1 - NEW
2 - NEW
Body shape: Swollen and cracked.
A Reddish-Purple tongue body colour usually indicates Blood stasis
deriving from or associated with Heat (whereas a Bluish-Purple colour
generally indicates Blood stasis deriving from Cold). In this case,
the tongue colour is consistent over the whole tongue so we cannot
determine from the tongue alone where the Blood stasis is located.
The pulse and the symptoms can tell us this. However, the most likely
pattern is that of Liver-Blood stasis.
The tongue body is also Swollen which indicates the presence of
Phlegm. The Lung and Heart areas of the tongue are especially swollen
which points towards the fact that the Phlegm is predominantly in
the Upper Burner. Phlegm and Blood stasis are often seen existing
side by side, especially in older patients, as they interact with
and "promote" each other. Blood stasis stops fluids from being transported
around the body smoothly therefore encouraging the production of
Phlegm, while Phlegm blocks the smooth flow of Qi and Blood leading
The tongue is totally peeled (without coating) and with many cracks,
both signs of chronic Yin deficiency. It is likely that the Yin
deficiency preceded the Blood stasis. Chronic Yin deficiency leads
to Empty-Heat and we know in this case that the Blood stasis derives
from Heat as the tongue is a Reddish-Purple colour. Although we
cannot tell conclusively from the tongue only, the Yin deficiency
is most likely of the Stomach and Kidneys
Therefore, in conclusion, we can say that this many suffers from
Yin deficiency with Empty-Heat, Blood stasis and Phlegm in the Upper
colour: Reddish-Purple, Bluish-Purple in the chest area on the
3 - NEW
Body shape: Stiff, slightly Swollen.
Coating: sticky coating without root.
The overall body colour of this tongue is Purple, indicating Blood
stasis. It is predominantly Reddish-Purple, which indicates Blood
stasis deriving from or associated with Heat but the chest area
on the right of the tongue is Bluish-Purple which indicates that
there is also some Cold which has lead to Blood stasis in the chest.
The tongue is also Stiff. A Stiff tongue indicates either severe
Blood stasis or internal Wind. As the tongue is also Purple, in
this case it is most likely that it indicates Blood stasis.
The sticky consistency of the coating simply indicates that there
is Dampness (or together with the Swollen tongue body Damp-Phlegm),
but the fact that it is rootless reflects a deficiency of Stomach-Yin.
A rootless coating reflects the beginning stages of Stomach-Yin
colour: Slightly Red but Pale on the sides.
4 - NEW
Body shape: Swelling in the Spleen area on the sides, Stomach
This tongue shows clearly a relatively common condition of Stomach-Yin
deficiency (leading to some Heat) and Spleen-Yang deficiency. The
cracks in the Stomach area indicate Stomach-Yin deficiency and the
overall colour of the tongue is slightly Red showing that this Yin
deficiency has lead to some Heat, but the sides of the tongue in
the Spleen area are Swollen and Pale. This relects Spleen-Qi and
Yang deficiency leading to Dampness.
It is important to distinguish between the Liver and the Spleen
areas on the sides of the tongue. The Liver area is a longer and
thinner strip, covering nearly the whole side of the tongue, whereas
the Spleen area is shorter and fatter and in the middle of the side
of the tongue.
In the case of this patient, it would therefore be necessary to
treat both Yin deficiency (of the Stomach) and Yang deficiency (of
the Spleen). Even though the Yin deficiency (and Empty-Heat) seem
predominant because the main area of the tongue body is Red and
it is peeled, it is likely that the Spleen deficiency came first.
As the Spleen and Stomach are so closely connected, a long-standing
case of Spleen-Qi and/or Yang deficiency may lead to a deficiency
of the Stomach (which has a tendency to become Yin deficient). A
suitable remedy for this condition might be Shen Ling Bai Zhu San.
colour: slightly Red.
5 - NEW
Body shape: Swollen, especially in the chest area with a
Coating: sticky coating.
This tongue is slightly unusual in that it clearly shows us the
exact location of a pathogenic factor. The chest area is clearly
more Swollen than the rest of the tongue indicating the presence
of Phlegm in the Upper Burner.
As a general rule, the tongue body shows more the presence of Phlegm
and the coating reflects the presence of Dampness. When the tongue
body is Swollen and the coating is sticky, as in this case, it normally
indicates the presence of Damp-Phlegm, in this case clearly in the
colour: slightly Red.
Body shape: Swollen, especially in the chest area with a
Coating: sticky coating.
The Reddish-Purple coating is more distinct on the sides in the
Liver area which points specifically towards Liver-Blood stasis.
The Liver area on the sides is also Swollen which usually indicates
severe or chronic Liver-Heat. The Liver area being Red and Swollen
simply indicates a more severe degree of Liver-Heat than if the
Liver area is just Red.
The strips of a slightly thicker, white coating on either side of
the tongue indicate a Gall-Bladder pathology, most usually Dampness
in the Gall-Bladder.
Although the tongue points towards the Blood stasis being especially
in the Liver, treatment of this patient should focus equally on
moving Blood in the Heart. The presence of a Heart crack indicates
a constitutional tendency to Heart patterns.
shape: swollen, central Heart crack, transverse Spleen cracks
on the sides.
thin-white (normal), slightly yellow in the centre.
pale tongue-bocolour indicates Yang deficiency (it may also indicate
Blood deficiency, but in a man, it is more likely to be Yang deficiency).
It is not possible from the tongue only to establish which organ
is mostly affected in this case by the Yang deficiency: however,
since the tongue body is also swody llen, which usually indicates
Phlegm, it is more likely to be Spleen-Yang deficiency. The central
crack in this case correlates with the Heart.
"Heart crack" is rather thin and long, extending from
near the root of the tongue to near the tip; a "Stomach crack"
is rather wide and is situated only in the middle section of the
tongue, in the Stomach area. What does a Heart crack indicate? It
depends on its depth and on the colour of the tongue tip. Generally
speaking, a Heart crack indicates a constitutional propensity to
Heart patterns and to emotional problems: the deeper the crack,
the stronger this propensity. If, in the presence of a Heart crack,
the tongue tip is red, it indicates that there already is a Heart
pattern usually from emotional problems. In other words, a change
in colour of the tongue body indicates that that particular constitutional
tendency to Heart patterns has manifested itself and generated an
actual Heart pattern. If we compare two people both with a red tip
of the tongue, one with a Heart crack and the other without, the
presence of a Heart crack indicates that that person has a constitutional
tendency to Heart patterns and that his or her condition is deeper
and more difficult to treat than that of the person without a Heart
small, transverse cracks on the sides usually indicate severe, chronic
Spleen deficiency. Thus, we can conclude that this man suffers from
a chronic Spleen-Yang deficiency and Phlegm.
colour: dark red, redder on the sides.
shape: swollen on the sides, Stomach crack.
dark red body colour clearly indicates intense Heat and the redder
colour and swelling on the sides shows that the Heat is in the Liver.
Thus, this patient has suffered from Liver-Fire for a long time
(we can deduce it is a long time from the dark-red colour) and the
intense Fire has begun to injure Yin. We know this from the fact
that the coating is rootless: this indicates the beginning of Yin
deficiency and, since the tongue is dark-red and there is a coating,
we can deduce that it is the Fire that is injuring Yin rather than
deficient Yin giving rise to Empty Heat.
colour: red slightly tending to purple, redder tip.
shape: swollen tip, tip curling up, Heart crack.
normal but there is a slightly peeled patch without coating on the
left side towards the root.
red body colour indicates Heat and the slight purple colour indicates
that there is some Blood stasis. The red tip indicates Heart-Fire
and the swelling of the tip and its curling up confirm and reinforce
this diagnosis. The presence of the Heart crack indicates that this
patient had a constitutional tendency to Heart patterns and to emotional
problems. The small patch without coating indicates the beginning
of Stomach-Yin deficiency.
colour: red, tending to purple
shape: very swollen, Stomach crack.
yellow, rootless, dry.
red body colour indicates Heat while its slightly purple hue indicates
that there is some Blood stasis. The very swollen body shape indicates
the presence of Phlegm. The red colour, together with the Stomach
crack and the yellow coating, indicates that the Heat is located
in the Stomach. This is confirmed by the rootless coating which
indicates the beginning of Stomach-Yin deficiency, presumably from
the Heat injuring Yin. The dryness of the coating confirms both
the Heat and the Yin deficiency (it could be due to either).
tongue has a rootless but relatively thick coating: this is doubly
bad. Why? The rootlessness of the coating indicates that there is
the beginning of Yin deficiency but the relative thickness of it
indicates that there is a pathogenic factor, in this case, Stomach-Heat:
thus, this patient suffers from a Full condition occurring against
a background of Stomach deficiency. In other words, it would have
been better if the coating had been either rootless but thin (indicating
Yin deficiency but no pathogenic factor) or thick with root (indicating
the presence of a pathogenic factor but also a good state of the
colour: reddish-purple, red sides
shape: very swollen, swollen sides, Stomach crack
coating: sticky-yellow, sticky-dry-rough-yellow inside the Stomach
reddish-purple colour of the tongue body indicates Blood stasis
deriving from or associated with Heat. The redness on the sides
indicates Heat in the Spleen and/or Stomach; in this case, the redness
on the sides is not related to the Liver because it occupies a wider
area than the Liver are and also because it is associated with a
Spleen-type of swelling on the sides. The general swelling of the
tongue body indicates the presence of Phlegm, while the swelling
on the sides is related to the Spleen and it indicates Dampness
occurring against a background of chronic Spleen deficiency.
sticky-yellow coating confirms the presence of Dampness while the
Stomach crack, together with the sticky-dry-rough-yellow coating
insides it indicates Phlegm-Heat in the Stomach.
conclusion, the main location of the disharmony in this case is
in the Middle Burner with Stomach and Spleen Heat, Damp-Heat and
Phlegm-Heat in the Stomach. The Blood stasis probably derives partly
from the Heat and partly from the chronic retention of Phlegm.
colour: slightly pale, almost normal
shape: very swollen, more so on the (patients) left side
coating: thick-white-rootless coating.
swelling of the tongue body indicates Phlegm while the partial swelling
on the left side often indicates a weakness of the channels on that
side. Such weakness may derive either from a febrile disease with
high temperature or from an accident to that side of the body.
rootless coating indicates Stomach-Qi or Stomach-Yin deficiency,
but its thickness indicates the presence of a pathogenic factor,
probably Dampness. A thick-rootless coating is doubly bad because,
on the one hand Stomach-Yin is deficient, but, on the other, there
is a pathogenic factor. It is better for a rootless coating to be
thin (indicating Stomach-Qi deficiency but no pathogenic factor)
or for a thick coating to have a root (indicating the presence of
a pathogenic factor but also intact Stomach-Qi).
shape: swollen sides
coating: thin-white-rootless coating, peeled in patches.
reddish-purple colour indicates Blood stasis with Heat. The swelling
on the sides indicates chronic Spleen deficiency and the rootless
coating missing in patches indicates Stomach-Yin deficiency.
patient too suffers primarily from a disharmony in the Middle Burner
with chronic Spleen-Qi deficiency and Stomach-Yin deficiency. Both
the swelling on the sides (related to the Spleen) and the rootless
coating missing in patches (related to Stomach-Yin) indicate a chronic
condition because this type of swelling and the lack of coating
develop over a long period of time.
is not possible to tell from the tongue only which other organ (apart
from the Stomach), if any, is affected by the Blood stasis and the
colour: red, red tip
slide is presented here mainly as an example of a short tongue body.
The patient could not stick the tongue out more than that. The red
tip indicates Heart Heat.