Evaluation of the Tongue
The tongue is the mirror of the body. Harmony and
disharmony are reflected in the tongue’s color, moisture, size, coating and the
location of abnormalities. Healthy Organ Systems and a lack of External
Pernicious Influences produce a healthy tongue, which is pinkish red, neither
dry nor too wet, fits perfectly within the mouth, moves freely and has a thin
white coating.
Imbalances in the Organ Systems and/or invasion by
Pernicious Influences produce an unhealthy tongue. External Pernicious
Influences produce changes in the tongue coating. Interior problems, such as
Organ System or Essential Substance disharmonies, produce changes in the tongue
body.When examining the tongue, the Chinese medicine doctor looks at the color
of the tongue body, its size and shape, the color and thickness of its coating
or fur, locations of abnormalities, and moistness or dryness of the tongue body
and fur. These signs reveal not only overall states of health but correlate to
specific organ functions and disharmonies, especially in the digestive system.
To evaluate the tongue accurately, always do the examination in natural light.
Tongue Body
The tongue body is a fleshy mass and has color, texture, and shape independent from the apparent qualities of the tongue coating. A pale tongue body indicates deficient Xue, Qi, or Yang or Excess Cold. An overly red tongue body indicates Excess Heat. A purple tongue indicates that Qi and/or Xue are not moving harmoniously and are stagnant. Pale purple means the Stagnation is related to Cold. Reddish purple is related to Stagnation of Heat. When the tongue is black or gray, it indicates extreme Stagnation; if black and dry, that indicates extreme Heat Stagnation; if black and wet, that indicates extreme Cold Stagnation. Bright red indicates Deficient Yin or Excess Heat. Dark red indicates Excess Heat. Cracks in a red tongue indicate Deficient Yin or Heat Injuring the Fluids. If the tongue is pale and cracked, there is Deficient Qi or Xue. Thorny eruptions of the buds on the tongue alert the doctor to Heat or Stagnant Xue.
Tongue Fur
The tongue’s coating is best described as moss or fur. It arises when the Spleen causes tiny amounts of impure substances to drift upward to the tongue. When the Spleen and stomach are in balance, there is a uniform density of fur, with a slightly thicker area in the center of the tongue. Thick fur indicates excess. Thin fur is related to deficiency during illness, but is normal if you are well. Fur that is wet indicates Excess Jin-Ye (fluids) and/or a Deficient Yang. Dry fur is a sign of Excess Yang or Deficient Jin-Ye. A greasy fur is a sign of mucus or dampness in the body. If the fur looks peeled off or missing, it reveals Deficient Spleen or Yin or fluids. White, moist fur indicates Cold. Yellow fur means Heat. However, white fur, resembling cottage cheese, points to heat in the Stomach. Gray/black fur with a red body is associated with extreme Heat; gray/black fur with a pale body is a sign of extreme Cold.
Size and Shape
The healthy tongue rests comfortably in the mouth. It is neither too small nor too large. If a tongue is enlarged and flabby, it indicates Deficient Qi. If, in addition to being enlarged and flabby, the tongue has scalloped (or tooth marked) edges, then it indicates dampness due to Deficient Qi or stagnation of fluids. If the tongue is enlarged and hard, it is a sign of Excess. If it swells so that it fills the mouth and is deep red, that means Excess Heat in Heart and Spleen are a problem. A small, thin tongue can indicate Deficient Yin or Xue.
Movement
A trembling, pale tongue indicates Deficient Qi. A flaccid tongue that is pale often reveals extreme Qi or Xue Deficiency. A flaccid tongue that is deep red reveals severe Yin Deficiency. A trembling, red tongue indicates interior Wind. If the tongue sits off-center in the mouth, early or full-blown Wind stroke may be present. A rigid tongue accompanies an Exterior Pernicious Influence and fever. This may indicate the invasion of the Pericardium by Heat and Mucus Obstructing the Heart Qi.
Location of Abnormalities
The location of disturbances on the tongue is vivid indications of where disharmonies in the mind/body/spirit are located. Certain organs are associated with the Upper, Middle and Lower Triple Burner, which are in turn associated with the front, middle and back sections of the tongue. For example, if there are red spots on the front third of the tongue, which is associated with the Upper Burner, this indicates that there is Heat in the Lungs. If the tip of the tongue is red, that indicates Heat in the Heart. Menstrual cramps, when associated with Stagnant Xue, are often accompanied by purple spots on the edges of the tongue in the Liver/Gallbladder area.
The Role of Tongue Diagnosis
Not all tongue irregularities are indications of
disharmony, however. Food and drugs may change the coating or color of the body
of the tongue. For example, coffee yellows the coating and Pepto-Bismol turns
the tongue black.
Furthermore, some people have minor, unchanging cracks
on their tongue, which are considered normal. Others are born with what is
called a geographic tongue, which is covered with severe cracks and covered with
hills and valleys. It is considered normal by some practitioners, but a sign of
congenital disharmony by others.
The way a tongue appears is not an
absolute indicator of the location of the disharmony, but when taken as part of
an overall pattern that includes a complete evaluation, it offers strong clues
to the location of disharmony.
Evaluation of Body Language-Styles of
Movement, Posture and Self-Presentation
Seeking clues to possible
Pernicious Influences, the practitioner looks for signs of heat or Cold
influences, Excess or Deficiency, Yin or Yang disharmonies. If a person has a
heavy-footed walk, loud voice and sits in a sloppy, spread-out posture, which
may indicate Excess. If a person acts frail and weak, sits with shoulders
slumped and is shy that may indicate a Deficiency. On the other hand, fast,
jerky, impulsive movement and an outgoing personality indicate Heat. If combined
with a full, red face, high energy and a loud voice, then both Heat and Excess
may be at work. Cold, as you might suspect, is associated with slow but not
sloppy movements and a pale face. When coupled with a low voice, shortness of
breath, or passivity, Cold and Deficiency may be at work.
Evaluation of Facial Color
When you are feeling off-balance or have a specific
disharmony, facial colors offer clues to the nature and the severity of the
imbalance.
There are several different methods of facial diagnosis:
Korean, Japanese, Worsley School, even macrobiotic. The following evaluation of
facial colors is derived from a combination of Traditional Chinese Medicine and
Five Phases principles. I have found this system provides accurate analysis.
TIP In order to obtain a clear idea of what the
various facial colors look like, always use natural light when examining your
face in a mirror.
The Significance of Facial Colors
If facial
color is bright and fresh, then the disease is called floating and is on a
superficial level.
If the color is moist, neither wet nor dry, the disease
is not severe and will be easy to treat.
If the color is shallow and
scattered over a large area, the number of days of the disease will be short.
If the color is dark and cloudy, then the disease is sinking into the inner
organs.
If the color is dark, cloudy and dry, the disease is severe and will
be difficult to cure.
If the color is deep and accumulated in one spot, the
disease is a long-term one.
Reading Between the Lines
Five colors appear on the face: red, green,
yellow, white and black. Depending on a person’s constitution, a healthy face
may have one color that is more predominant than others, but several may be
visible. To determine what colors are present in your face, always examine it in
natural light. Look for the overail color tone; study the skin to see what tones
appear from under the surface; look at any visible veins. For contrast, hold
your hand up alongside your face.
Red is the color associated with the Heart Organ
System and Xue. If the face is a fresh red, the Xue is Hot. If the face is dark
red, the Xue is Stagnant. If it is light red, the Xue is Deficient.
Green is the color associated with the Liver System
and circulation of the Xue. If veins on the face appear greenish purple, the Xue
is Hot. If the veins appear greenish black, the Xue is Stagnant. If the
condition is severe, the veins on the face appear black.
Yellow is the color associated with the Spleen
System. If the face appears light yellow, then the Spleen system is Damp and
Hot. If the face appears deep yellow, Heat has accumulated. If it is dark
yellow, Heat is the result of Xue Stagnation. Withered yellow indicates a Heat
Deficiency.
White is the color associated with the Lung System, which regulates Qi, the breathing in of oxygen, and the exhalation of carbon dioxide. If a person is not able to exhale completely-as in emphysema-his or her face will take on a grayish white color. If the person inhales inadequately, then the face will appear pale and lusterless.
Black is the color associated with the Kidney System. If the face is cold and black, the Kidney System is not filtering Xue properly. If the face color is black but bright and moist, the condition can be treated. If the face is not shining, the condition is not good. If the face is withered, the Kidney System Yin is dry. If the face is cloudy and dark, the Kidney System Yang is dying.
Occasionally, there are combitonguenations of colors. This further refines the evaluation. For example, if the color is red and white, both the Heart and Lung channels are involved.
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