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Tongue body

舌质 〔舌質〕 shé zhí

舌体〔舌體〕shé tǐ

The tongue itself, in contradistinction to the tongue fur (coating). Examination of the tongue body focuses on the form, bearing, and color of the tongue. The following discussion outlines the main variations in the tongue body and their diagnostic significance. For more detail, see tongue examination.

Tongue Form

Attention is paid to possible enlargement, shrinkage, red speckles and prickles, fissures, and mirror surface.

Enlargement: A swollen tongue, with dental impressions on the margin, is known as an enlarged tongue and indicates qì vacuity or the presence of water-damp. An enlarged tongue that is pale in color, with a white, glossy fur, indicates qì vacuity. Witha slimy tongue fur, enlargement generally indicates damp or damp-heat. In Western medicine, tongue enlargement may be seen in myxedema, chronic nephritis, and chronic gastritisand is thought to be due to hyperplasia of the connective tissue, tissue edema, or blood and lymphatic drainage disturbances. Enlargement is markedly different from a painful, swollen, red tongue, which characterizes an intense heat evil or heart fire flaming upward.

Shrinkage: A thin, shrunken tongue indicates a yīn liquid vacuity or a dual vacuity of yīn and qì. A shrunken tongue due to damage to yīn humor by exuberant heat is crimson in color and dry. In dual vacuity of qì and yīn, the tongue is pale in color. The results of modern clinical observation show that shrinkage generally occurs in the latter stages of externally contracted febrile diseases, in conditions described in Western medicine as pulmonary tuberculosis, and in advanced-stage carcinoma. It is explained as atrophy of the lingual muscle and epithelium due to malnutrition.

Red speckles and prickles: Red speckles and prickles appear on the tip or margins of the tongue and indicate exuberant heat. They occur in various externally contracted febrile diseases, particularly yáng brightness (yáng míng) repletion heat patterns, and in conjunction with maculopapular eruptions. Speckles, prickles, and pain in the tongue may also occur in patients suffering from insomnia or constipation or in those working late at night. According to Western medicine, speckles and prickles are due to an increase in the size or number of fungiform papillae.

Fissures: Fissures vary in depth and position. Occurring in conjunction with a dry tongue, they indicate fluid vacuity. They may also occur in exuberant heat patterns, in conjunction with a crimson tongue. Fissures are seen by Western medicine to result from mucosal atrophy, chiefly associated with chronic glossitis, and in 0.5 of cases to causes wholly unrelated to disease.

Mirror tongue: A completely smooth tongue, free of liquid and fur, is sometimes referred to as a mirror tongue and indicates severe yīn humor depletion. A smooth red or crimson tongue indicates damage to yīn by intense heat. If pale in color, a smooth tongue indicates damage to both qì and yīn. According to the results of recent clinical observation, the mirror tongue mostly occurs in the latter stages of glossitisbut may also be seen in vitamin B deficiency, anemia, and the latter stages of certain diseases. It is attributable to shrinkage of the filiform and fungiform papillae.

Tongue Bearing

Morbid deviations from normal tongue bearing include stiffness, limpness, trembling, deviation, contraction, and agitation.

Stiffness: If the tongue moves sluggishly, inhibiting speech, it is called a stiff tongue. This occurs in several serious diseases, such as heat entering the pericardium, phlegm confounding the orifices of the heart, phlegm obstructing the network vessels, and liver wind stirring in the inner body. Other signs are therefore decisive in determining the nature of the disease. In Western medicine, a stiff tongue generally indicates diseases of the central nervous system.

Limpness: A tongue that is soft and floppy, moves with difficultyand cannot be extended is known as a limp tongue. When limpness is due to intense heat or to yīn humor depletion, the tongue is also red or crimson, and dry. In qì and blood depletion, it is limp and pale. In Western medicine, a limp tongue is seen as a sign of neurological diseases or lesions affecting the lingual muscle.

Trembling: If the tongue trembles when it moves, the cause is ascendant hyperactivity of liver yáng, internal wind stirred by exuberant heat, or qì vacuity. In the first two cases, the tongue is red or crimson, whereas in qì vacuity the tongue is pale. The results of modern clinical observation shows that trembling of the tongue occurs in high fever, hyperthyroidism, hypertension, and several neurological disorders.

Deviation: In cases of wind stroke due to internal liver wind or phlegm obstructing the network vessels, the tongue often inclines to one side. Modern clinical observation associates a deviated tongue with disorders of the hypoglossal nerve or intracranial lesions.

Contraction: Contraction of the tongue preventing extension is a critical sign in most cases. The cause is either damage to yīn by extreme heat or fulminant yáng qì desertion. A short frenulum due to congenital factors may also prevent extension.

Agitation: Habitual extension of the tongue and licking of the lips is known as a agitated tongue. It is a sign of heat in the heart and spleen, and heralds the stirring of wind. It also occurs in mentally retarded children.

Tongue Color

The normal color of the tongue is a pale red. In tongue diagnosis, the term pale denotes any color paler than normal, whereas red denotes a color deeper than normal. If considerably deeper in color, the term crimson is used. A blue-green-purple tongue is a red tongue with a blue, or in pronounced cases, indigo hue. Changes in the color of the body of the tongue reflect the state of blood and qì and the severity of disease. In Western medicine, changes in the tongue color are explained by changes in blood chemistry, in the viscosity of the blood, and by hyperplasia or atrophy of the epithelial cells of the glossal mucosa.

Pale Tongue: A pale tongue indicates vacuity qì and blood. A pale tongue that is enlarged and well-moistened, accompanying cold signs indicates yáng qì vacuity. In Western medicine, a pale tongue is associated with the latter stages of schistosomiasis, chronic nephritis, cancer, and various forms of anemiaand is seen as the result of a reduction of red corpuscles, disturbance of protein metabolism, and tissue edema.

Red tongue: A red tongue indicates heat, due to either vacuity or to repletion. A crimson tongue with a yellow fur indicates repletion heat (more at crimson below); a fresh tender-red (a pastel red) indicates vacuity heat. A red shrunken tongue indicates yīn vacuity with effulgent fire, and a red tongue with prickles indicates heat in the provisioning aspect. A dry red tongue indicates damage to stomach liquid, and a tongue that is red at the tip indicates heart fire flaming upward; and a tongue that is red at the margins indicates depressed liver-gallbladder heat.

Crimson tongue: A crimson tongue is also associated with heat, but the added depth of color indicates that the heat is located in the provisioning or blood aspect. Red and crimson coloring of the tongue, according to modern clinical observation, is associated with heat effusion due to infection, burns, post-operative conditions, advanced carcinoma, hyperthyroidism, ascites due to cirrhosis of the liver, and tuberculosis. It is thought to be due to inflammation of the tongue causing dilation of the capillary vessels of the glossal mucosa.

Purple tongue: Purple coloration indicates an impaired flow of blood and qì leading to congealing blood stasis. This is a part of either heat or cold patterns. A generalized blue-green-purple coloration indicates severe blood stasis. Purple macules indicate less severe or localized blood stasis. A glossy blue-green-purple tongue characterizes cold patterns caused by failure of yáng qì to warm and move the blood. A reddish purple, dry tongue indicates binding blood stasis due to penetration of heat to the blood aspect. According to the results of modern clinical observation, a purple tongue is observed in cirrhosis of the liver, heart diseases, asthma, cholecystitis, ulcers, and gynecological diseases. It is associated with hemostasis of the blood in the orifice vein and superior vena cava.

Correspondences between tongue surface sections and the organs

Though subject to argument, some correspondence between parts of the tongue surface and the viscera is accepted. It is generally thought that the root of the tongue is related to the kidney, which in a sense is the root of the body. The center of the tongue’s surface is said to reflect the condition of the spleen and stomach, which are at the body’s center. The tip of the tongue reveals the condition of the heart. Agreement ends here. Some texts state that the condition of the liver and gallbladder is reflected on the sides of the tongue, and that the lung is reflected at the tip. In other sources, the left side of the tongue is assigned to the lung, and right side to the liver. A few other variations may also be found. In view of these inconsistencies, organ correspondences should always be correlated with data from the other examinations. See lists below.

Correspondences Between Tongue Color and Disease

Pale red (normal)

Bright Red

Crimson

Purple

Significance of Tongue and Fur

Pale Tongue (white)

Pale Red Tongue (normal)

Bright Red Tongue

Crimson Tongue

Green-blue or purple

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