9.26.15 Gmaciocia Tonguedx LN

TCM Tongue Diagnosis
By
Giovanni Maciocia, OMD, LAc
Leading Acupuncture CE Provider

For On Demand CEU/PDA in the office, at home or on the go.
Choose from videos, audio, articles or streaming Live webinars.
Lotus Institute of Integrative Medicine

PO Box 92493, City of Industry, CA 91715
Tel: 626-780-7182 Fax: 626-905-6887
Website: www.eLotus.org Email: info@elotus.org
www.eLotus.org
LEARN THE SCIENCE. PRACTICE THE ART. HEAL.
READ FIRST
Welcome to eLotus.
Before beginning your course, please read through our copyright information.
GENERAL POLICIES / GUIDELINES
2.
1.
CEUs/PDAs: CEU Certificates for distance learning and live

webinar courses can be immediately printed after you pass a
quiz (70% or higher).
2.
GIFT CERTIFICATE: We are the only organization offering

live CEU webinars where your full tuition is subsidized with a
gift certificate good towards the purchase of high-quality
herbs. The intention of this is to provide affordable and
effective CEU classes to help you maximize clinical success
and eventually reach our goal of helping the TCM profession
become an active, vital, and integral resource in the health
needs of the community. (Live CEU Webinars Only)
a. For educational purposes, each of our webinars are

recorded for future broadcast. Any information,
comments, or questions you post in the meeting room is
recorded. You understand that the Internet is not a
secure medium and that any material posted can be
accessible to anyone with Internet access.
b. You give Lotus Institute of Integrative Medicine, LLC. the
right and permission to use, reproduce, publish, transmit,
distribute, and display any of your postings for use in
promotional or educational materials, including but not
limited to articles, brochures, newsletters, CD, DVD,
audio and video recordings, company website, etc.
3.
COPYRIGHT AND CONSENT

1.
4.
b. Taping of webinars, online video recordings, and online

audio recordings is not allowed. All the relevant
information given (oral, written, or in any other format)
are copyrighted and intended for personal and
professional use in your clinical practice only. The
information you receive shall not be copied, duplicated,
or distributed in any format or be used for teaching
without prior written consent from Lotus Institute of
Integrative Medicine (eLotus).
c. Any information shall not be shared with any other
organization for any purpose. Association and/or
affiliation with any other organizations that may be
viewed as a competitor, i.e. organizations providing CEU
seminars, distance or live; herbal manufacturer or
distributor, instructors, schools, educational organization,
shall be disclosed.
Consent and Disclaimer Part III (Copyright)

a. Multimedia images used in this presentation are obtained
from various internet sources. No infringement of
copyright is intended in the usage of any multimedia
images in this presentation. Any multimedia images used
are purely for educational purposes by the instructor and
eLotus, to comply with Fair Use laws for multimedia
usage from internet sources.
Consent and Disclaimer Part I (Copyrighted Information)

a. Lotus Institute of Integrative Medicine,
PO Box 92493, City of Industry, CA 91715
Tel: 626-780-7182.
Fax: 626-609-2929.
Website: www.eLotus.org.
Email: info@eLotus.org
Consent and Disclaimer Part II (Webinar Recording)
Consent and Disclaimer Part IV (Speaker/Author)

a. Where expressly indicated, eLotus is engaged in
providing a forum to participants for information
exchange purposes only. eLotus does not make any
representations or warranties (express or implied) as to
the accuracy, currency or authenticity of the information,
services and materials presented at its seminars,
webinars, or publications written by any of its speakers.
b. eLotus, its employees and agents, do not accept any
liability to any person for the information, service,
materials or advice (including the use of such
information, services, or material or advice) which is
provided by any of the speakers at eLotus seminars,
webinars, or the speakers publications. Any such
information, service, materials, or advice provided by any
of the speakers at eLotus seminars, webinars, or
speaker's publications, shall remain the sole
responsibility of the author.
Our Mission
To provide the highest quality, clinically relevant information readily accessible to the
TCM community.
Our Vision
All TCM practitioners operate in the highest level of efficiency and effectivity
in the healing of patients and the professional practice becoming an active,
vital and integral resource in the health needs of the community.
Our Promise
To help you maximize clinical success and to make TCM the first choice
when it comes to healthcare.
www.eLotus.org
Services and Products by eLotus

For years, Lotus Institute of Integrative Medicine has taken pride in the presentation of the most qualified and experienced speakers and
practitioners of Oriental Medicine in their respective specialties. This allows us to fulfill our mission of providing the highest quality, clinically
relevant, and readily available information to the TCM community. Most of our speakers have over twenty-five years of clinical experience.
They have preserved and developed clinically effective approaches that now serve as testaments to their longevity of successful practice.
Our speakers are individuals who are respected by their peers, beyond the readily apparent scholastic and professional achievements,
but more so by their willingness to share their highly-valued insights so you will be able to utilize them immediately, the very next day in
your practice.
Like Lao-tzu's adage - when you do better, we all do better

LotusCEU WEBINARS
Get live CEU webinars (web-based seminars) streamed
right to your computer, wherever you are! This counts
as LIVE attendance for CA Acupuncturists!
LotusCEU SEMINARS
Want to attend a class in person instead? Join us
at a live 8-hour CEU seminar!
Lotus Website:
www.eLotus.org
Lotus OnlineCEU VIDEOS

Missed a webinar? Enjoy on-demand CEU video
recordings that you can view anytime, anywhere,
at your convenience!
Lotus OnlineCEU AUDIO

Missed a webinar? Enjoy on-demand CEU audio
recordings that you can listen to anytime, anywhere,
at your convenience.
Lotus OnlineCEU ARTICLES

Get CEUs with articles that you can read anytime,
anywhere, at your convenience!
DRUG-HERB
REFERENCE
GUIDE SET
2ND EDITION
is an invaluable suite of reference tool
that will serve as a catalyst to support
and multiply your skills for an effective
acupuncture and herbal practice.
Lotus WEBINAR Weekdays

A FREE 1-hour webinar every week! Sign up for
eLotus Updates to receive exclusive invitations!
TCM Wisdom Tube

Missed our free 1-hour webinars? Watch them FREE
on-demand in our TCM Wisdom Tube!
FREE Articles for Download

Auricular Acupuncture Acupuncture Disorders
Herbs Herb-Drug Interactions / Pharmacological
Effects of Herbs Pulse Diagnosis Practice
Management / Legal Aspects Others
eLotus Updates
FREE subscription to current events of ancient wisdom!
Get enriching articles emailed to you monthly. Be the
first to receive news, promotions, or invitations to our
webinars. Sign up today!!
nd
Clinical Manual of Oriental Medicine, 2 edition

CD Manual of Oriental Medicine, v.2
nd
Mini Manual of Integrative Medicine, 2 edition
www.eLotus.org
eLotus GOLD PASS

365 Days of 24/7 Unlimited CEUs
& Full Tuition Credit in Herbs*!
now available with
risk-free 7-day trial & 2 payment options
eLotus Gold Pass is everything you love

about the Full Access Pass & more!
The best deal for

CEU renewal. One
purchase, get all
your money back in
herbs, no worries!
- Mark
Webinars, videos, audios and articles from 70+ experts
This is the second

year that I have had
the Annual Pass
and it has totally
transformed my
practice and my
life. I have gained a
new level of clinical
effectiveness that
I did not think
possible.
Alistair
Unlimited CEUs (NCCAOM, CA, FL, IL, TX, CTCMA, IVAS, ABORM)
Automatically registered for ALL Live webinars throughout your Gold Pass
Live chat and phone support, plus easy sign up and payment
CEU/PDA Certificates issued immediately upon course completion
FULL TUITION back as a gift certificate from Evergreen Herbs
1295.00
OR
$125/mo
for 12 months
order/learn more @ www.eLotus.org/Gold

toll-free (866) 905-6887 or scan with smart phone g
*The Gold Pass is an yearly contract non-refundable after the 7-day trial. Please read the disclaimer in its entirety on our product webpage prior to purchasing.
LotusInstitute Of Integrative Medicine

LEARN THE SCIENCE. PRACTICE THE ART. HEAL..
www.eLotus.org
Toll-Free Tel: (866) 905-6887
Website:
TONGUE DIAGNOSIS IN CHINESE MEDICINE

TABLE OF CONTENTS
TCM TONGUE DIAGNOSIS
Part 1
Giovanni Maciocia
Red tip
Red sides/ red front
Red centre
The tongue body colour in exterior conditions
Differentiation between Heat and Fire
Red points and red spots
Red points tip
Red points/ spots sides and root
Red points Lung/ breast area
White vesicles
Shen disturbances and tip of tongue
Yin Xu and Empty Heat on tongue
Degrees of Yin Deficiency
Degrees of Empty Heat
Purple Tongue
Differentiation between reddish-purple and bluish-purple
Areas of Blood stasis
Blood stasis in women
Purple Chest/ Breast Area
Purple Chest Area-Breast area in women
Sublingual veins
Sublingual veins in relation to modern diseases
Observation of tongue body shape
Stomach-Yin deficiency
Yin deficiency of Stomach and Intestines
Spleen-Yin deficiency
Kidney-Yin deficiency
Sudden appearance or disappearance of partial coating
Root of coating
Coating without root
Filiform papillae
Thickness of Coating
Colour of Coating
Coating distribution
Sticky/ Slippery/ Mouldy coating
Tongue diagnosis and herbal therapy
Differentiation between deficiency of Qi or Yin of Stomach and Spleen
Differentiation between Heat at the Qi or Ying/ Blood level and that
Correlation between Types of Tongue and Endoscopy Results in Patients
with Chronic Illnesses of the Stomach and Duodenum
Correlation between Types of Tongue and Endoscopy Results continued
Gastroscopy Results and Tongue Coating
Correlation between Gastric Acidity and the Tongue
Types of Tongue in Cases of Perforated Ulcer
Limitations of tongue diagnosis

Items of observations of the Tongue
Aspects of tongue diagnosis
Normal Tongue
Topography of tongue
Tongue areas
Chest/ breast area
Swollen on the sides: differentiation between Liver Spleen and chest
Sides, Uterus
Spleen area on sides
Spleen-Yin deficiency cracks
Thick coating on root
Circumvallate papillae
Pale tongue
Red tongues
Red tongue areas
Thin tongue
Swollen tongue
Partial swelling of the tongue
Swelling of tip
Swelling of side area between centre and tip
Swelling of the side area between centre and tip photos
Swelling of front third of tongue
Swelling of sides, central section
Swelling of sides Liver area
Teethmarks
Cracks
Heart crack
Stiff tongue
Quivering and moving tongue
Deviated tongue
Preventing value of tongue diagnosis in the elderly
Tongue coating
Differentiation between thick coating and coating without
root
Aspects of tongue coating
Coating/absence of coating
Degrees of Yin deficiency
Areas of Yin deficiency
Lung-Yin Deficiency
Body Shape and Sublingual Veins

Tongue in Stomach Cancer-Body Colour
Tongue and Colonoscopy- Body Colour
Correlation between Atrophic-Necrotic Epithelial Cells of the
Tongue and Yin-Xu Epigastric Pain
Correlation between Atrophic-Necrotic Epithelial Cells of the
Tongue and Yin-Xu Epigastric Pain
Epithelial Cells of the Tongue in Three Groups
Wen Bing and tongue diagnosis
Giovanni Maciocia & Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715
Tel: 626-780-7182 Fax: 626-609-2929 Website:
www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.
Limitations of Tongue Diagnosis
Strength of Tongue Diagnosis

The tongue gives the true picture roughly 98% of the time e.g. Yin/
Yang Xu, Hot/ Cold.
The tongue does not always reflect all aspects of a condition e.g. in
Liver-Blood deficiency with Liver-Qi stagnation, the tongue will
often reflect the former but not the latter.
The progress, or lack of progress, of disease can be monitored e.g.:

Do not expect the tongue to reflect all the aspects of a pathology.
A purple body colour is expected to become less purple.
A tongue without coating is expected to develop a coating.
Thick coating is expected to become thinner.
It is easier than pulse diagnosis! Also more objective
Order of observation of the tongue
There is a lack of detail e.g. a thick-sticky, yellow coating on the

root shows Damp-Heat in the Lower Burner but not its exact
location.
Pulse diagnosis can clarify the exact location of Damp-Heat (e.g.
Damp-Heat in the Bladder presents with a Wiry pulse in the left Chi
position, in Damp-Heat in the Intestines the pulse is Wiry on both
Chi positions.)
1.
Body Colour:
It is important to analyze the tongue systematically, in a certain

order. One should not let ones attention be drawn to details of the
tongue first. One must look at the tongue systematically and this is
the order I recommend:
Heat or Cold
Yin or Yang deficiency
Xu
Shi
Fu (Stomach)
Hot/ Cold
Xu/ Shi
2.
1) Body colour
Body Shape:
2) Body shape
3) Coating
4) Moisture
3.
5) Shen
The importance of looking at a tongue systematically cannot be
overemphasized.
Coating:
Aspects of Tongue Diagnosis
Tel: 626-780-7182 Fax: 626-609-2929 Website:
Topography of Tongue
Normal Tongue
1. Body colour
Pale-red
2. Body shape
Not thin, not swollen
Lower Burner
Middle Burner
Not stiff, not flabby

Without cracks
Upper Burner
3. Coating
Thin white
4. Moisture
Slightly moist
5. Shen
With shen, fresh, radiant, brilliant
HE Heat
LU Heat
Please note that the Lung area encompasses

the Heart area
Differentiation between Liver and Spleen swelling

Tongue areas
Heart / tip
Liver / sides
Liver and Heart /

sides and tip
Stomach / centre
Stomach and Spleen /

sides in central section
Lungs / front third
Liver swelling
Spleen swelling
Chest/breast area
Spleen swelling
Spleen swelling
Differentiation between Liver, Stomach/Spleen and chest areas
The chest area is on the sides of the tongue, between the centre part
and the tip.
The chest area reflects a pathology of three organs: heart, lungs or
breast in women.
Changes in this area to look for are:

1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
Thin, long band = Liver
Broad band, middle section

= ST/ SP
Chest/breast
Chest/breast
3) Red points
4) Coating (absence of coating)
lung/heart
breast
Tel: 626-780-7182 Fax: 626-609-2929 Website:
The chest area reflects pathologies of the lungs, heart or breast but
in a Western medical sense. A change in the chest area may
involve a change in colour or body shape.
How to differentiate when a change in the chest area indicates a
problem of the lungs or heart or of the breasts in women? A
change in the chest area indicates a pathology of the breast in
women rather that of lungs/heart:
Examples of lung pathology manifesting in the chest area are

chronic asthma or chronic emphysema (in which case the chest
area would be swollen and possibly purple).
An example of heart pathology is chronic coronary heart disease
(in which case the chest area would be purple).
As the area on the sides between the centre and the tip reflects the
condition of heart/ lungs/ breast, I call this the chest area.
1) In the absence of an obvious lungs/heart pathology

2) Especially when it is unilateral
Swollen chest area
Apart from a purple colour and a swelling, other possible changes

in the breast area are teeth marks that are confined only to the
breast area, red points or the absence of coating of the breast area.
Teeth marks only in the breast area indicate usually a problem in
the breast in women (possible carcinoma) occurring against a
background of severe Qi deficiency
Red points in the breast area indicate Toxic Heat in the Lungs or
breast
The absence of coating in the breast area indicates a possible
problem in the breasts in women occurring against a background of
Yin deficiency.
Teeth marks
breast area on
left
Teeth marks
breast area on
right
Red points breast

area on right
Purple chest area
The same area on the sides that reflects the Liver, in women also
reflects the Uterus (especially when it is purple)
The sides indicate the state of the Liver but when they are Purple,
in women, they may indicate Blood stasis in the Uterus
No coating breast
area left side
Area on sides around centre

The area on the sides in the middle section of the
tongue (around the centre) reflects conditions of
the Stomach and Spleen.
Root of tongue
Thick-sticky-yellow coating with red spots on the root = Damp-Heat in
the Bladder, Intestines, Kidneys, prostate or uterus
If it is red, it denotes Heat of the Stomach and

Spleen. If it is swollen, it denotes Spleen
deficiency with Dampness.
Red centre: ST Heat
Red on the sides around the

centre: ST/SP Heat
Tel: 626-780-7182 Fax: 626-609-2929 Website:
Normal tongue
It is important to note that, in Chinese tongue diagnosis, we do not look

at the two large papillae (circumvallate papillae) that are right at the back
of the root of the tongue. They have no clinical significance. If we see
those two papillae, we are looking too far back.
The normal tongue is pale-red.

It is pale because the Stomach fluids flowing up to the tongue make it
pale. It is red for two reasons:
a) Because Heart-Blood makes it red (the tongue is an offshoot of

the Heart)
b) Because the Minister Fire flows up to the tongue making it red.
Therefore, the influence of Stomach fluids, Heart-Blood and Minister

Fire give the tongue a normal pale-red colour.
It follows, therefore, that a normal, pale-red tongue indicates a good state
of the Stomach, Heart-Blood and Minister Fire (and therefore KidneyYang).
Pale (too pale)

Normal tongue
ST-Fluids
HE-Blood
Minister Fire
Tongue Pale
Tongue Red
KI
HE
Pale-Red (Normal)
Tongue
Normal Red
By Pale is meant a tongue that is too pale, not a normal pale-red

tongue. The tongue may be pale either because not enough Blood
reaches it (Blood deficiency) or because a deficient Yang fails to
carry Blood to it (Yang deficiency). A deficiency of Kidney-Yang
also makes the tongue pale because not enough heat from the
Minister Fire reaches it.
Therefore, a pale tongue indicates either Blood deficiency or Yang
deficiency. The Blood deficiency may involve the Spleen, Liver or
Heart or a combination of these organs.
If there is Liver-Blood deficiency, only the sides of the tongue may
be pale. Other than that, one cannot pinpoint from the tongue only
which organ is primarily affected by Blood deficiency.
This tongue is almost normal in terms of body colour

and shape and coating. The only abnormality is a slight
swelling
Minister Fire
Pale, dry
Pale, dry
Red Tongue
Blood Xu
Yang Xu
Slightly dry
Slightly wet
Slightly thin
Slightly swollen
Women
Men and women
Frequently
pale on sides
in LIV-Blood
Xu
Occasionally
orangey in
Severe LIVBlood Xu
The tongue is never pale only on the tip
By Red is meant a tongue that is too red, not a normal, pale-red

tongue. Obviously, red refers to the colour of the body and not to
that of the coating.
A red tongue indicates pathological Heat. The first question we need
to ask ourselves when confronted with a red tongue is: does it have a
coating or not? For a red tongue with coating indicates Full Heat
while a red tongue without coating indicates Empty Heat. It is
important to understand that both Full Heat and Empty Heat are
indeed Heat and they therefore each make the tongue too red.
It is the lack of coating that indicates Yin deficiency and, for this
reason, if a tongue is too red and lacks a coating, it indicates Empty
Heat deriving from Yin deficiency.
Red with coating =

Full Heat
Normal colour,
without coating =
Yin deficiency
Red without coating =

Empty Heat
Tel: 626-780-7182 Fax: 626-609-2929 Website:
YIN XU VS EMPTY HEAT
= Yin
= Empty Heat
RED (Too red)
Normal Pale-Red
Coating with
root
Red = Heat
Tongue without coating
= Full Heat
No coating or
coating without
root
Time
Dark red
= Empty Heat
Red tongue without coating
Too thin
Without root
Red with normal coating

Full Heat
Partially without
coating
Totally no
coating
Red without coating = Empty Heat
If the whole tongue is red, it indicates Heat or Empty Heat, depending

on whether it has a coating or not. When the whole tongue is equally
red, we cannot actually pinpoint the location of the Heat.
Often however, the tongue is either red only in a specific area or,
although it is all red, it is redder in a specific area. The five areas where
the tongue is commonly either red (on a normal tongue) or redder (on a
red tongue) are:
The centre
The sides (Liver area)
The sides around the centre (Stomach/Spleen area)
The tip (Heart area)
The front third (Lung area)
RED TIP
Redder tip on red tongue without

coating = Heart Empty Heat
Redder tip on red tongue with

coating = Heart Full Heat
RED SIDES
(LIVER)
Centre
(ST)
Sides (LIV)
Sides (ST/SP)
Tip (HE)
Front third
(LU)
Redder sides on red tongue without

coating = Liver Empty Heat
Redder sides on red tongue with

coating = Liver Full Heat
RED SIDES
(ST/SP)
RED
CENTRE
Red sides around centre
(more on right) on tongue
without coating= ST/SP
Empty Heat
Red sides around centre on

tongue with coating= ST/SP
Full Heat
Red centre on tongue with

coating = Stomach-Heat
RED FRONT
(LUNG)
Redder front (LU area) on

red tongue with coating =
Lung Full Heat
Redder front (LU area) on

red tongue without
coating = Lung Empty
Heat
Red centre on tongue without

coating = Stomach Empty
Heat
Statistic on body colour based on

database of 2500 patients (UK)
Tel: 626-780-7182 Fax: 626-609-2929 Website:
The tongue body colour in exterior conditions
Differentiation between Heat and Fire
In exterior conditions with invasion of external Wind, the tongue may

not change much if the pathogenic factor is light. In some cases, the
tongue coating may change (see below). If the exterior Wind is
accompanied by Heat (i.e. Wind-Heat), the tongue body colour may
become red on the sides towards the front (i.e. same area as the chest
area defined above).
Heat (re) and Fire (huo) are not the same. Although they both share
similar characteristics as they both pertain to Heat (in a general sense),
they are not quite the same. The distinction between Heat and Fire is
particularly important in herbal therapy as they call for different
treatment methods.
This change is more likely to occur in children. Thus, in the beginning

stages of invasion of Wind-Heat, the chest area may become slightly red:
indeed this change is likely to occur in children even before symptoms
appear. When the redness spreads towards the centre, it means that the
pathogenic factor has become interior.
Chinese books do not always use the terms Heat and Fire
consistently. The confusion arises also because the term Heat has
two different meanings. In a broad sense, it indicates any syndrome
characterized by Heat, including Fire; thus, for example, Liver-Fire is
a Heat pattern.
In a narrow sense, Heat is used as opposed to Fire. This

distinction between Heat and Fire stems from the Yang Ming patterns
of the 6 Stages in the Shang Han Lun.
Exterior Wind-Heat
When centre becomes red, pathogenic factor has

moved to Interior
HEAT
FIRE
Within the Yang Ming stage of the 6 Stages, there are two patterns:
Channel Syndrome and Fu Syndrome. The Channel Syndrome is
characterized by Stomach-Heat with the four bigs, i.e. big sweating,
big fever, big thirst, big pulse.
The Fu Syndrome is characterized by Stomach-Fire and its main

manifestations are abdominal pain and constipation. These two
symptoms indicate that the Heat has penetrated deeper and has
affected the Fu organs by drying up the fluids: it is now called Fire.
Red body, thin yellow coating: Heat
Redder body, thick, dry, dark yellow/ brown/

black coating: Fire
6 STAGES
YANG MING CHANNEL
4 LEVELS
Thus, within the Qi Level, there are two energetic levels, that of Heat
and that of Fire, the former being more superficial.
Heat can be cleared with pungent-cold herbs (such as Bai Hu Tang

White Tiger Decoction) which expel Heat outwards.
STOMACH-HEAT
QI
LEVEL
YANG MING FU
STOMACH-INTESTINES-DRYHEAT
Fire can only be drained downwards with bitter-cold herbs as it is

energetically too deep to be expelled outwards. Tiao Wei Cheng Qi
Tang Regulating the Stomach Conducting Qi Decoction or Cheng Qi
Tang Conducting Qi Decoction are the representative formulae to
drain Fire at the Qi Level.
Tel: 626-780-7182 Fax: 626-609-2929 Website:
The 4 Levels
Expelled outwards towards

the surface with pungentcold herbs (Bai Hu Tang)
WEI LEVEL
HEAT
FIRE
QI LEVEL
YING LEVEL
Drained downwards through

the Intestines with bitter-cold
herbs (Cheng Qi Tang)
BLOOD LEVEL
The Channel Syndrome with

Stomach-Heat is treated by
pungent-cold herbs (such as Shi
Gao) which clear Heat because the
Heat is still superficial enough to
be expelled outwards towards the
surface with pungent herbs.
The Fu Syndrome with
Stomach-Fire is treated by
bitter-cold herbs which drain
Fire by moving downwards
and stimulating the bowel
movement. In the case of
Fire, this is too deep in the
Interior to be expelled by
pungent herbs.
Common manifestations: feeling of heat, thirst, red face, dark urine,

Rapid pulse and Red tongue with yellow coating
HEAT
FIRE
More intense: pronounced feeling of heat, intense
thirst
More drying: dark urine, dry stools, dry tongue

Red points (called dian in Chinese) or red spots (called ban in
Chinese) indicate Heat. Red points are small and pointed and they
indicates Heat; red spots are larger and flatter and they indicate Heat
with some Blood stasis. The latter are more commonly seen on the
root of the tongue.
Affects Shen more: agitation, mental restlessness,

insomnia
May cause bleeding: epistaxis, coughing up blood,
vomiting blood, blood in urine or stools
Tongue signs:
Red tongue with thick,
dry, yellow/ brown or black
coating
Tongue signs: Red tongue

with yellow coating
Treatment principle: Clear
Heat with pungent-cold
herbs to push Heat outwards
Red points front
Three large red spots

right side
RED POINTS AND SPOTS
DIAN and BAN
Treatment principle: Drain Fire with bitter-cold herbs which

move downwards

Red points and spots are a pathological change of the normal red
grains.
The ancient Chinese called the fungiform papillae red grains. Red
grains are a normal, physiological structure of the tongue body. They
are the individual papillae which form the body of the tongue. Red
in red grains refers to a physiological red. Also, the red grains are
flush with the tongue surface and do not stick out.
The physiological red grains are a manifestation of the physiological

Minister Fire of the Kidneys. Therefore, red grains indicate a
physiological condition of normal heat deriving from the Minister Fire.
Physiological Minister
Fire
Pathological
Tongue
Red points
(Dian)
Red grains Normal

(fungiform papillae)
Red grains
become:
- Redder
- protruding
Points = Dian
Spots = Ban
When this becomes excessive, it flares upwards and makes the red
grains redder and causes them to stick out of the tongues surface.
When this happens, red grains are called red points or red spots.
Spots indicate Heat with some Blood stasis

(more common on root)
Tel: 626-780-7182 Fax: 626-609-2929 Website:
Red points/spots sides and root
Red points tip
Red points sides
Red points/spots sides and root
Red points front, chest/breast area and

on Stomach/Spleen area, worse on right
Red spots on root
White vesicles
Similarly to red points and spots, white vesicles are also pathological
fungiform papillae. These protrude from the tongue surface but they
are white rather than red.
White vesicles indicate Dampness.
Red spots root
Red points Lung/ breast area
Red points breast area left side (also some

on the side, on the right)
Red points Lung area

(and also SP area right side)
Shen disturbances and tip of the tongue

Generally speaking, the progression of severity of emotional stress
according to the tip of the tongue is as follows:
Red tip, normal body colour
Red body colour, redder tip
Red body colour, redder tip with red points
Red body colour, redder and swollen tip
Red body colour, redder and swollen tip with red points
Red body colour, redder tip with red points, Heart crack
Red body colour, redder and swollen tip with red points, deep Heart
crack
Of course, this is only a guideline and actual situations in practice may

deviate from this outline.
White vesicles (Dampness)
Tel: 626-780-7182 Fax: 626-609-2929 Website:

The tongue shows conditions of Yin deficiency and Empty Heat clearly. It
is important to understand that, although Empty Heat derives from Yin
deficiency, it takes time for it to develop.
Therefore, a patient may display all the signs of Yin deficiency on the
tongue for several years without developing Empty Heat and the tongue
shows this clearly by being of a normal colour and lacking a coating.
In fact, Yin deficiency manifests on the tongue with a lack of coating;

therefore, a tongue without coating but of a normal body colour indicates
Yin deficiency without Empty Heat.
As Yin deficiency aggravates with time, Empty Heat may develop and this
turns the tongue red: therefore Empty Heat on the tongue is manifested by a
red body colour together with the absence of coating.
One often hears that in Yin deficiency the tongue is red (a statement that is
tempting to make since in Yang deficiency the tongue is pale). This is not
so:
A tongue without coating indicates Yin deficiency first and foremost

of the Stomach: in addition, it may also indicate Yin deficiency of the
Kidneys, Liver or Heart.
- In Yin deficiency, the tongue lacks a coating (and has a normal colour)
- In Empty Heat, the tongue lacks a coating and its body is red.

That Yin deficiency can occur without Empty Heat is demonstrated by
tongue diagnosis as many patients have a tongue that lacks a coating
(indicating Yin deficiency) but is not red.
YIN
EMPTY
HEAT
Tongue without coating
This tongue partially lacks

a coating and the other
coating is rootless (Yin
deficiency) and
has a normal colour
(= no Empty Heat)
Tongue red without coating
This tongue lacks a

coating (Yin
deficiency) and is
slightly red in the
centre (beginning of
Stomach Empty Heat)

Yin deficiency and Empty Heat are not formed in a short space of time:
it takes years from them to develop. The tongue shows clearly not only
the present condition but also the stage it is at: it therefore also shows
where it is developing from and what it may lead to. The three stages of
the formation of Yin deficiency are:
YIN XU
NO COATING
This tongue lacks a

coating (Yin
deficiency) and has a
normal colour (no
Empty Heat)
1) Rootless coating (this is the mildest form of Yin deficiency)

2) Coating partially peeled
3) Coating missing completely
Empty Heat may develop at any of these stages but it is more likely to
develop at the third.
YIN XU WITH
EMPTY HEAT
NO COATING
RED BODY
WITH COATING
FULL HEAT
WITHOUT COATING
EMPTY
HEAT
RED
Tel: 626-780-7182 Fax: 626-609-2929 Website:
10
Yin deficiency is a gradual process which develops over years. The

absence of coating in a tongue with a normal body colour indicates fairly
advanced Yin deficiency but without Empty Heat. The following slides
are illustrations of varying degrees of Yin deficiency.
1
Coating missing entirely,

colour normal: Stomach-Yin
Xu, no Empty Heat. Note that
the tongue is also swollen and
therefore there is Phlegm.
Coating entirely missing, slightly

red body: Deficiency of Yin of
Stomach and possibly Kidneys
with some Empty Heat. The
widespread presence of cracks
indicates a deeper stage of Yin
deficiency
Coating entirely missing, red body:

Yin deficiency of Stomach and
possibly Kidneys with Empty Heat.
The presence of a Heart crack also
leads us to deduce that there is possibly
also Heart-Yin Xu.
Entirely without coating everywhere:

deficiency of Yin of Stomach and
Kidneys. As the tongue is also deep
red, there is intense Empty Heat. This is
very severe Yin Xu and this patient had
liver cancer.
Purple Tongue
Purple is one of the pathological colours of the tongue body. Chinese
books regularly say that in Qi stagnation the tongue is purple. I do not
agree with this statement because the tongue body colour reflects the
condition of Blood rather than of Qi. Therefore, a purple body colour,
in my opinion always indicates Blood stasis.
In general, it takes a relatively long time for a tongue to become purple
and therefore, a purple tongue usually indicates a chronic condition.
The only two exceptions to this are trauma and surgery, after which
the tongue becomes purple in a matter of days or hours.
As indicated earlier tongue diagnosis allows us not only to diagnose

the pathology but also to assess the degree of the severity of such
pathology. In the case of a purple tongue, it allows us not only to
diagnose Blood stasis but also to ascertain its degree of severity. For
example, a tongue may be only slightly purple which means that the
Blood stasis is mild. By contrast, if a tongue is deeply purple it
indicates that the Blood stasis is severe.
It is important to remember that the purple colour is not always

obvious as it is often quite subtle. As a rule of thumb, I would say that
if a tongue is not of a normal colour, not pale nor red, the chances are
that it might be subtly purple.
It is important to be able to recognise a purple colour because it is
clinically very significant. A purple colour always indicates Blood
stasis which potentially causes serious diseases, e.g. coronary heart
disease, cancer, and stroke.
Severely purple, more
on the right side
Very slightly purple, more

on the left side
Purple Tongue
There are two pathological purple colours: bluish-purple and reddishpurple, the former indicating Blood stasis associated with Cold and/or
Yang deficiency, and the latter associated with Heat. Therefore, the
bluish-purple tongue develops from a pale tongue, while the reddishpurple tongue develops from a red tongue.
YANG
DEFICIENCY
COLD (Pale tongue)
HEAT
(Red tongue)
Cold congeals Blood
Heat condenses Blood
BLOOD
STASIS
BLUISHPURPLE
Bluish-purple
REDDISHPURPLE
Reddish-purple
Tel: 626-780-7182 Fax: 626-609-2929 Website:
11
Areas of Blood stasis

(Partially Purple tongue)
Just as in the case of the pale and red tongues, a tongue may also be
partially purple in a specific area. The three areas that are commonly
partially purple are: the sides, the chest area and the centre.
Purple sides indicate Blood stasis in the Liver or, in women, in the
uterus.
A purple colour in the chest area indicates Blood stasis in the heart or
lungs (in the sense of Western pathology) or in the breast in women.
A purple colour in the centre indicates Blood stasis in the Stomach.
Purple sides
(Blood stasis in
Liver/Uterus)
Purple chest/breast area

(Blood stasis in chest/breast
LU, HE, breast)
Purple centre
(Blood-stasis in
the Stomach)
Blood stasis in women (purple sides)

In women, purple sides (Liver area) may indicate Blood stasis in the
uterus. As Blood stasis in the uterus is very common, purple sides in
women usually indicate Blood stasis in the gynaecological system rather
than in the Liver itself.
Bluish-Purple
Bluish-Purple
It is important to remember, however, that the tongue may NOT be purple

in women if the Blood stasis is relatively mild. In other words, a woman
may display all the symptoms of Blood stasis in the uterus (painful
periods with dark menstrual blood and dark clots) without the tongue
being purple.
Moreover, the degree of severity of the purple colour of the tongue in
women is directly correlated to the severity of Blood stasis. We can
identify four stages of Blood stasis according to the tongue:
1. Normal body colour
2. Purple veins underneath the tongue
3. Purple sides
4. Whole tongue purple
Reddish-Purple
Bluish-Purple
Blood stasis in women

Four degrees of severity of Blood stasis
Purple chest/ breast area

As explained earlier the chest area on the tongue reflects Western
pathology of the heart or lungs or of the breast in women. When the
chest area reflects pathologies of the heart or lungs these will be very
obvious from the symptoms (e.g. coronary heart disease, chronic
obstructive pulmonary disease).
In women, the chest area may reflect a pathology of the breast
especially when the purple colour is unilateral.
1. Normal body colour
2. Purple veins underneath
3. Purple sides
4. Whole body Purple
Tel: 626-780-7182 Fax: 626-609-2929 Website:
12
Purple chest/breast area in women
Sublingual Veins
In women, a purple colour in the breast area often appears in breast

cancer as this usually occurs against a background of Blood stasis.
There is a correlation between the purple colour of the breast area and
the prognosis: the darker this area, the worse the prognosis.
If the breast area on the tongue is purple in women who have not been
diagnosed with breast cancer, this sign may indicate a tendency
towards the disease before any symptoms manifest; for this reason,
observation of the chest area in women is particularly relevant.
Observation of the tongue should always include observation of the

veins under the tongue. Under normal circumstances the veins are not
distended, not dark, and one can barely see their outline.
Although a purple colour of the veins under the tongue is clinically

very significant, other abnormalities may also be observed, such as, for
example, the veins being distended and shiny.
When the veins under the tongue are purple it indicates the early stages
of Blood stasis. The sublingual veins, therefore, become purple before
the rest of the tongue. A purple colour of the veins under the tongue
gives an early indication of Blood stasis particularly in the upper and
middle burners.
Bluish-Purple
chest/breast area
Purple, peeled
chest/breast area
Reddish-Purple
chest/breast area
In modern China, doctors also correlate the appearance of the

sublingual veins with modern diseases such as hypertension and
arteriosclerosis.
Distended = Qi Xu
Distended and dark = Blood Stasis
Early indication of Blood stasis in upper burner, Lungs, Heart, but also in
the Liver
Too thin = Yin Xu
Swollen, white-sticky = Dampness and Stasis of Blood (Bi syndrome)
Reddish, shiny = Damp-Heat
Yellowish = Turbid Dampness steaming upwards
White-slippery = Cold-Dampness
Dark-dry veins: severe Yin Xu with Empty Heat
Normal sublingual veins
Yellowish shiny sublingual veins:

Damp Heat
Dark sublingual veins
Sublingual veins slightly dark
Sublingual veins dark and

distended
Sublingual veins very dark

on the left side
Very slightly purple sublingual veins

on the right side
Tel: 626-780-7182 Fax: 626-609-2929 Website:
13
Sublingual veins in relation to modern diseases

Dark-Purple veins: Blood stasis in heart and/ or lungs; in some
cases it can indicate hardening of arteries in the brain.
TCM TONGUE
DIAGNOSIS
Distended-dark and crooked veins: hardening of the arteries, high

blood pressure. If veins also stick out a lot and look like
earthworms, the disease is severe.
Dark nodules on veins: small nodules like rice or wheat grains
indicate hardening of arteries and heart disease.
Part 2
Tongue-body shape
Observation of the tongue-body shape should come immediately after
that of the tongue-body colour. The normal tongue-body shape is
neither too thin nor too swollen, not cracked and neither too stiff nor
too flabby.
The tongue-body shape gives us an indication of the Full or Empty
character of the condition while the tongue-body colour gives us an
indication of Yin and Yang and Heat and Cold. The information
gleaned from the observation of the tongue-body shape and the
tongue-body colour therefore complement each other.
XU
TONGUE-BODY COLOUR = YIN/YANG, HEAT/COLD
SHI
TONGUE-BODY SHAPE = FULL/EMPTY
As we shall see, in general the clinical significance of a particular

tongue-body shape depends on the tongue-body colour. For example, a
thin tongue indicates Blood deficiency if it is pale, and Yin deficiency
if it lacks a coating.
The tongue-body shape reflects the Full or Empty character of the
condition and it also gives an indication of its severity. For example, if
a tongue is pale and dry it indicates Blood deficiency, but if in addition
it is also thin, it indicates that the Blood deficiency is severe.
TONGUE-BODY COLOUR = YIN/YANG, HEAT/COLD

Pale = Blood Xu
THIN
Tongue
Without coating = Yin Xu
Pale = Yang Xu, Cold
Red = Heat
TONGUE-BODY SHAPE = XU/SHI
Thin-Pale = Blood Xu
This tongue is Thin
(from Blood Xu),
compare with Pale
tongue above
This tongue is red,

but also swollen
(Phlegm)
Thin without coating = Yin deficiency
Statistic from practice = 1.9% of tongues are Thin
Tel: 626-780-7182 Fax: 626-609-2929 Website:
14
Although the tongue is often described as being Thin in Blood

deficiency, the Thin tongue is actually relatively rare. This is not
because Blood deficiency is rare (it is in fact very common especially
in women) but because the tongue is very frequently Swollen from
Dampness or Phlegm. Obviously, the tongue cannot be Thin and
Swollen at the same time and the swelling predominates.
SP-Qi Xu
Blood Xu
Dampness/
Phlegm
Therefore it is important to realise that, especially in women, if the

tongue is Swollen it does not mean that there is no Blood deficiency.
In fact in women Blood deficiency and Dampness or Phlegm often coexist.
This happens because when the Spleen is deficient it may lead to

Dampness or Phlegm which make the tongue Swollen. On the other
hand, a deficient Spleen fails to make Blood and this leads to Blood
deficiency: this would make the tongue Thin but it does not because
the tongue is Swollen from Dampness or Phlegm.
Thin
(Pale)
Swollen
The tongue on the left is a good example of

the co-existence of Blood deficiency and
Dampness in women. In fact, it is Pale and
Thin which indicates Blood deficiency but
it is Swollen on the sides which indicates
Spleen deficiency and Dampness.
Swollen sides
Swollen sides
Thin
Swollen Tongue
In my database of over 2500 patients, only 1.9% have a Thin tongue.
As we have seen this does not mean that Blood deficiency is
uncommon; on the contrary, it is common especially in women.
The tongue is often Swollen from Dampness or Phlegm (which are

very common pathogenic factors): if, in addition, there is also Blood
deficiency this cannot make the tongue Thin because it is Swollen
from Dampness or Phlegm.
In fact, in the same database of over 2500 patients, 38% have a

Swollen tongue.
The term Swollen refers to a tongue with a body larger than normal.
Although the tongue maybe partially Swollen in places, the term
Swollen indicates a tongue that is completely swollen in every part.
Just as when the tongue is smaller than normal it indicates that there is
a lack of some substance (Blood or Yin), when it is larger than normal,
it obviously indicates that there is a pathogenic factor (Dampness or
Phlegm). One often hears that a Swollen tongue indicates Qi
deficiency: this cannot be because the very swelling indicates the
presence of an excess of a substance that should not be there (in this
case Dampness or Phlegm). Of course it is true to say that Dampness
and Phlegm themselves derive from Qi deficiency, but the swelling
itself indicates Dampness or Phlegm and not Qi deficiency.
In my
database of
2500
patients
38% have a
Swollen
tongue.
Normal-sized tongue
Swollen Tongue
Partial swelling of the Tongue
When the tongue is completely Swollen it indicates the presence of

Dampness or Phlegm but especially the latter (Dampness is indicated
more by the stickiness of the coating). Note how the tongue changes
shape when it is swollen, it becomes more round.
Whole tongue swollen = Dampness and/ or Phlegm
(especially Phlegm)
A partial Swelling of the tongue indicates either the location of

Phlegm in a particular part of the body or, in some cases, Heat (in
which case that particular area would also be red).
Partial swelling
due to Phlegm
(Lungs)
Swollen tongues
When the tongue is partially Swollen it indicates either the localised

presence of Phlegm in a specific part of the body or, if the tongue is
Red, Heat.
The tongue may be partially Swollen in the following areas:
Tip
Front third
Sides between the centre and the tip
Sides (central section)
Sides (the whole side)
Partial swelling
due to Heat
(Liver)
Tel: 626-780-7182 Fax: 626-609-2929 Website:
15
Partial swelling of the tongue
Swelling of Tip
A swelling in the tip indicates

emotional stress affecting the Shen. It
usually appears in conjunction with a
redness of the tip.
Swollen front third
Swollen chest/breast area
Swollen tip
Sides (central section, ST-SP)
Sides (the whole side, LIV)
Swelling of chest/breast area

(heart/ lungs/breast)
As indicated earlier, changes in the area between the centre and the tip
reflect a pathology of the heart, lungs or breast in a Western medical
sense. A change in the chest area may involve a change in colour or
body shape. How to differentiate when a change in the chest area
indicates a problem of the lungs or heart or of the breasts in women?
A change in the chest area indicates a pathology of the breast in
women rather that of lungs/heart:
A swelling in the chest area indicates retention of Phlegm in the Lungs

or, in women, in the breast. Especially when the swelling is unilateral,
it is more likely to indicate Phlegm in the breast.
1) In the absence of an obvious lungs/heart pathology

2) Especially when it is unilateral
Examples of lung pathology manifesting in the chest area are chronic
asthma or chronic emphysema (in which case the chest area would be
swollen and possibly purple). An example of heart pathology is
chronic coronary heart disease (in which case the chest area would be
purple).
As the area on the sides between the centre and the tip reflects the
condition of heart/ lungs/ breast, I shall call this the chest area.
Swelling of front third of tongue
Swelling of sides, central section
A swelling in the front third of the tongue indicates retention of

Phlegm in the Lungs. This is often a residual pathogenic factor from
previous invasions of Wind.
A swelling in the central section on the sides indicates retention of

Dampness with Spleen deficiency
Tel: 626-780-7182 Fax: 626-609-2929 Website:
16
Swelling of sides (Liver area)
Teethmarks
A swelling in the Liver area indicates Liver-Heat or Liver-Fire.
Teeth marks indicate Spleen-Qi deficiency. Please note that the

presence of teeth marks does not necessarily indicate that the tongue
is Swollen as teeth marks appear also on normally-shaped tongues.
Teeth marks in breast area = possible breast cancer (the cancer is

located on the same side as the teeth marks).
Cracks
In general cracks indicate Yin deficiency
In general cracks indicate Yin deficiency. There are many different types of cracks according
to their location on the tongue:
Heart crack
Single Stomach crack
Scattered Stomach cracks
Spleen cracks
Central Lung crack
Bilateral Lung cracks
Stomach-Lung cracks
Ice-floe cracks
Kidney cracks
The location of the cracks therefore, allows us to identify which organ is affected by Yin
deficiency very clearly. Please note that not all cracks always indicate Yin deficiency. For
example a shallow Heart crack indicates a constitutional tendency to mental-emotional stress.
Bilateral Lung cracks indicate a past disease of the Lungs usually dating back to childhood.
Cracks can become shallower with treatment.
Heart crack
Stomach crack
Stomach cracks
Stomach/Heart crack
In general cracks indicate Yin deficiency
Heart crack
The Heart crack is a long, midline crack that starts near the root of the
tongue and extends all the way to the edge of the tip; occasionally, it
may extend to the very tip of the tongue.
Lung crack
Lung cracks
Spleen cracks
Old age cracks
Lung/Stomach crack
The clinical significance of the Heart crack depends on its depth and on
the colour of the tongue. If the Heart crack is relatively shallow and the
tongue-body colour normal, this indicates not an actual Heart pattern
but simply the constitutional tendency to mental-emotional stress. In
other words, when subject to the same stress, a person with a shallow
Heart crack will suffer more emotional problems than one without.
Kidney crack
Heart cracks
Tel: 626-780-7182 Fax: 626-609-2929 Website:
17
Stomach crack
Scattered Stomach cracks
The Stomach crack is a midline crack that is in the centre of the tongue
(Middle Burner area).
Scattered Stomach cracks may be all over the tongue. They are either
small horizontal cracks or irregular cracks that in Chinese books are
The clinical significance of the Stomach crack is either a Stomach-Yin

deficiency or a constitutional tendency to Stomach patterns. The
Stomach crack differs from the Heart crack in two respects: 1) It is only
in the centre; 2) It is wider than the Heart crack.
described as being the shape of the ren character
The clinical significance of the scattered Stomach cracks is either a

Stomach-Yin deficiency or a constitutional tendency to Stomach
patterns.
Ren-12, ST-36, SP-6 or even

just Ren-12
Lung crack
The Lung crack is a central crack in the front third of the tongue. It
indicates a constitutional tendency to Lung patterns and Lung-Yin
deficiency. LU-9 and Ren-12.
Lung-Stomach crack
A Lung-Stomach crack is a combined Stomach crack (that is in the middle
section of the tongue) and a Lung crack (because it extends to the Lung
area, front third of the tongue)
Lung crack
Diagonal Lung cracks
Lung/Stomach crack
Diagonal Lung cracks indicate a past lung disease such as whooping

cough in childhood.
Lung cracks
Spleen cracks
Spleen cracks are small transversal cracks on the edges of the
tongue: they indicate Spleen-Yin deficiency.
Old age cracks

Old-age cracks are also called ice-floe cracks. They are not
common and they simply indicate Kidney deficiency from old age.
Old age cracks

Spleen cracks
Tel: 626-780-7182 Fax: 626-609-2929 Website:
18
Kidney crack
The Kidney crack is longer than the Heart crack, extending towards
the root. It is also deep and it has small cracks radiating outwards from
the central crack. It indicates severe Kidney deficiency (usually Yin),
from overwork.
Stiff
The Stiff tongue indicates a tongue that is stiff and hard. The Stiff
tongue has three possible clinical meanings:
1. Internal Wind
2. Blood stasis
3. Yin deficiency
As indicated above, a change in body shape indicates a more severe
condition (compared to one in which there is a change only in the
body colour. For instance, a Purple tongue indicates Blood stasis
and if it is also Stiff, it indicates that the Blood stasis is severe.
Kidney crack
Internal Wind
STIFF
(Hard)
Blood stasis
Yin Xu
Quivering
The Quivering tongue trembles rapidly and with small amplitude.
The Quivering tongue generally indicates Spleen deficiency;
occasionally, in the elderly it may indicate Internal Wind.
Deviated
The Deviated tongue deviates off centre as the patient sticks it out. It
always indicates Internal Wind. Occasionally, in young people a
deficiency of the Heart and Pericardium may cause the tongue to be
Deviated but this is relatively rare.
Moving
The Moving tongue moves slowly from side to side as the patient
sticks it out. This movement is involuntary and the patient is not
aware of it.
QUIVERING = SP-Qi Xu
Rapid, trembling with a small amplitude
MOVING = Internal Wind
Slow, side to side movement with a large

amplitude
Internal Wind with a Deviated tongue is seen in the elderly after a

stroke or when suffering from a neurological disease such as
Parkinsons disease.
In those without symptoms a Deviated tongue always indicates

Internal Wind and is a sign that the practitioner should take active
steps to prevent the onset of an Internal Wind type disease.
Deviated
Preventative value of tongue diagnosis in the elderly
DEVIATED = Internal Wind

(except occasionally in young people = Heart and Pericardium Xu)
Tongue diagnosis plays a very important role in the prevention of

disease especially in the elderly. Middle-aged and elderly patients
often show abnormal signs on the tongue in the absence of any
obvious disease.
Elderly people often suffer from Internal Wind, Blood stasis, Phlegm,
Heat or Yin deficiency or a combination of these. For example, it is
common to have Blood stasis with Phlegm; or Phlegm with Yin
deficiency; or Internal Wind with Phlegm; or a combination of the
above. In the elderly, Blood stasis and Phlegm are so common that
there is a saying in Chinese medicine which states In the elderly,
when in doubt, invigorate Blood and resolve Phlegm.
In such cases, the tongue often shows clear signs of these pathogenic
factors and it therefore allows us to treat them before they give rise to
disease. In particular, stroke in the elderly usually derives from a
complex pathology involving Internal Wind, Yin deficiency with
Empty Heat, Phlegm, and Blood stasis.
In the elderly, when in doubt, invigorate Blood and resolve Phlegm
Tel: 626-780-7182 Fax: 626-609-2929 Website:
19
Tongue Coating
Preventative value of tongue diagnosis in the elderly
The tongue coating is a by-product of the Stomachs physiological

activity of digestion. The normal coating should be thin and white.
Thin means that the coating should be thin enough so that the tongue
body below is visible.
1) DEVIATED, MOVING
Internal Wind
2) RED, WITHOUT COATING
Severe Yin Xu Empty Heat

Phlegm
3) SWOLLEN BODY, STICKY COATING
Wind Stroke
Blood Stasis
4) PURPLE, STIFF
Thus, in Chinese medicine a coating with root indicates that StomachQi is intact even if the coating is pathological in colour and/ or
thickness. For example, a thick yellow coating usually indicates
Stomach-Heat but, if it has a root, it means that Stomach-Qi is intact.
By contrast, if the tongue lacks a coating it indicates a deficiency of
Stomach-Qi and/or Stomach-Yin.
In order to understand this, we should remember that a Full condition
(such as Stomach Heat) is characterised by the presence of a
pathogenic factor, but also by the fact that the patients Qi is relatively
strong and it is reacting against the pathogenic factor; therefore the
treatment is relatively easy and the prognosis good. By contrast, if
Stomach-Qi is deficient the treatment will take longer.
1) Reddish-Purple = Blood stasis

2) Deviated and Stiff = internal Wind
3) Swollen (slightly) = Phlegm
4) Coating missing in patches = Yin deficiency
Poll no. 1
Poll no. 2
Of these two tongues which is worse?
Of these two tongues which is worse?
The three tongues illustrated here are a good example of this principle.
The tongue on the left has a thick, dry, black coating; however if we
look at the other tongue signs carefully, we can see that the coating has
root, the body has shen, it is only slightly red and it has no cracks.
In this case the black, dry coating indicates severe Heat in the Stomach
and Large Intestine, but the other tongue signs indicate that the
patients Qi is strong.
Although the thick, black coating may look like an alarming sign, in
this case, it simply indicates severe Stomach Heat which is usually
relatively easy to treat.
We have to grasp the concept that the Stomach could have a pathology
such as Heat, Damp-Heat or Phlegm-Heat and yet its Qi being intact.
In fact, a Shi condition is characterized precisely by the presence of a

pathogenic factor but Zheng Qi is strong (and therefore fighting the
pathogenic factor).
A Xu condition is characterized by the weakness of Zheng Qi.
By contrast, the two tongues on the right have a thin, white coating
without root; this indicates Stomach-Qi deficiency. Although these
tongues may look less alarming than the one on the left, this condition
will actually be more difficult and take longer to treat.
Tel: 626-780-7182 Fax: 626-609-2929 Website:
20
Coating/absence of Coating
Normal
ST
By-product of
Stomach activity of
digestion
Thin-white
coating
When evaluating the tongue coating we should look at the following

six aspects:
The first aspect we need to consider is whether the tongue has a coating or
not. The presence of a coating (with root) indicates that Stomach-Qi is intact
while the absence of it indicates a deficiency of Stomach-Qi and/or
Stomach-Yin. Please note that this is irrespective of the colour or the
thickness of the coating. For example, a thick, sticky coating is pathological
but, if it has a root, Stomach-Qi is intact.
Please note also that the absence of coating denotes a Stomach-Yin
deficiency irrespective of the body colour: if the body colour is normal, there
is only Yin deficiency whereas, if the body colour is red, there is Yin
deficiency and Empty Heat.
1) Coating or no coating
2) With or without root
3) Thickness
4) Colour
5) Consistency (e.g. sticky)
Normal, thin-white coating
No coating
Thick, yellow coating
6) Distribution
Yin deficiency is a pathological process that takes a long time to

develop and it may therefore manifest in many different degrees of
severity.
The photos below show different degrees of Yin deficiency by itself

and with Empty Heat in increasing order of severity.
The tongue gives an accurate indication of the degree of Yin

deficiency and of the Empty Heat resulting from it.
YIN XU
EMPTY HEAT
The tongue shows clearly not only the present condition but also the
stage it is at: it therefore also shows where it is developing from and
what it may lead to.
The three stages of the formation of Yin deficiency are:
1) Rootless coating (this is the mildest form of Yin deficiency)
2) Coating partially missing
3) Coating missing completely
Rootless coating: mild

ST-Qi Xu
Coating
partially
missing:
ST-Yin Xu
Coating
missing
entirely:
ST-Yin
Xu
Coating missing
partially, body
Red: ST-Yin Xu
with Empty Heat
Coating missing
entirely, body
Red: ST- and KIYin Xu with
Empty-Heat
Empty Heat may develop at any of these stages but it is more likely
to develop at the third stage.
Degrees of Yin Deficiency and Empty Heat

Yin deficiency is a gradual process which develops over years. The
absence of coating in a tongue with a normal body colour indicates
fairly advanced Yin deficiency but without Empty Heat. The
following slides are illustrations of varying degrees of Yin
deficiency.
1
Coating missing entirely,

colour normal: Stomach-Yin
Xu, no Empty Heat. Note that
the tongue is also swollen and
therefore there is Phlegm.

possibly Kidneys with some Empty
Heat. The widespread presence of
cracks indicates a deeper stage of Yin
deficiency

Yin deficiency of Stomach and
possibly Kidneys with Empty Heat.
The presence of a Heart crack also
leads us to deduce that there is
possibly also Heart-Yin Xu.
Entirely without coating

everywhere: deficiency of Yin
of Stomach and Kidneys. As
the tongue is also deep red,
there is intense Empty Heat
Tel: 626-780-7182 Fax: 626-609-2929 Website:
21
When the tongue is partially without coating, it gives a clear

indication of the organ affected by Yin deficiency.
Lung-Yin Deficiency (no coating in front third)
When the coating is partially missing the most common areas

where it is so are:
Front third
Sides
Without coating in front third:

Lung-Yin Xu, also Empty-Heat as it
is red
Centre
Without coating in front third:

Lung-Yin Xu
Scattered small areas

Root
Deficiency of Stomach-Yin (no coating in centre)
Without coating in centre:

Stomach-Yin Xu
Without coating in centre and

front third: Lung- and StomachYin Xu (and Empty Heat)
DEFICIENCY OF YIN OF STOMACH AND INTESTINES
Deficiency of Yin of Stomach and Intestines

(coating partially missing in patches)
Without coating in patches on the

root: deficiency of Yin of Stomach
and Intestines
Coating missing on root, left side:

Intestines
Deficiency of Spleen-Yin (coating missing on the sides)
Yang Ming = Stomach and Large Intestine.

A Yin deficiency of the Stomach often affects the Large Intestine too,
although we do not have a syndrome called Yin deficiency of Stomach
and Large Intestine.
YANG
MING
ST
SP
Earth
L.I.
Coating missing on left side in central

section: Spleen-Yin deficiency (not Liver
because it is mostly in the middle section
and not all along the sides)
Tel: 626-780-7182 Fax: 626-609-2929 Website:
22
Deficiency of Kidney-Yin
Partially without coating
Although there is no specific sign or area on the tongue that points to

Kidney-Yin deficiency when the coating is missing, when Yin
deficiency is advanced, we can usually deduce that the Kidneys are
involved. Therefore if a tongue lacks coating in its entirety and it is red
from Empty Heat, we can deduce that, in addition to Stomach-Yin Xu,
theres also Kidney-Yin Xu.
Stomach-Yin Xu
(possibly antibiotics)
Coating missing in the centre:

Coating completely missing, very

red: deficiency of Stomach-Yin
and of Kidney-Yin with
pronounced Empty Heat

If a tongue has no coating it is always a good sign if the coating
returns gradually over a period of months. Conversely, if a tongue
has a thick coating it is a good sign if this coating recedes
gradually.
It is never a good sign if a partial coating appears suddenly on a
previously peeled tongue; conversely, it is also a bad sign if the
coating disappears partially and suddenly on a tongue with a thick
coating. The area where the coating appears or disappears suddenly
gives an indication of the problem location.
For example, if we are treating a patient whose tongue is normally
without coating and a patch of coating appears suddenly on the
edge of the tongue in the Liver area, this indicates an aggravation
of the condition with the location of the problem in the Liver;
similarly, if a patch of coating appeared suddenly in the chest area
it may indicate the location of the problem in the lungs, heart or
breast.
Root of coating
The normal coating should grow out of the body of the tongue like
blades of grass grow out of the soil: when this happens, the coating
is said to have a root. Also from the western anatomical point of
view, the filiform papillae (the coating in Chinese medicine) grow
out of the body of the tongue like blades of grass.
Stomach- and Liver-Yin

Xu
Stomach- and Lung-Yin

Xu
Stomach-Yin Xu
Kidney-Yin Xu
Yin Xu of Stomach
and Intestines

The clinical significance would be exactly the same if a patch
of coating disappeared suddenly in a specific area on a tongue
with thick coating.
In cancer patients, such sudden appearance or disappearance
of a patch of coating may indicate an aggravation of the
condition or a metastasis to an organ corresponding to that
area of the tongue.
Two key factors make the appearance or disappearance of a
patch of coating pathological: first, the fact that the coating
appears or disappears on a specific area; second, the fact that
the coating appears or disappears suddenly.
The coating without root looks like it has been added onto the tongue
rather than growing out of it. One can imagine a bare patch of soil with
blades of grass scattered on it.
Coating with root indicates a intact state of Stomach-Qi even if the

coating is pathological in other respects, e.g. thickness or colour.
For example, a coating may be thick and yellow indicating Stomach
Heat but, if it has a root, Stomach-Qi is intact (even though there is
Heat).
By contrast, if a coating lacks root it indicates that Stomach-Qi is
weak. In general, it is better to have a pathological coating with root
than a coating without root.
With root
Without root
It is important not to confuse the root (or lack of it) of a coating with
its thickness. In other words, a coating without root is not
necessarily always thin. A thin coating without root simply indicates
deficient Stomach-Qi, while a thick coating without root indicates
that Stomach-Qi is deficient and that there is a pathogenic factor.
Tel: 626-780-7182 Fax: 626-609-2929 Website:
23
The normal coating should be thin and white; it is thin enough for us to be
able to see the tongue body through it.
A thick coating always reflects the presence of a pathogenic factor which
may be Cold, Heat, Dampness, Phlegm or external Wind. The thicker the
coating, the stronger the pathogenic factor.
Thick coating with

root
Note that a thick coating may also lack a root: I call this the worst of both
worlds because it indicates that, on the one hand, the pathogenic factor is
strong and, on the other hand, the bodys Qi has been weakened.
In acute conditions, the tongue coating can appear quickly. Therefore, if
we see a new patient with a thick coating, we have to keep in mind the
possibility that it reflects an acute, passing problem.
Thick coating without root
Although the clinical significance of the coating is somewhat less

important than that of the tongue-body colour and shape, it is
clinically important to differentiate Full from Empty conditions. If the
tongue has a thick coating with root, the condition is Full; the
condition is Empty if the tongue coating is missing or if it is thin.
Normal coating
Thick coating
To summarise, we can identify four possible pathological conditions
from the thickness of the tongue coating:
1) Thin, white coating with root = normal, Stomach-Qi good
Moreover, in mixed Xu-Shi conditions, the thickness of the tongue

coating is important in choosing the appropriate treatment principle. If
the tongue coating is thick, I would start the treatment with a formula
that eliminates pathogenic factors; if the tongue coating is thin, I
would start with a formula that tonifies the bodys Qi.
For example, in chronic fatigue syndrome there is practically always a
combination of an Empty condition (often Spleen-deficiency) with a
Full condition (often Dampness). I consider the tongue coating an
important factor in deciding whether to concentrate on eliminating
pathogenic factors (if the coating is thick) or tonifing the bodys Qi (if
the coating is thin).
NOTE: although the thickness of the coating reflects the presence of a pathogenic
factor, it is not the only sign that does so. Notably, the swelling of the tongue body also
reflects the presence of a pathogenic factor. It follows therefore, that a thin coating
does not necessarily always indicate the absence of a pathogenic factor.
2) Thin, white coating without root = Stomach-Qi weakened, Empty

condition
3) Thick coating with root = pathogenic factor present, Stomach-Qi
intact, Full condition
4) Thick coating without root = pathogenic factor present, Stomach-Qi
weakened, Full-Empty condition. The worst of both worlds.
It is better to have a thick coating with root (indicating a pathogenic
factor) than a thin one without root (indicating weakened Stomach-Qi).
The former is easier to treat than the latter. I call the condition of a
thick coating (indicating a pathogenic factor) without root (indicating
Stomach-Qi deficiency), the worst of both worlds.
WITH ROOT = NORMAL

THIN
COATING
WITHOUT ROOT = STOMACH-QI XU
1) Thin; white; with
root = Normal STQi good
THICK
COATING
2) Normal colour;
coating without root;
thin = ST-Qi Xu
WITH ROOT = PATHOGENIC FACTOR
WITHOUT ROOT = PATHOGENIC

FACTOR ON BACKGROUND OF ST XU =
SHI/XU
(worst of both worlds)
3) Thick coating with

root = pathogenic
factor but ST-Qi is
still good
4) Thick coating but without

root = strong pathogenic
factor and ST-Qi is
weakened
Out of these conditions number 3 is better than number 2, and number

4 is the worst of both worlds.
Tel: 626-780-7182 Fax: 626-609-2929 Website:
24
Colour of Coating
The colour of the coating reflects conditions of Heat or Cold. A white
coating indicates Cold, while a yellow or brown coating indicates
Heat. A grey or black coating may indicate either Cold or Heat
depending on whether it is wet or dry. As we have seen above the
tongue body colour also reflects conditions of Cold or Heat, being Pale
in Cold and Red in Heat. The colour of the coating is affected by shortterm influences and it is therefore somewhat less significant than the
body colour in diagnosing Heat or Cold.
The pathological coating colours are:

-White = Cold
White
Cold
- Yellow (or brown) = Heat
Yellow
Heat
Green
Heat
- Green = Heat
As the tongue coating reflects in general the state of the Yang organs
(Fu), changes in colour of the tongue coating reflect conditions of Heat
or Cold mostly of the Yang organs. Examination of the coating colour
is more important in acute conditions as it is more easily affected by
short-term changes than the tongue-body colour.
- Grey = Heat if dry, Cold if wet
Grey
- Black = Heat if dry, Cold if wet
Black
Cold if wet
Heat if dry
Extreme Cold if wet
Extreme Heat if dry
Coating Distribution
Sticky (Ni )
Slippery (Hua )
Thicker in centre
Slippery but rougher than slippery
As if covered in oily fluid which adheres
firmly
Papillae can be seen
Cannot be scraped off
GB
ST
GB
Mouldy
Thick and patchy
Crumbly like tofu
Without root
Can be scraped off
GB
ST/ INT
Tongue Diagnosis and Herbal Therapy
Nourish ST-Yin and

resolve Dampness or
Phlegm (because the lack
of coating indicates
and the swelling of the
tongue body indicates
Phlegm)
Thicker in centre
Oily, smooth
As if covered in oily fluid which slips
Papillae seem to be hidden
Cannot be scraped off
Resolve Dampness or Phlegm

(because of the swelling of the
body)
Nourish Yin, clear

Empty Heat,
resolve Dampness
(because the lack of
coating indicates
Yin deficiency the
redness of the body
indicates Heat and
the stickiness of the
coating indicates
Dampness)
Clear Heat
(because of the
redness of the
body and the
yellow coating
with root)
Tonify Qi
and/or Blood
(because the
pale and dry
body indicates
Blood
deficiency)
Resolve
Phlegm, clear
Heat, invigorate
Blood (because
the swelling of
the body
indicates
Phlegm, the
redness
indicates Heat
and the Purple
colour indicates
Blood stasis)
Tel: 626-780-7182 Fax: 626-609-2929 Website:
25
2) Differentiation between deficiency of Qi or Yin of the

Stomach and Spleen
SP-Qi Xu
(Pale, swollen sides)
LIU JUN ZI TANG
(PROSPEROUS
EARTH)
ST-Qi Xu
(rootless coating,
ST crack)
SHEN LING BAI ZHU
SAN
(CENTRAL MANSION)
ST-Yin Xu
(No coating,
ST crack)
SHA SHEN MAI
DONG TANG
(JADE SPRING)
ST- and SP-Yin Xu

(lateral cracks and
central crack)
SHA SHEN MAI
DONG TANG
(JADE SPRING)
3) Differentiation between Heat at the Qi or Ying/ Blood level

and that between Heat and Fire.
Red body, thin coating =

clear Heat Qi level
Red body, no coating =

clear Empty Heat, nourish
Yin, Ying-Blood level
Red body, thin coating =

clear Heat Qi level
Red body, thick-dry-dark coating = drain Fire Qi level
Patient Statistics from Giovanni Maciocias practice

Total = 2220: Men 765 = 34% / Women 1455 = 66%
Purple (Total)
363 =
16%
814 =
36%
Bluish-Purple
31=
8%
Swollen sides
52 =
2.3%
Reddish-Purple
106 =
Thin
43 =
1.9%
Purple sides
Sticky coating
454 =
20%
ST-crack
195 =
Red (including red points)
1012
45%
HE-crack
151 =
Red Points
128 =
6%
ST-HE crack
Red
884 =
40%
Swollen
Pale
706 =
Purple
363 =
32%
6.5%
34 =
1.5%
9%
7%
36 =
2%
Only 6% were normal
16%
Normal colour: 6%
Tel: 626-780-7182 Fax: 626-609-2929 Website:
26
Correlation Between Types of Tongue and Endoscopy Results in Patients With Chronic Illnesses of the Stomach and Duodenum
Correlation Between Types of Tongue and
Endoscopy Results continued
Gastroscopy Results and Tongue Coating
Types of Tongue in 255 Cases of Perforated Ulcer
Correlation Between Gastric Acidity and the Tongue
Body Shape
Sublingual Veins
Tel: 626-780-7182 Fax: 626-609-2929 Website:
27
The Tongue in Stomach Cancer - Body Colour
The Tongue and Colonoscopy - Body Colour
Correlation between Atrophic-Necrotic Epithelial Cells of the Tongue and Yin-Xu Epigastric Pain
Coating
Coating
Correlation between Atrophic-Necrotic Epithelial Cells of the Tongue and Yin-Xu Epigastric Pain
Tel: 626-780-7182 Fax: 626-609-2929 Website:
28
Epithelial Cells of the Tongue in Three Groups
To read articles by todays speaker, watch

online videos, or to see his/her complete
seminar/webinar schedule for this year, please
visit www.elotus.org
More information on the classic single herbs mentioned in

this seminar/webinar can be found in the
Chinese Medical Herbology and Pharmacology
More information on the classic formulas can be found in
the Chinese Herbal Formulas and Applications
Herbs mentioned in this seminar/webinar, are

available through our sponsor Evergreen
Herbs & Medical Supplies. Please contact
them for a catalog and see how they can help
your practice.
Collection formulas can be found in the eLotus

Clinical Manual of Oriental Medicine
All the above texts are available through www.elotus.org
This webinar is sponsored by:
Evergreen Herbs & Medical Supplies

Toll-free Tel: 866-473-3697
Website: www.evherbs.com
Email: sales@evherbs.com
Tel: 626-780-7182 Fax: 626-609-2929 Website:
29
Evergreen Herbs is not just an Herbal company, we are an

environmentally friendly, health conscious contributor to the healthcare community at large. Evergreen was founded by Dr. John Chen
and Tina Chen, siblings and coauthors of the Chinese Medical
Herbology and Pharmacology, and the Chinese Herbal Formulas
and Applications books.
Evergreen is a family business that is run by professionals like you
who care about Chinese medicine. And as a family business, we
have the well-being and satisfaction of our customers at the top
of our list. We care about the quality of our herbs, because we
care about our consumers, and have your best interest at heart.
Our goal is to support you in improving your clinical skills, and
enhancing the well-being of your patients.
To learn more about Evergreen Herbs and our products, please

9.26.15 Gmaciocia Tonguedx LN

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

9.26.15 Gmaciocia Tonguedx LN

Hochgeladen von

Copyright:

Verfügbare Formate

TCM Tongue Diagnosis

Giovanni Maciocia, OMD, LAc

Leading Acupuncture CE Provider

Lotus Institute of Integrative Medicine

CEUs/PDAs: CEU Certificates for distance learning and live

GIFT CERTIFICATE: We are the only organization offering

a. For educational purposes, each of our webinars are

COPYRIGHT AND CONSENT

b. Taping of webinars, online video recordings, and online

Consent and Disclaimer Part III (Copyright)

Consent and Disclaimer Part I (Copyrighted Information)

Consent and Disclaimer Part II (Webinar Recording)

Consent and Disclaimer Part IV (Speaker/Author)

Services and Products by eLotus

Like Lao-tzu's adage - when you do better, we all do better

Lotus OnlineCEU VIDEOS

Lotus OnlineCEU AUDIO

Lotus OnlineCEU ARTICLES

Lotus WEBINAR Weekdays

TCM Wisdom Tube

FREE Articles for Download

Clinical Manual of Oriental Medicine, 2 edition

eLotus GOLD PASS

risk-free 7-day trial & 2 payment options

eLotus Gold Pass is everything you love

The best deal for

Webinars, videos, audios and articles from 70+ experts

This is the second

order/learn more @ www.eLotus.org/Gold

LotusInstitute Of Integrative Medicine

TONGUE DIAGNOSIS IN CHINESE MEDICINE

TCM TONGUE DIAGNOSIS

Limitations of tongue diagnosis

Body Shape and Sublingual Veins

www.eLotus.org Email: info@eLotus.org

Limitations of Tongue Diagnosis

Strength of Tongue Diagnosis

The progress, or lack of progress, of disease can be monitored e.g.:

It is easier than pulse diagnosis! Also more objective

Order of observation of the tongue

There is a lack of detail e.g. a thick-sticky, yellow coating on the

It is important to analyze the tongue systematically, in a certain

Yin or Yang deficiency

Aspects of Tongue Diagnosis

www.eLotus.org Email: info@eLotus.org

Not thin, not swollen

Not stiff, not flabby

With shen, fresh, radiant, brilliant

Please note that the Lung area encompasses

Differentiation between Liver and Spleen swelling

Liver and Heart /

Stomach and Spleen /

Lungs / front third

Differentiation between Liver, Stomach/Spleen and chest areas

Changes in this area to look for are:

Thin, long band = Liver

Broad band, middle section

www.eLotus.org Email: info@eLotus.org

Examples of lung pathology manifesting in the chest area are

1) In the absence of an obvious lungs/heart pathology

Swollen chest area

Apart from a purple colour and a swelling, other possible changes

Red points breast