Tongue diagnosis

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Common tongue syndromes Tongue syndromes.jpeg
Common tongue syndromes

Tongue diagnosis in traditional Chinese medicine is a method of diagnosing disease and disease patterns by visual inspection of the tongue and its various features. It is one of the major diagnostic methods in traditional Chinese medicine since the time of the Yellow Emperor's Inner Classic. [1] It is considered a part of the inspection method within the four methods of diagnosis. [2] Practitioners claim that the tongue provides important clues reflecting the conditions of the internal organs. Like other diagnostic methods in traditional Chinese medicine, tongue diagnosis is based on the "outer reflects the inner" principle, which is that external structures often reflect the conditions of the internal structures and can give us important indications of internal disharmony. [2]

Contents


Historical development

The practice of tongue diagnosis in Chinese medicine can be traced back over two thousand years to the Huangdi Neijing (Yellow Emperor's Classic of Internal Medicine), which contains early references to observing the tongue as part of clinical examination. During the Han dynasty, Zhang Zhongjing (张仲景) described numerous tongue presentations in his Shanghan Lun (Treatise on Cold Damage Disorders, c. 200 CE), correlating specific tongue appearances with particular disease stages and treatment strategies. Tongue diagnosis received further systematic development during the Yuan and Ming dynasties. The most comprehensive historical work on the subject is the Aoshi Shanghan Jinjing Lu (敖氏伤寒金镜录, Ao's Golden Mirror Record of Cold Damage) attributed to Du Ben (杜本) of the Yuan dynasty (c. 1341), which is considered the first monograph specifically devoted to tongue diagnosis and includes 36 illustrated tongue images with corresponding diagnostic interpretations. During the Qing dynasty, further advances were made by physicians such as Zhang Deng (张登), who authored the She Jian Bian Zheng (舌鉴辨正, Identification of Tongues and Correction of Diagnoses), expanding the range of documented tongue presentations and refining diagnostic criteria. [3] [4]

Topography of the tongue

The tongue is divided into topographic regions corresponding to the triple burner and zangfu organs. [1] By observing the various regions of the tongue, one can determine where the disease is located within the body.

One method of mapping the tongue is by dividing it into three sections to correspond to the triple burner. The tip of the tongue corresponds to the upper burner (heart, lungs); the middle corresponds to the middle burner (stomach, spleen), and the base of the tongue corresponds to the lower burner (kidneys, bladder, intestines). [1]

Another method is to map the tongue by zangfu organs. The tip of the tongue corresponds with the Heart, the region at the front of the tongue between the tip and the center corresponds to the Lung, the center corresponds with stomach and spleen, the right side corresponds to the gallbladder, the left side corresponds to the liver, and the base of the tongue corresponds to kidney, bladder, large intestine, and small intestine. [1]

Aspects of the tongue

The aspects of the tongue considered in diagnosis include:

In addition, various features are also considered, including absence or presence of and the characteristics of movement, bristles, cracks, and teethmarks. [1]


Tongue body color

The color of the tongue body (舌质, she zhi) is one of the most diagnostically significant features in tongue diagnosis, as it reflects the state of qi and blood and the balance of yin and yang in the body. A pale or light tongue (淡白舌) indicates qi deficiency, blood deficiency, or yang deficiency, and is commonly seen in chronic conditions or cold patterns. A red tongue (红舌) indicates the presence of heat, which may be due to either excess heat or deficiency heat (yin deficiency). A crimson or deep red tongue (绛舌) signifies more severe heat conditions, often involving the nutritive (营, ying) and blood (血, xue) levels, and is frequently observed in the later stages of febrile diseases. A purple tongue (紫舌) may appear in two forms: a bluish purple tongue indicates blood stasis associated with cold, while a reddish purple tongue indicates blood stasis associated with heat. A dark or dusky tongue may also suggest long standing blood stasis or severe internal cold. [5] [6]

Tongue body shape

The shape of the tongue body provides additional diagnostic information. A swollen or enlarged tongue (胖大舌) that appears larger than normal and may show tooth marks along the edges typically indicates spleen qi deficiency or the accumulation of dampness and phlegm. The presence of tooth marks (齿痕舌) alone on the tongue edges reinforces the diagnosis of spleen qi deficiency. A thin or emaciated tongue (瘦薄舌) that appears smaller than normal suggests deficiency of qi and blood or yin deficiency with internal heat. Tongue cracks (裂纹舌) may appear in various patterns and generally indicate yin deficiency or blood deficiency, though congenital cracks that have been present since birth are considered a normal variant and do not carry pathological significance. A stiff tongue (强硬舌) that lacks flexibility may indicate wind phlegm obstructing the channels or extreme heat consuming body fluids, while a trembling or quivering tongue (颤动舌) often suggests internal wind or qi deficiency. [7]

Tongue coating

The tongue coating (舌苔, she tai) is formed by stomach qi and provides important information about the state of the digestive system and the nature of pathogenic factors. A thin white coating is considered normal, indicating healthy stomach qi. A thick coating suggests the presence of pathogenic factors or food stagnation. The color of the coating is particularly significant: a white coating (白苔) generally indicates cold patterns or the early stages of exterior conditions. A yellow coating (黄苔) indicates heat, with deeper yellow suggesting more severe heat. A gray coating (灰苔) may indicate either interior heat or interior cold dampness depending on the moisture level. A black coating (黑苔) represents the most severe condition, indicating either extreme heat consuming yin fluids or extreme cold due to yang deficiency. The coating may also be described as greasy or slimy (腻苔), which indicates dampness or phlegm accumulation, or as peeled (剥苔) where the coating is partially or completely absent, suggesting damage to stomach yin or stomach qi. [8] [1]

Tongue moisture

The moisture level of the tongue reflects the state of body fluids (津液, jinye). A tongue with normal moisture indicates that body fluids are sufficient and are being properly distributed. A dry tongue (燥舌) indicates consumption or damage to body fluids, which may result from excess heat, yin deficiency, or prolonged fluid loss. A wet or slippery tongue (滑舌) with excessive moisture indicates the accumulation of dampness or water retention, often associated with yang deficiency or impaired fluid metabolism by the spleen and kidneys. [9]

Normal tongue

A normal, healthy tongue is pale red or pink with a thin white coating. The tongue should have spirit, but it should not tremble or quiver. It should have a shape which is not too swollen or flabby, with no cracks, and be slightly moist. [1]

Significance of the tongue in diagnosis

When differentiating between various patterns in clinical settings, tongue diagnosis plays a significant role. In a situation in which a patient has complex or even conflicting clinical presentations, TCM practitioners claim the tongue body color nearly always reflects the true underlying condition. [1] For example, a patient may present with various localized signs of heat, however, the tongue may reflect an underlying condition of cold from yang deficiency. In this case it is important to consider the underlying condition in the treatment principle. [1]

Scientific evaluation

A 2008 study found that interpractitioner and intrapractitioner reliability levels were low. [10] The features of the tongue are claimed to be tied to specific body parts, but evidence is lacking. [11]

See also

References

  1. 1 2 3 4 5 6 7 8 9 Maciocia, Giovanni (1995). Tongue Diagnosis in Chinese Medicine. Eastland Press. ISBN   978-0-939616-19-0.[ page needed ]
  2. 1 2 Maciocia, Giovanni (2015). "Tongue". The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences. pp. 324–331. ISBN   978-0-7020-5216-3.
  3. ↑ Maciocia, Giovanni (1995). Tongue Diagnosis in Chinese Medicine (revised ed.). Eastland Press. ISBN   978-0-939616-19-0.
  4. ↑ Deng, Tietao (2016). Diagnostics of Traditional Chinese Medicine (7th ed.). China Press of Traditional Chinese Medicine. ISBN   978-7-5132-3228-4.{{cite book}}: Check |isbn= value: checksum (help)
  5. ↑ Maciocia, Giovanni (2018). Diagnosis in Chinese Medicine: A Comprehensive Guide (2nd ed.). Elsevier. ISBN   978-0-7020-4496-0.
  6. ↑ Deng, Tietao (2016). Diagnostics of Traditional Chinese Medicine (7th ed.). China Press of Traditional Chinese Medicine. ISBN   978-7-5132-3228-4.{{cite book}}: Check |isbn= value: checksum (help)
  7. ↑ Maciocia, Giovanni (1995). Tongue Diagnosis in Chinese Medicine (revised ed.). Eastland Press. ISBN   978-0-939616-19-0.
  8. ↑ Maciocia, Giovanni (2018). Diagnosis in Chinese Medicine: A Comprehensive Guide (2nd ed.). Elsevier. ISBN   978-0-7020-4496-0.
  9. ↑ Zhu, Wenfeng (2007). Diagnostics of Traditional Chinese Medicine (2nd ed.). China Press of Traditional Chinese Medicine. ISBN   978-7-80156-813-2.{{cite book}}: Check |isbn= value: checksum (help)
  10. ↑ Kim, Minah; Cobbin, Deirdre; Zaslawski, Christopher (June 2008). "Traditional Chinese Medicine Tongue Inspection: An Examination of the Inter- and Intrapractitioner Reliability for Specific Tongue Characteristics". The Journal of Alternative and Complementary Medicine. 14 (5): 527–536. doi:10.1089/acm.2007.0079. PMID   18564955.
  11. ↑ Hall, Harriet (26 December 2017). "A Misguided Study to Test the Reliability of Traditional Chinese Medicine Pulse Diagnosis". Science-Based Medicine.

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