Topography of the Tongue

The tongue is divided into the four parts:

Tip of the tongue:

The tip of the tongue
represents the heart. The
lungs are represented
slightly behind the tip.

Center of the tongue:

The center of the tongue
represents stomach and
spleen.
Root of the tongue:
The root of the tongue
represents Kidney, Bladder,
Large Intestine and Small
Intestine (Liver and
Gallbladder belong to the
Lower Burner. Remember
this, if there is slippery coat
at the root of the tongue).
Sides of the tongue:
The sides of the tongue
represent Liver and
Gallbladder. Theoretically,
Gallbladder is represented
on the right side and Liver on
the left side. Because Liver
and Gallbladder are closely
related, this differentiation is
more of a theoretical nature.

The normal Tongue

Body colour of the normal tongue is pale red. The tongue body is neither too thick and nor too
thin. The normal coating is thin, white and the body colour should be seen through the coating.
It is important to be completely familiar with the normal tongue, so that changes are easily
observed. While it is easy to see obvious changes, it is difficult to observe the slight ones.

Examination of the Tongue

There are many food, beverages, and sweets etc. which change the color of the tongue and lead
to misinterpretation. This is the reason why the patient should have refrained from eating and
drinking for at least one hour before the tongue is examined. Additionally, proper lighting is
necessary. The best light is natural daylight. The tongue should be examined as close to a
window as possible. If artificial lightning is necessary, halogen lightning should be used.

The patient is asked to stick out his tongue as far as possible without using force. If the patient
doesnt extend his tongue enough it will appear to be swollen, similarly if he uses too much force,
when sticking out his tongue, it will become narrower and reddened by the effort.
The patient should extend his tongue for no longer than 20 seconds, less is better. If the patient
extends his tongue too long, the tongue body will redden. In general it is wise to extend the
tongue for only a short time and then repeat the process.

The therapist must examine the following areas:

Tongue body color (general impression, localization)

Moisture of the tongue
Tongue coating (thickness, color, localization)
Togue body (size, thickness, cracks etc.)
Points (color, localization)

Tongue body color

The body color of the tongue mirrors the state of Qi and Blood, of Yin and Yang. To make an
accurate diagnosis several tongue signs are needed. E.g. a pale body color of the tongue points
to Qi Deficiency as well as to Blood Deficiency.
Only when the moisture of the tongue is examined, can an accurate diagnosis be made. A dry
and pale tongue body points to Blood Deficiency whereas a wet and pale tongue body points to
Qi Deficiency.
In this chapter, pale, red and bluish tongue body colors are discussed as well as the meaning of
the localization of the body color.

Pale tongue body color

A pale tongue body color is lighter than the normal tongue. The paleness
varies between light and clear. The paler the color, the bigger is the disorder.
The pale color indicates a condition of deficiency. Depending on the nature it is
either Blood Deficiency or Qi (Yang) Deficiency. The pale color alone is not
sufficient to decide between Qi and Blood Deficiency. Additionally the moisture
of the tongue body is needed.
The pale tongue is divided into the pale dry and the pale wet tongue body.

Pale and dry

The pale and dry tongue body points to Blood Deficiency.

If the Blood doesnt reach the tongue, the tongue gets pale. Because the Blood also moistens the
tongue it gets dry. Therefore a pale and dry tongue refers to Blood Deficiency.

Typically the tongue body is thin. If a pale and dry tongue has a thick tongue body, the thickness
of the tongue body points to Dampness.

Pale and wet

The pale and wet tongue body points to Qi Deficiency.

If Qi doesnt reach the tongue, the tongue gets pale (just as with Blood Deficiency). With Qi
Deficiency the transformation of the body fluids is restricted. So Dampness occurs and the tongue
gets wet. Accordingly a pale and wet tongue points to Qi Deficiency.

If the tongue is extreme pale and wet, there is Yang Deficiency. In this case, signs of Cold
must exist.

Typically the tongue is thick. If a pale and wet tongue has a thin tongue body, the thin body points
to Blood Deficiency.

Red tongue body color

By a red tongue body color, the color is redder than the normal tongue. The
reddening varies between light red and dark red.
The red tongue body indicates a condition of Heat. The redder the tongue
body is the higher the Heat. This Heat can be deficient Heat caused by Yin
Deficiency or excess Heat. This excess Heat can be caused internally or externally by the
pathogenic factor Heat (e.g. with an infection).
The red tongue body is divided into the red and dry, the red and wet and the red without coating
tongue body.