The colour of the tongue body

What colour is the tongue body, and what does it say about Qi, Blood, Yin, Yang and Heat?

After this lesson you can read the colour ladder from Pale to Blue with all the steps in between, separate the three kinds of Pale and the two kinds of Red, read colour by area and through the coating, recognise a colour that changes, say what light and camera do to colour, and name the colours that are a medical question first.

Schematic: Pale. Deficiency of Qi, Blood or Yang.

Schematic: Pale-Red. The normal colour.

Schematic: Red. Heat; the coating says whether it is full or empty.

Schematic: Deep-Red. Heat that sits deeper and lasts longer.

Schematic: Reddish-Purple. Stasis with Heat.

Schematic: Bluish-Purple. Stasis with Cold.

Schematic: Blue. Severe Cold or stasis; with blue lips, lack of oxygen first.

Know by heart

The ladder. Pale: Deficiency. Pale-Red: normal. Red: Heat. Deep-Red: Heat that sits deeper. Reddish-Purple: stasis with Heat. Bluish-Purple: stasis with Cold. Blue: severe Cold or stasis; mnemonic: too little paint is pale, fire colours red, standstill colours purple.
Three kinds of Pale. Slightly Pale: Qi deficiency. Pale, Thin and slightly dry: Blood deficiency. Pale, wet and Swollen: Yang deficiency; mnemonic: dry lacks Blood, wet lacks fire.
Two kinds of Red. Red with coating, especially yellow: Full-Heat. Red with little or no coating: Empty-Heat from Yin deficiency. Normal colour without coating: Yin deficiency that does not yet give Heat; mnemonic: first the moss goes, then the soil turns red.
Deep-Red. With coating: severe Full-Heat. Without coating: severe Yin deficiency with Empty-Heat. With fever: Heat at the level of Ying and Blood.
Colour by area. Tip redder: Heat in the Heart. Sides redder: Liver and Gall-Bladder. Sides Pale: Liver-Blood deficiency. Purple on the sides: stasis in the Liver.
Looking at colour. Look at the edges and the tip, where the coating is thin; daylight, put out briefly; the body changes over weeks, so a change of colour within a few days is something you distrust first.
Red flags. Blue with breathlessness: emergency services (112 in Europe, 999 in the UK, 911 in North America). Deep-Red and dry with high fever and drowsiness: a doctor straight away. Smooth, red and burning: iron, B12 and folate. Very Pale with tiredness, breathlessness or blood loss: Hb.

The rest of this lesson is reference.

Three practice questions from this lesson

Case. Woman of 29, tired, dizzy on standing up, blurred eyes in the evening, scanty periods. Tongue Pale, Thin, slightly dry, thin white coating.

Liver-Blood deficiency: too little substance to fill
Spleen-Yang deficiency: too little fire to give colour
Yin deficiency with Empty-Heat: the fluids dry up

Answer: Liver-Blood deficiency: too little substance to fill. Pale, Thin and slightly dry is Blood deficiency; eyes and periods point to the Liver. Yang deficiency gives a wet, Swollen tongue; Empty-Heat a Red one. But first have Hb and ferritin measured.

Case. Man of 66, chilly, cold knees and lower back, urinates twice a night; appetite and stools normal. Tongue Pale, wet, Swollen.

Kidney-Yang deficiency: too little fire in the Kidneys
Spleen-Yang deficiency: too little fire in the Spleen
Liver-Blood deficiency: too little Blood to give colour

Answer: Kidney-Yang deficiency: too little fire in the Kidneys. Pale, wet and Swollen is Yang deficiency. Cold in the lower back and knees with urinating at night is the Kidneys; with the Spleen the cold sits in the abdomen, with watery stools. Blood deficiency gives a Thin, slightly dry tongue. But first have the prostate and blood sugar checked.

Two Red tongues: one with a thick yellow coating, the other bare and shiny. What is the difference?

Thick yellow: Full-Heat; bare: Empty-Heat from Yin deficiency
Thick yellow: Empty-Heat from Yin deficiency; bare: Full-Heat
No difference: Red is Heat, the coating at most says the depth

Answer: Thick yellow: Full-Heat; bare: Empty-Heat from Yin deficiency. The colour says Heat, the coating says Full or Empty. Without coating the Yin is exhausted and the Heat comes from that lack.

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.

Try two lessons free See Tongue and Pulse