The Normal Tongue

The normal tongue reflects energetic harmony within the body. The right interplay of yin and yang, qi, blood, and fluids is reflected in the color, shape, and coating of the tongue body. As previously mentioned, the first step in the examination of the tongue is to gain an overall impression, especially of the vitality of the tongue. A vital tongue has a fresh-looking body that is well supplied with hlood, giving it a fresh, pale-red color. When the tongue is full of vitality, it moves easily and can protrude from the mouth without difficulty. The normal tongue should also be a little moist, indicating the presence of adequate fluids.

During the second step of the examination, the following individual aspects of the tongue should be evaluated:

A) The normal tongue color is pale red.

The red coloration indicates that the qi and yang are strong enough to transport blood to the tongue. It also reflects the quality and quantity of the hlood

Circulation in the body. The tongue has a pale tinge due to the supply of fluids that ascend from the Stomach to the tongue (see Chapter 5).

The clear part of the fluids (jin) also serves the function of thinning the blood. If there is a deficiency of fluids in the body, the blood will be correspondingly less dilute. This will cause the tongue to appear redder. In a healthy person, the pale-red tongue body color arises from the appropriate mixture of blood and fluids. If a tongue is lighter than pale red, it is called pale. If it is darker than pale red, it is called reddish or red.

B)  The normal tongue body shape is neither too thick nor too thin.

The tongue body should move easily and look neither too soft nor too stiff. The tongue’s surface should be smooth and soft and show no cracks. The size of the tongue body usually corresponds to the constitution of the individual, and therefore does not necessarily imply pathology. It could thus be said that the tongue fits the body shape of the individual. A big, strong person normally has a big tongue body, while a thin, small person has a thin, smallish tongue.

The volume of the tongue body, however, is important. It should be neither too thin nor too thick. A slight tapering toward the tip of the tongue is also normal. The tongue body shape reflects the condition of a person in relation to their long-term energetic development. It can, for example, take years before a contracted or extremely swollen tongue body develops. The formation of cracks in the tongue body may also represents lengthy pathological process.

C)  The normal tongue coating is white and thin.

A thin, white tongue coating is regarded as normal, although it can also indicate acute, externally-contracted wind-cold. If the tongue shows no coating but is moist and of a normal color, this is also normal and does not suggest pathology. A slightly thick, pale-yellow tongue coating at the root of the tongue arises from the physiological activity of Stomach qi during the process of digestion. Fermentation of the ingested liquids and solids results in ‘steam,’ which materializes as a form of turbid moisture on the coating of the tongue. This coating is thickest at the root of the tongue and steadily thins out toward the tip of the tongue. Due to the turbidity rising up, it is normal for the tongue coating, at the root, to be of a pale-yellow color. If there is coating in the middle and anterior parts of the tongue, but none on the posterior, this is indicative of a condition characterized by deficiency (see Section 3.6). This so-called ‘rootless’ coating originates most commonly from deficiency of Stomach qi. Stomach yin, and Kidney yin.

D) Veins underneath the tongue are not distended.

In the case of a normal tongue, the sublingual veins are either barely visible or not visible at all. Their color should be light and not of a dark-blue or purple color. When examining the veins underneath the tongue, particular attention should be paid to the following:

• The patient should curl the tongue up lightly and gendy, and rest the tip of the tongue on the palate.

If the patient does this more than once within a short space of time, the veins can become an intense bluish color. Similarly, if the patient has been talking a lot before the examination, the veins may also appear more bluish and distended. In such cases, the practitioner must be careful in formulating a diagnosis of blood stasis based on the changed appearance of these veins (see Section 8.3).

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