Inspection of Tongue Coating

How is the tongue coating formed according to TCM theory
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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 & locationIndications: 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 & locationIndications: 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, Yinexterior: 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, blackSummary: Tongue coating color & their relationshipcold 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: worseON 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: betterON 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: betterON 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: worseglossy 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: sufficientrough 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 injuryDefinition of ViscosityViscosity 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 transformationstomach qi + turbidity (right amount) = Thin clean coating Dampness, phlegm, food stagnation & water retention --> excessive amount of turbidity steams up = greasy coating or moldy coatingON 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 simultaneouslyON 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 simultaneouslyexplain the connection of coating (pathogenesis) at different portions of the tonguedifferent 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 processesDistribution of coating even & uneven (partial) coating explain even coatingeven coating: wide spread of pathogens in the body & stagnation of damp phlegm in middle-jiaoDistribution 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 deepDistribution of coating even & uneven (partial) coating explain uneven coating, specifically posterior area (rear half)posterior: mild exopathogens invasion with stomach function disorderDistribution of coating even & uneven (partial) coating explain uneven coating, specifically coating on one sideon the side: pathogens in between exterior & interior, or in liver & gallbladderDistribution of coating even & uneven (partial) coating explain uneven coating, coating absence on centerstomach qi or kidney yin deficiency, or deficiency of all yin, essence, qi and bloodPeeling: 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 arisesWax & Wane: increase or decrease of tongue coating, changes of thickness of coatingwax: 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 failureRooted & Non-rooted coating: rooted: difficult to wipe off non-rooted: easy to wipe offif 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 conditionTongue body & tongue coating combinedTongue body: judge condition of vital Qi & nature of pathogens Tongue coating: location of disease & nature of pathogens