Clinical Tongue Diagnosis Atlas and Disease Treatment

Author: Chief Editor: Weng Weiliang
Publisher:
Publishing Date: 1997-11-01
Features: This book is a specialized atlas on TCM tongue diagnosis. It is divided into two parts. The first part discusses the origin and development of TCM tongue diagnosis; the anatomical and physiological characteristics of the tongue, as well as modern research progress in tongue diagnosis, such as microcirculation of the tongue, pH value, tongue body measurement, tongue diagnosis and blood rheology, tongue ultrasound, tongue color research, computerized tongue diagnosis system research, TCM tongue image true-color imaging system research, and animal experimental research on tongue diagnosis. The second part is a of tongue diagnosis for identifying and diagnosing diseases. It collects the experience of clinicians who have long engaged in integrated traditional Chinese and Western medicine, featuring 120 pathological color tongue images and case analyses with treatment prescriptions. It provides valuable references for TCM and integrated traditional Chinese and Western medicine doctors in clinical, teaching, and research work.
Excerpt:
Part 1 Chapter The Origin and Development of TCM Tongue Diagnosis
Tongue diagnosis is a major component of "inspection" in the "Four Examinations" of TCM and one of the primary methods for clinical disease diagnosis. It has a long history and rich content. Ancient physicians accumulated extensive experience in tongue diagnosis through long-term practice, making it a valuable treasure of TCM. The origin of tongue diagnosis can be traced back to the ancient Shang Dynasty, with records of tongue diseases found on oracle bones unearthed from Yin ruins. However, the true beginning of TCM tongue diagnosis can be considered the Western Zhou Dynasty, as documented in historical records. By the Spring and Autumn and Warring States periods, the foundation of tongue diagnosis had largely been established.
During the Western Zhou Dynasty, the state had medical organizations. According to the Rites of Zhou·Heavenly Officials, there were "physicians" responsible for medical affairs, with sub-departments such as "disease physicians," "sore physicians," "dietary physicians," and "veterinary physicians," indicating the separation of medicine and divination, with dedicated physicians specializing in treating illnesses. At that time, physicians diagnosed diseases by observing "five qi, five sounds, and five colors," assessing life and death, and considering changes in the nine orifices, as well as the activities of the nine internal organs, which included the content of inspection. This may have also involved "observing the tongue," although no specialized medical texts from that period have survived. However, the Yellow Emperor's Inner Canon, compiled during the Warring States period, already contained substantial and scientifically grounded content on tongue diagnosis. It can be said that tongue diagnosis had indeed begun to take root in the Western Zhou Dynasty.
Based on modern research into ancient texts, the earliest records of tongue diagnosis are attributed to Bian Que. Bian Que was a renowned ancient Chinese physician, born around the 5th to 4th centuries BCE in Moe County, Bohai Prefecture, and named Qin Yue Ren, also known as Lu Yi. He was skilled in internal medicine, five senses, gynecology, and pediatrics, as well as acupuncture, moxibustion, heat therapy, and herbal medicine. He possessed extensive diagnostic knowledge, including inspection, auscultation, inquiry, and palpation. Sima Qian's Records of the Grand Historian·Biographies of Bian Que and Cang Gong described Bian Que as "the master of physicians" and stated that "all who speak of pulse diagnosis today trace it back to Bian Que." He was also skilled in "palpating the pulse, observing the complexion, listening to sounds, writing descriptions, and identifying the location of diseases." This indicates that Bian Que was not only the founder of pulse diagnosis but also had experience in inspection. Tongue diagnosis, being a part of inspection, was included within his diagnostic methods.
The Biographies of Bian Que and Cang Gong also mention that Bian Que taught Taicang Gong two books: Pulse Book and Five Color Diagnosis. The Book of Han·Bianque's Inner Canon and Outer Canon also listed the titles Bianque's Inner Canon and Bianque's Outer Canon. During the Jin Dynasty, Wang Shuhe's Pulse Canon, Volume 5, included sections such as Bianque's Yin-Yang Pulse Method and Bianque's Essential Methods for Diagnosing Reversed and Death Pulsations, which recorded tongue diagnosis: "Pulse alternation, suddenly present and absent, deep and sinking, leading to coughing, coughing causing shortness of breath, severe shortness of breath causing shoulder breathing, shoulder breathing causing bleeding from the mouth and tongue; the stomach pulse is deep and throbby, the external stomach pulse is large, the heart pulse is small and urgent, all belonging to partial paralysis. Men develop it on the left, women on the right. If the tongue can move and speech is clear, the prognosis is good." These records show that Bian Que emphasized both pulse diagnosis and tongue diagnosis. The tongue's ability to move in paralyzed patients, with clear speech, indicated a favorable prognosis—a very accurate summary of experience.
The Outline of the History of Chinese Medicine considers that Wang Shuhe's Pulse Canon quoted relevant texts from famous physicians like Bian Que. Thus, the earliest records of tongue diagnosis were written by Bian Que in his works and compiled by Wang Shuhe in the Pulse Canon, allowing them to be passed down to this day. It can be said that Bian Que was the earliest physician in China to apply and record tongue diagnosis.
In the history of Chinese medicine, the first work to record tongue diagnosis is the Yellow Emperor's Inner Canon. It contains approximately 60 entries related to the "tongue." The book discusses the anatomy, physiology, and pathology of the tongue, clearly highlighting its role and significance in TCM diagnosis. The Spiritual Pivot focuses on the anatomical and physiological aspects of the tongue, while the Basic Questions primarily addresses the pathological diagnostic significance of the tongue. For example, in the Spiritual Pivot·Intestines and Stomach, it records: "The tongue weighs ten taels, is seven inches long, and two and a half inches wide." It describes the tongue as a muscular organ, stating, "The lips and tongue are the roots of muscle." The base of the tongue has cartilage supporting its movement, which is consciously controlled to adjust the tongue for speech and language formation. "The tongue is the mechanism of sound, the horizontal bones are controlled by the spirit, and they dominate the tongue's movement." The tongue is the "organ of the heart" and the external manifestation of the spleen, with a unique physiological function for distinguishing flavors and mixing food, allowing for preliminary digestion in the mouth. For instance, in the Spiritual Pivot·Pulse Measures, it states: "The heart's qi connects to the tongue; when the heart is harmonious, the tongue can distinguish the five flavors. The spleen's qi connects to the mouth; when the spleen is harmonious, the mouth can distinguish the five grains." Moreover, the tongue is directly or indirectly connected to all the body's organs through "meridians." For example, in the Spiritual Pivot·Meridians, it records: "The branch of the small intestine's meridian connects to the base of the tongue," "The liver is connected to the tendons and meridians at the base of the tongue," "The large intestine's meridian connects to the base of the tongue and spreads to the under the tongue," and "The kidney's meridian of the small intestine enters the lungs, runs along the throat, and flanks the base of the tongue." This shows that all five internal organs are closely connected to the tongue.
The Spiritual Pivot·Tendon Meridians states: "The branch of the sun bladder meridian enters and connects to the base of the tongue," and "The branch of the triple warmer meridian connects to the base of the tongue." The Spiritual Pivot·C states: "The upper (jiao) originates from the upper mouth, reaches the tongue, and descends to the large intestine." This indicates that the bladder, triple warmer, and stomach among the six internal organs are also connected to the tongue. Other organs, such as the gallbladder, large intestine, and small intestine, are indirectly connected to the tongue through the meridians of their corresponding exterior-interior organs, such as the liver, lungs, and heart, as stated in the Spiritual Pivot·Pathogenic Qi and Internal Organs. This explains that the tongue is not only an organ with physiological functions such as distinguishing flavors, adjusting sounds, mixing food, and aiding digestion but is also an external manifestation of the body, closely linked to the internal organs.
In terms of pathological diagnosis and observation of the tongue for syndrome differentiation and treatment, the Basic Questions also contains many discussions. For example, in the Basic Questions·Great Discussion on the True Principles of Diagnosis: "When the ( jueyin) dominates, wind pathogens prevail, causing pain in the upper abdomen, stiffness of the tongue base." In the Basic Questions·Discussion on Inspection of Meridians: "When the ( jueyin) ends, there is heat in the throat, dryness, restlessness, and severe mental distress, leading to tongue curling and upward contraction." In the Basic Questions·Discussion on Wind: "The symptoms of heart wind include severe speech difficulties, diagnosis in the mouth (tongue), and redness in the mouth (tongue)." In terms of syndrome differentiation and treatment, the Basic Questions·Discussion on Rare Diseases states: "A person with sweet taste in the mouth is called 'spleen obstruction.' This is caused by excessive consumption of rich and fatty foods. Such individuals must frequently eat sweet and fatty foods, which cause internal heat. Sweetness causes fullness, leading to overflow at the gas mouth, which turns into diabetes. Treatment should use orchid to dispel pathogenic qi."
The Inner Canon systematically records the content of tongue diagnosis, playing a crucial role in pioneering, inheriting, developing, and serving as a classical reference in the history of TCM tongue diagnosis. The development of tongue diagnosis primarily involved further validation, enrichment, and refinement of the theoretical foundations laid by the Inner Canon in practice, gradually integrating theory with practice to serve clinical syndrome differentiation and treatment. During this period, notable contributors to the development of tongue diagnosis included Hua Tuo and Zhang Zhongjing, with Zhang Zhongjing making the greatest contributions.
Zhang Zhongjing (150–219 CE), named Ji, was from Nanyang County, Nanjun Prefecture during the Eastern Han Dynasty (now Nanyang County, Henan Province). He summarized over three hundred years of clinical experience from the Qin and Han dynasties into a groundbreaking medical work, Treatise on Cold Damage and Miscellaneous Diseases (now divided into Treatise on Cold Damage and Essentials from the Golden Cabinet). Through his clinical practice, he significantly advanced the theory of syndrome differentiation and treatment in Chinese medicine. Tongue diagnosis was a part of his "syndrome differentiation and treatment" principles and also served as an indicator and basis for syndrome differentiation and treatment.
There are 24 records of tongue diagnosis in Treatise on Cold Damage and Essentials from the Golden Cabinet. Most of this content is scattered in the Sun Yang Disease and Yang Ming Disease sections of Treatise on Cold Damage. It can be categorized into three types: tongue body, tongue coating, and taste sensation, which align with the Inner Canon in classification. However, in terms of pathological tongue manifestations, both quality and quantity show significant improvements compared to the Inner Canon. Notably, Zhang Zhongjing was the first to coin the term "tongue coating," which later became a general term for the greasy substance on the tongue and a specialized term in tongue diagnosis.
In terms of the scope of application, Zhang Zhongjing's tongue diagnosis was far broader than that of the Inner Canon. In the six meridians of Treatise on Cold Damage, four involve tongue diagnosis. In the treatment of miscellaneous diseases in Essentials from the Golden Cabinet, 40+ diseases use tongue diagnosis for syndrome differentiation. Patterns can be identified in these applications. He paid special attention to observing changes in the tongue coating when diagnosing three Yang diseases and six Fu organ disorders, while focusing on the morphological changes of the tongue body when diagnosing three Yin diseases and five Zang organ disorders. In disease diagnosis, he also emphasized the integration of the four examinations to achieve a comprehensive understanding of etiology, pathogenesis, treatment principles, and prognosis. For example: In the Essentials from the Golden Cabinet·Section on Palpitations, Hemoptysis, Hematuria, Chest Fullness, and Blood Stasis: "A patient with chest fullness, limp lips, blue tongue, dry mouth, and a desire to rinse but not swallow, without fever or chills, a slow and weak pulse, and no abdominal fullness, but claiming chest fullness, indicates blood stasis."
Another example from the Essentials from the Golden Cabinet·Section on Stroke and Arthritis: "When collaterals are empty, pathogens do not drain, and when pathogens are in the collaterals, the skin feels numb; when pathogens are in the meridians, the limbs feel heavy; when pathogens enter the Fu organs, the person becomes unconscious; when pathogens enter the Zang organs, the tongue becomes difficult to move, and saliva is expelled."