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Module 4   Lesson 4   She Tai

Tongue 2: coating, moisture, areas and protocol

What does the layer on the tongue tell you about the Stomach and the pathogen, and how do you look so that a colleague sees the same?

After this lesson you can read the coating by thickness, colour, root, quality and distribution, follow the coating over time, interpret the moisture, place a finding on the area map and the Three Burners, and work to a fixed protocol.

back of the mouth Lower Burner Kidneys, Bladder, bowels Middle Burner Spleen, Stomach Liver, Gall-Bladder Liver, Gall-Bladder Upper Burner Lungs Heart tip, towards you Thickness none Stomach-Qi or Yin spent thin normal or onset thick pathogen, deeper Colour white Cold; thin: normal yellow Heat grey, black extreme Moisture dry Heat or Yin spent slightly moist normal wet low Yang, Dampness plus: root, sticky or loose, distribution, course
Schematic. The area map is textbook knowledge (module 1, lesson 11); some sources read the left side as Liver and the right as Gall-Bladder. The rulers summarise textbook knowledge. The book on coating, moisture and areas: ch. 23 pp. 328 to 331.

Know by heart

  • Where the coating comes from (textbook knowledge). The Stomach ripens the food; a thin, white, rooted coating shows that the Stomach-Qi is working. No coating: Stomach-Qi or Yin spent. Thin: normal or an onset. Thick: a pathogen, stronger and deeper; mnemonic: thin is a Stomach at work, thick is a guest who stays, gone is a Stomach running out.
  • Colour. White: Cold (thin white is normal). Yellow: Heat, the darker the hotter. Grey or black: extreme; wet is Cold, dry is Heat.
  • Root and quality. Rooted (grows out of the tongue, does not come away): Stomach-Qi intact. Rootless (lies on top, scrapes off): Stomach-Qi weak. Sticky: Dampness or Phlegm. Loose and grainy: food retention with Stomach-Heat. Peeled: Stomach- or Kidney-Yin spent.
  • Course. From thick to thin: favourable. Suddenly gone: unfavourable. From white to yellow: Cold turns into Heat, or the pathogen moves inwards; mnemonic: the coating is this week's weather, the body is the climate.
  • Moisture. Slightly moist is normal. Wet: Yang deficiency or Dampness. Dry: Heat consuming the fluids, or Yin deficiency.
  • Areas. Tip Heart, just behind it Lungs, centre Spleen and Stomach, sides Liver and Gall-Bladder, root Kidneys, Bladder and Intestines; as Three Burners: tip Upper, centre Middle, root Lower.
  • Protocol. Daylight; before eating, drinking and brushing; stick out briefly and repeat; first the body, then coating, moisture, area and underside; ask about anything that stains.

The rest of this lesson is reference.

Tongue 2: coating, moisture, areas and protocol: What does the layer on the tongue tell you about the Stomach and the pathogen, and how do you look so that a colleague sees the same?
The chart as an image, to save or share

Three practice questions from this lesson

According to textbook knowledge, where does the normal thin white coating come from?
  1. From the Stomach ripening the food
  2. From Phlegm from the Lungs
  3. From the Kidneys letting fluid rise

Answer: From the Stomach ripening the food. The coating is a by-product of the Stomach ripening the food. Thin, white and rooted: the Stomach-Qi is working.

In three days the coating has gone from thin white to thick yellow.
  1. The Stomach-Qi and Yin are recovering
  2. The pathogen is retreating and the Heat is decreasing
  3. The pathogen is growing, moving deeper and turning hot

Answer: The pathogen is growing, moving deeper and turning hot. Thin to thick is growing or moving inwards; white to yellow is Cold turning into Heat. Retreating shows as thick to thin and yellow to white; recovery of Stomach-Qi and Yin as a thin white coating coming back.

After a week of treatment, a thick sticky coating becomes thinner and stays rooted.
  1. Favourable: the pathogen is retreating
  2. No meaning: the coating always fluctuates
  3. Unfavourable: the Stomach-Qi is running out

Answer: Favourable: the pathogen is retreating. Thick to thin while keeping the root: the pathogen retreats while the Stomach-Qi holds. That is the course you want to see. Stomach-Qi running out shows as a coating that suddenly disappears.

The rest of this lesson

In the course you get the step-by-step explanation, 16 case-based practice questions, 20 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 4: Diagnosis.

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