Tongue pictures by pattern

Which tongue goes with which pattern, and which tongues look alike?

After this lesson you can read a tongue in two steps (first the substance, then the place), you know the tongue of four deficiencies, six excesses and more than forty organ patterns, you can name for each pattern the neighbour that resembles it and the finding that decides, and you know which patterns the tongue cannot separate. Module 4 adds the pulse, organ by organ.

Schematic, Qi deficiency: slightly Pale.

Schematic, Yang deficiency: Pale, Swollen, wet.

Schematic, Blood deficiency: Pale, Thin, slightly dry.

Schematic, Yin deficiency with Empty-Heat: Red, bare, dry.

Schematic, Full-Heat: Red, yellow coating.

Schematic, Full-Cold: thick white coating.

Schematic, Dampness: sticky coating.

Schematic, Phlegm: Swollen, thick sticky coating.

Schematic, Qi stagnation: normal, or red sides when it turns hot.

Schematic, Blood stasis: Purple, here Reddish-Purple with spots; Bluish-Purple with Cold.

Know by heart

Two steps. First the substance (colour, shape, moisture, coating), then the place (area); mnemonic: the colour is the substance, the coating is the guest, the place is the address.
Four deficiencies. Qi: Pale, often only slightly. Yang: Pale, wet, Swollen. Blood: Pale, Thin, slightly dry. Yin: Red without coating; early on still normal in colour without coating.
Six excesses. Full-Heat: Red with a yellow coating. Full-Cold: thick white coating. Dampness: sticky. Phlegm: Swollen with a thick sticky coating. Qi stagnation: normal or red sides. Blood stasis: Purple, thick veins underneath; Bluish-Purple with Cold, Reddish-Purple with Heat.
The place chooses the organ. Redder tip: Heart. Red, pale or purple sides: Liver. Centre: Stomach (bare: Yin; thick dry yellow: Heat). Root: Kidneys and Bladder. Front part: Lungs.
Five pairs. Liver-Fire dry yellow, Damp-Heat in the Liver and Gall-Bladder sticky yellow. Heart-Fire yellow coating, Heart and Kidneys little coating. Spleen-Qi not wet, Spleen-Yang wet. Spleen with Dampness thin and sticky, Damp-Phlegm thick and Swollen. Lung-Yin Red and bare, Lung Dryness dry with a normal colour.
What the tongue does not separate. Spleen-Yang, Kidney-Yang and Heart-Yang share one tongue; Heart-Blood and Liver-Blood almost; Liver invading the Spleen has no fixed tongue; Wind-Cold and Liver-Qi stagnation often leave the tongue normal; mnemonic: the tongue chooses the substance, the history chooses the organ.
Red flags. Every tongue picture has a Western double: Pale and Thin (Hb, ferritin), large, Pale and wet (TSH), smooth, Red and bare (B12, iron, folic acid), Purple with thick veins (blood pressure), blue with breathlessness (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

Two Red tongues with redder sides. One carries a dry yellow coating, the other a sticky yellow coating. Which is which?

Dry: Liver-Fire; sticky: Damp-Heat in the Liver and Gall-Bladder
Dry: Damp-Heat in the Liver and Gall-Bladder; sticky: Liver-Fire
Both Liver-Yang rising, because the sides are red

Answer: Dry: Liver-Fire; sticky: Damp-Heat in the Liver and Gall-Bladder. The colour and the place say Heat in the Liver; the coating says whether Dampness is involved: sticky is Dampness, dry is Heat consuming the fluids.

Case. Woman, 47, does not sleep through, dreams a lot, has palpitations, night sweats and tinnitus. Tongue Red with a redder tip and little coating. Which pattern?

Heart and Kidneys not harmonised
Heart-Fire
Kidney-Yin deficiency without Heart signs

Answer: Heart and Kidneys not harmonised. Red with little coating is Empty-Heat; the redder tip and the palpitations show the Heart is involved; tinnitus and night sweats the Kidneys. Heart-Fire has a yellow coating.

Case. Man, 63, feels the cold, cold lower back, gets up three times a night to urinate. Tongue Pale, wet, Swollen. What separates Kidney-Yang from Spleen-Yang here?

The history and the pulse at chi, not the tongue
The wetness: with the Kidneys the tongue is wetter
The colour: with the Kidneys the tongue is more purple

Answer: The history and the pulse at chi, not the tongue. Spleen-, Kidney- and Heart-Yang deficiency share the same tongue. Lower back, urination at night and a deep weak pulse at chi choose the Kidneys. Urination at night goes to a GP first.

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