Relationship Between Tongue Body Color and Shape

The color and shape of the tongue body are very closely linked to one another and should not be considered in isolation. Together, they reflect the strength of normal qi {zhengqi}.

In general, tongue body color shows, with the exception of acute illnesses, the underlying pattern of disharmony in a person’s constitution. A pale tongue body may indicate Kidney yang deficiency, a dark-red body Kidney yin deficiency. If there is a strong contrast in color from a healthy pale-red tongue body, this commonly reveals the onset of a more serious illness, usually involving the internal organs. In addition, where there are contradictory symptoms—for example, a patient with all the signs of Kidney yin deficiency but experiencing an intense internal feeling of cold (‘false cold, true heat’), or of an underlying Kidney yang deficiency but experiencing hot flushes—the tongue body color is a reliable indicator.

As a rule, the normal tongue shape changes only when pathology persists over a long period of time. A pale, swollen tongue body shows that the qi in the body has been deficient for quite a while. It indicates that the qi is not only failing to bring blood to the tongue (hence the pale color) but is also failing to transform and transport the fluids (swollen tongue body). A red tongue with a normal tongue body can indicate the beginning of Kidney yin deficiency, or of the penetration of heat into the blood level. A red tongue with a small, contracted body may reveal Kidney yin deficiency with a severe loss of fluids. This combination of color and shape is an indication that the yin has been exhausted over a long period of time: yin deficiency has given rise to heat, which in turn has injured the fluids, eventually leading to the contracted appearance of the tongue body.

Thus the combination of tongue body color and shape provides precise information about the condition of the qi, blood, yin, yang, and fluids. In the case of chronic illness, it is especially important to use the results of this diagnostic procedure to assess the severity of the illness.

In relation to the eight principles, the tongue body color and shape reflect the state of yin and yang as well as the presence of heat and cold. Yin deficiency produces heat, which is represented by a red tongue body, and, in severe cases, by a contracted body as well. By contrast, the internal cold that develops with yang deficiency is reflected in a very pale, swollen tongue body. Again, the tongue body color and shape are important indicators when assessing chronic illness.

Cracks, depressions, and localized swellings on the tongue body reflect energetic disharmonies in specific organs. For example, if the anterior third of the tongue is noticeably swollen, this implies retention of phlegm in the Lungs. If such a patient complains of a cough, it must be given immediate attention. However, if there are no Lung symptoms, it is of no special significance, and should just be noted.

Sometimes the tongue does not reflect a pattern of disharmony. This, in my experience, is especially true of patterns involving the Liver. For example, it is inadvisable to differentiate a pathology caused by ascending Liver yang or Liver fire based entirely on the appearance of a specific tongue sign, namely, redness or red points on the side of the tongue. An accurate diagnosis is possible only by considering the pulse qualities in conjunction with the symptoms experienced by the patient, since both of the aforementioned tongue signs can denote ascending Liver yang as well as Liver fire.

This is also the case with skin disorders. Atopic eczema, for example, does not always show up on the tongue. Patients who have suffered with long-term skin disorders manifested in itchy skin, sensations of heat, and redness of the skin will often present with a tongue that is pale, or show no signs at all of heat in the blood. Thus, for the diagnosis and treatment of skin disorders where the most obvious signs are skin lesions, indicators on the tongue are of little, if any, importance and occasionally must be ignored.

These examples will serve to underscore that tongue diagnosis must be integrated with other Chinese diagnostic techniques. It is only one aspect, albeit a very informative and important one, of the entire diagnostic protocol in Chinese medicine.

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