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• Tongue-body colour
• The normal body colour should be pale-red.
• The body colour reflects the state of Blood and Nutritive Qi and the Yin organs.
• There are five pathological colours: Pale, Red, Deep-Red, Purple, and Blue.
• Pale
• A Pale body colour indicates either deficiency of Yang or deficiency of Blood.
• In deficiency of Yang the tongue is also usually slightly too wet and swollen.
• In deficiency of Blood the tongue tends to be somewhat dry.
• If the sides of the tongue are especially Pale, or in severe cases slightly orangey, it indicates Deficiency of Liver-Blood.
• Red
• By "Red" is meant too red.
• A Red tongue body always indicates Heat. If the tongue has a coating, it indicates Full-Heat; if there is no coating, it indicates Empty-Heat.
• A Red tip, usually on a Red tongue, indicates Heart-Fire or Heart Empty-Heat, according to whether the tongue has a coating or not.
• In severe cases, the tip can also be swollen and have red points on it.
• Red sides indicate Liver-Fire or Gall-Bladder Heat (with coating); Liver Yin Deficiency (without coating)
• In severe cases they may also be swollen and display red spots.
• A Red centre indicates Stomach-Heat.
• These are raised papillae and always indicate Heat; if they are rather large, in addition to Heat, they also indicate stasis of Blood.
• Red points or spots are frequently seen on the tip (Heart-Fire), on the sides (Liver-Fire), on the root (Heat in the Lower Burner) and around the centre (Stomach-Heat).
• Deep-red
• This is simply a shade darker than Red and its clinical significance is the same as for the Red tongue, except that the condition is more severe.
• Purple
• A Purple tongue always indicates stasis of Blood. There are two types of Purple colour: Reddish‐Purple and Bluish-Purple.
• A Reddish-Purple tongue indicates Heat and stasis of Blood, and it develops from a Red tongue.
• A Bluish-Purple tongue indicates Cold and stasis of Blood, and it develops from a Pale tongue.
• A Purple colour on the sides indicates Liver-Blood stasis; in the centre, indicates Blood stasis in the Stomach.
• Bluish purple sides in women: Blood stasis in uterus
• Purple colour on the sides but only towards the middle section, and the sides are swollen and the rest of the tongue is bluish-purple, indicates stasis of Blood in the chest.
• Blue
• The significance of a Blue tongue is the same as a Bluish-Purple tongue, i.e. Interior Cold giving rise to stasis of Blood.
• Tongue-body shape
• The body shape of the tongue gives an indication of Blood and Nutritive Qi and it reflects the Full or Empty character of a condition.
• Thin
• A Thin body indicates either Blood deficiency if it is Pale, or Yin deficiency if it is Red and Peeled.
• In both cases, it indicates that the condition is chronic.
• Swollen
• A Swollen tongue that is also Pale indicates retention of Dampness deriving from Yang deficiency.
• If it is Red or normal-coloured, it indicates retention of Damp-Heat.
• Stiff
• A Stiff tongue usually indicates Interior Wind.
• Flaccid
• A Flaccid tongue indicates deficiency of Body Fluids.
• Long
• A Long tongue indicates tendency to Heat, and in particular Heart-Heat.
• Short
• A Short tongue indicates interior Cold if it is Pale and wet, or extreme deficiency of Yin if it is Red and Peeled.
• Cracked
• Cracks indicate either Full-Heat or deficiency of Yin.
• Short horizontal cracks indicate Stomach-Yin deficiency.
• A long-deep midline crack reaching the tip indicates a tendency to a Heart pattern.
• A shallow-wide crack in the midline not reaching the tip indicates Stomach-Yin deficiency.
• Short transversal cracks on the sides, in the middle section of the tongue, indicate chronic Spleen-Qi deficiency.
• Quivering
• A Quivering tongue usually indicates Spleen-Qi deficiency.
• Deviated
• A Deviated tongue indicates interior Wind.
• Toothmarked
• A tongue with teethmarks indicates Spleen-Qi deficiency.
• This is frequently called a “scalloped” tongue
Tongue coating
• The tongue coating reflects the state of the Yang organs and in particular the Stomach.
• A normal tongue should have a thin-white coating.
• The tongue coating is formed from some residual "dirty dampness" (AKA turbid dampness) which is left over from the Stomach's digestion and reaches the tongue upwards.
• Thus a thin-white coating indicates that the Stomach is digesting food properly.
• The coating gives an indication of the presence or absence of a pathogenic factor and of its strength.
• A thick coating always indicates the presence of a pathogenic factor and the thicker the coating the stronger the pathogenic factor.
• Such a pathogenic factor may be exterior or interior, such as exterior Wind, Dampness (interior of exterior), Cold, retention of Food, Phlegm, Heat, Fire.
• The absence of coating indicates deficiency of Stomach-Yin and / or Kidney‐ Yin.
• If the tongue is also red all over, it is a definite indication of deficient Kidney-Yin.
• The pathological coating colours can be: white, yellow, grey and black.
• White indicates a Cold pattern (unless of course, it is thin and white, in which case it is normal).
• Yellow indicates a Full-Heat pattern.
• Grey and black can both indicate either extreme Cold or extreme Heat, according to whether the tongue is wet or dry.
• Moisture
• The amount of moisture on a tongue gives an indication of the state of Body Fluids.
• Whenever the tongue is Red or Deep-Red, one should check the moisture: if the tongue is also dry, it means that the Heat has begun to injure the Body Fluids.
• A normal tongue should be very slightly moist, indicating that the Body Fluids are intact and are being properly transformed and transported.
• If the tongue is too wet, Yang‐Qi is not transforming and transporting fluids and these accumulate to form Dampness.
• If it is dry, it may indicate either Full-Heat or Empty-Heat, according to whether the tongue has a coating or not.
• If the coating is sticky or slippery, it indicates retention of Dampness or Phlegm.
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