All lessons Module 1: Tongue Lesson 4
Cracks, points, spots and the underside
How do you read the signs on the tongue, and which of them are a predisposition?
After this lesson you can interpret cracks by location, length and depth, tell red points apart from raised prickles and from the ordinary papillae, read purple spots as local stasis, examine and grade the veins under the tongue, recognise ulcers and patches that go to a dentist or to a GP or primary care doctor first, and weigh predisposition against pathology.
Know by heart
- Cracks by location. Long in the centre, reaching to the tip: Heart. Wide in the centre, not reaching the tip: Stomach. Short and transverse on the sides: Spleen. Scattered on a Red, bare tongue: Yin deficiency; mnemonic: the long line is the Heart, the middle the Stomach, the side the Spleen, everywhere the Yin.
- Depth and duration. The deeper, the longer it has existed and the more it weighs. A lifelong crack without complaints is a predisposition. A rough yellow coating in a crack: Phlegm-Heat.
- Points. Red points: Heat in the Blood. Raised red prickles: stronger Heat. The area points to the organ; on the tip lighter, on the sides or all over heavier. Do not confuse them with the ordinary papillae on the tip and edges; mnemonic: flat is warm, raised is hotter.
- Purple spots. Local Blood stasis in that area: sides Liver, tip Heart and chest. The rest of the tongue can be normal.
- The underside. Tip against the palate. Normally thin and light blue. Thick and dark, or tortuous: stasis. Changes slowly, over years; in Western terms linked with age, smoking and high blood pressure.
- Predisposition or pathology. Four questions: since when, in the family, does it fit the complaints, does it change with them? A fissured tongue and a geographic tongue often run in families.
- Red flags. An ulcer, white or red patch or hardening after three weeks: a dentist or a GP. Pinpoint bleeds with bruises or bleeding gums: a GP, as soon as possible. A dark spot that grows: have it checked.
The rest of this lesson is reference.
Three practice questions from this lesson
A narrow crack in the midline running from almost the root to almost the tip. Which organ?
- The Heart
- The Stomach
- The Spleen
Answer: The Heart. The long line reaching to the tip is the Heart crack: a predisposition to Heart patterns. The Stomach crack is wider and stays in the centre; Spleen cracks are short and transverse on the sides.
Case. Woman, 50, thirsty but takes only small sips, little hunger, a vague discomfort in the epigastrium, dry stools. Tongue: a wide crack in the centre with no coating there; otherwise normal in colour.
- Stomach-Yin deficiency without Empty-Heat
- Stomach-Heat that uses up the fluids
- Spleen-Qi deficiency not nourishing the Stomach
Answer: Stomach-Yin deficiency without Empty-Heat. A wide central crack with a bare centre is Stomach-Yin deficiency. The colour is still normal, so there is no Empty-Heat (yet). Stomach-Heat gives a Red centre with a dry yellow coating.
Case. Man, 39, tired after eating for years, poor appetite, loose stools. Tongue Pale with teeth marks and short transverse cracks on the sides of the central part.
- Long-standing Spleen-Qi deficiency
- Yin deficiency with Empty-Heat
- Stomach-Yin deficiency with a bare centre
Answer: Long-standing Spleen-Qi deficiency. Short transverse cracks on the sides of the centre belong to a Spleen that has been falling short for a long time; the teeth marks and the complaints fit. A Stomach crack is wider and lies in the centre itself.
The rest of this lesson
In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 16 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 1: Tongue.