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Inspection of Tongue Coating johannleu@aol.com

Terms in this set (34)

How is the tongue coating formed according to TCM theory
by rising of "the smoke of digestion"
from the stomach & spleen.
the tongue's coating is just like the earth has mosses!
How does normal tongue coating looks like
thin & white with clear grains, evenly scattered & rooted to the tongue.
it cannot be wiped off, and is neither wet nor dry, sticky nor greasy
Explain tongue coating formation
generated by stomach qi, it is created by the upward tide of the spleen & stomach yang qi evaporating & transforming damp turbidity. it is evenly distributed, and moist
stomach qi is the root of coating
dampness=phlegm=chronic inflammation, high cholesterol, indigestion
western definition of coating
The major changes of the tongue coating are changes in the filiform papillae. the tip of the filiform papillae are differentiated into cornified trees of either complete or incomplete cornification. the spaces betw. the cornified tree branches are fillded with exfoliated cornified epithelium, saliva, bacteria, fungi food particles & exuded leucocytes
list the clinical significance of observing tongue coating
- dermine the depth of the disease
- identify pathogenic factors & the thermal nature of the disease (heat / cold)
- assess the condition of the stomach
- very important stomach qi, 1% stomach qi, client will survive
What are the 2 major categories of content of observing tongue coating
- color
- quality/properties, e.g. thickness, viscosity
Tongue coatings can be in what colors
- white
- yellow
- grey
- black
What does the tongue color indicate
normal color is transparent white
- nature & severity of the pathogens (heat/cold)
- locations (organs)
White tongue coating:
Tongue coating color is white in color.
What is the indications & location
antibiotic is cold, will result in white tongue
Indication:
1. exterior syndrome
2. cold syndrome
- white coating can be found in exterior, interior, excessive & deficient patterns
Location:
Lung & Large intestine
Yellow tongue coating:
Tongue coating color is yellow, it may vary from light yellow to dark or brown yellow
damp heat=white coating with slight yellow coating in the middle
What is the indications & location
Indications:
1. interior syndrome
2. heat syndrome
the different hue of yellow reflect the increasing severity of pathogenic heat
- Yellow coating can be seen in exterior, interior, hot, excessive, & deficient patterns
Location:
Spleen & Stomach
Grey tongue coating:
same as a slightly black coating, it develops from the white or yellow coating
What is the indications & location
Indications:
1. heat syndrome: dry & gray
2. Cold syndrome: moist & gray
- gray coating can only be seen with interior & excess heat patterns, never with exterior or deficiency cold patterns
Location: ?
Black Tongue Coating:
Tongue coating color looks black & usually evolves from gray coating or yellow coating
What is the indications & location
Indications:
1. Extreme heat: Dry & cracked
2. Extreme cold: Moist & greasy
3. Recent history of bismuth based medicines for indigestion, i.e. Pepto-Bismol, not a pathology
- Black coating reflects a disease of long duration & a critical condition. Can be seen only with INTERIOR PATTERNS, never with exterior patterns
Locations: ?
ON TEST
8 Princicples & tongue coating color
exterior, interior
heat, cold
excess, deficiency
yang, Yin
exterior: white, yellow
interior: white, yellow, gray, black
heat: white, yellow, gray, black
cold: white, yellow, gray, black
excess: white, yellow, gray, black
deficiency: white, yellow, no deficiency cold, black
yang: yellow, black
yin: white, gray, black
Summary:
Tongue coating color & their relationship
cold syndrome:
white --> gray --> black (extreme cold)
heat syndrome:
yellow --> gray -->black (extreme heat) or yellow -->black (extreme heat)
ON TEST
thin coating:
tongue body can be seen clearly through its coating
Indication?
Pathogen?
Location?
Severity?
Stage?
Prognosis?
Indication: normal, exterior syndrome, or mild, early stage disease
Pathogen: weak
Location: exterior or mild interior disorder
Severity: mild
Stage: initial stage
Prognosis: thin to thick: worse
ON TEST
thick coating:
tongue body can not be seen clearly through its coating
Indication?
Pathogen?
Location?
Severity?
Stage?
Prognosis?
Indication: dampness, water, food or phlegm retention or stagnation
Pathogen: strong
Location: interior
Severity: sever
Stage: later stage
Prognosis: thick to thin: better
ON TEST

moist coating:
normal condition, neither glossy/slippery nor dry
Indications?
Pathogenesis?
Body Fluids?
Prognosis?
Indications: healthy person, or body fluid has not been injuried even during illness
Pathogenesis: body fluid from stomach & kidney rise up to nourish tongue
Body Fluids: sufficient
Prognosis: from dry to moist: better
ON TEST

dry coating:
coating is very dry without fluid on it
Indications?
Pathogenesis?
Body Fluids?
Prognosis?
Indications: Excess heat, Yin deficiency, Yang deficiency, exopathogenic dryness invades the lung
Pathogenesis: dryness or heat cause injury to the body fluids, stomach, kidney yin deficiency: yang deficiency unable to transform water into body fluids
Body Fluids: injured or deficient
Prognosis: from moist to dry: worse
glossy coating:
tongue covered with a transparent or semitransparent film of fluid, even dripping off the tongue when extended
Indication?
Pathogenesis?
Body Fluids?
Indications: cold syndrome, dampness, phlegm, water retention, yang deficiency
Pathogenesis: yang deficiency fails to transform water into body fluids which becomes dampness & water accumulation that rises to the tongue surface
Body Fluids: sufficient
rough coating:
tongue coating granules are very rough like sandpaper which is rough when touched by fingers
Indication?
Pathogenesis?
Body Fluids?
Indications: severe injury to body fluids
Pathogenesis: severe damage to the body fluids leads to a lack of nourishment for the tongue surface
Body Fluids: severe injury
Definition of Viscosity
Viscosity of tongue coating is the appearance of the tongue coating
- clean coating
- moldy coating (easy to scrap off)
-greasy coating (sticky coating)
Pathophysiology of tongue coating viscosity
The tongue coating is engendered b the upward flow of the stomach's steaming of spleen dampness (turbidity). the viscosity of the tongue coating reflects the amount of turbidity.
The coating can help to identify the pathogenic factors as well as the condition of water transformation
stomach qi + turbidity (right amount) = Thin clean coating

Dampness, phlegm, food stagnation & water retention --> excessive amount of turbidity steams up = greasy coating or moldy coating
ON TEST

Moldy coating:
coating is thick & patchy, looks like COARSE mulch granules (cottage cheese, tofu)
Coating Particles: big & loose (like cottage cheese)
Indication: food stagnation, phlegm, internal abscess
Adherence: easily wiped or scraped off
Pathogenesis: excessive yang heat steams the turbid & putrid Qi rise to the tongue surface
Remark: moldy & greasy coatings can appear simultaneously
ON TEST

Greasy coating:
coating is sticky & made of FINE particles that are thicker in the middle & thinner on the margins (greasy mucus, peanut butter)
Coating Particles: fine & small, like greasy fat (oily)
Indication: food stagnation, phlegm, dampness
Adherence: difficult to be wiped or scraped off
Pathogenesis: excess pathogenic factors obstruct the yang qi followed by stagnation of dampness on the tongue
Remark: moldy & greasy coatings can appear simultaneously
explain the connection of coating (pathogenesis) at different portions of the tongue
different portions of the tongue reflect the functions of different organs. When damp turbidity arises from the spleen & stomach, the distribution of the coating will reflect the location of any pathogenic factors or processes
Distribution of coating
even & uneven (partial) coating
explain even coating
even coating:
wide spread of pathogens in the body & stagnation of damp phlegm in middle-jiao
Distribution of coating
even & uneven (partial) coating
explain uneven coating, specifically anterior area (front half)
anterior area: stomach qi deficiency before the invasion of external pathogens to the internal organs of the body. pathogens in the interior but not deep
Distribution of coating
even & uneven (partial) coating
explain uneven coating, specifically posterior area (rear half)
posterior: mild exopathogens invasion with stomach function disorder
Distribution of coating
even & uneven (partial) coating
explain uneven coating, specifically coating on one side
on the side: pathogens in between exterior & interior, or in liver & gallbladder
Distribution of coating
even & uneven (partial) coating
explain uneven coating, coating absence on center
stomach qi or kidney yin deficiency, or deficiency of all yin, essence, qi and blood
Peeling:
under certain conditin the tongue coating suddenly comes of completely or partly.
List them & indications
- partial exfoliative coating
- geographic coating
- exfoliative like coating
- mirror tongue
Indications: stomach yin & qi deficiency. Mirror tongue very bad, stomach yin exhausted
Pathogenesis: when stomach yin is exhausted and stomach qi fails to produce a tongue coating, the peeled tongue arises
Wax & Wane:
increase or decrease of tongue coating, changes of thickness of coating
wax: increase
- from thin to thick, pathogenic factors getting stronger or invade deeper
- from no to have coating, stomach qi recovered
wane: decrease
- from thick to thin, righ Qi overcomes the pathogenic factors
- from have to no: stomach qi failure
Rooted & Non-rooted coating:
rooted: difficult to wipe off
non-rooted: easy to wipe off
if stomach qi is sufficient = rooted coating
if stomach qi is exhausted = unrooted coating
rooted: prognosis good, can be in all stages of the illness
non-rooted: prognosis poor, only seen in chronic, & critical condition
Tongue body & tongue coating combined
Tongue body: judge condition of vital Qi & nature of pathogens
Tongue coating: location of disease & nature of pathogens
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