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Module 1   Lesson 11   She Zhen

Tongue diagnosis

What does a tongue you see in ten seconds tell you, and what does it not?

After this lesson you can read a tongue in the fixed order, lay the picture next to the nineteen patterns, and you know which features two raters see the same way.

back of the mouth Kidneys, Bladder, intestines root Liver, Gall-Bladder Liver, Gall-Bladder Spleen, Stomach centre Lungs behind the tip Heart tip towards you
Schematic, not a photo. The colours of the zones follow the Five Elements of lesson 4 (Water, Wood, Earth, Metal, Fire); they are not tongue colours.

Know by heart

  • The reading order. Colour, shape, coating, moisture, zone; mnemonic: Cool Sharks Cruise Many Zones.
  • The zones. Tip Heart; just behind the tip Lungs; centre Spleen and Stomach; sides Liver and Gall-Bladder; root Kidneys, Bladder and intestines; mnemonic: the trunk from top to bottom: Heart and Lungs at the front, Spleen and Stomach in the middle, Kidneys and intestines at the back; the Liver at the side, as in the abdomen.
  • Colour. Pale: Qi or Blood deficiency; pale and wet: Yang deficiency. Red with coating: Full-Heat; red without coating: Yin deficiency with Empty-Heat. Purple: Blood stasis, bluish with Cold, reddish with Heat; mnemonic: with red, ask straight away "with or without coating?".
  • Shape. Swollen with teeth marks: Spleen-Qi or Spleen-Yang deficiency with Dampness. Thin: Blood or Yin deficiency. Cracks: Yin deficiency; a central crack: Stomach or Heart.
  • Coating. Thin white: normal, or the start of external Cold. Thick: Excess, a pathogen. Sticky yellow: Damp-Heat. Sticky white: Damp-Cold or Damp-Phlegm. Peeled or rootless: Yin deficiency of the Stomach or Kidneys; mnemonic: yellow is hot, white is cold, thick is full, gone is empty.
  • Underside. Distended sublingual veins: Blood stasis; look with the tip against the palate.
  • Two lessons from the patterns. Pale, wet, swollen is Spleen-Yang (7) and Kidney-Yang (12) alike, and the history decides; a normal tongue rules out nothing (1, 5, 17).

The rest of this lesson is reference.

Tongue diagnosis: What does a tongue you see in ten seconds tell you, and what does it not?
The chart as an image, to save or share

Three practice questions from this lesson

A thick coating, whatever the colour, means
  1. Excess: a pathogen is present
  2. Deficiency: the zheng qi is running out
  3. Blood stasis: the Blood stands still

Answer: Excess: a pathogen is present. A thick coating is Excess. The coating is the footprint of a xie qi; no coating means precisely a deficit, zheng qi running out. Blood stasis you read from a purple tongue and distended sublingual veins, not from the coating.

Sticky yellow coating
  1. Damp-Cold
  2. Damp-Heat
  3. Yin deficiency of the Stomach

Answer: Damp-Heat. Sticky yellow is Damp-Heat; sticky white is Damp-Cold or Damp-Phlegm.

Teeth marks along the edge
  1. Liver-Qi stagnation: normal tongue or red sides
  2. Spleen-Qi or Spleen-Yang deficiency with Dampness
  3. Liver-Fire

Answer: Spleen-Qi or Spleen-Yang deficiency with Dampness. Swollen with teeth marks is Spleen-Qi or Spleen-Yang deficiency with Dampness. Liver-Qi stagnation has a normal tongue or red sides, Liver-Fire redder sides with a yellow coating; teeth marks belong to neither.

The rest of this lesson

In the course you get the step-by-step explanation, 18 case-based practice questions, 24 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 1: Foundations.

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