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3 Inspection of the tongue body
The body of the tongue is in close relation with the visceral qi and blood through meridians .By means of inspection , one can understand the conditions of the visera , qi and blood .
Inspection of the body of the tongue includes the colour , shape and movement of the tongue .
1.1.3.3.1 Colour of the tongue
It includes the four change as follows :
Light-reddish tongue : The tongue is light ¨Creddish, moist and lustrous .Such a condition of the tongue is usually seen among healthy people , suggesting sufficiency of qi and blood .Sometime it is also seen in mild cases , such as primary stage of exogenous disease , mild pathological condition , or mild internal impairment , indicating that qi , blood , yin , yang and viscera are not involved .
Light-whitish tongue : The colour of the tongue is lighter than that in normal condition , more white and less re , or even showing no signs of blood ( see colour Fig .2) .Such a condition suggests deficiency of qi and blood or asthenia of yangqi.
Malnutrition of the tongue due to asthenia of qi and blood ;The tongue is light-white due to asthenia of qi and blood or asthenia of yangqi which fails to transport blood to nourish the tongue .For example , light-white and thin tongue is due to deficiency of qi and blood ;light-white and bulgy tongue is due to asthenia of yangqi .which fails to transport blood to nourish the tongue .For example , light-white and thin tongue is due to deficiency of qi and blood , light-white and bulgy tongue is due to asthenia of yangqi.
Red and deep-red tongue : The tongue is redder than that in the usual condition ( see colour Fig .3) .The deep or dull red tongue is called deep-red tongue ( see colour Fig .4).Red and deep-red tongue both indicates heat syndrome .The redder the tongue , the severer the heat .
Red or deep-red tongue is caused by superabundance of blood in the vessels of the tongue due to hyperactivity of the tongue .Slightly red tongue or reddish margins and tip of the tongue indicates exogenous superficial heat syndrome ; reddish tongue tip indicates up-flaming of heart fire ; deep-red tongue with fur indicates sthenia-heat syndrome frequently seen at the superabundant heat stage of exogenous disease , or in relative predominant visceral heat in miscellaneous diseases due to internal impairment ; deep-red tongue with scanty fur or without fur indicates asthenia-heat syndrome seen at the advanced stage of exogenous febrile disease with consumption of yin fluid or in patients with yin asthenia and superabundance of fire due to internal impairment and chronic disease .
Cyanotic and purplish tongue : The tongue is completely cyanotic or purplish , or cyanotic and purplish or purplish macules on the surface of the tongue ( see colour Fig .5) , indicating inhibited circulation of qi and blood .
Cyanotic and purplish tongue is caused either by internal exuberance of yin cold and obstruction of vessels ; or by superabundance of pathogenic heat and obstruction of vessels ; or by decline of yangqi , weak transportation of blood and inhibited flow of blood ; or by failure of the liver to disperse and convey as well as qi stagnation and blood stasis .Light-purplish or dull purplish tongue with moisture is caused by inhibited flow of qi and blood due to yang asthenia and yin exuberance ;purplish red or deep-purplish and dry tongue is caused by superabundant heat consuming fluid and stagnation of qi and blood ; dull purplish tongue or tongue with purplish macules is caused by internal retention is also seen in cases of congenital heart disease or intoxication by drugs or food .
1.1.3.3.2 Shape of tongue
Shape of tongue mainly includes several changes as follows :
Rough tongues and tender tongue : Rough tongue is marked by rough or curved texture , dry surface and dull colour ;while tender tongue is characterized by fine texture , moistened and lustrous surface , light colour and bulgy appearance .
Inspecting to see whether the tongue is rough or tender is helpful for understanding whether the disease is of asthenia or sthenia .Rough tongue usually indicates sthenia syndrome and heat syndrome due to hyperactivity of yang-heat and consumption of body fluid .Tender tongue usually signifies asthenia syndrome and cold syndrome due to failure of asthenia yang to transport dampness , or due to qi asthenia and deficiency of yin-essence , which fail to nourish the tongue .
Bulgy tongue : The tongue is bigger than usual ( see colour Fig .6) , usually indicating internal retention of dampness and phlegm .
Bulgy tongue is caused either by qi asthenia or yang asthenia which fail to warm and transform fluid , leading to stagnation of fluid or accumulation of dampness into phlegm in the tongue collaterals .Light-white and bulgy tongue with moist and slippery fur is due to asthenia of spleen and kidney yang which fails to transform body fluid and leads to internal retention of dampness and phlegm .Light-red or red and bulgy tongue with yellowish greasy fur is usually due to damp-heat in the spleen and stomach .
Swollen tongue :Swollen tongue means that the tongue is usually suggesting sthenia syndrome .
Swollen tongue is either caused by superabundant heat in the heart and spleen , or by mixture of febrile pathogenic factors with alcoholic toxin attacking on the upper , or by intoxication which leads to stagnation of qi and blood in the tongue collaterals .Deep-red and swollen tongue is due to superabundant heat in the heart and spleen .Purplish , dull and swollen tongue is due to ascoholism or intoxication .
Thin and emaciated tongue : The tongue is thinner than usual ( see colour Fig .7), indicating asthenia of qi and blood or consumption of yin fluid .
Thin tongue is usually due to asthenia of qi and blood , or consumption of yin fluid and insufficient moisture and nutrition of the tongue .Light-coloured and thin tongue is caused by deficiency of qi and blood ; deep-red and thin tongue is caused by exuberant heat consuming yin or by superabundance of fire due to yin asthenia .
Fissured tongue : There are various fissures on the tongue ( see colour Fig .8) , indicating defiviency of fluid or essence and blood .
Fissured tongue is usually due to consumption of body fluid or asthenia of essence and blood .Deep ¨Cred and fissured tongue is due to exuberant heat consuming fluid ; light-coloured and fissured tongue is due to asthenia of essence and blood .
However , fissured tongue may be seen in some healthy people , known as congenital fissured tongue .Such a tongue is marked by fine fissures and covered with tongue fur .
Prickly tongue : The tongue is covered with reddish prickles ( see colour Fig .9), suggesting superabundance of pathogenic heat .
Prickly tongue is due to superabundance of heat in the viscera , invasion of heat into blood and accumulation of heat in the tongue collaterals .The location of prickles may indicate the location of pathogenic heat .Prickles on the tongue center indicate superabundance of heat in the stomach and intestines ; prickles on the margins indicate exuberance of liver and gallbladder fire .The more the prickles and the deeper the colour , the severer the pathogenic heat .
Tooth-marked tongue : The margins of the tongue are printed with tooth marks ( see colour Fig .10) , indicating qi asthenia or yang asthenia and internal retention of dampness .
The spleen governs transportation and transformation .The decline of the spleen qi or spleen yang will lead to dysfunction in transportation and transformation as well as internal retention of dampness in the tongue , resulting in bulgy tongue which is squeezed by teeth .That is why tooth-marked tongue and bulgy tongue appear simultaneously .
However , tooth-marked tongue is also seen among some healthy people , characterized by constant existence of slight tooth-marks and no bulging manifestation .
1.1.3.3.3 Movement of tongue
This mainly includes the examination of the changes of movement of the tongue .Normally the tongue is soft and flexible , indicating sufficiency of qi and blood , normal circulation of vessels and meridians as well as normal functions of the viscera .There are four kinds of different movement of the tongue .
Stiff tongue : The tongue is not soft ; it is inflexible or stiff and immobile .Such s change of the tongue is usually seen in exogenous diseases due to exuberant heat consuming body fluid , or due to invasion of heat into the pericardium , or due to phlegm and turbid substance confusing the heart .It is also seen in miscellaneous diseases due to internal impairment caused by wind phlegm obstructing the collaterals .
Stiff tongue seen in exogenous diseases is caused either by hyperactivity of pathogenic heat which consumes body fluid and leads to malnutrition of the tongue and inflexibility of the tongue ; or by invasion of heat into the pericardium involving the spirit ; or by phlegm and turbid substance confusing the heart and affecting the tongue .Stiff tongue seen in miscellaneous diseases due to internal impairment is caused by obstruction of the tongue collaterals due to liver wind complicated by phlegm .Deep-red stiff tongue with scanty fluid is due to exuberant heat consuming body fluid or invasion of heat into the pericardium , frequently seen at the severe heat stage of exogenous diseases . Stiff tongue with greasy and thick fur seen in miscellaneous diseases due to internal impairment is caused by wind-phlegm obstructing collaterals .If the tongue suddenly becomes stiff , accompanied by aphasia , numbness of the limbs and dizziness , it is the premonitory sign of wind stroke .
Shivering tongue : The tongue is involuntarily tremoring , indicating endogenous liver wind .
Shivering tongue is caused either by consumption of blood or body fluid which fails to nourish the tendons and vessels : or by extreme heat generating wind due to exuberant heat scorching the liver meridian ;or by liver yang transforming into wind .Light-whitish and shivering tongue is due to asthenia of qi and blood and endogenous asthenia-wind , usually seen in internal impairment , chronic diseases and severe diseases ; reddish shivering tongue with scanty dry fur is due to consumption of yin fluid , malnutrition of the tendons and vessels and endogenous wind , usually seen at the advanced stage of exogenous febrile diseases ; deep-red and shivering tongue is due to extreme heat generating wind , frequently seen at the severe heat stage of exogenous diseases ; reddish and shivering tongue is due to liver yang transforming into wind , often seen in miscellaneous diseases due to internal impairment accompanied by headache and dizziness .
Deviated tongue : The tongue is deviated to one side ( see colour Fig .11), suggesting wind stroke or premonitory sign of wind stroke due to liver wind complicated by phlegm or liver wind complicated by stagnation in the collaterals of the tongue .
Flaccid tongue : The tongue is too weak to protrude and withdraw , suggesting extreme consumption of fluid or decline of qi and blood .
Flaccid tongue is caused by extreme consumption of yin fluid , or by decline of qi and blood as well as malnutrition of musculature and vessels of the tongue .Deep-red and flaccid tongue with scanty fur in chronic disease due to internal impairment is due to extreme predominance of fire resulting from yin asthenia ; light-whitish and flaccid tongue is due to decline of qi and blood .Reddish dry and flaccid tongue at the advanced stage in exogenous febrile diseases is due to consumption of yin by heat .
Shrunk tongue : The tongue is contracted and cannot protrude , or cannot even reach the teeth , usually indicating critical condition .Such a syndrome is either of cold or of heat nature .
Shrunk tongue is caused either by invasion of pathogenic cold ; or by stagnation of endogenous cold in the musculature and vessels of the tongue ;or by extreme heat consuming fluid and causing spasm of the musculature and vessels ; or by stagnation of liver wind with phlegm in the vessels of the tongue .Light-whitish or cyanotic , purplish , moist and shrunk tongue is due to stagnation of cold in the musculature and vessels of the tongue ; deep-red , dry and shrunk tongue is due to extreme heat consuming fluid ;bulgy and shrunk tongue with greasy fur is due to liver wind complicated by phlegm .
However , congenital short sublingual frenum also prevents the tongue from protruding .
Protruding and wagging tongue : The tongue that protrudes our but is unable to retreat is called protruding tongue ; the tongue that frequently protrudes out but immediately draws back or licks the lips or corners of the mouth is called wagging tongue . Both conditions suggest heat in the heart and spleen . In severe cases , protruding tongue indicates invasion of pestilence into the heart or healthy qi on the verge to exhaust .Wagging tongue is the premonitory sign of endogenous wind , also seen in children with maldevelopment of intelligence .
Inspection of the body of the tongue includes the colour , shape and movement of the tongue .
1.1.3.3.1 Colour of the tongue
It includes the four change as follows :
Light-reddish tongue : The tongue is light ¨Creddish, moist and lustrous .Such a condition of the tongue is usually seen among healthy people , suggesting sufficiency of qi and blood .Sometime it is also seen in mild cases , such as primary stage of exogenous disease , mild pathological condition , or mild internal impairment , indicating that qi , blood , yin , yang and viscera are not involved .
Light-whitish tongue : The colour of the tongue is lighter than that in normal condition , more white and less re , or even showing no signs of blood ( see colour Fig .2) .Such a condition suggests deficiency of qi and blood or asthenia of yangqi.
Malnutrition of the tongue due to asthenia of qi and blood ;The tongue is light-white due to asthenia of qi and blood or asthenia of yangqi which fails to transport blood to nourish the tongue .For example , light-white and thin tongue is due to deficiency of qi and blood ;light-white and bulgy tongue is due to asthenia of yangqi .which fails to transport blood to nourish the tongue .For example , light-white and thin tongue is due to deficiency of qi and blood , light-white and bulgy tongue is due to asthenia of yangqi.
Red and deep-red tongue : The tongue is redder than that in the usual condition ( see colour Fig .3) .The deep or dull red tongue is called deep-red tongue ( see colour Fig .4).Red and deep-red tongue both indicates heat syndrome .The redder the tongue , the severer the heat .
Red or deep-red tongue is caused by superabundance of blood in the vessels of the tongue due to hyperactivity of the tongue .Slightly red tongue or reddish margins and tip of the tongue indicates exogenous superficial heat syndrome ; reddish tongue tip indicates up-flaming of heart fire ; deep-red tongue with fur indicates sthenia-heat syndrome frequently seen at the superabundant heat stage of exogenous disease , or in relative predominant visceral heat in miscellaneous diseases due to internal impairment ; deep-red tongue with scanty fur or without fur indicates asthenia-heat syndrome seen at the advanced stage of exogenous febrile disease with consumption of yin fluid or in patients with yin asthenia and superabundance of fire due to internal impairment and chronic disease .
Cyanotic and purplish tongue : The tongue is completely cyanotic or purplish , or cyanotic and purplish or purplish macules on the surface of the tongue ( see colour Fig .5) , indicating inhibited circulation of qi and blood .
Cyanotic and purplish tongue is caused either by internal exuberance of yin cold and obstruction of vessels ; or by superabundance of pathogenic heat and obstruction of vessels ; or by decline of yangqi , weak transportation of blood and inhibited flow of blood ; or by failure of the liver to disperse and convey as well as qi stagnation and blood stasis .Light-purplish or dull purplish tongue with moisture is caused by inhibited flow of qi and blood due to yang asthenia and yin exuberance ;purplish red or deep-purplish and dry tongue is caused by superabundant heat consuming fluid and stagnation of qi and blood ; dull purplish tongue or tongue with purplish macules is caused by internal retention is also seen in cases of congenital heart disease or intoxication by drugs or food .
1.1.3.3.2 Shape of tongue
Shape of tongue mainly includes several changes as follows :
Rough tongues and tender tongue : Rough tongue is marked by rough or curved texture , dry surface and dull colour ;while tender tongue is characterized by fine texture , moistened and lustrous surface , light colour and bulgy appearance .
Inspecting to see whether the tongue is rough or tender is helpful for understanding whether the disease is of asthenia or sthenia .Rough tongue usually indicates sthenia syndrome and heat syndrome due to hyperactivity of yang-heat and consumption of body fluid .Tender tongue usually signifies asthenia syndrome and cold syndrome due to failure of asthenia yang to transport dampness , or due to qi asthenia and deficiency of yin-essence , which fail to nourish the tongue .
Bulgy tongue : The tongue is bigger than usual ( see colour Fig .6) , usually indicating internal retention of dampness and phlegm .
Bulgy tongue is caused either by qi asthenia or yang asthenia which fail to warm and transform fluid , leading to stagnation of fluid or accumulation of dampness into phlegm in the tongue collaterals .Light-white and bulgy tongue with moist and slippery fur is due to asthenia of spleen and kidney yang which fails to transform body fluid and leads to internal retention of dampness and phlegm .Light-red or red and bulgy tongue with yellowish greasy fur is usually due to damp-heat in the spleen and stomach .
Swollen tongue :Swollen tongue means that the tongue is usually suggesting sthenia syndrome .
Swollen tongue is either caused by superabundant heat in the heart and spleen , or by mixture of febrile pathogenic factors with alcoholic toxin attacking on the upper , or by intoxication which leads to stagnation of qi and blood in the tongue collaterals .Deep-red and swollen tongue is due to superabundant heat in the heart and spleen .Purplish , dull and swollen tongue is due to ascoholism or intoxication .
Thin and emaciated tongue : The tongue is thinner than usual ( see colour Fig .7), indicating asthenia of qi and blood or consumption of yin fluid .
Thin tongue is usually due to asthenia of qi and blood , or consumption of yin fluid and insufficient moisture and nutrition of the tongue .Light-coloured and thin tongue is caused by deficiency of qi and blood ; deep-red and thin tongue is caused by exuberant heat consuming yin or by superabundance of fire due to yin asthenia .
Fissured tongue : There are various fissures on the tongue ( see colour Fig .8) , indicating defiviency of fluid or essence and blood .
Fissured tongue is usually due to consumption of body fluid or asthenia of essence and blood .Deep ¨Cred and fissured tongue is due to exuberant heat consuming fluid ; light-coloured and fissured tongue is due to asthenia of essence and blood .
However , fissured tongue may be seen in some healthy people , known as congenital fissured tongue .Such a tongue is marked by fine fissures and covered with tongue fur .
Prickly tongue : The tongue is covered with reddish prickles ( see colour Fig .9), suggesting superabundance of pathogenic heat .
Prickly tongue is due to superabundance of heat in the viscera , invasion of heat into blood and accumulation of heat in the tongue collaterals .The location of prickles may indicate the location of pathogenic heat .Prickles on the tongue center indicate superabundance of heat in the stomach and intestines ; prickles on the margins indicate exuberance of liver and gallbladder fire .The more the prickles and the deeper the colour , the severer the pathogenic heat .
Tooth-marked tongue : The margins of the tongue are printed with tooth marks ( see colour Fig .10) , indicating qi asthenia or yang asthenia and internal retention of dampness .
The spleen governs transportation and transformation .The decline of the spleen qi or spleen yang will lead to dysfunction in transportation and transformation as well as internal retention of dampness in the tongue , resulting in bulgy tongue which is squeezed by teeth .That is why tooth-marked tongue and bulgy tongue appear simultaneously .
However , tooth-marked tongue is also seen among some healthy people , characterized by constant existence of slight tooth-marks and no bulging manifestation .
1.1.3.3.3 Movement of tongue
This mainly includes the examination of the changes of movement of the tongue .Normally the tongue is soft and flexible , indicating sufficiency of qi and blood , normal circulation of vessels and meridians as well as normal functions of the viscera .There are four kinds of different movement of the tongue .
Stiff tongue : The tongue is not soft ; it is inflexible or stiff and immobile .Such s change of the tongue is usually seen in exogenous diseases due to exuberant heat consuming body fluid , or due to invasion of heat into the pericardium , or due to phlegm and turbid substance confusing the heart .It is also seen in miscellaneous diseases due to internal impairment caused by wind phlegm obstructing the collaterals .
Stiff tongue seen in exogenous diseases is caused either by hyperactivity of pathogenic heat which consumes body fluid and leads to malnutrition of the tongue and inflexibility of the tongue ; or by invasion of heat into the pericardium involving the spirit ; or by phlegm and turbid substance confusing the heart and affecting the tongue .Stiff tongue seen in miscellaneous diseases due to internal impairment is caused by obstruction of the tongue collaterals due to liver wind complicated by phlegm .Deep-red stiff tongue with scanty fluid is due to exuberant heat consuming body fluid or invasion of heat into the pericardium , frequently seen at the severe heat stage of exogenous diseases . Stiff tongue with greasy and thick fur seen in miscellaneous diseases due to internal impairment is caused by wind-phlegm obstructing collaterals .If the tongue suddenly becomes stiff , accompanied by aphasia , numbness of the limbs and dizziness , it is the premonitory sign of wind stroke .
Shivering tongue : The tongue is involuntarily tremoring , indicating endogenous liver wind .
Shivering tongue is caused either by consumption of blood or body fluid which fails to nourish the tendons and vessels : or by extreme heat generating wind due to exuberant heat scorching the liver meridian ;or by liver yang transforming into wind .Light-whitish and shivering tongue is due to asthenia of qi and blood and endogenous asthenia-wind , usually seen in internal impairment , chronic diseases and severe diseases ; reddish shivering tongue with scanty dry fur is due to consumption of yin fluid , malnutrition of the tendons and vessels and endogenous wind , usually seen at the advanced stage of exogenous febrile diseases ; deep-red and shivering tongue is due to extreme heat generating wind , frequently seen at the severe heat stage of exogenous diseases ; reddish and shivering tongue is due to liver yang transforming into wind , often seen in miscellaneous diseases due to internal impairment accompanied by headache and dizziness .
Deviated tongue : The tongue is deviated to one side ( see colour Fig .11), suggesting wind stroke or premonitory sign of wind stroke due to liver wind complicated by phlegm or liver wind complicated by stagnation in the collaterals of the tongue .
Flaccid tongue : The tongue is too weak to protrude and withdraw , suggesting extreme consumption of fluid or decline of qi and blood .
Flaccid tongue is caused by extreme consumption of yin fluid , or by decline of qi and blood as well as malnutrition of musculature and vessels of the tongue .Deep-red and flaccid tongue with scanty fur in chronic disease due to internal impairment is due to extreme predominance of fire resulting from yin asthenia ; light-whitish and flaccid tongue is due to decline of qi and blood .Reddish dry and flaccid tongue at the advanced stage in exogenous febrile diseases is due to consumption of yin by heat .
Shrunk tongue : The tongue is contracted and cannot protrude , or cannot even reach the teeth , usually indicating critical condition .Such a syndrome is either of cold or of heat nature .
Shrunk tongue is caused either by invasion of pathogenic cold ; or by stagnation of endogenous cold in the musculature and vessels of the tongue ;or by extreme heat consuming fluid and causing spasm of the musculature and vessels ; or by stagnation of liver wind with phlegm in the vessels of the tongue .Light-whitish or cyanotic , purplish , moist and shrunk tongue is due to stagnation of cold in the musculature and vessels of the tongue ; deep-red , dry and shrunk tongue is due to extreme heat consuming fluid ;bulgy and shrunk tongue with greasy fur is due to liver wind complicated by phlegm .
However , congenital short sublingual frenum also prevents the tongue from protruding .
Protruding and wagging tongue : The tongue that protrudes our but is unable to retreat is called protruding tongue ; the tongue that frequently protrudes out but immediately draws back or licks the lips or corners of the mouth is called wagging tongue . Both conditions suggest heat in the heart and spleen . In severe cases , protruding tongue indicates invasion of pestilence into the heart or healthy qi on the verge to exhaust .Wagging tongue is the premonitory sign of endogenous wind , also seen in children with maldevelopment of intelligence .
Comment made on this article doesn't stand for the position of TCMADVISORY.
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