Tongue Diagnosis

Question 1

Structures and Functions of the Tongue (List)

Answer 1

Filiform papillae
Fungiform papillae
Circumvallate papillae

Question 2

Structures and Functions of the Tongue
Filiform Papillae (describe)

Answer 2

The most numerous and smallest papillae on the tongue, distributed over the tongue tip, body, and sides of the tongue. They are no taste buds, characterized by increased keratinization

TCM: Filiform papillae are formed by Lung Qi and Ming Men fire.

Question 3

Structures and Functions of the Tongue
Fungiform Papillae (describe)

Answer 3

Mostly seen on tip of the tongue and scattered among the filiform papillae.

TCM: Fungiform papillae are formed by Heart and Kidney Qi

Question 4

Structures and Functions of the Tongue
Circumvallate Papillae (describe)

Answer 4

The largest papillae, seven to nine in number, arranged in a V-shaped sulcus terminalis, which separates the tongue body from the tongue root.

Question 5

Relationship of Tongue and Zang Fu Organs
Heart

Area of Tongue:
Description:
Function:

Answer 5

Relationship of Tongue and Zang Fu Organs
Heart

Area of Tongue: tongue body - tip of tongue

Description: sprouts, opens

Function: distinguish tastes, speech

Question 6

Relationship of Tongue and Zang Fu Organs
Liver

Area of Tongue:
Description:
Function:

Answer 6

Relationship of Tongue and Zang Fu Organs
Liver

Area of Tongue: tongue body - side of tongue (middle)

Description: controls tendons

Function: move flexibly, mix food, speech

Question 7

Relationship of Tongue and Zang Fu Organs
Kidney

Area of Tongue:
Description:
Function:

Answer 7

Relationship of Tongue and Zang Fu Organs
Kidney

Area of Tongue: tongue body - back of tongue

Description: Stores congenital jing and yin

Function: normal shape and moisture

Question 8

Relationship of Tongue and Zang Fu Organs
Spleen

Area of Tongue:
Description:
Function:

Answer 8

Relationship of Tongue and Zang Fu Organs
Spleen

Area of Tongue: tongue body - middle/center of tongue

Description: external sign, controls muscle

Function: Normal shape, move flexibly, ability to taste

Question 9

Relationship of Tongue and Zang Fu Organs
Stomach

Area of Tongue:
Description:
Function:

Answer 9

Relationship of Tongue and Zang Fu Organs
Stomach

Area of Tongue: tongue coat - middle/center of tongue

Description: rising, evaporation

Function: thin white coating

Question 10

Relationship of Tongue and Zang Fu Organs
Lung

Area of Tongue:
Description:
Function:

Answer 10

Relationship of Tongue and Zang Fu Organs
Lung

Area of Tongue: tongue coating - just behind tip of tongue

Description:

Function: filiform papillae

Question 11

Clinical Significance of Tongue Diagnosis

Describe

Answer 11

1) To judge the exuberance or decline of the vital Qi
2) To distinguish the nature of the disease
3) To detect the location of the disease
4) To estimate the prognosis of the disease

Question 12

Contents of Tongue Inspection

List - Full

Answer 12

Tongue Spirit
Tongue Color
Tongue Shape
Tongue Bearing
Hypoglossal Vessels
Coating Color
Coating Properties

Question 13

Contents of Tongue Inspection

List - Short

Answer 13

Tongue Body

Tongue Coating

Question 14

Normal Tongue

Describe

Answer 14

Normal tongue is neither too large or small, soft, neither tough nor tender, moves freely, has a pink color which is covered by a thin and even white coating with moderate moisture. This coating can’t be scraped away and has its root in the tongue body.

Question 15

Inspection of Tongue Body

Tongue Spirit - Flourish (Define)

Answer 15

Refers to the brightness of the tongue body with energetic movement and enough fluid in the body.

Question 16

Inspection of Tongue Body

Tongue Spirit - Withered (Define)

Answer 16

Refers to the dark and dry tongue body with sluggish movement.

Question 17

Inspection of Tongue Body
Tongue Spirit - Flourished

Tongue Color:
Moisture:
Movement:
Indication:
Prognosis:

Answer 17

Inspection of Tongue Body
Tongue Spirit - Flourished

Tongue Color: light red

Moisture: moist

Movement: energetic

Indication: normal stomach qi

Prognosis: good

Question 18

Inspection of Tongue Body
Tongue Spirit - Withered

Tongue Color:
Moisture:
Movement:
Indication:
Prognosis:

Answer 18

Inspection of Tongue Body
Tongue Spirit - Withered

Tongue Color: dark and dim

Moisture: dry

Movement: sluggish

Indication: stomach qi exhausted

Prognosis: poor

Question 19

Pathophysiology of the Tongue Color
Pale Tongue

Description:
Pathogenesis:
Indications:

Answer 19

Pathophysiology of the Tongue Color
Pale Tongue

Description: the tongue color is lighter than normal, or even bloodless

Pathogenesis: there is insufficient Blood to fill in the tongue body.

Indications:
A. Cold syndrome: moist
B. Yang deficiency: enlarged and moist
C. Qi and blood deficiency: thin and small

Question 20

Pathophysiology of the Tongue Color
Red Tongue

Description:
Pathogenesis:
Indications:

Answer 20

Pathophysiology of the Tongue Color
Red Tongue

Description: the tongue is redder than normal

Pathogenesis: heat accelerates Blood movement, which fills up the vessels

Indications:
Heat syndrome
External heat: only slight red or red on tip and edge
Internal heat:
1) Excess heat: red and tough tongue with thick dry coating
2) Deficiency heat: red (with cracks) tongue with little coating

Question 21

Pathophysiology of the Tongue Color
Crimson Tongue

Description:
Pathogenesis:
Indications:

Answer 21

Pathophysiology of the Tongue Color
Crimson Tongue

Description: crimson tongue comes from red tongue, but the color is heavy and darker than red, it also called deep red

Pathogenesis: Heat concentrates and accelerates the movement of Blood

Indications:
Heat syndromes
A. Exogenous febrile diseases
B. Yin deficiency or exhausted: dry and small, without coating
C. Blood stagnation: with purple color

Question 22

Pathophysiology of the Tongue Color
Purple Tongue

Description:
Pathogenesis:
Indications:

Answer 22

Pathophysiology of the Tongue Color
Purple Tongue

Description: tongue body looks purple

Pathogenesis: blood stagnates and accumulates in the tongue body

Indications: extreme heat: crimson purple

Question 23

Pathophysiology of the Tongue Color
Bluish Tongue

Description:
Pathogenesis:
Indications:

Answer 23

Pathophysiology of the Tongue Color
Bluish Tongue

Description: the tongue color is like that of the blue veins exposed on skin, or bloodless like a buffalo’s tongue

Pathogenesis: cold constricts vessels, and so Blood stagnates.

Indications:
A. Pathogenic cold accumulation
B. Blood stagnation

Question 24

Pathophysiology of the Tongue Size
Enlarged Tongue

Description:
Pathogenesis:
Indications:

Answer 24

Pathophysiology of the Tongue Size
Enlarged Tongue

Description: the tongue body is wider than normal

Pathogenesis: fluids accumulate in the tongue body

Indications:
A. Dampness accumulation
B. Spleen and Kidney Yang deficiency with dampness

Question 25

Pathophysiology of the Tongue Size Swollen Tongue Description: Pathogenesis: Indications:

Answer 25

Pathophysiology of the Tongue Size Swollen Tongue Description: the tongue body is enlarged both horizontally and vertically. It can fill up the mouth and can be difficult to retract, in some cases the mouth can not even shut. Pathogenesis: Qi, Blood stasis in the tongue body due to heat Indications: A. Pathogenic heat invasion Heart and Spleen: red and swollen B. Alcohol poisoning: purple and swollen C. Blood stasis caused by chemical toxicity: darkish blue purple, swollen

Question 26

Pathophysiology of the Tongue Size Teeth Marked Tongue (Scalloped Tongue) Description: Pathogenesis: Indications:

Answer 26

Pathophysiology of the Tongue Size Teeth Marked Tongue (Scalloped Tongue) Description: teeth marks are visible on the tongue’s edges Pathogenesis: water or dampness stagnates in the tongue, enlarging the tongue body. Indications: A. Dampness: (+pale and moist) B. Spleen, or Qi deficiency: (+slight red)

Question 27

Pathophysiology of the Tongue Size Thin Tongue Description: Pathogenesis: Indications:

Answer 27

Pathophysiology of the Tongue Size Thin Tongue Description: the tongue body is thinner both horizontally and vertically, and thus smaller than normal Pathogenesis: tongue body lacks nutrition. Indications: A. Qi and Blood deficiency: (+pale and thin coating) B. Yin deficiency with heat: red with little or no coating

Question 28

Pathophysiology of the Tongue Shape Cracked Tongue Description: Pathogenesis: Indications:

Answer 28

Pathophysiology of the Tongue Shape Cracked Tongue Description: There are obvious fissures on the surface of the tongue which are not covered with a coating. The size, depth and shape of cracks are different. It may be seen on the whole tongue or restricted to the front part, or both sides of the tongue tip. Pathogenesis: Malnutrition of the tongue body and eventual atrophy of the tongue surface Indications: A. Excess heat: deep red crack with dry coating B. Yin deficiency: red body with cracks but no coating C. Blood deficiency: pale or slightly red body with cracks D. Spleen deficiency with dampness: pale, enlarged with teeth marks and cracks on the edges

Question 29

Pathophysiology of the Tongue Shape Prickles (Thorns, Dots, Spots) Tongue Description: Pathogenesis: Indications:

Answer 29

Pathophysiology of the Tongue Shape Prickles (Thorns, Dots, Spots) Tongue Description: there are spots or prickles on the surface of the tongue that look like strawberry thorns. Spots are flat or only slightly raised. They can be red, white, or black. Prickles are raised and can appear red or black. Both can appear on the borders of the tongue, or scattered over the entire surface Pathogenesis: accumulation of excessive pathogenic heat putrifies tongue’s surface Indications: excess pathogenic heat A. Excess heat toxin: bright red with yellow coating B. Pathogenic heat invasion into Ying or Xue levels: crimson red C. Damp-heat accumulation: yellow coating

Question 30

Pathophysiology of the Tongue Shape Ulcerated Tongue Description: Pathogenesis: Indications:

Answer 30

Pathophysiology of the Tongue Shape Ulcerated Tongue Description: form is like millet kernels, on top there are yellow dimples, after a long time they erode and create ulcerations, and the area may is red and painful. Pathogenesis: heat flaming upward accumulates on the tongue’s surface and putrefies the tissue. Indications: A. Heat toxin in the Heart channel: red with yellow coating B. Deficiency heat: cracked, red with scanty yellow coating

Question 31

Pathophysiology of the Tongue Body Tough (Old) Tongue Description: Pathogenesis: Indications:

Answer 31

Pathophysiology of the Tongue Body Tough (Old) Tongue Description: the striae of tongue are rough and sturdy Pathogenesis: excessive pathogens invasion and struggle with vital Qi, causing Qi and Blood rise, consuming Qi and body fluids Indications: excessive heat syndrome

Question 32

Pathophysiology of the Tongue Body Tender (Young) Tongue Description: Pathogenesis: Indications:

Answer 32

Pathophysiology of the Tongue Body Tender (Young) Tongue Description: the striae of tongue are delicate, fine and smooth Pathogenesis: Qi and Blood deficiency, or Yang deficiency failing to transform drink into body fluids and generating cold damp which accumulates and causes the tender tongue. Indications: Deficiency syndrome A. Qi and Blood deficiency: tender and dry B. Yang Qi deficiency: tender and wet

Question 33

Pathophysiology of the Tongue Bearing Flexibility - Stiff Tongue Description: Pathogenesis: Indications:

Answer 33

Pathophysiology of the Tongue Bearing Flexibility - Stiff Tongue Description: the tongue’s body has difficulty in moving or turning. It causes slurred speech and difficulty with eating. Pathogenesis: Tongue tendons spasm due to malnutrition. Indications: A. Pathogenic heat invades the pericardium: crimson with dry yellow coating B. Turbid phlegm obstructs the meridian: flabby tongue, with thick greasy coating C. Internal wind: Slight red or green purple tongue

Question 34

Pathophysiology of the Tongue Bearing Flexibility - Flaccid Tongue Description: Pathogenesis: Indications:

Answer 34

Pathophysiology of the Tongue Bearing Flexibility - Flaccid Tongue Description: it refers to a weak tongue unable to protrude or curl up with atrophy of the tongue muscle. In severe cases it has a crumpled look, with many lines on its surface. Pathogenesis: tongue tendons and muscles lack nutrition Indications: A. Severe Qi and Blood deficiency: pale and flaccid B. Excessive pathogenic heat injury body fluids: crimson and flaccid C. Yin fluids exhausted: deep red and dry flaccid, and no coating

Question 35

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Shaking Tongue Description: Pathogenesis: Indications:

Answer 35

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Shaking Tongue Description: the tongue body shivers and sways uncontrollably. Pathogenesis: tongue tendons spasm due to malnutrition Indications: A. Qi and Blood deficiency, or Yang depletion: pale and flaccid B. Internal wind due to extreme pathogenic heat: red

Question 36

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Deviated Tongue Description: Pathogenesis: Indications:

Answer 36

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Deviated Tongue Description: when tongue protrudes out of the mouth, it points to one side Pathogenesis: unilateral obstruction of the collateral ``` Indications: A. Liver Yang rising: purple red B. Blood deficiency: pale C. Wind phlegm: Thick coating D. Extreme heat: red tongue ```

Question 37

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Protruding and Licking Description: Pathogenesis: Indications:

Answer 37

Pathophysiology of the Tongue Bearing Abnormal Tongue Movements - Protruding and Licking Description: The tongue stretching out of mouth is called a protruding tongue. And that tongue stretches out and immediately retracts into mouth or like snack head move around is called licking. Pathogenesis: heat creates dryness which leads to tendon spasms Indications: A. Pathogenic heat in the Heart channel B. Pathogenic heat in the Spleen channel

Question 38

Pathophysiology of the Tongue Bearing Contraction of the Tongue - Shortened (Contracted) Tongue Description: Pathogenesis: Indications:

Answer 38

Pathophysiology of the Tongue Bearing Contraction of the Tongue - Shortened (Contracted) Tongue Description: the tongue contracts and shortens, and is inability to stretch, even can not reach teeth Pathogenesis: tongue tendon atrophy or construction due to cold, or malnutrition. Indications: critical condition A. Excessive pathogenic cold invades: pale with moisten coating B. Turbid phlegm accumulation: Flabby with greasy coating C. Excessive pathogenic heat: red tongue with dry yellow coating D. Spleen and Kidney failure, both Qi and Blood deficiency: pale tenderness tongue and flabby.

Question 39

Pathophysiology of the Tongue Bearing Contraction of the Tongue - Loose (Protracted) Tongue Description: Pathogenesis: Indications:

Answer 39

Pathophysiology of the Tongue Bearing Contraction of the Tongue - Loose (Protracted) Tongue Description: the tongue hangs outside the mouth when it is extended, and is difficult to retract. It may drip with saliva Pathogenesis: tongue tendon couldn’t contract due to malnutrition which may results channels and collaterals obstruction or deficiency Indications: A. Excessive heat or heat phlegm B. Qi deficiency

Question 40

Hypoglossal Vessels Normal Hypoglassal Vessels (Describe)

Answer 40

In normal condition, beside the frenulum of tongue, two thick bluish purple vessels can be seen. Their diameter is no more than 2.7 mm. Their length is no more than one third of the length from the sublingual caruncle to the tip of the tongue. There are no branches or spots.

Question 41

Hypoglossal Vessels Abnormal Hypoglassal Vessels (Describe)

Answer 41

The shape of main part are varicosity in some part or diffuse varicosity The length of main part is over reaching the middle point The filling degree of main part are filling up all parts with little crooked or dilation with crooked The color is bluish purple or purple black The peripheral parts cystic, thick processes just like grapestring The diameter over 2.7 mm Indication: Qi and blood stagnation