tongue diagnosis webinar - bradley mcewen 21.07.15 · pdf fileexamination of the tongue •...

Tongue Diagnosis

© Bradley McEwen PhD July 2015 1

Tongue Diagnosis

Dr Bradley McEwen PhD

Webinar Sydney

21 July 2015

About the Presenter

• Qualifications:• Bachelor of Health Science

• Advanced Diploma of Naturopathy• Diploma of Botanic Medicine

• Diploma of Nutrition• Diploma of Homoeopathy

• Diploma of Sports Medicine• Cert IV Training and Education/Assessment

• Postgraduate studies:• Master of Health Science (Human Nutrition) • Doctor of Philosophy (PhD) at the University of Sydney

• Experience• 16 years of clinical experience• Over 11 years teaching experience

• Currently lecturing and supervising student clinic

Tongue Diagnosis


Introduction

• Tongue diagnosis is a non-invasive,simple and valuable diagnostic tool.

• Observation of the shape, size, texture,coating, and colour of the tongue is amethod for diagnosing the patient’sconstitution and health conditions.

• The appearance of the tongue has beendetermined to be an outer manifestationof the status of the human body.

© Bradley McEwen PhD 2015

Introduction

• In modern Western medicine, the tonguehas increasingly been viewed as anextension of the upper gastrointestinaltract that can provide important clues tothe current condition of the person andglobal information about the person’shealth status.

• Signs of the tongue and mouth cancorrelate with nutritional deficiencies.


Tongue Diagnosis


Introduction

• This comprehensive webinar will enable practitioners

to greatly expand their scope of understanding in the

use of tongue diagnosis in clinical practice.

• Strategies in improving clinical outcomes will be

discussed.

• This webinar also aims to improve the skills of

clinical examination in relation to nutritional

deficiencies.

• This informative webinar will also be beneficial to

students to consolidate their learning.

• This is a follow up webinar to the previous webinar

on Nail Diagnosis.

“An ounce of prevention is worth a pound of cure.”

– Benjamin Franklin

Tongue Diagnosis


Introduction

Clinical examination• Tongue diagnosis• Nail diagnosis• Pulse• Blood pressure• Physical appearance

• Blood tests• Scans, X-Rays…


Introduction

• The tongue is a mass of muscle that is

almost completely covered by a mucous

membrane.

• The tongue is known for its role in:

• taste

• assists with mastication (chewing)

• deglutition (swallowing)

• articulation (speech)

• oral cleaning.

• Five cranial nerves contribute to the complex

innervation of this multifunctional organ.


Tongue Diagnosis


Introduction

• Tongue diagnosis is an important

method in TCM to detect constitution

like:

• qi deficiency

• yin deficiency

• blood stasis

• dampness


Examination of the tongue

Tongue Diagnosis



• In tongue diagnosis, observation of

the surface of the tongue is mainly

focused on the:

• shape

• fur

• body of the tongue.

Examination of the tongue – colour

• The tongue body can be:

• pale

• light-coloured

• light red

• red

• crimson

• dark-coloured

Tongue Diagnosis


Examination of the tongue – normal colour

• A normal tongue exhibits light-red

colour with a very thin white coat.

• The thin white coat may be more

pronounced in the morning.

Examination of the tongue – pale

• A pale tongue indicates deficiency.

• Pale tongue reflects qi and blood

lacking.

• If the tongue is pale and moist it

indicates a deficiency of yang.

• This may sometimes called deficient

cold as it causes cold symptoms in

the body.

Tongue Diagnosis


Examination of the tongue – pale moist

• The person with a pale moist tongue:• feels easily cold especially in the limbs• exhaustion• lack of motivation• depression• sensitivity to the cold• tends to wear more clothes• desires hot drinks• a slow and weak pulse• has loose stools

Examination of the tongue – purple colour

• A purple tongue can be caused by

“failure” of blood to move properly –

blood stagnation.

• It can be caused by too much “cold”.

• A purple tongue with a bluish tinge is

due to coldness causing blood to

stagnate.

• A reddish purple tongue is due to

heat causing the blood to stagnate.

Tongue Diagnosis


Examination of the tongue – red colour

• Red or crimson tongue represents

repletion heat or yin lacking fire.

• Excess heat often relates to

inflammation and possibly infection.

• Some tongues have red spots on

them. This is a sign of heat. Check

the location of the spots.


• There may also be:

• bruise dots

• fissures

• tooth marks

• red dots

Tongue Diagnosis


Examination of the tongue – fluid

• Common body fluid is normal.

• Insufficient or lack of body fluid

means yin deficiency.

Examination of the tongue – fur

• The fur of the tongue can be white,yellow, black, slimy, thick, thin, peeling ornone at all.

• Pale fur is considered normal.• Thick fur is mapped to bad stomach qi.• Peeling fur corresponds to weak stomach

qi or stomach yin insufficiency.• Grey or black fur means toxin deposit or

diseases caused by cold.

Tongue Diagnosis


Examination of the tongue – white fur

• White fur can represent conditions causedby cold.

• If the coat is thick then the degree of coldis more pronounced than if the coat isthin.

• If the white coat appears greasy it is dueto dampness accumulating in the body.

Examination of the tongue – yellow fur

• Yellow fur can representconditions caused by heat.

• If the coat is thick then thedegree of heat is morepronounced than if the coatis thin.

• If the yellow coat appearsgreasy it is due todampness accumulating inthe body.

Tongue Diagnosis


Examination of the tongue – shape

• The shape of the tongue can be:

• medium

• fat

• thin

• tilted.

Examination of the tongue – enlarged

• A normal tongue should be one with amedium shape.

• A fat tongue indicates water “toxin”.• If the tongue is enlarged and hard, it is a

sign of excess.• If a tongue swells so that it fills the mouth

and is deep red, there is excess heat inheart and spleen.

Tongue Diagnosis


Examination of the tongue – thin

• A thin tongue represents:

• deficiency

• yin deficiency

• qi and blood lacking

Examination of the tongue – fissures

• Fissures often appear with

malnutrition.

• Multiple nutritional deficiencies.

Tongue Diagnosis


Examination of the tongue – location examples

• The location of disturbances on thetongue give an indication of wheredisharmonies in the mind/body/spiritare located.

• Certain organs are associated withthe Upper, the Middle and the LowerBurner, which are in turn associatedwith the front, middle and backsections of the tongue.

Examination of the tongue – location examples

• If there are red spots on the front third

of the tongue, which is associated with

the upper burner, this indicates that

there is heat in the lungs.

• If the tip of the tongue is red, that

indicates heat in the heart.

• Menstrual cramps, associated with

stagnant xue (blood), are often

accompanied by purple spots on the

edges of the tongue in the

liver/gallbladder area.

Tongue Diagnosis


Periodontal disease

• Periodontal disease increases the risk to

certain systemic diseases:

• heart attack

• the leading cause of death among type

2 diabetes

• majority accounted for ischaemic heart

disease that develops after thickening

of coronary arteries

• stroke

• lung and respiratory diseases

• osteoporosis

• joint diseases

Periodontal disease

• Recently microorganisms that cause

periodontal disease have been found

in joints of patients with rheumatoid

arthritis.

• Periodontal disease complicates

blood glucose control and high blood

glucose levels worsen gum disease

Tongue Diagnosis



Tongue diagnosis

Tongue Diagnosis


Glossitis with central fissure

Glossitis with central fissure

• Smooth surface of thetongue.

• Sore and tender tongue.• Tongue swelling.• Discomfort, pain or burning

sensation.• Tongue colour changes• Pale, if caused by

pernicious anaemia.• Fiery red, if caused by a

lack of other B vitamins.

Tongue Diagnosis


Fissure

• The appearance of deepfissures, or grooves, on thesurface of the tongue.

• Signs of malabsorption.• Calcium, zinc and silica

deficiency.

Geographic tongue

Tongue Diagnosis


Geographic tongue

• Patches on the surface ofthe tongue are missingpapillae and appear assmooth, red “islands”, oftenwith slightly raised borders.

• These patches (lesions)give the tongue a map-like,or geographic, appearance.

Geographic tongue

• The lesions often heal inone area and then move(migrate) to a different partof the tongue.

• There may be a linkbetween geographic tongueand psoriasis.

Tongue Diagnosis


Indentations in tongue

Indentations in tongue

• Sometimes referred to asscalloped tongue.

• Teeth indentations around theedge of the tongue are a sign ofQi deficiency.

• Signs of stress, tension, andexhaustion.

• Spleen deficiency.

Tongue Diagnosis


Red tip of tongue

Red tip of tongue

• A red tip on the tongue is

related the heart.

• Could indicate emotional

upset or emotional

stress.

• Niacin deficiency.

Tongue Diagnosis


Candidiasis

Candidiasis

• Candida grows rapidly whendiabetes causes alterationsin saliva's composition,which can in turn impairlocal immunologicalresistance.

Tongue Diagnosis


Candidiasis

• Causes include:• reduction of salivary flow• reduction of salivary

antimicrobials factors• leukotaxins• opsonins• lysozyme• lactoperoxidase• lactoferrin• thiocyanate ion• immunoglobulin

Candidiasis

• Causes include:• reduced action of

antimicrobial factors dueto the presence of ahigher mucinconcentration

• higher salivary glucoseconcentration

Tongue Diagnosis


Xerostomia

Xerostomia

• Xerostomia is subjectivesensation of dry mouth

• Generally associated withdiminished salivaproduction

• 10-30% prevalence inpeople with diabetes.

Tongue Diagnosis


Xerostomia

• Hyposalivation can cause:

• glossodynia

• ulcers

• cheilitis

• fissured tongue

• decays

• Difficulty in keeping

denture's adherence can

lead to soft tissue trauma

that by in turn predisposes

to infections

Early xerostomia

Hairy tongue

Tongue Diagnosis


Hairy tongue

• Known predisposing factorsinclude:• smoking• excessive coffee/black

tea consumption• poor oral hygiene• trigeminal neuralgia• general debilitation• xerostomia• medication use.

Hairy tongue

• Caused by debris, bacteria orfungi in the mouth, which makethe tongue appear yellow, blackor hairy.

• The bacteria build up on thepapillae. Instead of shedding, asthey normally do, the papillaestart to grow and lengthen,creating hair-like projections.

Tongue Diagnosis


Hairy tongue

• Complications include:• burning mouth syndrome• halitosis• nausea• gagging• dysgeusia• metallic taste in mouth

Lichen Planus

Tongue Diagnosis


Lichen Planus

• A chronic inflammatory condition

that appears as:

• Lacy, white, raised patches of

tissues.

• Red, swollen, tender patches of

tissues.

• Open sores.

• The white, lacy patches may not

cause discomfort when they

appear on the inside of the cheeks

but may be painful when they

involve the tongue.

Lichen Planus

• The red, inflamed lesions andopen sores of oral lichenplanus can cause a burningsensation or pain.

• T lymphocytes are active at thesite and cause the lesions.

Tongue Diagnosis


Cheilitis/Cheilosis

Cheilitis/Cheilosis

• Acute or chronic inflammationof the lips.

• Symptoms include:• erythema• dryness• scaling• fissuring• oedema• itching• burning

Tongue Diagnosis


Cheilitis/Cheilosis

• Causes of cheilitis include: • atopic dermatitis• anaemia• contact irritants • allergens• chronic sun

exposure• infection• SLE• Crohn’s• Sjogren’s

Angular Cheilitis/Cheilosis

• Anaemia is considered one of the main causes of angular cheilitis.

• It also may be related to deficiency of the cofactors, especially B2, B3, B6.

Tongue Diagnosis


Mouth and tongue signs with nutrient deficiencies

Mouth

Symptom/Sign Deficiency treatment cause

Cracked lips & corners of the

mouth (cheilosis)B2, B6, Folic acid

Distended, purplish-blue

veins under the tongueB2 (circulation poor, congested)

Gums receding, bleeding

(gingivitis)

C, Bioflavonoids, Calcium,

Alkalisers

Halitosis (bad breath)B6, Zinc, Magnesium, Propolis,

Chlorophyll (cleansing)

Mouth ulcersFolic acid, B6, Zinc

Alkalise, allergy test

Purplish or magenta lips B6

Loose teethAdvanced vitamin C deficiency

(scurvy)

Scaling of lips Biotin

Tongue Diagnosis


Tongue


Beefy, enlarged tongue Pantothenic acid

Burning, sore tongue B2, B6, B12, Niacin

Distended, purplish-blue veins

under the tongueB2 (circulation poor, congested)

Furrowed tongue B1, Pantothenic acid

Papillae prominent or erased Niacin

Cracked, swollen, dark red

tongueRiboflavin

Oedema or tooth-marks on

tongueNiacin

Purplish or magenta tongue B2

Tongue


Tongue red at tip or edges;

severe deficiency: whole

tongue scarlet red, sore

Niacin, B6

Tongue shiny, smooth, beefy;

early sign: strawberry-red

tip/sides

B12, Folic acid

Tongue too small or too large Niacin, Pantothenic acid

White-coated tongue Intestinal putrefaction, Cleansing

White patches on tongueB2 and other B vitamins. Check

for allergy

Yellowish-brown-coated

tongueLiver or gall bladder problems

Tongue Diagnosis


Tissue salts/Celloids


Tissue Salt Memory Key Tongue Mouth

Calcium

Fluoride

Tissue

strengthener

• Cracked, split

• Mapped.• Cracked lips,

corners of mouth,

hands, fingers

• Periodontosis

Calcium

PhosphateCell builder

• Small red

spots at edge

of a pale

coated

tongue.

Strawberry

appearance.

• Halitosis

Calcium

Sulphate

Suppuration

remover

• Thick grey

superficial

coating.

• Flabby

tongue.

Tongue Diagnosis




Iron

Phosphate

Inflammation

remover

• Bright red

meaty tongue.

• Raw beef

appearance.

• Pale gums

Magnesium

Phosphate

Neuromuscular

co-ordinator

• Short tongue.

Difficulty

sticking it out.

• Quivers and

shakes.

• Convulsions of

the corners of

mouth

Potassium

Chloride

Congestion

remover

• Very light

white or

greyish

coating all

over tongue.

• Pale.



Potassium

Phosphate

Nerve power

activator

• Mustard seed

coloured

coating.

• Red edges on

side of

tongue.

• Dry mouth

and tongue.

• Periodontosis

• Gum bleeding

• Halitosis

Potassium

SulphateCell oxygenator

• Moist yellow

coating.

• Slimy

appearance.

• Yellowish around

the mouth

SilicaCalcium

reorganiser

• Long and

pointed -

arrow-like.

Tongue Diagnosis




Sodium

Phosphate

Metabolic acid

remover

• Creamy thick

coating

(worse at

back of

tongue or roof

of mouth).

• Sour taste in

mouth.

• Pale mucous

membranes

Sodium

Sulphate

Problem fluid

remover

• Clear, shiny or

greenish-

brown.

• Serrated or

scalloped

edges.

• Bitter taste in

mouth.

Conclusion

Tongue Diagnosis


Conclusion


References

• Braun L, Cohen M 2015, Herbs & Natural Supplements, 4th Ed. Elsevier Chatswood. NSW.

• Hechtman L 2012, Clinical Naturopathic Medicine, Churchill Livingstone, Edinburgh.

• Sarris J, Wardle J 2014, Clinical Naturopathy, 2nd Ed. Elsevier Chatswood, NSW.


Tongue Diagnosis


Thank you



tongue diagnosis webinar - bradley mcewen 21.07.15 · pdf fileexamination of the tongue •...

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