All lessons Module 1: Tongue Lesson 3
Shape, size and movement
What do the thickness, length, edges and movement of the tongue say?
After this lesson you can read the shape of the tongue through three questions (too little, too much or Wind), interpret Thin, Swollen, Partially Swollen, teeth marks, Long and Short always together with the colour, recognise Stiff, Flaccid, Quivering and Deviated, name the Western neighbours of teeth marks and a large tongue, and say which shapes and movements are a matter for neurology or an emergency first.
Know by heart
- Three questions. Too little (Thin, Flaccid, Pale and Quivering), too much (Swollen, teeth marks, Long), or Wind (Deviated, Red and Quivering, Stiff); mnemonic: a lack shrinks, an excess swells, Wind moves.
- Thin. Too little substance to fill the muscle: Pale and Thin is Blood deficiency, Red and Thin is Yin deficiency with Empty-Heat.
- Swollen. Too much: Dampness or Phlegm. Pale and wet: Yang deficiency that does not transform the fluids. Red: Heat, often with Dampness or Phlegm. Partially Swollen: read the area.
- Teeth marks. The Spleen does not hold the shape: Spleen-Qi deficiency, often with Dampness. Western neighbours: a large tongue in a small jaw, clenching, sleep apnoea, an underactive thyroid; mnemonic: the teeth only press in once the tongue no longer fits the space.
- Length. Long and Red: Heat, especially in the Heart. Short or retracted: Pale and wet is Cold that contracts, Red and dry is extreme Heat. A short frenulum is constitutional.
- Tension and movement. Stiff: Wind, Heat or Phlegm. Flaccid: severe deficiency (Pale Qi and Blood, Red Yin). Quivering: Pale deficiency, Red Liver-Wind. Deviated: Wind.
- Red flags. Suddenly Deviated, Stiff or Flaccid with loss of speech or strength: emergency services (112). Suddenly swollen with difficulty swallowing or breathing: emergency services (112). A tongue that gets thinner or ripples at rest, with swallowing problems: a GP or primary care doctor. Always large in someone who has become slow, chilly and heavier: TSH.
The rest of this lesson is reference.
Three practice questions from this lesson
What is the logic behind Thin versus Swollen?
- Thin is too little substance; Swollen is something accumulating
- Thin is Heat, Swollen is Cold: the temperature determines the shape
- Thin is acute, Swollen is chronic: the tongue grows with the duration
Answer: Thin is too little substance; Swollen is something accumulating. A lack shrinks, an excess swells: Swollen is Dampness or Phlegm accumulating. The colour says which lack (Blood or Yin) or what goes with the excess (Yang deficiency or Heat); the shape itself does not tell the temperature or the duration.
Case. Woman of 47, heavy and tired, bloated after eating, sticky stools that are hard to flush away. Tongue Pale, Swollen, teeth marks, sticky white coating.
- Spleen deficiency with Dampness
- Yin deficiency with Empty-Heat
- Liver-Fire
Answer: Spleen deficiency with Dampness. Pale and marks: the Spleen is weak. Swollen and sticky: Dampness that lingers. Heaviness and sticky stools confirm it.
Case. Man of 58, night sweats and a dry mouth at night for months. Tongue Red, Thin, dry, without coating.
- Yin deficiency with Empty-Heat
- Full-Heat consuming the fluids
- Liver-Blood deficiency
Answer: Yin deficiency with Empty-Heat. Red and Thin is too little Yin to fill and to cool; without coating the Heat is empty. Full-Heat leaves a coating behind; Pale and Thin would be Blood deficiency.
The rest of this lesson
In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 17 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.