Stomach and the Intestines

A peeled centre, a thick yellow coating, a sticky root, a full pulse on the right in the middle: which pattern of the Stomach, Small Intestine or Large Intestine do you read, and which finding separates the neighbours?

After this lesson you know where to read the Stomach and the intestines (the centre and the root of the tongue, right guan, and the two maps for the intestines), you know the tongue and pulse of all patterns of the Stomach, Small Intestine and Large Intestine, you read the coating as the work of the Stomach, you separate the tricky pairs, you know which tongues and pulses go to a doctor first, and you read a stomach complaint with a peeled centre from finding to principle.

Schematic: Stomach-Qi deficiency. Slightly Pale, thin white coating.

Schematic: Stomach deficient and cold. Pale, Swollen, moist.

Schematic: Stomach-Yin deficiency. Centre peeled, wide crack in the centre.

Schematic: Stomach-Heat. Red, thick dry yellow coating in the centre.

Schematic: Cold invading the Stomach. Thick white coating.

Schematic: Retention of Food. Thick, loose and grainy coating, thickest in the centre.

Schematic: Small Intestine Full-Heat. Red, redder swollen tip, thin yellow coating.

Schematic: Damp-Heat in the Large Intestine. Red, sticky yellow, thickest at the back.

Schematic: Heat in the Large Intestine. Thick, dry, dark yellow coating.

Schematic: Large Intestine Dryness, the Blood side. Pale, Thin, dry.

Know by heart

Where you look and feel. The Stomach: the centre of the tongue and right guan. The intestines: the root of the tongue, and at the pulse at chi (body map) or at cun, Small Intestine left and Large Intestine right (channel map); mnemonic: the Stomach in the middle, the intestines at the back.
The Stomach makes the coating. Thin, white and rooted: the Stomach is working. Thick: something is lying there (food, Cold, Dampness, Heat). Rootless, then peeled, then bare: Stomach-Yin is running out; mnemonic: first loose, then patches, then bare.
Three deficiencies. Qi: Pale; empty at right guan. Deficient and cold: Pale, Swollen, moist; deep, weak. Yin: centre peeled or bare, Red with Empty-Heat; floating-empty or thin; mnemonic: weak, cold, dry.
Excess in the centre. Cold invading: thick white; deep, slow, tight. Food: thick, white or yellow, thickest in the centre; slippery and full. Blood stasis: Purple; choppy. The Liver invading: normal or red sides; wiry.
Three kinds of yellow. Stomach-Heat: Red, thick dry yellow; full, rapid. Damp-Heat: sticky yellow; slippery-rapid. Phlegm-Heat: sticky yellow in a wide crack in the centre; slippery, rapid, overflowing; mnemonic: dry burns, Damp sticks, Phlegm fills the crack.
The intestines. Small Intestine, Full-Heat: redder swollen tip, yellow; rapid, overflowing. Large Intestine: Damp-Heat sticky yellow at the back, slippery-rapid; Heat thick dry yellow to brown, full, rapid; Cold thick white, deep, tight; Dryness dry, thin; deficient and cold Pale, deep.
Red flags. Vomiting blood or coffee grounds, black stools, difficulty swallowing, weight loss, pain on exertion, a hard abdomen, vomiting without stools or wind: see a doctor first, often the same day or emergency services (112 in Europe, 999 in the UK, 911 in North America).

The rest of this lesson is reference.

Three practice questions from this lesson

In the centre of the tongue lies a thin white coating that looks sprinkled on and comes away with light scraping. The colour of the tongue is normal. What is the earliest interpretation?

Early Stomach-Yin deficiency: the coating lacks a root
Retention of Food: the coating is loose and grainy
Stomach-Heat: the coating is drying in the centre

Answer: Early Stomach-Yin deficiency: the coating lacks a root. The coating disappears in stages: first rootless, then peeled, then bare. Retention of Food gives a thick coating, Stomach-Heat a thick, dry yellow one.

Case. Man of 58, for months a burning, empty feeling in the epigastrium, hungry but no desire to eat, thirst with small sips, dry throat in the afternoon and warm in the evening. Tongue Red with a bare centre and a crack; pulse thin and rapid, right guan the weakest. Which pattern?

Stomach-Yin deficiency with Empty-Heat
Stomach-Heat
Stomach-Qi deficiency
Kidney-Yin deficiency with Empty-Heat

Answer: Stomach-Yin deficiency with Empty-Heat. Bare and Red with a thin, rapid pulse is Yin deficiency with Empty-Heat; the centre and right guan point to the Stomach. Stomach-Heat has a thick, dry yellow coating and a full pulse; Stomach-Qi deficiency a Pale tongue; Kidney-Yin deficiency makes the root bare, with night sweating and the lower back.

Case. Man of 33, the morning after a large buffet: full, sour regurgitation, foul breath; after vomiting he feels better. Tongue with a thick, loose and grainy coating, thickest in the centre; pulse slippery and full, strongest on the right in the middle. Which pattern?

Retention of Food
Stomach-Heat
Cold invading the Stomach

Answer: Retention of Food. Began after one meal, better after vomiting, a thick grainy coating in the centre and a slippery, full pulse: food that stays put.

The rest of this lesson

In the course you get the step-by-step explanation with illustrated tongues and animated pulse models, 15 case-based practice questions, 19 spaced-repetition flashcards, the pitfalls, the bridge to physiology and the visual trainer. This lesson belongs to module 4: Organ by organ.

Try two lessons free See Tongue and Pulse