Tongue diagnosis is mainly based on looking at the tongue, including tongue feeling (taste) diagnosis and pulse wiping diagnosis. Looking at the tongue is one of the methods of diagnosis by observing the picture of the tongue. Tongue image is an image composed of tongue quality and tongue coating.
Therefore, looking at the tongue mainly depends on the quality of the tongue and the coating of the tongue.
(A) the relationship between the tongue and the viscera and meridians
The connection between tongue and viscera is mainly realized through the circulation of meridians. Neijing holds that the heart, liver, spleen, kidney, bladder, triple energizer and stomach are directly connected with the tongue through meridians, channels or tendons. As for the lung, small intestine, large intestine and gallbladder meridian, although they are not directly related to the tongue, their hands and feet are matched with Taiyin, hands and feet with the sun, hands and feet with Yang, and hands and feet with Yangming. Therefore, the qi of the meridians of the lung, small intestine, gallbladder and large intestine can also indirectly pass through the tongue. Therefore, the tongue is not only a wonderful part of the heart, but also an external disease of the five internal organs. Physiologically, the essence of zang-fu organs can reach the tongue through the connection of meridians, which can nourish the tongue and maintain its normal function. Theoretically, the changes of zang-fu organs will inevitably affect the changes of essence and qi, which will be reflected on the tongue.
According to the law of biological holography, any part is similar to the epitome of the whole, and the tongue is no exception, so predecessors said that the tongue should correspond to the internal organs. Its basic law is: equal top, equal middle right, and so on. There are three specific division methods.
The length of zang-fu organs belongs to the site of tongue diagnosis.
The heart and lungs are on the top, and the tip of the tongue is used to control the heart and lungs; The spleen and stomach are in the middle, so the tongue dominates the spleen and stomach; The kidney is located below, so the root of the tongue governs the kidney; The liver and gallbladder live on the side of the body, so the tongue governs the liver and gallbladder, the left side belongs to the liver, and the right side belongs to the gallbladder. This expression is generally used for internal injuries.
2. Triple energizer belongs to the tongue.
According to the sequence of triple lesions, it belongs to the part of tongue diagnosis, with the lesions above the tip of the tongue as the main focus, the lesions in the middle of the tongue as the main focus, and the lesions below the base of the tongue as the main focus. This classification is mostly used for exogenous diseases.
3. Stomach cavity belongs to tongue diagnosis site.
Upper epiglottis is dominated by the tip of the tongue, middle epiglottis is dominated by the tongue, and lower epiglottis is dominated by the root of the tongue. This method is often used for gastrointestinal diseases.
Different parts of the tongue and other viscera are one of the topics to study the laws of biological holography at present. Although there are different opinions, they all have reference value. In clinical diagnosis, it can be verified by combining the diagnosis of tongue quality and tongue coating, but the four diagnoses should be combined with reference and comprehensive judgment, and should not be too rigid.
(B) the content of looking at the tongue
The content of looking at the tongue can be divided into two parts: looking at the tongue and coating the tongue. Tongue quality, also called tongue body, is the muscle and vein of the tongue. The quality of looking at the tongue can be divided into four aspects: looking at God, looking at color, looking at shape and looking at posture. Tongue coating is a layer of tongue coating attached to the tongue, which is divided into two aspects: coating color and coating quality
Normal tongue picture, referred to as "reddish tongue with thin white coating". Specifically, its tongue is soft and elastic, and its color is reddish and vivid; Its fat, thin, old and tender size is moderate, without deformity; The tongue coating is thin, white and moist, with uniform particles. Apply it thinly on the surface of the tongue and it won't rub off. There are roots and tongues under it, which are moderately dry and wet, not sticky or greasy. In short, the normal manifestations of the basic factors of tongue quality and tongue coating are combined to form a normal tongue picture.
1. Comrade Wang
(1) Tongue God: Tongue God is mainly manifested in the fluency and agility of the tongue. The key to studying the tongue is to distinguish between prosperity and decline.
Noble people are radiant, radiant, manifested in flexible tongue, rosy color, bright luster and full of vitality. This means that there is a god, even if they are sick, they are still good. The dry person is dull, which is characterized by poor tongue movement and dry tongue quality, indicating that there is no god, which is dangerous and bad weather. It can be seen that the existence of tongue spirit reflects the ups and downs of viscera, qi, blood and body fluid, which is related to the prognosis.
(2) Tongue color: color, that is, the color of the tongue. Generally, it can be divided into light white, light red, red, crimson, purple and cyan. Except for reddish, which is a normal tongue color, the rest are major diseases.
1 reddish tongue: the color of the tongue is white with red, not deep or shallow, and moderately reddish, which is a manifestation of qi and blood circulation, indicating that the heart is full and the yang is insufficient, so it is a normal tongue color.
2 pale white tongue: the color of the tongue is lighter than that of the reddish tongue, or even completely bloodless, which is called pale white tongue. Because yang deficiency reduces the function of biochemical yin and blood, and the power of promoting blood circulation is also weakened, so that blood can not run in the tongue, so the tongue color is pale and white. Therefore, this tongue governs deficiency-cold or deficiency of both qi and blood.
3 red tongue: the color of the tongue is bright red, which is deeper than the pale red tongue, so it is called red tongue. Because of intense heat, boiling qi and blood, and full tongue pulse, the tongue is bright red, so it is the main heat syndrome. Visible in the empirical evidence, or deficiency-heat syndrome.
4 crimson tongue: crimson is crimson, darker and thicker than red tongue. It's called crimson tongue The main diseases can be divided into exogenous diseases and internal injuries. Exogenous disease is heat entering the blood. Miscellaneous diseases caused by internal injuries are all due to yin deficiency and excessive fire.
5 purple tongue: purple tongue is always caused by poor blood circulation and blood stasis. Therefore, the purple tongue governs the disease, which is nothing more than cold and heat. Excess heat impairs body fluid, and qi and blood stagnate, which is mostly manifested as crimson dryness and insufficient body fluid. Cold coagulation and blood stasis or yang deficiency lead to a cold, and the tongue is pale purple or blue and moist.
6 green tongue: the color of the tongue is like the "blue veins" exposed from the skin, and there is no red at all, which is called green tongue. Ancient books describe it as the tongue of a buffalo. The tongue is blue and purple because of yin cold and evil spirits, yang stagnation, blood coagulation and blood stasis. Main cold congeals yang depression, or yang deficiency congeals cold, or there is blood stasis inside.
(3) Tongue shape: refers to the shape of the tongue body, including old and tender, fat and thin, expansion and contraction, cracks, burrs, tooth marks and other abnormal changes.
1 old tongue: the tongue is rough and solid, which is called old tongue. No matter what the color of the tongue is, the old tongue belongs to an empirical study.
2 delicate tongue: the tongue is delicate in quality, delicate in color and swollen in shape, which is called delicate tongue and has many major deficiency syndromes.
3 swollen tongue: divided into fat and swollen. The tongue body is larger than the normal tongue, and even the tongue is covered with oral cavity or tooth marks, which is called fat tongue. The tongue is swollen, full of mouth and can't be closed, which is called swollen tongue and fat tongue. Most of them are caused by phlegm-dampness block caused by drinking water. Tongue swelling is mostly caused by stagnation of qi and blood due to heat toxicity and alcoholism, which leads to swelling of the tongue, and is mainly used for heat syndrome or toxic syndrome.
4 thin: the tongue is thin and thin, called thin tongue. It is always caused by deficiency of qi, blood and yin that cannot fill the tongue. Dominate deficiency of both qi and blood or fire flourishing due to yin deficiency.
5 thorn: there is soft thorn on the tongue surface (that is, tongue * * *), which is normal. If the number of soft thorns on the tongue surface increases and bulges like thorns, it is called a barbed tongue. Most of them are caused by excessive pathogenic heat. The more thorns, the more pathogenic heat. According to the place where the tingling occurs, it can be distinguished that the heat in the five internal organs, such as the tingling on the tip of the tongue, is mostly caused by excessive heart fire; There are thorns on the tongue side, mostly liver and gallbladder fire; There are thorns on the tongue, which dominate the stomach.
6 crack: there is a crack on the tongue surface, but there is no tongue coating in the crack, which is called cracked tongue. Most of them are caused by blood loss, body fluid injury and tongue dystrophy. So many experts have lost blood. In addition, it is about 0 in healthy people. 5% people have deep longitudinal and transverse grooves on the tongue surface, which is called congenital cleft lip and palate. Most cracks are covered with tongue coating and there is no other discomfort in the body, which is different from cracked tongue.
7 Tooth marks: There are tooth marks on the edge of the tongue, so it is called tooth marks tongue. Its etiology is mostly due to spleen deficiency, which can not be too wet, so that the temperature is blocked by the tongue, and the fat of the tongue is squeezed by the dentition to form tooth marks. Therefore, tooth marks are more common in the fat and tender tongue, which is mainly caused by spleen deficiency or dampness.
(4) Tongue state: refers to the state when the tongue body moves. The normal tongue picture state is flexible tongue body activity, and the pathological tongue picture state is tough, weak, vertical, short, paralyzed, trembling, crooked, vomiting and so on.
1 toughness: the tongue is hard and stiff, and its movements are ineffective, resulting in unclear language, which is called a tough tongue. Most of them are caused by heat disturbing the mind, uncontrollable tongue, or yin injury caused by high fever, nutrient loss of tendons and veins, or phlegm blocking tongue collaterals. It is more common in pericardium invasion by heat, body fluid injury by high fever, phlegm and blood stasis, stroke or stroke omen.
2 flaccidity: the tongue is weak, unable to flex and stretch, and flaccidity is invalid, which is called flaccidity. Most of them are caused by deficiency of qi and blood, and yin fluid does not nourish tendons and veins. Visible in the deficiency of both qi and blood, heat burning and body fluid injury, extreme yin deficiency and other syndromes.
Tongue lengthways: The tongue sticks out of the mouth, and it is difficult or impossible to retract, which is called tongue lengthways. It is always caused by the relaxation of tongue muscles. It can be seen in excess heat, phlegm-fire disturbing the heart and qi deficiency syndrome.
4 shortening: the tongue is tight and unable to stretch, which is called shortening the tongue. Contraction can be caused by cold coagulation of tendons and veins and contraction of tongue; Internal resistance of phlegm-dampness induces liver wind, wind evil carries phlegm and blocks the root of tongue; Excessive heat injures body fluids and narrows the tendons; Deficiency of both qi and blood, loss of nourishing temperature of tongue. Whether due to deficiency or excess, it is a critical symptom.
Paralysis: If the tongue feels numb and the movement is ineffective, it is called tongue paralysis. Most of them are caused by blood not getting to the tongue. If the tongue is numb for no reason, it is heart-blood deficiency; If the tongue is numb and vibrates from time to time, or there is, it is the syndrome of liver wind moving internally.
6 tremor: the tongue vibrates and cannot move autonomously, which is called trembling tongue. Most of them are caused by deficiency of both qi and blood, dystrophy of tendons and veins, or extreme heat injury to body fluids. It can be seen in the syndrome of blood deficiency leading to wind and extreme heat leading to wind.
7 skew: the tongue is tilted to one side and the tongue body is not straight, which is called skew tongue. Most of them are caused by wind evil in collaterals, or wind phlegm blocking collaterals, and some of them are caused by wind evil in zang-fu organs. However, due to the obstruction of meridians and veins on one side and the relaxation of tongue muscles on the diseased side, they always tend to lean towards the healthy side. More common in stroke syndrome or stroke aura.
8 Spit out the tongue: those who often stick out of the mouth are "spit out the tongue"; If the tongue does not stop licking the upper, lower, left and right lips, or if the tongue sticks out of the mouth slightly, it will be withdrawn immediately. This is called "getting the tongue". Both of these diseases are called tongue spitting, which are caused by internal heat of the heart and spleen, burning body fluids, tightening the tendons and veins, and frequent shaking. Tongue distortion is common in children with mental retardation.
Look at tongue coating
Normal tongue coating is steamed from stomach qi, so the rise and fall of stomach qi can be reflected from the change of tongue bitterness. The formation of pathological tongue coating is caused by the rising of turbid qi in the stomach and food stagnation; One is the rise of evil spirits. When looking at tongue coating, we should pay attention to the changes of coating quality and coating color.
(l) moss; Moss refers to the shape and quality of tongue coating. Including the thickness of bitter tongue, moist, rough and sticky, greasy, peeling, rooted and rootless.
1 thickness: the thickness is based on "bottoming out" and "bottomless". The place where the quality of the tongue is faintly visible through the coating of the tongue is the bottom, that is, the thin coating. Born of stomach qi, it belongs to normal tongue coating, and it is common to see diseases, mostly for the first time or on the surface, and the condition is mild. If you can't see the tongue through the tongue coating, it is bottomless and thick coating. Most of them are pathogenic factors, or gastrointestinal stagnation, and the condition is serious. The tongue coating is thin and thick, mostly positive and invincible, and the pathogenic factors from the outside to the inside, and the condition changes from light to heavy, which is the performance of the disease development; The tongue coating turned from thick to thin, mostly due to the return of healthy qi, the evil of internal depression was dissipated, and the condition turned from heavy to light, and the condition subsided.
2 Moistening: The tongue surface is moist, with moderate dryness and wetness, which is moistening the fur. Indicates that the body fluid is not injured; If there is too much water, it will be slippery, and even the tongue will drip. This is slippery moss. It is a reflection of dampness and cold, which is more common in the syndrome of yang deficiency and phlegm. If hope dries up. There is no body fluid in ammonia, which is caused by dry moss and body fluid can't be carried out. It is more common in syndromes such as heat hurting body fluid, yin deficiency, yang deficiency and water insoluble body fluid, and dryness hurting lung. Tongue coating turns from moistening to dryness, mostly because dryness hurts body fluid, or heat consumes a lot of body fluid, indicating that the condition is aggravated; Bitter tongue turns from dryness to moistening, mostly due to dryness and heat, and body fluid gradually recovers, indicating that the condition has improved.
3 Rotten and greasy: the thick and coarse particles of the moss are scattered, which looks like bean curd residue accumulated on the tongue surface and can be wiped off, so it is called "rotten moss". Due to excessive yang heat in the body, turbid qi in the transpiration stomach overflows, which is common in phlegm and food retention, and has the syndrome of gastrointestinal stagnation. Moss particles are so fine that they can't be wiped off or scraped off. The upper mask is covered with a different layer of greasy mucus, which is called "greasy fur", which is caused by the stagnation of spleen and the suppression of yang by yin evil. More common in phlegm and dampness.
Exfoliation: the patient's tongue is covered with moss, and suddenly all or part of it falls off, and the falling place bottoms out, which is called exfoliative moss. If it is completely peeled off, it will not grow new moss, and it is as smooth as a mirror, which is called mirror tongue and sliding tongue. It is caused by stomach yin failure, severe stomach qi injury and no hair-generating qi. No matter what color it is, it belongs to the danger that stomach qi will run out. If the tongue coating is not completely peeled off, the peeling place is smooth and the residual spots are mottled, which is called flower peeling, which is caused by both stomach qi and yin injuries. Tongue coating from existence to absence is a manifestation of deficiency of both stomach qi and yin and gradual decline of healthy qi; However, after the tongue coating is peeled off, the thin and white coating will revive, which is a good sign that the evil can be overcome and the stomach qi will gradually recover. What's more, no matter whether the tongue coating is long or light, it is not as good as gradual. If the tongue coating suddenly grows back, it is mostly a sign of mutation.
5 Rooted moss and rootless moss: No matter whether the moss is thick or thin, if it adheres to the surface of the tongue, it seems that there is root moss coming out of the tongue, which is also called true moss; If the moss is not firm, it seems to float on the tongue and scrape it off. If it is not born on the tongue, it is called rootless moss, also called false moss. Root coating shows that although pathogenic factors are abundant, stomach qi is not declining; No root coating means that the stomach qi has failed.
In short, by observing the thickness of tongue coating, we can see the depth of the disease; The moistening of tongue coating can distinguish the profit and loss of body fluid; The tongue coating is greasy and can be seen as wet and turbid; Tongue coating shedding, rooting and rootlessness can show the rise and fall of qi and yin and the development trend of diseases.
(2) coating color: coating color, that is, the color of tongue coating. Generally, it can be divided into four categories: white hair, yellow bitter, gray black and color change, because the color of fur is related to the nature of disease and evil. Therefore, observing the color of fur can understand the nature of the disease.
1 white fur: generally common in exterior syndrome and cold syndrome. Because exogenous pathogens have not spread, the tongue coating often has no obvious change, and it is still a normal thin white coating. If the tongue is pale and the coating is white and wet, it is often cold syndrome or cold-dampness syndrome. But under special circumstances, white fur also treats heat syndrome. If the tongue coating is white, if there is white powder accumulation, it will not dry, because "accumulated powder coating" is caused by dirty gas outside and toxic heat inside. Common in febrile diseases or carbuncle. Another example is that the fur is white, dry, cracked like gravel and rough, which is called "rough hair". All of them are caused by rapid transformation of heat due to dampness, sudden fire and sudden injury of body fluid. The fur is not yellow, and the internal heat is blazing, which is common in fever or taking warm tonics by mistake.
② Yellow coating: general interior syndrome and heat syndrome. The yellow fur is due to evil heat. Light yellow heat, heavy dark yellow heat, scorching heat junction. Exogenous disease, the fur turns from white to yellow, is a sign that the exterior evil enters the interior and turns into heat. If the moss is thin and yellow, it is exogenous wind-heat exterior syndrome or wind-cold heat. Or the tongue is light, fat and tender, and the fur is yellow and slippery, which is mostly caused by yang deficiency and water dampness.
3 gray moss: the gray moss is light black. Often transformed from the dullness of white fur, it can also be seen with yellow fur. Interior syndrome is common in internal heat syndrome and cold-heat syndrome. The fur is gray and dry, mostly caused by excessive heat, which can be seen as exogenous fever or fire due to yin deficiency. Common in internal injuries and diseases. The fur is gray and moist, which can be seen in phlegm and turbidity, or cold and dampness.
4 black moss: black moss is mostly developed from brown moss or gray moss. Generally speaking, the main symptoms, whether cold or hot, are mostly critical.
The darker the moss, the more serious the disease. If the moss is black and dry, it will even produce thorns, which is extremely hot and dry; Black and dry fur, seen in the tongue, is a sign of intestinal dryness, otherwise the stomach will be destroyed; Seen at the base of the tongue, the lower jiao is very hot; What you see on the tip of your tongue is self-immolation; The fur is black and slippery, and the tongue is pale and white, which is yin cold and the water is not wet; The black and sticky fur is caused by phlegm-dampness blocking collaterals.
3. Comprehensive diagnosis of tongue quality and tongue coating
The development of disease is a complicated whole process. Therefore, we should also analyze the relationship between tongue quality and tongue coating when we grasp the basic changes and main diseases of tongue quality and tongue coating respectively. It is generally believed that tongue quality focuses on distinguishing the deficiency and excess of healthy qi, including the nature of evil qi; The focus of tongue coating research is to distinguish the shallowness and nature of pathogenic factors, including the existence of stomach qi. As far as the relationship between the two is concerned, it is necessary to comprehensively understand, whether it is a single change or a simultaneous change, it is necessary to comprehensively diagnose. In general, the changes of tongue quality and tongue coating are consistent, and the main diseases are often the combination of independent diseases. If it is full of heat syndrome, it is more common to see red tongue and Huang Gan; Cold syndrome due to deficiency in the interior is characterized by pale tongue and white and wet fur. This is the main point of learning tongue diagnosis, but there are also times when the two changes are inconsistent, so it is more necessary to combine the four diagnoses and make a comprehensive evaluation. For example, although white fur dominates cold and dampness, if red fur is combined with white dry fur, it will be hot and hurt body fluid. Because the dry fire quickly turns, the fur has not turned yellow, and it has already entered the camp; Another example is the thick accumulation of powder and moss, which is also dominated by evil heat, not cold; Gray-black fur can belong to heat syndrome or cold syndrome, and it must be distinguished by moistening the tongue. Sometimes the two diseases are contradictory, but they also need to be seen together. Such as red, crimson, white and greasy fur, is damp and hot in the external sense; Internal injury is yin deficiency and fire flourishing, with phlegm and turbid food accumulation. It can be seen that learning can be mastered separately, and comprehensive diagnosis must be made when using it.
(3) Methods and precautions of looking at the tongue
In order to obtain accurate results, we must pay attention to ways and methods, and pay attention to some problems, as follows:
1. Tongue extension posture: When looking at the tongue, ask the patient to extend the tongue out of the mouth to fully expose the tongue body. Open your mouth as far as possible, and relax your tongue naturally without exerting force. The tongue surface should be flat and relaxed, and the tip of the tongue naturally hangs down to the lower lip.
2. Order: Look at the tongue in a certain order. Generally, look at the tongue coating first, and then look at the quality of the tongue. The order is the tip of the tongue, the edge of the tongue, the middle of the tongue and the root of the tongue.
3. Light: It is better to look at the tongue with sufficient soft natural light, facing the bright place, so that the light can directly enter the mouth, and avoid colored doors and windows and colored objects with strong reflection around, so as to avoid the illusion of tongue coating color.
4. Diet: Diet also has a great influence on the tongue picture; It often changes the shape and color of the tongue coating. Due to the repeated friction of chewing food, thick moss can be thinned; Just drink water to make your tongue moist; Too cold, too hot diet and spicy food often discolor the tongue. In addition, some foods or drugs can stain the tongue coating, which is called "coating". These are temporary false tongue quality or tongue coating caused by external interference, which are not directly related to the lesions of patients when they see a doctor and cannot reflect the nature of the lesions. Therefore, when the tongue coating does not match the condition, or the tongue coating suddenly changes, we should pay attention to asking the patient about his recent diet and medication, especially some time before seeing a doctor.
Look at the tongue, facial features, brain, diagnosis,