In addition to the pulse examination, the inspection of the tongue Jihva Pariksha is one of eight classic examination procedures in Ayurveda. The traditional compendium Ashtanga Samgraha Samhita already described signs of a tongue „spoilt“ by Vata, Pitta, Kapha and blood.
Our tongue lies on the floor of the oral cavity and is a muscular organ belonging to the upper digestive tract. It is subdivided into the root, body and tip of the tongue and can be divided externally into the back, underside and edge of the tongue. Physiologically, the tongue is involved in chewing, sucking, swallowing and speaking. As a sensory organ, we can taste and touch with it.
Traditional medical systems from Asia and Europe have always regarded the tongue as a valuable diagnostic tool for assessing a patient's state of health. Modern conventional medicine also examines tongues as part of a physical examination and correlates some tongue signs with certain diseases (e.g. strawberry tongue in scarlet fever, lacquer tongue in vitamin B12 deficiency or bluish tongue in poor circulation).
In Ayurvedic medicine, only sparse information on tongue diagnostics has traditionally been handed down in writing. Nevertheless, according to my personal practical experience of over 20 years, the following diagnostic information can be derived from the tongue image:
- State of Vata, Pitta and Kapha and their respective properties
- State of the first two body tissues rasa (nutritive juice) and rakta (blood)
- Mucus (Kapha Mala)
- Load with undigested residues = Ama
- Degenerative and inflammatory processes
- Psychovegetative conditions
Very important: The tongue does not directly indicate diseases, but rather their pathogenesis and pathophysiology! Experienced diagnosticians can therefore recognise the characteristics and developmental processes of bronchitis via the tongue - but there is no general tongue sign that clearly indicates bronchitis.
Tongue inspection versus pulse palpation
Compared to pulse palpation, tongue inspection offers certain advantages:
- It can be objectified with the help of photo documentation, and a professional exchange with colleagues is also possible using the template.
- Patients can see the change with their own eyes using before-and-after images and are thus directly motivated, and it is also possible to monitor the progress of a therapy visually in the long term.
- The patient can look at their tongue in the mirror in the morning and communicate their experience, albeit certainly with limited speech.
- The tongue is largely independent of acute emotional states.
- The tongue indicates long-term conditions more comprehensively and therefore tells us a lot about a patient's history.
The pulse conveys finer connections of the nervous system and specifically represents the Prana Vata in the human body. As part of the gastrointestinal tract, the tongue specifically represents the state of our digestive and metabolic power Agni.
The pulse can therefore be quickly irritated by mental states, and the tongue changes daily according to eating behaviour and digestive status.
Carrying out a tongue examination
The best lighting conditions for inspecting a tongue are in daylight in the early morning. Alternatively, halogen light can be used on dark days or at dark times of day.
Firstly, the patient loosely sticks their tongue out forwards to give the therapist an initial impression without focussing on individual areas in detail. The tongue is a muscle that becomes more perfused and red with prolonged contraction. For this reason, the tongue should be stuck out briefly several times, which is also much more pleasant for the patient.
The therapist can concentrate on one parameter each time the tongue is stuck out. The overall interpretation only takes place at the end of the recording of all tongue signs.
Three parameters of tongue diagnostics
Tongue body
- Volume: small or large, thin or thick/swollen, short or long, narrow or wide
- Surface: smooth or rough, cracked or crack-free, elevations
- Moisture: dry or moist, slimy or clear
- Colour: pale red, pale, livid or reddish
- Movement: quiet, shaky, limp
Tongue coating
- Thickness: thin, medium thick, thick
- Colour: whitish, greyish, brownish, yellowish, greenish, blackish
- Moisture: dry-old or moist-fresh
- Topography: which third of the tongue is occupied and how
Under tongue side
- Colour: pale, livid, reddish, yellowish
- Veins: barely visible, protruding, dark coloured, congested-taut-whisked
A topographical classification of organs on the tongue has not been handed down in writing in the classical compendia of Ayurveda. In order to close this gap, I transfer concepts from neighbouring traditional Chinese medicine and interpret them ayurvedically.
To put it simply, three thirds of the tongue can be distinguished from each other: the posterior third correlates with Vata-Sthana (seat of Vata in the abdomen), the middle third with Pitta-Sthana (seat of Pitta in the middle abdomen) and the front third with Kapha-Sthana (seat of Kapha in the thorax).
The healthy tongue is of medium size, its surface is smooth and free of cracks, it is well moistened without mucus deposits, its colour is pale red, the coating is light and thin like fresh morning dew in the posterior third of the tongue and the sublingual veins are barely visible at rest.
Increased Vata is characterised by loss of volume, a rough and cracked surface, dryness and paleness. The tongue coating tends to be thin and greyish, the underside is pale and the veins tend to be slightly livid.
Increased Pitta causes a medium-volume tongue including the underside to blush, the thin coating is yellowish in colour and the body of the tongue appears muscular. The presence of red bumps also often indicates the impairment of the blood tissue in the sense of raktadushti.
Increased Kapha causes the rather pale, large and moist body of the tongue to swell, which often results in dental impressions. Tongue coatings are also moist and whitish in colour, the veins of the lower tongue may be somewhat swollen but pale and inconspicuous in colour. The strength of Agni decreases with the increase in Kapha and leads uncontrollably to the development of Ama.
On the tongue, this ama a similar picture to that described for Kapha with the addition of thickening of the plaque, stickiness and swelling in the sense of a bulging puffiness. The colour of the plaque in Ama depends on the association with the respective dosha and can therefore appear whitish (Sama-Kapha), yellowish-greenish (Sama-Pitta) or greyish-dirty (Sama-Vata).
In future, look at your tongue in the mirror every morning before you scrape off the existing coating as part of your morning routine. This will give you valuable „bio-feedback“ from your inner self every day. Consult an experienced Ayurvedic diagnostician for a professional medical tongue examination and interpretation.
With best wishes for your health,
Ralph Steuernagel
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