Pale

The Pale tongue is paler than normal. The pallor ranges from a very slight paleness to a paleness so extreme that the tongue is almost white. (See Plate 24.1 on p. P22)

The Pale tongue indicates either Yang deficiency or Blood deficiency; in Yang deficiency it will tend to be slightly wet, whereas in Blood deficiency it will tend to be slightly dry. The latter is much more common in women. If it is only slightly Pale this may also indicate Qi deficiency.

The tongue is often Pale only on the sides. If the pallor is all along the sides this indicates Liver-Blood deficiency; if it is only in the central section it indicates Spleen-Blood deficiency. In severe cases of Liver-Blood deficiency the sides may also become orangey.

The Pale tongue normally has a coating, and a Pale tongue without coating indicates severe Blood deficiency; this is relatively rare and it is usually seen only in women.

Box 24.1 summarizes the patterns underlying a Pale tongue.

Red

The Red tongue is redder than the normal colour. Although traditionally two shades are described (i.e. Red or Dark-Red), the clinical significance of these two is essentially the same. (See Plate 24.2 on p. P22.)

A Red tongue always indicates Heat, which may be Full or Empty. Therefore, when we observe a Red tongue the first thing we should ask ourselves is whether it has a coating or not. If the tongue is Red with a coating with root (whatever its colour) this indicates Full-Heat; if the tongue is Red without a coating, or coated only partially, or with a rootless coating (whatever its colour), it indicates Empty-Heat.

It should be stressed that a Red tongue without coating indicates specifically Empty-Heat rather than Yin deficiency, although obviously it arises from the latter. In other words, it is the lack of coating that indicates the Yin deficiency and the redness (without coating) that indicates Empty-Heat. The implication of this is, of course, that there are many tongue types that indicate Yin deficiency while the tongue-body is not Red.

Box 24.2 summarizes the patterns underlying Red tongue and tongue coating.

The tongue-body may be Red in specific areas, especially the tip, the front third, the centre or the sides. A Red tip of the tongue (Fig. 24.1) indicates Heart-Heat (Full or Empty); if the tip only is Red, this indicates that the condition of Heart-Heat is slight, whereas if the whole tongue is Red and the tip redder it indicates that there is generalized Heat and severe Heart-Heat. (See Plate 24.3 on p. P22.)

Red sides all along the edge indicate Liver-Heat (Fig. 24.2, see also Plate 24.4 on p. P22), while a redness on the sides only in the central section indicates either Stomach-Heat or Spleen-Heat (Fig. 24.3).

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