Chapter 3 The Technique of Tongue · PDF fileThe Technique of Tongue Diagnosis ......

Chapter 3The Technique of Tongue Diagnosis

The patient’s face is turned to the lightand the tongue is examined in a flat,stretched out position, not, however,to the extent that its natural colorchanges (Fig. 17). It is best to examinethe tongue by daylight. If, under cer-tain conditions, the examination hasto be done by artificial light, thewrong results may be obtained. If thetongue has to be examined initially byartificial light, it is advisable to exam-ine it again later on by daylight. It isimportant to distinguish between thetrue color of the tongue and a discol-oration caused by certain foods, medi-cation, or mechanical influences. Milk,for instance, leaves a white coating onthe surface of the tongue, coffee abrown surface. Bilberries (blueberries)

and beet tinge the tongue bluish-red,whereas colored sweets make thetongue look green, yellow, or blue.Chocolate leaves a brown smear;toothpaste can leave a white layer,etc. The coating on the tongue canalso be changed by brushing it with atoothbrush or after eating certainkinds of food. Food can be responsiblefor rubbing off a thick coating and thusmake the coating look thinner or evennormal. Hot, pungent, and spicy foodcan change the color of the tongue,leaving it either bright red or dark pur-ple. For these reasons, the physicianshould never examine the tongue im-mediately after the patient has eaten,drunk, or brushed his or her teeth andtongue.

46 Methodology of Tongue Diagnosis

Fig. 17

aus: Schnorrenberger u. a., Pocket Atlas of Tongue Diagnosis (ISBN 9783131398321) © 2011 Georg Thieme Verlag KG

474 Systematic Procedure of Tongue Diagnosis

Chapter 4Systematic Procedure of Tongue Diagnosis

The basic method of any medical ex-amination is the differentiation be-tween opposed phenomena. In Chi-nese medicine this procedure is calledbian zheng, which is the differentiationbetween contradictory findings. It isthe Chinese version of the famousPrinciple of Contradiction, which foroccidental science was formulated bythe Greek philosophers Heraclitus, Par-menides, Plato, and Aristotle.

In examining the tongue the physi-cian must be able to differentiate be-tween the body of the tongue and thecoating. In addition, the structure orconsistency of the tongue is important.The body of the tongue is made up ofthe tongue muscles, arteries and veins,lymphatic vessels, salivary glands, andfine blood vessels (capillaries). Thecoating is the uppermost layer of thetongue. Usually, the human tonguelooks soft and tender and moves freelyand easily. It is light red, slightly wet,and covered with a fine white layer.Chinese medicine refers to this normalappearance of the tongue as a “lightred tongue with a thin white coating”(Fig. 18).

This normal condition of the tonguechanges with the seasons and climate.In summer the coating is usuallysomewhat thicker or it turns yellowas the result of summer heat. In au-tumn the coating is thin, white, andslightly dry. The physician must beaware of these natural seasonal

changes so as not to confuse themwith pathological ones.

In the case of illness, changes in thebody of the tongue must be differenti-ated from changes in the coating of thetongue. The body of the tongue can un-dergo changes in consistency, color,and form. It primarily reflects eitherstrength or weakness of the arterialor venous blood flow (xue qi), in-creased or decreased capillary pressureand lymph drainage, decreased con-centration of plasma proteins, etc. InChinese medicine this is referred to asa deficiency or a fullness of the vesselsof storage and hollow organs, the jingmai, running deep inside the organism.The coating of the tongue can changein form, color, and in consistency aswell. This will indicate whether the

Fig. 18


4. The thin, small tongueA thin, small tongue which is light incolor usually indicates a deficiency ofblood and qi (xue qi) or it indicates thatboth heart and spleen are in a condi-tion of emptiness. Such a condition canoften be found in younger individualswith psychosomatic disorder (lack ofappetite, insomnia, forgetfulness, ner-vousness, palpitation, etc.) (Fig. 34).

A dark red, thin, small tongue cor-responds to a yin emptiness with anabundance of heat, rendering thebody fluids (jin ye) diminished or im-paired. This is usually a sign of a seri-ous disease. The patient depicted inFigure 35 is a rather tall person buthis tongue is not at all in proportionwith his body height of 189cm. He suf-fers from high blood pressure, insom-nia, and diabetes due to yin deficiencyand internal heat.

58 Methodology of Tongue Diagnosis

Fig. 34 Fig. 35


594 Systematic Procedure of Tongue Diagnosis

5. The fissured tongueIf the tongue has many transverse andlongitudinal fissures with cracks andgrooves in it, it is referred to as a “fis-sured tongue.” If such a tongue is alsodark red, this usually shows the pres-ence of an abundance of heat. The pa-tient in Figure 36 suffers from a severeand generalized allergy.

If such a tongue is white and lightin appearance, this can indicate a lackof yin and blood. The patient shown inFigure 37 suffers from multiple disor-ders of his gastrointestinal tract andhas a history of hepatitis.

Fig. 36 Fig. 37


The Swollen Tongue (1)

Fig. 83: This tongue is larger and thick-er than a normal tongue. If the color ofthe swollen tongue is light and white,this is a sign of an emptiness of the qiand yang in the spleen and stomach.

Fig. 84: This female patient, in addi-tion, presents tooth marks on bothsides of her tongue, which is typicalfor a yang deficiency. There is a stickycoating indicating an accumulation ofmucus (phlegm) in the middle and thelower burner.

102 Clinical Part

Therapy According to Syndrome Differentiation

Replenish qi and yang; strengthenthe spleen and the stomach

Chen Chiu Foramina

● ST-36● BL-20, BL-23

● CV (ren mai)-4,CV-6 (moxa)

● CV-12

Fig. 84 in addition: ● SP-6, SP-10, ST-40

Chinese Herbs (Prescription)

Zingiber officinalis, Dioscorea batatas, Atractylodes macrocephala, Astragalus membrana-ceus, Codonopsis pilulosa, Glycyrrhizas uralensis, Panax Ginseng, Cinnamomum cassia,Poria cocos.


1035 Clinical Applications

Fig. 83: ▷Shape of the tongue body Fig. 84: ▷Shape of the tongue body

Fig. 84: Leave Panax Ginseng out! Instead: Angelica sinensis, Pinellia ternata.

Dietetic Treatment

✘ To be avoidedAvoid food with cold and cool properties from the wood element with sour taste, milkproducts.

✔ Recommended dietEat warm and hot dishes from the earth element (e. g., fennel, cinnamon, potato,pumpkin). Eat warm meals and roasted cereals.


The tip corresponds to the upper burner (heater), including heart and lungs.

Case 1 (Fig. 133): Around age 45 yearsthis patient developed emptiness ofthe heart yin and of the heart–blood(xin xue xu). Her complaints were pal-pitations, restlessness, insomnia, andsweating during the night. In conjunc-tion with this, a round, shiny wart ap-peared on the end of her tongue. Hergynecologist had recommended treat-ment with estrogens, which had notbrought about any improvement.

Therapy with acupuncture concen-trated on nourishing the heart yin andthe heart–blood. The patient was com-pletely cured after 10 sessions. She isnow without any symptoms, workingfull-time as a self-employed business-woman, and needs no medication atall.

204 Clinical Part


Strengthen the heart yin andblood, and strengthen the kidneyyin

Chen Chiu Foramina

● HT-3, HT-7● PC-6

● SP-6, SP-10● BL-15, BL-20, BL-23

● CV (ren mai)-6, CV-12


Scrophularia ningpoensis, Salvia miltiorrhiza, Poria cocos, Schizandra chinensis, Polygalatenuifolia, Platycodon grandiflorum, Angelica sinensis, Asparagus cochinchinensis, Ophio-pogon japonicus, Biota orientalis, Ziziphus jujuba, Rhemannia glutinosa, Cinnabar, PanaxGinseng (prescription: tian wang bu xin tang).


2056 Typical Topographic Changes of the Tongue in Relationship to Syndrome Differentiation

Fig. 133

Upper burner

Lung Heart Lung

Middle burner

Stomach Spleen

Lower burnerKidney Bladder Kidney

IntestineLiver

Live

r,ga

llbla

dder

Dietetic Treatment

✘ To be avoidedAvoid too salty dishes and hot food from the fire element like chillies, brandy, andgrilled meat.

✔ Recommended dietEat food that generates body liquids, especially from the earth and wood elements, forexample wheat and morel cherries. Serve food which is not too salty from the waterelement to strengthen kidney yin (seafood, algae).


Case 3: Hypermenorrhea and Metromenorrhagie (Fig. 147)

There is a time difference of approxi-mately 25 years between the two pho-tographs shown in Figures 147a and147b. Initially, apart from an appendec-tomy, the young woman had beenhealthy except children’s diseases suchas measles, chicken pox, and mumps.Figure 147b reveals the developmentof her health situation around age 45.Her tongue has become markedly red,which is typical for a yin deficiency,and it is considerably swollen. The redtongue indicates an emptiness of yin as-sociated with rising emptiness–fire (xuhuo). The swollen body with toothmarks at the same time signifies a yangdeficiency. During the past 10 years shesuffered from insomnia, constipation,and gynecological problems like hyper-

menorrhea and metromenorrhagia, acondition Chinese medicine refers to asheat–fire in the lower burner, associat-ed with myoma. Because of the myomashe was operated on twice, initially toremove the growth, and then, when thebleeding got out of control, a hysterec-tomy was carried out. She complains ofmental depression, insomnia, nervous-ness, and night sweating. These are typ-ical symptoms of an emptiness of yinassociated with rising emptiness–firewhich causes the red discoloration ofher tongue. Her internal fire is quitestrong and irritating, a condition moti-vatingher to sleepwithwide-openwin-dows in the night, even in the cold win-tertime. Consequently, she frequentlysuffers from cold attacks and flu.

236 Clinical Part


Nourish yin and blood extinguishinternal heat, and reinforce yang

Chen Chiu Foramina

● SP-6, SP-10● KI-3● ST-36 (moxibustion)

● BL-15, BL-17, BL-23● L I-4, L I-11

● HT-7● CV (ren mai)-4● GV (du mai)-14


Ophiopogon japonicus, Asparagus cochinchinensis, Ziziphus jujuba, (red dates), Angelicasinensis, Rhemannia glutinosa, Trichosanthes kirilowii, and Glycyrrhiza uralensis.


2377 Assessment of the Course of a Disease by Application of Tongue Diagnosis

Fig. 147a Fig. 147b

Dietetic Treatment

✘ To be avoidedAvoid very hot and cold food and drinks, for example citrus fruits and bitter liqueur.Do not eat food from the fire element.

✔ Recommended dietEat cereals with a sweet taste (wheat, barley, buckwheat, millet), and soybean sprouts.Serve cool food from all five elements, in addition to uncooked food and milk prod-ucts, with watermelon and cucumber.


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