth
Exhaustion

Western diagnosis

Fig. 3.4.4
Female
65 years old

Emphysema
Chronic bronchitis

Background to disease
Working conditions
Environmental factors

Tongue description
Deep red, wide, short
Yellow, old, dry coating

Symptoms
Fever
Constipation
Loss of memory
Wasting
Weakened vision

Western diagnosis
Stroke with hemiplegia

Background to disease
Smoking for 50 years
Alcohol abuse

~
Chinese diagnosis

Severe Kidney yin deficiencywith injury to fluids due


to vigorous heat
Heat accumulation in yang brighmess (yangming)
organ stage

.,$%~..:. ..! .,

,.*z>**
,.; j;,.,&$". %
:
, +."
.'<
.*.>.
.C.'
.,.,.

&-

I.,,

b ,'

. -

,. ,,; .

.'

'\\

ig. 3.4.5
4ale
4 years old

Fig. 3.4.1

Tongue SignsAssociated w i t h Kidney Disharmonies

Case History
The parents of Mrs. S divorced when she was 13 years of age. She was extremely
upset about the separation and felt responsible for it. She lived with her mother who
was obsessed with dieting. Around this time, the patient seemed to have lost her
appetite. She starved herself, and despite long stays in the hospital, never gained
weight again. She is now 19 years of age, 176cm tall, and weighs 42kg. When she
was 15 years old, she had a single menstruation.
The patient was studying for her A-level examinations. She had great difficulty
concentrating, could hardly sleep, felt very restless, and needed to be active all the
time. She also suffered from constipation. The tongue was noticeably small and red.
Her pulse was thin (xi) and deficient (xu).
Analysis. The red, short tongue shows serious Kidney yin deficiency with some
Heart fire developing. Since the fluids, blood, and yin are deficient, the tongue is
malnourished and shortened. Due to chronic starvation, the postnatal qi has been
weakened, leading to malnourishment of the Kidney yin and essence. The essence
controls, among other things, the menstrual cycle and participates in the production
of blood. Her lack of periods is due to the unavailability of 'material' for the production of blood, and her weakened essence.
In this patient, communication between the Heart and Kidneys is disturbed.
Heart fire, which resulted from the deficiency, causes severe restlessness and insomnia and manifests in a very pointed tongue shape. The prickles on the tip of the
tongue corroborate this diagnosis. Her unresolved emotional problems contribute to
the strong heat in the Liver, indicated by the tongue's red edges. This aggravates the
existing sleeping problems and inner restlessness. The heat in the Liver and the lack
of fluids are responsible for the constipation.
Discussion. Red, short tongues are always an indication of intense heat in the body.
Heat dries the fluids and injures the yin, and it is often the case that the Lung and
Stomach yin are injured in the process. Which of the yin organs has been most
affected can only be ascertained from the symptoms. Besides draining heat gently,
treatment in this case must focus on long-term tonification of the fluids, blood, and
yin so that all the tissues and organs in the body may again function harmoniously.

Cracked Tongues
In general, there are no cracks in a normal tongue. The softness and suppleness o f the tongue body shows that i t is moistened b y the fluids and nourished through the blood and yin. Heat and dryness account for the appearance o f cracks inthe tongue body. Thus, small, horizontal cracks are a sign of
yin deficiency, especially when they appear o n a red o r slightly red tongue.
As a rule, injury t o the substance does n o t occur unless the pathology has
been present for a while. This is one reason why cracks are rarely seen in the
tongues o f children. In adults, they appear rather suddenly, for example, duri n g a severe disease, after chemotherapy, or when yin-injuring habits (like
cigarette smoking or frequent consumption o f spicy foods) are indulged over
a long period o f time.

Tongue Signs Associated with Kidney Disharmonies


Cracks in a pale tongue body can originate from a deficiency of blood. If
they are only superficial, this is an indication of Stomach and Spleen qi deficiency with blood deficiency. In the case of deep cracks, besides deficiency of
blood, there may also be injury to the fluids.
In a red tongue, cracks are an unmistakable sign of the exhaustion of fluids or the onset of Stomach and Kidney yin deficiency, caused by injury from
excessive heat in the nutritive and blood levels. A red shiny tongue (see
Chapter 4) with cracks indicates severe yin and fluid damage.
A single, small crack on the tongue body is less significant than cracks
that are distributed over the entire body of the tongue. In modern China,
cracks are differentiated according to the following three degrees of severity:

First degree: Flat and short, that is, no longer than 0.55mm, and no
more than three cracks.
Second degree: Identical to the first degree except there are four or
more cracks.
Third degree: The cracks have a depth of at least lmrn and are longer
than 1 . 5 ~ m . ~
The following photographs illustrate this pattern. They are presented in
order of increasing degree of injury to the yin. The first photograph shows a
slight deficiency of fluids and yin, while the last one shows a severe deficiency.

Tongue description

Chinese diagnosis

Pale red
Pale sides
Curled-upedges
Horizontal cracks in the center

Slight Spleen qi deficiency


Liver blood deficiency
Liver qi constraint
Lack of fluids,Stomach yin deficiency, onset of
Kidney yin deficiency
Onset of essence deficiency

Depression at the root


Symptoms
Headaches
Pain in the shoulder girdle
Inner tension
Exhaustion
Poor memory
Depression
Toothache
Western diagnosis
Onset of periodontitis
Background to disease
Pregnancy at a late age
Breastfeeding for a long time
Lack of sleep

Tongue SignsAssociated with Kidney Disharmonies


Tongue description

Chinese diagnosis

Reddish, big, slightly thin


Horizontal cracks, rough tongue surface
Deep vertical crack in lhe anterior third

Onset of Kidney yin deficiency


Onset of Stomach yin deficiency
Lung yin deficiency
I

Fig. 3.5.2
Male
22 years olo

Symptoms
Chronic nasal congestion
Pain and pressure in the nasal sinuses
Feeling of tightness in the chest and asthmatic
anacks
Tendency to catch colds

Western diagnosis
Allergic rhinitis
Allergic asthma

Background to disease
Family history of allergic rhinitis and asthma
Poor diet during puberty
Emotional problems due to divorce of parents

Fig. 3.5.3
Female

49 years old

Tongue description

Chinese diagnosis

Pale
Red in anterior third
Vertical crack with horizontal cracks branching out
Dry, reddish center
Thorns distributed over the entire tongue body

Blood deficiency
Heat in the upper burner
Onset of Stomach and Kidney yin deficiency
Lack of fluids in the Stomach
Internal heat

Symptoms
Exhaustion
Thirst
Severe palpitations
Headaches at the vertex
Night sweats

Western diagnosis
Iron deficiency anemia

Background to disease
Caffeine and nicotine abuse

Tongue SignsAssociated with Kidney Disharrnonixs


Tongue description

Chinese diagnosis

Reddish, dry
Deep, horizontal cracks
Dry, coating without root

Lack of fluids
Stomach and Kidney yin deficiency
Kidney yin deficiency

.:ig. 3.5.4
Female
28 years old

Symptoms
Night sweats
Insomnia
Shortness of breath
Inner tension
Exhaustion

Western diagnosis
None

Background to disease
Difficultpregnancy and binh

Tongue description

Chinese diagnosis

Slightly pale with firmtongue body

Slight deficiency of blood and fluids


Lack of fluids
Onset of Stomach and Kidney yin deficiency

Dry
Horizontal and vertical cracks

Symptoms
Dry cough, dry throat
Difficulty with inspiration
Difficultyin breathing during the night

Western diagnosis
Allergic rhinitis
Allergic asthma

Background to disease
Family history of allergic rhinitis and asthma

Fig. 3.5.5
Female
35 years old

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Reddish
Cracks distributed over the entire tongue body
Center of the tongue red and without coating
Thin, yellow, one-sided coating

Slight Kidney yin deficiency


Stomach and Kidney yin deficiency
Stomach yin deficiency
Slight retention of damp-heat in the Liver and
Gallbladder

Symptoms

Fig. 3.5.6

Burning sensation of the tongue


Night sweats
Palpitations
Insomnia
Frequent smelly, loose stools
Pain under the right hypochondrium
Inner restlessness

Female
! years old

Western diagnosis
None

Background to disease
Overworked
Caffeineabuse
Pregnancy at a late age

Fig. 3.5.7
Male
48 years old

CASE HISTORY

Tongue description

Chinese diagnosis

Slightly red, firm tongue body


Slightly bluish
Horizontal cracks over the entire tongue body
Yellow, dry coating

Kidney yin deficiency


Blood stasis
Kidney yin deficiency
Accumulation of damp-heat in the Liver and
Gallbladder

Symptoms
Pain in the ankle upon exertion
Smelly diarrhea
Chronic sinusitis
Itchy scalp

Western diagnosis
Sudeck syndrome

Background to disease
Alcohol and salt abuse
Trauma (fracture of the tibia with ensuing osteoporosis)

Tongue Signs Associated with Kidney Disharmonies

Case History
When Mrs. D gave birth to her two children she was 38 and 41 years old. The first
pregnancy, the extended period of breastfeeding, and the lack of sleep led to severe
exhaustion. She had to rest frequently in the course of the day in order to fulfill her
role as wife and mother. Her extreme fatigue made her very irritable. As her physical
and mental stress increased, she experienced tension around the muscles of her neck
and shoulders, which often resulted in headaches. During her two pregnancies she
suffered frequently from toothache and bleeding gums, which was diagnosed as the
onset of periodontitis. Her memory became much worse during this time. While the
tongue body color was normal, the center was cracked. Her pulse was deficient (xu),
thin ( X I ] , and a little floating (fu).

Analysis. The essence in a pregnant woman nourishes the embryo and fetus. If the
mother is young and strong, her essence will be of good quality, and the pregnancy
will generally be without problems. Essence in women tends to decline after their
35th year, thus pregnant women over this age have less essence to draw upon. Often,
mature women find that the recovery period after pregnancy is more difficult and
prolonged, as it was in this case. The depression at the root of the tongue and the
slightly thin tongue body were the first indications of the loss of substance, which
may have been accelerated by breastfeeding for 12 months. A part of the mother's
blood i s transformed into milk; therefore, long periods of breastfeeding can injure the
blood. If the blood becomes deficient, the Kidney yin will also be affected, which
can lead to insufficient support of the essence. The deep, small, horizontal cracks,
visible from the root to the tip of the tongue, are another indication of Kidney yin
deficiency.
Because the blood is insufficient, the Liver cannot store enough of it, and this i s
reflected in the pale edges of the tongue. Here, the edges are also curled up, an indication of Liver qi constraint. Also, when the Liver blood is deficient, it i s unable to
rise and nourish the head and the muscles of the neck and shoulders, hence the
headaches.
Toothache is a common phenomenon during pregnancy. One explanation is that
deficiency of Kidney yin gives rise to heat from deficiency that transforms into fire
and ascends to the teeth, resulting in severe toothache. Another explanation for
toothache and bleeding gums during pregnancy is the appearance of Stomach fire.
Because of the existing deficiency of essence and yin, the yin of the Stomach i s not
nourished, which may lead to Stomach heat. Heat injures the channels that supply
the teeth, resulting in bleeding gums and toothache.
Poor memory and deep exhaustion again suggest a deficiency of essence. The
deep exhaustion may also be exacerbated by an underlying slight Spleen qi deficiency.
The deficient, thin pulse reflects the general deficiency of qi and blood. Its floating
quality underscores the blood and yin deficiency.

Fig. 3.5.1

Tongue SignsAssociated w i t h Kidney Disharmonies

Case History
This 48-year-old builder suffered an accident at work that resulted in a complicated
fracture of the tibia. After a corrective operation, the patient underwent 18 months of
physical therapy. Nevertheless, osteoporotic changes developed around the site of
the fracture. The affected leg was painful, especially with any movement or physical
strain.This did not improve despite extended physical therapy.
Fig. 3.5.7

The patient seemed v e y restless. His scalp felt itchy and hot. He had several
bowel movements during the day. His stools were soh, occasionally watery, and
were accompanied by a strong smell. He also suffered from chronic sinusitis, which
led to nasal congestion. The tongue was slightly red and bluish, dry, and cracked. His
pulse was floating (fu),excessive (sh~),and w i y (xian).

Analysis. The reddish, cracked tongue showed a deficiency of Kidney yin. The
overuse of salt over a period of many years, the chronic diarrhea, and the presence of
heat from deficiency all contributed to a lack of fluids and yin.
Because essence i s closely associated with Kidney yin, a long-standing deficiency of Kidney yin will always affect the essence. It is the essence that is responsible for the health and nourishment of the bones. Here, it was because of the underlying deficiency of yin and essence that the healing process of the fracture was
retarded and incomplete.
The patient drank large quantities of wine and liquor daily. The yellow, dry
tongue coating reflects the presence of damp-heat in the Liver and Gallbladder,
possibly caused by the consumption of alcohol. The Liver channel traverses the
cheeks and sinuses. When heat from excess enters the channel, it becomes constrained and cannot drain out. This can lead to a clumping of fluids that transform
into phlegm-heat. This, in turn, interferes with the downward-moving action of Lung
qi, the impairment of which here resulted in sinusitis and nasal congestion.
Damp-heat in the lower burner is responsible for the loose, smelly stools. The
hot, itchy scalp may be an indication of heat rising to the head.
The internal heat is a dominant factor in the pathology of this patient. It injured
the fluids, resulting in a dry tongue coating as well as a firm tongue body. In turn, this
heat continued to injure the Kidney yin, preventing the healing of the bone. Even
after six months of treatment with Chinese herbs that focused on this pathology, the
osteoporosis did not improve. However, the patient had become free of pain, and the
mobility of his ankle had greatly improved.

Tongue Signs Associated with Kidney Disharmonies

3.6

The Tongue Coating and Kidney


Yin Deficiency3

This coating has lost its root. Due to the lack of fluids, insuffi:

A red tonme with a oeeled coating is a definitive sign of Stomach and Kidnev

yin defic;ncy.
cient material is available for the formation of the turbid 'steam' that contributes to the formation of the coating. The function of Stomach qi is to ferment the solids and liquids. In the normal course of thiigs, during the
process of digestion a little dampness rises to the tongue and forms the coating. However, where there is deficiency, too little moisture rises and this
manifests in the peeled tongue or in an irregularly distributed coating.
The same energetic imbalance can create an old-looking coating, that is,
it looks dry and gives the impression that it could be easily wiped off (Fig.
3.6.6). Where a new, fresh coating should have appeared, the old coating
remains next to a raw or dry area (Fig. 4.1.2.1). The formation of new coating
does not take place because of exhaustion of and injury to the fluids. The
result is a tongue coating without root, which can evolve into a dry tongue or
one without coating.
A red tongue with no coating at the root, but which is red and dry, indicates extreme exhaustion of Kidney yin that has led to Kidney fire. Although
it does indicate a less severe pathology, the same is true for a pale red tongue
with no coating at the root, or a discolored, reddish root.

Tongue description

Chinese diagnosis

Slightly red, swollen


Peeled coating, especially in the anterior and
posterior thirds
White, slightly greasy, thin coating in the center

Accumulation of damp-heat
Stomach yin deficiency,lack of communication
between Heart and Kidney
Blockage of Stomach qi by damp turbidity

Fig. 3.6.6

Symptoms

Fig. 3.6.1

Panic attacks with tachycardia and pain in the chest


Inability to fall asleep, fatigue
Fits of rage
Feeling of heaviness in the bodv

Female
28 years old

Western diagnosis
Cardiac neurosis

Background to disease
Excessive anger and frustration
Unsatisfactory emotional relationships
Excessive consumption of sweets

See discussion
of this case
on p. 216

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Red, swollen

Kidney yin deficiency, accumulation of dampheat in the Liver and Gallbladder


Kidney yin deficiency
Kidney fire
Phlegmfire in the Stomach

Peeled coating, especially in the posterior third


Thorns in the posterior third
Deep vertical crack with yellow coating

Symptoms

Fig. 3.6.2

Inner restlessness
Feeling of heat in the body
Vertigo
Soft stools
Occasional night sweats

Male
25 years old

Western diagnosis
None

Background to disease
Incorrect treatment with Radii Aconiti lateralis
praeparata (fuzi)

Fig. 3.6.3
Male
23 years old

Tongue description

Chinese diagnosis

Red
Red, swollen sides
Slightly deviated
Swollen, red tip of tongue
Peeled coating, especially in the posterior third

Kidney yin deficiency


Ascending Liver yang
Internal wind
Heart tire
Kidney yin deficiency

Symptoms
Intense diminess
Feeling of heat in the head
Bad mood
Smelly, loose stools

Western diagnosis
Vertigo

Background to disease
Overwork
Caffeine abuse
Emotional problems

Tongue Signs Associated with Kidney Disharmonies


Tongue description

Chinese diagnosis

Pale red, swollen


Red center with yellow, old coating
Peeled coating and red root

Spleen qi deficiency (accumulation of dampness)


Stomach heat with phlegm-fire
Kidney yin deficiencywith Kidney fire

Symptoms
Paranoiac panic attacks
Inner restlessness, nervousness
Night sweats
No drive

Western diagnosis
Manic depression

Background to disease
Unresolved emotional conflicts
Caffeineand nicotine abuse
Irregular eating habits
Excessive consumption of chocolate and sweets

Tongue description

Chinese diagnosis

Red, contracred

Severe exhaustion of Kidney yin and essence, heat


in the blood level
Lack of fluids
Stomach yin and Kidney yin deficiencywith
clumping of damp-heat in the Gallbladder
Heart yin deficiency

Dry
Yellow, old, one-sided coating
Flanened and contracted tip

Symptoms
Extreme physical weakness
Night sweats
Chronic low grade fever
Dry cough
Mouth ulcers
Stomach pain

Western diagnosis
AIDS
Anemia
Kaposi's sarcoma

Badcground to disease
Viral activity (toxic heat]

Fig. 3.6.5
Male

44 years old
See discussion
of this case
on p. 215

Tongue Signs Associated with Kidney Disharmonies

Tongue description

Chinese diagnosis

Red,firm, stiff

Kidney yin deficiencywith internal heat


Lack of fluids
Stomach and Kidney yin deficiencywith heat
accumulation in yang brightness organ stage
lyang mingfu eheng)

Dry
Yellow, old, tofu-like coating

Fig. 3.6.6
65 years old

Symptoms

Loss of memory
Severe headache
Fever
Occasional night sweats
Constipation
Vertigo

Western diagnosis
Suffered stroke 3 days before

Background to disease

Smokingcigarettes for 30 years


Alcohol abuse

Case History
The patient's first acute paranoiac psychotic episode occurred seven years ago following his final examination as a concert pianist. Since then, this 35-year-old patient

spent two years in a hospital. Sedation with strong drugs as well as 14 electric shock

treatments alleviated the depressive and suicide-mania states. Despite heavy medication, the patient experienced panic attacks every morning and felt severe fright. His
sleep was very disturbed, he had great difficulty relaxing, and he complained of a
lack of drive and energy.
His appetite, however, was good, although he never cooked any food. Rather, he
lived off yogurt and cakes. He consumed about two liters of coffee and black tea
daily and smoked about 40 cigarettes daily. His stools were soft and occasionally
sticky. The red, coatless root of the tongue was obvious. His pulse was deep (chen),
slippery (hua), and slightly slow (chi).

Analysis. Vigorous Heart fire developed in this patient due to the extreme emotional
pressure while preparing for his examination. The patient was worried that he was
not living up to his father's expectations. (His father was a famous professor of
music.) His inability to deal with this situation led to the Heart fire, which seriously
disturbed him. To this day, the patient feels a lot of anger toward his father who never
showed him the respect he felt he deserved. This led to constrained Liver qi, and
because of the intensity of his unresolved emotions, this evolved into Liver fire.

Tongue Signs Associuted w i t h Kidney Dishurrnonies

When the Liver qi becomes constrained, its control over the Spleen becomes
excessive, resulting in Spleen qi deiicicncy This deficiency impairs the transformation
and transportation of iluids, which in turn accumulale and transform into dampness.
The accumulation of dampness is reflected in the slightly swollen tongue body. Due
to the consumption of phlegm and heat-producing foods (yogurt, cake, coffee), the
accumulation of dampness and the existing fire generated by the Liver qi constraint
led to the appearance of phlegm-heat, which agitated the Heart. When phlegm-heat
collects and is also subjected to emolional tension over a period of time, it explodes
into phlegm-fire, lcading to extreme emotional instability and manic behavior.
There is an alternalive explanation for the developmenl o i his illness. When
Liver qi is constrained and the fluids are not distributed, over time it will lead to the
formation of phlegm. Long-standing Liver qi constraint with the presence of phlegm
can develop inlo phlegm-iirc, especially when it exists alongside emotional tension
and the intalcc of large amounts of heat-producing foods. Phlegm-fire is visible here
in the dark yellow, old, Sreasy tongue coaling. When the fire is very intense, the
patient will glide into a manic phasc. When the phlegm is more dominant, the
patient w i l l feel morc depressed, which i s characterized by a laclc of drive and
energy.
Bcsides neuroleptic mediation, the palient is also lhcing treated with powerful
antidepressive drugs that are responsible for the slow and deep pulse. The slippery
aspect of the pulse denotes [he presence of phlegm.
Both the severe attacks of fear and fright as wcil as the medication have contrihulcd over the years t11 a deficiency of i<idney yin, reflectcd in ihc tongue coating
without root. When the patienl rel~orledthal thc fears and inner restlessness had
again hecome stronger, the root of thc tongue developed an intensely red discoloration. At (his point, the Kidncy yin deficiency allc~wedl<itlney fire to arise, which
conlribuled lo the agitation of the spirit.

Discussion. The longue shapc as well as the coating reflect Kidney yin deiiciency, If
the coaling is pccled and looks old, this inrlicates a laclc o i iluids and Kidncy yin
dciiciency. In this case, a new coaling was no1 produccd because o i a lack o i iluirls
and yin, not because of Stomach qi deficiency. When a peeled, old-loolcing coatins
appears in cumhination wilh an inlcnscly rcd tongue body, the Icidney yin deficiency
is very severe.

3.7

Special Tongue Shapes Associated


with Kidney Yin Deficiency
A pale, hammer-shaped tongue represents severe exhaustion o f the qi in t h e
m i d d l e burner. A red, hammer-shaped tongue is indicative o f severe exhaust i o n o f yin. Severe, l o n g - t e r m emotional problems, irregular eating habits, o r
excessive sexual activity can each lead t o t h e exhaustion o f qi a n d yin.
As discussed in Chapter 2, a deficiency o f y i n a n d essence m a y manifest
as a depression at t h e r o o t o f the tongue. In red tongues this pathology shows
itself occasionally in a contracted tongue root. This is a sign t h a t t h e yin's
strength is diminishing. I t is i m p o r t a n t t o r e m e m b e r t h a t t h e r o o t o f t h e
tongue represents t h e strength a n d vitality o f t h e Kidney energy.

Tongue Signs Associated with Kidney Disharmonies

Fig. 3.7.1
Female
29 years old

Tongue description

Chinese diagnosis

Pale red, hammer-shaped


Red on the anterior third with red points

Spleen qi, Kidney yin, and essence deficiency


Heart fire

Symptoms
Restless fetus, slight uterine bleeding (8th weekof
pregnancy)
Low-grade fever
Insomnia
Nervousness, inner restlessness, panic attacks
Pain around the kidneys
Lack of appetite

Western diagnosis
Habitual miscarriage, acute threatened miscarriage
Underweight

Baclcground to disease
Unresolved emotions due to suicide of mother
Insufficient intake of food and drink

Fig. 3.7.2
Mal
35 years ol

Tongue description

Chinese diagnosis

Red, swollen
Contracted root
Yellow, thick coating at the root

Accumulation of damp-heat
Kidney yin and essence deficiency
Accumulation of damp-heat in the lower burner

Symptoms
Occasional burning sensation with urination
Smelly soft stools
Dry cough
Exhaustion

Western diagnosis

Chronic prostatitis

Background to disease
Drugs and alcohol abuse
Severe demands at work

Tongue Signs Associated with Kidney Disharmonies


Tongue description

Chinese diagnosis

Pale red, swollen edges


Contracted root with thin, yellow coating

Spleen qi deficiency
Kidney yin deficiency with accumulation of dampheat in the Bladder

Symptoms
Frequent and urgent urination
Insomnia
Night sweats
Depression
Feeling of pressure in the stomach
Epigastric fullness

Western diagnosis
Chronic cystitis

Background to disease
Irregular eating habits
Lack of sleep
Overwork
Unresolved emotional problems

Tongue description

Chinese diagnosis

Reddish,long, soft body

Intense heat injured the fluids


Heat due to Liver qi constraint
Damp-heat lodged in the Intestines

Red edges
Yellow, greasy coating covering the anterior third of
the tongue

Symptoms
Smelly, soft stools with pus and blood
Urgency in defecation
Borborygmus
Abdominal pain
Severe loss of weight
Poor memory

Western diagnosis
Ulcerative colitis

Background to disease
Alcohol abuse
Excessive consumption of fatty, greasy foods

:ig. 3.7.4
Aale
i3 years olo

Tongue Signs Associated with Kidney Disharmonies

Endnotes
1. In some rare cases a red, wet tongue is not indicative of yin deficiency, but quite

the opposite: It reflects yang deficiency. For a discuss~onof red, wet tongues, see
Maciocia G. Tongue Diugnosis i~zChinese Medicine, rev. ed. Seattle: Eastland
Press, 199547-48.
2. Compare Li N-M. Zhongguo sheilze~zdu c/unn. Beijing: Xueyuan Publishing
Company, 1994:1196.
3. A pathological tongue coating caused by Stomach yin deficiency will be
discussed in Chapter 4.

Tongue Signs Associated


with Stomach and
Spleen Disharmonies
The relationship between tongue coatings and yin deficiency was discussed
in Chapter 3. This chapter will focus on how deficiency of fluids and yin creates
specific tongue signs indicative of disharmonies of the Spleen and Stomach.
The yin of the body is rooted in the Kidneys. All the organs and tissues
are nourished by this constructive energy. A general deficiency of yin will
eventually lead to malnourishment of the Lungs, Liver, Heart, Stomach, and,
to a lesser extent, the Spleen. Depending on the patient's constitution, Kidney
yin deficiency may lead, for example, to Lung or Heart yin deficiency.
However, a single yin organ can suffer from yin deficiency without the
pal-ticipation or involvement of Kidney yin. For example, an 'isolated' yin
deficiency of the Stomach does not necessarily mean that the yin of the
Kidneys is automatically affected. However, over the long term, deficiency of
Stomach yin will lead to Kidney yin deficiency.

4.1

4.1 .I

Tongue Signs Associated with Stomach


Yin Deficiency
Red, Dry, and Cracked in the Center of the Tongue
The Stomach plays a very important role in the production of energy and
Iluids. It is the only hollow (yang) organ that can present with a pattern ot
true yin deficiency; it has a close connection to the five yin organs.'

Tongue Signs Associated with Stomach and Spleen Disharmonies


In the Chinese medical classics, the Stomach is described as the "sea of
fluids and grains."' Solids and liquids are received, rotted, and ripened by the
Stomach. In order to properly function, the Stomach needs a damp environment, hence the saying, "The Stomach loves dampness and dislikes dryness."."
The Stomach condenses the impure part of the essence in food, which
then forms part of the body fluids. The tongue coating reflects the quality of
the Stomach qi and of the damp environment in the Stomach. A thin, white,
and moist coating is a sign of the harmonious working of healthy Stomach qi.
When taken in excess, fried or toasted foods, hot spices (curry, chili, pepper, mustard), or hot drinks (coffee) have a drying effect on the fluids in the
Stomach. In the beginning, the center of the tongue becomes dry. After a
while, the continuous intake of such foods will injure the Stomach yin. This
development is reflected in different signs in the tongue. First, a dry tongue
center is visible, which is a sign of slight deficiency of fluids. If this area
becomes redder, it reflects the development of Stomach heat. The typical
feeling of hunger that accompanies this pathology is described as follows in
Chapter 20 of the Divine Piuol (Lingshu): "When the pathogen is located in
the Stomach and Spleen, a person will suffer from pain in the muscles and
flesh. When the yang qi [Stomach] has a surplus and the yin qi [Spleen] is
insufficient, there will be la sensation of] heat in the center and the person
will be constantly hungry.""
One who suffers from Stomach yin deficiency will experience constipation, dry mouth and throat, and thirst (but without a desire to drink). Small,
irregular, or horizontal cracks in the center of the tongue, together with a
pale red tongue body, reflect the onset of Stomach yin and fluid deficiency.
The cracks can appear quite quickly as a result of improper eating habits, but
once these habits are changed, the cracks will disappear. The cracks in red
tongues often appear to be deeper than those in pale tongues because the
yin deficiency is accompanied by the development of heat.
A deficiency or lack of fluids will result in insufficient tongue coating,

which will take on a peeled appearance or show an irregular distribution. II


these types of coatings appear specifically in the center of the tongue, it is a
sure sign of Stomach yin deficiency. To summarize:
In the case of Stomach yin deficiency, the tongue coating in the center
of the tongue will be especially affected; it will be peeled, dry, or without root.
In the case of Kidney yin deficiency, a rootless, irregular-looking coating will be more widespread and will appear in connection with a red
tongue body.

Tongue SignsAssociated with Stomach and Spleen Disharmonies


Tongue description

Chinese diagnosis

Slightly pale, swollen edges


Slightly reddish center without root
White, thin coating
Depression at the root

Spleen qi deficiency (accumulation of dampness)


Onset of heat and dryness in the Stomach
Normal
.
Essence deficiency

Symptoms
Tendency to catch colds
Severe exhaustion
Desire for sweet foods
Weight gain
Loose stools

Z:;;.1.1

42 years old

Western diagnosis
None

Background to disease
Overworked
Caffeine abuse

Tongue description

Chinese diagnosis

Pale red, slightly swollen


Slightly peeled, red center
Yellow coating with red points at the root

Slight Spleen qi deficiency


Onset of heat in the Stomach
Damp-heat in the Intestines

Symptoms
Heartburn, regurgitation
Stomach pain with stress
Diarrhea after intake of dairy products

Western diagnosis
None

Background to disease
Stress due to examinations
Excessive intake of dairy products

Fig. 4.1.1.2
Male
26 years old

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale red
Peeled, red, cracked center
Yellow, greasy coating at the sides

Normal
Stomach yin deficiency with heat in the Stomach
Accumulation of damp-heat in Stomach and
Large Intestine
Heat in the upper burner, especially in the Heart

Reddish in the anterior third

Symptoms

Fig. 4.1 .I.3


Female
51 years old

Bleeding eums

See
CASE HISTORY
below

Lumbar pain

Western diagnosis

Background to disease

Fig. 4.1.1.4
Male
44 years old

Physically overworked
Late evening meals
Caffeine abuse

Tongue description

Chinese diagnosis

Pale red, slightly thin tongue body, edges slightly


pale
Vertical crack with small horizontal cracks
branching off; without coating
Slightly reddish center to the tongue

Spleen qi deficiency (slight Liver blood


deficiency)
Stomach yin deficiency
Heat in the Stomach

Symptoms
Heartburn
Stomach pain
Hot feeling in the sto~nach
Fatigue, inability to fall asleep

Western diagnosis
Reflux esophagitis

Background to disease
Irregular eating habits
Strong demands at work

Tongue SignsAssociated with Stomach and Spleen Disharmonies


Tongue description

Chinese diagnosis

Pale red
Pointed shape
Dry,red center with small cracks

Normal
Slight heat in the Heart
Heat in the Stomach at the onset of Stomach yin
deficiency
Liver qi constraint

Slightly contracted sides of the tongue

Fig. 4.1.1.5
Female
38 years old

Symptoms
Bleeding gums
Dry stools
Pain under the ribs

ee discussion

Western diagnosis

of this case

Periodontitis

on p. 218

Background to disease
Excessive consumption of spicy foods, caffeine, and
black tea

Tongue description

Chinese diagnosis

Pale red, slightly swollen sides


Small cracks a t the center of the tongue, dry center
without coating
Yellow, thin coating at the posterior third

Spleen qi deficiency (accumulation of dampness)

Symptoms
Severe itching of the skin
Damp, red skin lesions
No appetite
Feeling of fullness after eating
Soft, smelly stools
Night sweats
Inner restlessness, depressive moods

Western diagnosis
Atopic eczema

Background to disease
Family history of eczema
Alcohol and caffeine abuse
Long-standing emotional problems

Onset of Stomach yin deficiency


Slight retention of damp-heat in the lower burner

Fig. 4.1.1.6
dale

22 yearsob

Tongue Signs Associated with Stomach and Spleen Disharmonies

Tongue description

Chinese diagnosis

Red, wide, thin


Peeled, red, cracked center
Curled-up, slightly swollen edges
Reddish, curled-down tip
Yellow, slightly thick coating with red points at the
root

Injury to fluids due to heat


Stomach yin deficiencywith heat in the Stomach
Liver qi constraint with heat in the Liver
Heat from deficiency in the Heart
Accumulation of damp-heat in Large Intestine

Symptoms
Constant headache, migraines
Inner restlessness
Occasional stomach pains
Smelly, loose stools

Western diagnosis
None

Background to disease
Trauma (fracture of the skull 2 years ago]
Alcohol abuse in the past
Excessive consumption of spicy foods
Emotional problems

Fig. 4.1.1.8
Female
39 years old

Tongue description

Chinese diagnosis

Reddish
Deep crack in the center
Peeled coating at the root
Curled-up, slightly red edges
Red tip

Slight heat in the blood


Stomach yin deficiency
Kidney yin deficiency
Liver qi constraint with heat in the Liver
Heat in the Heart

symptoms
Red, itchy, dryskin at the neck and face
Sensations of heat in the body
Depression
Occasional feeling of tightness in the chest

See
CASE HISTORY

Western diagnosis

below

Atopic eczema
Allergic rhinitis
Allergic asthma

Background to disease
Weak constitution
Repressed emotions
Unhappy marriage

Tongue Signs Associated with Stomach and Spleen Disharmonies


Tongue description

Chinese diagnosis

Pale red, swollen


Thick, greasy coating on the left side

Spleen qi deficiency with accumulation of dampness


Accumulation of damp-heat in the Liver and
Gallbladder
Stomach yin deficiency
Stomach yin deficiency with accumulation of
phlegm-fire in the Stomach

Coating without root


Deep crack in the center with yellow, greasy contine

Symptoms

Fig. 4.1.1.9

Loss of hearing in lefi ear


Tinnitus and earache
Panic attacks
Inner restlessness, nervousness
Dizziness in the morning
Headaches
Insomnia
Occasional night sweats

Female
54 years old

Western diagnosis
Acute loss of hearing

Background to disease
Excessive demands at work
Emotional problems

Tongue description

Chinese diagnosis

Red, firm tongue shape


Coating without root, especially at the center and
root
Yellow, old coating

Kidney yin deficiency


Stomach and Kidney yin deficiency

Symptoms
Severe constipation
Heartburn
Stomach pains
Extreme physical weakness
Night sweats
Pain in the bones

Western diagnosis
Prostate cancer with metastasis to the bones*

Background to disease
Overwork
Emotional problems

'Patient died three months after photo was taken.

Accumulation of damp-heat in Large Intestine

Fig. 4.1.1.1 0
Male
66 years old

Tongue Signs Associated with Stomach and Spleen Disharmonies

Case History

Fig. 4.1.1.3

This 51-year-old Catholic nun worked for charity organizations since the age of
twenty. The worlc and life in the cloister drained her. She tried to fighi off continual
fatigue by increasing her intake of coffee, and ate very late at night before continuing
to work for several more hours. She often suffered from mouth ulcers and bleeding
gums. She had daily bowel movements, but her stools were very dry. Her tongue
showed a peeled, red, cracked center. Her pulse was slightly rapid (shuo) and frail
(rou).

Analysis.

A tongue center without coating i s a typical sign of Stomach yin


deficiency. Small cracks in this area point to a long-standing weakening of the fluids
in the Stomach. Late evening meals and chronic overwork are responsible for this
deficiency. This and the excessive intake of coffee gave rise to Stomach heat, which
moved the qi and blood vigorously into the Stomach channel. Since the teeth and
gums are situated along the yang brightness (yang ming) channels of the Stomach
and Large Intestine, injury to these channels by heat could well result in bleeding
gums.
Incessant mental and physical overwork, as well as heat in the Stomach, agitates
the Heart. When the heat becomes excessive, it evolves into fire. This can injure the
tongue (an offshoot of the Heart) and cause the appearance of small, red, painful
mouth ulcers. In this context it is interesting to see how, at the beginning, the redness
is found in the center of the tongue, and then later spreads to the tip of the tongue.
Heat in the yang brightness channels also involves the Large Intestine. This and
the underlying Stomach yin deficiency are responsible for the dry stools. Finally,
a slightly rapid pulse reflects the presence of heat, and the frail pulse indicates qi
deficiency from overwork.

7
Fig. 4.1.1.8

Case
History
Mrs. S suffered from atopic

eczema since the age of twenty-five. Whenever she


encountered emotionally difficult situations, her skin immediately turned red and
dry, and became very itchy. Her skin was particularly red around the neck and face.
For many years she used large amounts of cortisone creams to improve the appearance of her skin.
In addition, her marriage proved to be a great strain on her as her husband
became mentally ill. She was very anxious and fearful and unable to express her
frustration and anger. In general, she felt very unhappy and experienced times of
deep depression. As a child she experienced frequent asthmatic attacks and acute
bouts of allergic rhinitis, but they rarely manifested in adulthood. The reddish tongue
showed a very deep crack in the center, and the tip was very red. Her pulse was very
rapid (shuo), thin (xi), and slightly wiry (xian).

Analysis. The energetic condition of this patient can be characterized by a deep


constraint of Liver qi with the development of heat. The curled-up and slightly red
tongue edges confirm this diagnosis; they often appear when long-standing emotional problems cannot be resolved. Here, heat in [he blood is mainly responsible for
the condition of her skin. Over many years, the blood and fluids in the relat~vely
superficial layers of the body were injured by heal, which manifested as dry, red skin.
This woman was always sick as a child and had a weak constitution. This, together
with the application of cortisone creams for well over twenty years, were the main
factors underlying the weakening of the Stomach and Kidney yin. The rootless coat-

7b1zg1~e
Signs Associc~tedwith Stornuch a17.dSpleen Disharrnor~ies
ing of [he tongue is an imporlanl indicalion I I ~their tleiiciency. The deep crack in
tlic ccntcr rcilccls Slomacli yin dciicicncy. Tlic l<iclncyyin deficiency and internallygenerated heat disturAcd thc organ's harnmonious communication wilh ihe Heart,
maniicslccl in anxiety ancl tlcprcssivc slalcs. Finally, (he rapid and lhin pulse denotes
heat from dciicicncy clue ICI a lack I I yin,
~
and ils wiry qualily suggests ihc prcscnce
of Liver qi conslrainl.
Discussion. Tlie ccntcr oi ihc tongue sh~uldhe moist and show a lhin coaling. In
~liccase oi Slomacli yin clciicicncy, cracks or dryness will appcar in this area. An
improper diet as well as eating in a hurry, too late, or irregularly may be important
factors in the dcvclol~mcntof this deficiency. If the tongue body color is pale or pale
retl, the S~omacliyin can bc regeneratecl within w e c l ~or months, prclvided the diet
has hccn rcclificcl. However, ii thcse tongue signs appear wilh a red tongue hody, it
is indicalivc oi Slomacli anti Kidncy y i n deficiency, suggesting iliat the healing
process will lake lk~ngcr.

4.1.2

Vertical Midline Crack


A red tongue with a vertical crack along the midline and within the center of
the middle third of the tongue body is typical of Stomach yin deficiency.This
is especially true when the center is dry. A diagnosis of Kidney and Stomach
yin deficiency is confirmed when, in addition to the midline crack, the
tongue body color appears very red and presents with either a peeled coating
or none at all.

In clinical practice, this midline crack is otien seen in patients with pale
or pale red, swollen tongues. In such cases, the pathogenesis is complicated.
The swollen tongue body denotes accumulation of dampness, which arises
from a deficiency or weakness of Spleen qi. Spleen and Stomach qi deficiency often appear together. Spleen qi deficiency reduces the organ's function or transport; there is thus a lack of tl-ansport through the Stomach qi.
Reduced appetite, loose stools, or weakness of the extremities are common
symptoms of this pathology. Over the long term, however, Spleen and
Stomach qi deficiency can evolve into yin deficiency. Now, in addition to qi
deficiency symptoms, yin deficiency symptoms will also appear, for example,
epigastric pain, dry mouth and throat especially in the afternoon, and
intense thirst with no desire to drink. This yin deficiency is reflected in the
vertical crack along the midline of the tongue.
If, however, a vertical crack along the midline appears with normal
tongue body color and shape as well as a normal coating, it can be ignored,
especially i f the patient does not show any symptoms relating to the functions of the Spleen and Stomach. This is quite frequently witnessed in adults
who, in puberty or early adulthood, experienced symptoms of Stomach yin
deficiency and developing heat, but are currently free of such symptoms as
their lifestyles became Inore regulated with advancing age. Another interpretation of this tongue sign can he found in the literature: A pale or pale red
tongue with a vertical crack along the midline is interpreted as an indication
of Stomach qi deficiency.'

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Slightly red, swollen

Slight Kidney yin deficiencywith accumulation of


dampness
Onset of Stomach yin deficiency
Regeneration of Stomach yin and Spleen and
Stomach qi
Slight deficiency of essence

Thin, vertical crack


White, new, thin coating in the center
Slight depression at the root of the tongue

Fig. 4.1.2.1
Female
37 years old

31

See
CASE HISTORY

Night sweats
Severe exhaustion
Panic attacks
Sore lower back

Western diagnosis
None

Bac-und
-

to disease

Severe loss of blood followinga traumatic injury


to the underside of the leg, with subsequent
amputation

Tongue description

Chinese diagnosis

Pale, slight teeth marks

Spleen qi deficiency with accumulation of


dampness
Stomach yin deficiency with accumulation of
damp-heat

Deep, vertical crack with small amount ofyellow,


greasyfur

Fig. 4.1.2.2
Female
43 years old

Symptoms

symptoms
Frequent mucoid stools with undigestedl food
Tenesmus
Flatulence
Weight loss
Na appetite
Fatigue

below

Western diagnosis
Ulcerative colitis for 10 years
Allergic rhinitis

Background to disease
Long-standing emotional problems

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale, swollen

Spleen Yang deficiencywith accumulation of


dampness
Chronic Stomach yin deficiency
Onset of Kidney yin and essence deficiency

Deep, vertical crack


Rootless, peeled coating, and depression at the root
of the tongue

Symptoms

Fig. 4.1 2 . 3

Severe exhaustion
Heartburn
Epigastric distention
Feeling cold
Swollen,hot knee and metatarsal joints

Female
54 years old

Western diagnosis
Rheumatoid arthritis

Backgroundto disease
Diet of exclusively raw, uncooked foods
Overuse of anti-inflammatorydrugs and painkillers

Tongue description

Chinese diagnosis

Reddish with red edges, slightly swollen

Accumulation of damp-heat in the Liver and


Gallbladder
Stomach yin deficiency with accumulation of
phlegm-heat
Accumulation of damp-heat in the lower burner

Vertical crack with greasy,yellow coucing


Yellow, greasy coating at the root of the tongue

Symptoms

1
1

Fig. 4.1 2.4

Back pain with numb feeling in the left leg


Inner restlessness
Insomnia
Nervousness
Panic attacks
Smelly, soft stools
Feeling of fullness after eating

Western diagnosis
Protruding disc between the 4th and 5th lumbar
vertebrae

Background to disease
Alcohol abuse
Irregular eating habits
Suppressed emotions
Too much sitting

Male

32 years old

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale, swollen

Spleen qi deficiencywith accumulation of


dampness and blood deficiency
Stomach yin and Kidneyyin deficiency
Heart yin deficiency

Deep, vertical crack and rootless, peeled coating


Peeled coating at the tip of the tongue

Fig. 4.1.2.5
Female

Symptoms
Severe attacks of fear and panic
Feelingof pressurein the head
Inner restlessness
Cold hands and feet

52 years old

Western diagnosis
None

Background to disease
Mental overwork
Menopause

Case History

Fie. 4.1.2.2

Mrs. F fell ill with ulcerative colitis at a time of great upheaval in her personal life.
She was successfully treated with conventional medicine and stayed free of symptoms for eight years. Her stools then suddenly became soft and mucoid again, and
the tenesmus was very painful. This was accompanied by a lack of appetite, weight
loss, and a feeling of extreme fatigue. The vertical crack along the midline of her
tongue was deep and showed a small amount of greasy, yellow coating. The tongue
body was pale. Her pulse was deficient (xu) and rapid (shuo).

Analysis. Mrs. F suffered for a long time from Spleen qi deficiency that led to an
accumulation of fluids and dampness in the middle burner, as evidenced by the
pale and swollen tongue body. Dampness is a heavy factor that sinks, and, in this
case, gathered in the Large Intestine and caused the soft, mucoid stools. The dampness blocked the proper circulation of qi in the lower burner.This stagnation, due to
a collection of fluids and dampness, produced the abdominal pain and tenesrnus.
The greasy, yellow tongue coating as well as the deep vertical crack indicated the
presence of dampness and developing heat, which was also reflected in the rapid
pulse. In this patient, the heat manifested in the imperative urge to defecate.
The accumulation of dampness, due to underlying Spleen qi deficiency, was
the dominant pathological factor in this case. 8ecause the Spleen was unable to
adequately transform or transport food and nutrients, the patient suffered from
weight loss, fatigue, and lack of appetite. Although the tongue body shows the presence of Spleen qi deficiency, the vertical crack with its coating denotes the simultaneous presence of heat in the body. The vertical crack along the midline points to
severe Stomach qi deficiency.The conspicuous depth of the crack warns of developing Stomach yin deficiency, which can occur as a consequence of long-standing
diarrhea and smoldering heat.

Tongue Signs Associated with Stomach and Spleen Disharmonies

Discussion. Red tongues with deep, vertical cracks in their center are indicative oi
Stomach yin deiiciency and developing interior heat. In a palc tongue, hy contrast,
such a crack may suggcst a n old, healcd injury t11 thc Stomach yin. However, i t can
also denote weakness of Spleen and Stomach qi with thc possible development of
Stomach yin deficiency.
4.1.3

Shiny and Mirror Tongues


These tongues have no coating. ?'he entire tongue body appears very
smooth, as if the skin has been peeled off. This gives the impression of a
sheen, but in reality the tongue is dry.
The mirror tongue is sometimes also called a shiny tongue;" however,
there is a difference between the two. The shiny tongue is always red or dark
red, and is always indicative of severe Kidney yin deficiency. The tongue
body, accordingly, often shows cracks and dryness, and may even be
contracted. In the case of red or reddish tongues, a shiny tongue reflects
Stomach and Kidney yin deficiency as well as a severe lack of body fluids. If
there is a deficiency of fluids, the Stomach becomes dry and no coating is
formed. If the center of the tongue is visibly shiny, this denotes Stomach yin
deficiency. If, howevel; the entire tongue is affected, it is indicative of Kidney
yin deficiency. This tongue type is often present in the terminally ill, that is,
in the terminal stages of cancer, liver cirrhosis, or tuberculosis. This stage of
an illness is characterized by severe deficiency of fluids and yin, which is
reflected in the shiny tongue. If this kind of tongue develops during an
illness, the condition of the patient can be expected to deteriorate.
The mirror tongue is characterized by the fact that the tongue papillae
completely disappear, thus making it look like a mirror. The papillae on the
tongue depend on the true qi (zlzerz yi) and the fluids and yin of the internal
organs for nourishment. If the tluids and yin dry up, qi also diminishes, and
the tongue, particularly the papillae, will not be propcrly nourished. The
papillae become smaller and smaller, and then disappear altogether until the
longue surface is shiny like a mirror.'
It is thus clear that the origin of this type of tongue is not only a deficiency of tluids and yin, but also of qi. The mirror tongue accordingly represents a combined pattern ofqi and yin deficiency. As expected, the tongue
body color and coating (if there is one) will then show which pathology predorninales.
A mirror tongue on a pale tonguc body is indicative of severe deficiency
of blood due to a long-standing deficiency of Spleen and Stomach qi!'

In this case, the Stomach qi is too weak to build a new coating, and the
blood deficiency is so severe that thc tongue is not moistened anymore. A
mirror tongue on a pale red and dry tongue body indicates deficiency of qi
and yin in addition to the presence of heat. A mirror tongue that is red and
painful indicates deficiency o f yin with blazing fire. A mirror tongue on a
dark and purple tongue body reflects stagnation and obstruction of qi and
blood.

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale red, mirror tongue

Severe Spleen and Stomach qi deficiencywith


deficiency of fluids
Heat in the Liver
Dangerous exhaustion of yin

Slightly red, swollen sides


Tofu-like, thin coating on the leftside of the
tongueg

Fig. 4.1.3.1
Female
72 years old

Symptoms
Shortness of breath
Severe exhaustion
Weight loss
Lack of appetite

1
I

Western diagnosis
Breast cancer

Background to disease
None known

Fig. 4.1.3.2
73 years old

Tongue description

Chinese diagnosis

Reddish, mirror tongue


Small cracks in the anterior third
Tofu-like, thin coating on the left side of the tongue

Lung qi and yin deficiency,Kidney yin deficiency


Lung yin deficiency
Dangerous exhaustion of yin

Symptoms
Shortness of breath
Dry cough
Pain in the chest
Intense thirst
Night sweats
Headache
Exhaustion

Western diagnosis
Bronchial cancer

Background to disease
Cigarette smoking for 40 years

Tongue SignsAssociated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Reddish, shiny, without coating


Swollen anterior third

Severe Stomach and Kidney yin deficiency


Accumulation of phlegm-heat in the Lungs

Symptoms

Fig. 4.1.3.3

Shortness of breath
Chronic cough with expectoration of scant, thick,
yellow sputum
Dry stools
Belching
Lack of appetite

Female
75 years old
See
CASE HISTORY
below

Western diagnosis
Chronic bronchitis
Emphysema

Background to disease
Cigarette smoking for over 40 years

Tongue description

Chinese diagnosis

Dark red, shiny, slightly thin, without coating

Q---e Stomach and Kidney yin deficiency

Symptoms
Insomnia
Frequent urination at night
Acute back pain

Western diagnosis
None

Background to disease
None known, except perhaps old age

1
Fig. 4.1.3.4
Male
83 years old

Tongue Signs Associated w i t h Stomach a n d Spleen Disharmonies

Case
This 75-year-old ~ a t i e n tsuffered

from severe shortness of breath. Although the


chronic cough was very uncomfortable for her, she continued to smoke. She expectorated scant, yellow, and thick sputum, and complained about a feeling of constriction i n her chest. She felt weak and had no appetite. Her stools were dry. The reddish, shiny tongue was swollen in the anterior third. Her pulse was deficient (xu) and
floatinc lfui.

Fig. 4.1.3.3

Analysis. The reddish or red shiny tongue is always an indication of severe Stomach
and Kidney yin deficiency. In this case, the dry, red root of the tongue as well as the
deficient, floating pulse underscores the deficiency. Years of smoking caused the
buildup of phlegm-heat in the Lungs, as reflected in the anterior swollen third of the
tongue. The stronger the heat and the longer it is present in the Lungs, the more the
fluids will be 'brewed.' This causes internal clumping of phlegm-heat, which is
responsible for the thick, gummy texture of the sputum. Phlegm-heat interferes with
the downward-moving function of the Lung qi, which here not only led to a cough,
but also to the constricted feeling in the chest and the shortness of breath. Chronic
disorders of the Lungs that injure the yin and fluids may eventually lead to Kidney
yin deficiency, as indicated by the dry stools in this case. Conversely, Kidney yin
deficiency is capable of causing Lung yin deficiency, which i n turn may lead to heat
from deficiency and eventually phlegm-heat.
Discussion. Shiny or mirror tongues always reflect a serious clciiciency of fluids and
yin. This a dangerous pathological condition, as the deficiency is so serious that it
may cause a separation of yin and yang. In the worst cases, this can lead to death. If
the tongue body is pale, it i s an indication of chronic deficiency of Spleen and
Stomach qi as well as exhaustion of blood. Red, shiny tongues that give the impression of freshly peeled meat indicate a severe lack of Stomach and Kidney yin.

Tongue Signs Associated with


Spleen Yin Deficiency
In t h e first e d i t i o n o f h i s b o o k o n tongue diagnosis, Giovanni Maciocia
described cracks situated o n the sides o f the tongue as evidence o f l o n g standing Spleen qi a n d yang deficiency"' In clinical practice, these tongue
signs o f t e n appear in c o n j u n c t i o n with deep physical exhaustion. In such
cases the tongue b o d y is pale a n d often swollen, a n d thus reflects Spleen qi
deficiency. However, the process t h a t is responsible f o r the appearance o f the
cracks is n o t w e l l understood. As a rule, cracks arise w h e n heat a n d l o r dryness injures the fluids a n d eventually the yin. O f course, a process like this
can always gain m o m e n t u m a n d injure the substance, manifested in cracks
o n the sides o f the tongue. Perhaps that is why, in the second edition o f his
book, Maciocia interprets these cracks to m e a n Spleen y i n deficiency."
Surprisingly, Spleen y i n deficiency is discussed very little and has always
played a secondary role in m a n y o f the different schools o f Chinese m e d i cine. This is a l l the m o r e surprising since the other y i n organs, w h i c h are also
basically responsible for the storage a n d conservation o f essences a n d fluids,
c o m m o n l y have specific pathologies a t t r i b u t e d t o t h e i r y i n aspects. This
omission m a y s i m p l y have arisen because Spleen qi a n d yang deficiency

fongue SignsAssociated with Stomach and Spleen Disharmonies


occur so readily in people. However, it is more likely a result of the influence
of Li Dong-Yuan, author of the famous 13th-century book Discussion of the
Spleen and Stomach (Pi wei lun). Li and his followers strongly emphasized
tonifying the Spleen qi and yang with warm, sweet foods and herbs.
Nevertheless, there are other schools of thought which discuss in great detail
the signs, symptoms, and treatment methods associated with pathologies of
the Spleen yin."
The yin of the Spleen has been important in Chinese medicine for some
time. Consider, for Example, the following passage from Chapter 8 of the
Divine Pivot (Lingshu):I3
"Nutritive qi is stored in the Spleen. . . . It is the yin of the Spleen that
forms the basis of the nutritive qi and blood. Stomach yin controls the body
fluids and is regarded as the sea of fluids. The yin of the Spleen supports the
production of blood and fluids, and thus has the ability to moisten and support Stomach yin."
Despite sharing many common symptoms, there are important differences between the Stomach and Spleen yin. Exhaustion of the Spleen yin
develops very slowly, often over the course of years or during a serious illness. By contrast, Stomach yin deficiency can develop quite quickly; for
example, through an externally-contracted illness with fever and sweating, or
through poor eating habits. Qpical symptoms of Stomach yin exhaustion
include dry mouth and throat, constipation, stomach pains, and thirst that
can only be sated in small sips.
Spleen qi deficiency that has existed for a long time serves as the foundation for Spleen yin deficiency. Because of this, symptoms will manifest primarily as digestive problems. Besides the well-known symptoms of Spleen qi
deficiency (soft stools, lack of appetite, fatigue, weakness in the extremities),
other symptoms that are specific to Spleen yin deficiency include dry lips,
wasting or difficulty in gaining weight, and emaciation.'"
Over a period of time, yin deficiency causes a loss of substance, which
will manifest in the tongue as transverse cracks at the sides. If they appear in

conjunction with a red tongue body, and other symptoms just described, a
diagnosis of Spleen yin deficiency would be justified.
Spleen and Stomach yin deficiency can also be responsible for the
already described peeled tongue coating. In this case, the tongue is pale red
or red, and shows an irregularly distributed coating. The peeled coating is
shiny like a mirror, and the tongue papillae in these areas are not visible (Fig.
4.2.8).

Tongue Signs Associated with Stomach and Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale
Slightly reddish center
Thin cracksat thesides
Red in the anterior thud

Spleen qi deficiency with slight blood deficiency


Heat in the Stomach
Spleen qi deficiency
Heat in the Lungs

Symptoms

Fig. 4.2.1

Chronic cough with expectoration of thick


phlegm
Occasional difficultywithbreathing
Sneezing fits in the morning
Runny nose
Itchy eyes
Dry mouth
Premenstrual syndrome
Short menstrual cycle (21 days1

Female
46 years old

Western diagnosis
Chronic bronchitis

Background to disease
Condition followed pneumonia2 years before

Fig..4.2.2
Male
40 ye: irs old

Tongue description

Chinese diagnosis

Slightly pale, slightly thin


Thin, vertical crack at the center
Transuerse macks ar rhe sides
Red points at the tip

Spleen qi deficiency with blood deficiency


Onset of fluid deficiency in the Stomach
Severe Spleen qi deficiency
Heat in the Heart

Symptoms
Pressure pain under the ribs
Depression
Constipation
Fatigue

Western diagnosis
Poisoning through pesticides

Background to disease
Pesticide poisoning

Tongue Signs Associated with Stomach and Spleen Disharmonies


Tongue description

Chinese diagnosis

Pale, swollen
Crevices at the sides
White, wet coating

Spleen qi deficiency, slight Spleen yang deficiency


Long-standing Spleen qi deficiency
Cold-dampness attacks the Spleen

Symptoms

Fig. 4.2.3

Chronic cough with expectoration of white phlegm


Nausea
Exhaustion
Painful lower back
Insomnia

Female
53 years old

Western diagnosis
Prolapse of the pelvic floor

Background to disease
Exhaustion due to work and personal pressure
Caring for a mentally ill son
Miscarriage at the age of 45 years

Tongue description

Chinese diagnosis

Slightly pale, thin


Pale, slightly curled-up edges
Deep cracks at the sides

Spleen qi deficiencywith blood deficiency


Liver blood deficiency, Liver qi constraint

Symptoms
Severe mood swings
Depression
Exhaustion
Soft stools
Intense menstrual pains

Western diagnosis
Anorexia nervosa

Background to disease
Sexual abuse
Repressed emotions

ig. 4.2.4
male
8 years old
ee
ASE HISTORY
elow

Tongue Signs Associated with Stomach a n d Spleen Disharmonies

Tongue description

Chinese diagnosis

Pale red
Red areas a t the left edge and tip
Deep cracks a t the sides

Normal
Heat in the Heart and Liver
Long-standing Spleen qi deficiency

Symptoms
Sneezing fits
Runny nose
Exhaustion
Intense bouts of hunger
Inability to gain weight

Western diagnosis
Allergic rhinitis

Background to disease
Excessive consumption of dairy foods
Overwork
Emotional problems due to difficult divorce

Fig. 4.2.6
Female
28 years old

Tongue description

Chinese diagnosis

Reddish, slightly swollen


Long vertical crack
Cracks at the sides
Red spots at the side of the tongue

Heat in the blood


Heat in the Heart
Long-standing Spleen qi deficiency and onset of
Spleen yin deficiency
Ascending Liver yang

Symptoms

Severe migraines with the onset of menstruation


Shortened menstrual cycle (23days) with profuse
bleeding
Intense lower abdominal pain with menstrual
bleeding
Severe thirst
Dry mouth
Inner restlessness

I.

Western diagnosis
Kone

Background to disease
Irregular lifestyle
Alcohol and caffeineabuse
Overwork

Tongue Signs Associated with Stomach and Spleen Disharmonies


Tongue description

Chinese diagnosis

Reddish, swollen
Coating without root, especially a t the root of the
tongue
Cracks a t the sides

Spleen qi deficiencywith accumulation of dampness


Onset of Stomach and Kidney yin deficiency
Long-standing Spleen qi deficiency

Symptoms

Exhaustion
Fatigue
Hair loss
Tension of the neck muscles
Headache
Soft stools

Fig. 4.2.7
male

5 years old

Western diagnosis
Chondrosmoma

Background to disease
Condition followed operation to remove tumors

Tongue description

Chinese diagnosis

Reddish
Deep transverse cracks a t the sides
Cracks in the anterior third
Curled-under tip
Slightly yellow coating without root

Normal
Long-standing Spleen qi and yin deficiency
Lung yin deficiency
Heat from deficiency in the Heart
Accumulation of damp-heat in the lower burner.
Stomach yin deficiency

Symptoms

Fig. 4.2.8

Intense pain and twitching of the left leg


Insomnia
Dizziness
Urgency of urination at night
Dry mouth
Cold hands and feet

Female
78 years old

Western diagnosis
Deafness
Irregular heartbeat

Background to disease
Shock duringworld War I1 (buried under rubble)

Tongue Signs Associated w i t h Stomach and Spleen Disharmonies

Fig. 4.2.4

Case History
As a small girl, Mrs. Z was repeatedly sexually abused by a relative, and she never
fully recovered mentally from this experience. To this day, she suffers irom depression and mood swings. From ages 16 to 2 5 , she suffered irom anorexia nervosa. She
now eats regularly and has opted for a vegetarian diet. Her bowel movements are
regular, but the stools are soit. She suffers from severe menstrual cramping. She tries
to fight her inner tension by jogging. She jogs many hours a day, in all weather, w e n
though she feels exhausted. Her face is noticeably yellow. The pale red tongue body
is thin. The edges are curled up and the sides of the tongue show numerous transverse cracks. Her pulse is very wiry (xian) and thin (xi).

Analysis. This patient's sexual abuse in childhood was the basis for her mental and
physical suffering. It not only caused Liver qi constraint but also blood stagnation in
the Penetrating vessel. The qi and blood stasis are responsible for the menstrual
pains. The constrained qi led to inner tension and mood swings, which is clearly visible
in the curled-up tongue edges. The wiry pulse coniirms this diagnosis.
Her chronic starvation for nine years injured the postnatal qi. Although she
started eating regularly again, the deficiency of Spleen and Stomach qi did not vanish, but manifested as fatigue. The deficient Spleen qi failed to adequately transform
the food into blood, a condition exacerbated by her vegetarian diet. The thin tongue
body denotes deficiency o i blood. This is especially apparent in the pale tongue
sides. Due to her excessive jogging, her qi weakened even more. It is true that exercising contributes to mnving constrained Liver qi and helps one's mental condition,
but this will only be for a short time. Here, the excessive exercise and the continuing
transverse rebellion of Liver qi injured the Spleen qi. The severity of this pathology is
reilected in the transverse cracks at the sides of the tongue. The weight loss may be
due to the exercise, but may also be associated with Spleen yin deficiency.

Discussion. Cracks appearing at the sides of a pale tongue indicate severe Spleen qi
deficiency. In such cases, patients will always complain of deep exhaustion and
fatigue. It is important that such patients eat and rest regularly.
If the tongue body i s red, there may be symptoms indicative of Kidney and
Spleen yin deficiency. Besides dry mouth, lack of taste, and emaciation, there may
be night sweats and sensations of heat in the body. A red tongue with transverse
cracks on the sides must be taken seriously because it reflects not only injury to
Kidney yin, but also to Spleen and Stomach yin."

Endnotes
1. Larre C. Rochat de laValMe E. Spleen and Stomach. Cambridge: Monkey Press,
1990:135.
2. See RenY-Q. Huangdi neijingzlzungju s ~ ~ o y iBeijing:
n.
Peoples Medical
Publishing House,1986:37. See also Spleen and Stomach, 134.
3. Maciocia G. Foundations of Chinese Medicine. Edinburgh: Churchill Livingston.

1989:113.
4. See Ren, 332

5. Maciocia G. Tongue Diagnosis in Chinese Medicine, rev. ed. Seattle: Eastland


Press, 1995:79.

Tongue Signs Associated with Stomach and Spleen Dishanrionies


6. Compare 1.i N-M. Zii.ori.gg~fo
sheii?.endo c/ua,i. Beijing: Xueyuan Publishing
Company, 1994:1190.

8. See Li. 1190.l'he text cites an investigation undertaken in Inner Morlgolia and
states that the mirror tongue reflects conditions of deficiency as well as excess.
or cold as well as heat palterns. With a lieat disorder, the tongue body is red and
dry, and with a cold disorder, the tongue body is pale and wet.
9. This lofu-like coating indicates severe exhaustion of yin. See Song.1-B. Allas 01
llie Tofi.gfrea17dLirzg~ralCoatirzgs iin Chinese Medicine. Beijing: Peoples Medical
Publishing House and Editions Sinomedic, 1981:16.
10. Maciocia G. 7bfi.gueDicigri.osisi n Chinese Medicine. Seattle: Eastland Press,
1987:70.
11. Maciocia G. Tofigue Diugnosis i n CliineseMedicif7e, rev. ed. Seattle: Eastland
Press, 1995:78.
12. Clavey S. "Spleen and stomach yin deficiency: differentiation and rrcatmenl.
The IOIII~IINI
01Chilzese Medici~ie1995; 47:23-29.
13. See Ren Y-Q. Ilua~zgdifzei j i ~ z g i h a ~ z gsuo
j u y i ~ iBeijing:
.
Peoples Medical
Publishing I-louse. 1986:291.
14. Clavey, ibid
15. Compare Flaws B. My Sisler; The Moo~z.Boulder, CO, Blue Poppy Press. 1992:
Chapter 2.

C H A P T E R

..........................................................

Tongue Signs Associated


with Lung Disharmonies
5.1

Tongue Signs Associated with


Lung Yin Deficiency
In Chapter 3 it was noted that Lung yin deficiency can develop during the
course of an illness, or, depending on the individual's constitution, from
Kidney yin deficiency. This chapter focuses on the early and later stages of
Lung yin deficiency that develops independently of Kidney yin deficiency. An
important causative factor of an 'isolated' Lung yin deficiency is smoking.
Over the long term, smoking generates heat in the Lungs, which gradually
leads to a clumping of Lung fluids. The pathology is characterized by
'smoker's cough,' which typically occurs in the morning and causes the
expectoration of thick, discolored phlegm. Many years of smoking leads to a
dry or irritating cough, a result of the phlegm drying up. The heat in the
Lungs shows itself in the anterior third of the tongue, which will be red. In the
case of a more advanced stage of injury to the Lung yin, this area of the
tongue will present with small, thin cracks (Fig. 5.1.5). In such cases, the
color of the tongue body is very often reddish or red.
Years of working in dry, dusty conditions can also cause Lung yin deficiency. Bakers and miners, for instance, often suffer from this condition. The
Lung yin can also be injured by external dryness, either from extremely dry
weather or central heating and air conditioning. Dryness in the Lungs manifests as a dry cough and dry throat or mouth. When Lung yin deficiency has
manifested, additional symptoms such as hoarseness, itchiness of the throat,
occasional blood-tinged sputum, and a feeling of heat in the body or of subfebrile temperatures in the afternoon will also appear. Dryness in the Lungs
is reflected in a dry tongue. An intense red discoloration of the tongue body

Figure 5.1.5

Tongue SignsAssociated with Lung Disharmonies


will only appear when there is both Lung and Kidney yin deficiency (Fig.
5.1.11).

Figure 5.1 .I 1

Figure 5.1.1

Figure 5.1.9

Teachers, singers, and actors frequently suffer from Lung qi or yin deficiency. Overuse of the voice may l 4 d to a weakening of the gathering qi
(zong qi). This energy controls the strength of the voice and influences
speech as it supports the qi of the Heart and Lungs. Early signs of gathering
qi deficiency are a depression in the anterior third of the tongue and a pale
tongue body (Fig. 5.1.1). Such individuals may also have a tendency to catch
colds or have trouble with their voice. Deficiency of the gathering
- qi- is often
accompanied by symptoms indicating Heart and Lung qi deficiency.
Occasionally, this tongue sign appears in people who suffer fromlong-standing sadness and grief. Sadness disperses Lung qi and weakens Heart qi. If
sadness and grief remain unresolved for many years, the Lung qi deficiency
may evolve into Lung yin deficiency (Fig. 5.1.9).
A tongue body that is red with many small cracks and with a depression
in its anterior third may indicate the onset of Lung yin deficiency. Patients
who suffer from Stomach yin deficiency will also often show signs of Lung
yin deficiency. If the fluids in the Stomach are injured or exhausted, the yin of
the Lungs will be undernourished. Stomach yin deficiency that leads to Lung
yin defiAency is reflected in a vertical crack along the midline of the tongue
and small cracks over the anterior third of the tongue.
Frequent illness caused by wind-heat, which often manifests in sore
throats or loud, barking coughs, can also lead to Lung yin deficiency.
Persistent, long-lasting coughing can injure the Lung qi, which will eventually affect Lung yin. In the case of feverish illnesses, when heat has entered
the qi level and lingers in the Lungs and Stomach, the anterior third of the
tongue will have red points. These reflect either the presence of toxic heat or
heat in the Lungs. An illness of this nature can also produce Lung yin deficiency, as the heat will injure the fluids in the Stomach and Lungs (Fig. 5.1.3).
Specific tongue signs indicating Lung yin deficiency will be evident.

Tongue Signs Associated with Lung Disharmonies


Tongue description

Chinese diagnosis

Pale red, swollen, with teeth marks


Depression in theanterior third

Spleen qi deficiency (accumulation of dampness)


Deficiency of gathering qi and Lung qi

Symptoms

Figure 5.,1.1
Male
32 years old

Runny nose
Sneezing fits
Tightness of the chest
Cough
Occasional difficultbreathing
Tendency to catch colds

Western diagnosis
Allergic rhinitis
Allergic asthma

Background to disease
Family history of allergies
Overuse of voice (opera singer)
Overworking
Irregular eating habits

Tongue description

Chinese diagnosis

Pale with slight teeth marks


Depression in the anterior third
Slight reddening of the tip
Yellow, thin, greasy coating

Spleen qi deficiencywith blood deficiency


Deficiency of gathering qi and Lung qi
Slight heat in the Heart
Slight accumulation of damp-heat in the lower
burner

Symptoms

Figure 5.I .2

Dry throat
Dry cough
Tendency to catch colds
Constipation
Insomnia
Exhaustion

Female
56 years old

Western diagnosis
Prolapse of the uterus

Background to disease
Overwork
Lack of sleep

Tongue SignsAssociated with Lung Disharmonies

Tongue description

Chinese diagnosis

Pale with slight teeth marks


Vertical crack in the anterior third
Red points a t the tip
White, greasy coating

Spleen qi deficiency [blood deficiency)


Onset of Lung yin deficiency
Heat in the upper burner
Food stagnation

Figure 5.1.3

Female
31 years old
See

CASE HISTORY

Symptoms
Dry mouth at night
D~Skin
Constipation
Bloated abdomen

Western diagnosis

below

None

Background to disease
Long-lasting pertussis one year ago
Overwork
Smoking

Tongue description

Chinese diagnosis

Reddish with curled-up edges


Vertical crack in the anterior third
Yellow, thick, dry, coating

Liver qi constraint (slight Spleen qi deficiency)


Lung and Heartyin deficiency
Accumulation of damp-heat in the lower burner

Symptoms

Figure 5.1.4
Male
65 years old

Pressure and fullness in the chest


Shortness of breath upon exertion
Intense thirst
Pain during urination
Back and abdominal pain

Western diagnosis
Coronary heart disease
Kidnev stones
Type I1 diabetes

Background to disease
Smoking for 35 years
Heavy physical labor

Tongue Signs Associated with Lung Disharmonies


Tongue description

Chinese diagnosis

Reddish, slightly thin


Curled-up, slightly red edges
Cracks in the anterior thud'
Yellow, thin, greasy coating

Slight blood and yin deficiency


Liver qi constraint with heat in the Liver
Lungyin deficiency with heat in the Lung
Slight accumulation of damp-heat in the lower
burner

'

Symptoms

Figure 5.1.5
Male
41 years old

Dry cough
Pain in the chest
Stomach pain
Difficultysleeping
Tendency to develop high fevers
Irritability

Western diagnosis
Acne vulgaris

Background to disease
Abuse of nicotine, black tea, and cannabis
Irregular lifestyle
Frequent viral and bacterial infections with high
fevers

Tongue description

Chinese diagnosis

Pale red, very swollen

Underlying Kidney yang deficiency (accumulation


of dampness in the middle and upper burners)
Blockage of Lung qi due to accumulation of dampness, blockage of water pathways (onset of Lung yin
deficiency)

Swollen, dry, and cracked in the anterior third and


center of the tongue

Symptoms
Frequent colds with cough
Shortness of breath
Swollen lower legs
Dizziness
Intense inner feeling of cold

Western diagnosis
Edema of the lower legs
Chronic bronchitis

Background to disease
For years, her work required that she stand
Overwork

Figure 5.1.6
Female
58 years old

Tongue SignsAssociated with LungDisharmonies

Tongue description

Chinese diagnosis

Pale red, pale edges


Deep horizontal cracks in the center and anterio~
third
Slight swelling in the anterior third
Red in the anterior third

Spleen qi deficiencywith blood deficiency


Stomach and Lung yin deficiency

Dry

Retention of phlegm in the Lungs


Heat in the upper burner
Deficiency of fluids

Figure 5.1.'

Symptoms

Female
28 years old

Chronic cough with profuse, white, and slightly


yellow mucus
Nasal congestion
Dry throat
Exhaustion
Mood swings

Western diagnosis
Chronic sinusitis
Chronic bronchitis

Background to disease
Repressed emotions
Excessive consumption of spicy foods

Tongue description

Chinese diagnosis

Pale red, thin


Small irregular cracks in the anterior third
Yellow, dry coating without root in the posterior
third

Spleen qi deficiency with slight blood deficiency


Onset of Lung yin deficiency
Onset of Kidney yin deficiency with retention of
damp-heat

Figure 5.1.8

Symptoms

Male
35 years old

Chronic dry cough


Dry mouth
Thirst
Inability to fall asleep

Western diagnosis
Chronic bronchitis

Background to disease
Cigarette smoking for many years
Irregular lifestyle

Tongue Signs Associated with LungDisharmonies

Tongue description

Chinese diagnosis

Reddish, rough tongue surface


Red edges
Deep, irregular crack in the anterior third
Deep red spots at the tip
Yellow, thick, greasy coating especially at the roo1

Onset of Kidney yin deficiency


Heat in the Liver
Lungyin deficiency
Long-standing retention of toxic heat
Accumulation of damp-heat in the lower burner

Symptoms

Figure 5.1.9
Female
38 years old

Difficult breathing
Dry mouth
Thirst
Night sweats
Restlessness
Tendency to catch colds

See

CASE HISTORY
below

Western diagnosis
Chronic tonsillitis with abscesses of the crypts
Allergic rhinitis
Bronchial asthma

Background to disease
Repressed emotions, especially grief and feelings of
guilt due to having given birth to a handicapped
child
Family history of respiratory diseases

Tqngue description

Chinese diagnosis

Pale red, slightly swollen

Slight Spleen qi deficiency (accumulation of


dampness)
Stomach yin deficiency
Lung yin deficiency

Small horizontal cracks over the entire tongue


Deep, irregular cracks in the anterior third

Symptoms

Figure 5.1.1 0

Chronic cough with sticky, yellow mucus


Intense thirst
Constipation

Female
51 years old

Western diagnosis
Chronic bronchitis

Background to disease
Dusty working conditions
Excessive consumption of dairy foods

Tongue SignsAssociated with LungDisharmonies

Figure 5.1.11
71 years old

"Ie

Tongue description

Chinese diagnosis

Deep red
Contracted, red, dry, peeled in anterior third

Kidney yin deficiency with lack of fluids


Lungyin deficiency

Symptoms

Cough with blood-tinged sputum


Pain in the chest
Dry throat and mouth
Night sweats
Exhaustion
Western diagnosis
Bronchial cancel
Background t o disease
Smokingfor 50 years

Case History

:1g. 5 . . ._

Mrs. S, 31 years old, worked as journalist. A year ago she contracted pertussis. She
did not react well to conventional treatment and suffered for weeks with coughing
fits. She continued to smoke during the illness, however. Since then, her skin felt
very dry, and she was very constipated with dry stools. She also complained about a
severely bloated abdomen. The tongue body was pale and showed a crack in its
anterior portion. The pulse was noticeably choppy (se).

Analysis. Mrs. S was very healthy until she contracted pertussis. This is reflected in
the normal tongue shape. The pale tongue and choppy pulse indicate blood deficiency. The white, greasy tongue coating points to food stagnation caused by hectic
eating habits at work. Food stagnation disrupted the downward-moving actions of
Stomach qi, which caused abdominal distention. The constipation was due to a lack
of blood to moisten the Intestines as well as the lack of descending Stomach qi.
The vertical crack in the anterior third of the tongue is associated with the pertussis and the persistent coughing fits. Both injured the Lung yin. The patient's continued smoking gave rise to heat in the Lungs, which was an additional contributing
factor. In Mrs. S, Lung yin deficiency manifested as dryness, that is, dry mouth, skin,
and stools.

Tongue Signs Associated with Lung Disharmonies

Case History
Mrs. L, 38 years old, appeared exhausted. She looked after her physically and mentally handicapped child night and day. Her marriage had become strained because
she spent too little time with her husband. Sadness, feelings of guilt, and deep-seated
anger over her circumstances determined her emotional life. For months she suffered
from restlessness and night sweats. After any emotional stress or physical exertion
she felt a tightness in the chest and occasionally experienced difficult breathing. She
was susceptible to colds and suffered from frequent tonsillitis. She was therefore
unable to cope with the tasks of her life.
The tongue coating was yellow and greasy, especially in the posterior third. The
deep, irregular, vertical crack in the anterior third of the tongue was particularly
noteworthy. The tip of the tongue showed dark red spots, and the edges of the tongue
were red. Her pulse was rapid (shuo) and wiry (xiani.

Analysis. Mrs. L's unresolved emotions caused Liver qi constraint, which led to heat
in the Liver. This is manifested in the tongue's red edges and the wiry quality of the
pulse. Her long-standing sadness had injured both the Lung qi and yin, which occasionally led to asthmatic attacks. The tongue reflects both of these pathologies quite
clearly: the red edges show Liver heat while the deep vertical crack in the anterior
third of the tongue indicates Lung yin deficiency. Lung qi and yin deficiency contributed to her tendency to catch colds, which were characterized by sore throats
and inflamed, swollen tonsils. The dark red points at the tip of the tongue reflect the
presence of toxic heat, which was retained in the chronically inflamed tonsils.
The underlying Kidney yin deficiency gave rise to heat, which in this case manifested as night sweats, while the heat in the Liver contributed to the accumulation of
heat in the interior.This heat depleted the fluids, resulting in a dry mouth and intense
thirst.The greasy, yellow coating in the posterior third of the tongue reflects the presence of damp-heat in the lower burner, which has not yet caused any corresponding
symptoms in the patient.

Discussion. Lung yin deficiency will always lead to dryness and/or heat from deficiency. As a rule, this will be reflected in changes in the anterior third of the tongue:
redness, dryness, and the formation of cracks. The appearance of any of these tongue
signs should be a signal to abstain from eating spicy, hot foods and herbs, and (more
importantly) from smoking; all of these activities will have a drying and heating effect
on the body.

Fig. 5.1.9

Tongue SignsAssociated with Lung Dishanonies

Tongue Signs Associated with


Constitutional Weakness of the Lungs
Two vertical, parallel cracks in the anterior third of the tongue are indicative
of an inherited disposition toward weakness of the Lungs. If a parent or
grandparent had contracted or died of tuberculosis, this tongue sign may
appear one or two generations later. In my experience these cracks suggest
the frequent appearance of chronic illness of the respiratory tract, for example, bronchial asthma. They point to a tendency toward both Lung qi and yin
deficiency. In these cases, the diagnosis of the tongue provides important
information about the constitution of the patient. When such cracks are evident, the practitioner must inquire about the family history. A positive
answer indicates a constitutional weakness of the Lungs, which must be
taken into consideration when determining the treatment plan.

Tongue description

Chinese diagnosis

Pale red, slightly wet


Two parallel oblique cracks in the anterior third

Spleen qi deficiency
ConstitutionalLung yin and qi deficiency
Symptoms

Figure 5.2.1
37 years old

Palpitationswith or without exertion


Tendency to catch colds
Painful knees
Fatigue
Western diagnosis
Cardiac arrhythmia
Reiter's disease

1
I

Background to disease
Family disposition toward Lung weakness [grandmother died of tuberculosisl
Overwork
Emotional problems

Tongue Signs Associated with Lung Disharmonies


Tongue description

Chinese diagnosis

Pale red, swollen, slight teeth marks


One oblique, mrtical crack in theanterior third

Spleen qi deficiency(accumulation of dampness)


Constitutional Lung yin and qi deficiency

Symptoms
Runny nose
Sneezing fits
Pressure in the chest
Occasional difficult breathing
Soft stools
Fatigue
Western diagnosis
Allergic rhinitis
Background to disease
Family history of respiratory illness
Overwork

5.3

Special Tongue Signs


Swelling in the anterior third of the tongue is indicative of retention of
phlegm in the Lungs. Very often, this tongue sign will appear in conjunction
with a pale tongue body. The damp-phlegm in such cases is associated with
underlying Spleen qi deficiency. Fluids accumulate and form phlegm if the
Spleen qi is too weak to transform and transport solids and liquids. The
phlegm is retained in the Lungs where it interferes with the qi mechanism
and leads to coughing with copious white and easily-expectorated sputum.
This may show up on the tongue as a white, slippery coating. The swelling in
the anterior third of the tongue reflects the chronic nature of this pathology.
If this sign appears in conjunction with a red tongue body and a yellow,
greasy coating, it is an indication that the phlegm coexists with heat. The
patient will then be coughing up yellow, viscous sputum.

Figure 5.2.2
36 years old

Tongue SignsAssociated with Lung Disharmonies

Tongue description

Chinese diagnosis

Pale, swollen
Swollen in theanterior third
Whitish. thin coatine

Spleen qi deficiency accumulation of dampness)


Retention of damp-phlegm in the Lung
Normal

Symptoms

Figure 5.3.
Femal
41 years ol

Cough with copious white mucus


Tendency to catch colds
Exhaustion

Western diagnosis
Chronic bronchitis
Several miscarriages

Background to disease

Figure 5.3.2
Female
37 years old

Overwork
Irregular eating habits

Tongue description

Chinese diagnosis

Pale-red, slightly swollen


Swollen in theanterior third
lepression in the anterior third

Spleen qi deficiency [accumulation of dampness)


Retention of damp-phlegm in the Lungs
Gathering qi and Lung qi deficiency

Symptoms
Feeling of tightness in the chest
Tendency to catch colds
Severe exhaustion
Cold hands
Soft stools

Western diagnosis
None

Background to disease

Overwork

Tongue Signs Associated with Lung Disharmonies


Tongue description

Chinese diagnosis

Pale red
Swollen in theanterior third
Red points on the anterior third
Yellow, slippery coating at the root

Slight Spleen qi deficiency


Retention of damp-phlegm in the Lungs
Acute, externally-contracted wind-heat
Retention of damp-heat in the lower burner

Symptoms

Figure 5.3.3

Sore throat
Dry cough
Joint pain
Weight gain
Inability to sleep through the night

Female
48 years old

Western diagnosis
Acute cold
Ovarian cancer
Hypothyroidism

Background to disease
Condition followed chemotherapy

Tongue description

Chinese diagnosis

Pale
Swollen in theanterior third
White, wet coating

Spleen qi deficiency
Retention of phlegm in the Lungs
Acute, externally-contracted wind-cold

Symptoms

Figure 5.3.4

Cough with profuse white mucus


Tendency toward chronic bronchitis
Catches colds easily
Fatigue
Profuse menstrual bleeding

Female
36 years old

Western diagnosis
Iron deficiency anemia
Acute cold, chronic bronchitis

Background to disease
Sadness and grief after the death of mother
Repeated use of antibiotics
Overwork

Tongue Signs Associated w i t h LungDisharmonies

Figure 5.3.5
Female
52 years old

Tongue description

Chinese diagnosis

Pale red, slight teeth marks


Swollen in the anterior third
Red points in the anterior third
Yellow, greasy coating in the posterior third

Spleen q i deficiency
Retention of phlegm in the Lungs
Remaining pathogenic heat lingering in the Lungs
Retention ofdamp-heat in the lower burner

Symptoms
Cough with profuse white, frothy mucus
Phlegm in the throat
Pressure i n the sinuses
Frequent blood-tinged sputum
Loss of sense of smell and taste after a cold

Western diagnosis
Acute cystitis
Pulmonary emphysema
Bronchial asthma

Background to disease
Family disposition toward illnesses of the
respiratory tract
Overwork

Case History
Mrs. H, 41 years old, worked as a pharmacist. She complained of chronic fatigue.
She was always busy and never took any time off to rest or relax. In her spare time,
she and her husband renovated an old farmhouse, which was physically exhausting.
The dusty environment contributed to the onset of Mrs. H's chronic cough. She had a
tendency to catch colds, which always exacerbated the cough. She coughed up

:ig. 5 .

copious amounts of white sputum. During this time the patient became pregnant but
had a miscarriage in her seventh week of pregnancy. Her diet was very irregular, and
she preferred cold or hardly cooked foods. Her tongue was pale, and especially
swollen in the anterior third. Her pulse was submerged (chen) and frail (ruo).
Analysis. The pale, swollen tongue and the submerged, frail pulse indicate deficiency of qi and blood. In this patient, Spleen qi deficiency resulted from chronic
overwork, lack of rest, and inappropriate diet. The miscarriage was a result of the qi
and blood becoming so weakened that the fetus was undernourished.
The accumulation of phlegm in the Lungs was reflected in the constant expectoration and in the swelling of the anterior third of the tongue. The presence of phlegm
disrupted the descent of Lung qi, which led to the chronic cough. However, the
underlying pathology is the Spleen qi deficiency, which over the long term led to the
formation of phlegm. The Spleen and Lung qi deficiency are responsible for the
chronic fatigue. With the help of Chinese herbs, the cough has cleared and the
patient has given birth to a healthy child.

Tongue Signs Associarecl with Lung Disharmonies


Discussion. Swelling in the anterior lhird o i thc tongue is an indication of the accumulation of phlegm in the Lungs. Patients with this tongue sign will often suffer from
illnesses affecting the respiralory tract. Coughing with expectoration of copious
amounts or sputum is typical of phlegm obstructing the Lungs. Dietary changes
should be advised, and phlegm-producing roods should be avoided.

Endnote
1. 'I'he following passage appears in Co~npendiurnofcharts ancl Books Pas1 arzd

Present: Complete Collectiofi of the Medical Section (Gu j i n r u shu ji cheng: Yi DL


I
c l ~ ~ alu).
i ? Beijing: Peoples Medical Publishing House, 1991: 531: "The tongue
looks red and shows a crack that resembles the character for man (re!%),which
means that the ~ninisterialfire is blazing and toxic heat burns. I t i s appropriate
to administer Cool the Diaphragm Powder (liangge safi)." The patient here shows
this tongue sign. It is interesting to note that within a year after the photo was
taken, he developed acute porphyria cutanea tarda (a hepatic disorder).

Tongue Signs Associated with


Disharmonies of the Heart
Heart yin deficiency occurs frequently in older people. Symptoms caused by
this deficiency tend to bc sleeping disorders, dry mouth [especially at night).
and increased anxiety. The diminished strength of Kidney yin, which is less
able to nourish the I-leart yin, is physiologically normal in old age. The Heart
is linked to the element fire and has a close affinity to heat. As the cooling.
calming qualities of yin diminish, heat tends to rise faster. tleart yin deficiency can also develop in young people and is related to long-standing
emotional problems, constant excitement and agitation, stress, hectic
lifestyles, drug abuse, or a constitutional weakness of the Heart.
It is important to closely inspect the shape and color of the tip of the
tongue, as this reflects the state of the Heart energies. A red, swollen tip
is indicative of the flaring-up of heat from deficiency of the 1-ieart.l A red,
cracked tip, or a long midline crack on a red and peeled tongue, may reflect
Heart yin deficiency.
A general deficiency of blood, commonly found in women, can lead to
Heart blood deficiency. The Heart depends on an adequate supply of blood
to support its function of storing the spirit. When the I-kart is deprived of this
nourishment, the patient will present with anxiety andlor insomnia. In general. Heart blood and I-leart yin deticiency share some common symptoms:
palpitations, anxiety, forgetfulncss, and dream-disturbed sleep. However, the
two can be distinguished by their effect on sleep and differences in tongue
signs. In the case of blood deficiency, the patient may Find i t difficult to fall
asleep, but once asleep, she will continue to sleep through the night. In addition, because the blood that reaches the tongue is inadequate, the tongue
a n d tongue body color will be pale. By contrast, in the case of Heart yin
deficiency, the patient will wake u p frequently during the night and be very
restless. Also, the tongue body color tends to be red.

Tongue SignsAssociated with Disharmonies of the Hearl

Figure 6.3.6

Figure 2.1.1 1

Over the long term, Heart blood deficiency may lead to heat from deficiency of the Heart. Because blood is part of yin, over time Heart blood
deficiency can also affect Heart yin. Both processes can be seen when the
tongue tip is red and the tongue body is pale (Heart blood deficiency with
flaring heat from deficiency) or there is a pathological change in the shape of
the tip (Fig. 6.3.6).
The symptoms of heat or fire from deficiency of the Heart-irritability,
palpitations with anxiety, insomnia, restlessness, and a dry mouth and
throat-are much more pronounced in Heart yin deficiency than in Heart
blood deficiency. In the former case, the tongue body will be red with a
strongly discolored red tip, or there may be, in addition to a peeled coating, a
lnng vertical midline crack.
In this chapter we will discuss the tongue signs associated with the
patterns mentioned above as well as those associated with constitutional
weakness of the Heart. The latter condition may contribute to the formation
of heat in the Heart or to Heart yin deficiency.
In the case of Heart yang deficiency, the tongue body will be pale, swollen, and wet. Besides fatigue and exhaustion, the patient will often experience
severe shortness of breath upon exertion. If Kidney yang deficiency accompanies this condition, there will also be sensations of cold in the body (Fig.
2.1.11).

Tongues Signs Associated with


Constitutional Weakness of the Heart
Long Tongues
A long, pale red or pale tongue that is big but within the normal range points
to a strong constitution. As a rule, tongues tend to be narrow or thin. If the

tongue is very pointed towards the tip and of a reddish color, it may indicate
a constitutional weakness of the Heart. If the tongue body is reddish or red
and shows reddish areas on the tongue body surface, it is an indication of the
presence of internal heat. Heat in the body not only dries the body fluids, it
also moves qi and blood vigorously. This movement of qi and blood causes
the tongue to be extended so that it will protrude further from the mouth
than normal. The opposite mechanism obtains for short and pale tongues.
Cold slows down the flow of qi and blood and its contracting effect manifests
in a short, often contracted, tongue body.
A long, reddish tongue often appears with a firm tongue body. Longstanding heat depletes fluids and yin, which in general causes hardness,
firmness, and dryness of the tongue body. On the other hand, an accumulation of yin (dampness) is responsible for a swollen and soft tongue body.
The diagnosis of heat in the Heart is confirmed by the appearance of a
long tongue with a very red tip or red points on the tip. It is not surprising,
therefore, to find a long tongue, which is often seen as an indication of heat
in the body, in conjunction with a reddish or red tongue body. The degree of
narrowness of the tongue body reflects the extent of injury to the body fluids
and yin. In general, a long, reddish, and especially firm tongue indicates a
tendency to yin deficiency. Further, since yin deficiency often gives rise to
heat from deficiency, which readily affects the Heart, a long tongue may
specifically point to an imbalance in the fire phase.

6.1 .I

Tongue Signs Associated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Reddish, very long


Slightly red edges
Yellow, greasy coating in middle and posterior thirds

Constitutional heat in the Heart


Heat in the Liver
Retention of damp-heat in the middle and lower
burners

Symptoms

'igure 6.1.1.1

Raised, bleeding skin lesions


Strong itchiness
Soft stools
Inability to fall asleep

female
22 years old

Western diagnosis
Lichen simplex (an eczematous dermatitis)

Background to disease
Caffeine abuse
Frustration

Tongue description

Chinese diagnosis

Pale red, long


Drawn-in sides in the anterior third
Slight reddening of the tip with curled-down tip

Constitutional heat in the Heart


Onset of Heart yin deficiency
Heart blood deficiency

Symptoms
Headaches
Stomach pains with stress
Inability to fall asleep
Inner tension, inability to bear any emotional
pressure
Nervousness

Western diagnosis
Uterine fibroids

Background to disease
Repressed emotions

Figure 6.1.1.2
Female
39 years old

Tongue Signs Associated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Pale red
Long, pointed shape
Red tip
Vertical crack in the center

Normal
Constitutional weakness of the Heart
Heat in the Heart
Phlegm-fire in the Stomach

Symptoms

Figure 6.1.1.3
Female
14 years old

Acute stomach pains


Hypochondriac pain
Heartburn
Insomnia
Restlessness
Ravenous hunger

Western diagnosis
None

Background to disease
Irregular lifestyle
Caffeine and cannabis abuse

Tongue description

Chinese diagnosis

Slightly pale
Long
Vertical crack in the center with rootless coating

Slight Spleen qi deficiency (blood deficiency)


Constitutional weaknessof the Heart
Stomach yin deficiency, onset of Kidney yin
deficiency

Figure 6.1.1.4
Female
2 y e a r old

Symptoms

Inability to relax
Inner tension
Headaches with tight neck muscles
Pain and weaknesi of the lumbar area
Occasional numbness and tingling ofthe
arm
Insomnia
Fatigue

Western diagnosis
Neck pain
Primary infertility

Background to disease
Overwork
Perfectionist attitude

Tongue Signs Associated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Reddish, long, narrow

Heat with injury to the fluids, constitutional heat in


the Heart
9ccumulation of damp-phlegm in the Stomach

Slightly yellow, thick, greasy coating

Symptoms

Figure 6.1.1.5

Stomach pain with stress


Epigastric fullness
Lack of appetite
Depression
Fatigue

Female
42 years old

Western diagnosis
Polyps in the stomach

Background to disease
Overwork
Emotional problems due to death of mother and
divorce in the same year

Tongue description

Chinese diagnosis

Red, very narrow, contracted


Long, firm tongue body
Slightly deviated
Red tip
Midline crack over the entire tongue body
Old, yellow coating

Severe exhaustion of Kidney yin and essence


Lack of body fluids
Onset of internal wind
Heat in the Heart
Constitutional weakness of the Heart
Injury to body fluids due to heat from excess

Symptoms

Figure 6.1.1.6

Atrophy and pain of facial muscles


Complete loss of all body and head hair
Facial eczema
Exhaustion
Insomnia
Unwanted weight loss

Female
38 years old

Western diagnosis
Atypical, progressive collagen-vascular disease

Background to disease
Weak constitution
Night work for many years
Chronic lack of sleep
Irregular eating habits
Tea and coffee abuse
Overwork
Excessive use of willpower

.-

Figure 6.1.1.4

Tongue SignsAssociated with Disharmonies of the Heart

Case History
Mrs. H is 32 years old and runs her own architectural business. She describes herself
as a perfectionist. She is thus very critical of herself and the people around her, causing her to experience constant inner tension. At the same time, she is always worried
about not being successful. She connects this fear to a feeling of tension around the
neck and shoulders. She works more than 60 hours a week; the lack of spare time
means she eats irregularly. She also drinks a lot of coffee and sleeps very little. The
physical symptoms of which she complains are headaches and tension around the
shoulders and neck. She is also extremely worried about her infertility.The tongue i s
noticeably long and shows a rootless coating. Her pulse is slightly (apid (shuo) and
choppy be).

Analysis. For constitutional reasons, her emotional reactions give rise to heat in the
Heart, as manifested in the red points at the tip of the tongue and the slightly rapid
pulse. Because the discoloration of the red points at the tip is not very severe, the
heat in the Heart appears to be of recent origin, possibly related to starting her own
business. However, the long tongue body reflects a constitutional tendency toward
the development of heat in the Heart. Stress, a hectic lifestyle, and inner tension lead
more readily to the formation of heat in those with this tendency than would be the
case in individuals with other types of constitution.
The patient's irregular eating habits and excessive consumption of coffee has
injured her postnatal qi, which in the long run will lcad to malnourishment of Kidney
yin and essence. The onset of this pathology is reilected in the rootless coating on the
posterior third of the tongue, as well as the soreness in her lower back.
The vertical crack in the midline of the tongue indicates a slight deficiency of
Stomach yin. Although the pale tongue and the choppy pulse denote blood deficiency, the pathology of the patient also points to the onset of Heart and Kidney yin
deficiency. The sleeping problems, restlessness, and functional infertility point to
blood as well yin deficiency. The occasional headaches and the tingling and numbness are related to Liver blood deficiency.
Treatment consisted of harmonizing the communication between the Heart and
Kidney, and strengthening the blood and Kidney yin. Tai ji chuan, acupuncture, and
herbs helped all the symptoms, including the infertility; two years later, she gave
birth to a healthy baby.

Discussion. The long tongue reflects disharmony between fire (Heart) and water
(Kidneys), which may in some cases be of constitutional origin. This disharmony may
give rise to symptoms like restlessness and sleeping disorders that go hand in hand
with deep-seated fears and long-lasting exhaustion.

Tongue SignsAssociated with Disharmonies of the Heart

6.1.2

Tongues with a Long,Vertical Crack in the Midline


A crack in the midline of the tongue is often seen as an indication of Stomach
yin deficiency. The crack appears in the middle third of the tongue and is
very often deep and wide. Constitutional weakness of the Heart can also present with a deep midline crack. This crack, however, is much longer than the
former. It starts in the posterior third and runs to the tip or just short of the
tip. If the tongue body color is pale red or normal, and if the crack is thin,
there may be no pathology. The crack may simply indicate that there is possible constitutional weakness of the Heart. If, however, the tongue body is very
red and the midline crack is very deep, Heart fire is probably present. If such
is the case there will also be restlessness, irritability, palpitations, and mouth
ulcers. If the crack is covered by a yellow, greasy coating, phlegm-fire is agitating the Heart. In this case the patient will exhibit restless agitation, a bad
temper, and manic behavior. Finally, a red tongue body with a rootless or
peeled coating in conjunction with a long, vertical midline crack indicates
deficiency of Heart and Kidney yin.
A constitutional weakness of the Heart does not mean an organic weakness of the Heart. In those with this tongue type there is a tendency toward
certain kinds of mental or emotional weakness: frequent attacks of melancholy
and crying spells, emotional instability, fearfulness since childhood, depression. However, with an appropriate lifestyle, there may be no symptoms at
all. Great care must be taken, therefore, when assessing the significance of
this crack.

Tongue description

Chinese diagnosis

Reddish, slightly swollen

Slight Spleen qi deficiency (accumulationof


dampness)
Constitutional heat in the Heart with phlegm-fire in
the Stomach
Heat in the Heart
Accumulation of dampness

Long, vertical crack in the center with yellow, thin,


greasy coating
Red tip
White, greasy coating
Symptoms
Panic attacks with fainting spells
Palpitations
Severe feelings of fear
Diarrhea with emotional pressure
Western diagnosis
None
Background to disease
Long unhappy marriage
Overwork
Excessive consumption of chocolate

Figure 6.1.2.1
Female
35 years old
See
CASE HISTORY

below

Tongue Signs Associated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Reddish, slightly swollen


Long, vertical crack in the center with slightly
yellow, thin, greasy coating

Spleen qi deficiency (accumulation of dampness)


Constitutional heat in the Heart with phlegmheat in the Stomach
Symptoms

Figure 6.1.2.:
Fernals

Sudden vertigo
Trembling of the entire body
Numb areas in the extremities
Severe feelings of fear
Tendency to catch colds
Western diagnosis'
Chronic fatigue syndrome
Background t o disease
Physical and mental demands of competitive
sports

Figure 6.1 2 . 3
Female
38 years old

Tongue description

Chinese diagnosis

Pale red
Slightly red and curled-up edges
Long, vertical crack in the center
Indentation at the tip
Depression at the root of the tongue
Yellow, greasy coating along the midline crack

Normal
Liver qi constraint with heat in the Liver
Constitutional weakness of the Heart
Heart blood deficiency
Essence deficiency
Phlegm in the Stomach transforms into fire

Symptoms
Pain in the jaw
Loose teeth
Severe irritability
Exhaustion
Constipation
Thirst
Western diagnosis
Osteoporosis affecting the jaw
B a c l q m u n d to disease
Anorexia nervosa as teenager
Mental and emotional pressures at work

Tongue SignsAssociated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Reddish
Red edges
Long, vertical crack in the center with a red tip
Yellow, thin, greasy coating

Normal
Heat in the Liver
Heat in the Hean
Accumulation of damp-heat

Symptoms

Figure 6.1.2.4
Female
38 years old

Inability to stay asleep


Hot feet at night
Occasional night sweats
Headaches
Tightness of the neck muscles
Blocked sinuses

Western diagnosis
Uterine fibroids
Allergic rhinitis

Background to disease
Long-standing emotional problems

Tongue description

Chinese diagnosis

Red, swollen tongue body

Kidney yin deficiency with heat in the Heart and


Stomach
Constitutional heat in the Heart
Normal

Long, deep vertical crack


Thin, white coating

Symptoms
Palpitations
Anxiety, restlessness
Insomnia, fatigue
Washcs hcrsclf all day
Nausea and vomiting with agitation

Western diagnosis
Compulsive neurosis

Background to disease
Unwanted divorce
Loneliness

Tongue SignsAssociated with Disharmonies of the Heart

Case History

Fig. 6.1.2.1

This 35-year-old private secretary complained about her unhappy marriage of 10


years. She did not know how to improve the relationship. During this period, her
panic attacks occurred more frequently and became more intense. They always
started with palpitations, a stifling sensation in the chest, and sudden diarrhea. She
often called ior an ambulance in these situations, thinking that she had suffered a
heart attack. The patient occasionally fainted when the feeling of fear became too
strong. She appeared nervous and hectic but at the same time gave an impression of
vitality.There was a long, vertical crack on the midline of the tongue, and the coating
was thin, yellow, and greasy. Her pulse was rapid (shuo) and slightly slippery (hua).

Analysis. The deep midline crack in this case, which extends to the tip of the
tongue, is not just an indication of constitutional weakness of the Heart, but also suggests the presence o i heat in the Heart. The red tip and midline crack are covered
with a yellow, prickly coating.This is a sign of phlegm-heat in the Stomach. Phlegmheat disturbs the chest, which the patient described as a stifling sensation. Because it
i s blocked by phlegm, the clear yang cannot rise, and thus causes fainting spells.
There are two mechanisms at work here:
1. Panic attacks and spells of diarrhea dominate when heat in the Heart transforms
into fire.
2. When phlegm-heat is the more prominent causative factor, it will agitate the
Heart, manifesting in chest pains, palpitations, and fainting spells.

Discussion. A midline crack that extends to the tip of the tongue is an indication of
constitutional weakness of the Heart with a tendency to develop heat in the Heart.
People with this type of tongue tend to suffer from restlessness andlor frequently lead
overactive lives. If this condition is aggravated by phlegm-heat, the individual will
suffer irom inappropriate emotional reactions, which in extreme cases can lead to
mental illness.

Tongue Signs Associated with Disharmonies of the Heart

6.2

Tongue Signs Associated with


Heart Blood Deficiency
Blood deficiency in the body will reduce the supply of blood to the tongue,
which will thereupon become pale and dry. There are three visible manifestations of this pathology on the tongue:
1. The tip of a normal tongue is red or shows many red, small, and fine
points while the tongue body is pale or pale red. A slight reddening of the

tip is likewise normal and important as it reflects good communication


between the gate of vitality (ming men) and the Heart. The physiological
fire of the gate of vitality causes this slight redness in the tip of the tongue.
However, a strong red discoloration of the tip points to the presence of
heat in the Heart. The degree of redness indicates the strength of the heat,
which will also manifest in corresponding symptoms.
2. A pale or pale red tongue with a curled-down tip indicates heat from deficiency of the Heart (Fig. 6.2.41.When accompanied by a pale tongue body,
there will be a tendency toward depressive moods.
3. In my opinion, pale tongues that show contracted or indented tips also

reflect Heart blood deficiency with a tendency toward Heart yin deficiency. This sign might be said to reflect a lack of 'substance' with which to
fill out the tip of the tongue, thus depriving it of its normal shape. A different pathology is involved in the long and very pointed tongue. In that case,
it is heat which injures the blood, yin, and fluids, depriving the tip of 'substance.' The presence of heat or fire in the Heart is much stronger and
more vigorous than in the situations described above, and results in an
extreme protuberance of the tongue, quite the opposite of what is
observed with pale and dry tongues.
The tip of the tongue in those who have suffered for a long time from unstable emotions like depression is often contracted. Although no reference to
this tongue shape could be found in the literature, there may be another way
of interpreting it, which I have confirmed in my clinical practice. A contracted tip may indicate a dysfunction of the Womb (bao mar3. It is the function of the Penetrating vessel to send Heart qi and blood to the Womb. When
this internal vessel is free of any blockage, menstrual blood will flow freely
and the Heart can communicate freely with the Womb. Because of this connection between the Heart and Womb, deficiency of Heart blood, as deduced
from a contracted tongue tip, maylead to malnourishment of the Womb. The
contracted tongue tip may also indimte a blockage of the Penetrating vessel,
which will interfere with the smooth flow of Heart blood to the Womb.' I
often interpret this tongue sign, especially when it is accompanied by distended, swollen, and blue sublingual veins, to mean possible stasis of blood
in the Womb (see Chapter 8). Patients presenting with these tongue signs frequently have menstrual problems, especially pain and uterine fibroids.

Figure 6.2.4

Tongue Signs Associated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Pale, swollen, slight teeth marks

Spleen qi deficiency [accumulation of dampness


and deficiency of blood)
Heart blood deficiency
Normal

Indentation of the tip


White, thin coating

Figure 6.2.1

Symptoms

Femalc
38 years oltl

Headaches for past 20 years, especiall)r during


menstruation
Nausea in the mornings
Lack of concentration
Fatigue

Western diagnosis
Hypothyroidism

Background to disease
Family history of headaches
Long-standing emotional problems
Excessive anxiety

Figure 6.2.2
Female
46 years old
See
CASE HISTORY

below

Tongue description

Chinese diagnosis

Pale red, swollen


Slight reddening of the tip
Indentation of the tip

Spleen qi deficiency (accumulation of dampness)


Heat from deficiency of the Heart
Heart blood deficiency

I
1

Symptoms
Inability to fall asleep, fatigue
Painful menstruation
Prolonged bleeding
Depressive moods

Western diagnosis
Uterine fibroid (4 x 6cml

Background to disease
Womes a great deal
Emotional problems due to difficultpersonal
relationships
WOabortions

Tongue Signs Associated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Pale red, soft


Indentation of the tip
Swollen in the anterior third
Yellow, thin coating with red points at the root

Spleen qi deficiency
Heart blood deficiency
Possible Heart qi deficiency
Heat in the lower burner

Symptoms

Figure 6.2.3

Long-lasting, profuse menstrual bleeding


Lower abdominal pain during menstruation

Female

28 years old

Western diagnosis
Menorrhagia
Infertility

Background to disease
Long-standing emotional problems

Tongue description

Chinese diagnosis

Pale, slightly swollen


Curled-down tip with red points

Spleen qi deficiency (accumulation of dampness1


Heat from deficiency of the Heart

Symptoms
Insomnia, exhaustion
Feeling hot at night
Anger and depressive moods
Cough
Shortness of breath

Western diagnosis
None

Background to disease
Unwanted divorce
Overwork
Lack of rest after the birth of her first child

Figure 6.2.4
Female
40 years old

Tongue Signs Associated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Pale, slightly swollen

Spleen and Lung qi deficiency (accumulation of


dampness)
Heart blood deficiency
Deficiency of essence
Retention of damp-heat in the lower burner

Slight indentation of the tip


Depression at the root
Yellow, thick coating

figure 6.2.5

Symptoms

Male
57 years old

Depression, despondency
Crying spells
Fatigue
Lack of appetite, loss of weight

See
CASE HISTORY
below

Western diagnosis
None

Background to disease
Difficult divorce
Physical and mental exhaustion

Tongue description

Chinese diagnosis

Pale, swollen
SwoUen center of the tongue
Indentation of the tip
Slightly raised red points at the tip

Spleen qi deficiency (accumulation of dampness)


Retention of turbid phlegm in the Stomach
Heart blood deficiency
Acute externally-contracted wind-heat

Figure 6.2.6

Symptoms

Female
28 years olc

Itchy eyes
Runny nose
Headaches with change of weather
Fatigue
Occasional depressive moods

Western diagnosis
Allergic rhinitis

Background to disease
Severe mental demands at work
Lrregular eating habits

rongue SignsAssociated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Pale, swollen

Spleen qi deficiency (accumulationof dampness)


Lack of fluids in the Stomach
Onset of Stomach and Lung yin deficiency
Heart qi and yin deficiency

DV
Small, deep cracks in the center and anterior third
Deep crack in the tip of tongue

Symptoms
Severe exhaustion
Shortness of breath
Inner tension

Western diagnosis
Non-Hodgkin's lymphoma
Right heart insufficiency

Background to disease
Condition after chemotherapy, radiation therapy,
and splenectomy

Case History
During a routine medical examination a uterine fibroid was found in this 46-year-old
journalist. In addition, her menstruation had changed in the last six months. The
patient had noticed spotting before and after the period as well as stronger menstrual
bleeding. Occasionally, she felt pain and pressure in her lower abdomen. She had
several difficult emotional relationships, and because of this, felt very unsure of herself. She had a tendency to suffer from depression and was restless and discontented.
The tongue body color was normal, its shape was slightly swollen, and the tip was
indented. The sublingual veins were slightly distended. Her pulse was deficient (xu)
and slightly slippery (hua).

Analysis. The constant anxiety, pensiveness, and self-analysis resulting from her
painful relationships weakened the Spleen qi and Heart blood of this patient. The difficulty in falling asleep and the depressive moods were related to these deficiencies.
The fibroid was the result of stasis of blood in the Womb. In addition, her two abortions, at 30 and 35 years of age, may have contributed to injuring the Penetrating
vessel. This vessel controls the blood flow to the Womb; it thus prevents stasis and
regulates the menstrual cycle. Because the Penetrating vessel was blocked, there was
painful menstruation as well as long-lasting spotting.
The qi and blood deficiency led to blood stasis, as the blood was not sufficiently
moved. Moreover, the weakened Spleen qi did not produce enough blood, which
affected not only the Heart blood, but also gave rise, over time, to blood stasis in the

Figure 6.2.7
Female
63 years old

Tongue Signs Associated with Disharmonies of the Heart

Womb. The deficient, slippery pulse confirms this diagnosis. The contracted tip in
this case reflected the failure of the Heart blood to flow freely to the Womb, and a
blockage of the Penetratingvessel.

Case History

Fig. 6.2.5

After his divorce, 57-year-old Mr. G began a new life, going back to school and buying himself a house that he then renovated. Strong depressive moods then set in,
characterized by crying spells, feelings of hopelessness, a lack of drive, and suicidal
thoughts. He was very tired, lost his appetite, and suffered weight loss. His tongue
was pale and showed an indented tip and a depression at the root. His pulse was
very frail (ruo) and submerged (chen).

Analysis. In this case, the combination of deficiency of essence, Spleen qi, and
Heart blood resulted in a weakness of essence (iing) and spirit (shen).The changes in
his life caused Mr. G to throw himself into all sorts of activities to compensate for the
emptiness he felt, thereby abusing his energetic resources. His essence, which at the
age of 57 should be preserved by contemplation and a quiet lifestyle, was thereby
weakened, which was manifested in his reduced vitality. The frail pulse, and the
depression at the root of the tongue, confirm this diagnosis. The simultaneous physical exhaustion caused by the renovation of his house led to a deficiency of Spleen
and Lung qi.
Blood is produced in the Heart, and the essences from food distilled by Spleen
qi are essential to this process. These essences are transformed into blood in the
Heart with the help of the source qi. Spleen qi deficiency can therefore readily lead
to Heart blood deficiency, which in this case is reflected in the indented tip of the
tongue.
Discussion. In general, it can be said that Spleen qi deficiency not only causes an
accumulation of dampness but also contributes to Heart blood deficiency. This is
especially common when the patient suffers from excessive mental and physical
strain.The indentation at the tip of the tongue is an important indication of Spleen qi
and Heart blood deficiency.

Tongue Signs Associated with


Heat in the Heart
The slight redness at the t i p o f the tongue is due t o a reddening o f the papillae. This is considered normal when it appears with a pale or pale red tongue.
I t shows that the communication between the Heart a n d gate o f vitality
(ming men) is functioning. The gate o f vitality warms the Heart and supports
the Heart in housing the spirit. A pale tongue body without the slight reddeni n g at the tip denotes a weak spirit or Heart yang deficiency.

A red tongue tip that appears during an illness as a result o f internal factors
(e.g, long-term q i constraint and depression, strong emotional pressures, and
consumption o f drugs like cocaine and ecstasy) denotes the presence of heat
or fire in the Heart. The degree o f intensity o f the red discoloration o f the

Tongue Signs Associated with Disharmonies of the Heart


tongue body has an influence on the diagnostic significance of the red
tongue tip. If the tip is very red or dark red, the intensity of the redness of the
tongue body color reflects the severity of the pathology. This tongue type will
be accompanied by strong palpitations, mouth ulcers, a feeling of heat in the
body, restlessness, and insomnia. The presence of Heart fire will also result in
increased agitation and diminished mental clarity. In addition to a strong
reddening of the tip, in extreme cases the tip may also be slightly swollen.
Here, the extreme heat leads to clumping of fluids that have transformed to
phlegm-fire in the Heart, which can lead to very serious psychiatric disorders
(Fig. 6.3.10).
The symptoms associated with heat from Heart yin deficiency tend to be
less severe than those associated with Heart fire. In this case, the tongue tip
will be red, but the tongue body will often be red with a peeled coating as
Heart yin deficiency is closely linked with Kidney yin deficiency.

Figure 6.3.10

Long-standing Heart blood deficiency can also lead to Heart yin deficiency, which in turn will give rise to heat from deficiency of the Heart. This
may be reflected in a less red tongue body, but the tip will still look very red,
or will occasionally be turned upwards (Fig. 6.3.3).
Heat in the Heart is generally caused by too much stress and a hectic
lifestyle, especially if combined with an unfulfilled emotional life. Constant,
long-term grief and worry will slowly lead to the formation of heat in the
Heart. Most patients with this tongue type will suffer insomnia. Excessive
grief and worry can, over a shon period, also cause heat in the Heart that will
impair its function of storing the spirit; this manifests in a reddening at the
tip of the tongue.
In general, it is important to judge the redness of the tongue tip in relation to the intensity of the redness of the tongue body. Heart fire will have
more serious consequences in an individual with a red tongue than with a
pale tongue.
It is also important to distinguish between a red tongue tip caused by
heat in the Heart, and red points at the tip of the tongue caused by an externally-contracted wind-heat disease, for example, an acute infection like tonsillitis or bronchitis. More often than not, these points often appear fresher,
bigger, and coarser than the points that result from heat in the Heart." In
addition, the points associated with externally-contracted wind-heat are
located not only at the tip of the tongue, but also in the anterior third, where
they reflect the function of the Lungs. The appearance of these red points
indicates that the heat still resides in the superficial layers of the body.
A dark red tongue with a very red tip may be caused by toxic heat enter-

ing the nutritive and blood levels. To differentiate between these red points
and those described above is not difficult, as the acute symptoms of toxic
heat include high fever, skin rashes, sudden nose bleeds, blood in the urine,
restlessness, and even loss of consciousness and coma. [In Chapter 9, red
points that are indicative of externally-contracted wind-heat and toxic heat
are discussed at greater length.)
Another diagnostic meaning of red tongue points was suggested in the
following study: 500 patients were examined in a Gui Yang hospitalqo study
the appearance of red points at the tip of the tongue. Here, however, it was
found that they were an expression of Liver qi constraint. The investigation

Figure 6.3.3

118

Tongue Signs Associated with Disharmonies of the Heart


showed a direct correlation between the red points and the inability of some
patients to freely express their emotions. This is not entirely surprising, as
long-standing Liver qi constraint will eventually lead to heat formation,
which in turn will agitate the Heart.
Another clinical investigation in China" showed a connection between
red points at the tip of the tongue and menstruation. It was observed that
three to seven days before the onset of the period the tongue papillae would
swell up, fill with blood, and turn red. In fact, the tongue papillae became
even redder with the actual start of menstruation, then became smaller and
lost their intense color three to seven days after menstruation. According to
this investigation, the appearance of the red points at the tip shortly before
menstruation has no diagnostic significance.
In the case of long-standing heat in the Heart, besides the reddening of
the tip of the tongue, a pathological change of the tongue shape may also
occur. There seem to be two mechanisms responsible for this change in
shape:
1. Heat evaporates the fluids. The blood that is formed by the Heart is

thinned by the body fluids (jin ye); the blood thereby remains liquid and
contributes to giving the tongue-especially the tip-its soft, elastic, and
slightly rounded form. However, if there is constant heat, the tip of the
tongue will no longer receive adequate nourishment from the blood and
fluids. The slightly rounded shape of the tip will then disappear and
instead become very pointed.
2. Heat vigorously moves the remaining fluids. This process pushes the tip to
the outside and results in a pathological tongue shape. (The same process
is observed in the case of long tongues.) The heat moves the blood so vigorously that, besides the reddening of the tongue, the tip may also take on
a n unusual shape. This is reflected in the photographs of the following
section.

Patients with these tongue signs are often psychologically unbalanced or ill.
If there are no signs or symptoms of a disturbance of the spirit, the patient
may show a tendency to easily lose his mental balance.

Tongue SignsAssociated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Pale red, thinning out toward the tip


Long
Contracted,flattened, reddened tip

Heart blood deficiency with heat from deficiency


Constitutional weakness of the Heart
Onset of Heart vin deficiency

Symptoms

Inability to fall asleep and to sleep through the night


Sexual dreams
Occasional night sweats
Inability to form relationships

Figure 6.3.1
47 years old

Western diagnosis
None

Background to disease
Excessive masturbation

Tongue description

Chinese diagnosis

Pale red
Long, narrow

Normal
Constitutional weakness of the Heart, onset of fluid
deficiency
Heart blood deficiency with heat in the Heart

Red,flattened tip with red points

Symptoms

Figure 6.3.2

Night sweats
Severe sweating on the chest
Severe itchiness
Formation of pustules on the skin
Strong menstrual pains

Female
34 years old

Western diagnosis
Lichen sclerosus et atrophicus (a chronic skin
disease) for the past 18years

Background to disease
Unclear

Tongue Signs Associated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Pale red

Normal
Heat in the Heart
Stomach yin deficiency
Accumulation of turbid dampness

Curled-up and red tip


Slight midline crack
Slightly yellow, greasy coating

Symptoms

Figure 6.3.3
Female

Strong stomachache with stress


Feeling of pressure in stomach
lnabil6 to fall asleep, waking early, fatigue
Knee pain upon exertion

Western diagnosis
None

Background to disease
Caffeine abuse
Irregular eating habits
Maritial problems

Tongue description

Chinese diagnosis

Pale red, slightly bluish

Slight stasis of blood


Heart blood deficiency with heat in the Heart
Externally-contracted wind-cold

Curled-up,fIattened,red tip with red points


White, thin, dry coating

Figure 6.3.4
Female
44 years olc

Symptoms
Scratchy throat
Backache
Feeling of tension
Nervousness
Severe stage fright

Western diagnosis
Psoriasis

Background to disease
Divorce
Overwork

Tongue SignsAssociated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Pale, with pale edges


Red, pointed tip
Yellow, old, dry coating

Spleen qi and Liver blood deficiency


Heat from deficiency in the Heart
Heat in the Stomach and onset of Stomach yin
deficiency

Symptoms
Insomnia, fatigue
Depression
Fear of dying
Weakness and feeling of heaviness in the left leg

Western diagnosis
Hypertension

Background to disease
High blood pressure for years
Condition began after a stroke 4 months previously

Tongue description

Chinese diagnosis

Reddish
Pale edges
Red, very pointed and contracted tip

Heat from deficiency


Liver blood deficiency
Heart blood and yin deficiencywith heat in the
Heart
Slight dryness in the Stomach

Whitish, dry coating

Symptoms

Figure 6.3.6

Palpitations
Insomnia for 10 years
Anxiety on awakening
Painful and swollen wrist and ankle joints
Backache

Female
46 years, old

Western diagnosis
Chronic polyarthritis

Background to disease
Long-standing problems with relationships
Severe mental demands at work

Tongue SignsAssociated with Disharmonies of the Heart

Tongue description

Chinese diagnosis

Reddish, long tongue body


Pale edges
Red, very pointed tip with dark red points
White, thin, dry coating with rootless coating at
the root

Constitutional heat in the Heart


Liver blood deficiency
Heart fire
Onset of deficiency of fluids and Stomach yin

Symptoms
No desire to sleep
Restlessness
Increased drive
No appetite
Strong thirst

Western diagnosis
Bipolar disorder

Background to disease
Family history of bipolar disorder

Figure 6.3.8
Female
52 years old

Tongue description

Chinese diagnosis

Pale red
Pale edges
Many small cracks
Red tip with protrusion
Depression at the root of the tongue

Normal
Liver blood deficiency
Stomach yin deficiency
Heat in the Heart
Essence deficiency

Symptoms
%itching of facial muscles
Sudden attacks of fright
Insomnia

Western diagnosis
Compulsive neurosis

Background to disease
Condition began after hysterectomy

TongueSigns Associated with Disharmonies of the Heart


Tongue description

Chinese diagnosis

Red, long

Kidney yin deficiency with constitutional heat in the


Heart
Heart fire
Normal

Red, wry pointed tip


Slightly moist

Symptoms

Figure 6.3.9

Fear of open spaces


Fear of leaving her house
Headaches
Hot flushes and night sweats
Depression
Exhaustion

Female
50 years old

Western diagnosis
Agoraphobia

Background to disease
Difficultchildhood
Unwanted divorce

Tongue description

Chinese diagnosis

Red with red sides

Kidney yin deficiencywith ascendant Liver yang


Constitutional heat in the Heart
Heart fire
Lack of fluids in the Stomach

Long
Xed uerypointed tip
White, dry coating

Symptoms

igure 6.3.1 0

Inability to open her eyes


Severe frontal headaches
Irritability
Depression
Inability to sleep through the night

emale
'0years old

Western diagnosis
Compulsive neurosis

Background to disease
Shell-shocked as a teenager in World War I1

ee
ASE HISTORY
elow

Tongue Signs Associated with Disharmonies of the Heart

Case History
Mrs. R, 70 years old, had suffered from compulsive neurosis ior 10 years. She kept
her eyes closed all day, which caused her to suffer irom frontal headaches. She had
no problems with her vision and was able to open her eyes in order to cook supper
for her husband, mend clothes, or read a book. She was dependent on her husband
who accompanied her at all times.
Fig. 6.3.10

She was angry, irritable, and also depressed since nobody could help her. She
complained constantly about her fate. She slept very badly. Physically, she felt fine
and never suffered from any illness. All her liie she had been mentally unstable. The
red, pointed shape of the tongue was very noticeable. Her pulse was excessive (shO,
wiry (xian), and rapid (shuo).

Analysis. The patient's mental instability, which dated from her childhood but was
later exacerbated, is a typical indication of a constitutional weakness of the Heart. As
a very young woman she witnessed the bombing of Hamburg, which severely
shocked her and from which she never entirely recovered. Mental shock disperses
Heart qi. In the moment of shock, essence is released to compensate for the momentary loss of the Heart qi and the possible blockage o i this energy. In this patient, the
shock produced heat in the Heart, and, because of her underlying constitution, eventually resulted in Heart yin deficiency.Throughout this time she tried to control herself and repress her real feelings. This was very important to her as her husband was
a strict, severe man who managed to easily intimidate her. Owing to this restraint,
the heat from deficiency in the Heart evolved into Heart fire. This was aggravated by
the underlying Liver qi constraint which, over time, transiormed into heal, as
reflected in the wiry pulse.
Over the long run, this type of pathology can injure the Kidney and Liver yin,
which then leads to ascending Liver yang. It is interesting to note that her neurosis
manifested itself in her eyes. The ethereal soul (hun), the psychic aspect of the Liver,
is anchored by Liver blood and yin. During the day the ethereal soul moves to the
eyes so that we can see. At the same time, the hun is responsible, on the mental
level, for providing insight as well as helping to maintain a happy and balanced
emotional life. The spirit and the ethereal soul, which are both anchored through
blood and yin, are not in harmony in this patient. The Kidney yin deficiency and
essence deficiency do little to ameliorate the existing disharmony of the spirit.
Because of this, the prognosis for healing or even improving her compulsive neurosis
with Chinese medicine is extremely doubtful.

Discussion. Very red or extremely pointed tongue tips are indicative of heat or fire
in the Heart. In people with these particular tongue signs, agitation or excessive
worry can trigger symptoms like restlessness, panic attacks, or depressive states. In
this case, it is very important to calm the spirit to help alleviate these states of panic.

Endnotes
1. Maciocia G. Tongue Diagnosis i n Chinese Medicine, rev. ed. Seattle: Eastland

Press. 1995:70.
2. See Flaws B. My Sister, TheMoon. Boulder, CO: Blue Poppy Press, 1992:4.

Tongue Signs Arsociutecl with Disharmonies of the Heurt


3. See Li N-M. %I?ongguo shezhol do r/llun.Beijing: Xueyuan Publishing Company,
1994:1197. Investigators in a study undertaken in aTCM hospital in IHeoan,
China felt that red points at the tip of the tongue suggest that the patient has
contracted a cold. On the first two days uf the cold. the points have a special
appearance: they are fresh red, stand together very narrowly, partly 'sprout' in a
bunch-like fashion, and do not occupy more than the First third o f t h e anterior
part of the tongue. On the third and fourth days of the cold the points slowly
became flatter, no longer form a bunch, and the color is not as intense. The area
covered by the points becomes bigger, that is, they take up the entire anterior
third of the tongue, but not the center. After one week, the points are no longer
visible.
4. [bid.

Tongue Signs Associated


with Liver Disharmonies
7.1

Tongue Signs Associated with


Ascending Liver Yang and Liver Fire
Thus far we have discussed tongue signs associated with patterns of yin deficiency of the yin organs and the Stomach. Liver patterns are, however, an
exception to this structure as there is no independent pattern of Liver yin
deficiency. Rather, it occurs either in combination with Liver blood or Kidney
yin deficiency. Liver and Kidney yin have a common root, the essence, which
nourishes both yin organs. Kidney yin deficiency will always lead to Liver yin
deficiency, and long-standing Liver blood deficiency may also lead to Liver
yin deficiency.
If the Liver yang is not sufficiently controlled by the Kidney and Liver yin,
it will ascend to the head. Thus, deficiency of yin can evolve inlo a condition
of excess: ascending Liver yang. Headaches, dizziness, and tinnitus are
some of the symptoms characteristic of ascending Liver yang. Such symptoms as dry mouth and throat or dry eyes may appear as a consequence of
Kidney and Liver yin deficiency.

Because of the dynamic nature of yang, the fire, qi, and blood in those
suffering from ascending Liver yang or Liver fire can move so vigorously that
they give rise to fits of rage, sudden nosebleeds, facial redness, or sudden
dizziness. This movement also manifests itself in the shape and color of the
tongue body. It will be red, especially in the case of Liver fire, reflecting the
extreme heat that causes the blood to move recklessly. The tongue shape will
appear swollen due to the intense movement of fluids. All this is reflected in
the edges and sides of the tongue, which are the areas that correspond to the
Liver (see Chapter 1).Thus, in the case of ascending Liver yang or Liver fire,

Tongue Signs Associated with Liver Disharmonies


the sides of the tongue will be redder than the rest of the tongue body, and, as
noted above, the sides of the tongue may be swollen. This type of swelling, as
well as the redness of the sides, extends over the entire length of the tongue
body (Figure 7.1.2).

I
Figure 7.1.2

It is very difficult to differentiate between ascending Liver yang and Liver


fire on the basis of tongue diagnosis alone, since it is a matter of degree. The
tongue body, and especiallythe sides of the tongue, tend to be darker red and
drier in Liver fire than in ascending Liver yang. The former is characterized
by excessive heat in the Liver. The dry tongue arises from the intense heat
that injures the fluids. In addition, ascending Liver yang mainly develops
from a deficiency of Kidney yin; thus, the tongue body may show cracks or a
rootless coating.
Occasionally, there are red points in a line at the sides of the tongue (Fig.
7.1.1).These may indicate the presence of Liver fire or ascending Liver yang,
and suggest that heat is developing in the Liver. The red points must be differentiated from those that are positioned only in the middle of the tongue
sides, which are indicative of Stomach heat, a condition that is rather
uncommon.

Figure 7.1.1

If the yin, and especially the Liver yin, is not properly nourished by the
Liver blood, heat will develop in the Liver and the Liver yang will ascend. Yet,
despite this condition of excess in the Liver, the tongue body often remains
pale and thin. It is the sides and edges, however, that are often reddish or red,
and may show red points. Women who lose a lot of blood through menstruation may quickly develop a condition of Liver blood deficiency, or, after
awhile, Liver yin deficiency. Headaches that are centered near the temples, or
migraines that occur during menstruation, are indicative of ascending Liver

Yaw.
To summarize, the tongue does not always reflect the presence of ascending Liver yang. Pulse diagnosis and the presenting symptoms must also be
taken into account to verify the diagnosis.

lbngue SignsAssociated with Liver Disharmonies

Tongue description

Chinese diagnosis

Slightly pale
Red points along the sides and at the tip

Blood deficiency
Ascending Liver yang and heat in the Heart

Symptoms

@re 7.1.1

Chronic headaches at the temples


Migraines with severe nausea
Shortened menstrual cycle with profuse bleeding

'emale
!8 years old

Western diagnosis
Chronic migraines

Background to disease
Family history of migraine
Hectic lifestyle

Tongue description

Chinese diagnosis

Pale red
Swelling a t thesides with red points
Slight notch at the tip with red points

Slight blood deficiency


Ascending Liver yang
Heart blood deficiencywith heat in the Heart

Symptoms
Panic attacks
Waking at night with palpitations and sweating,
nightmares
Trembling of the head with rest
Shortened menstrual cycle with emotional stress
Exhaustion

Western diagnosis
None

Background to disease
Long-standing emotional problems

Figure 7.1.2
Female
44 years old

Tongue Signs Associated with Liver Disharmonies

Figure 7.1

Tongue description

Chinese diagnosis

Reddish tongue body


Red, curled-up edges
Red center of the tongue with cracks reaching to
the tip
Curled-down tip of tongue

Onset of Kidney yin deficiency


Ascending Liver yang
Stomach heat and Stomach yin deficiency with
heat in the Heart
Heat from deficiency in the Heart

.:

Symptoms

Malt
44 years old

Devastating headaches with intense heat sensations in the head


Restlessness
Heartburn
Stomach pains with stress
Occasional night sweats

Western diagnosis
Migraines for 20 years

Background to disease
Family history of migraines
Frustration at work
Strong sense of being a victim

Tongue description

Chinese diagnosis

Pale red, wide, thin, dry tongue body


Curled-up edges, very red edges in the anterior
third, red points at the side
Slightly yellow, old, greasy coating

Injury to fluids from heat


Liver qi constraint and heat in the Liver transforming into Liver fire
Long-standing damp-heat in the Liver and
Gallbladder
Onset of Kidney yin deficiency

Rootless coating at the root

./

Symptoms

iigure 7.1
Malt

Hot feet
Tremors
Tension and restlessness that rises from the
patient's bottom to his top
Palpitations
Nausea
Diarrhea
Headaches at the forehead and temples

Western diagnosis

Heroin withdrawal

Background to disease
Heroin addiction

Tongue Signs Associated with Liver Disharmonies


Tongue description
Red
Swollen, red sides

Symptoms
Tinnitus
Restlessness and nervousness
Inability to fall asleep
Tachycardia and palpitations
Night sweats

Western diagnosis
Acute loss of hearing

Background to disease
Overwork
Emotional problems
Frustration due to lack of professional success
Lack of sleep due to working at night
Caffeine abuse

Chinese diagnosis

r
Kidney yin deficiency
Liver fire

Tongue description

Chinese diagnosis

Red tongue body with thorns


Swollen, red sides

Heat in the Stomach, possibly toxic heat


Liver fire

Figure 7.1.5
Male
5 years old

Symptoms

Figure 7.1.6

Insomnia
Wakes up frequently
Restlessness, tension, and nervousness
Constipation
Stomach cramps

Male
28 years old

Western diagnosis
Heroin withdrawal

Background to disease
Heroin addiction

Tongue SignsAssociated with Liver Disharmonies

Tongue description

Chinese diagnosis

Red, swollen tongue body


Red sides with red points
Midline crack over the entire tongue body
Yellow, thick, dry coating

Damp-heat in the Liver and Gallbladder


Liver fire
Constitutional heat in the Heart
Accumulation of phlegm-heat in the Stomach

Figure 7.1.7

Symptoms

Female
36 years old

Sudden, one-sided, right facial pain


Purulent secretion from the right eye
Conjunctival redness
Facial redness
Nausea
Bitter taste in the mouth
Restlessness
Insomnia

Western diagnosis
Heroin addiction
Fibroadenoma in the right breast
Trigeminal neuralgia

Background to disease
Heroin and alcohol addiction
Lack of sleep

Tongue description

Red tongue body


Red, curled-up edges
Thin midline crack over the entire tongue body,
curled-down tip
Yellow, thick, dry coating, especially at the root

Chinese diagnosis
Onset of Kidney yin deficiency
Liver fire
Constitutional heat in the Heart
Retention of damp-heat in the Liver, Gallbladder,
and Large Intestine

Figure 7.1.8

Symptoms

Male
39 years old

Sudden, strong-smelling diarrhea


Sudden fits of rage
Headaches with tightness of the neck muscles
Occasional night sweats

Sep
CASE HISTOR',
below

Western diagnosis
None

Background to disease
Alcohol, nicotine, and caffeine abuse
Irregular eating habits
Chronic lack of sleep
Repressed emotions

Tongue Signs Associated with Liuer Disharmonies

Case History
Mr. F, 39 years old, worked for many years as a manager o i a funeral home. He had a
history of emotional dependency with the owner of the business, and because of this
relationship, was constantly exploited. Mr. F never talked about his anger. He tried to
calm his inner tension with alcohol and incessant smoking. He stopped cooking for
himself and ate only junk food. Within a, year, he started to suffer from headaches
and tight muscles in the shoulder and neck region. Although he had a reputation ior
being soft and emotionally stable, Mr. F. found that he was unable to control himseli
anymore. He had sudden iits of rage, which he relieved by kicking against glass
doors and cupboards. He also sufiered irom diarrhea and occasional night sweats.
The tongue body was red, with red, curled-up edges. The coating was yellow, thick,
and dry. His pulse was wiry (xian), excessive (shi), and slightly rapid (shou).

Analysis. The repressed anger caused Liver qi constraint, which maniiested in the
curled-up tongue edges and the wiry pulse. Over the course of a year this evolved
into Liver fire, as reilected in the red edges of the tongue. This was aggravated by the
constant consumption of alcohol and greasy foods like pizza and hamburgers, which
led to the formation of damp-heat in the Liver and Gallbladder, impairing the free
flow of Liver qi. When the Liver develops a condition of excess, i t not only attacks
the Spleen and Stomach bul also the Large Intestine. This can produce either diarrhea
or constipation, depending on the individual constitution. Because the dietary habits
of the patient led to the formation of damp-heat in the Large Intestine, it manifested
as damp-heat diarrhea.The headaches as well as the iits of rage were caused by Liver
iire. The tense, hard muscles in the neck and shoulder area were due to the excess in
the Gallbladder channel. Caifeine abuse, the chronic lack of sleep, and overwork
combined to weaken the Kidney yin, which was reilected in the occasional night
sweats.
After losing his job, the patient felt better very quickly. By regulating his diet and
obtaining regular acupuncture treatments, the diarrhea and night sweats disappeared.

Discussion. Long-standing Kidney yin deficiency can lead to ascending Liver yang,
and Liver qi constraint can lead to Liver fire. These pathologies manifest in changes
to the sides and edges o i the tongue: red or dark red and curled sides, or dark red
points. The combination o i preexisting Liver qi constraint and frequent consumption
of fatty foods and/or alcohol can quickly lead to the iormation of damp-heat in the
Liver and Gallbladder. This pathology is reflected in a yellow, greasy, thick, and often
dry tongue coating. The above case is a good example of a pathology that evolves
from Liver iire and damp-heat in the Liver and Gallbladder.

Fig. 7.1.8

Tongue SignsAssociated with LiuerDisharmonies

Tongue Signs Associated with Liver Qi


Constraint and the Development of Heat
In many people the pressures of daily life constrain the flow of Liver qi.
Frustration, anger, and repressed emotions may all lead to stagnation of qi,
which can manifest in such symptoms as hypochondriac pain, a feeling of
something caught in the throat, or mood swings. Long-term constrained
Liver qi can easily lead to Liver heat. In the tongue, this process is reflected in
red edges and curled-up sides. The heat represents an intermediate stage
between Liver fire and ascending Liver yang.
Liver qi can bind the qi of the middle burner, causing fullness andlor
pressure in the chest and abdomen. Inner heat develops when the qi does
not flow freely, and the constrained qi is not moved. This inhibits the circulation of qi to the extremities, causing cold fingers and toes. In this situation,
the remainder of the body is warm, and the patient does not experience an
aversion to cold. This process is expressed in the red and curled-up edges of
the tongue.
The intensity of Liver qi constraint varies depending on the particular
situation; the associated symptoms are likewise in constant f l u . Sometimes
patients complain of feeling bloated, wound up, or of having hard, dry, pelletlike stools. On other days they may suffer from soft stools and depressive
moods.

Tongue description

Reddish, curled-up edges, red points


Figure 7.2.1
Female
56 years old

Chinese diagnosis
Liver qi constraint with Liver heat transforming
into Liver fire
Symptoms
Perit mal'absence' seizures in the mornings
Strong anger, fits of rage
Irritability
Red eyes
Weak vision
Western diagnosis
Epilepsy
Background to disease
Long-standingrepressed emotions

~bngueSignsAssociated with Liuer Disharmonies


Tongue description

Chinese diagnosis

Reddish, with red, curled-up edges


Small, thin cracks in the center

Liver qi constraint with Liver heat


Onset of Stomach yin deficiency

Symptoms
Bloating
Stomach and hypochondriac pain
Hot flushes
Inability to fall asleep
Heart pain and palpitations with agitation
Attacks of fright
Headaches in the morning
Profuse menstrual bleeding

Figure 7.2.2
Female
46 years old

Western diagnosis
Uterine fibroids

Background to disease
Alcohol and nicotine abuse
Excessive consumption of sweet foods
Long-standing emotional problems

Tongue description

Chinese diagnosis

Reddish
Long
Red, curled-up edges, and yellow, greasy, thick
coating on the posterior third
Curled-down tip

Normal
Constitutional heat in the Heart
Liver qi constraint with Liver heat, retention of
damp-heat in the Liver and Gallbladder
Heat from deficiency in the Hean

Symptoms

Figure 7.2.3

Hoarseness
Feeling of a lump in the throat
Cough with thick phlegm
Inner tension, nervousness

sale

Western diagnosis
Polyps on vocal cords

Background to disease
Existential angst
Severe demands at work
Irregular eating habits

12 years old

Tongue Signs Associated with Liuer Disharmonies

Tongue description

Chinese diagnosis

Reddish
Curled-up, red, swollen edges
Yellow, dry coating in the center of the tongue

Development of heat
Liver qi constraint with Liver heat
Liver qi attacking the Stomach, heat in the
Stomach
Heat in the Heart

Red points at the tip of tongue

Figure 7.2.4

Symptoms

Female
55 years old

Heartburn
Sensation of undigested food in the stomach
Bloated abdomen
~iatulence
Sharp pain around the umbilicus
Changing stool pattern
Occasional dizziness

Western diagnosis
Reflux esophagitis
Posttraumatic neck syndrome

Background to disease
Repressed anger
Long-term intake of nonsteroidal anti.
inflammatory drugs

Figure 7.2.5
Male
41 years old

Tongue description

Chinese diagnosis

Pale red, slight teeth marks


Curled-up edges with several red points
Yellow coating at the root of the tongue body
Red points at the tip of tongue

Spleen qi deficiency
Liver qi constraint with Liver heat
Slight retention of damp-heat in the lower burner
Acute, externally-contracted wind-heat

7
Symptoms

Acute sore throat


Stomach pain after eating
Feeling of fullness in the abdomen
Burping
Feeling of pressure under the hypochondrium
Irritability
Restlessness

Western diagnosis
Hepatitis C for 20 years

Background to disease
History of heroin addiction

Tongue Signs Associated with Liuer Disharmonies


Tongue description

Chinese diagnosis

Red

Heat in the blood


Liver qi constraint with Liver heat
Normal

Curled-up, red edges


White, moist coating

Symptoms
Restlessness
Irritability
Sleeping problems
Bloated abdomen
Feelingof pressure under the ribs
Fatigue

See
CASE HISTORY
below

Western diagnosis
Hepatitis C

Background to disease
Unknown

Case History
This 42-year-old manager was diagnosed with hepatitis C three years ago. He was
very irritable, tense, and restless. When he got angry, he felt pressure under the ribs.
He was constantly tired and complained that his sleep was not refreshing. The
tongue body was red and showed curled-up edges. His pulse was wiry (xian) and
slightly floating (fou).

Analysis. In this case, the red tongue was a sign of injury to the blood by toxic lieat.
The patient, in a chronic phase of his illness, presented with relatively few organic
liver symptoms. The restlessness and irritability were the result of Liver qi constraint
and heat in the Liver, as reflected in the curled-up edges of the tongue and the wiry
pulse. If the Liver qi is constrained for a long time, its control over the Spleen
becomes oppressive, which manifested here in fatigue. The constrained Liver qi in
this case also affected the Large Intestine, blocking the flow of qi and causing constipation. Liver heat agitates the ethereal soul (hun) at night, which accounts for the
sleeping problems.

Discussion. When Liver qi constraint is caused by strong emotions, it will be the


primary pathology even where there is a simultaneous weakening of Spleen qi. In
this type of Liver qi constraint the tongue body is pale and the edges are red and
curled up.lhe symptoms are those of a condition of excess: feeling of fullness in the
abdomen, bloated abdomen, constipation, or pain under the ribs. This energetic
imbalance can quickly produce heat, which in extreme cases can evolve into Liver
fire with such symptoms as bouts of dizziness and fits of rage.

Fig. 7.2.6

Tongue SignsAssociated with Liver Disharmonies


Due to the transverse rebellion of Liver qi, a condition of deficiency can also
develop, especially when there is preexisting Spleen qi deficiency. In such cases the
tongue body will be pale or pale red with curled-up edges of the same hue. Other
principal symptoms include lack of appetite, fatigue, soit stools, as well as pain or a
feeling of pressure under the ribs.

Tongue Signs Associated with


Internally-GeneratedWind
Symptoms that occur suddenly and are characterized by trembling and
tremors, spasms, vertigo, muscle tics, sudden numbness, or convulsions
reflect the internal movement of wind. An illness caused by internally-generated wind can leave serious damage in its wake. However, there are a few
warning signs that signal its approach, one of which being a constantly moving
tongue: when extended, it moves from one side to the other. Alternatively, the
patient will be unable to extend the tongue fully, and will retract it, only to
extend it again.

Figure 7.3.6

A noticeably stiff tongue body that is very red or is covered with a thick,
greasy coating also reflects the formation of internally-generated wind (Fig.
7.3.6). This is an important tongue sign, especially in conjunction with other
appropriate symptoms.
Clinically, internally-generated wind frequently occurs in those with
long-term deficiency of Kidney yin, which can lead to the ascending of Liver
yang. Often a severe quarrel or fit of anger is enough to trigger the uncontrolled movement of internal wind, which will cause a deviation in the
tongue (Fig. 7.3.6). Sudden loss of consciousness, spasms, or the sudden
deviation of an eye and mouth are characteristic signs. As a rule, the tongue
body is red and dry because of the underlying deficiency of Kidney yin.
A pale and deviated tongue body is indicative of Liver blood deficiency
generating internal wind. The paleness of the tongue reflects the Liver blood
deficiency, while its deviation is typical of internally-generated wind. The
symptoms are less severe in deficient-type internally-generated wind than in
the excess type, and include numbness of the extremities, tics, and slight
tremor of the head and hands.
A pale, deviated tongue can also occur in the case of externally-contracted wind-cold that blocks the channels in the face, possibly causing facial
paralysis. When wind-phlegm causes dizziness, numbness, headaches, or
even a wind-stroke, the tongue may deviate and be covered with a thick,
greasy coating.

Internal wind can also arise from externally-contracted heat from excess.
This will cause illnesses that are characterized by high fever. The heat penetrates into the blood level and causes skin rashes, like the petechia that
appears during the course of meningitis. The internally-generated wind is
responsible for convulsions or rigidity of the neck. The tongue is also deviated and frequently presents with red, raised points that denote heat in the
blood and the presence of toxic heat (Fig. 9.1.7).

7.3

longue SignsAssociated with Liver Disharmonia


Tongue description

Chinese diagnosis

Reddish, slightly blue, stifftongue body

Kidney yin deficiency and blood stagnation


obstructing the channels
Wind-phlegm blocking the channels
Heart blood deficiency

Deviated with yellow, greasy coating


Notch at the tip

Symptoms

Figure 7.3.1

Extreme stiffness and pain of both elbows and t b


right knee
Fatigue
Depressive moods

Male
35 years old
See
CASE HISTORY
below

Western diagnosis
Degenerative joint disease with involvement of multiple joints
Early stage in atrophy of various muscle groups

Background to disease
Physical overexertion at work
Repressed emotions

Tongue description

Chinese diagnosis

Slightly pale, swollen


Slightly blue
Slightly deviated

Spleen qi deficiency with accumulation of phlegm


Heart blood stasis
Internally-generated wind
Blood deficiency

Dry

Symptoms
Sudden diiziness
Occasional tingling of hands and arms
Tight feeling in the chest
Fatigue
Slight mental confusion
Poor memory

Western diagnosis
Insufficiency of the right heart

Background to disease
Physically overworked for many years
Excessive consumption of sweet and dahy foods

Tongue SignsAssociated with Liver Disharmonies

Tongue description

Chinese diagnosis

Pale, swollen, teeth marks


Pale edges
Deviated
Thin, greasy, yellowish coating

Spleen qi deficiency (accumulation of dampness)


Liver blood deficiency
Internally-generated wind
Accumulation of damp-heat in the middle burner

Symptoms

Figure 7.3.3

Inability to move right arm and leg


Numb feeling
Mental confusion
Epigastric fullness
Nausea
Lack of appetite

Female
35 years old

Western diagnosis
Cerebral apoplexy
Hemiplegia

Background to disease
Occurred after severe fall on the head
Extreme physical and mental demands of looking
after her mentally and physically handicapped
child

Tongue description

~-~

Pale, deviated
Yellow ~reasv
cnatine in the center of the tonme

Figure 7.3.4
Male

59 years old

Chinese diagnosis
Blood deficiencywith internally-generated wind
Heat in the yang brightness (yangming) channel

Symptoms
Right-sided hemiplegia
Loss of memory
Constipation
Epigastric fullness

Western diagnosis
Stroke

Background to disease
High blood pressure for 15 years
'hysically overworked

Tongue Signs Associated with Liuer Disharmonies


Tongue description

Chinese diagnosis

Red, swollen with darkyellow coating a t thesides of


the tongue
Rootless coating at the center of the tongue
Deuiated

Retention of damp-heat in the Liver and Gallbladder


Stomach yin deficiency
Internally-generated Liver wind

Symptoms

Fip;

Slight left-sided facial paralysis


Paralysis of the left arm
Irritability
Restlessness
Urgent urination, burning sensation with urination

7.3.5

69 years old

Western diagnosis
Stroke
Prostatitis

Background to disease
High blood pressure for 15 years

Tongue description

Chinese diagnosis

Red, deviated

Kidney yin deficiency with ascending Liver yang and


internally-generated Liver wind
Heat in the upper burner
Onset of injury to the fluids
Long-standing retention of damp-heat in the
Gallbladder

Red in the anterior third


Yellow, rootless, greasy coating
Right-sided, dirty yellow, thick, greasy coating

Symptoms
Dizziness
Slight hemiplegia
Constipation
Restlessness

Western diagnosis
Stroke

Background to disease
High blood pressure for many years

Figure 7.3.6
Male
66 years old

Tongue Signs Associated with Liuer Disharmonies

Case History

Mr. F, 35 years old, worked as a craftsman for 10 years. The pain in his elbows began
during this time. His complaints developed so quickly that before long he could not
bend his elbows. The stiffness was soon followed by atrophy of the muscles of the
underarms, which forced him to give up his work. He also experienced severe damage to the cartilage of his left knee, which was painful upon exertion. Mr. F reported
that as a child he had suffered from pain in his right knee. The impression he gave
was that of a very unhappy and introverted person. The tongue was stiff and deviated. His pulse was very tight (iin).

u
Fig. 7.3.1

Analysis. Mr. F suffered from a constitutional weakness of Kidney yin. Over the
years, the deficiency of Kidney and Liver yin led to malnourishment of the tendons,
sinews, muscles, and bones. Because his joints had been weak since childhood, the
physical demands of his job triggered local stagnation of qi and blood in the elbows,
followed by the muscles of the underarms. In this case, the blood stagnation
obstructed the channels and was responsible for the extreme stiffness in the joints.
This stagnation is visible in the slightly bluish tongue body. It is possible that stagnation in this area was aggravated by the presence of phlegm, reflected in the greasy
tongue coating. The deviated tongue indicates the formation of internally-generated
wind and could be a warning sign that the illness i s progressing. All of this points to
the possible involvement of other joints in the body. In summary, the internal movement of wind was caused by a deficiency of Kidney yin and blood, which was also
responsible for the atrophy of the muscles.
Discussion. Internally-generated wind only occurs when energetic disharmonies
exist in the body for a long time. All of the causative factors that lead to deficiency of
Kidney yin and blood can cause the formation of internally-generated Liver wind, or
contribute to the movement of internal wind in the channels. Stasis of blood,
phlegm, and damp-heat are other factors that play a role in the formation of internally-generatedwind. With blood stasis, the stiff or deviated tongue body will have a
bluish hue. Damp-heat and phlegm are associated with a yellow, greasy coating.

Tongue Signs Associated with


Liver Blood Deficiency
Long-standing deficiency o f Spleen q i usually causes deficiency o f blood.
This especially affects the Liver, as this yin organ has the important function
o f storing the blood. If too little blood is produced, or too m u c h blood is lost
(e.g., through profuse menstrual bleeding), the Liver can readily develop a
deficiency o f blood. It will then b e incapable o f supplying the Conception
and Penetration vessels with sufficient blood, which may cause scanty or n o
menstruation. Since blood also has a moistening function, Liver blood deficiency w i l l lead t o dryness o f the hair, skin, a n d eyes, a deterioration in
vision, and brittle nails.
This deficiency manifests as a pale, dry tongue body w i t h pale edges and
sides; in severe cases, they may take o n a n orange hue. This indicates that the
deficiency o f blood is so severe that Kidney yin has also been affected. This
occurs because blood is part o f yin. The deficiency o f Kidney yin, in turn, will

Tongue Signs Associated with Liver Disharmonies


affect the essence. Should this happen, the tongue body will also be thin,
indicating the underlying deficiency of blood, with a reddish tongue body
and pale edges and sides.
Deficiency of blood can, especially after a severe loss of blood, lead to
deficiency of qi. When the qi is deficient it will lose its ability to properly
move the blood, which, over the long term, will contribute to stasis of blood.
A pale tongue body with distended blue sublingual veins is often indicative
of this pathology.

Tongue description

Chinese diagnosis

Pale red

Normal
Liver qi constraint and Liver blood deficiency
Normal

Pale, curled-up edges


Red points at the tip

Symptoms
Irregular menstruation
Irritability
Tighmess and pain in the breasts before
menstruation
Western diagnosis
None
Background to disease
Emotional problems due to divorce
Vegetarian diet for 10 years

Figure 7.4.1
Female
38 years old
See
CASE HISTORY

below

Tongue Signs Associated with Liver Disharmonies

Tongue description

Chinese diagnosis

Slightly pale
Pale, slightly contracted edges

Slight Spleen qi deficiency


Liver blood deficiency
Heat from deficiency in the Heart and Liver

Red nnints at the tin and edeefi

Symptoms

Figure 7.4.2
Female
33 years old

Insufficient lactation
Weakness and pain of the muscles
Exhaustion
Irritability

Western diagnosis
None

Background to disease
Severe exhaustion during pregnancy
Inadequate diet
Lack of sleep during pregnancy

Figure 7.4.3

Female
42 years old

Tongue description

Chinese diagnosis

Pale, dry
Pale, slightly orange sides
Swollen in the center of the tongue

Spleen qi deficiency with Liver blood deficiency


Severe Liver blood deficiency
Accumulation of damp-phlegm

I
I

Symptoms
Pain in the right hypochondrium
Pain in the lower abdomen
Constipation
Nausea
Dry skin
Inability to fall asleep

Western diagnosis
Colon cancer with metastases to the liver

Background to disease
Long-standing emotional problems
Repression of emotions

Tongue Signs Associated with Liver Disharmonies


Tongue description

Chinese diagnosis

Pale, especially in the anterior third

Heart blood deficiency

Pale, dry edges

Extreme exhaustion of the blood, especially Liver


blood; lack of fluids
Kidney yin deficiency with Kidney fire

Deep red in the middle and posterior thirds of the


tongue

Symptoms

Figure 7.4.4

Fatigue
Shortness of breath
Low-grade fever
Night sweats
Severe pain in the right hypochondrium and lower
abdomen
Brown urine
Weight loss to the point of emaciation

Female

38 years old

Western diagnosis
Colon cancer with metastases to the liver
Ascites

Background to disease
Condition followed chemotherapy

Case History
Mrs. K, 38 years old, is a fun-loving secretary who works part time. She is a single
parent wilh one child. Over the past six months she experienced pain and tightness
in her breasts for about 10 days prior to the onset of menstruation. She noticed that
during this time she was in a bad mood that she was unable to change. Her menstrual cycle became longer and increased to around 45 days.These symptoms started
when she separated from her boyfriend. She had no other symptoms. Mrs. K had
been a vegetarian for 10 years. The pale, curled-up edges of the tongue are very
noticeable. Her pulse is choppy (se) and slightly wiry (xian).

Analysis. This type of case is a very common one. Emotional problems that start
before a separation, then continue during the separation, can lead to development of
Liver qi constraint.This manifests in the premenstrual syndrome with breast pain and
irritability. The breast pain can be explained by the internal pathway of the Liver
channel, which traverses the ribs via the outer region of the breast to the neck. In the
tongue, Liver qi constraint is expressed as curled-up edges. Here, Liver qi constraint
together with Liver blood deficiency-which in this patient i s reflected in the pale
edges of the tongue and the choppy pulse--is the dominant pathology. When the
Liver qi is constrained, its control over the Spleen becomes oppresive, resulting in
Spleen qi deficiency. This leads to insufficient production of blood, which in this case
was further aggravated by the vegetarian diet. Unfortunately, Liver blood deficiency
can exacerbate Liver qi constraint, thus forming a vicious circle. Liver qi constraint

Fig. 7.4.1

Tongue Signs Associated with Liver Disharmonies


leads to inadequale circulation of blood. In women, the Penetrating vessel i s especially affected by the ensuing stasis. Pain as well as an irregular menstrual cycle may
resulr. The Liver qi constraint and Liver blood deficiency will also contiibuie to an
irregular cycle.

Discussion. Liver qi constrainl can lead lo blood deficiency by overcorrtrolling ihe


Spleen, li lhere is not enough blood, the Liver's function of storing blood is impaired.
This is rcflecled in tongue edges (ha1are pale, or in severe cases, orange.
Proper circulation and movemenl o i blood can be impaired as much by blood
deficiency as by Liver qi constraint. Blood deiiciency can also contribute l o blood
stasis.This may be reflected in a bluish tongue body, or in blue, distended sublin~ual
veins.

Endnote
1. For further information, see Flaws B. My Sisler; TheMoo~i.Boulder. CO: Blue
Poppy Press, 1992, as well as Kirschbaum B. DleAcl?lAusserordeniliche GefuJe i17
der TCM. Uelzen, Germany: Medizinisch-l.iterarischer Verlag, 1995.

C H A P T E R

Tongue Signs Associated


with Blood Stasis
8.1

Blue or Bluish Tongue Bodies


Blood stasis is often responsible for conditions involving pain. When the
movement of blood becomes impaired or sluggish, the individual will experience a fixed, localized, sharp pain that often worsens at night or with rest.
This can occur in any part of the body. If, for example, it occurs in the upper
burner region there will be chest, heart, or shoulder region pain. If the middle
burner is affected there will be fixed pain in the abdomen or under the ribs.
And in the lower burner this pattern is responsible for lower abdominal pain
or severe menstrual pain. Hard, fixed masses or tumors are also frequently a
sign of blood stasis.'
The color of the tongue body can, as a rule, accurately reflect any impairment in the movement of blood. The nature of the color is indicative of the
flow of energy throughout the body. If the qi is weak, insufficient blood will
be transported to the tongue, resulting in a pale tongue body. When the yang
of the body moves excessively and moves blood too vigorously to the head
and tongue, a red tongue body may ensue. In the case of blood stasis, the
movement of blood will be seriously impaired, and the tongue will take on a
characteristic blue tinge which occasionally may also be seen on the lips and
fingernails.
The basic color of the tongue body provides information about the
cause or origin of the blood stasis. A pale and bluish tongue can reflect
either qi deficiency, whereby the qi is not strong enough to move the blood,
or blood deficiency, whereby blood stasis is induced by severe bleeding. A
pale, bluish, swollen tongue body suggests that the blood stasis is related to

Tongue Signs Associated with Blood Stasis


accumulation of inner cold resulting from underlying Kidney yang deficiency; as a consequence, the movement of blood is impaired.
Externally-contracted pathogenic influences, especially cold, can attack
the superficial layers of the body and cause stagnation of blood in the channels, muscles, and joints. Externally-contracted cold can also penetrate to
the deeper layers of the body and cause, for example, stasis of blood in the
Womb. Cold congeals the blood and thus impedes menstrual flow, causing
delayed menstruation or dark, coagulated blood.
Heat works through a different pathway. Blood is thickened by the evaporation that occurs when Heat in the blood level results first in the evaporation of fluids, and then in the thickening of blood. This heat injures the fluids
that normally thin the blood. As a result, the blood is insufficiently thinned
and begins to congeal, resulting in blood stasis. In this case the tongue body
takes on a red-bluish tinge.
The bluish discoloration occasionally appears on only a portion of the
tongue, that is, the remainder of the tongue body may have a normal color.
In such cases the practitioner should consult a topographical drawing of the
tongue to determine the affected area (see Chapter 1).A bluish discoloration
of the tip of the tongue can indicate stasis of Heart blood. If the tongue body
is also pale, this points to underlying Heart yang deficiency. Alternatively, if
the tongue edges and sides show a red-bluish discoloration, one may deduce
that a pattern of Liver blood stasis with Liver heat is present. This diagnostic
procedure call be applied to blue points or singular spots on the tongue.
However, there are exceptions to every rule, and a discolored area or singular
point that appears on the tongue as a result of blood stasis in a particular
organ may not always appear in the topographical location associated with
that organ on the tongue. An example from my own practice will illustrate
this problem.

Figure a.!,

A patient came for treatment because she felt exhausted. The tongue
body had a normal shape, and its color was pale. At the edge of the anterior
third, a dark bluish spot was clearly visible (Fig. 8.2.1). Based on its location, I
suspected a pattern of blood stasis in the upper burner. The patient was
advised to see her doctor for a general examination and to have a blood test.
The examination did not reveal any problems in the parts of the body related
to the upper burner, although two small uterine fibroids were found. In
Chinese medicine, uterine fibroids are mostly due to stasis of blood in the
Womb. The blue spot, therefore, correctly showed a pattern of blood stasis, but
it was not located in the area of the tongue-the posterior third-associated
with the involved part of the body. Interestingly, the patient returned three
years after this photo was taken with a diagnosis of cirrhosis of the liver (of
unknown origin). This example illustrates quite clearly that one must not rely
too rigidly on a particular classification or a generalized tongue diagnosis in
relation to a particular discolored area. Nevertheless, and in spite of this, the
topographical chart is generally a good guide to follow.
Important sources of blood stasis include injuries, bone fractures,
surgery, and abortions. If the injuries are very serious, the tongue body may
show a bluish discoloration within days. But it must be emphasized that the
tongue body does not always change its color, even when there is a distinct
possibility of physical injury-induced blood stasis. In some cases, blood stasis
is only visible in the distended sublingual veins, and not in a discoloration of

Tongue Signs Associated with Blood Stasis

the tongue body (see Section 8.3 below). Moreover, although the tongue
may present signs of blood stasis-bluish discoloration, blue spots or
points, discolored areas, distended sublingual veins-it may not b e present
at the time of the examination. Still, the practitioner should note these signs
and carefully observe any changes concerning them.

Tongue description

Chinese diagnosis

Very pale blue

Spleen qi and yangdeficiency with blood deficiency,


slight blood stasis
Gate of vitality (~ningmenlcommunicating with the
Heart (nonpathological)
Accumulation of dampness

Reddish tip
White, thin coating

Symptoms

Figure 8.1.1

Muscle cramps upon exertion


Exhaustion
Tendency to catch colds
Nasal congestion

Male

Western diagnosis
Chronic fatigue syndrome after infection with
Epstein-Barr virus
Allergic rhinitis

Background to disease
Excessive physical training because of work as a
professional dancer

35 years old

Tongue Signs Associated with Blood Stasis


Tongue description

Pale blue
Slightly narrow, pointed tongue body
White, slippery coating

Chinese diagnosis
Liver blood stasis
Constitutionalweakness of the Heart
Accumulation of dampness

Symptoms

Figure 8.1.2
Female
41 years old

Severe, cramp-like pain before menstruation


Night sweats with stress
Deptessive moods, phobias
Runny nose

Western diagnosis
Allergic rhinitis
Eczema

Background to disease
Long-standing emotional problems

Figure 8.1.3

58 years old

Tongue description

Chinese diagnosis

Pale red, bluish, slight teeth marks


Reddish blue sides on the posterior third
Raised, dark red spot

Heart qi deficiency and blood stasis


Heat in the Liver with blood stasis
Liver blood stasis

Symptoms
Constricted feelingin the chest
Shortness of breath with labored breathing and
sweating, aggravated by stress and anger
Palpitations
Occasional stomach pains with epigastric fullness

Western diagnosis
Stenosis of the coronaries
Irregular cardiac rhythm

Background to disease
Excessive consumption of fatty foods
Repressed emotions

TongueSigns Associated with Blood Stasis


Tongue description

Chinese diagnosis

Pale blue, swollen

Heart yang deficiency with accumulation of damp.


phlegm
Heart blood stasis
Internally-generatedwind
Accumulation of cold-dampness
Blood stasis in the upper burner

Intense blue discoloration in the anterior third


Slightly deviated
White, greasy coating
Very distended, dark blue sublingual veins

Symptoms

Figure 8.1.4

Paralysis of the left arm


Slurred speech
Racing of the heart
Exhaustion

Male
75 years old

Western diagnosis
Stroke
Hypertension
Kidney stones

Background to disease
Chronic hypertension

Tongue description

Chinese diagnosis

Bluish red
Red sides
Red, slightly curled-up tip
White, slightly greasy coating

Kidney yin deficiencywith Liver blood stasis


Liver qi constraint with heat in the Liver
Heat in the Heart
Accumulation of dampness

Symptoms

Figure 8.1.5

Edema of the left arm


Night sweats
Restlessness
Severe attacks of fear and irritability

Female
54 years old

Western diagnosis
Breast cancer

Badcground to disease
Condition followed radiation therapy and mastectomy
Repressed emotions

See
CASE HISTORY
below

Tongue Signs Associated with Blood Stasis

Tongue description

Chinese diagnosis

Red-bluish
Red sides
Grayish, slightly greasy coating

Heat in the Liver with blood stasis


Liver qi constraint transforming into fire
Food stagnation

rigure 8.1.6

Symptoms

Female
48 years old

Fits of rage, irritability


Ctying spells
Feeling of fullness in the chest and under the ribs
Bitter taste in the mouth
Diarrhea after eating
Flatulence

Western diagnosis
Menopause

Background to disease
Repressed emotions

Tongue description

Chinese diagnosis

Red-bluish
Red, swollen sides
Dirty yellow, greasy coating

Heat in the blood with blood stasis


Liver fire
Retention of damp-heat in the Liver and
Gallbladder

Figure 8.1.7

Symptoms

Male
49 years old

Severe headaches
Sudden nosebleeds
Tightness of the neck muscles
Irritability
Insomnia
Dry mouth
Dry stools

Western diagnosis
Hypertension
Migraines

Background to disease
Alcohol abuse
Overwork

TongueSigns Associated with Blood Stasis


Tongue description

Chinese diagnosis

Pale blue, swollen

Spleen qi deficiency with accumulation of dampness, blood deficiency and stasis


Severe Liver blood stasis

Dark blue areas

Symptoms

.-1gure
. 8.1.8

Caput medusae [dilated cutaneous veins around the


umbilicus)
Severe weight loss
Weakness
No appetite
Edema of the lower legs

dale

i 0 years old

Western diagnosis
Cirrhosis of the Liver

Background to disease
Unknown

Case History
Mrs. P, a 54-year-old businesswoman, was bitter and disappointed over her failed
marriage. She tried to repress her feelings by constantly working. Three years after
her divorce, during a routine examination, a malignant lump in the breast was found.
She had a mastectomy and underwent radiation and chemotherapy. Since that time
the patient experienced deep fear, restlessness, and night sweats. After axillary lymphadenectomy, she developed slight edema of the corresponding arm. Her tongue
was red-bluish and slightly deviated. Her pulse was wiry (xian) and slightly rapid
(shou).

Analysis. In this case, the bitter emotions experienced by the patient led to the
development of Liver qi constraint, which in turn caused blood stasis. The inner path
of the Liver channel traverses the outer side of the breast. A long-standing blockage
in the flow of Liver qi and blood can lead to stasis of blood in this region, which contributes to the formation of lumps. The pronounced blood stasis in Mrs. P is reflected
in the bluish discoloration of the tongue.
All surgery can cause local stagnation of qi, blood, and fluids, thus creating a
blockage in the channels of the affected region. In this case, the excision of the
lymph node was certainly responsible for the stagnation of the fluids (edema) in the
arm.
The restlessness and night sweats were attributable to Kidney yin deficiency and
the developing heat in the Heart. The latter factor is reflected in the red, curled-up tip

Fig. 8.1.5

Tongue Signs Associated with Blood Stasis

Discussion. Stasis of blood frequently arises irom a pattern oi Liver qi constraint. If a


person does not resolve repressed emotions, there is always the danger that the qi
constraint will lead to blood stasis. In women, this pathology may initially manifest
as painful menstruation. Over the long term, blood stasis contributes to the accumulation of 'material' that lays the foundation for masses: uterine fibroids, lumps, or
tumors.

Partial Bluish Discoloration of the Tongue


Blood collects in every tissue and organ. Insufficient movement of qi through
the organs, especially the Heart, Liver, Stomach, and Womb, contributes to
the development of blood stasis. As discussed above, the location of the stasis
can often be deduced from the position of the bluish discolored areas or
singular points, spots, or patches on the tongue.
Long-standing heat in the body injures the blood, especially its fluid
component, which, as previously discussed, may contribute to blood stasis
in the Heart. Sudden retrosternal pains, a constricted feeling in the thorax,
labored breathing, blue lips, and a bluish complexion are characteristic of
this pattern. In Heart blood stasis with underlying heat, the tip of the tongue
is often red-blue, or there may be bluish or dark red spots there. Years of
extreme emotions, emotional shocks, or the consumption of large amounts
of alcohol and nicotine can be responsible for such a pattern.
When Heart blood stasis is associated with underlying Heart yang deficiency, the tip will have a pale blue tinge. Heart yang deficiency can only
arise from Kidney yang deficiency. The lack of dynamism of the yang in such
cases impairs the circulation of blood. Chest pains will also be present; however, this pattern differs from Heart blood stasis in that there will also be cold
extremities and an aversion to cold. Patients will be much more tired and will
show less drive than those suffering from Heart blood stasis.
Another cause of blood stasis is long-standing Liver qi constraint. Here,
the Liver blood stasis will be reflected in bluish discoloration of the sides of
the tongue, with a pale or pale red tongue body. Unresolved emotions and
repressed desires and feelings impair the free flow of Liver qi. Since the Liver
governs the storage of blood and its distribution, Liver qi constraint can trigger an uncontrolled movement of blood. Thus, Liver blood stasis can, on the
one hand, cause sudden nosebleeds, and on the other hand, a delayed menstrual cycle. The Liver has a close relationship to the Conception and Penetrating vessels. Liver blood stasis may thus affect the functioning of these
vessels, which will manifest as intense pain before and during menstrual
bleeding. The same mechanism can be found in the formation of uterine
fibroids, as these benign tumors correspond in Chinese medicine to congealed and stagnant blood. Distended sublingual veins and a dent at the tip
of the tongue (see Section 6.2.) are, in my opinion, frequently seen tongue
signs in women who suffer from this pathology. Interestingly enough, bluish
discoloration of the sides of the tongue appears very seldom in these cases,
even though this area does reflect Liver function, and the formation of uterine
fibroids is strongly connected to Liver blood stasis and stagnation in the
Penetrating vessel.

Tongue Signs Associated with Blood Stasis


A red tongue body with bluish sides is indicative of heat in the Liver,
which can lead to Liver blood stasis. In this case, heat thickens and clumps
the blood. In patients with chronic hepatitis B or C, the sides of the tongue
are frequently red and curled up because of the heat in the Liver. If the sides
should take on a dark red or bluish color, the pattern of Liver blood stasis has
developed in these patients. One study found that this often coincides with
the beginning of cirrhotic changes in the liver cells.z
Another investigation showed that blue areas on the side of the tongue
point to liver pathology, but it is not possible to deduce from the appearance
.~
one should
of blue spots that malignant tumors are p r e ~ e n t Nevertheless,
note the intensity of the color of the blue spots as well as other signs to gamer
an indication of the severity of the illness.
Severe, sharp stomach pains may indicate blood stasis in the Stomach.
The diagnosis is confirmed when the center of the tongue is of a blue discoloration. Because this is a condition of excess, the consumption of food or the
application of pressure or warmth will aggravate the pain.

Tongue description

Chinese diagnosis

Slightly pale tongue body and edges


Slightly curled-up edges
Blue spot on the right side of the anterior third

Spleen qi deficiencywith Liver blood deficiency


Liver qi constraint
Blood stasis

Symptoms
Migraines with menstruation
Long-lastingbleeding
Hot flushes
Fatigue
Weight gain
Western diagnosis
Uterine fibroids
Cirrhosis of the liver of unknown etiology
Background to disease
Menopause
Long-standing emotional problems
Excessive consumption of sweets and dairy foods

Figure 8.2.1
Female
48 years old

Tongue SignsAssociated with Blood Stasis

Tongue description

Chinese diagnosis

Reddish, swollen

Retention of damp-heat in the middle and lower


burners
Blood stasis in the Stomach
Slight Stomach yin deficiency
Stagnation of qi, blood, and dampness in the
channels

Reddish-blue center of the tongue


Thin vertical crack with small horizontal cracks
Left half of tongue swollen

Figure 8.2.2

Symptoms

Female
61 years old

Heartburn
Stomach pains
Constipation or dry stools
Painful legs
Sleeping problems

Western diagnosis
Hiatus hernia
Chronic gastritis
Arterial obstruction of both lower legs

Background to disease
Excessive worry for many years
Excessive consumption of sweet and fatty foods

Tongue description

Chinese diagnosis

Dark pale with bluish patches on the sides of the

Liver blood stasis

tongue
Swollen tongue body, teeth marks

Spleen qi deficiency (accumulation of dampphlegm)

Figure 8.2.3

Symptoms

Female
59 years old

Palpitations
Severe fatigue
Soft stools
Changing appetite
Tendency to catch colds

Western diagnosis
Breast cancer
Hyperthyroidism

Background to disease
Condition followed mastectomy, chemotherapy,
and radiation therapy

Tongue Signs Associated with Blood Stasis

Tongue description

Chinese diagnosis

Red, swollen sides with dirty yellow, old, greasy


coating at the sides
Blue patches at thesides
Reddish-blue center of the tongue without coating

Retention of damp-heat in the Liver and Gallbladder

Blue, distended sublingual veins

Symptoms
Irritability
Stomach pain
,
Severe weight loss
Severe sweating, day and
night
~ilareralprotrusion of the
eyes

Liver blood stasis


Onset of blood stasis in the Stomach. Stomach yin
deficiency
Blood stasis

Figure 8.2.4
Male
33 years old

Western diagnosis
Hyperthyroidism

Background to disease
Unclear

Tongue description

Chinese diagnosis

Reddish, long, with curled-down tip

Constitutional heat in the Heart, with heat from


deficiency in the Heart
Liver blood stasis with underlying heat in theLiver
Accumulation of phlegm

Redsides with bluish patches


Whitish,greusy coating

Symptoms
Shortness of breath
Fatigue
Night sweats
Severe, sharp pains in the hip joint
Dry,red facial skin
Vivid dreams
Overweight

Western diagnosis
Chronic myeloid leukemia
Necrosis of the hip joint

Background to disease
Within three years, more than 20 x-rays because of a
complicated fracture of the lower leg
Side effects of chemotherapy
Excessive consumption of fatty foods
*Patient died 9 months after this photo was taken.

Figure 8.2.5
Male

50 years old*
See
CASE HISTORY
below

Tongue Signs Associated with Blood Stasis

Case History

Fig. 8.2.5

Mr. G, a 50-year-old mathematician, was diagnosed with chronic myeloid leukemia


four years ago. Most of the time he felt quite well. He developed aplastic anemia
from the medication for his illness, and since then, he has suffered from severe shortness of breath and fatigue. When the exhaustion becomes very severe, he gets night
sweats. Due to necrosis of the hip joint, he suffered from severe, sharp pains in that
region. He recently complained about red, dry facial skin and an open ulcer on the
lower leg that took a long time to heal. The tongue was distinctive with the bluish
patches at the sides. His pulse was submerged (chen) and perturbed (dong).

Analysis. Three years prior to the diagnosis of leukemia the patient had been
exposed to many x-rays that were necessary due to a complicated fracture of the
lower leg. X-ray examinations may be compared to the penetration of toxic or
extreme heat that injures the fluids and causes heat in the blood. Over the long term
this will thicken the blood and lead to blood stasis. In this patient there were no visible signs on the tongue that would indicate toxic heat. Instead, heat in the blood and
toxic heat were diagnosed from the open leg ulcer and the quality of his iacial skin.
The bluish patches on the tongue, denoting a pattern of blood stasis, are very
interesting. In Chinese medicine there is a saying, "In the presence of blood stasis,
new blood cannot f ~ r m . " ~ T hmeans
is
that blood stasis leads to anemia. In this case,
the severe, sharp hip pains due to the necrosis were also indicative of blood stasis.
The whitish, greasy coating pointed to an accumulation of phlegm. This accumulation i s understandable in light of the patient's desire for fatty foods, especially
sausage, which contributed to weight gain.

Discussion. Blood stasis in the organs can present as bluish discoloration on certain
areas of the tongue. The bluish points, however, do not always appear in the topographical location associated with the problem organ. Thus, in order to make an
accurate diagnosis, one should always take the other symptoms into account. For
example, Stomach blood stasis is characterized by severe, localized stomach pains,
while Heart blood stasis i s characterized by chest pains.

Distended SublingualVeins
This section focuses o n the examination o f the underside o f the tongue.
There are two prominent veins, one o n each side o f the frenulum. When the
tip o f the tongue is rolled up t o the palate, the two veins should be barely visible. The observer can gain information about blood stasis from the color,
size, and degree of distention of the sublingual veins. These signs, however,
tell very little about the location o f the stasis. Western medicine sees distended sublingual veins as a sign o f stasis i n the venous return o f blood as it
occurs, for example, in right-heart insufficiency.%hinese medicine, similarly, often judges these veins as a sign o f blood stasis in the upper burner."
The intensity o f the color and the degree of the distention o f the sublingual veins, in combination w i t h other tongue signs, provide a picture of the
degree of blood stasis in the entire body. The severity o f the blood stasis is
reflected in the intensity o f the color a n d degree o f swelling o f the veins.
Occasionally, these veins take o n a thick, swollen appearance. If they are also
dark blue in color, the blood stasis is severe.

TonguesignsAssociated with Blood Stasis


A bluish tongue body, also a sign of blood stasis, does not always appear
when the sublingual veins are distended. Even in life-threatening diseases
such as metastisizing carcinomas, which are commonly accompanied by
chronic stasis of blood, the tongue body color may be unchanged with no
blue discoloration. In these cases, however, the sublingual veins are frequently distended (Fig. 8.3.2).

Maciocia views distended sublingual veins that appear in combination


with a normal tongue body color as an early indication of qi and blood disorders.' This can be further expanded upon. Many women with uterine fibroids
or positive Pap-smears often have tongues with normal body, color, and
shape, but with severely distended sublingual veins. The veins are also visible
when the Penetrating vessel is afflicted with long-standing blood stasis
resulting, for example, from sexual abuse or multiple abortions. However, if
the sublingual veins are thin and light in color, the blood stasis is not very
serious. This diagnostic evidence should be taken into account when examining patients who suffer from menstrual disorders, habitual miscarriages, or
infertility.
Injuries such as bone fractures or torsion to the sinews, tendons, or muscles interrupt the circulation of blood, resulting in localized stagnation of
blood in the channels, muscles, and joints. This type of blood stasis is superficial and is usually found unilaterally. It may present on the tongue as a unilateral, distended sublingual vein. Again, the sidedness of the injury and of
the distended subliigual vein may not coincide.
Accumulation of phlegm or damp-heat in the body can also be observed
in the sublingual vein^.^ In this case, they are reddish blue and have a sheen.
Other signs include blue, black, or dark spots (Fig. 8.3.6).These signs are
an indication of Heart blood stasis that manifests as coronary heart disease,
or illnesses of the Liver such as chronic hepatitis, cirrhosis of the liver, or liver

Figure 8.3.2

Tongue Signs Associated with Blood Stasis

Tongue description

Chinese diagnosis

Red, swollen, yellow, greasy, dry coating

Heat in the Liver with long-standing retention of


damp-heat in the Liver and Gallbladder
Liver blood stasis

Red, slightly bluish sides, blue distended


sublingual veins

symptoms

Figure 8.3.1

Epigastric fullness
Sharp pains in the right
hypochondrium
Fatigue
Muscle pains

38 years old

Western diagnosis
Hepatitis C for 13 vears

Background to disease
Heroin and alcohol abuse

Figure 8.3.2
Female
31 years old

CASE HISTORY

below

see

Tongue description

Chinese diagnosis

Reddish, slightly narrow


Red tip
Thick, blue tortuous sublingual veins

Onset of Kidney yin deficiency


Heat in the Heart
Blood stasis in thewomb

Symptoms
Painful menstruation
Night sweats
Insomnia
Depressive moods
Fear

Western diagnosis
Cervical cancer

Background to disease
Long-standing emotional
problems
E m m e mental demands
at work

Tongue Signs Associated with Blood Stmis


Tongue description

Chinese diagnosis

Reddish, slightly contracted tongue body


Red in the anterior third with red points
Coatingwithout root
Dark blue, distended sublingual veins

Kidney yin deficiency


Heat in the Heart
Stomach and Kidney yin deficiency
Liver blood stasis

Symptoms
Severe hair loss
Fatigue
Sense of fullness in the right
hypochondrium

Western diagnosis

12 years old

Malignant hepatoma

Background to disease
Use of contraceptive pills
for18years

Tongue description

Chinese diagnosis

Dark red, small, shiny


Dark purple sublingual ueins with dark spots

Lung, Stomach, and Kidney yin deficiency


Severe blood stasis in the upper burner

Symptoms
Dry cough
Night sweats
Low-grade fever, intense
feeling of heat in the body
Labored breathing and
shortness of breath
Exhaustion

Western diagnosis
Chronic bronchitis
Emphysema

Background to disease
Heavy smoking for 60 years

:igure 8.3.4
dale
33 years old

Tongue Signs Associated with Blood Stasis

Figure 8.3.5
Male
66 years old

Tongue description

Chinese diagnosis

Red, firm tongue body


Rootless coating, especially at the center and root
of the tongue
Slightly yellow, old coating
Thick, dark blue, distended sublingual veins with
dark spots

Kidney yin deficiency


Stomach and Kidney yin deficiency
Retention of damp-heat in the Large Intestine
Swere blood stasis

Symptoms

Long-standing constipation
Heartburn
Stomach pain
Extreme physical we&ess
Night sweats
Pain in the bones

Western diagnosis
Prostate cancer with
metastases to the bones

Background to disease
Overwork
Emotional problems

Figure 8.3.6
33 years old

Tongue description

Chinese diagnosis

Pale red, swollen in the anterior third and center


of the tongue
Red points in the anterior third
Yellow, greasy coating at the root of the tongue
Blue, very distended sublingual veins with
branching, bright red capillai--

Spleen qi deficiencywith retention of phlegm


Heat in the Lungs
Retention of damp-heat in the lower burner
Blood stasis in the upper burner with the development of toxic heat

Symptoms
Cough with blood-tinged
sputum
Pain in the chest
Night sweats
Constant low-grade fever
Thirst
Nausea

Western diagnosis
Inoperable bronchial cancer

Background to disease
Smoking 40 cigarettes daily
for 15years

Tongue Signs Associated with Blood Stasis

Case History
Mrs. M i s a 31-year-old archeologist. Her work included frequent travel, which
contributed to an irregular lifestyle. Irregular eating habits, insufficient sleep, and
unsatisfactory personal relationships all contributed to her feeling unwell. She was
constantly exhausted and suffered from depressive moods. Over a few months, the
length of bleeding and the intensity of her menstrual cycle changed, so she decided
to visit a gynecologist. The finding was cancer of the cervix without lymph node
involvement. Her tongue showed a very red tip and thick, blue, distended sublingual
veins. Her pulse was thin ( x i ) and frail (ruo).

Analysis. The irregular lifestyle and lack of sleep were responsible for a slight weakening of Kidney yin. This was accompanied by Liver qi constraint, possibly caused by
the emotional instability in her personal relationships. The two disharmonies manifested i n strong mood swings that vacillated between anger, grief, and fear. The
Kidney yin deficiency, as reflected in the small tongue body, was responsible for the
night sweats and sleeping problems. The red tip of the tongue indicated heat in the
Heart that was caused by the long-standing emotional problems, as well as the
underlying slight Kidney yin deficiency. The thin, frail pulse reflected the underlying
deficiency of yin and blood.
Long-standing Liver qi constraint often leads to a pattern of Liver blood stasis,
which, in turn, impairs the circulation of blood in the Penetrating vessel. The result is
a pattern of blood stasis in the Womb, which in this case is visible in the thick and
swollen sublingual veins. This suggests a long-standing pattern of blood stasis, which
may be responsible for the cellular changes found in the cervix.

Discussion. In many cases, distended sublingual veins are indicative of an ongoing


process of blood stasis in the body. Although some research suggests that the appearance of these veins is a sure sign of disease affecting the Heart, Lungs, and Liver, a
diagnosis using the sublingual veins does not always allow one to determine the
exact location of the blood stasis in the body. This must be determined with the help
of the other presenting symptoms. In general, a valid interpretation of the severity of
the blood stasis can be made based upon the appearance of these veins. As previously stated, the severity of the blood stasis is reflected in the intensity of the color
and the degree of distention and swelling of the veins. As one would expect, thin,
bluish, distended sublingual veins are indicative of mild blood stasis.

Endnotes
1. See Li N-M. Zhongguo shczhen da quan. Beijing: Xueyuan Publishing Company,
1994:1190. The appearance of a blue tongue i s found in the following illnesses:

colon cancer, liver cancer, stomach cancer, cirrhosis of the liver with ascites, and
malignant tumors in the peritoneum.
2. See Chen Z, Chen M-E The Essence and Scientific Bukground of Tongue Diagnosis.

Long Beach, CA: Oriental Healing Arts Institute, 1989:38. An investigation was
described wherein 76 patients with primary liver cell carcinoma were examined.
The orthodox medical findings were compared with TCM diagnosis. From a
Chinese medical point of view, the cause of disease was diagnosed as mainly
Liver blood stasis. In 59 of these patients (77%), the tongue showed the so-called

Fig. 8.3.2

Tongue Signs Associated witlz Blood Stasis

'Liver cancer line,' a bluish or crimson line located at the sides of the tongue, or
bluish patches on the tongue.

3. Li, 1202. An investigation was described whereby patients were included in a


study if they had bluish spots or patches at the sides of their tongues, suffered
from an organic liver illness, or were ill from a malignant disease. Subjects
included those with acute and chronic hepatitis, cirrhosis of the liver, liver cell
carcinoma, or metastases of the liver. In all cases of acute hepatitis, no bluish
discoloration was fnund.Ten percent of patients with chronic hepatitis had them.
Ilowever, 40% of the patients with liver cell carcinoma and 100% (three patients)
of the patients with metastases of the liver had bluish areas. Those who suffered
from malignant diseases other than in the liver did not have the blue discoloration,
and only 0.9?4 of those with non-malignant diseases showed the discoloration.
4. This idea is usually traced back to the nineteenth-century authorl'ang Rong-

Chuan. For more information on this see subject, see Al-Khafaji M. "Stasis o f
blood." Ti?elolrt-rzalof Chi~zeseMediciize 1990:32.
5. Beaven DE. Brooks SE. Color Allas orthe Tongue in Clir~icalDiugiiosis. Ipswich,
UK: Year Book Medical Pulishers, 1988:30.

6. Chen, 96-97. The authors report thc results from many clinical trials that were
undertaken with patients who were diagnosed with blood stasis. The Western
medical diagnoses for these patients included cancer, coronary hean disease,
cor pulmonale, rheumatic heart disease, and hypertension. The majority of
patients presented with distended sublingual veins, suggesting that more
importance should be attached to the diagnosis of the sublingual veins. See ulso
I.i, 1370. This study relates that distended sublingual veins appeared in 35 out of
37 patients with coronary heart disease.
7. Maciocia G. Ibnglie L)iagfiosis if?.Cl~ifieseMedicifie, rev. ed. Seattle: Eastland
Press. 1995:63.

8. Chen. ibid.
9. Li, 1200.Tlic appearance of blue spots under the tongue were also mentioned
with respect to other illnesses such as hypertension, atherosclerosis, hypercholesteroleniia, chronic bronchitis, emphysema, and all types of heart disease.
In addition, a study was conducted of 131 patients with blue spots under the
tongue. Seventy percent of these patients also had bluish discoloration of tlie
tongue sul-face.These patients presented with a pathology of blood stasis. l'he
spots diminished after therapeutic measures were taken to invigorate tlie blood.
Flowever, if the therapy was interrupted, the spots reappeared. It was also noted
that the appearance of blue spots under the tongue was Inore Frequent in elderly
patients. Among young people, even if the illness was severe, the blue spots
rarely appeared.

C H A P T E R

............................................................

Tongue Signs Associated


with Heat Disorders
9.1

Red Points at the Tip of the Tongue


Red points at the tip of the tongue can be a sign of externally-contracted
wind-heat or toxic heat. These red, 'rough-grained' points often herald the
beginning of a cold, and are occasionally visible one or two days before the
onset of the illness. They should not be confused with points that reflect heat
in the Heart. In the latter case, the points tend to be positioned very closely
to each other, rather like fine-grained sand, are less raised, and are of a light
red color; they can, however, evolve to a deep red color (Fig. 6.3.7). By contrast, the red points associated with external wind-heat or toxic heat tend to
be bigger, more raised, and of a darker red color. And because they are positioned wider apart from each other, the points have a rough-grained look.
While the points indicating heat in the Heart are only visible at the tip of the
tongue, those indicative of externally-contracted wind-heat extend over the
entire anterior third of the tongue. And if heat toxin is present, they may
extend even further, occasionally covering the entire tongue body.
Externally-contracted wind-heat enters the body through the nose and
mouth. The symptoms include fever, sore throat, headaches, and thirst.
Often acute, externally-contracted wind-heat penetrates directly into the
Lungs where it impairs the Lung qi, which manifests in a cough. At the onset
of such an illness, the tongue has a thin white or yellow coating. A floating,
rapid pulse is another sign of wind-heat attacking the outer protective layer
of the body. If the heat is very strong, red points may appear and can extend
from the tip to the end of the anterior third of the tongue.
The presence of heat toxin also manifests as red points, but in contrast to
those of wind-heat, they can extend over the entire tongue body. As a rule,

I
I

Figure 6.3.7

Tongue SignsAssociated with Heat Disorders

'

these points tend to be bigger and/or darker in color, but this is only so when
the toxic heat is very strong. In extreme cases, 'thorns' appear on the tongue
surface. They look like small prickles and are caused by extreme heat that
injures the papillae and pushes them to the surface and to the outside (Figs.
7.1.6 and 3.5.3).

-.,
rlgure -.
I . I .o
-

Figure 3.5.3

Toxic heat may arise from externally-contracted heat that lodges in the
interior and is then transformed into toxic heat by constrained dampness or
phlegm. It can also be formed from an accumulation of internally-generated
heat. Contributing- factors are frequent use of alcohol and too much fatty and
spicy foods, both of which will aggravate any preexisting damp-heat or
phlegm-heat. The heat is constrained by the dampness or phlegm in the system and will eventually transform into fire, which can, in a very short time,
evolve into heat toxin. This development is clearly visible as a thick, greasy,
and yellow coating on the tongue. Patients with an underlying disposition
toward retaining and accumulating damp-heat or phlegm-heat can develop
toxic heat quite quickly after contracting an external pathogenic factor. In
such cases a thick, greasy, and yellow coating and red or dark red spots on
the tongue body will appear simultanously.
Infectious diseases such as meningitis, hepatitis, or AIDS are characterized by epidemic toxic qi. Epidemic wind-heat diseases like mumps, measles,
chickenpox, and scarlet fever also give rise to toxic heat. The heat is so strong
in these diseases that it can penetrate to the blood level where it is expressed
in skin rashes, fevers, and other symptoms. Acute conjunctivitis, acute febrile
tonsillitis, ulcers, and acute urinary tract infections can also be caused by
heat toxin.

Figure 9.1.1 0

Because their symptoms are so different, it is easy to differentiate


between externally-contracted wind-heat and toxic heat. Important symptoms that are indicative of wind-heat include:
Fever
Cough
Sore throat
Headaches
Thin white or yellow tongue coating
Floating, rapid pulse.
Wical manifestations of accumulating heat toxin include:

Severe malaise or sickness


High fever
Purulent, red, hot, painful ulcers
Furuncles, carbuncles, abscesses
Chronic abscesses of the tonsils
Acute mastitis
Pus and blood in the stool
Yellow tongue coating and widely distributed red points on the tongue.

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Pale, swollen

Spleen qi deficiency with blood deficiency and


accumulation of dampness
Acute, externally-contracted wind-heat

Red points at the tip and anterior third

Symptoms

Figure 9.1.1

Fever
Sore throat
Severe pain upon swallowing
Cough

37 years old

Female

Western diagnosis
Acute cold

Background to disease
Lack of sleep
Overwork

Tongue description

Chinese diagnosis

Pale red, swollen

Slight Spleen qi deficiency (accumulation of


dampness)
Essence deficiency
Acute, externally-contracted wind-heat

Depression at the root


Red points at the tip and sides

Symptoms
Severe difficulty in swallowing
Sore and dry throat
Cough
Chronic white, vaginal discharge
Early graying of hair

Western diagnosis
Acute bacterial pharyngitis

Background to disease
Overwork for many years
Irregular eating habits
Smoking for 20 years

figure 9.1.2
Female
40 years old

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Pale, swollen, teeth marks

Spleen qi deficiency (accumulation of dampness


in the middle burner)
Accumulation of damp-phlegm

White and thick in the center with lightyellow


coating
Bright red raised points a t the tip andsides
Figure 9.1.3

Acute, externally-contracted wind-heat, dampheat transforming into toxic heat

Symptoms
Severe sore throat with strong feeling of malaise
Tendency to catch colds
Cough with yellow, thick phlegm
Exhaustion

Female
32 years old
See

CASE HISTORY

Western diagnosis

below

Chronic tonsillitis

Background to disease
Excessive physical training as a dancer
Dancing in cold working conditions while sweating
Irregular eating habits
Excessive consumption of raw foods

Tongue description

Chinese diagnosis

Red, swollen
Deep vertical crack in the center of the tongue
with light yellow, dry coating
Two localized, rootless, round patches1

Heat in the blood and accumulation of dampness


Stomach yin deficiencywith heat in the Stomach

Deep red, raised poinn nt tip and red points a t the


sides
Figure 9.1.4
Female
29 years old

Heat in the Stomach, penetration of heat toxin


into the center of the tongue
of heat

Symptoms
Frequent formation of furuncles with pus and
blood
Muscle aches
Night sweats
Tiredness

Western diagnosis
Lead poisoning

Background to disease
Lead poisoning

Tongue Signs Associated with Heat Disorders


Tongue description

Chiiese diagnosis

Pale red, swollen


Red, big, slightly raised points in the anterior and
middle thirds
Yellow, slippery coating

Spleen qi deficiency (accumulation of dampness)


Toxic heat lodging (festering)in the upper burner
Accumulation of damp-heat

Symptoms

Figure 9.1.5

Swollen, red tonsils


Frequent sore throats
Frequent otitis media
Irregular menstrual cycle

Female
32 years old

Western diagnosis
Chronic tonsillitis
Habitual miscarriages

Baclcground to disease
Overwork
Emotional problems

Tongue description

Chiiese diagnosis

Pale red, swollen

Slight Spleen qi deficiency (accumulation of


dampness)
Accumulation of heat toxin

Lighr red und brownish, raised points over the enrlre


tongue body
White, thin coating at the sides, light yellow, thick
coating in the center
Yellow, greasy coating at the root

Symptoms
Nonspecific feeling of malaise
Burning of the tongue
Occasional feelings of internal cold
Tiredness
Inner tension

Western diagnosis
None

Background to disease
Possible food poisoning by crabmeat

Externally-contracted dampness penetrating to the


interior
Retention of damp-heat in the lower burner
Figure 9.1.6
Male
31 years old

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Pale red
Deviated
Pointed shape with red tip
Red, big, raised points at the anterior third and the
sides
Light yellow, thick, greasy coating

Normal
Internally-generated wind
Heat in the Heart
Long-standing toxic heat lodging in the interior,
possibly Liver fire
Accumulation of phlegm-heat

Figure 9.1.7

Symptoms

Female
31 years old

Severe headaches at the vertex that are worse


upon exertion
Tight neck muscles
Inner restlessness

Western diagnosis
None

Background to disease
Condition arose after contracting viral meningitis
in 1968 and 1988

Figure 9.1.8
Female

Tongue description

Chinese diagnosis

Red with red sides


Deep red points on the anterior third and sides
Yellow, thick, greasy coating at the center and root
of the tongue

Heat in the Liver transforming into fire


Toxic heat lodging in the upper burner
Accumulation of damp-heat in the middle and
lower burners

Symptoms
Sore throat with hoarseness
Strong night sweats
Insomnia
Inner tension
Flatulence
Cold hands and feet

Western diagnosis
Acute cold

Baclcground to disease
Difficult divorce
Repressed emotions
Overwork
Lack of deep

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Pale red, bluish


Pale patches at the sides
Red points ouer the entire tongue body
Red, big, slightly raised pointson theanteriorand
middle thirds
Dark yellow, dry coating

Blood stasis
Liver blood deficiency
Long-standing heat toxin lodging in the interio~
Long-standing accumulation of heat toxin
Accumulation of damp-heat in the lower burner
transforming into heat toxin

Symptoms

Figure 9.1.9

Explosive, foul-smellingdiarrhea after eating


Nausea
Thick, yellow vaginal discharge
Extremely profuse menstrual bleeding
Short menstrual cycle

Female
39 years old

Western diagnosis
Suffered 15 years from anorexia nervosa
Underweight

Background to disease
Prolonged sexual abuse in childhood
Many operations due to injuries of the genitals
Abuse of nicotine, black tea, and chocolate

Tongue description

Chinese diagnosis

Red
Red points on the tip and the sides
Dirty yellow, thick, greasy coating

Heat in the blood level


Liver fire
Accumulation of damp-heat in the Liver and
Gallbladder transforming into heat toxin

Symptoms

Figure 9.1.1 0

Pain under the right hypochondrium


Nausea
Feeling shattered
Low-grade fever
Epigastric fullness and pain after eating
Night sweats
Thirst
Dry mouth

Female
37 years old

Western d i i o s i s
Acute hepatitis C

Background to disease
Viral infection

See
CASE HISTORY
below

Tongue Signs Associated with Heat Disorders

Case History

Fig. 9.1.3

This 32-year-old professional dancer frequently caught colds. She often worked on
unheated stages that were either drafty or too warm. She had to watch her weight all
the time, which meant that she ate too many fruits and salads. Her colds almost
always started with a severe sore throat, and her tonsils immediately became
inflamed, red, and swollen. She was also troubled with fevers and coughed copious
amounts of phlegm. Her frequent colds, as well as the requirements of her life as a
dancer, led to severe exhaustion. The tongue presented with a white, thick coating
and bright red, raised points at the tip and sides. Her pulse was frail (ruo) and thin
(xn.

Analysis. The photograph was taken when this patient had fallen ill with acute tonsillitis, that is, at an early stage of a warm-febrile disease.The bright red, raised points
at the tip and sides of the tongue indicate the presence of heat in the upper burner.
The fever that subsequently set in reflected the battle between the pathogenic influences and protective qi. In acute situations, especially with underlying accumulation
of phlegm-heat in the Lungs, externally-contracted pathogens often begin by attacking the Lungs. They constrain the qi level of the Lungs, which results in obstruction of
the throat.They also impair the downward-moving action of the Lungs, which in this
patient manifested as a productive cough.
Because of her inappropriate diet and lifestyle, this patient developed Spleen qi
deficiency that resulted in an accumulation of dampness, as reflected in the swollen
tongue body and teeth marks. In her case, dampness transformed into phlegm-heat,
with expectoration of a large amount of yellow phlegm; this i s reflected in the
whitish-yellow tongue coating. In addition, the chronically inflamed tonsils formed a
reservoir of heat toxin in the throat.The heat toxin formed as a result of the combination of internal phlegm-heat, the pathogenic influences, and weak protective qi. The
toxic heat is reflected on the tongue as raised, red points at the tip and sides.
The severe exhaustion of the patient was, on the one hand, due to the physical
demands of her work as a dancer. The frequent rehearsals and performances
depleted her qi. On the other hand, the frequent infections drew on her essence,
which contributed to the depth of her exhaustion. Both deficiencies were responsible
for the weakness of her protective qi. Where there is a deficiency of Spleen qi, not
enough qi derived from food i s sent to the Lungs, where it joins with the qi from air
and, with the help of source qi, is transformed into true qi. Here, not enough true qi
was created.The protective qi is one manifestation of true qi. Here it was too weak to
guard the exterior. This was aggravated by the weakened Kidney essence (from which
the protective qi issues) and resulted in her tendency to catch colds.

Tongue Signs Associated with Heat Disorders

Case History
This 34-year-old patient contracted hepatitis C, possibly through sexual intercourse
with her boyfriend, a heroine addict. Two months into the disease, she still suffered
from severe pain under the right hypochondrium, nausea, and exhaustion. She ate
hardly at all, as she experienced pain after eating as well as a sensation of fullness in
her stomach. Thirst, dry mouth, and low-grade fever were the other prominent symptoms. Her tongue was red with red points at the tip and sides, and the coating was
dirty yellow and greasy. Her pulse was floating (iu), rapid (shuo), and slightly slippery
(hua).
Analysis. The yellow, thick coating is an indication of damp-heat that has collected
in the interior of the body. The red tongue with red sides, and the floating, rapid
pulse are signs of heat, while the epigastric fullness aiter eating, tiredness, and slippery pulse reflect the accumulation of dampness. In this case, the thirst and dry
mouth are due to damp-heat collecting internally, where they prevent the fluids from
ascending. Low-grade fevers are also the result of the damp-heat. Here, the heat i s
trapped within the dampness; thus, the heat cannot disperse through the superficial
layer of the body. Instead, it collects at the qi level, leading to a low-grade fever.
The nausea was caused by Gallbladder heat attacking the Stomach. The dampheat in the Liver and Gallbladder impaired the free flow of Liver qi, both of which
factors account for the hypochondriac pain.
The color and thickness of the coating, in combination with the red tongue body
and red spots, indicate that the damp-heat is transforming into toxic heat. This may
also reflect the active virus in this patient.
Discussion. The redder the points at the tip of the tongue and the wider their distribution over the tongue body, the stronger the activity of the toxic heat. Where there is
much toxic heat, any subsequent acute illness will always be characterized by a general feeling of sickness or malaise. The presence of ulcers that are filled with pus and
blood, and purulent secretions or swellings, always indicate the presence of heat
toxin. Because this type of heat is exacerbated by fatty, fried, and strongly seasoned
foods, it is important that the patient avoid them. Instead, she can help the healing
process by eating foods with neutral or cooling characteristics.

9.2

Red Tongue Body


Externally-contracted heat that penetrates deeply i n t o t h e b o d y c a n transf o r m i n t o excessive heat o r fire. I f t h e qi level o r the y a n g brightness lyang
ming) stage is affected, there w i l l b e such symptoms as h i g h fever, profuse
sweating, aversion t o heat, thirst, irritability, a n d a r e d tongue body, w h i c h is
a sign o f heat in the interior. The tongue b o d y will b e dry because heat dries
the fluids, a n d the coating will be yellow a n d dry, indicating the presence o f
heat a n d i n j u r y t o the fluids.

If the nutritive level is affected, the tongue b o d y color will change t o dark
r e d a n d the tongue b o d y itself will be dry. These tongue signs reflect intense
heat in the interior. Only w h e n a p o r t i o n o f the heat remains in the qi level
will there still b e a yellow coating. However, if the heat has penetrated further

Fig. 9.1.10

Tongue SignsAssociated with Heat Disorders

Figure 7.1.6

into the nutritive level, the tongue will be extremely dry or have no coating.
Thus, the tongue coating must be considered in order to correctly diagnosis
the depth to which the heat has penetrated. Symptoms characteristic of heat
in the nutritive level are high fevers that worsen at night, indistinct erythema
(redness of the skin caused by congestion of the capillaries), insomnia, and
inner restlessness.
High fever, skin rashes, sudden bleeding from the mouth or nose, and
blood in the stool or urine are characteristic of heat penetrating the blood
level. Here, heat causes the blood to move recklessly, that is, the blood is
forced out of its vessels, which manifests in sudden bleeding. Because of the
excessive heat, the tongue body color becomes dark red or scarlet red. There
may even be the appearance of thorns or prickles on the tongue surface (Fig.
7.1.61, and the tongue will have no coating, or will show the remains of a n old
coating (Fig. 3.6.5). A scarlet red tongue often indicates a contagious infectious disease or a viral or septic d i ~ e a s e . ~

Figure 3.6.5

Figure 9.2.1
Female
23 years old

Tongue description

Chinese diagnosis

Scarlet red
Slightly narrow and soft
Red points on the tip and sides
Yellow, old, greasy coating

Heat in the nutritive and blood levels


Injury to the fluids from heat
Heat toxin
Retention of damp-heat in the three burners

Palpitations
Fever
Pain in the throat
Inner restlessness
Feeling of malaise

Western diagnosis
Acute Hashirnoto's thyroiditis

Background to disease
Unclear

Tongue Signs Associated with Heat Disorders


Tongue description

Chinese diagnosis

Scarlet red, especially in the anterior third

Wind-heat penetrating into the interior, heat in the


blood
Development of heat
Retention of damp-heat in the three burners

Long tongue body


Yellow, thick, dry coating

Symptoms
Sore and red throat
Swollen tonsils
Bright red wheals distributed over the entire body
Severe itchiness

Western diagnosis
Acute urticaria for three days
Tonsillitis

Background to disease
Climatic factors

9.3

Tongue Signs Associated with


Damp-Heat
A yellow, thick, greasy tongue coating that covers the tongue indicates the
presence of damp-heat (see also Chapter 10). The quality of the coating can
be used to determine the relative strength of the dampness and heat: If the
dampness predominates, the coating will be more greasy, and if the heat predominates, the coating will be more yellow. If the coating appears to be dirty
yellow in color, the damp-heat has been present for a long time in the body
and is often located in the yang brightness lyangming) channels.

Externally-contracted pathogenic damp-heat can cause acute illnesses,


especially in the summer and in hot, damp, tropical climates. Damp-heat
can penetrate into the protective and qi levels and cause fevers that worsen
in the afternoon, headaches, a feeling of heaviness in the body, and general
body aches. At the onset of such a disease, the tongue coating remains white.
If the pathogenic influence is strong or penetrates further into the interior,
the coating will change and appear more yellow and greasy This is especially
noticeable in the center of the tongue.
Spleen qi deficiency also leads to the formation of damp-heat. The fluids
accumulate and are transformed into dampness. The internally-generated
dampness, in turn, obstructs the qi mechanism in the middle burner. This
can impair the Stomach's function of moving the impure parts of digested

Figure 9.2.2
Female
10 years old

Tongue Signs Associated with Heat Disorders


foods downward. The accumulation of dampness and the stagnation of qi in
the middle burner gives rise to heat. This process is more likely to occur
in those who favor fatty, fried, and spicy foods. The use of alcohol also
contributes to this process. If the accumulation of damp-heat is due to
underlying Spleen qi deficiency, the tongue body will be pale or pale red, and
the yellow, greasy coating will most likely be located in the root (or the posterior third) of the tongue.
Damp-heat can collect throughout the body. Because of its heavy nature,
it has a tendency to gather in the lower burner where it impairs the flow of qi.
Damp-heat often affects the Intestines and Bladder. Characteristic tongue
signs of this pathology are a yellow, greasy, thick coating in the posterior third
that is interspersed with big red points (Fig. 9.3.7).

Figure 9.3.7

By itself, tongue diagnosis is not a very precise instrument for identifying


the location of the damp-heat when the symptoms include recent-onset
burning sensation when urinating, dark, turbid, and scanty urine, or strongsmelling, burning diarrhea. The presence of the yellow, greasy thick coating
in the posterior third of the tongue only confirms the presence of damp-heat;
it does not identify its location, that is, in the Bladder or Intestines. This
information can only be obtained by combining tongue diagnosis with pulse
diagnosis and a differentiation of the other symptoms. In the middle burner,
damp-heat causes a sensation of fullness in the epigastrium and abdomen as
well as abdominal distention. When it affects the Stomach and Intestines, the
symptoms include foul-smelling diarrhea or constipation. Again, the tongue
coating is yellow, thick, and greasy, especially in the center of the tongue,
reflecting the accumulation of damp-heat in the Stomach.
When dampness is transformed into phlegm it will be stored in the
Lungs. The formation of phlegm-heat in the Lungs can be attributed either to
fire 'brewing' the fluids that have become stagnant owing to underlying
Spleen qi deficiency, or to externally-contracted heat that has lodged in the
Lungs. Smoking, or the consumption of hot, spicy foods, aggravates this
pathology. Phlegm and heat interfere with the downward-moving action of
the Lung qi, resulting in a loud cough with copious, yellow phlegm. Here, the
coating- is again
yellow
and greasy,
and occasionally the anterior third of the
.
tongue is swollen (see Chapter 12, Case 6).
The Liver and Gallbladder are especially vulnerable to accumulation of
damp-heat. All the above mentioned factors as well as Liver qi constraint can
lead to accumulation of damp-heat in the Liver and Gallbladder channels, or
just the Gallbladder channel. Characteristic symptoms include a bitter taste
in the mouth, feeling of fullness and pain in the chest and under the ribs,
nausea, vomiting, dizziness, and jaundice. The tongue coating is also yellow,
thick, and greasy. An interesting variation is presented by the appearance of
bilateral lines on each half of the tongue, which is indicative of damp-heat
(heat dominant) in the Liver and Gallbladder.

Figure 9.3.3

In addition, in the case of rheumatic illness-painful obstruction (bi)


disorders that are characterized by swollen and hot joints--the tongue coating is often yellow and greasy (Fig. 9.3.3). Besides pain, redness, swelling, and
limited movement of the afflicted joint, the patient often experiences a sensation of heaviness in the body. A damp climate can aggravate joint pain as
well as the general state of well-being in such patients.

Tongue Signs Associated with Heat Disorders


A swollen, red or dark red tongue is also indicative of damp-heat,
although this is less frequently seen. This type of tongue is, however, quite
common in those who consume a lot of alcohol or fatty foods. The heat is
responsible for the redness, and the dampness is responsible for the swollen
tongue body.

Tongue description

Chinese diagnosis

Pale red, swollen, teeth marks


Ligl~tyellow,
slippery coating over the entire tongue
body
Yellow, thick coating at the root
Red spots in the anterior third

Spleen qi deficiency (accumulation of dampness)


Acute, externally-contracted damp-heat in the
middle burner
Retention of damp-heat in the lower burner
Heat toxin in the upper burner

Symptoms
Diarrhea
Nausea and vomiting
Fever
Epigastric fullness and pain
Occasional sore throats

Western diagnosis
Acute gastroenteritis
Chronic tonsillitis

Background to disease
Consumption of fattyfoods and salads with
mayonnaise dressing in the summer

Figure 9.3.1
Female
28 years old

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Red, slightly swollen, wet


Yellow, thick, greasy coating with red poinrs at the
mot

Heat developing with accumulating dampness


Retention of damp-heat in the Bladder

Symptoms

Figure 9.3.4

Frequent burning sensation with urination


Smelly urine
Sneezing fits
Itchy eyes
Mouth ulcers
Inflamed gums

Female
30 years old

Western diagnosis
Chronic urinary tract infection
Allergic rhinitis

Background to disease
Long-standing emotional problems
Excessive consumption of raw and dairy foods

Tongue description

Chinese diagnosis

Red, long
Vertical crackin the center of the tongue
Light yellow, thick, greasy coating over the entire
tongue body
Lightyellow, thick coating with red points on the
posterior third

Constitutional heat in the Heart


Stomach yin deficiency
Retention of damp-heat

Symptoms
One-sided swelling of Bartholin's gland
Pain in the genitals
Yellow vaginal discharge
Inner restlessness

Western diagnosis
Chronic Bartholinitis

Background to disease
Excessive sexual activity together with excessive use
of alcohol
Emotional problems

Retention of damp-heat in the lower burner


transforming into heat toxin

Figure 9.3.5
Female
32 years old

Tongue Signs Associated with Heat Disorders

Tongue description

Pale red, swollen, slightly wet, teeth marks


Yellow, thick mating with red poinuat the root
Slight notch at the tip
Figure 9.3.6
Female
28 years old

Chinese diagnosis
Spleen qi deficiency (accumulation of dampness)
Retention of damp-heat in the Large Intestine
and genitals
Slight Heart blood deficiency

Itching and burning in the vagina


Swelling and redness of the labia
Smellx soft stools
Foul-smellingflatulence
Tiredness
Strong inner tension

Western diagnosis
Acute candidiasis

Background to disease
Condition followed Frequent use of antibiotics
Long-standing emotional problems

Tongue description

Chinese diagnosis

Pale red
Wide with curled-up edges

Nonnal
Slight retention of damp-heat in the Liver and
Gallbladder with Liver qi constraint
Onset of Stomach yin deficiency
Accumulation of damp-heat in the lower burner

Small, horizontal cracks in the center of the tongue


Dry, greasy, thickened, andyellow toward the
posterior third

Symptoms
33 years old

Pain upon defecation


Frequent dribbling of urine
Burning sensation with urination
Dizziness
Inner tension
Insomnia
Itchy skin at night

Western diagnosis
Chronic prostatitis
Chronic urticaria

Background to disease
Alcohol and drug abuse
Excessive sexual activity
Long-standing emotional problems

Tongue Signs Associated with Heat Disorders


Tongue description

Chinese diagnosis

Reddish, long with curled-down tip


Reddish center of the tongue
Yellow, thick, greasy coating with red, swollen
papillae a t the root

Heat in the Heart blood


Heat in the Stomach
Retention of damp-heat in the Large Intestine
transforminginto heat toxin

Symptoms
Purulent and bloody stools with cramp-like abdominal pains
Burning sensation at the anus
Thirst
Slight fever
Weight loss
Tiredness

2~1;~9.3.8

41 years old
See
C 4 S E HISTORY

below

Western diagnosis
Ulcerative colitis

Background to disease
Family history of ulcerative colitis
Long-standing emotional problems
Severe demands at work
Caffeineand nicotine abuse

Tongue description

Chinese diagnosis

Red, swollen

Accumulation of damp-heat in the Liver and


Gallbladder
Excessive heat in the Gallbladder
Long-standing retention of damp-heat

Red on the right side of the tongue without coating


Dark yellow, greasy coating

Symptoms

Figure 9.3.9

Paroxysmal one-sided facial pain, especially in the


temple and cheek
Irritability
Facial redness
Insomnia

Female
24 years old

Western diagnosis
Trigeminal neuralgia

Background to disease
Alcohol abuse
Heroin addiction in the past

Tongue Signs Associated with Heat Disorders

Tongue description

Chinese diagnosis

Pale, very swollen, teeth marks


Thi&, dry, dirty yellav coating

Spleen qi deficiency (accumulation of dampness]


Accumulation of heat toxin in the three burners

Symptoms

Figure 9.3.10
Female
52 years old

Red, swollen, inflamed, and bleeding gums


Purulent ulcerations
Severe facial pain
Red face
Sweating
Thirst
Feeling of malaise
Overweight

Western diagnosis
Necrotizing ulcerative gingivitis

Background to disease
Insufficient dental care and treatment
Alcohol abuse
Excessive consumption of sweet foods

Tongue description

Chinese diagnosis

Pale red, wide

Accumulation of damp-heat
Retention of damp-heat and phlegm in the three
burners

Brownish yellow, thick, dry coating over the entire


tongue body

Figure 9.3.1 1
Female
58 years old

Diffuse, dull pain throughout the entire body


Exhaustion
Mental confusion
Soh, smelly stools
Inability to sleep through the night
Itchy skin

Western diagnosis
Chronic urticaria

Background to disease
Excessive physical and mental demands due to
personal problems

Tongue SignsAssociated with HeatDisorders

Case History
Three weeks after she received a vaccination against Central European encephalitis,
Mrs. F noticed joint pains and a sensation of heaviness in her body. Within three
months she had limited movement in her joints and was handicapped because of the
severe pain, forcing her to give up work. Her palms and soles were extremely
swollen and hot, and she could hardly walk or do anything. The stiffness of the joints
was most marked in the mornings. In addition, Mrs. F sweated easily upon exertion.
The sweat was of a sticky consistency. Mrs. F had a very negative view of life in general and appeared embittered and discontented with her own life. Due to the lack of
exercise, she had gained about 10 kilograms in the previous three months. The
tongue showed a yellow, thick, greasy coating. Her pulse was slippery (hua) and
slightly floating (fu).

Fig. 9.3.2

Analysis. From a traditional Chinese viewpoint, the vaccination introduced heat


toxin into Mrs. F, which augmented her preexisting, internally-generated heat. Her
negative outlook on life, which resulted from an inability to maintain satisfactory
relationships and her constant conflicts with others, not only caused Liver qi constraint, but also heat in the Liver. The reddish-blue color of the tongue body and the
red edges reflected the heat in the Liver as well as the onset of blood stasis, which
was caused by the underlying Liver qi constraint.
Overconsumption of sweets and dairy foods through the years aggravated the
development of dampness, which was transformed into damp-heat as a result of her
underlying condition. The yellow, thick, greasy tongue coating and the slightly floating and slippery pulse both reflect the presence of damp-heat in the body. Because of
her energetic predisposition, the ground was prepared for a reaction to the vaccine,
the heat toxin. The result was damp-heat painful obstruction (bi) that manifested as
hot, swollen joints. The stiffness in the morning arose from the blockage caused by
damp-heat, which prevented the smooth flow of qi and blood through the channels.
The occasional low-grade fever, and the sticky sweat, are other expressions of the
retention of damp-heat.

Case History
Mrs. A had just overcome personal and professional difficulties when she began to
suffer from severe, cramping abdominal pain that was accompanied by purulent and
bloody stools. The burning sensation around the anus and the itchiness after each
defecation were very uncomfortable for her. She gave a very tired and washed-out
impression, and she continuously lost weight. Until the outbreak of her illness, her
life had been very turbulent. She was eating nothing but fast foods and consumed a
lot of coffee; she took a daily slug of red wine to help her relax. The yellow, thick,
greasy tongue coating with the red, swollen papillae werevery noticeable. Her pulse
was excessive (shi) and slippery (hua).

Analysis. Here, damp-heat and heat toxin collected in the Large Intestine and
caused a blockage of qi and blood in the intestines. The yellow, greasy tongue coating indicates the presence of damp-heat, and the swollen papillae at the root of the
tongue are a clear sign of the excessive heat in the lower burner. The damp-heat
scorched the collateral channels of the Large Intestine, as evidenced by the bloody

Fig. 9.3.8

Tongue Signs Associated with H e a t Disorders

stools and burning sensation around the anus. The heat toxin, which was generated
by the severe, internally-generated damp-heat, 'brewed' in the inteslines and caused
purulent stools. The damp-heat caused stagnation of qi and blood that was responsible for the cramping abdominal pains. The excessive nature of this disorder is also
reflected in the full and slippery pulse. Alcohol, fast foods, emotional problems, and
a family disposition toward this condition were important factors underlying its
appearance.

Discussion. Accumulation of damp-heat is a frequent cause of illness. Damp-hcat


can remain for years in the lower burner without causing any serious problems.
Occasionally, smelly, soft stools or a yellow vaginal discharge may be the first signs
of the pathology. Dampness has a strong tendency to cause stagnation of qi and
blood in those areas where it collects, which can then evolve into damp-heat. In this
pattern the heat is constrained by the dampness, and the dampness becomes thicker
because of the heat. Thus, the consistency of the damp-heat will become siiclcier and
drier.
Alcohol and fatty foods are important factors that contrihuie lo damp-heat.
However, prolonged emotional stress can also trigger damp-heat or phlegm-heat.
The yellow, thiclc, greasy tongue coating is an importanl indication of this paihc~logy.
The patient was counselled about her diet and emotional life.

Endnotes
1 . See Compendium of Churts und Books Pus1 und Presenl: Complete Colleclioi? 01
the Medicul Seclion (Gu j i n tu shu ji cheng: y i bu yuan lu). Beijing: Peoples
Medical Publishing House. 1991;5:84. Here i t is noted that a tongue that looks
yellow and rough and presents with a localized patch indicates heat that has
penetrated deeply into the Stomach. I n addition, the toxin of the pathogenic
influence is located at the same depth. If Heart fire leads to inner restlessness
and thirst, one should prescribe Major Order the Qi Decoction (da clze~igyirai?.gl
to guide it downward.
2. Li N-M.Zhongguo shezhen du yuan. Beijing: Xueyuan Publishing Company,
1994:1188.

C H A P T E R

Tongue Coatings
10.1

Tongue Coatings and the


Eight Principles
A number of tongue coatings were discussed in Chapters 3 , 4 , and 9. In this
chapter, the nature of the coatings will be analyzed further.'
An assessment of the coating is important in order to carry out a differential diagnosis according to the eight principles. A thick coating reflects
excess (Fig. 9.3.2) and a lack of coating reflects deficiency (Fig. 4.1.3.3). For
example, in the case of Stomach and Kidney yin deficiency, there may be an
absence of coating, often in combination with a red tongue body. But in
Spleen and Kidney yang deficiency, which can lead to an accumulation of
dampness, the development of this excessive disorder is manifested in a
thick, white, slippery coating. The tongue body will typically be pale and
swollen.

As a general rule, a white coating reflects the presence of cold and a


yellow one the presence of heat. The diagnosis of the tongue coating is of
particular importance when illnesses are caused by externally-contracted
pathogenic factors. In such cases, the coating will reflect their quality and the
depth of penetration. Thus, in the case of externally-contracted wind-cold
the coating is white, while in the case of externally-contracted wind-heat it
may be yellow. At the onset of a banal cold caused by extemally-contracted
wind-cold, the coating is often white and thin, which is also typical of a normal
tongue coating (see Chapter 1).
Once a cold has been contracted, the thickening of the tongue coating
over one or two days reflects the further penetration of the pathogenic factor.
At this point, the coating often begins to change its color and tends to
become yellow, showing that the externally-contracted wind-cold has transformed into heat in the interior. This transformation is also manifested in the

I
Figure 9.3.2

Figure 4.1.3.3

Tongue Coatings
location of the coating on the body of the tongue: the tip of the tongue
reflects the exterior of the body while the middle and posterior thirds of the
tongue reflect the interior. In cases of externally-contracted wind-cold, the
theory is that the coating is mainly located on the anterior third of the
tongue, but in my own clinical experience, it is often not visible. It is important to realize that the coating at this stage is still quite thin. This tells us
something about the location of the pathogenic factor, namely, that the illness is still in the superficial level of the body and has not yet penetrated into
the interior. If this thin, white coating is also wet, it suggests that the dispersing function of Lung qi is impaired.
In the case of a pathogenic factor that has penetrated to a deeper level,
the coating will often be located in the center of the tongue. If the coating
becomes yellow and dry, it points to the formation of inner heat that is
beginning to injure the fluids. Thus, the color, thickness, moisture, and location of the coating on the tongue body all provide information about a disorder
caused by an externally-contracted pathogenic factor. An interesting distribution of the coating can be found in cases of acute disorders in the lesser
yang (shaoyang) stage of the six stages of disease. A one-sided, white, slippery or wet coating in the right half of the tongue means that the pathogenic
factor is half-exterior and half-interior. If this right-sided coating is dry and
yellow, it represents the retention of phlegm-heat or damp-heat in the
Gallbladder (Fig. 10.2.3.7).By contrast, a one-sided yellow coating on the left
half of the tongue is indicative of heat in the Liver. Finally, yellow strips of
coating on either half of the tongue signify intense damp-heat in the Liver
and Gallbladder.

Changes to the coating due to the penetration of externally-contracted


pathogenic factors. The arrow indicates the direction of the
penetration from the exterior to the interior.

Tongue Coatings

10.2

Different Aspects of the Tongue Coating


Excess and deficiency are reflected in the thickness of the coating. However,
the coating does not identify the cause. For example, a thick coating can
appear in interior as well as exterior patterns of disharmony. Among patterns
caused by internal factors, dampness, phlegm, food stagnation, interior heat,
and cold are most prominent. Among patterns caused by external factors,
externally-contracted wind-cold, wind-heat, or summer-heat are the leading
factors.
To summarize, in acute cases it is especially important to note changes
in the coating. If it is thin at the onset of an illness and starts to thicken, it is
always an indication of the further penetration of the pathogenic factor. If
the coating becomes thinner and lighter in color, this is a clear sign that the
patient is recovering. The pathogenic factor is now becoming weaker, and
the defensive (protective) qi is again gaining strength.
The moisture or degree of wetness of the tongue reflects the condition of
the body fluids. A normal tongue should be slightly moist, which reflects
proper circulation of the fluids. A dry, wilted tongue mirrors the exhaustion
of the fluids.
In this chapter we will discuss the nature of the tongue coating and its
moisture. Examples of wet, slippery, greasy, rough, and dry coatings are
shown in the accompanying photographs.

10.2.1

Wet and Slippery Coatings


A wet coating may indicate an accumulation of dampness caused by a deficiency of Spleen qi and yang, or of Kidney yang. Here, the tongue body is pale
and swollen, and the coating is white. The wet, white, and thin coating can
also indicate penetration of externally-contracted wind-cold.

If the coating appears very wet, greasy, or slightly sticky, it is described as


slippery. This coating represents a further stage in the evolution of a wet
coating and points to a more serious yang deficiency, especially if it is white,
as this represents an accumulation of damp-cold. In this case, the tongue
body color is pale. However, this type of tongue can also indicate further
penetration of the pathogenic factor.
If the slippery coating appears to be of a thicker consistency and slightly
greasier, it may be assumed that more dampness has accumulated. If the
coating also appears to be a little sticky, the dampness is transforming into
phlegm. If the coating is both yellow and slippery, the dampness is transforming into damp-heat. This type of coating is often visible where there is
disharmony between the Liver and Gallbladder, or between the Spleen and
Stomach.

Tongue Coasings
Tongue description

Chinese diagnosis

Pale red, swollen

Slight Spleen qi deficiency (accumulation of


dampness)
Acute externally-contracted wind-cold
Retention of damp-heat in the Bladder

Wet, white, thin coating


Thin, greasy, yellow coating in the posterior third
Figure 10.2.1.1
Male
25 years old

Generalized body aches


Headache
Heavy sensation in the body
Runny nose
Occasional burning sensation with urination

Western diagnosis
Acute cold

Background to disease
Overworked
Long-standing emotional problems

Figure: 10.2.1.2
Male
33 years old

Tongue description

Chinese diagnosis

Pale red and swollen with wet, white, thin coating


Depression at the root of the body

Spleen qi deficiency (accumulation of dampness)


Onset of essence deficiency

Symptoms
Tiredness
Lack of concentration
Heavy sensation in the head
Flatulence
Inner restlessness
Weakened vision

Western diagnosis
Diabetes mellitus

Background to disease

Tongue Coatings
Tongue description

Chinese diagnosis

Pale, swollen, slight teeth marks


Wet, white, chin coating
Thin, pale yellow coating in the posterior third

Spleen qi deficiency (accumulation of dampness]


Accumulation of damp-cold
Retention of dampness in the lower burner

Symptoms

Figure 10.2.1.3
Female
40 years old

Acute stomach pain, as if a stone were lying in the


stomach
Nausea
Depressive moods
Tiredness

Western diagnosis
Fibroadenoma of the left breast

Background to disease
Long-standing emotional problems
Irregular eating habits

Tongue description

Chinese diagnosis

Slightly pale, swollen, slight teeth marks

Slight Spleen qi deficiency (accumulation of


dampness]
Heat in the blood
Accumulation of damp-cold transforming into
damp-heat in the lower burner

Red points at the tip and sides


Slippery, whire coating with greasy, yellow coating in
the posterior third

Symptoms

Figure 10.2.1.4

Binges of eating sweets


Overweight
Red, dry, itchy skin in the w i n t ~ r

26 years old

Western diagnosis
None

Background to disease
Irregular eating habits
Excessive consumption of sweet foods

Female

Tongue Coatings

Tongue description

Chinese diagnosis

Pale
Swollen right half of tongue
Slippery, white, thin coating
Slight notch at the tip of the tongue

Spleen and Lung qi deficiency


Dampness obst~ctingthechannels
Accumulation of damp-cold
Heart qi and blood deficiency

Symptoms

Figure 10.2.1.5
Female
67 years old

Cough with white, thin mucus


Frequent urination
Lack of appetite
Dry mouth

Western diagnosis
Coronary heart disease

Background to disease
Physically overworked for many years, hard
working conditions
Smoked for 40 years

Tongue description

Chinese diagnosis

Very pale
Slippery, white, thick coating

Spleen qi deficiency (blood deficiency)


Long-standing cold-dampness transforming to
phlegm

Symptoms

Figure 10.2.1.6
Male

54 years olc

CASE HISTORY

below

Frequent bouts of diarrhea


Shortness of breath
Tiredness
Feeling of heaviness in the extremities
Inability to fall asleep

Western diagnosis
None

Background to disease
Excessive consumption of raw foods
Excessive physical activity
Excessive use of sauna

Tongue Coatings
Tongue description

Chinese diagnosis

Reddish, swollen
Red points at the sides
Slippery, white, thick coatingwith greasy coating in
the center

Accumulation of dampness with heat


Slight heat in the Liver
Accumulation of dampness with food stagnation

Symptoms

@re 10.2.1.7
:emale

Morning sickness with vomiting and nausea


Epigastric fullness after eating
Lower abdominal pain
Slight uterine bleeding

!5 years old

Western diagnosis
Threat of miscarriage

Background to disease
Physically overworked
Excessive consumption of fatty foods

Tongue description

Chinese diagnosis

Reddish, slightly contracted tongue body


Red points at the tip
Slippery, pale yellow coating
Yellow, thick, greasy coating in the posterior third

Slight Kidney yin deficiency


Heat from deficiency in the Hean blood
Acute, externally-contracted damp-heat
Onset of transformation of damp-heat into heat, and
sinking of damp-heat

Sym~tom
Slight fever
Acute diarrhea with foul-smellingstools
Vomiting
Stomach pains
Exhaustion

Western diagnosis
Acute summer flu

Background to disease
Inappropriate clothing
Consumption of raw foods

Figure 10.2.1.8
Female
37 years old

Tongue Coatings

Tongue description

Chinese diagnosis

Pale red, swollen


Reddish, slightly swollen sides

Spleen qi deficiency (accumulation of dampness)


Retention of damp-heat in the Liver and
Gallbladder
Accumulation of dampness transforming into
damp-heat in the lower burner

Slippery, pale yellow, thick couting, thicker at the


posterior third

Symptoms
Occasional lower abdominal pains
Frequent urination
m b i d urine
Thick, sticky sperm

Western diagnosis
Chronic orostatitis
Sterility

Background to disease
Unclear

Tongue description

Chinese diagnosis

Pale, swollen
Long vertical crack in the midlie
Red points in the middle of the tongue sides
Slippery, pale yellow coating cowering the entire
tongue body

Spleen qi deficiency (accumulationof dampness)


Constitutionalweakness of the Heart
Heat in the Stomach
Retention of damp-heat in the Stomach

Figure

10.2.1 .I 0
Female
47 years old

Vomiting
Nausea
Abdominal pains
Watery diarrhea
Slight fever
Feeling of severe weakness
Anxiety, fearfulness

Western diagnosis
Acute gastroenteritis

Background to disease
Food poisoning
Long-standing emotional problems

Tongue Coatings

Tongue description

Chinese diagnosis

Pale red and swollen, with red sides


Long midline crack
Thick, slippery,yellow coating, especially in the
center of the tongue

Retention of damp-heat in the Liver and Gallbladder


Constitutional weakness of the Heart
Retention of phlegm-heat in the Stomach, phlegm
mists the Heart

Symptoms

Figure 10.2.1.1 1

Mental retardation, slow to understand


Poor hearing
Numbness of the finger tips
Smelly urine at night

Male
59 years old

Western diagnosis
Diabetes mellitus (type 11)

Background to disease
Possible birth defect
Excessive consumption of sweet and fatty foods

Tongue description

Chinese diagnosis

Pale red
Red points at the sides and tip of the tongue

Slight Spleen deficiency


Acute, externally-contracted wind-heat with
penetration to the interior
Externally-contracteddampness transforming into
damp-heat

Slippery, white, thin coating transforming into yellow


coating in the center and posterior third

Symptoms
Burning sensation with urination
Turbid urine
Acute episodes of diarrhea after consumption of
fruit and alcohol
Runny nose
Itchy eyes
Dry cough, especially at night

Western diagnosis
Acute cystitis
Acute allergic rhinitis
Chronic sinusitis

Background to disease
Irregular eating habits

Figure 10.2.1
Female
50 years old
See
CASE HISTORY
below

Tongue Coatings

.:

.$

Case
not P,
Mr.
particularly
54History
years old,
smelly.
oftenHe
suffered
was very
from
tired.
bouts
Even
of diarrhea.
though his
Hisbody
stoolsfelt
were
heavy,
watery
he still
but

,
'

,,,..
.~,..
,
,
..,..>,...
,.i.,r

;.

Fig. 10.2.1.6

forced himself to exercise a great deal. After his daily training program, he used the
sauna. In order to stay fit, he chose a diet consisting mainly of salads and fruit. He
also had difficulty falling asleep, but once asleep, he slept well. His tongue was pale
and showed a slippery, white, thick coating. His pulse was frail (ruo) and submerged

Analysis. Excessive physical activity and the consumption of raw foods weakened
the transportive and transformative functions of the Spleen. Owing to the deficiency
of Spleen qi, fluids accumulated and transformed into dampness. This was manifested
in the loose stools and feeling of heaviness in his body. The pale tongue body with the
slippery, white, thick coating, as well as the weak pulse, also reflected this pathology.
The inability of Mr. P to fall asleep was caused by Heart blood deficiency. This
was due to both insufficient blood as a result of the Spleen qi deficiency, and excessive sweating, which injured the blood.

Case History
Mrs. C, 50 years old, complained of an acute burning sensation when she urinated.
This started only a few days prior to her examination. Since the urine was turbid and
strong-smelling, she assumed that she had a bladder infection. At the same time, she
experienced acute hay fever. Her itchy eyes and runny nose were very uncomfortable.
Occasionally, after consuming fruit or alcohol, Mrs. C suffered from acute diarrhea.
Besides red points at the tip and the sides of the tongue, there was a slippery, white,
thin coating that became yellow toward the center. Her pulse was floating (iu) and
tight (jin).

Analysis. Mrs. C suffered from two complaints simultaneously: a sensation of burning during urination and an episode of acute allergic rhinitis. The penetration of
externally-contracted dampness contributed to both. The dampness met with heat in
the interior and transformed into damp-heat, as reflected i n the yellow, slippery
tongue coating. The turbid, smelly urine and the burning sensation during urination
were the result of impaired Bladder qi due to the sinking of damp-heat.
In addition to the externally-contracted dampness, the patient also suffered from
externally-contracted wind-heat, as reflected in the red tip and sides of the tongue.
The clear, watery nasal secretion was an expression of this factor, while the itchy
eyes resulted from the anack of wind-heat.
The fact that fruit and alcohol triggered acute diarrhea was an indication of the
presence of retained damp-heat in the interior. Alcohol can cause internal heat, and
fruit can cause dampness, as its cooling nature weakens the Spleen qi. Both the
alcohol and fruit reinforced the underlying pathology.

Discussion. A wet and slippery coating can indicate externally-contracted dampness as well as internal dampness. In both cases, dampness encumbers the Spleen
and causes the qi of the middle burner to stagnate. O n the other hand, Spleen qi
deficiency can give rise to internal dampness, which over the long run can transform

Tongue Coatings

into damp-heat. Imagine still water that i s turbid and gives off a musty smell: This
corresponds to damp-heat. In order to get rid of the smell, the water must be cleaned
and moved around. In the body, this means strengthening the Spleen qi so that it is
again capable of properly transporting and transformins ingested foods. The dampness can also be moved and eliminated from the body through diuresis.

10.2.2

Greasy Tongue Coatings


A yellow tongue coating does not just reveal the penetration of externally-

contracted pathogenic factors, it also reflects internal patterns of disharmony.


This type of coating is a common feature in clinical practice.
The yellow coating looks sticky and dry and is often of a thick consistency,
which, in the case of an interior disease, reflects an accumulation of dampheat or phlegm-heat. If the coating is more yellow and dry than sticky, then
heat is the more dominant factor. If heat meets with an accumulation of
dampness in the interior, over a period of time the heat will interact with the
accumulated dampness, resulting in phlegm-heat. This process of dampness
transforming into phlegm is reflected in a rough or sticky consistency to the
coating. If the coating is thin and of a light yellow color, the dominant factor
is accumulated dampness.
In the case of acute food stagnation, the coating will be greasy and of a
pale yellow or slightly gray color. In such cases, it is generally located in the
center of the tongue and reflects the stagnation of qi in the middle burner. If
this disharmony persists for a long time, the coating will become thicker,
which is commonly associated with an aggravation of the symptoms.
A white, thick, and greasy coating is associated with cold-dampness or
cold-phlegm. This type of tongue coating will be accompanied by such
symptoms as a sensation of heaviness in the body, a feeling of fullness in the
chest and epigastrium, or a lack of appetite.

Tongue Coatings

Tongue description

Chinese diagnosis

Reddish blue, with blue and black points


Greasy, white, thick coating

Heart blood stasis


Accumulation of cold-dampness and food
stagnation

Figure 10.2.2.1

Symptoms

Male
75 years old

Feeling of fullness in chest and epigastrium


Pains in the chest
Dry cough
Palpitations
Sour taste in the mouth

Western diagnosis
Angina pectoris

Background to disease
Smoking for many years
Physically overworked

Figure 10.2.2.2
Female
40 years old

Tongue description

Chinese diagnosis

Pale red, with red sides


Greasy, white coating a t the sides becomingyellow
in the center
Rough, dry yellow coating in the center and
posterior third

Heat in the Liver


Accumulation of damp-heat transforming into
phlegm-heat in the Stomach
Damp-heat transforming into phlegm-heat in the
Stomach

Symptoms
Constipation
Stomach pain
Feeling of fullness in the stomach
Pain under the ribs
Headache
Swollen fingers in the morning

Western diagnosis
None

Background to disease
Irregular eating habits
Frequent bouts of gastritis during puberty
Emotional problems

Tongue Coatings

Tongue description

Chinese diagnosis

Reddish, swoUen
Red points at the tip
Vertical crack with greasy, yellow coating
Greasy, thick, yellow coating in the posterior third

Retention of damp-heat in the Liver and Gallbladder


Heat in the Heart blood
Accumulation of phlegm-heat in the Stomach
Accumulation of damp-heat in the lower burner

Symptoms

Stomach pain when excited


Burning sensation with urination
Yellow vaginal discharge
Burning sensation in the vagina
Pain during intercourse

Chronic Urnplasma urealyticum infection of the


urogenital tract

Background to disease
Irregular eating habits
Long-standing unhappy marriage
Sexual problems

Tongue description

Chinese diagnosis

Pale red, swollen


Red tip
Greasy, yellow coatingfrom the center to the posterior
third

Spleen qi deficiency [accumulation of dampness)


Heat in the Heart
Accumulation of damp-heat in the Liver and
Gallbladder

Distention and pain in the breasts preceding menstruation


Painful mensrruarion
Irritability, fits of rage
Lack of appetite
Flatulence
Constipation

Western diagnosis
Fibroadenoma and cysts in the right breast

Background to disease
Repressed anger
Irregular eating habits
Nicotine and cannabis abuse

29 years old
See

Western diagnosis

Symptoms

Figure 10.2.2.3
Female

Tongue Coatings

Tongue description

Chinese diagnosis

Pale red, with curled-up edges


Greasy, thick,yellow coating

Liver qi constraint

Old, thin coating i n the center of the tongue

Accumulation of damp-heat in the Liver and


Gallbladder
Stomach yin and fluid deficiency
Symptoms

Figure 10.2.2.5
Male

Severe burning pain in the left waist area and


chest
Exhaustion
Lack of appetite
Severe dryness of the mouth
Rapid weight loss

53 years old

Western diagnosis
AIDS
Postherpetic neuralgia
Background t o disease
Viral activity
Inability to eat

Case History

For over two years this 29-year-old banker suffered form a burning sensation when
she urinated, a yellow vaginal discharge, and pain during intercourse. Laboratory
findings showed that both she and her husband had a chronic urogenital infection
caused by the bacterium Ureaplasma. The infection had been treated over the years
by conventional methods, but it never cleared up for any length of time. The patient
was unhappy in her marriage and constantly wondered whether she should divorce.
The tongue coating was very greasy, thick, and yellow in the posterior third. Her
pulse was wiry (xian) and excessive (shi).

Fig. 10.2.2.3

Analysis. The symptoms indicate a pattern of excess caused by an accumulation of


damp-heat in the lower burner. This is manifested on the tongue as a thick, greasy,
yellow coating in the posterior third.The excessive pulse also confirms this finding of
excess.
The tongue body is slightly swollen and shows some teeth marks, which suggests
an underlying Spleen qi deiiciency with accumulation of dampness. Despite this, the
slight redness of the tongue body and the yellow, thick coating must also be taken
into account when formulating a diagnosis and treatment strategy. These two aspects
point to the presence of damp-heat, especially in the Liver and Gallbladder channels.
The patient's long-standing emotional problems caused Liver qi constraint,
which is confirmed by the wiry pulse, and led to the development of heat in the

Tongue Coatings
Liver. The heat has combined with the underlying dampness to form damp-heal. This
excess in the Liver and Gallbladder has impaired (he free flow of qi in the Girdlc vcsscl.
As a result, the lbinding function of this vessel has been impaired, as reflected in (he
yellow vaginal discharge.
The red points at the lip of the tongue reflect the formation o i heat in [he Heart,
which was caused by the patient's obsessive thinking and emotional strain. Because
t
Small Intestine channels,
of the interior-exterior relalionsliip belween lhe ~ e a r and
the heat was lransferred lo [lie Small lntesline channel. This is reflected in the disruption in the secretion of body fluids, and the burning sensation during urination.
A gynecological examination underlaken because of her pain during intercourse

produced no findings. However, from the Chinese medical point of view, this was
clcarly the result o i Liver qi conslraint.

Discussion. A greasy, Chick, and yellow coating reflects a condilion of excess. Often
i l occurs with acute symptoms. Even if underlying Spleen qi deficiency is at (he root
of the dampness, a tonifying strategy would be inappropriate. Initially, the heat must
be cleared and llic dampness dried. The patient should also abstain from alcohol,
fatly, spicy ioods, and dairy products to support the trealmenl.

I0.2.1

Dry and White orYellow Coatings


Independent of its colo~;a dry or rough-looking coating is always an indication of depleted body fluids. For example, a white, greasy, dry, or rough coating may suggest Spleen and Stomach qi deficiency, as well as a deficiency of
fluids in the Stomach. On the one hand, owing to the weakness of Spleen and
Stomach qi, there is an accumulation of dampness, giving the coating its
greasy consistency. On the other hand, the deficiency of fluids in the
Stomach means that the tongue is not receiving adequate moisture; the coating will therefore appear dry.
If the coating is yellow and dry without being sticky or greasy, it is an
indication of injury to the fluids by internal heat, which will thicken any
accumulated dampness or phlegm in the interior. As a result, the coating will
become rough and dry and yellow in color, all of which suggest the presence
of the heat.

Tongue Coatings

Figure 10.2.3.1
Female
28 years old

Tongue description

Chinese diagnosis

Pale, swollen, slight teeth marks

Dry,white coating in the anterior third and center

Spleen qi deficiency (accumulation of dampness)


Accumulation of cold-phlegm

of the tongue
Greasy, thick, yellow coating in the posterior third

Accumulation of damp-heat in the lower burner

Symptoms

i HISTORY

below

Nausea after eating cheese


Runny or congested nose
Cough with copious amounts of mucus
Dizziness during menstruation
Backache
Frequent urination at night

Western diagnosis
Allergy to cow's milk
Allergic rhinitis

Background to disease
Excessive consumption of fruit (a minimum of 10
bananas per week)

Tongue description

Chinese diagnosis

Pale red
Red, raised points in the anterior third
Dry, rough, white coating

Normal
Heat toxin in the upper burner
Deficiency of fluids in the Stomach

Symptoms

Figure 10.2.3.2
Female
3, years old

Swollen cervical and inguinal lymph nodes


Stomach pains and epigastric fullness
Distended lower abdomen

Western diagnosis
Non-Hodgkin's lymphoma

Background to disease
Condition followed radiation therapy and
chemotherapy

Tongue Coatings

Tongue description

Chinese diagnosis

Pale, swollen, teeth marks


Vertical crack with light yellow, dry coating

Spleen qi deficiency (accumulation of dampness)


Accumulation of phlegm with slight heat developing
in the yang brightness wangming) channel
Insufficient production of fluids, Spleen qi deficiency
Retention of damp-heat in the lower burner

White, dry, greasy coating in the middle third


Greasy, thick, yellow coating with red points in the
posterior third
Slight depression at the root of the tongue

Slight essence deficiency

Symptoms

Figure 10.2.3.3

Loose teeth
Bleeding gums
Frequent periodontitis
Strong-smelling, watery diarrhea
Flatulence
Sour taste in the mouth
Exhaustion

Female
39 years old

Western diagnosis
Periodontitis

Background to disease
Irregular lifestyle during puberty with alcohol and
drug abuse

Tongue description

Chinese diagnosis

Pale, slightly thin


Red tip
Vertical crack with light yellow, dry coating

Slight deficiency of blood


Heat from deficiency in the Heart
Accumulation of phlegm with slight Stomach yin
deficiency
Deficiency of fluids with internal heat

Greasy, dry, pale yellow coating

Symptoms

Figure 10.2.3.4

Cough with copious mucus


Blocked nasal passages
Thirst
Dry mouth
Heartburn
Exhaustion

Female
32 years old

Western diagnosis
Chronic sinusitis

Background to disease
Excessive consumption of dairy foods
Caffeine abuse

Tongue Coatings
Tongue description

Chinese diagnosis

Reddish, big, rough tongue body

Kidney yin deficiency with slight deficiency of


fluids
Heat in the Heart
Accumulation of phlegm, heat developing

Red points at the tip


White, dry coating turning yellow toward the
center of the tongue

Symptoms

Figure 10.2.3.5
Female

Purulent stye
Red conjunctiva
Strong thirst
Constipation
Inability to sleep through the night
Inner restlessness

Western diagnosis
Chronic sinusitis
Acute conjunctivitis

Background to disease
Overworked
Lack of sleep
Long-standing emotional problems

Chinese diagnosis

Pale red, wide


Small, horizontal cracks
Greasy, dry, yellow coating

Retention of damp-heat
Slight deficiency of fluids
Accumulation of heat in the yang brightness
wangrning) channel with injury to the fluids

Symptoms

Figure 10.2.3.6
Male
29 years old
See
CASE HISTORY
below

Tongue description

Foul-smelling, loose diarrhea and flatulence


Inner restlessness
Sleeping problems
Inability to concentrate

Western diagnosis
None

Background to disease
Caffeine abuse
Stress from failingexamination

Tongue Coatings
Tongue description

Chinese diagnosis

Pale red
Curled-down tip
Right-sided, dry, yellow coating

Normal
Heat from deficiency in the Heart
Retention of damp-heat in the Gallbladder

Symptoms

Figure 10.2.3.7

Skin rash at the waist


Brownish skin pigmentation with itchiness
Urge to urinate and dribbling of urine
Tinnitus
Inner tension
Depressive moods

=ernale
43 years old

Western diagnosis
Tinea corporis

Background to disease
Physical and mental exhaustion

Tongue description

Chinese diagnosis

Red, dry
Thick, greasy, white at the sides, dirty yellow coating
in thecenter of the tongue

Kidney yin deficiency


Accumulation of cold-dampness with blockage of qi
in the middle burner, transforming to heat

Symptoms
Dizzy spells
Tingling and numbness of the arms
Pains in the shoulder and lumbar region

Western diagnosis
None

Background to disease
Excessive consumption of fatty foods
Physically overworked

Figure 10.2.3.8
Female
62 years old

Tongue Coatings

Case History

Fig. 10.2.3.1

For six months, 28-year-old Mrs. H followed a new diet. In the mornings, she ate
only fruit, and her other meals consisted mainly of fresh salads and vegetables. As
Mrs. H was hungry in between her main meals, she satisfied her appetite with
bananas. She liked this new diet because she could not tolerate dairy products.
However, while following the diet, she became increasingly tired and was more
susceptible to cold. She had contracted a cold several months before, which left her
with a cough; she expectorated copious amounts of white sputum. She also complained about a constantly runny nose. Her sleep was troubled by a frequent urge to
urinate; her urine was yellow and odorless. Conventional medical tests were negative.
The tongue showed a dry, white coating in the center and anterior third and a thick,
yellow coating in the posterior third. Her pulse was confined (lao) and submerged
(chen).

Analysis. This is a typical example of how raw foods can injure the Spleen qi. Cold
foods lessen the transformative and transportive strength of the Spleen qi and yang,
and contribute to the ensuing accumulation of dampness. In this case, the Spleen qi
deficiency was discernible in the swollen tongue body with teeth marks. The white,
dry coating and the firm pulse reflect an accumulation of cold-dampness and the
ensuing stagnation of qi in the middle burner.The dryness of the coating points to the
long-standing accumulation of dampness and the resulting constraint in the movement of qi. The regular consumption of bananas further contributed to the Spleen qi
deficiency and to the buildup of dampness and phlegm.
The symptoms also suggest that dampness i s a causative factor for her complaints.The runny nose, and the cough with copious phlegm, reflect the impairment
in the Lung's downward-moving action as a result of the retention of phlegm.
Because dampness is heavy and tends to sink, it transforms into damp-heat in the
lower burner; it is responsible for the frequent urge to urinate in this case.The thick,
yellow coating at the root of the tongue reflects this pathology.

Case History

Fig. 10.2.3.6

After twice failing to graduate from university, Mr. B began to experience inner restlessness, insomnia, and the inability to concentrate, all of which prevented him from
re-taking the examination. He tried to compensate for his lack of concentration by
taking stimulants like guarana products (a dried paste prepared from the seeds of
Paullinia cupana and used as an astringent) and consuming as many as 15 cups of
coffee daily. His stools became loose and foul-smelling, and he suffered from flatulence. The wide tongue showed a yellow, greasy, and dry coating. His pulse waz
excessive (shi) and rapid (shuo).

Analysis. In this case, the excessive study and thinking, as well as the severe disappointment at not graduating, gave rise to heat in the Heart. Surprisingly, this was
not visible on the tongue. Rather, the tongue reflected only the abuse of guarana
and caffeine. Those two substances can, if taken in excess, injure the Kidney yin
and the fluids through enhanced diuresis.The injury to the Kidney yin resulted in a
disturbance in the harmonious communication between the Kidneys and the
Heart, which is reflected in his inner restlessness and insomnia.

Tongue Coatings
The yellow, dry, greasy coating reilecls ihe intense heal in thc lower burner that
has injured [lie fluids. This is visible in the cracks as well as in (he lhinned coating in
the center oi the posterior lhird oi (he tonguc body. Thc smelly, loose stools were the
rcsult oia retention oi damp-heat in (he Large Inlesline; here, [he hcat is inore dominanl than the dampness. The full and rapid puisc confirms that this condition is one
of cxccss.
Discussion. Thc appearance of a dry, rough coaling is caused by damp-heat
wherein the heal is more dominant than (he dampness. Here, the heal injured the
iluids in the Stomach, resulting in (he dry, rough coaling. In (his case, i l is important
lo clear the heal and increase ihc iluids. The palient was therefore given dielary
counseling, and enco~~raged
lo cal more moistening ioods, like pears, and less hol
and spicy foods.
10.2.4

Black Coating
A black coating is often a n indication of a serious illness. As a rule, it is the
result of a long-standing pathology. It indicates extreme heat as well as cold
patterns of disease.
If the black coating is also slippery in appearance, it reflects a deficiency
of Spleen and Kidney yang with excessive internal cold. If this type of coating
is only visible at the center of the tongue, while the sides show the remains of
a white coating, it is indicative of Spleen yang deficiency with the accumulation of cold-dampness.
If the black coating is dry and appears cracked, it can be assumed that
there is a serious development in a persisting disorder. This type of coating
indicates that the yin is declining, which may lead to its separation from the
yang. The patient may be in danger since the black coating reflects the development of extreme heat that can consume the body fluids. The drier and
blacker the coating, the more severe the exhaustion of yin and fluids.

A yellow coating at the sides and a black, greasy coating in the center of
the rongue are indicative of extreme heat in the Stomach. A persistantly
yellow coating reflects the long-standing retention of damp-heat. Extreme
heat in the Stomach burns the fluids and causes the black, burnt-looking
coating.

Tongue Coatings

Figure 10.2.4.1
Male
33 years old

Tongue description

Chinese diagnosis

Reddish with red sides, contracted tongue body


and tip
Black coating in the center and posterior third of
the tongue, yellow a t thesides

Heat in the Liver, Lungs, and Heart, injury to the


yin in the upper burner
Long-standing heat in the yang brightness [yang
ming) channel with injury to the fluids

Symptoms
Pain in the throat
Dry mouth
Feeling of heat in the nose
Occasional nosebleeds
Blocked nasal passages
Headache

Western diagnosis
Carcinoma of the nasopharynx

Background to disease
Smoked for many years
Possible environmental factors (pollution)

Figure 10.2.4.2
Female
83 years olc

Tongue description

Chinese diagnosis

Red, swollen
Slightly pale sides
Deviating
Black, thick, greasy coating with dirlyyellow
coating a t the sides

Retention of phlegm-heat
Slight Liver blood deficiency
Movement of internally-generated wind
Retention of phlegm-heat in yang brightness
lyangming) channel

rn

Symptoms
Slurred speech
Constipation with hard, dry stools
Loss of memory
Inability to move left arm and leg

Western diagnosis
Apoplexy with left-sided hemiplegia

Background to disease
High blood pressure for 20 years

zbngue Coatings

10.2.5

Tofu-Like Coating
This coating looks like tofu or soy cheese. It consists of big, rough-grained
flakes that seem to lie just on the surface of the tongue.
- This coatinp.
- can indicate extreme yang and excessive heat in the interior (Fig. 3.6.6).
There is another interpretation of this tongue coating in the literature: "a
rise of turbid substances as in food stagnation or turbid phlegm." This means
that food stagnation as well as retention of damp-heat can cause this type of
coating2

Figure 3.6.6

Tongue description

Red, soft, slightly narrow tongue body


Thick,greasy, tofu-like, pale yellow coating
Symptoms
Cough with blood-tinged sputum
Shortness of breath
Pains in the chest
Backache
Subfebrile temperatures
No appetite
Western diagnosis
Carcinoma of the nasopharynx
Metastases to the lungs and cervical vertebrae
Background to disease
Smoked for 40 years

Chinese diagnosis
Kidney yin deficiency
Internal heat with retention of phlegm-heat

Figure 10.2.5.1
63 years old

Tongue Coatings

Tongue description

Chinese diagnosis

Bright red, narrow tongue body


Tofu-like, pale yellow coating

Kidney yin deficiency with injury to the fluids


Retention of damp-phlegm in the yang brightness
(yang ming) channel transforming into phlegmheat, food stagnation

Symptoms

Figure 10.2.5.2

Subfebrile temperatures
Pain under the right hypochondrium
Foul-smelling stools
Flatulence
Distended abdomen

Male
69 years old

Western diagnosis
Carcinoma of the large intestine, with metastases
to the liver

Background to disease
Unknown

Endnotes
1. See Maciocia G. Tongue Diagnosis in Chinese Medicine, rev. ed. Seattle: Eastland

Press, 1995. This book discusses different tongue coatings at great length and
should be frequently consulted on this subject.
2. Song T-B. Atlas of the Tongue and Lingual Coatings in Chinese Medicine. Beijing:

Peoples Medical Publishing House and Editions Sinomedic, 1981:64.

C H A P T E R

1 1

Special Tongue Sign:


The Completely
Cracked Tongue
A unique type of tongue is the completely cracked tongue. Deep, wide cracks

always located at the edges and sides of the tongue are a distinctive feature of
this completely cracked tongue body. Despite its startling appearance, no
particular disharmony or pattern of disease is associated with this type of
tongue, and it often occurs in more than one family member.
Nevertheless, the cracked tongue may point to a constitutional weakness
and deficiency of tluids and Kidney yin.'
These tongues are usually big and swollen. It is therefore important to
check the rongue body color. If it is pale, it is indicative of deficiency of the
blood and fluids; if it is red and completely cracked, it indicates deficiency of
the yin and fluids. As a rule, this type of tongue has very little coating or no
coating at all, which can be explained by the lack of fluids in general. However, it bears repeating that a person with this type of tongue does not necessarily have any serious or organic illness.

Special Tongue Sign: The Completely Cracked Tongue


Tongue description

Chinese diagnosis

Pale red with reddish patches


Thin vertical crack with horizontal cracks
Deep cracks at the sides of the tongue

Blood deficiency with heat developing


Slight Stomach yin deficiency
Spleen qi deficiencywith the onset of Spleen yin
deficiency
Heat in the Heart

Reddish tip

Symptoms

Figure 11.1
Male
42 years old

Foul-smellingdiarrhea
Flatulence
Plum-pit feeling in the throat
Burning of the tongue
Tiredness

Western diagnosis
None

Background to disease
Overwork
Emotional problems
Constitutional weakness

Tongue description

Pale red with cracks over the entire surface, with


notches and cracks at the sides
Yellow, thin coating at the center of the tongue

Figure 11.2
Female
35 years old

Chinese diagnosis
Constitutional weakness of qi, blood, yin, and
fluids
Retention of damp-heat in the Stomach

Symptoms
Stomach pains
Heartburn
Vomiting with excitement
Feelings of fear

Western diagnosis
None

Background to disease
Overworked
Emotional problems
Constitutional weakness

Special Tongue Sign: The Completely Cracked Tongue


Tongue description

Chinese diagnosis

Reddish with cracks over the entire surface, with


notches and cracks at the sides
White, thin coating at the center of the tongue

Constitutional weakness of qi, blood, yin,and fluids


Normal

Symptoms

Figure 11.3

Depressive moods
Inner restlessness
Cough with scantymucus
Hoarseness
Joint pains

Female
40 years old

Western diagnosis
Chronic inflammation of vocal cords

Background to disease
Overuse of the voice
Irregular eating habits
Emotional problems
Constitutional weakness

Tongue description

Chinese diagnosis

Red
Reddish tip
Deep vertical crack in the center of the tongue
Notches and cracks at the sides
No coating

Kidney yin deficiency


Heat in the Heart
Stomach yin deficiency and deficiency of fluids
Deficiency of fluids and yin
Stomach yin deficiency

Symptoms
Impotence
Difficultyurinating, dribbling urine
Depressive moods
Irritability
Heartburn

Western diagnosis
Hypertrophy of the prostate

Background to disease
Emotional problems
Constitutional weakness

Figure 11.4
Male

46 years old

Special Tongue Sigiz: The Completely Crucked Tongue

212

Endnotes
1. Songl'l3. Allas

ofthe Tongueu~zdLiizguulCoulifzgsin Clziizese Mediciize. Beijing:

Peoples Medical Publishing House and Editions Sinornedic, 19815 4 .

Changes in the Tongue


Following Treatment

In this chapter, various case studies are presented that demonstrate changes
in the tongue that occurred following treatment with acupuncture or
Chinese herbs, and the simultaneous improvement in the condition of the
treated patients.

CASE 1: Severe Exhaustion


Mrs. R, a 43-year-old lawycl; complained about severe exhaustion. For years
she had worked 12-hour days, six days a week. Inevitably, her personal relationships broke down. Despite her fatigue, she was unable to sleep, and her
nights were spent thinking and worrying. She occasionally felt pressure
building u p under her ribs and complained about inner restlessness. At the
same time, her menstruation began to change. She experienced spotting that
lasted up to 14 days. She had little appetite and was very thin. In addition,
her hair became noticeably grayer. Her tongue was pale and swollen and
showed a deep depression at the root. tIer pulse was frail ( ~ L L osubmerged
),
( c l ~ e nand
) , hidden W I ) .
ANALYSIS
Chronic overwork as well as irregular and insufficient eating had weakened
the Spleen qi in this patient. Eventually this led to an accumulation of dampness, as reflected in the swollen tongue body. One function of Spleen qi is to
hold the blood, but because the Spleen qi was deficient, there was constant

Changes in the Tongue Following Treatment


bleeding. Owing to the exhaustion of the postnatal qi, overwork, constant
worry, and lack of sleep, the essence and Kidney yin were also affected, as
reflected in the depression in the root of the tongue. Since the Kidney yin and
blood were deficient, the Heart blood and yin became malnourished, resulting in deficient fire in the Heart. This led to inner restlessness and insomnia.

Fig. 2.2.4

Mrs. R also suffered from Liver qi constraint, which manifested in the


occasional feeling of pressure under the ribs, a result of her inability to
appropriately express the anger and rage she sometimes felt. The Liver qi
constraint was not reflected in the tongue or pulse.
TREATMENT
Mrs. R. was advised to change her diet to include warm foods, and to eat regularly. Porridge or millet was recommended to start the day, so as to
strengthen the Spleen qi. She also introduced meat, fish, vegetables, and
grains into her diet.

After treatment

Mrs. R was given weekly acupuncture treatments for six months, aimed
at reviving her Spleen qi, eliminating dampness, calming the spirit, and
spreading the Liver qi. The following acupuncture points were used:
Point

Needling technique

ST-36 (zu san 113


SP-6 (san yin jiao)
LI-4 (hegu)
LI-1l(qu ch0
LI-10 (shou san 10
PC-6 (nei guan)
LR-3(tai chong)
SP-9 (yin lingquan)
HT-7 (shen men)

Tonification
Fireneedle
Tonification
Tonification
Tonification
Neutral
Neutral
Draining
Draining

She was also prescribed a decoction of Rambling Powder (xiao yao san),
with modifications, over a period of eight weeks.
Six months later, Mrs. R felt much better. Her menstruation had become
normal, she slept well, and felt much stronger. This was reflected in the
tongue body color and shape. The tongue is now a pale red color, and the
swelling has disappeared. Her pulse is still submerged, but now has a noticeably wiry quality. It is interesting to note that as the patient's energy became
stronger, the Liver qi constraint became more obvious, as reflected in the
tongue's curled-up edges.

CASE 2: Constipation
This 40-year-old patient worked as a manager of a big factory. The job
required her to travel a great deal. She worked hard and ate irregularly. Over
the course of a year, she complained of constipation, which was aggravated
by the constant travel and demands of her job. She had only one bowel
movement every three days, and while the stools were usually well-formed,
she occasionally excreted small, hard pellets. In addition to a feeling that she

Changes in the Tongue Following Treatment


had never quite emptied her bowels, she suffered constantly from foulsmelling flatulence. Her abdomen was bloated and distended. She was tired,
suffered from mood swings, and felt unhappy and stressed. The tongue body
was long, pointed, and slightly pale. The tongue coating appeared moist and
slippery. A thickish, yellow coating showed at the root of the tongue. Her
pulse was frail (ruo) and wiry (xian).
ANALYSIS
The patient's hectic lifestyle, emotional situation, and constant travelling
caused Liver qi constraint. This led to a blockage of qi in the lower abdomen.
Constipation, pellet-like stools, a distended abdomen, and a feeling of insufficient evacuation are all acknowledged symptoms. The wiry pulse, which
also indicated Liver qi constraint, confirmed the findings. Liver qi constraint
leads to stagnation of qi in the middle burner and impairs the transportive
and transformative functions of the Spleen, interfering with the upward and
downward directed actions of the Stomach. The ensuing buildup of dampness is reflected in the slippery tongue coating. The abdominal bloating and
flatulence is a result of the disrupted flow of qi, a consequence of obstruction
by dampness and food stagnation. The root of the tongue shows a yellow
coating, which suggests the presence of damp-heat in the lower burner.

Fig. 12.2

- -

The tongue of this patient was noticeably long and pointed, indicating a
constitutional weakness of the Heart. Her constitution and hectic lifestyle are
incompatible, and over a period of time led inevitably to development of
heat in the Heart.
TREATMENT
The treatment was directed at spreading Liver qi, regulating the Spleen,
lubricating the Intestines, and calming the spirit. The patient was treated
with a modified version of Frigid Ektremities Powder (si ni san). The following herbs were added to the basic formula: Radix Aucklandiae Lappae (mu
xiang), Rhizoma Cyperi Rotundi (xiangfu), Semen Persicae (tao ren), and
Semen Biotae Orientalis (baizi ren).
After taking the decoction for one week, the patient's flatulence and
bloated abdomen had disappeared. After a month, despite the travelling, her
constipation disappeared, and she felt more relaxed. The tongue had
resumed to its normal shape. Six months later, the patient was still free of
symptoms. She had resigned from her job and was looking for a less stressful
occupation.

CASE 3: Wasting Syndrome


Mr. H, 44 years old, was infected with HIV 11 years ago. Last year he developed Pneumocystis carnii pneumonia. When his treatment with Chinese
herbs began, his T-helper cells count was only 10~1.Since then he felt weak
and had a constant dry cough, severe night sweats, and bouts of fever. He lost
weight and was verp thin (47kg and a 180cm waist). Every three weeks he
needed a blood transfusion for his severe anemia. He also complained about
painful mouth ulcers. The tongue body was red and contracted. One side of
the tongue had an old, yellow coating. His pulse was thin (xi), slightly tight
(jin), and rapid (shuo).

After treatment

Changes in the Tongue Following Treatment

u
7

Fig. 3.6.5

l"K

ANALYSIS
The red, contracted tongue body reflects the severe exhaustion of Kidney yin
and essence. The dryness of the tongue suggests exhaustion of the body fluids caused by the night sweats and bouts of fever. The old, one-sided yellow
coating underscores the presence of yin deficiency, including the deficiency
of Stomach yin. The presence of both Stomach and Kidney yin deficiency
prevents the formation of a new coating. The one-sided coating can also be
interpreted as a sign of extreme heat in the Liver, aggravated by insufficient
nourishment of Liver yin, Kidney yin, and essence. This type of deficiency
gives rise to fire from deficiency, which is responsible for the night sweats
and fever. Over the long term, this pathology leads to wasting and emaciation, as reflected in the extreme thinness of the patient.
The pneumonia created heat in the Lungs that scorched the Lung yin.
Although treatment with antibiotics healed the pneumonia at the time, heat
and fire remained trapped in the Lungs. Consequently, the Lung qi did not
properly descend and was not sufficiently nourished or moistened, resulting
.m the uncomfortable, dry cough.
Heat in the nutritive level, possibly due to viral activity, may have contributed to the night sweats and the extreme redness of the tongue. The
accumulation of heat toxin, manifesting in mouth ulcers, contributed to the
exhaustion of the patient and his general feeling of sickness. The thin and
rapid pulse was an indication of general yin deficiency and the resulting
heat.
TREATMENT
The purpose of treatment was to nourish the yin and enrich the Kidneys,
resolve the heat from deficiency, and clear heat from the nutritive level. The
foundation of the herbal prescription was Drain the White Powder (xie bai
sanl, prescribed to drain constrained heat from the Lungs. Herbs were added
to resolve the heat from deficiency, ton$ Lung and Stomach yin, and stop
the coughing. In addition, the qi and blood were gently tonified. For 12 weeks
the patient took the following decoction, with slight modifications: Cortex
Mori albae Radicis (sang bai pi), Cortex Lycii Radicis (di gu pi), Honeytoasted Radii Glycyrrhizae uralensis (zhi gan cao), Plastrum Testudinis (gui
ban], Tuber ophiopogonis Japonici (mai men dong;), Radix adenophorae seu
Glehniae (sha shen), Radii Stemonae (bai bu), Rhizoma Coptidis (huang
lian), Ganoderm (ling zhi), Radii angelicae Sinensis (danggui), Radix astragali Membranacei (huangqi), and Massa Fermentata (shen qu).
The night sweats and fever responded quickly to the treatment, and the
cough improved after a few weeks. The patient gained five kilograms (about
11 pounds) and did not require any more blood transfusions. Slowly, the
tongue lost its red color. It is now less contracted and a new coating is forming. Besides treatment with Chinese herbs, the patient later underwent a
newly developed form of chemotherapy.

CASE 4: Cardiac Neurosis


This 28-year-old beautician was known for her rash, loud, boisterous, and
inconsiderate behavior. For three years she had suffered from a heart neurosis and sleeping problems. Her panic attacks occurred mostly at night.

Changes in the Tongue Following Treatment


Tachycardia and pains in the chest, connected with a strong feeling of fright,
had her husband calling for an ambulance on many occasions. Conventional
medical findings were negative. Because of her panic attacks, she was unhappy and dissatisfied with herself. In general, she was very aggressive,
talked loudly, and appeared restless. The appearance of her panic attacks
coincided with the complete disappearance of her sex drive. In her spare
time, she sat in front of the television and ate sweets. While her menstrual
cycle was regular, her periods were very heavy. The tongue was reddish and
slightly swollen. The tongue coating appeared peeled, and her pulse was
rapid (shou) and thin (xi).

I
tlg. 3.b. I

ANALYSIS
Although the tongue body was swollen and of a reddish color, it was the large
areas of peeled coating that suggested the onset of Kidney yin weakness. The
coating was especially peeled in the anterior and posterior thirds of the
tongue, which is indicative of Heart and Kidney dysfunction. The history did
not clearly show the reason for the deficiency. However, in my opinion it was
due to her strong fears about life, that she would become homeless, or that
her husband would leave her. The panic attacks started in a phase of her life
when she lived alone for the first time. She felt very lost and lonely at this
time and did not cope well with being on her own.
The peeled coating reflected, quite clearly, the location of the energetic
disharmony, that is, the failure of fire and water to communicate harmoniously. The Kidney yin was not nourishing the Heart yin sufficiently. The
ensuing fire from deficiency in the Heart gave rise to the panic attacks, inner
restlessness, and sleeping problems. The profuse menstrual bleeding contributed to blood deficiency, which also affected the Heart.
The profuse menstrual bleeding also weakened the Liver blood. Her
inability to fall asleep, and her unbalanced emotions, may be due to insufficient anchoring of the ethereal soul (hun)by the Liver blood.
The swollen tongue indicates an accumulation of dampness in the interior. This may have been caused by the overconsumption of sweet, sticky
foods. The slightly greasy coating in the center of the tongue indicates an
accumulation of turbid dampness in the middle burner, which is related to
her inappropriate diet.
TREATMENT
Treatment was directed at restoring communication between the Heart and
Kidneys, calming the spirit, and nourishing the blood. Simultaneously with
the treatments, which lasted four months, the patient started to practice qi
gong. Acupuncture treatments were given weekly for eight weeks, followed by
treatments at two-week and then four-week intervals. As a rule, not more
than four acupuncture points were used in each treatment. Two sets of
points were used quite frequently. The first set consisted oE
Point

Needling technique

HT-7 (shen men)


CV- 15 (jiu we0

Draining
Neutral
Tonification

After treatment

Changes in the Tongue Following Treatment


The second set consisted oE

PC-6(neiguan)
LR-8 (qu quan)
KI-3 [taixiJ

Neutral
Tonification
Tonification

After four months of treatment, the patient felt well. She became noticeably
quieter, more relaxed, and more pleasantly mannered. She has not had any
panic attacks for two months. In addition, the tongue lost its peeled coating,
although the tongue body is still slightly swollen and of a reddish color. To
stabilize the communication between the Heart and Kidneys, the prepared
medicine Emperor of Heaven's Special Pill to Tonify the Heart (tian wang bu
xin dan) was prescribed for 12 more weeks.

CASE 5: Feeling of Pressure and Pain under the Ribs

Fig. 4.1.1.5

Mrs. S had changed her diet according to the principles of the five elements.
She diagnosed herself as suffering from Spleen qi deficiency, so she selfprescribed a diet of hot, spicy foods. After three months of this diet, she suddenly experienced an uncomfortable pressure under the ribs that was worse
on the right side. The pain was occasionally quite strong, worsened at night,
and sometimes woke her up in the early morning.
From ovulation until the onset of menstruation, the intensity of this pain
increased. During this time she also suffered from painful, distended breasts.
After meals Mrs. S often experienced a heavy or full feeling in her abdomen.
Her stools changed from being dry and pellet-like to being loose.

After treatment

Mrs. S worked 40 hours a week and studied at night. She often felt tired
and overstretched from too many demands, as well as emotionally imbalanced. Over the past 12 months the dentist diagnosed the onset of periodontitis. The tongue body color was normal, but the center of the tongue was
red, dry, and slightly cracked. Her pulse was thin (xi) and slightly wiry (xian).

ANALYSIS
The daily consumption of hot and spicy foods gave rise to heat in the
Stomach. This was reflected in the red, dry center of the tongue. Because of
the demands at work and her constant tiredness during the day, the patient
consumed a lot of black tea and coffee, thus contributing to the heat and
leading to a slight deficiency of fluids in the Stomach. This case of early-stage
Stomach yin deficiency manifested in the tongue as small cracks in its center.
The Stomach yin deficiency plus the heat in the Stomach were likely responsible for the inflamed gums.
The different demands in her life led to Liver qi constraint. The uneven
flow of Liver qi manifested as pain and a sensation of pressure under the ribs,
as well as increased pain during her menstrual cycle. The changing stools,
painful breasts, and wiry pulse were also signs of Liver qi constraint. The
upward and downward directed actions of the Stomach qi were also impaired by the constrained Liver qi, as reflected in the sensation of epigastric
fullness after meals. Pain under the ribs that worsens at night may be due to
the constraint of qi, which often gets worse when one is passive and
improves with movement.

Changes in the Tongue Following Treatment


TREATMENT
The goals of treatment were to spread the Liver qi, clear the heat from the
Stomach, and nourish the Stomach yin. Mrs. S changed her diet; she started
to eat fruit, especially pears, and abstained from spicy foods. The patient was
also treated for six months with acupuncture and Chinese herbs. The following set of points was frequently used:
Point

Needling technique

PC-6 (neigum)
LR-3 (tai chong)
GB-41 (zulin qrl
TB-6 (zhigou)
ST-44 (nei ting)
ST-34 (lianqu)
ST-36 (zusan 111
SP-3 (tai bail

Neutral
Neutral
Drainiig
Draining
Draining
Draining
Tonification
Tonification

This treatment was supported with Chinese herbs. Over a period of three
months, the patient took a decoction of Minor Bupleuurm Decoction (xiao
chai hu tang).
Her symptoms improved considerably, and she seldom experienced
pain. However, the demands of work and emotional problems still had a tendency to trigger the pains under her ribs.
The tongue resumed its normal shape. The center of the tongue was no
longer red, and the depth of the cracks slowly diminished. This reflected the
regeneration of fluids and yin in the Stomach. In addition, the pulse lost its
wiry quality.

CASE 6: Chronic Cough


After having severe pneumonia as a child, Mrs. B suffered from a mild fonn
of bronchiectasis. The 50-year-old patient had a chronic cough with copious
green-yellow sputum, and reported that she always felt its presence in her
lungs. She had a tendency to catch colds during the autumn and winter.
One year ago, a benign tumor of the parotid gland was diagnosed, which
at the time of treatment measured 3cm by lcm. The tumor was of a firm, rubbery consistency, although it caused no pain. In general, the patient felt well.
Her menopause had passed without incident. The tongue body was pale and
had deep red points plus a depression in its anterior third. The center and
posterior third of the tongue had a dark yellow coating. Her pulse was confined (lao)and slippery (hua).

Fig. 12.6

ANALYSIS
As a result of the chronic cough, Lung qi had lost its root, which led to Lung
qi deficiency. This was reflected in the depression in the anterior third of the
tongue, which suggested deficiency of the gathering qi and Lung qi. This
weakness also contributed to her tendency to catch colds.
Mrs. B also suffered from long-standing clumping of phlegm-heat in the
Lungs that was responsible for the expectoration of green-yellow sputum.

After treatment

Changes in the Tongue Following Treatinen1


The heat was reflected in the deep red points on the tongue. The chronic
phlegm-heat in the Lungs interfered with the downward-directed action of
the Lung qi and gave rise to the chronic cough.
Before treatment with Chinese medicine began, Mrs. B ate a vegetarian
diet with a lot of raw foods and dairy products. This weakened the Spleen qi
and was responsible for the formation of internal dampness. Her protective
qi was weak, as evidenced by the frequent invasion of wind-cold in the
autumn and winter. The pathogenic factors constrained the Lung qi, which
quickly transformed into heat. Because of the underlying acculnulation of
dampness and phlegm, phlegm-heat in the Lungs readily formed and continuously fed the persisting pathology.
The coating on the anterior third of the tongue, which corresponds to the
Lung area, was thin and showed a depression. Thus, as stated above, the
tongue only showed the deficiency of the Lung qi. The presence of phlegm in
the Lungs, however, was not visible on the tongue. The yellow coating, indicating the presence of accumulated damp-heat, was located at the center
and posterior third of the tongue. This confirmed the underlying involvement of the Spleen in producing dampness, especially as the center of the
tongue body was also slightly swollen. The yellow color was indicative of the
transformation of dampness and phlegm into phlegm-heat.
A similar pathology was responsible for the formation of the tumor in the
parotid gland. The inability of Spleen qi to transport and transform dampness led to an accumulation of phlegm, which interfered with the flow of qi.
The phlegm, in this case, coalesced into a knot, which is to say, a tumor. The
rubbery and firm consistency of the tumor, as well as the firm, slippery pulse,
corroborated this finding.

TREATMENT
The aim of treatment was to clear the heat from the Lungs, transCorm
phlegm, regulate the Lung qi, and soften and dissipate the tumor. The
patient was advised to abstain from raw foods and dairy products.
Over a period of four months, the patient was prescribed a modified
combination of Fritillaria and Trichosanthes Fruit Powder (bei 1x11 gun lolr
saiz) and Sargassum Decoction for the Jade Flask (hai i u o yli lzu ta~zg).
Ingredients included Bulbus Fritillariae Thunbergii (zhe bei in[r), 1:ructus
Trichosanthis (guu 10~11,Radix Trichosanthis Kirilowii (1iuii l z ~ ~j'eiz),
a
Sclerotium Poriae Cocos (fLI ling), Radix Scutellariae Baicalensis (!~~~nizgqi~z),
llerba Sargassii (haiiao), Thallus algae (ICLLI~
b~i),Rhizoma Pinelliae Ternatae
(ban xi%), Radix angelicae Sinensis (cluizg ~ L L OPericarpium
,
Citri Reticulatae
(chen pi), Fructus t'orsythiae Suspensae (liaii, qiao), Radix Glycyrrhizae
uralensis (gun cno), and Massa Fermentata (shen 911).
Following this treatment, and for the first time in her life, Mrs. B did not
catch cold in the autumn or winter. The cough was noticeably lessened and
the expectoration reduced. The sputum was now a pale yellow color. The
tongue shape and color had likewise improved. The depression in the anterior third of the tongue was no longer visible, and the coating was normal.
'The latest examination by ultrasound showed that the tumor had
decreased in size by lcm and felt softer. As Mrs. B tolerated the herbs so well,
the treatment was continued for a few more months.

Abdonien
bloated. 88, 136. 137
distended, 15,208
feeling o f f~lllness,136
pain in. 192
Abdo!ncn, lower
distended, 200
pain in. 144, 145, 191
w i l h menstrual bleeding, intense, 80
occasillnal, 192
Acne vulgaris. 89
Agl~raphobia.123. Sepriiso Fear, o f o p e n spaces
AIDS. 55, 197
Alcohol. internal heal and loxins from. 40
Allergy l o cow's milk, 200
Amalgam poisoning. See Poisoning, from amalgam
Amenorrhea, 43
Ancmia, 55
iron dciiciency, 48.97
Anger. 113
filsilf,41
strong, 134
Angina pecloris. 196
Ankle, pain o n exerlion. 50
Anorexia nervosa, 43.79, 171
postnalal q i irijury 82
Spleen q i deficiency. 82
Slornacli qi deficiency, 82
AI~L~S
anal pain. 26
burning sensation. 26, 181

Anxiety, 109, 192


Spleen q i deficiency, 115
o n waking. 121
Apoplexy
ccrchral. 140
will1 hemiplegia. Id't-sided, 206
Appctilc
changing. 156
lackol'. 26.43.44.58.74.75. 105, 114, 140, 190,
197. 198
rionc. 12, 15. 23, 65. 70, 122, 153, 207
Arm(s1
edema i n lel'l, 151
illability l o move, and leg, 206
inability t o move, right and right leg, I 4 0
paralysis i n lel'l, 151
and shoulders, pain i n right. 28
lingling and numbness. 203
tingling and numbness ill right, lti
occasional, 104
tingling, occasional and i n hands. 139
Arrhythmia, cardiac. 94
Arlerial obslruction, o f b u l h lower legs. 156
Arlliritis
pulyarlliritis, chn)nic, 121
rheumatoid, i l
chronic, I 7 8
Ascitcs. 145
Asthma
allergic. 48.49.66.87
attacks. 48
b n ~ n c h i a l91.98
.
Awake, inability loslay, 109

Back pain, 25,88,120,121,200,207


acule. 75
lower back, 13.70.79
with n u m b feeling i n l e l i leg, 71
Bartholinilis, chronic. 179
Bartholin's gland, one-sided swelling. 179
Behavior, compi~lsive,109
Belching, 23, 75. Seenlso Burping
Bipolar disorder. 122. Seealso Depression, manic:
Mood swings, severc
Bitter taste in moulh, 132, 152
Bladder channel, 2
Bladder, damp-heat in, 59
coating, yellow, thick, greasy, 179
coating, yellow, thin, greasy in poslerior third, 188
points, red a1 rout. 179
Bladder, damp-heat accumulation, 59
Bladder. damp-heat, relention
coating, yellow. thick, greasy, 179
coating, yellow. thin, greasy i n posterior third, 188
poinls, red at root, 179
Bladderqi, impaired
burning urination, 194
turbid urine, 194
Bleeding, uterine. slight during pregnancy. 58, 191
Blindness, due to optic nerve atrophy, 38
Bloating, 14, 135
Blockage of water pathways
longue, swollen, dry, and cracked, 89
Blood and yin deficiency, slight
lunguc, reddish, slightly thin. 89
Blood deficiency, 12
accumulalion oldampness. 167
internally-generated wind, tongue pale, devialed.
140
edges. pale, 90
Spleen q i deficiency and, YO
edges, pale, 90
longue, pale. 76. 87
tongue, pale, slightly, 78, 79
longue, rcd, pale. 90
tongue, teeth marks, slight, 87
tongue, thin. 78,79. 90, 201
tongue, thin, slightly, 78
Spleen q i deficiency, and accumulation of
dampness, 167
symptoms of, 25
tongue, color with, 4
longue, drawn-in. 28
tongue, dry, 139
longue. will1 heal developing, pale red with
reddish patches, 210
lungue, pale. 25.48. 76. 78, 87. 129, 201
and cracked. 47

and firm, 49
and red, 90, 129
with reddish palches. 210
and narrow, 27
and swollen, 12. 14. 16, 167
i n [middle part of sides. 31-32
and thin, 25-26, 79
and uneven sides, 29-31
tongue, swollen (halt'), 29,30
longue, teeth marks, slighl. 87
longue, leeth marks, uneven, 29
tongue, thin, 78,79
tongue, shape, uneven, 30
Blood, heal in, 39,41-42, 55
Blood stasis, 158, 163
emotions, unresolved, 153
Heart q i deficiency, 150
heat in blood, 152
Penelralingvessel, blockage, 116, 163
sexual abuse and, 82
sublingual veins, blue, distended, 157
longue signs and, 147-148
longue, leeth marks, slighl. 150
lungue, blue or bluish, 50, 147-149. 178
longue, bluc spot o n anleriur third, 155
tongue, narrow, drawn-in, 27
tongue, pale, swollen, 16
tongue. red-bluish. IS!
tongue. red, pale, bluish, 171, 121
Blood stasis, in Stomach
tongue. reddish-blue center. 156
Blood stasis, in Slomacli, and Stomach yin deliciency
longue. reddish-blue center, 157
Blood stasis, in upper burner
lusic Ileal and, 162
sublingual veins. dark blue. very distended, I51
with branching, brighi red capillaries, 162
sublingual veins, dark purple, I G I
Blood stasis, in womb
sublingual veins, blue, thick, tortuous, 160
Blood stasis, severe
sublingual veins, dark blue, distended with dark
spots, 162
Ulood stasis, slight
longue. blue, slightly, 178
longue, red, pale, slightly bluish, 120
Blood. weakness of. cunstiu~lional
tongue. reddish and cracked
with notches and cracks at sides, 21 1
Blood yin deliciency, red tongue with, 38
Body. Seealsoli~nguebody
achesand pain, 182, 188
Bones. pain in. 67, 162
Borborygmus, 59. Seeniso Gurgling, abdominal
Brachial plexus neuropalhy, 28
Breasl reeding, effect on blood, 51

Breast(s)
cancer of, i 4 , 151, 156
bilateral, 28
fibruadenoma, 132
fibroadenoma, left. 189
libroadenoma with cysts, right, 197
pain and distention belore menstruation, 197
pain and tightness before menstruation. 143
Breathing
difficult, 91
difficult occasionally, 78, 87,95
difficulty during inspiration, 49
difficulty during the night, 49
labored, with shortness o f breath, 161
~llorlne~
o fsbreath, 44,49,74,75, 113, 115, 145,
157.190,207
aggravated by stress and anger, 150
with labored breathing. 161
with sweatingand labored breathing, 150
upon exertion. 88
Bronchial cancer, 74, 92
inoperable, 162
metastasizing, 44
Bronchitis, chronic,44,45, 75.78,89,90,91,96,97,
161
tendency toward, 97
Uurning sensation
anus, around. 26. 181
Burping, 136. Seeulsv Belching

Caffeine abuse
heat in Heart, 204
Kidney yin deficiency, 133
Kidney yin injury. 204
Calves. spasms in, upon exertion, 30
Cancer
breast, 74, 151, 156
bilateral. 28
wit11 tnetastases l o liver, 28
hronchial. 74, 92
inoperable. 162
metastasizing, 44
cervical, 160
colon
with metastases l o liver. 144, 145
liepatoma, malignant, 161
intestine, large
with nietastases to liver, 208
Kaposi's sarcoma. 55
leukemia. myeloid, chronic, 157
nasopliarynx. 206,207
non-Hodgkink lymphoma, 115,200
~ ~ v a r i a97
n,
prostate, with metastases to hones, 167

Candidiasis, acute, 180


Caput medusae, 153
Cardiac neurosis, 53
treallnent for, 216-218
Cardiac rhythm. Seealso IHeartbeat
arrhythmia. 94
irregular, 150
Channel connections. 1-2
Channel undernourishment, 29-30
Chest
burning pain. severe, 198
constricted feeling in, 150
fullness and pressure, 88
fullness, feeling of, 152, 196
pain in, 74.89.92, 162, 196,207
pressure in, 95
sweating, sevcre, 119
tightness. feeling of, 48.87.96, 139
occasional, 66
Chlamydia infection, history of, 178
Cliondrosarcoma, 81
Chronic fatigue syndrome, 108
after infection with Epstein-Barr virus, 149
following influenza. 21
Coating. SeeTongue coating
Cold
acute, 97, 167, 170, 182
extremities, 17
reeling or, l i , 22, 30, 71
in hands and Feet, 72
intense, 14.23
internal
intensc Scelinguf, 89
occasional feelings of, 169
sensation or i n stomach, 17
Cold-dampness, 32
i n Stomach, 23
Cold-dampness, accumulation
blockage o f q i i n middle burner, 203
transforming10 heat, 203
coating, white, greasy, 151
coating, white, greasy, thick at sides, 203
coating, while, thick, greasy, 196
coating, yellow, dirty at center. 203
food stagnation with, 196
Cold-dampness attacks the Spleen
coating. white, wet. 79
(:old-dampness, long-standing
coating, while, thick, slippery, 190
transforming into phlegm, 190
Cold disorders, tongue color with, 4
Cold-phlegm. accumulation
coating, white, dry in anterior third and center,
200
Colds
catches easily. 16,21,30,48,63.87,91.94.96,97,
108,149.156.168

excessive, 33
frequent, 31
w i l h cough, 89
(:olilis. ulccrativc, 26, 59, 70, 181
Collagcn-vascular disease, 105
Colon cancer. with metaslases l o L.iver, 144. 145
Cump~llsiveneurosis, 109, 122. 123, 124
Concenlration
inability l o concentrate, 22.202
lackoi: 13, 112, 188
Conhsiun
mental. 139. 140, 182
(:ongestion, nasal. 90
Cunjunclival redness, 132,202
Conjunclivilis, acute, 202
C~~nslipation.
12, 13,2(i,43,45.56, 78,87,88,9l, 108,
131,140.141.144.156, 196, 197,202,206
long-standing, 162
severe, 67
lrealmenl lbr, 214-215
(:orr>nsry heart disease, 88, 190
Cough. 21, 87, 113, 1157
climnic, 45
dry, 90
lreatmcnl for, 219-220
chronic. will? ~ i i l ~ c u s
pruflse. while, and slightly yellow, 90
slicky, yelluw. 91
chronic, witli phleg~ri
lhick, 78
white. 79
chronic, witli sputum
scanl. Lliick, yellow. 75
with colds, Recluenl, 89
dry. 44. 45). 55. 58, 74. 87, 89. 97, I61, 196
especially at ~ i i g h l 193
,
with ~ i i u c ~ ~ s
copious, 200,201
copious, white, 96
profuse, wliile, 97
~irofuse.white, frothy, 98
scanl, 211
white, thin, 190
witli phlegni
damp-heat, accumulalion, 204
scant, 44
lliick, 135
thick, yellow, 168
phlegm-heat i n I.ungs, 172
will1 sputum, blood-tinged, 92, 162, 207
with spulum, blood-tinged, frequent. 98
Cryiligspells, 114, 152
Cyslilis
acule, 98. 193
ciironic, 21, 59

Cysts
w i l h libroadenoma, right breast, 197
ovary, 15

Damp-cold, accumulalion
coaling, wliile, slippery, 189
coaling, while, thin, slippery, 190
cuating, white, thin, wet. 189
coaling. yellow. greasy i n posterior lliird, I89
transforming inlo damp-hcat i n lower burner, 189
Darnp-heal
coaling, yellow, dry, rough i n ccntcr and poslerior
lliird, 196
diet. improper. 183
discussion of, 175-1 76
illnesses of, 175-176
localioli oi; 176
phlegm-heal i n S l < ~ m a c 196
l~,
rhinitis. I94
tongue signs and. 175-177
Damp-heal, accumulalion or retention. 53, 58. See
also I-leal
coaling. brownish yellow, lliick, dry, 182
coaling. dark yelluw at sides. 141
coaling. dark yellow. dry, 171
coating, dirty yellow, grcasy, 152
coating. dirty yellow. old. grcasy a1 sides, 157
cuating, dirly yellow, lhick, grcasy, 171
coaling. dirty yellow. lliick. greasy, riglit-sided.
141
coaling, greasy while a1 sides. 196
cualing. liglil yellow. lhick. 179
coaling. liglil ycllow. tliick. greasy. 179
coaling. pale yelluw, slippery, 192
coaling. slighlly ycllow. 81
coaling, slighlly yelluw. old, greasy, 1G2
coaling, thick, greasy, 67
coating, yellow a1 ruut, 136
coating, yellow, dry, righl-sided. 203
cuating, ycllow, dry willioul rout, 90
cuating, ycllow, greasy, 70
coating, yelluw, greasy at roo1,71, 162, 169
coating, yellow, greasy, dry, thickcncd, 180
coating. yellow, greasy from center l o posterior
third, 1 9 i
coating. yellow, greasy i n ,middle and posterior
thirds, 103
coaling, yelluw, greasy in posterior third, 98
coating. yellow i n center, 196
coating, yellow, old. G i
coaling. yellow. old. greasy. 174
coaling, yclluw, slightly lliick, GG
cualing, ycllow, slippery, I69

coating, yellow, slippery a l root, 97


coating, yellow, thick, 114, 177, 178, 180
coating. yellow. lhick. dry, 88, 175
coating. yellow. thick, dry, especially at rout. 132
coating, yellow. thick. greasy, 170. 179, 181, 198,
20 1
coaling, ycllow. thick. greasy, especially at root, 91
coaling, yellow. thick, greasy in posterior third,
197. 200
coating, yellow, thin at center, 210
coating, yellow, thin, greasy, 89, 109
coaling. yellow, thin. greasy i n posterior third, 188
coating, yellowish, thin, greasy, 140
cough with phlegm, 204
diet, bland. 199
fever, low-gradc, 173, 183
long-standing coating, dark yellow. greasy, 181
papillae. red, swollen, 181
phlegm-heat in Stomach. 196
points. at root. 179
poinls, red a1 root, 66. 179, 180
poinls. rcd in posterior third, 179, 201
runny inose, 204
sidcs, rcd. 193
sidcs. rcd. swollcn, 157
sidcs. slightly swollcn. 192
slight
and Liverqi constrainl. 180
tongue, wide with curled-up edges, 180
Stomach yin deficiency. 70.81
longlic, crack. deep, vertical, 70
l o n g ~ ~red.
c , pale, 182,202
lunguc, rcd, palc, swollcn, I93
tongue, red, swollen. 141, 181
tongoc, reddish, 192, 197
tonguc. rcddish. swollcn. 156. 178
tongue. rcddish. with rcd cdgcs. 71
tnnguc, stiffness, 183
1l)ngue. swnllen,, 71. 197
longi~e,teeth marks, 178
tongue, wide, 182, 202
Iransforming into heat toxin. 178
urination. Frequcnt orgc. 204
Damp-lical, cxtcrnally-conuactcd, acutc
coating. light ycllow. slippery, 177
coating, pale yellow, slippcry, 191
Damp-hcat, cdernally-contracted i n middle burner,
~ICLIlC

coaling, lighl yellow, slippery, I77


Damp-heat i n Bladder, accumulation, 59
Ilamp-heat i n Bladder, retention
coaling. ycllow, thick, greasy, 179
coating. ycllow, thin, grcasy i n posterior third. 188
points. red at rool. I79
Damp-heal in Bladder. 59
coating, ycllow, thick, greasy, 179

coating, yellow. thin, greasy i n posterior third, 188


poinls, red at root, 179
Damp-heat i n Gallbladder, 50.51, 52, 54, 55
coating. dirty yellow, greasy. 152
coating, dirty yellow. old, greasy at sides, 157
coating, dirty yellow, tliick, greasy, 141. 171
coating, slightly yellow, old, greasy, 130
coating, thick, greasy, 67
coating, yellow, dry, right-sided, 203
coating, yellow, greasy from center to posterior
third, I97
coating, yellow, thick, dry, especially at root. 132
coating, yellow, thick, greasy. 198
Liver q i constraint. 180
sides, red. 193
sides. red. swollen, 157
sides, slightly swollen, 192
tongue, red. pale, swollen, 193
tongue. red, swollen, I32
tongue. reddish. 192,197
tongue. reddish. with red edges. 71
tongue, swollen, I97
Inngue, swullcn, slightly, 71
tongue, wide with curled-up edges, 180
transforming into heal louin, 171
Damp-heal i n genitals
coaling. ycllow, thick. 180
points. rcd at root, 180
Danip-heal i n intestines, 59
coating, yellow with red points at root, 63
Damp-heal i n Large Intestine
coaling, yellow, greasy at sides. 64
coaling, yellow, old, 67
coating, yellow, slightly tliick. 66
coating, slightly yellow, old, greasy. 162
coating, ycllow. thick. 180
coating, ycllow, thick. dry. cspccially at root, I32
coaling, ycllow, thick. grcasy. 181
papillae, red, swollcn, 181
poinls. red a1 root. 66. 180
transforming into heat toxin, 181
Danip-heat i n Liver, 50.52.54
coating, dirty ycllow, greasy, 152
coaling, dirty ycllow. old, greasy at sidcs. 157
coating, dirry yellow, tliick, greasy, 171
coating, sides, dark yellow, 141
coating, slightly yellow, old, greasy, 130
coating, tliick. greasy. 67
coating, yellow, grcasy Frnm ccnter to posterior
third, 197
coating, yellow, ihick. dry. especially a1 rool. 132
coating, yellow, thick, greasy, 198
Liver q i constraint and. I80
sides, red. 193
sides, red, swollen, 157
sides, slightly swollen, I92

tongue, red, pale, swollen, 193


tonguc, red, swollen, 132, 141, 181
tongue, reddish, 192. 197
tongue. reddish, with red edges, 71
tongue, swollen, 71, 197
tongue. wide with curled-up edges. 180
transforming into heat toxin, 171
Damp-heal in lower burner. 13.58
coating at root
yellow. 136
yellow, greasy, 71. 162, 169
yellow, slippery, 97
coating, light yellow, thick, 179
coating, dark yellow, dry, 171
coating, yellow, greasy in middle and posterior
thirds 103
coating, yellow, thick, 114, 177
coating, yellow, thick, dry, 88
coating, yellow, thick, greasy, 170,201
coating, yellow, thick, greasy, dry, 180
coating. yellow, thick, greasy, especially at root, 91
coating. yellow, thick, greasy in posterior third.
197.200
coating, yellow. thin at posterior third, 65
coating. yellow, thin. greasy. 87.89
coating. slightly yellow. 81
points, red in posterior third, 179.201
Stomach yin deficiency and. 81
tongue. reddish. swollen, 156
transforming into heat toxin. 171, 179
Damp-heat in middle burner
coating, yellow, greasy in middle and posterior
thirds, 103
coating, yellow, thick, greasy, 170, 178
coating. yellowish. thin, greasy, 140
tongue, reddish, swollen, 156
Damp-heat in Stomach
coating, pale yellow, slippery, 192
coating. yellow. greasy at sides, 64
coating, yellow, thin at center. 210
Damp-heat in three burners
coaring, brownish yellow, thick, dry, 182
coating, yellow, thick, dry, 175
phlegm retention. 182
Damp-heat transforming into heat
coating, yellow, thick. greasy on posterior third.
191
onset of transformation, 191
sinking ofdamp-heal. I91
Damp-heal transforminginto toxic heat
tip and sides, bright red, raised points, 168
Damp-phlegm, 31
coating, light yellow, 168
Heart yang deficiency and, 151
tongue, blue, pale, swollen, 151
tongue, swollen center, 144
tongue, white and thick in center, 168

Damp-phlegm in Lung
tongue, swollen in anterior third, 96.97
Damp-phlegm in Stomach
coating. slightly yellow, thick, greasy, 105
Damp-phlegm in yang brightness iyungmi17.g)
channel
coating, tofu-like, pale yellow, 208
food stagnation and, 208
transforming into phlegm-heat, 208
Dampness 15.57
blood deficiency and, 71
blood deficiency and stasis with, 153
coating, greasy in center, 191
coaring, pale yellow. thick, slippery, 192
coaring, pale yellow, thin in posterior third, 189
coating, wet. 30
coating, white, greasy. 107
coating, white, slightly greasy, 151
coating, white, slippery, 13, 150
coaling. white. thick. slippery. 191
coating, white, thin, 149
food stagnation and, 191
heat in blood and, 168
Kidney yin deficicncy and. 70
Spleen qi deficicncy and. 67, 70,71,72.81, 153
tongue. asymmetrical. 3 0 3 1
tongue, hlue, pale, swollen, 153
tongue, pale, 12-17.21-23.30
tongue. pale, slight teeth marks. 70
tongue, pale, swollen, 71
tongue. red. pale, 30.30-31.55
tongue, red, pale, swollen. 67.89
tongue, red. slightly and, swollen. 70
tongue. red. swollen, 168
tongue, reddish. swollen. 81
tongue. swollen, 12-17.21-23.55
tongue, swollen, slightly, 30
tongue. teeth marks. 30
tonguc. thin, 13.30
Dampness, accumulation wit11 heat
tongue. reddish. swollen. 191
Dampness, externally-contracted
coating, whitc, thin, slippery. 193
coating, yellow in center and posterior third. 193
transforming into damp-heat. 193
Dampness. externally-contracted, penetrating to
interior
coating, lighr yellow, thick in center. 169
coating. while, thin at sides. 169
Da~npncssin lower burner
coating, pale yellow, thin in posterior third, 189
Dampness in ~niddleburner, 15,89
Dampness in, upper burner, 89
Dampness obstructing channels
tongue, swollen right hall, 190
Dampness, turbid
coating, slightly yellow, greasy, 120

Deafness. 81
Defecation
pain upon. 180
urgency in. 59
Degenerative joint disease
orhip, bilateral. 29
multiple, 30, 139
,
Depression, 1 5 . 2 2 , 2 5 . 3 8 . 3 9 . 4 2 . 4 7 , 5 9 , 6 678.79,
105, 114,121,123
manic. 55. See also Bipolar disorder; Mood swings,
severe
Depressivemoods, 65. 112. 113. 139. 150, 160, 189,
203.211
occasional. 114
Spleen qi deficiency and, 115
Dermatitis. eczematous. 103
Despondency. 114. Seeaiso Depression; Moods.
depressive
Diabetes riiellilus. 188
"ype 11, 88.193
Diarrhea, 130, 177
aculc
ailerdrinkingalcohol. 193
aiter eating R.ui~,1Y3
with blood and mucus. 26
with foul-smelling stools, 191
aftcr caring, 152
after caling dairy products, 63
will1 emolional pressure, 107
explosive, foul-smelling after eating, 171
~IILII-smelling. 210
ioul-smelling, loose. 202
frequent. 190
heat i n Heart, transforn?inginto fire and. 110
smelly, 50
strong smelling, sudden, 132
slrong smelling, watery, 201
watery, 192
Diet, bland
danip-heat, accumulation and, 199
heal ioxin. I73
Lung yin deficiency and. 93
Diet, improper
damp-heal. 183
Liver q i constraint and, I33
poslnatal q i injury, 106
Spleen q i deficiency and, 98, l i 2
Stomacl? yin deficiency and, 69
Diet. raw b o d s
Splccn q i deficiency and, 194.204
Disc, protruding, 71
Discharge, vaginal, 64
red. prolonged after menstruation. 22
Dizziness. 38. 81. 89, 141, 180, 20'3
intense feeling of. 54
Livcr fire and. 137

during tnenslruation. 200


i n morning. 67
occasional, 136
sudden, 139
Dreams
sexual, 119
vivid, 1 5 i
Drivc
increased, I22
none, 14,15,55
Dysmenorrhea, 21

Earache
with tinnitus. 67
Eating binges. 189
Eczema, 150
atopic, 41, 65, 66
facial, 105
Edema
oiarm, left, 151
oilower legs, 89, 153
Edges. Seelhngue edges
Eight extraordinaryvessels, i n protective q i
distribution, 33
Elbows, stiffness and pain, 139
Emotional pressure, inability to bear, 103
Emotions
anger and 1.iver qi constraint. 133
bitterness and Liver qi constraint. 153
feelingshallered. 171
heat i n Heart and, 106.199
Livcr q i constrain1 and, 137
ncgative
heat in Liver and, 183
Liver q i constraint and, 183
sadness
Lungqi and yin deficiency with, 93
unresolved
blood slnsis and, 153
heat i n l-leart and. 163
Liver q i constrain1 and. 93, 145, 198
Emphysema. 4.3.45. 75,161
pulmonary, 98
Energetic deficicncics, 18
Epigastric
distention. 71
rullness, 30.59, 105, 140, 160, 196
after ealing, 191
pain with, 177. 178
pain after eating with. 171
Stomach pain with, 150.200
Epilepsy, 134. Seealso Seizure
Epstein-Barr virus and chronic fatiguc syndrome, 149

Esophagilis, reflux, 64. 136


Esscncc. 18
dccreasc in, 18-29
Kidney yin and, 36
Kidney yin deficiency and, 52
menstrual cycle and, 46
role of, 3 3
Essence deficiency
colds and tlu, 33
exhaustion, 116.172
pregnancy, 51
longue. depression at mot. 21-24.25-26,3?,47.
57. 63, 70. 108. 114, 122, 188.201
tongue. hammer-shaped. 58
tongue. red. 43. 58
tunguc, contracted root. 58
tunguc. short. 43
Essence, exhaustion
tongue, red. contracted, 55,57, 105
Essence and Kidney yin deficiency, onset of
coaling, rnollcss, peelcd, 71
lnnguc. depression a1 mot. 71
Excrcisc, cxccssivc. 31
Liver q i conslrainl a n d , 112
Spleen qi deficiency and, 194
Exhauslion. 16. 21, 22. 23, 24. 26, 30. 41, 42,44, 45, 47
48.49.58. 74,79,80. 81.87.90.92.96. 105. 108. 113.
123. 129. 144. 149. 151. 161, 168, 182, 191, 198.201.
See also 1:atigue
deep, 25.26
csscncc deficiency and. 116
severe, 3 8 . 3 9 . 6 3 , 7 0 , 7 1 , 7 4 , 9 6 ,115
and deficiency o f esscnce. depletion o l
protcctivc qi. 172
treatmenl of, 213-214
Exhauslion of blood. especially l.ivcr blood
cdges, pale, dry, 145
Exlremilies. cold. 14, I7
Eye(s)
conjunctival redness, 132
conju11ctivilis.ac111c.202
inability l o open, 123
itchy, 78, 114. 179. 193
will1 purulent secretion, 132
protrusion of, bilateral. I57
red. 134

Facc
musclcs. atrophy and pain in, 105
muscles, twitchingin, 122
pain
especially in tcmplc and cheek. one-sided. 181
paroxysmal. one-sided, I81

severe, 182
suddcn, onc.sided, 132
paralysis, slight, 141
red. 64,132,157. 181.182
skin of, dry, 157
Fainting spells
phlcgm-heat and, 110
Fantasies, suicidal. 43
Fatigue. 12, 14. 16, 23. 24, 28.30,32. 53, 64, 68, 70, 78.
81.94.95.97, 104, 105. 109, 112, 114. 120. 121, 137,
139,145,155. 156, 157, 160, 161
chronic, Lung and Spleen q i deficiency and. 98
especially after meals, 13
Fear. 160.192.210
attacksoffright. 26, 107, 108, 122, 135, 151
ofdying, 121
of leaving home, 123
of open spaces. 123. Seeniso Agoraphohia
sevcrc attacks with panic. 72
stage friglil. 2
Fcct
cold. with cold hands. 72, 81. 170
1101, 130
l i n t a1 night, 109
Feli~s,reslless, 58
[Fever, 45, 56, 167, 174. 177
high. tendency to develop. 89
low-grade.44.58. 145, 161, 171
chronic. 55
constar~t,162
with damp-heat, 173, 183
occasional. 178
slight. 181, 191. 192
subfehrile, 207, 208
Fingers
lingerlip numbness. I93
swollcn in !morning. 196
Flatulence. 15.70. 136, 152, 170, 180, 188. 197.201.
202, 208, 210
Flu
acule, summer, 191
cxccssivc, 33
Fluids, accumulalion. 57
Fluids, deficiency, 39
coating, old. thin i n center, 198
sides. notches and cracks. 21 1
Spleen q i deficiency, severe and, 74
Stomach yin deficiency and, 21 1
longue coaling and 41
tongue. crack. deep, vertical, center, 21 I
tongue. crack. in centcr. 47
tongue. dry, 56, 90
tongue, pale, firm. 49
tongue, red, pale
longue. shiny or mirror. 74, 76
yin and yangseparation and. 76

Fluids, deficiency, i n S m n a c i ~48


.
coaling. while. rough, dry, 200
121uids,deficiency, onset
coating. roolless a1 rool, 122
coating, while, iliiti. dry. 122
Heart. constiluli~tnalwcakncss atid, 119
Stomach yin deficiency and, 122
longue. dry. 56, 90
tongue, long, narrow, II 9
longue. pale, Firm, 49
tongue. red, pale
longue. shiny or mirror. 74, 75
Fluids, deficiency, slight
cracks. small. horizontal, 202
Kidney yin deliciency and, 20:2
tongue, reddish, big, rough, 202
Fluids, deficiency with internal heal
coaling, pale yellow, dry, grcasy, 201
Fluids. exliauslcd
tonguc, dry, 49.53.55
longue. dry, reddish, 49
longuc, dry, uncoated. 44
Ionguc. red. crackcd, 47
1:luids. injury due to lical. 38, 15
longue. narrow, sliglilly, I74
longue. red, pale. 130
longue. red, widc. thin, 66
tongue, sort, 174
tongue, wide, Iliin. dry, 130
1:ltiids. injury due I<] heal from cxccss
coaling, yellr~w,old. 105
IFluids, injury due 10 heal, intense. 59
Fluids, injury onset
coaling. ycllow. grcasy. roolless. 1.11
IPluids, insulficicnl production o f
coaling. wliitc, dry. grcasy. 201
Spleen q i deliciency and
coating, while, dry, greasy, 201
tonguc. long, firm. 105
Fluids, wcakncss of, cotistilulional
tongue. reddish witli cracks, 21 1
sides. nolchcs and cracks. 21 1
Flushes, lhol. 135. 155
irritability, helijrc mcnslrualion. 38
nigh1 sweals. 123
Food slagnalion
coaling, grayish. slightly grcasy, I52
coaling, light ycllow, grcasy, 15.29
coaling. liglil ycllow. Iliili.slippery, 15
coaling, sliglitly while-ycllowisli, grcasy coating
witli. 12
coating, while. greasy. 88
I:llll,less
al'ler eating, 65, il
epigastric, 12.59. 160, 196
aftcreating. 23. I91

pain and, 177, 178


pain afterealingand. 171
Slomacli pain and, 150.200
I:~lruncles, lrequenl with pus and lilood, 168

(:alliiladder, damp-heat
coating, dark yellow a1 sides, 141
coating, dirty yellow, greasy, I52
coating, dirty yellow, old, greasy at sides, I57
coaling, dirty ycllow, thick, greasy, 141, lil
coaling, slightly ycllow, old. greasy. 130
coaling, iliick. greasy, ti7
coaling, ycllow. 50, 52
coaling, ycllow, dry, right-sided. 203
coaling, ycllow. grcasy from center l o posterior
third, 197
coaling, yellow, old. one-sided, 55
coaling, yellow. thick, dry, especially at rool, 132
coating. yellow, thick. greasy. 198
I.ivcrqi consIrain1 and, I80
papillae, red, swollen. 181
sides, red. 1%
sides. red. swollcn. 157
sides. slightly swollcn. 192
longuc. red, pale, swollen, 193
longuc. red, swollcn. 132, 141
languc. rcddish, 192, 197
Iongi~c.rcddish, with red edges, 71
longue. swollen. 197
longue, swollen, slightly, 71
longue, wide with curlcd-up edges. I80
lranslorniing inlo heal l o i n , 171
Gallhladder, damp-heat, long-standing
coating, slighlly yellow, grcasy, old. 130
(;allbladdcr, daml>-heat. slighl
I.ivcl- qi constraint and, 180
Ionguc. widc with curled-up edges. 180
(;allbladder, heat i n
longue. red on right side, without coaling, 181
Gas. Se? Belching; Flatulcncc
Gastritis. chronic. 17, 156
Gastl-uciilcritis, acille. 177. 192
(;ale ~ ~ l v i l : ~ l(i?t y? ? i ~
177e??j
?g
communicaling witli I leal-1
lip, reddish, 149
Gallieringqi, deliciency of
longuc, depression in anlerior lhird, 87, 96
Genitals. damp-heal
coating. ycllow, thick, 180
l i ~ ~ i n tred
s , at ir1ol. 180
(;enilals, pain in, 179
Gingivitis, necmtizing. ulccrarive. 182
Girdle vcsscl, impaired with vaginal discharge, 199

Growling, o f Slomach. SeeBorborygmus


Gums
bleeding, 64.65.201
inflamed, I79
rcd, swollen. intlamed, and bleeding. 182
Gurgl~ng,abdominal, loud. 12. Seeolso Uorborygnius

Hair, early graying of. 167


Hair loss, 22,26.44,81
scvere. 32. 161
total body, 105
FTand(s1
cold, 96
cold, with cold feet, 72.81, 170
tingling and numbness. right, 16
tingling, ~lccasional,with arms, 139
tremor oi; 42
Hashimolo's thyroiditis, acute. 174
Head
pressure, Feeling of, 72
trembling, 129
Head, Ileal i n
feelings of, 54
with intense headaches. 130
sides and tip. red points. 129
tip. rcd, 109
tip, red, very pointed and contracted, 121
I-leadachc(s1,32, 47, 67, 74. 81, 103, 109, 123, 188, 196,
206. Seeniso Migraines
change orwealher and. 114
co!isla~il,66
devastating, with inlense heal sensation, 130
a1 Ibreliead and lemples, 130
Fronlal, severe, 123
wilh heal ill head, 130
Liver fire and. 133
during mensvualion, especially, 112
i n morning. 135
severe, 56, 152
a1 temples, chronic, 129
with tight neck muscles, 104, 132
a1 vertex. 48
severe, worse upon exertion, 170
tlearing
acute lossof, 67,131
loss oi; left ear, 67
poor, 193
I-learl
conslilulional weakness of. 42
disharmony of, ? I
hcat from deficiency of, 15
hcat in. 39.42
insufficiency, right, 115, 139

pain, 135
racing of, 151
Heart and Kidney, harmonious co~nmunication
insomnia and, 204
I-Ican and Livcr deficiency. heat from
tip and edges, red points, 144
I-leart blood deficiency, 2. 15. 41
heal i n Ilearl. 119,121,129
inability10 fall asleep and. 194
symplolns of, 101-102
thinning toward tip, 119
tip, curled-down, 103
tip, indentation, 108, 112, 113, 114
tip, indentation, slight, 114
tip, notch with red points, 129
tip. notched. 139
tip, red. flattened with red points, 119
lip, red, very pointed and contracted, 121
tip, slight notch. 190
tip. slight reddening. 103
longuc. pale, especially i n anlerior third, 145
longuc. red, pale, I19
tongue signs and. III
Hearl blood dericiency. slight
tip, slight notch, 180
Hearl blood stasis
tonguc, bluc. intense in anterior third, 151
tongue, blue, sliglilly, 139
tongue, points, blue and black, 196
tongue, reddish bluc. 196
I-lcart, constitutional heat i n
coaling, yellow, thin, greasy, 108
plilcgm-heat in Stomach and. 108
tongue, crack, long vertical in center, 108
I-learl, constitutional weakness
fluid dericiency, onset. 1I 9
tonguc, crack. long, midlinc. 193
tongue, crack, longverlical i n cenler, 108, 192
tonguc, crack. midline, 105
longue. long, 104. 119
lunguc. long, narrow. 119
tongue, long, poinled, 104
tongue. narrow, sliglitly. 150
longue, pointed, I50
tongue signs and. 102
Heart discasc, coronary. 88, 190
Hean, disharmonies o f
longue signsand, 101-102
I-learl fire. 46, 56
tip, red. decp, 40
tip, red, swollen. 54
lip. red. very poinled. 123
lip. red. very poinled with dark red points. 122
tongue, pointed and prickle at tip, 43
tongue, red, 58

I-lcart. heat in, 39, 42


caffeine abuse and, 204
contracted body and tip. 206
emotions and. 106.199
emotions, unresolved and. 163
I-lean blood and yin deficiency with. 121
injury to yin in upper burner and, 206
Kidney yin deficiency and, 109
Liver yang, asccnding and, 129
shock and, I24
sides and tip, red points, I29
stress and. 106
tip and left edge, red areas, 80
tip, curled-up and red. 120. 151
tip, norclicd with red points. 129
tip, red.66, 104, 105, 107, 160. 170. 197
tip, red, flattencd with red points, 119
lip, red points, 78. 136. 202
tip, red with protrusion. 122
tip. reddish, 210.21 1
tongue. crack, long, verlical, 80. 109
tongue. pointed. 170
tonguc. red in anlerior third with red points. 161
tongue. red, swollen, 109
tongue, reddish with i-cd sides. 206
tongue signs and, 116-1 18
Hearl, heat in, conslilutional
coating. yellow, thin. greasy. 107
heal from deficiency o1Heart and. 157
Kidney yin deficiency and, 123
will, phlegm-fire in Stomach. 107
tongue, crack. long, deep vertical, 109
tongue, crack. long, vertical in center. 107
tonguc, crack. midline, thin, curled-down tip, 132
tongue, long. 123.135
tongue, pale red, long. 103
tonguc. red, long. 123, 179
tongue. reddish. lung. 122
tongue, reddish. long. curled-down tip, 157
longue. reddish, very long, 103
Hearl. heal in. slighl
pointed, 65
tip, slighl reddening, 87
Heart, heat in, transforming into Rre
diarrhea. 110
panic attacks. l I0
Ilearl-Kidney, lack of comnlunication between, 53
I-lcart qi. 2
shuck, 124
Heart qi deficiency
hlood stasis
tongue. red, pale, bluish. with slight leeth
marks. 150
lip, deep crack, 115
tip, slight notch, 190
tongue. swollen in anterior third, 113

Heart. weakness of, constitutional


emotional weakness and, 1 0 i
mental instability and. 124
symptoms of. 107
tongue, red. pale with cracks, and notches and
crackson sides. 210
Heart yangdeficiency, 17
damp-phlcgrn accumulation
tongue, blue, pale, swollen, 151
Heart yin deficiency
symploms of, 101
tip. deep crack. 115
tip, with pecled coating, 72
Fleart yin deficiency, onset
sides, drawn in on anterior third, 103
tip, contrdctcd, flattcned, reddened. 119
Heartbeat
irregular, 81
irregular cardiac rhythm, I50
Heartburn, 23,40,42.63,64,67,71,104, 130, 136.
156.162.201.210,2ll
Heat. Seeolso Damp-heal: Heal toxin
coaling and, 41
constrained. 36
from deficiency, 42
from deficiency oltlie Heart
tip, curled-under. 81
edges, red, 59
excessive, 40
intense, 59
internal, 48.52
I.ung yin deficicncy and. 93
retained, externally-contracled. 14
longue, red. 40
vigorous, 43
yin deficiency and, 36-37
Heat. accumulalion
in yang bl-ightness organ sragc, 45, 56
I-Icat, devclopment of
dampness accumulation and, 179
Spleen qi deficiency and. 72
longue, long, I75
tongue, red. slightly swollen. 179
tongue, reddish, 136
tongue signs and, 134
tongue, wel, 179
I-leat disorders, 4
lip, red poinls, 165-1 66
tongue signs and, 165-166
Heal from deficiency o l Hearl. 15
symptoms of, I02
tip, curled-down. 130. 135. 203
tip, curled-down, with red points, 113
tip, red. pointed. 121
lip, reddish, curled-down, 66
tip, slightly reddened. 112
longue, reddish. 121

Heal from deficiency of lleart blood


lip, rcd points, 191
Meal i n hlood, 36,39,41-42,55
blood slasis and, I52
dampncss a c c u m u l a l i ~ nand, 168
l i p and sides. rcd poinls, 189
lc~nguc,red. 137. lil.178
tongue, red-bluish, 152
longue, red, swollen, I68
tongue. reddish, 66
longue, reddish, slightly swollen, 80
longuc. scarlel. especially i n anterior third, I75
I-lcat i n body, 44.54, 66. 161
Heat in yang brightness fyu~zg~i~i~i.gl
channel
coating. yellow, greasy i n center, 140
Heat i n Gallbladder, excessive
tongue, red on right sidc withoul coating, 181
Heal in head
feelings ol; 54
with intense headaches, 130
sides and lip, red points, 129
tip. rcd. 109
til). red, very pointcd. and conlraclcd. I21
I-leal i n I-lcarl, 39. 42
caffeine abuse and. 204
conlractcd body and lip, 206
emolions, 106, 199
emotions, unresolved. 163
I-lean blood and yin dcficiency witli, 121
injury to yin in upper burner and. 206
Kidney yin dcficicncy and, 109
l.ivcl- yang, ascending and, I29
sliock and. 124
sidcsand tip, red poinls. 129
slressand, 106
symptoms ol: 117
lip, 118
l i p arid lefl edge. red al-cas. 80
lip, curled-up and red, 120. 151
tip. notch with red points. 129
lip. rcd.66, 104, 105, 107, 109. 160. 170. 197
tip. red, flattened with rcd points, 119
tip, red points, 78, 136, 20'2
tip, red, very poinrcd and contracted, 121
lip, red witli provusion, 122
tip, rcddish. 210.21 1
longuc. crack. long, verlical, 80. 109
longue, pointed, 170
tongue. red i n anlcriur third wilh red points. 161
longuc. red. swollen. 109
longue, reddish witli rcd sides. 206
111ngucsigns arid, 116-1 Ill
l l c a l in Heart hlood
tip. red points, 197
ll~nguc.reddish, long. curled-down tip, I81

Heat in I-Ieart, constitutional


coating, yellow, thin, greasy, 107
heat from deficiency of Heart and, 157
Kidney yin dcficicncy and, 123
with phlegtn-fire i n Stomach, 107
tongue, crack, long, deep vertical, 109
tongue, crack, long, vertical i n center, 107
tonguc, crack. midline, thin, curled-down lip, 132
longue. long, 123. 135
longuc. pale red. long, 103
longuc, rcd, long, 123, 179
tongue. reddish. long. 122
tongue, reddish, long, curled-down tip, 157
tongue, reddish, very long, 103
Heat in lleart, slight
tip. slight reddening. 87
tonguc. pointed, 65
Heal in I-leart. transforming into fire
diarrhea and. 110
panic attacks and, 110
Heal in lntestinc. Small
urinalion, burning during, I98
I-lcal in Liver. 38. 43
hlood slasis and. 152
coating. yellow. greasy. dry, 160
contraclcd body and lip. 206
danip-hcat i n Liver and Gallbladder, longslanding and. 160
edges, curled-up, slightly red. 66, 89. 108
edges, red. 91, 109
edges, slightly rcd. 103. 178
cmolions, negative and. 183
injury l o yin in upper burner and, 206
I.iver blood stasis and
sides, red wilh bluish patches. 157
Liver q i constrainl and. 66. 89. 108, 151
sidcs. rcd, 151, 196
sides. rcd, slighlly swollen, i 4
sides, willi red points, 191
l i p and left cdgc. red areas. 80
longuc. red-bluisli, I52
tongue. red, pale, I!lli
tongue. red, swollcn, 160
tongue. reddish with red sides, 206
transforming into fire. rcd tongue with red sidcs.
170
Hcal i n Liver transforming into l.iver firc
Livcr q i consll-aint and
edges, curlcd-up, very red
sidc. red points, 130
!-leal i n lower burnclcoating, yellow. thin with red pointsal root, 113
Hcat in Lungs, 44
contraclcd longtie and lip. 206
injury to yin i n uliper burner and, 206
puints, red i n antcrior third, 162

Influenza. See Flu


Insomnia, 21,26,39,40,43,49,50,58,59,67,71, 75,
79, 81, 87, 104, 105, 109, 113. 121, 122, 131, 132, 152,
160,170,180,181,204
Intercourse, pain during, 197
Intestine. damp-heat in
coating, yellow with red points at root, 63
Intcstinc, danip-hcat, accumulation, 59
Intestine, large
cancer, with metastases to liver, 208
Intestine. Large, damp-heat i n
coating, slightly yellow, old, greasy, 162
coaring. yellow, thick, 180
points, red at root, 66
Intestine, Large, damp-heat, accumulation o f
coating, yellow, old, 67
coating, yellow, slightly thick, 66
Intestine, Large, damp-heat, retention of
coating. yellow, greasy at sides, 64
coating, yellow, thick, dry, especially a l root, 132
coating, yellow, thick. greasy, 181
papillae, red, swollen, 181
points, red at root, 180
transforming into heat toxin, 181
Intestine, Small, heat i n
urination, burning during. 198
Iron deficiency
anemia, 48. 97
Irritability. 89, 108, 123, 134. 136, 137, 141, 143, 144,
151.152.157. 181, 197,211
hot flushes, prior to menstruation and. 38

Jaw
osteoporosis of, 1 08
pain in, 108
Joint disease. degenerative
of hip, bilaterally, 29
of multiplc joints. 30. 139
Joints
ankle
swollen and hot, 178
swollen and painful. 121
knee, swollen and hot. 71
metacarpal, swelling, redness and deformation.
178
metacarpalphalangeal, swelling. redness and
deformation, 178
metatarsal, swelling, redness and deiormation.
178
pain in, 97.21 1
pain upon exertion, 21 1
stiffness
stagnation ofqi, blood and, 142

wrist
swollen and hot, 178
swollen and p a i n h l , 121

Kaposi's sarcoma. 55
Kidney and lieart, harmonious comtnunication
insomnia, 204
Kidney and Stomach yin deficiency
coating, rootless. 162
Kidney channel, 2
Kidney enerby, iii root of11)ngue. 57
Kidney fire
Kidney yin deficiency, 55
tongue, red, deep i n middle and posterior
thirds, 145
root. red, and uncoated, 53
Kidney-Heart, harmonious communication
insomnia and. 204
Kidney, pain around, 58
Kidney qi, 19
Kidney stones, 88, 151
Kidney yang, 33
Kidney yin and, I 9
Kidney yang deficiency, 4, 17, 19,33
Kidney yang deficiency, underlying
tongue. pale red, very swollen. 89
Kidney yin, 35-36
as essence, 19
Kidney yangand, 19
Kidney yin, constitutional weakncss o f
tnuscles and bones, I42
Kidney yin deficiency, 4.5. 19.54.55.76
ascendant Liver pang and, 123
blood slagnation obstructing the channels and
tongue, reddish, slightly bluc, stiff. 139
coating, absent, 75
coating, peeled, 54
old, 57
coating, peeled at rout. 66
coating, rootless. 162
coating. rootless, peeled, 72
coating without rout, 67.81, 161
coaring, yellow
thin, 59
contracted root and. 58
coaring, yellow, thin, 59
dampness, accumulation o l
tongue, red, slightly and, swollen, 70
essenceand, 19.5'2
from fear and fright. 57
fluid deficiency, slight
reddish, big, rnugli. 202
tluids injury and
tongue, narrow, red, bright, 208

heal and. 36
heat i n Heart and Stomach and
tongue, red, swollen, 109
heal i n Heart, constitutional and
tongue, red. long. 123
Kidney lire and. 55
longue, red. deep i n middle and posterior
thirds, 145
Liver blood slasis and
tongue, red, bluish, 151
Liver yangascending and
Liver wind. internally-generated
longue, red. deviated, 141
tongue. red with red sides. 123
mood swings. severe and. 163
nigh1 sweats and. 93, 163
rool, uncoated, 49
Slomacli lire and, 40
longue. big, thin, 48
tongue, contracted. slightly, 161
longue, cracks and, 47-51
tongue, crack. deep, vertical, 72
coating. rootless, peeled, 7 2
tongtle. cracked, 47,52
tonguc. firm, 50
longue, firm. stiff, 56
longue, hammcr-shaped. 5 i , 58
lungue, narrow and bright red, 208
tongue, narrow. slighlly. 160. 207
tongue, old, 57
longue, pale
and hammer-shaped, 57
and thin, 25
longue. peeled. 40-41.113-46.53
longuc, rcd, 36-41.54, 131,211
and bluish. 151
and cracked. 4 i
and short. shiny, 44
and deviated. 141
and dry, 203
and firm. 50, 67. 162
and firm, stiff. 56
and hammer-shaped. 58
and long. 123
and peeled, 40-41,53
and red sides. 123
and short. 43-46
and swollen. 54.70, 109
w i t h o i ~1001.
t
40-41
tongue, red, dark, shiny, 75
lliin, slightly
coating. none, 75
tongue. red. deep. 92
and shun. shiny. 44
l o n g ~ ~red,
e , decp i n middle and posterior thirds.
145

tongue. red, soft


and narrow, slightly, 207
tongue, reddisli. 50
and big. thin. 48
and contracted, slightly, 161
and cracked, 52
tongue, reddish, big. rough, 202
tongue, reddish, shiny, 75
without coaling. 75
tongue. reddish, slightly blue, and stilf, 139
tongue. scarlet, 41-42
longue. shiny, 76
tongue. Lhin, 25.75
tongue characteristics of, 35-36
tongue coaling witli, 53-57
a1 rool. 19
without 1001.38.49
longue shapes with. 57-59
tongue, yellow. old coating
one-sided, 55
and lofit-like. 56
Kidney yin deficiency, onset
coating, rootless, peeled
depression at rout. 71
coating, roolless a1 rool, 130
coating, without root, 81. 104
damp-hcat i-ctention and
coating, yellow, dry wilhoul rool, 90
Slomacli yin deliciency and
crack, vertical in cenler
with rootless coating, 104
longue, red, 132
lungue. reddisli. 130. 160
longue. reddisli. rough surface. 91
Kidney yin dcficicncy, scvere and
langue. red, dark, shiny
lliin. slightly
without coating. 75
Kidncy yin deficiency, slight
longue. conlracied, slightly, 191
tongue, reddisli, 191
Kidney yin exhaustion. 5 5 5 7
Kidney yin injury
cai'feine abuse and. 204
Kidncy yin, scvere exhauslion
tongue, red, very narrow, contracted, 105
Knee(s1
pain upon exertion. 120
p a i n l i ~ l94
,
slillness and pain. right. I39

I:abia, swelling and rcdness. 180


1.,l~lallon,
. ' insuBicient, 144

Leg(s)
edema oi'lowcr, 89. 15.3
lhcavy feeling in. 21
inability 11, move. and arm. 206
inability l o move. righl and right arm. 140
n u m b l'celing w i l h back pain, left, i l
pain in. 156
swollcli lower, 89
Iwilchingwith illtense pain, 81
weakness and licaviliess, left, 121
Lcuke~nia,mycloid
chronic, 157
Lichen sclerosus e l atrophicus. I I 9
I.icllctl sirllpleu, 103
Lighting. i n longue inspeclion, 3
I.iver b l o t ~ dddicicncy
edges. curled-up, palc. 79
cdgcs. pale, 121. 122, 140, 155
edges. palc, contracted slightly. 144
Liver qi conslrainl and
edges. curled-up, pale. 79, 143
~iienslrualcycle and. 146
sides, palc. 4 i
sidcs, pale patches, 171
Spleen q i deliciency and
loligue, pale
edges. palc, 155
longuc, pale, dry, 144
longuc, palc, 155
lunguc, pale, dry, I44
IongLIe. pale. Ihin. 26
11)ngue.palc will1 pale edges, 121
longlle signs and, 142-143
I.ivcr blood delicicncy, severe
sides, palc, sliglilly orange. 144
Liver hluod dcficicncy, slight
sidcs. sliglilly p;llc, 206
ILivcr blood slssis
Ihc;ll in Livcr, undcrlyingand
sides. red with bluish palches, 157
Kidney yin dcRcicncy and
lollg~rc.red, bluish, I51
sidcs. blue palches. 157
sides. red, slightly bluish
veins. sublingual. blue. distended, 160
sides. red wilh bluish patches. 157
sublingual veins, dark blue. dislcnded. 161
lunguc, blue, pale, 150
longue, palc, dark
sides, bluish patchcs. I56
longue. red. dark. ralscd spot, 150
Liver blllud slasis, drawn-in longuc. 28
I.ivcr blood SI. d s t h,, ?evere
tunglle, hlue, dark areas. 153
Liver channel. 2
I.ivcr, cirrllosis oi: 153
unknown eliolo~y,I55

.' .

I.iver, damp-lieat. 50.52.54


coating. dirty ycllow, greasy, 152
coaling, dirty yellow, old, greasy a1 sides, 157
cllaling. dirty yellow, tilick. greasy. 171
ct~aling.sides, dark yellow, 141
coaing. slighlly yellow. old, greasy, 130
coaling, Ihick, greasy, tii
coaling, yclluw. greasy li.llm center to postcrior
Ihird. I97
coaling, ycllow. Ihick. dry, especially at root. 13:!
coaling, yellow, thick. greasy, 198
Liver q i conslraint, I80
sides. red, I93
sides. red. swollen. 157
sidcs. slighlly swt~llen,192
longuc, red. pale, swollen, 193
longue, red, swollen. 132. 141. 181
longue, reddish, 192. 197
l o n g i ~ crcddisli,
,
will1 red cdgcs. i l
longuc. swollcn, 197
Irlngllc. swollcn, slighlly, 71
longue. wide w i l h curlcd-up edges. 180
Irallslbrllling into Ileal toxili, 171
Liver deficiency, lhca! lrom
l i p and cdges. red points. 144
Livcr disliarmony, 31
tollgue signs and. 127-128
Liver disorders, 5
Liver lire, 56
discussion o t 127-128
dizziness, 137
edges. curled-up, red. 132
rage, lils ol, l:li
sides, red, swollen, 152
sidcs. rcd with red poinls. 132
sidcs. swollcn, red, 131
symploms of, I27
lip. red points
and sidcs, red poilils, 171
Iungue signs oL 127-128
Liver heal. 38. 43
blood slasis and. 152
coaling. yellow, greasy, dry, I60
contracled body and tip. 206
damp-Ileal r e l e n l i ~ ~i nnLivcrand Gallbladder,
long-standing and, 160
cdges. curled-up. sliglilly red. 66, 89. 108
cdgcs, red. 91, 109
edges. slightly red. 103. 178
emotions, negative and. 183
injury l o yin i n upper burlier and. 206
Liver q i conslrainl and, 66. 89, 108, 151
sides. red. 151. 196
sides. red puinls, 191
sidcs. red, slightly swollen. 74
l i p and l c l i edge, red arcas. 80

longue, red-bluish. 152


tongue, red, pale. 196
longue. red, swollen, I60
tongue. reddish with red sides. 206
Liver hear, transfurniinginlo Livcr tire
Liver qi constraint and
edges, curled-up, very red
side, red points, 130, 134
tongue, red with red sides, 170
Liver heat, underlying
Liver blood stasis and
sides, red with bluish patches, 157
Liver qi
discussion or,134
symptoms oi, 134
will1 longue muscle tension, 3
transforming into fire
sides, red, 152
Liver qi attacking Stomach
heal in Stomach and
coating. yellow, dry in centcr. 136
Liver qi constrainl, 56-57
edges, curled-up, 25-26, 47, 51, 88, 155, 198
edges, curled-up, pale. 79, 143
edges, curled-up, red, 88, 135, 137
edges, curled-up, red, pale, 198
edges. curled-up, red, swollen. 136
edges. curled-up, slightly red. 66. 89, 108
edges, curled-up, slightly swollen, 66
edges, curled-up, very red
side, red points, 130
edges, curled-up with red points, 136
edges. red, 59
edges, reddish, curled-up with red points, 134
emotions and, 137
bitter. 153
negative, 183
u~iresolved,93, 145, 198
exercise, excessive and, 82
heat from, 59
heat in Livcrand, 66,89, 108, 130, 151
hypochondriac pain and, 173
Liver blood deficiency and
edges, curled-up, pale, 79. 143
Liver heat and
edges, ctlrled-up, red, 137
coaling, yellow, thick. greasy on posterior
third, 135
edges, curled-up, red, swollen, 136
edges. curlcd-up, slightly red, 66.89, 108
edges, curled-up with red points, 136
sides, red, 151
longue, reddish
edges. curled-up. red, 135
Livcr heat lransforming into Liver fire and
edges, curled-up. very red

side, red points. 130


edges. reddish curled-up with red points, 134
menstrual cycle and, 146
mood swings, severe and, 163
pain duringintercourse and, 199
premenstrual syndrome and, 145
sexual abuse and. 82
side, red points, 130
sides, red, 151
sides, slightly contracted, 65
Spleen qi deficiency and, 57
Stomach heat and
edges, curled-up, slightly swollen, 66
longue, narrow. drawn-in, L'i-28
tongue, pale. asymmetrically narrow, 27
tongue. red. pale
edges, curled-up, 198
tongue, reddish
edges. curled-up, 88
edges. cilrled-up. red. 135
Longue signs and, 134
Liver wind, internally-generated, deviated, 141
Liver yang
discussion of, 127-128
symptoms of. 127
Liver yang, ascending. 54
edges, curled-up, red, 130
lieat in Heart and, 129
Kidney yin deficiency and. 123, 141
Liver wind, internally-generated and
tongue, red. deviated, 141
sides and lip, red points, 129
sides, red, 123
sides, red spots, 80
sides. swollen with red points, 129
longue. deviated. 141
tongue, red, deviated, 141
tongue, red with red sides. 123
langue signs and. 127-128
Liver yin deficiency, 43
Lower burner
tongue roo1 and. I9
Lower burner, damp-heat in, 13.58
coaling, dark yellow. dry. 171
coating, light yellow, thick. 179
coating, slightly yelloiu, 81
coaling, yellow, 13
coating, yellow a1 root, 136,71
coating, yellow, greasy at root, 162, 169
coaling, yellow, greasy in middle and posterior
thirds, 103
coating, yellow, slippery at root. 97
coating. yellow, thick, 114, 177
coating, yellow, chick at n ~ o l58
,
coating, yellow, thick, dry, 88
coaling, yellow, thick, greasy, 170,201

coating, yellow, thick. greasy. dry, 180


coating, yellow, thick, greasy, especially at root, 91
coating, yellow, thick, greasy in posterior third,
197
coaling, yellow, thin in posterior third. 65
coating. yellow, thin, greasy, 87,89
points, red in posterior third, 179.201
Stomach yin deficiency and, 81
longue, reddish, swollen, 156
transforming into heat toxin. 171, 179
Lower burner, dampness in, 189
Lumbar region
pain in, 64,203
pain with weakness. 104
Lung and Stomach yin deficiency
tongue, cracks, deep, horizontal in center and
anterior third, 90
tongue. cracks, small, deep in center and anterior
third, 115
Lung, damp-phlegm retention of
longue, swollen in anterior third, 96,97
Lung qi and yin deficiency
and Kidney yin dericiency
longue, reddish, mirror, 74
Lungqi and yin deficiency, constitutional
tongue, crack, one oblique, vertical crack in
anterior third, 95
longue. cracks, two parallel, oblique in anterior
third. 94
Lung qi blockage, 76
blockage of water pathways
longue, swollen, dry, and cracked, 89
Lungqi deficiency
fatigue from. 24, 98
Kidney yin deficiency
tongue, reddish, mirror, 74
sadness, 93
tongue, depression in anterior third, 44.87. 96
longue, pale, 190
tollgue, pale, swollen, 11, 21, 114
Lung qi impairment, sinusitis and nasal congestion
from, 52
Lung, Stomach, and Kidney yin deficiency
tongue, red, dark, small, shiny, 161
Lung weakness, constitutional
tongue signs and, 94
Lung yin and qi deficiency
and Kidney yin deficiency
tongue, reddish, mirror. 74
I.ung yin and qi deficiency, constitutional
tongue, crack, one oblique, vertical crack in
anlerior third. 95
longue, cracks, two parallel, oblique in anterior
third, 94
Lung yin deficiency
conditions for developing. 85-86

diet, bland and, 93


early stages of, 85-86
heat and, 93
with heat in Lung
cracks in anterior third, 89
illnesses o t 86
Kidney yin deficiency and
reddish, mirror tongue, 74
mouth, dry and, 92
related professsions, 86
sadness and, 93
skin, dry and, 92
smoking, abstinence rrum and, 93
stuols, dry and, 92
tongue, deep red, short, shiny, 44
tongue. contracted, red, dry, peeled in anterior
third, 92
longue, crack. deep, irregular in anterior third, 91
longue, cracks, 48
longue, cracks, deep, horizontal in center and
anlerior third, 90
tongue. cracks, deep, irregular in anterior third. 91
tongue. cracks in anlerior third, 81.89
tongue, cracks, small, deep in center and anterior
third. 115
tongue, cracks, small in anterior third, 74
tongue, depressions, 44
tongue, dry, 44
tongue signs and, 85-86
Lung yin deliciency, constitutional
tongue, crack, one oblique, vertical crack in
anterior third, 95
tongue. cracks, two parallel, oblique in anterior
third. 94
Lung yin deficiency, onset
longue, crack, vertical in anterior third, 88
tongue, cracks. small, deep in center and anterior
third, 115
tongue, cracks, small, irregular in anterior third,
90
tongue, swollen, dry, and cracked, 2
Lungs. heat in, 44
injury lo yin in upper burner and. 206
tongue, contracted body and tip, 206
longuc, red in anterior third, 78
tongue, red points on anterior third. 162
tongue, reddish with red sides. 206
Lungs, heat lingering in
points. red in anterior Lliird, 98
Lungs, phlegm-heat in, 76
cough and, 172
tongue, swollen anterior ihird. 75
tonsillitis and, 172
Lungs, phlegm in
Spleen qi deficiency and, 98
tongue, slight swclling in anterior third, 90
tongue, swollen in anterior third, 97, 98

Lymph nodes, swollen


cervical, 200
inguinaL 200
maxillary, 28
Lymphoma
non-Hodgkin's, 115, 200

Malaise, 174, 182


nonspecific, 169
Manic-depression, 55. See also Bipolar disorder
Memory
loss o t 45.56, 140,206
poor, 42.47.59.139
Menopause, 152
Menorrhagia, 113
Menstrual bleeding
long-lasting. 155
with pain, lower abdonlinal, 113
intense, 80
profuss 22.97, 135
extremely, 38, 171
long-lasting, 113
with shortened menstrual cycle, 129
prolonged. l I2
with pain, 1 12
scvere, long-lasting, 39
Menstrual blood
red (dark),strung smelling, 39
red, very, 38
strongsmelling, 39
Menstrual cycle
irregular, 169
Liver blood deficiency and, 146
Liver qi constraint and, 146
Penetratingvessel, blockageand, 146
with profuse bleeding and shortened cycle, 80
short, 26, 171
shortcned, 38.78
with e~notionalstress, 129
with profuse bleeding, 80. 129
Merlstrual cycle, essence on, 46
Menstrual onset, prior to
pain, severe, cramp-like, 150
Menstrual periods
with intense cold feelings, 15
none for three months, 14
Menstruation
and headaches. 112
irregular, 143
with pain, 119
intense, 79
severe, cramping, 21
painful, 112, 160, 197

Mental instability
weakness of Heart, constitutional, 124
Middle and lower burners, damp-heat in
coaling, yellorv, greasy in middle and posterior
thirds, 103
coating. yellow. thick, greasy, 170
tongue, reddish, swollen, 156
Middle burner, 2
da~iipnessin, 15
qi exhaustion in, 57
qi mechanism obstruction in. 31
Middle burner, damp-heat
coating. yellow, greasy in middle and posterior
thirds, 103
coating, yellow, thick, greasy, 170, 178
coating, yellowish, thin, greasy, 140
tongue, reddish, swollen, 156
Middle burner, damp-heat, externally-contracted
coating, light yellow, slippery, 177
Middle burner, damp-heat in, retention
coating, yellow. greasy in middle and posterior
thirds, 103
tongue, reddish, swollen, 156
Middle burner, dampness, accumulation, 89
Migraines, 66,130,152. Seealso Headaches
chronic with severe nausea. 129
during menstruation. 155
during menstruation with sensitivity to light, 27
with onset of menstruation, severe, 80
preceding and following menstruation. 32
preceding menstruation with diarrhea and
vomiting. 14
with sensitivity to light during menstruation, 27
since 9 years ui'age, 32
Mirror tongue, 73. See ulso Shiny tongue; Tongue
coalings
Miscarriage
habitual, 58, 169
multiple, 96
threatened, 191
threatened, acute, 58
Moisture. 2
Mononucleosis, 21
Mood swings. 15,90
severe, 79. Seealso Bipolar disorder; Depression,
!manic
Mood swings, severe
Kidney yin deficiency and, 163
Liverqi constraint and, 163
Moods
bad, 54
Morning sickness, with vomitingand nausea, 191
Mouth
bitter taste in, 132. 152
dry,45,78, 80, 81, 90,91, 152, 171, 190,201, 206
with dry throat, 92

since childhood, 32
witli tachycardia and chest pain, 53
Paralysis
arm, left, 151
face, slight, lefl-sided, 141
Penetrating vessel, blockage
'blood stasis and, 115, 163
menstrual cycle and, 146
Periodontitis, 65. 201
frequent, 201
onset of, 47, 51
Pliaryngitis, hactcrial, acute, 167
Phlegm
accumulalion, 40
coaling. whitc, dry. turning yellow toward center,
202
coating, whitish, greasy, 157
wilh heat developing
coating, white, dry, turning yellow toward
center, 202
with slight heat developing in yang brightness
clian~>cl
crack. vertical, with light yellow, dry coating.
20 I
in Lungs
and Spleen qi deficiency, 98
Spleen qi deliciency and
tongue, slightly pale, swollen, 139
Stomach obstructed by, 30
in Slomacli
Iransforms into fire
crack, midline with yellow, greasy
coating. 108
in Stomacli, turbid
longue. swollen ccnter. 114
Slomacli yin deficiency, slight and
crack, vertical with light yellow, dry coating,
20 1
tongue. crack, vertical, with light yellow, dry
coating, 201
longue, slightly pale. swollen, 139
tongue, red. pale, 162
tongue, red, pale, swollcn in anterior third and
center, 162
tongue. swollen in anlerior third. 75,90.97,98
Phlegm-lire, 40, 57
witli Stomach heal, 55
Piilegrn-fire accumulation in Stomach
coating. yellow, grcasy, 67
Stoniacli yin deficiency and
crack, deep in center
with coating, yellow. greasy, 67
tonguc, crack, deep in center. 67
Piilegm-fire in Stoniach. 54
coating, yellow, thin, greasy, 107
longue, crack, long, vertical in center, 107
tongue. crack, vertical in center, 104

Phlegm-heat, 57
fainting spells and, 110
palpitations and, 110
Phlegm-heat, accumulation
coating, light yellow. thick, greasy, 170
in Stomach
crack, vertical
coating, yellow, greasy, 197
Phlegm-heat in Lungs, 76
cough and, 172
tonsillitis and. 172
Phlegm-heat in Lungs, accumulation
tongue, swollen anterior third, 75
Phlegm-heat in Stomach
coating, yellow, thin. greasy, 108
Heart, constitutional heat in, 108
tongue, crack, long vertical in center, 108
Phlegm-heat in Stomacli, accumulation
coating, yellow, thick, dry, 132
Plilegm-heat in yang brightness (yur?,gming)channel,
coating, black, thick greasy, 206
coaling, dirty ycllow at sides. 206
i'lilegm-heat, rctention
red. swollen, 206
in Stomacli
phlegm mists the Heart
coating, yellow, thick, slippery, 193
Phobias, 150
Poisoning
from amalgam in tooth fillings, 22
lead, 168
through pesticides, 78
Polyps
in stomach, 105
on vocal cords, 135
Posthcrpetic neuralgia, 198
Postnalal qi injury
anorexia nervosa and. 82
diet. improper and, 106
Posttraumatic neck syndrome. 136
Premenstrual syndrome, 78
Liver qi constrain1 and, 145
Pressure pain
under ribs, 78
Prolapse
of pelvic floor, 79
of uterus, 87
Prostate
cancer, witli metastases to thc bones, 67, 162
hypertrophy of. 211
Prostatitis. I41
chronic, 13,58, 180. 192
Protective qi. 33
Protective qi, depletion
exhaustion, 172
Psychosis. paranoid. 56-57

Pulling sensation, with weakness, 30


Pulmonary emphysema, 98
Pulse diagnosis, vs. tongue diagnosis, 6-i

Qi. 36. Seecriso specific types, e.g.. Nutritive qi


Qi, blockage in middle burner
coating. dirty yellow at center, 203
coaling. white, greasy, thickat sides, 203
Qi deficiency
sides, uneven, 29-31
tongue body color. 4
tongue, drawn-in, 28
tongue, pale, 20
and swollen, I 1
and uneven sides, 29-31
tongue, swollen, 11
tongue, uneven shape, 30
tongue, uneven teeth marks. 29
Qi dcficiency. Heart
blood stasis and
tongue, red, pale, bluish
and teeth marks, slight. 150
tip. deep crack, 115
tip, slight notch, 190
Qi deficiency, Heart
tongue, swollen in anterior third, 113
Qi deficiency, Lung
fatigue and, 24.98
sadness and, 93
tongue, depression in anterior third, 44,87,96
tonguc, pale, 190
tongue, pale, swollen, 11. 21, 114
Qi deficiency. Spleen, 12,25,51
anorexia nervosa and, 82
anxiely and, 115
blood deticiency and
blood stasis, slight
tongue, blue, very pale, 149
dampness accumulation
tongue, pale. swollen. 1 6 i
edges, pale, 90
tongue, pale, 76, 87
tongue, pale, slightly. 78
longue, pale, swollen. 71, 167
tonguc. red. pale, 90
tongue. slightly pale, thin, 79
tongue, teeth marks, slight, 87
tongue, thin, slightly, 78
blood deficiency, slight and
tongue, blue, pale, swollen, 153
lnngue. red, pale, thin. 90
coating, wet, white, thin, 188
coating. white, dry, greasy, 201

dampness, accumulation and, 72, 167


blood deficiency
tongue, pale, swollen, 71
blood deficiency and stasis
tongue. blue. pale. swollen. 153
tongue, pale, red. swollen, 67
tongue, pale, slight teeth marks, 70
tongue, reddish, swollen, 81
depressive moods and, 11.5
diet, improper and, 98, 172
diet, of raw foods and, 194,204
edges, curled-up, 88
edges, pale, 90
edges, slightly pale, 64
edges, swollen, 59
exercise, excessive and, 194
exhaustion and
with swollen edges, 59
fatigue and, 24, 98
fluids, deficiency and, 74
fluids, insufficient production of, and coating. 201
heat. development and. 72
Liver blood deficicncy and
tongue, pale, dry, 144
tongue, pale with pale edges, 155
Liver qi constraint and, 57
overwork and, 98
phlegm and, 98
tongue, pale, slightly, swollen. 139
tongue, red, pale. I62
tongue, swollen in anterior third and center,
162
rest. lack of and. 98
sides. swollen, 42
sides. swollen in middle. 31-32
Spleen yangdeficiency and
tongue. pale. swollen, 79
Spleen yin deficiency, onset and
cracks, deep at sides, 210
tongue, cracked. 47
tongue, cracks at sides, 79,80,81,82
tongue. cracks, deep at sides, 79,80,210
tongue. cracks, thin at sides, 78
tongue. cracks. transverse at sides, 78
tongue. hammer-shaped, 58
tongue. narrow. 2 i
tongue. pale,29, 31, 76, 87,97, 190
and dry, 144
and edges. pale. 104,144,121,155,189
and edges, swollen, 63
and narrow. 27
and sides, swollen in middle, 31-32
and swollen, 11-17.21-23.71.79.96, 114, 115,
167,192

witli teeth marks, 168,201


with teeth marks. slight, 112. 140, 189,200
and swollcn. slightly, 30. 113. 114
and swollen, very
witli teeth marks, 182
and teeth marks. slight, 70.88
and thin, 25-26
tongue. pale. slightly, 78
and swollen, 139
tongue, pale, very, 190
tongue. red, hammer-shaped. 58
~ o n g u ered,
, pale, 47, 90, 91,97, 162, 167, 169, 188
and mirror, 74
and sides, slightly swollen, 65
and soft, I 13
and swollen. 55.67. 112, 169, 192, 197
coating. wet, white. thin, 188
with teeth marks, 87
with teeth marks, slight, 95
and swollen, slightly, 63
and teeth marks, 177
and teeth marks. slightly wet, 180
and teeth marks, slight, 98, 136
and thin with edges slightly pale, 64
and wet, slightly, 94
and wet, slightly, with teeth marks, 180
tongue body color with, 4,11,25
tongue, reddish
and swollen, 81, 107, 108
tongue, swollen, 11-17,21-23.55,91, 112. 139,
156, 167, 169, 188-189,192
anterior third and center, 162
slightly, 30
tongue, teeth marks, 87. 156, 168, 177, 180, 182,

Rage
fits of, 53, 132. 134, 152, 197
Livcr Rre and, 133, 137
Regurgitation. 63
ReiterS disease, 94
Relationships, inability to form. 119
Relax, inability to, 104
Rest, lack of
Spleen qi deficiency and, 98
Restlcss fetus, 58
Restlessness, 22,23,91, 104, 109, 122, 130, 131, 132.
136,137,111,151
inner, 38, 39, 40, 42, 50. 54, 55, 58, 65, 6 7 . 7 1 ,
72.80,170,174,179.188.202,211

inner, strong, 43
whole body. rising from bottom, 130
Retardation, mental, 193
Retention of toxic heat, long-standing
tip, deep red spots. 91
Ithinitis
allcrgic, 48.19, 66, 70, 80, 87, 91.95, 109, 114, 149,
150,179,200
acute, 193
damp-heat and. 194
Ribs
fullness under, feeling of, 152
pain under, 65, 196
pressure and pain under, 78
treatment for, 218-219
pressure under. feeling of, 137
Ringing noise in ear. SeeTinnitis

201

tongue, tccth marks. slight. 87.88.95.98. 112, 136,


140,189,200
tongue, thin, 25-26.64,78, 79.90
tongue, wet, slightly, 94. 180
Qi deficiency, Stomach, 74
anorexia nervosa and. 82
fluid deficiency, and pale, red, mirror tongue, 74
tongue, crack, small, vertical in center, 16
tongue, cracked. 47
tongue. pale. swollen, 23
tongue coating with, 19
Qi exhaustion, 57
in middle burner, 57
Qi, regeneration of, 70
Qi, wcakness of, constitutional
tongue, reddish, with cracks
sides. notches and cracks. 211
Quadriccps
muscular tightness
extreme, 29

Sarcoma. KaposiS. 55
Scalp, itchy, 50
Seizure. See nlso E p i l e ~ s y
petit inal 'absence' in morning, 134
Self-worth, lack of, 39
Sexual abuse
blood stasis and. 82
Liver qi constraint and, 82
Sexual drive, excessive. 40
Shape. 1
Shattered feeling, 171
Shiny tongue. Seealso~l'onguecoatings, shiny
fluids, deficiency and, 73,76
Stomach and Kidney yin deficiency and, 76
Shock
Heart qi and, 124
heat in Heart and, 124
Shoulder(s1. pain in. 28,203
Sides. SeeTongue sides.

Sinew undernourishmeni, 28
Sinuses
blocked. 109
pressure. 98
pain and pressure, 48
Sinusitis
chronic, 50,90, 193,202
Skin
brownish pigmentation, with itching, 203
disorders of, 5
dry,41,88, 144
Lung yin deficiency and, 92
Face and neck
red, itchy, dry. 66
face, dry red, 157
itching, 182
dry. red. 41, 189
at night, 180
severe, 65,119, 175
strong, 103
i n winter. 189
lesions
damp, red. 65
raised, bleeding, 103
lichen sclerosus et atrophicus. 119
psoriasis of, 120
pustule formation. 119
rash at waist. 203
wheals, bright red over entire body, 175
Sleeping. See also Insomnia
awake, inability to stay, 109
difriculty in, 89
difficulty i n lallingasleep, 12, 13
early waking. 120
frequent waking, 131
inabilityiofall asleep,22,23,53, 64, YO, 103. 112,
119,120, 131, 135, 144, 190
I-Teart blood deficiency and. 194
inability to sleep through the night. 42.97, 119,
123,182,202
no desire For sleep, 122
problems, 137, 15G, 202
restless sleep, 42
waking at night. 129
Smell, loss orsense of, 98
Sncczing
fits of, 80. 87, 95, l i 9
i n morning, 78
Sour taste i n nlouth, 196.201
Source qi, 33
Spasms. i n calves, upon exertion, 30
Speech, slurred, 151,206
Sperm, thick, sticky, 192
Spleen
cold-dampness, 79
Spleen channel, 2

Spleen deficiency, 21
tongue, red, pale, 193
Spleen qi, 1-2
Spleen q i deficiency, 12,25,51
anorexia nervosa and. 82
anxiety and. 115
blood deficiency and
blood stasis, slight
tongue, blue, very pale, 149
dampness accu~nulation
tongue. pale, swollen, 167
edges, pale, 90
tongue. pale, 76, 87
tongue, pale, slightly, 78
tongue, pale, swollen, 71, 167
tongue, red, pale, thin, 90
tongue. slightly pale, thin, 79
tongue, teeth marks, slight, 87
tongue. thin, slightly, 78
coating. wet, white, thin, 188
coating, white. dry, greasy, 201
dampness. accuniulation and. 72, 167
blood deliciency
tongue, pale, swollen, 71
blood deficiency and stasis
tongue, blue, pale, swollen, 153
tongue, pale, red, swollen, 67
tongue, pale, slight teeth marks, 70
tongue, reddish, swollen. 81
depressive moods and. 115
diet, improper and, 98, 172
diet, raw. 194.204
edges, curled-up, 88
edges, pale, 90
edges, slightly pale. 64
edges, swollen, 59
exercise, excessive and, 194
exhaustion and
with swollen edges, 59
fatigue and, 24. 98
fluid deficiency and. 74
fluids, insufficient production o f w i t h coating, 201
heat, development of and, 72
Liver blood deficiency and
pale. dry, 144
pale with pale edges. 155
Liver q i constraint and, 57
overwork and, 98
phlegm and, 98
tongue, pale, slightly, swollen, 139
tongue, red. pale, 162
tongue, swollen i n anterior third and center,
I62
rest, lackorand, 98
sides, swollen, $2

sides, swollen in middle, 31-32


Spleen yang deficiency and
tongue. pale, swollen. 79
Spleen yin deficiency and. 77
tongue, blue, pale
and swollen, 153
tongue body color with, 4, 11,25
tongue, cracked. 47
tongue, cracks at sides. 80.81.82
tongue. cracks. deep at sides, 79,80,210
tongue. cracks. deep transverse at sides, 78.81
longue, cracks, thin at sides, 78
tongue, crevices at sides, 79
tongne, hammer-shaped, 58
tongue, narrow, 27
longue, pale. 29.31. 76, 78, 87.97, 104, 144, 189.
190
and dry, 144
edges, pale, 121, 155
edges, swollen, 63
and narrow, 27
sidcs, swollen in middle, 31-32
and swollen, 11-17.21-23,30. 71, 79,96, 113,
114, 115, 134. 167, 192
with teeth marks, 168, 182, 201
with teeth marks, slight, 112, 140, 189,200
and teeth marks, slighl, 70.88
and thin, 25-26
longue, red, hammer-shaped, 58
longue, red, pale. 47, SO. 91, 97, 162, 167, 169, 188
and mirror. 74
sides, slightly swollen, 65
and soft. 113
and swollen. 55, 63.67, 112, 169, 192. 197
coating, wet, while, thin. 188
with teeth [narks, 87.95
and tecth marks, 98. 136, 177
and teeth marks, slightly wet. 180
and thin. with edges slightly pale, 64
and wet, slightly. 94
and wct. slightly with teeth marks. 180
tongue, reddish, 88
and swollen. 81
and swollen, slightly, 107, I08
tongue, swollen, 11-17,21-23,30.55,91, 112, 139,
156, 167, 169, 188. 189. 192,197
anterior third and center, 162
tongue, teeth marks. 87, 156, 168, 177. 180, 182.
20 1
tongue, teeth marks, slight, 87, 88, 95, 98, 112. 136,
140,189,200
tongue, thin. 25-26.64,78,79,90
tongue. wet. slightly. 94. 180
Spleen qi, regeneration of
coating in center, white, thin, new, 70

Spleen yangdeficiency
dampness accumulation and
tongue, pale, swollen, 71
Spleen qi dericiency and
longue, pale, swollen, 71, 79
tongue, pale
and asymmetrical, 31
and swollen, 14, l7,71
with teeth marks, 17,22-23.30
tongue, swollen, 14, 17,22-23,71
tongue, teeth marks, 17,22-23,30
Spleen yin
and Stomach yin, differences in, 77
Spleen yin deficiency. 42
tongue signs and, 76-77
Spleen yin deficiency, onset
Spleen qi deficiency and
cracks, deep at sides. 210
Spleen qi deficiency, long-standing and
cracks at sides. 80
Sputum, excessive. 12
Stagnation of qi, blood
dampness in channcls and
longue, swollen, left-sided, 156
joint stiffness and. 142
Stenosis of the coronaries, 150
Sterility, 192
Stiffness
damp-heat, 183
Stiffness, morning. 30, 178
Stomach, 1-2
cold-dampness in. 23
cramps, 131
feeling of pressure in, 59, 120
feeling or pressure in center of
with stress, 16
heat. 26
hot feeling. 64
pain. 13.55,64,67,89. 135. 156. 157. 162, 191, 196,
210
acute, 104, 189
after eating, 136
and epigastric fullness, 200
occasional, 66
occasional with epigastric fullness. 150
with stress, 63, 103, 105. 130
when excited, 197
phlegm-fire in, 54
phlegm obstruction of, 30
polyps in, 105
sensation of cold in. 17
sensation of undigested food in, I36
Stomach ache
acute, 29
strong with stress. 120

Stomach, blood stasis in


tongue, reddish-blue center, 156
Stomach, blood slasis onset
Stomach yin deficiency and
reddish-blue center, 157
Stomach channel. 2
Stomach, damp-phlegm accumulation
coating, slightly yellow, thick, greasy, 105
Stomach dryness
center. reddish. 63
Stomach dryness, slight
coating, whitish, dry, 121
Stoniach fire
Kidney yin deficiency and, 40
toothache from, 51
Stomach fluid deficiency
coating, white, dry, 123
Sromach, fluid deficiency
dry, 115
Stomach fluid deficiency, onset of
tongue, crack. thin, vertical at center, 78
Stomach heat, 26
ccnler, pceled. red. 63
center. reddish, 63,64,78. 181
coating. yellow, dry, old, 121
edges, curled-up, slightly swollen. 66
heat toxin penetration and, I68
heat toxin (possible) and, 131
Kidney yin deficicncy and, 109
Liver qi constraint and. 66
edges, curled-up, slightly swollen, 66
phlegm-fire and, 55
sides. red points in middle, 192
Stomach yin deficiency and, onset, 121
dry, red cenler with cracks, 65
Stomach yin deficiency with hcar in Fleart and
with red center. cracks lo lip, 130
tongue, red, swollen. 109
tongue, red with thorns, 131
tongue. rootless round patches. I68
Stomach, phlcgm in
transforms into lire
crack, midline
coating, yellow, greasy, 108
Stomach, phlegm-fire in
coating, yellow, grcasy, 67
coating, yellow, thin, greasy, 107
Slomach yin deficiency and
crack, decp in ccnter
with coating, yellow. greasy, 67
tongue. crack, deep in center. 67
tonguc, crack, long, vertical in center, 107
tongue, crack, vertical in center, I04
Stomach, phlegm-Ileal in
coaling, yellow. lhin. greasy, 108
coating, yellow, thick, dry, 1323

crack, long vertical in center


coating, yellow, thin, greasy, 108
Heart, constitutiunal heat in
crack, long vertical in center
coating, yellow, thin, greasy, 108
Stomach qi. 53
blockage of, by damp turbidity, 53
Stomach qi deficiency
anorexia nervosa and, 82
tongue coating witli, 19
tongue. cracked. 47
small, vertical, in center. 16
tongue, pale, swollen. 23
Stomach qi deficiency, severe, 74
fluid deficiency and
pale, red, mirror tongue, 74
Stomach qi, regeneration of
coating, center, white, thin, new, 70
Stomach yin
regeneration of, 69
and Spleen yin. diffcrcnccs in. 77
Stomach yin deficicncy, 76
blood stasis in Slomach and, 157
center, abscnce of coating, 50
center, peeled, red, cracked, 64,66
coating, absence of, 64, i 5 , 21 1
coating, greasy, yellow, 71
coaling, light yellow, dry, I68
coating. old, thin in center, 198
coating, rootless at center, 141
coaling, rootless, peeled. 72
coating, white, thin, dry, 122
coatingwithout root, 38.67,81,161,162
coating, yellow, greasy, 67, 70
coating. yellow, old, onc sided. 55
coaling, yellow, old, tofil-like, 56
damp-heal accumulation and, 70
diet, improper and, 69
edges. pale, 26
fluids, deficiency and. 21 1
Ileal in Stomach and, 64.66, 168
Kidney yin deficiency, onset and, 104
phlegm-fire accumulation in Stomach and, 6 i
phlegm-heat accumulation and, 71
tongue, crack, deep in center. 66.67
tongue, crack, deep, vcrtical, 70, 71, 72, 168
tongue, crack, deep, vertical, center, 21 1
tongue. crack, midline. slight. 120
tongue, crack, vertical, i l
tongue. crack, vertical in center, 104. 179
tongue, crack, vertical, witli small horizontal
cracks, 64
tonguc, cracked tongue and, 47-50
tongue. cracks, deep, horizontal in center and
anterior third. 90

tongue, cracks, small, deep in center and anterior


third. 115
tongue, cracks. small, horizontal, 91
tongue, cracks. small. many, 122
tongue, dry, 44
tongue, pale, swollen, 23
tongue, peeled, 53
tongue, red, 44,47,50,53
tongue, red, dark, shiny, 75
tongue, reddish area in, raw, 42
tongue. reddish-blue center, 157
tongue. reddish, shiny, 75
tongue. with rootless coating, 104
tongue. rootless coating at root, 122
tongue, shiny. 76
tongue, short. shiny. 44
tongue, thin. slightl): 75
Stomach yin deficiency, onsct
center, dry without coating, 65
coating without root, 81
tonguc, crack, thin, vertical. 70
tongue, cracks, small at ccnter, 65
tongue, cracks, small, deep in center and anterior
third. 115
tongue. cracks. small. horizontal in center, 180
tongue. cracks. small, thin, in center, 135
Stomach yin deficiency, severe
coating, nonc. 75
tongue, red. dark, shiny, 75
tongue, thin, slightly, 75
Stomach yin deficiency, slight
tongue, crack, thin, vertical with small horizontal
cracks, 156
tongue. crack. vertical with light yellow, dry
coating, 201
tongue, cracks, thin. vertical with horizontal
cracks, 210
with plilegn?, 201
Stomach yin, regeneration or
coatiilg. center. wliite. thin, new, 70
Stone in stomach, 189
Stools
with abdominal pain, cramp-like, 181
changing pattern of. 136
with diarrhea, 191
dry. 64. 65.75, 152. 156
dry. hard, 206
dry. and Lung yin deficicncy. 92
foul-smelling, 191, 208
frequent, 50.70
loose, 23.29.63
loose and smelly, 13,54,66
loose and smelly, frequent, 50
loose. without smell. 3-4 times daily, 15
mucoid. undigested food, frequent, 70
purllleht and bloody, 181

with pus and blood, 59


smelly and soft, 58, 59, 65. 71, 178, 180, 182
soft, 12.54,79,81,95,96. 103, 156
watery without smell, morning, 14
Stress
heat in Heart, 106
Stroke, 140, 141, 151
with hemiplegia. 45
recent, 56
three days prior, 56
Stye, purulent, 202
Subfebrilc temperature. 207, 208
Sublingual veins. 6
normal, 8-9
Sudeck syndrome, 50
Suicidal fantasies, 43
Swallowing
severe difficulty with, 167
severe pain with, 167
Swearing, 182
on chest, severe, 119
severe, day and night. 157
sweats easily, 178
Sweats, night. See Night sweats
Sweet foods
binges of eating, 189
desire for, 63
Swelling
Bartholin's gland, one-sided, 179
in lower legs 89

Tachycardia
and palpitations, 131
with panic attacks and chcst pain. 53
Taste, loss o f sense of. 98
Teeth
loose, 108.201
Teeth marks. 22. SeenlsoTongue body, teeth marks
tongue, pale, 22-23.30
and swollen, 11. 14. 15.22-23
uneven, 29
Tendon undernourishment, 2
Tencsmus, 70
Tension, 131
reeling of, 120
inner.47.49. 103. 104. 115.135. 169. 170. 180,203
strong, 180
whole body, rising from bottom, 130
Texture. 1

Thigh
numbness of, left. 38
Thirst,42, 48, 90, 91. 108. 162, 171, 181, 182,201
intense, 74. 88, 91

severe, 80
strong, 122, 202
Throat
dry, 49.87.90, 167
dry with dry niouth, 92
lump in, 135
pain, 174,206
phlegm in, 98
plum-pit feeling. 210
scratchy. 120
sore, 38,39,97, 167
acute. 136
frequent, 14. 169
with lhoarsencss, 170
occasional, 177
and red, 175
severe with strong feeling or malaise, 168
Thumb
tingling and numbness. 28
Thyroiditis. I-lashimoto.s, acute, 174
'l'inea corporis, 203
Tinnilus, 131.203
and earache, 67
ill rig111 ear. 28
Tip. SeeTongoc tip
Tiredness, 168, 169, 180, 181, 188, 189. 190.210
Tongue body. Seeniso'lbngue body co1or;Tonguc
body shape: Tongue coating:Tongue edgcs;Tonguc
sides:'lbngue tip
burning sensation of. 49,50.169.210
contracted. slightly, 161, 191
colllraction~i l l , 20, 25
at mot, 57.58
crack(s).5,8, 39.46-52,210,211
anterior third. 81, 89
at ccntcr, 65
centcr lo tip. 130
deep, at cenlcr, 66,67
deep, lhorizontal, 49
decp, irregular. in anterior third, 91
deep. small, in ccntcr and anterior third. 115
deep, vertical, 70, 71, 72
deep, vertical, a1 center, 168.21 1
deep, vertical, long, I I0
lhorizontal, in center. 47, 51
lhorizontal, deep, 49
lhorizontal, deep, anterior third. 90
lhorizontal, deep, center, 90
horizontal, sniall, 46. 91, 202
horizontal, sniall, in center, 180
horizontal and vertical, 48
irregular, deep, 91
irregular. deep, anterior third, 91
long, at midline, 193
long. vertical. 42. 80, 107
coating, yellow, thin, greasy, 10i, 108

long, vertical, center, 108, I09


long, vertical, deep, 110
many, small, 122
midline, 105
oblique, parallel, 94
oblique, vertical. 95
slight, midline, 120
small, 65
small, deep, in center and anterior third, 115
small, horizontal, 46, 91, 202
small, horizontal, in center, 180
small, in anterior third, 74
small, irregular, anterior third. 90
small, many, 122
small. thin, at center. 135
small. vertical in center, 16
thin, in center, 26
thin, midline, 132
thin, vertical, 70. 78
thin. vertical, with lhorizontal cracks, 156, 210
vertical, 71
coating, dry, light yellow, 201
coating, greasy, yellow, 197
vertical and horizontal, 48, 49
vertical. anterior third, 88.89
vertical. center, 104
vertical, dccp, 70, 71, 72
vertical, deep, center, 21 1
vertical, long. 42. 80. 107. 108
vertical, long, center, 108, 109
vertical, long, deep, I10
vertical. midline, 69
vertical, oblique. 95
vertical, small, in center, 16
vertical, with small horizontal cracks. 64
vertical, thin, 70, 78
vertical. thin, with lhorizontal cracks, 156, 210
cracked, 209
discussion ol: 209
depression(s), 5.20
in anterior third. 44, 87,917
at root. 18-24.22,23,25-26.32.47.57, 63, 114,
122,167,188
decp. 22
slight. 21.70
deviated, 43. 105, 140, 141, 170,206
deviated. slightly, 54. 139, 151
dry. SeeTongue coating, dry
firm, 49, 67, 162
firm, long. 105
firm, stifi: 56
moist, 22
narrow, slightly. 174. 207
narrow, slightly. soft. 174, 207
rcd, 173-174
discussion or, 173-174

root of, 19-20.57


rough, 48
shiny. 44.47, 73.75, 161. Seeulso Shiny tongue
size of, 8
sniall, 161
sniall. contracted. 5
Soh, 37,59, 113,174,207
stiff, 37, 45, 139
stiff. firm, 56
teeth marks, 11, 14. 15, 17.22.22-23,30,87, 140,
156, 168,177,178,180,182,201
slight. 70, 87, 88, 95, 98. 112, 136, 200
uneven, 29
thorns,48,54, 131
veins, suhlingual, 158-159
distended
blue. 157, 160
dark blue, 161
lhick, blue wirh dark spots, 162
distended, very
blue with branching bright red capillaries,
162
dark blue, 151
purple, dark wirh darkspots, 161
thick. tortuous. blue. 160
volume of, 8
wet. SeeTongue coating, wet
with yangcunslilution, 35
with yin conslilulion. 35
zones or, 2
Tongue body color, 1.4
blue, areas o f dark. 153
bluc. iniense
swollen, 151
blue or bluish
.
154
discussion ~ r147-149,
blue, pale
and blue, intense o n anterior third and
swollen, 151
with dark blue areas, 153
and narrow, slightly pointed, 150
blue, pale very, 149
blue. spot of, 155
bluish, 50. 52
bluish, partial, 154-155
bluish red, 151
bluish, slightly, 16
eatingand. 3-4
normal. 7-9
observalion oi, 3
pale, 5, 11-33,32, 48.49. 70, 78. 87, 88, 97
blood deficiency and, 25
with depression a1 root, 18-24
and devialed, 140
and dry, 25, 144
cssence and. 20

hammer-shaped and, 57
narrow and, 27-28
with pale edges. 121
with red (deep) in middle and posterior third,
145
will1 red or orange tint. 25
with reddish patches, 210
and swollen. 11-17,22.?8.71, 72,7996, 112,
114, 115, 167,168,192,200,201
big. 23
deviated, 140
and swollen edges, 63
and swollen rig111hall, 190
and swollen, slightly, 113, 114
and swollen. very, 182
and thin. 25-26
and ihin, slightly, 201
and with uneven sides, 29-31
pale, dark
swollen, 156
pale, slightly, 12, 63, 129, 144
with bluespot on anlerior third, 155
and long, 104
slightly blue and slightly dcviated, 139
and sbvollen, 13.21-22.27.28
and thin, 79
thin, slightly, 78
pale. vely, IF, 190
and swollen. 23
red.5, 19,36-41,48,54,78, 131, 132, 137, 170, 171

21 I
at center. 26.50, 55.65.66
and cracked, 64
and peeled and crackcd, 66
and peeled, slightly, 63
and contracted, 5 5 7
and conlracled, very narrow, 105
and deviated. 141.206
and dry, 36,37.53,203
and dry, peeled, 92
and firni, 67. 162
and iirm, siifi. 56
and long, I23
and longwith red points, 179
with peeled coating, 53
will1 red points. 58. 178
at root. 55
and shiny, 47
and sliorl, 43-46
with slight swclling. 90
and sof1. 37
and soft, slightly narrow, 207
and swollen, 53.54.58, 109, 132, 141, 160, 168,
181,206
and swollen, slightly. 179
and thin. cracked. 38

red, conl.
and thin, white, 66
and thin, wide, 66
and thin, slightly, 39
with thorns, I31
and wet, 179
and wide. 66
red-bluish
and red sides, I52
and sides, swollen, red, 152
red, bright
and narrow, 208
red, dark
and small, shiny, I61
and thin, slightly without coating, 75
red, deep, 4.39, 92
in center. 40
in middle postcrior third, 145
and short, 45
red. pale, 7-8.47.59, 64. 65, 80. 90,97,98. 108.

120,122,129,136,143.193. 196, 198,203


and bluish, 150
and bluish, slightly, 120
and bluish, with red points, 171
with cracks, 210
and deviated, pointed. 170
and hammer-shaped, 58
and long, I03
and long, narrow, 119
and long, pointed, 104
and mirror tongue, 74
and pointed. deviated. 170
and pointed, long, 104
with red, raised points, 200
and soh. 113
and swollen, 55. 67, 87,95. 112, 162, 167, 169,
188,189,192,193. I97
with red spots, 177
and wet, slightly, 180
and swollen, slightly, 6 3 , 9 1 , 9 6
and swollen, very, 83
and thin, 90
slightly, 25, 64
and widc, 202
and wide, dry, 130
and thinning toward tip, long, 119
wet. slightly, 94
wide, 180, 182
thin, 202
thin and dry, 130
red, scarlet
and long, 175
and narrow, slightly and soh, 174
red, slightly
and swollen, 70

reddish. 49, 50. 66, 81,88.91, 109, 121, 130, 135,


136
i n anterior third, 64
and big, 202
at center, 48.64
without root, 63
and contracted, slightly, 161, 191
and contracted with black coating, 206
and cracked, 52.21 1
and long, 122, 135, 157
narrow, I 05
reddish center, 181
soft, 59
and mirror tongue, 74
and narrow, slightly. 160
with red points, 134
and reddish-blue center, swollen, 156
and reddish center, long, 181
and shiny without coating. 75
and swollen. 81, 191, 197
and swollen, slightly, 71.80, 107. 108
and thin, big, 48
and thin. slightly, 89
and very long, I03
reddish blue
blue and black points, 196
at center, 156, 157
reddish, slightly, 78
reddish, slightly blue, 139
and swollen, with red spots. 178
scarlet, 41-42
and shiny, slightly, 42
tongue shape and, 4-6
with yangdeficiency. 5
with yin deficiency. 5
Tongue body shape
big. 202
coating and, 6. See a1soli)ngoe coating
color and, 4-6. SeeolsoTonguc body color
conlracted, 5.37, 92. 206
narrow, very, 105
at root, 57
small. 5
contracted, slightly, 161, 191
hammer-shaped, 57, 58
Kidney yin deficiency and. 57-59
long. 103. 104, 122. 123. 135. 174. 179. 181
and firm, I05
and narrow, 105, 119
and pointed, I04
and thinning toward tip, 119
long, very. 103
Ilarrow, 27,2i-28,208
and drawn in, 27-28
on one side, 28
and long. 105, 119

narrow, slightly, 160


and pointed, 150
and soft, 174.207
narrow, very, contracted, 105
normal, 8, 9
pointed, 65, 170
and lung. I04
and narrow, slightly, 150
shun, 43-46
small, 161
contracted. 5
swollen. 5 . 8 . 11. 11-17. 13, 14, 15, 16, 17. G i , 70,
71,72,7Y. 81.87,95.96, 109, 112, 114, 115, 132,
139, 156, 160, 167, 168, 169, 177, 178, 180, 181,
188, 189, 191, 192, 197,200,201,206
anterior third. 75,96,97,98,113
anleriur lhird and cenler. 162
in center. 30
cenler, 114
localized, 5
in middle part of sides, 31-32
and thin. 79
swollen, right half. 190
swollen, slightly. 63,71,80,91.96, 107, 108, 113,
114,179
anterior third. YO
swollen, very. 16, 17,89, 182
thin, 90
and swollen. 79
and wide, 66,130
thin, slighlly, 64, 75, 78. 89, 201
thinning loward lip, and long. 119
wide, 16, 182,202
and thin, 66, 130
with yang deficiency, 5
Tongue, changes in following treatment, 213-220
for cardiac neurosis, 216-218
lor constipation, 214-215
for cough, chronic, 219-220
for exhaustion. severe, 213-214
fur pressure and pain under ribs, 218-219
for wasling syndrome, 215-216
Tongue coaling. 1
absenceoL 19,39.44,75,211.
in anlerior third
dry, white. 200
aspects uf, 187
black. 205
in ccnler and posterior third, 206
discussion o t 205
and greasy, thick, 206
sides, yellow, 206
in center. 50
dry. 48
greasy, 191
old, thin, I98

peeled. 66
r0otless. 141
sides, white, thick, greasy, 203
transforming into yellow, 196
turning yellow, 202
while, lhin.21 l
yellow. dirty, 203
yellow, dry, 136
yellow. greasy. 103, 140
yellow, thin, 210
in center and anterior third
dry, while, 200
in center and posterior third
black with yellow sides, 206
greasy and yellow, 197
rough, dry and yellow, 196
lransforming inlo yellow. 193
in center and root
yellow. thick. greasy, 170
in cenler, especially
yellow, ihick, slippery, 193
coating, we1 and slippery. 187
color and texture o t 6
discussion of, 185-187, 195. 199.205
disharmony and, 6
dry. 19,38.41,44.49,52.53,55,56, 65, 119
ill center, 48
and greasy
yellow, 160, 180,202
yellow, pale, 201
and palc. 25
and red, 36,37
and lhick
white. 200
yellow, 88. 132, 175, 182
yellow, brownish, 1H2
and thin, while, 120, 122
and while, 123
cenler and anterior Ihird, 200
rough, 200
thin, 120, 122
turning yellow toward center, 202
and whilish, 121
and yellow
discussion o t I99
in center, 136
greasy. I liO, 180. 202
old. 121
righl-sided. 203
lhick. 88. 132. 175. IN2
without root in posterior third, 90
and yellow, brownish and thick. 182
and yellow. dark. 171
and yellow, light, 168
with vertical crack, 201
and yellow, pale and greasy, 201

Ibngue coating, cant.


dry, slightly, 26, 32
eight principles and, 185-186
grayish, and greasy, slightly, 152
greasy, 195
and black, thick, 206
discussion of. 195
and dry
ycllow, 160, 180.202
yellow, pale, 201
and old
yelluw. 174
yellow, dirty, 157
yelluw, slightly, 130
at posterior third, 12
at sides, 64
and thick
black, 206
on left side, 67
white, 196
yellow, 91, 135, 170, 178. 179, 181, 197, 198,
20 1
yellow. dirty. 141. 171
yellow, light. 179
yellow, slightly. 105
and thin
yellow, 87,89, 108, 109, 188
yellowish. 140
and white, 88. 107, 151
thick, 196
and white-yellowish, slightly, 12
and whitish, 157
and yellow, 59, 64, 70, 139, 140, 162, 197
center to posterior third, 197
with deep crack, 67
dry, 160, 180,202
[middle and posterior thirds, 103
old, 174
in posterior third, 98
at rool, 71. 169
thick, 91, 135, 170, 178, 179, 181, 197, 198.
20 1
thin, 87,89, 108, 109, 188
and yellow, dark, 181
and yellow. dirty, 152
old, 157
thick, 141, 171
and yellow. light
thick, 179
thin, 15
and yellow, pale and dry, 201
and yellow, slightly, 120
old, 130
thick, 105
and yellowisli, thin, 140

greasy, slightly
and grayish, 15''
and white, 53, 151
with heal, 41
Kidney q i and, I 9
Kidney yin deficiency and, 53-57
lefl side, thick. greasy, 67
left side. tofu-like, thin, 74
i n middle and posterior thirds, yellow and greasy,
103
i n middle third, white, dry, greasy, 201
mirror. 73
moist, white, 137
normal, 8, 9
old
and dry, yellow, 121
and greasy
yellow, 174
yellow, dirty, 157
yellow, slightly, 130
and thin at center, 198
and yellow, 105
dirty, greasy, 157
dry. 121
greasy, 174
and yellow, slightly. 162
greasy, 130
one-sided, 55
peeled. 53-55.72
at center, 66
a1 rool, 66
and rootless, 71
at tip. 72
peeled, slightly, 63
i n posterior third
dry, greasy. thick, yellow, 180
greasy, 12
red points, 179,201
thin, pale yelluw, 189
transforming into yellow irom white, 193
yellow, dry, rough, 196
yellow. greasy. 98, 103, 189, 197
yelluw, greasy, thick. 135. 191. 200
yellow, pale, slippery, :hick. 192
i n postcrior third and center
black with yellow sides, 206
raw new, 5'3
red points at root. 179. 180
red points on posterior third, 179,201
right-sided
dirty yellow, thick and greasy, 141
dry, yellow, 203
at rout, 19-20
peeled. 66
red points, 179. 180

rootless, 122, 130


yellow, 136
greasy, 169
slippery, 97
thick, 177
yellow, thick. greasy, 170
at root, especially
yellow, thick, dry, 132
yellow, thick, greasy, 91
rootless, 104
ill center. 141
at root, 122, 130
rough. 38,41
white, dry, 200
shiny, 44.47.74.75, 161. Seealso Shiny tongue
sides
greasy, 64
greasy. thick, 203
while, greasy, 196
while with dirty yellow center, 203
yellow with black center, 206
slippery
discussion of. 187
at sides, 40
and thick
while, 190, 191
yellow, 193
yellow, pale, 192
and thin
white, 13.32, 190
yellow, 190, 193
yellow, light. 15
and white, 150. 189
with greasy yellow i n posterior third, 189
thick, 190, 191
Illin, 13,32, 190
and yellow, 13, I69
at root, 97
(hick, 193
thin, 190, 193
and yellow, light, thin, 15
and yellow, pale, 192
thick, 192
Stomach q i deficiency and. 19
thick
and black, greasy, 206
and dry
yellow, 88, 132. 175, 182
yellow, brownish, 182
and greasy
black. 206
on left side, 67
white, 196
yellow.91. 135, 170, 178, 179, 181, 197, 198,
201
yellow, dirty. 141. 171

and greasy, coni.


yellow, light, 179
yellow, slightly, 105
at root. 58
and slippery
white. 190, 191
yellow, 193
yellow, pale, 192
and whitc
greasy, 196
slippery. 190, 191
and yellow, 114, 178
dry, 88,132,175,182
greasy,91, 135, 170, 178, 179, 181, 197, 198,
201
with red points at root. 180
at root. 177
and slippery, 193
and yellow. brownish, and dry, 182
and yellow. dirty, and greasy, 141, 171
and yellow, light
greasy, 179
will1 red points on posterior third, 179
and yellow, pale, and slippery, 192
and yellow. slightly and greasy, 105
thick, slightly
and yellow with red points at root, 66
thickness 06 4 , 6
thin
and dry, while, 120, IT2
and greasy
yellow, 87.89. 108, 109, 188
yellowish. 1-10
and old at center, 198
at posterior third, 65
and slippery
white. 190
yellow, 193
and tofu-like, left sidc, 74
and wet, 30
while, 188
and white, 63, 109, 112, 149
i n center, 21 1
dry, 120, 122
new, 70
slippery, 190
wel, 188
and whitish. 96
and yellow, 59, 65
i n center, 210
greasy. 87, 89. 108. 109. 188
with red points at root, 113
slippery, 193
and yellow. palc on posterior third, 189
and yellowish. greasy. 140
at tip, peeled, 72

tofil-like. 56, 207, 208


and thin on left side, 74
and yellow, pale, 208
thick and greasy, 207
tongue body shape and, 6. SeealsoTongue body
shape
wet
discussion of, 187
and thin, white, 188
and white, 79, 97
thin, 188
while
in center, 23
discussion of, 185
and dry, 123
center and anterior third. 200
rough, 200
thin, 120, 122
turning yellow toward center, 202
and greasy, 88. 107, 151
thick, 196
and greasy, slightly, 53, 151
and moist. 137
and rough, dry, 200
and slippery, 150, 189
with greasy yellow in posterior third, 189
thick, 190, 191
thin, 190
and thick
greasy, 196
slippery, 190. 191
and thin. 8, 14, 16, 63, 109, 112, 149
in center, 21 1
dry, 120, 122
new, 70
slippery, 13,32, 190
and wet, 188
and wet, 79.97
thin. 188
without rooL 23
white and dry
discussion ol, 199
whitc-yellowish and greasy, 12
whitish
and dry, 121
and greasy, 157
and slippery at sides, 40
and thin. 96
without root, 19,23,38,39,49.67, 161
cspccially at center and root,67
especially at root, 81
in posterior third, 90
and yellow and dry, 90
and yellow, slightly, 81
yellow, 58, 63
wit11 cracks, 54

and dry, 52
in center, 136
greasy, 160, 180,202
old, 121
right-sided, 203
thick, 88, 132, 175, 182
without root in posterior third, 90
and greasy, 59,64, 139, 140, 162, 197
center to posterior third, 197
with deep crack, 67
dry, 160, 180,202
fur, 70
middle and posterior thirds. 103
old, 174
in posterior third, 98
at rout. 71, 169
Lhick,91, 135. 170, 178, 179, 181, 197, 198.
201
thin, 87, 89. 108. 109, 188
and old, 55,56,67, 105
dry, 45. 121
greasy, 174
and pale, ihick, 8
with red points at root, 63
at root, 13, 136
and slippery, 13, 169
at root, 97
thick. 193
thin, 19'3
and thick, 114, 178
dry, 88. 132, 175, 182
greasy, 91. 135, 170, 178, 179, 181, 197. 198
with red points at root, 180
at root. 177
slippery, 193
and thick, slightly
with red points at root, 66
and thin, 59.65
in center, 210
greasy, 87,89, 108, 109, 188
one-sided, 50
with red points a1 roor, I 13
slippery, 193
ycllow and dry
discussion uf, I99
yellow. brownish. dry, thick, 182
yellow, dark
and dry. 171
and greasy, 181
yellow, dirty
at center, 40.41
and greasy, 152
and old, 157
thick, 141. 171

yellow, liglit. 168


and dry, 168
with vertical crack, 201
and greasy, 15,29
thick. 170. 179
and slippery, thin, 15
and thick
greasy, 170, 179
with red points on posterior lhird, 179
yellow, pale
and greasy, dry, 201
and slippery, 192
thick, 192
and thin in posterior third, 189
yellow, slightly
and greasy, 120
old, 130
thick, 105
and old, 162
without root, 81
yellowish, greasy, thin, 140
Tonguc diagnosis
conditions for accuracy in, 3-34
enerby and. 18
vs. pulse diagnosis. 6-7
Tongue edges
contracted, slightly
pale, with red points, 143
curled-up. 25. 26, 47. 51. 88, 180. 198
and pale, 143
and red. 130,132.135,137
swollen. 136
and red points
reddish color, 134
several. 136
and red. slightly, 66. 89, I08
and reddish color with red points, 134
and swollen, slightly, 66
curled-up, slightly, 155
and pale, 79
pale. 26.51, 90. 122. 140
and dry. 145
pale, slightly. 64. 79
red. 59. 71.80. 91. 109
rcd, inrcnse. 43
red, pale
and swollen. 59
red, slightly, 103. 178
swollen. 63
Tongue inspection, 3-7
body color and shape in. 4-6
coating in. 6
conditions For diagnostic accuracy in, 3-4
sublingual veins in, 6
three-step procedure of, 3
Tongue moisture. 8 , 9

Tongue, normal, 7-9


Tongue sides
blue patches, 157
blue spot, right side, 155
contracted, slighlly. 65
cracks. 80.81
deep. 79,210
and notches, 210.21 1
transverse, 78
transverse, deep, 81
crevices, 79
drawn-in, anterior third, 103
pale, 47
pale and orange, slightly, 144
pale patches. 171
pale, slightly, 206
points. deep red, 170
points, raised
red. big, 170
red, bright, 168
red, 151, 152, 196
with red points, 132
and swollen, 131. 152, 157
redpoints. 129. 130. 132. 167, 171. 189. 191. 193
middle only, 192
red, slightly, and swollen, 74
red, slightly bluish, 160
reddish and slightly swollcn, 192
spots on, red, 14
swollen, 54
at center, 42
lor entirc Icngth, 31
i n middlc part, 31-32
and red, 157
with red points, 129
and red, slightly, 74
swollen, slightly, 65
and reddish. 192
uneven, 29-31
Tongue tip
contracted, 206
and red, very pointed, 121
and reddened, flattcncd, 119
crack, deep, I15
curlcd-down, 130. 135, 157, 181,203
with red points, 113
with reddening, slight. 103
and reddish, 66
curled-under, 81
curled-up
and red, 120
and red with red points and flattened, 120
flattened
and contracted, 55
and contracted, reddened, 119
and red with red points. 119
curled-up, 120

indentation, 108, 112. 113, 114


indentation, slight. 114
notched, 41. 139
notched, slight, 180, 190
and red points, 129
peeled coating, 72
pointed
with prickles on. 43
and red, 121,170
pointed. very
and contracted. 121
and red. 123
and red with dark red points, 122
prickles on and pointed, 43
protrusion in, slight, 21
red, 9, 12,39,66, 104, 105, 107, 109, 160, 197,201
and contracted, very pointed, 121
and contracted, slightly. 15
and curled-up, 120
and curled-up, slightly. 151
and deep. 40
and tattcncd with red poitits, 119
and pointed, 121. 170
and puinted, very. I23
contracted, 121
dark red points. 122
with protrusion, 122
and red points. flattened. 119
and curled-up, 120
and swollen, 54
symptoms of. 116
red areas, 80
red points,78.88, 129, 136, 143, 144, 167, 171, 174,
189, 191. 193, 197,202
bright rcd and raised. 168
curled-down. 113
discussion or, 165-166
and emotions. 118
and menstrual cycle, 118
and notched, slightly, 129
and raised, slightly, 114
and red, flattened. 119
red points, dark
red and pointed. very. 122
red spots, 14
rcd spots, deep, 91
reddened
and contracted, flattcned, 119
reddening, slight. 87, 112
and curled-down, 103
reddish, 149. 210. 211
and curled-down, 66
symptoms associatcd with various, 111
'lhngue topography, 2-3

Tonsillitis. 175
chronic. 38.39, 168, 169. 177
with abscesses of the crypts, 91
phlegm-heat i n 1.ungsand. 172
Tonsils
swollen, 175
swollen, red. 169
'l'ooth filling amalgam poisoning. See Poisoning. from
amalgam
Toothache, 47
in pregnancy, 51
Topography, tongue, 2-3
Toxin, heat
upper burner
red spots in anterior third, 177
Toxin, heat, accunlulation
points, raised, light red and brownish, 169
Trernhling
of entire body, 108
o l head with rest, 129
'Tremor
o f t h c hands. 42
'I'remors. 130
'I'rigeminal neuralgia, 132, 181
Triple Burncr, 2

IJlcerations, purulent, 182


lllcerative colitis, 26, 59
lllcers
heat toxin and. 173
Umbilicus
dilated cutaneousveins around. 153
sharp pain around, 136
Undcrwcight, 23,24,43,58, 171
Uppcr burner, blood stasis
with development o f toxic heat, I62
veins, sublingual, blue, very distended with
branching, bright red capillaries, 162
veins, sublingual dark blue. very distended, 151
llpper burner, blood stasis, severe
veins, sublingual. dark purple, 161
Upper burner, dampness, accumulation, 89
Upper burner, heat in, 48
Ilreaplasma ureulyficum infection
chronic, 197
lJrinary tract
infection, chronic, 179, 179
Orination
burning sensation
during.58. 141, 179, 180, 188, 193. 197
aftcr. 21
and Bladderqi, impaired. 194
and heal i n Small Intestine, 198

difficulty in. 21 1
frequent. 13, 190, 192
at night, 75.200
frequent and urgent, 59
frequent urge
damp-heat, accumulation, 204
pain during, 88
urge for, 203
urgent, 141
at night. 81
urgent and frequent. 59
lJrine
brown, 145
dribblingol, 180.203.21 1
smelly, 179
strong, smelly
at night. 193
turbid, 13, 192. 193
Bladderqi, impaired, 194
Urogenital tract
chronic infection, 197
Urlicaria
acutc, 175
chronic. 180. IH2
IJterinc bleeding. slight, with pregnancy, 58, 191
Uterus
fibroidsof, 103. 109, 112. 135, 155
prolapsc of, 87

Vaccinations
heat toxin, 183
Vagina
burning sensation in. 197
itchingand burning. I80
Vaginal discharge. 64
chronic. white, 167
Girdle vessel, impaired, 199
thick. yellow, 171
yellow. 179, 197
Veins, sublingual. 6
discussion of. 158-159
normal, 8-9
Vertigo. 54, 56
sudden. 108
Vision
wcdk. 45. 134. 188
Vocal cords
inflammation, chronic, 21 1
polyps on, 135
Vomiting, 191, 192
agitation and. 109
excitement and, 210
nausea and. 177

Waist
rash on skin. 203
Waist, left
pain, severe burning, 198
Wasting. 45
Wasting syndrome
treatment for, 215-216
Weakness, 153
left side of body, 30
left thigh
with pulling sensation, 30
physical
extreme. 17.55. 67. 162
severe, 192
Weather
winter
red, dry, itchy skin, 189
Weather changes
headaches and, 114
pain worscns whcn damp, I78
Weight
gain, 14. 16,32.63,97,155
inability to gain, 80
loss, 28,70, 74. 114, 181
to emaciation, 145
rapid. 198
severe. 59, 153, 157
unwanted, 105
Wheals
bright red, over entire bod)! 175
Wind-cold. externally-contracted
coating, white, thin. dry, 120
coating. white, wet. 188
Wind-cold, externally-contracted, acute
coating, white, wet, 97
Wind-heat, externally-contracted
symptoms of, 165-166
lip, slightly raised red points, 114
Wind-heat, externally-contracted. acute
penetration to interior
sides and tip, red points, 193
red points at sides. 167
red points on anterior third. 97
tip and sides, bright red, raised points, 168
lip, red points, 136, 167
Wind-heat penetrating into interior
tongue. scarlet, especially in anterior third. 175
Wind. internal, 43.54
Wind, internal, onset of
tongue. deviated. slightly. 105
Wind, internally-generated
discussion or. 138
muscleatrophy, 142
symptoms of. 138

tongue, deviated, 140, 170.206


tongue. deviated. slightly, 139, 151
tongue signs and, 138
Wind-phlegm blocking the channels
tongue, deviated. coating yellow. greasy, 139
Womb, blood stasis in
veins. sublingual. blue. thick, tortuous. 160
Wrist and ankle joints
painful and swollen, 121
swollen and hot. 178

X-rays
heat, toxic, 158

Yang brightness channels


damp-phlegm in
coating. tofu-like, pale yellow, 208
heat in
coating. yellow. greasy i n center. 140
Yang brightness organ stage, heat accumulation in,
45.56
Yangconslitution, 35
Yang deficiency
tongue body color and. 4.5
tongue. pale. swollen, l 1. 16, 17
Yangdeficiency, Meart, 17
damp-phlegm accumulation and
tongue, blue, pale, swollen. 151
Yang deficiency, Spleen
Spleen q i deficiency and
tongue, pale, swollen, 79
Yang ming channel
damp-phlegm retention and
coating, tofu-like, pale yellow, 208
Yang lningchannel, phlegm-heat accumulation
coating, black. thick greasy
coating, dirty yellow at sides, 206
Ya1lgmi17g,f~f
iize~?g,
56
Yang ming, heat i n
coating, yellow. greasy in center, 140
Yang mingorgan stage, heat accumulation in. 45
Yang ming. phlegm-heat, accumulation of
coating, black, thickgreasy
coaring. dirty yellow at sides. 206
Yin, 19,35-36
Yin and blood deficiency, slight
tongue. reddish. slightly thin. 89
Yin and yangseparation
fluids, deficiency, 76
Yin constitution, 35

Yin deficiency
blood deficiency, slight blood stasis and
tongue, blue, very pale, 149
heat from, 36-37
long-standing
tongue, cracks, deep transverse at sides, 81
severe, 43
sides. notches and cracks, 211
tongue body color and shape with, 5
tongue characteristics of, 35-36
Yin deficiency, Heart
tip, deep crack, 115
tip. with peeled coating. 72
Yin deficiency, Heart, onset
sides. drawn i n anterior third. 103
tip. contracted, flattened. reddened, 119
Yin deficiency, heat in Heart
tip, red, very pointed and contracted, 121
Yin deficiency, Kidney. 4,5, 19.54.55.76
ascendant Liver yang and, 123
blood stagnation obstructing the channels and
reddish, slightly blue, stiff, 139
coating, abscnt. 75
coating. peeled, 40-41.43-46.53.54
old. 57
at root. 66
coaring, rootless, peeled, 72
coating without root. 38,49.67. 81, 161, 162
coating, yellow
thin. 59
dampness accumulation and
tonguc, red, slightly and, swollen, 70
essence and. l 9 , 5 2
fear, fright and, 57
fluid deficiency, slight and
tongue. reddish. big, rough. 202
fluids, injury to and
rongue, narrow
and red, bright, 208
with heat, 36
with heat i n Heart and Stomach
red, swollen. 109
heat in I-lcart, constitutional and
red, long. 123
Kidney fire and. 55
tongue, red, deep i n middle and posterior
thirds, 145
Liver blood stasis and
tongue, red, bluish. 151
Liver wind, internally-generated and
tongue, deviated, red, 141
Liver yang, ascending and
with Liver wind, internally-generated
tongue. red, deviated. 141
tongue, red with rcd sides, 123
mood swings, severe and, 163

night sweats and, 93, 163


sides, red, 123
Stomach fire and, 40
tongue characteristics oE 35-36
tongue coating with, 53-57
at root, 19
tongue, big, thin, 48
tongue. cracks, 47-51
tongue, contracted, slightly, 161
tongue, contracted root with, 58
coating, yellow, thin. 59
tongue, crack, deep, vertical, 72
coating, rootless, peeled, 72
tongue. cracked, 47.52
tonguc, dry
rout. uncoated. 49
longue, hammer-shaped, 57, 58
tongue. firm. 50
tongile, firm, stiff, 56
LOngue. narrow and bright red, 208
tongue, narrow, slightly, 207
tongue, old, 57
tongue, pale
and hammer-shapcd. 57
and thin, 25
tongue, red. 36-41,54,131,211
and cracked, 47
and deep red. and short. shiny, 44
and deviated. 141
and dry, 203
and firm. 50.67.162
and firm, stift 56
and hammer-shaped, 58
and long, l z 3
and peeled, 40-41,53
and short. 43-46
and swollen, 54
and without root, 40-41
tongue, red, bluish, 151
tongue, red. dark. shiny, 75
and thin, slightly
without coati~ig,75
longue. red, deep in middlc and posterior thirds,
145
tongue. red, soh
narrow, slightly, 207
tonguc, red with rcd sides. 123
tongue, reddish, 50
and blue. sliglitly, stiil', 139
and big, thin. 48
and big, rough, 202
and contracted, slightly, 161
and cracked, 52
and shiny, 75
and, thin, slightly, 89
withuut coating, 75

tongue, scarlet. 41-42


tongue body shapes with, 57-59
tongue, shiny, 76
tongue, thin, 25
tongue, thin, slightly, 75
without coating. 75
tongue, yellow, old coating with
one-sided, 55
tofu-like. 56
Yin deficiency, Kidney, onsct
coating, rootless, 81, 104
coating, rootless at root, 130
coating, rootless, peeled
rout. depression, 71
damp-heat, retention ofand
coating. yellow, dry without root, 90
Stomach yin ddiciency and
longue, crack, vertical in center
with rootless coating, 104
tongue. crack. vertical in center. 104
tongue, narrow, slightly, I60
tongue, red. 132
tongue, reddish. 130, 160
tongue, reddish, rough surface, 91
Yin deficiency, Kidney, severe
tongue, red, dark, shiny
and thin, slightly
without coating, 75
Yin deficiency. Kidney, slight
tongue. contracted. reddish, 191
Yin deficiency, Lung
diet, bland and, 93
longue. dry, 44
heat and, 93
wilh heat in Lung
longue, cracks in anterior third, 89
Kidney yin deticiency and
longue, reddish, mirror, 74
inouth, dry and, 9'2
sadness and, 9'3
skin, dry and, 92
smoking. ahstirienceand, 93
stools, dry and, 92
longue dcprcssions and, 44
tongue signs and, 85-86
tonguc, contracted. red, dry, peeled in anterior
third, 92
tongue. crack, deep, irregular in antcrior third, 91
longue, cracked, 48
tonguc, cracks, deep, horizonral in center and
antcrior third. 90
tongue, cracks, deep, irregular in anterior third, 91
tongue, cracks in anterior third, 81,89
tongue, cracks, small. deep in center and anterior
third. 115
longue, cracks, small in anterior third, 74

tongue, deep red, short, shiny, 44


Yin deficiency, Lung, onset
tongue. crack, vertical in anterior third, 88
longue, cracks, small, deep in center and anterior
third, 115
tongue, cracks, small, irregular in anterior third,
90
tonguc, swollen, dry, and cracked. 2
Yin deficiency, Spleen, 42
Yin deficiency, Spleen,
longue signs and. 76-77
Yin deficiency. Spleen, onset
Spleen qi deficiency
tongue. cracks, deep at sides, 210
Spleen qi deficiency, long-standing
tongue, cracks at sides, 80
Yin deficiency, Stomach
coating, rootless, peeled, 72

coatingwithout root, 67,81, 161


tungue, crack, deep, vertical, 72
coating, rootless, peeled, 72
tongue, red, dark, shiny, 75
and thin, slightly
without coating, 75
Yin exhaustio11. 57
Yin exliaustiun, dangerous
coating, tofu-likc, thin, 74
Yin, regeneration of, 70
Yin. weakness of, constitutional
longue. reddish. with cracks
sides, notci~esand cracks, 21 1