• TCM Tongue Study

This part includes observation of the overall body (spirit, color, form, bearing) as well as localized areas of the body, and the tongue etc. This is a method for TCM physicians to understand and predict the pathological changes of internal organs through observing abnormal changes in the patient's vitality, appearance, behavior, secretions and excretions. The Chinese physicians realized a close relationship between the external body, especially the face and tongue, and the internal organ systems, a slight change appearing on the body surface can reveal the pathological condition of particular region of internal body. Chinese medicine inspection usually focuses on the followings:

Check spirit

Spirit is the outward manifestation of vital activities, and is checked through the eyes, expressions, body motions, speech, and responses of patients. By inspecting it, one gains insight into the development of the disease, and can measure the strength or weakness of the disease, and judge the prognosis. If the person behaves normally, is alert and co-operative, the disease is usually mild; but if responses are sluggish or confused, the disease could be serious.

Check color

Skin color varies according to your race; the appearing of skin reflects the prosperity or decline of qi (vital energy) and essence. According to the five elements theory, there are five colors that correspond to organs - green is for the liver, red for the heart, yellow for the spleen, white for the lungs, and black for the kidneys. Changes in skin complexion reflect the nature of a disease and involved organs. Discolorations are usually seen in: purple or green-blue, yellow, red, pale and dark gray.

Common discolorations in TCM examination

Discoloration	Associated disharmonies
Purple, green-blue	Disharmony of cold, painful conditions, blood stasis or liver disease
Flush red	Heat disharmony
Sallow	Dampness disharmony, deficient disharmony
Pale	Cold disharmony, blood deficiency
Dark gray	Kidney deficiency, cold disharmony, painful condition, blood stasis or body fluid problem

Check form

Physicians look at the body shape and any deformity on the body. A normal form appears as well-developed physique,  firm and straight skeleton, strong muscles, free of motions and quick response. TCM believes overweight people tend to accumulate phlegm or dampness in the body; a thin person with dry skin indicates insufficiency of blood; great loss of weight in chronic illness indicates exhaustion of essence.

Check bearing

The patient's body movement and posture can help evaluate pathological changes. For example, paralysis on one side of body, facial distortion, limb cramps, and twitching of lips or cheek may indicate stroke; when hypertensive individuals experience finger numbness, head heaviness and lightness in lower limbs, it may indicate the aura of stroke;  limb contraction, restricted movements, swelling and painful joints appear in rheumatoid arthritis.

TCM Tongue Study

Division of tongue surface Observation of the tongue, also known as tongue diagnosis, is an important procedure in TCM examination. It includes observing the tongue's form and color, and any coating it may have. The tongue body refers to the muscular tissue of the tongue. The tongue coating (fur) refers to a layer of "moss" over the tongue surface, which is produced by the stomach qi. In ancient times, it was established that different parts of the tongue correspond to different internal organs. The tip of the tongue reflects the heart and lungs; the middle part, the spleen and stomach; its root, the kidneys; and both sides of the tongue, liver and gall-bladder. The tongue body and fur together create the tongue sign. Tongue signs are an important factor in diagnosis, as changes in the signs, reflect changes in the condition of the disease. A normal tongue sign is proper size, soft in quality, free in motion, pale red in color and with a thin layer of white coating which is neither dry nor overly moist.

Pale tongue with white and thin coating	Pale red tongue with white glossy coating	Red tongue with fissures; and the coating is white, thin and a little rough
Red tongue with yellow, thick and greasy coating	Deep red tongue without any coating	Purple tongue with white, thin and slimy coating

Commonly tongue signs during clinical examination are below:

Tongue body	Tongue coating	Problem Indicated
Pale, tender, slightly larger than normal	Thin, white	Qi deficiency
Pale, normal in size or slightly shrunken	Slightly dry, thin, white	Blood deficiency
Pale, enlarged and tender, teeth marks on the sides	Moist with much fluid, white and thick	Deficiency of yang qi leading to accumulation of cold and dampness internally
Pale	Thin, white, peeled center	Insufficient stomach yin
Pale	Yellow, slimy	Weakness of spleen and stomach
Pale red	Thin, white, moist	Normal, or contraction of wind and cold evils.
Pale red with a red tip	White fur	Heart fire blazing
Red	Yellow and rough	Retention of heat
Red, prickles	Thick, yellow, dry	Extreme heat in the interior
Red	Dry in center of the tongue	Heat scorching the stomach fluids
Red	Yellow and slimy	Dampness and heat disturb qi movements
Red	Thick, yellow and glossy	Dampness and heat distending and stagnating in spleen and stomach
Red	Little or no fur	yin deficiency with internal heat
Deep red (crimson), prickles	Thick and yellow	Heat evil entering the blood
Deep red	Dry and cracked fur	Excess heat exhausting yin
Deep red	Black	Extreme heat disharmony
Deep red, shrunken	Dry, little or no fur	Long term yin deficiency
Deep red	Yellow and slimy	Internal heat accompanied phlegm and dampness accumulation
Dark red	Purplish spots or patch	Blood stasis plus heat
Pale purple, tender	Glossy and moist	Internal cold flourishing
Blue green or purple	White and glossy	Blood stasis
Blue green or purple	Yellow and dry	Exhaustion of yin and blood, or yin deficiency with excess virtual fire
Blue green	White and glossy	Extreme cold disharmony