Medical Dialogue

医学会话

Teaching on Tongue Diagnosis
舌诊教学

Professor Graham Butler at the Lake District School of TCM in the United Kingdom is starting a discussion of tongue diagnosis in his diagnostic class for first-year students.

professor:	Good morning students and welcome to another day of study! I hope everyone is invigorated from the taichi class this morning with Sifu Jampa. Today I would like to discuss the use of tongue observation in establishing a differential diagnosis in TCM. Who can tell me what it is about the tongue observation that helps in pattern discrimination?
student:	When observing the tongue, we look at the tongue body — that is, the fleshy part, as well as the tongue coating.
professor:	Good! Who can distinguish different aspects of the tongue body, and also tell us what each different aspect may indicate?
student:	When observing the tongue body, we look basically at its shape and color. For instance, a tongue may be swollen, which would indicate some dampness or phlegm. And a thin tongue would indicate the opposite, a lack of a body fluid.
professor:	When you say body fluid, what do you mean?
student:	Well, that would depend on the color of the tongue body. If the color was red, it would indicate a deficiency of yin, and is then usually accompanied by no coating on the tongue. If the tongue body was pale, it would then be a blood deficient indication.
professor:	Very good, that brought together three important aspects of tongue observation to clarify our diagnosis: (1) the shape of the tongue body; (2) the color, and (3) the coating or lack of coating. Can anyone tell me more about tongue coating?
student:	The color and texture of tongue coating tell us about the health of the stomach and yang, especially yang of the spleen. A thin white coating is a good indication of digestive strength. The color of the coating is an especially good indication of temperature.
professor:	What do you mean by that? And let's have someone else answers for that question.
student:	As I understand it, white coatings are cool or cold in nature and yellow coatings show various stages of heat. And a thicker coating indicates that the pathogenic factor is stronger, in either case. Isn't that so?
professor:	Both of those answers are accurate. Now, are there other shapes besides swollen and thin? And please give diagnostic indications.
student:	A tooth-marked tongue around the edges indicates spleen qi deficiency. A long tongue indicates heat, and conversely a short tongue indicates cold.
professor:	That answer is OK, but not complete. What more could be said about long and short tongues? Who wants to answer?
student:	Well, sir, I am not quite sure, but I think that a long tongue does indicate heat, especially of the heart, as the tongue is sometimes called the sprout of the heart. I am not sure about a short tongue.
professor:	Consider the color of the tongue body in a short tongue. What do you say then?
student:	Well, it would make sense that if it was pale, there would be a cold aspect and if it was red, there would be heat.
professor:	Consider moisture and coating on these.
student:	It would seem that a short red tongue would also indicate a deficiency in yin, assuming there was no coating on the tongue. And a pale tongue would show a white coating, or at least be wet.
professor:	Very good deductive reasoning. It seems you have been studying! Are there any questions at this point?
student:	I am interested in knowing the topical geography of the tongue. I remember reading that the tip of the tongue represents the upper burner, the area just behind that is the middle burner and the very back of the tongue is the lower burners.
professor:	I wanted to stay focused on the shape, color and coating today, but we can expand our view since you have asked. Can anyone comment further on the topography* of the tongue?
student:	Well, given the other student's description of the placement of the triple burners on the tongue, that would indicate that the lungs and the heart would be at the front of the tongue, and the middle part of the tongue would include the stomach, spleen, liver and gallbladder, and the back of the tongue would include the kidneys and bladder.
professor:	Good thinking. Since class is almost over, I want everyone to refine the answer regarding the topographical placement of the organs. It is good, but it could be more precise. We will start our next class there.
student:	Thank you very much Professor Butler. Some of us students were talking this morning about how we respect your knowledge and sharing that with all of us. Your style is very easy-going and we like your humor.
all students:	Thank you, Professor Butler. (Clapping in background)