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Tongue Diagosis in TCM

Traditional Chinese Medicine (TCM) incorporates various diagnostic methods to assess a person's health status and aid in disease diagnosis. One of these methods is tongue diagnosis, which involves observing the tongue coating, tongue color, and tongue shape to gather insights into the individual's well-being and determine the severity of their condition.


According to TCM principles, the tongue serves as a reflection of the body's meridians, organ systems, and their functionalities. By carefully examining the tongue coating, which includes its color, form, and moisture, as well as the tongue itself, including its color, shape, and texture, TCM practitioners can infer pathological changes occurring within the body.


Common Abnormal Tongue Colors and Their Clinical Significance:

  1. Pale Red Tongue: A tongue that appears pale red indicates sufficient blood supply, strong yang qi, and harmonious circulation of qi and blood. It is often observed in healthy individuals, external conditions, or early stages of organ diseases when qi and blood are not significantly affected.

  2. Pale White Tongue: A tongue with a lighter color than the normal pale red tongue is referred to as a pale white tongue. It indicates deficiency of qi and blood or a cold syndrome. A pale white and thin tongue may indicate deficiency of qi and blood, while a pale white and swollen tongue may suggest water-dampness accumulation due to yang deficiency.

  3. Red or Crimson Tongue: A tongue that appears bright red is referred to as a red tongue, while a deep red color is termed a crimson tongue. These colors suggest excessive heat in the body. Red tongue indicates excess heat, which can be further classified as excess heat with a yellow or dry coating. Crimson tongue indicates deficient heat and may have little or no coating. Red or crimson tongues can be observed in external febrile diseases or when heat affects the qi or blood circulation.

  4. Bluish-Purple Tongue: A bluish-purple tongue indicates stagnation of qi and blood in the tongue's blood vessels. Depending on its depth, moisture, and texture, different patterns of diseases can be identified. A dark bluish-purple and dry tongue suggests extreme heat and stasis of qi and blood. A pale purple or bluish-purple and moist tongue often indicate blood stasis due to congestion. The presence of blood stasis spots on the tongue indicates blood stasis. Therefore, a bluish-purple tongue is associated with excessive heat, extreme cold, or blood stasis patterns.

Common Abnormal Tongue Shapes and Their Clinical Significance:

  1. Wrinkled or Rigid Tongue: A tongue with rough texture, firmness, and reduced flexibility is known as a wrinkled or rigid tongue. Regardless of the coating color, it generally indicates patterns of excess and heat. It is caused by excessive yang and heat, leading to damage to body fluids and tongue muscle dryness and rigidity. It is commonly observed in conditions of excess and heat.

  2. Swollen or Tender Tongue: A tongue with delicate texture, swelling, and tenderness is referred to as a swollen or tender tongue. It generally indicates patterns of deficiency and cold. It is caused by deficiencies in qi, blood, or yang, leading to water-dampness accumulation and tongue muscle infiltration.

  3. Thick or Thin Tongue: A tongue that appears larger and plumper than normal is known as a thick tongue, indicating patterns of phlegm and fluid retention. It is associated with deficiency of spleen and kidney yang, water-dampness accumulation, or phlegm-dampness retention in the tongue. Conversely, a tongue that appears smaller and thinner than normal is referred to as a thin tongue, indicating patterns of deficiency. It suggests deficiencies in qi, blood, yin, or fluids, leading to inadequate nourishment of the tongue.

  4. Cracked Tongue: A tongue with varying depths, sizes, and unequal furrows is termed a cracked tongue. It generally indicates patterns of blood deficiency or yin deficiency. It is caused by insufficient essence, blood, and yin, resulting in inadequate moistening and nourishment of the tongue, leading to dryness and cracks.

  5. Tooth Marks: The presence of indentations on the edges of the tongue, resembling tooth imprints, indicates patterns of qi deficiency and spleen-kidney yang deficiency. Often seen in combination with a thick tongue, it is caused by the pressure exerted by teeth on the tongue, resulting in long-lasting indentations

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