Transcription
[Music] This week's review question: We examine what does a pale and scalloped tongue indicate? Does it indicate cold damp stagnation, or blood deficiency, or Chi deficiency, or Yang deficiency?
Now, to start with, we know that a patient with cold damp stagnation would also have a thick, greasy tongue coat. And since there's no tongue coat mentioned here, it's implied that it's a thin white coat. So we can eliminate cold damp stagnation. And we know that a patient presenting with blood deficiency would have a pale and dry tongue, but not a scalloped tongue. So we can eliminate blood deficiency.
Now we're wanting to differentiate between Chi deficiency and Yang deficiency. Both have a pale tongue. However, right now we're looking at what does a scalloped, pale tongue indicate? Scalloped means that there are tooth marks along the borders of the tongue. It also implies that there's a problem with fluid metabolism, and so the tongue becomes swollen. And when it's swollen, it presses against the edges of the teeth.
When we look at fluid metabolism, which organs are involved? We have the lungs, which regulate water passages; the spleen, which governs transportation and transformation; and the kidneys, which govern water and water passages. So the three main Zang organs involved in water metabolism are the lungs, spleen, and kidneys.
When we talk about the lungs' involvement, uh, symptoms that arise when there's problems with the lungs' influence on water metabolism tend to be things like phlegm accumulation in the lungs, or perhaps the lungs not distributing moisture to the surface of the body and causing dry skin. Um, however, when we're looking at swelling of the tongue and edema and that kind of fluid metabolism, the emphasis is really on the spleen and kidneys.
One of the beauties and fine points of Chinese medicine is understanding how parts of the body relate to each other. So in this case, looking at the relationship between the spleen and kidneys, the main connection between the spleen and kidneys is one of congenital and acquired Chi. So the kidneys uh have a strong influence on congenital Qi, also known as pre-birth Qi or pre-Heaven Qi, and the spleen has an influence on acquired Qi, also known as post-birth Qi or post-Heaven Qi. The spleen and kidneys also have a strong influence on water metabolism, and that's specifically in relation to their uh Yang aspect.
So when the kidney Yang is deficient, it fails to warm the spleen Yang, leading to spleen Yang deficiency. And similarly, when spleen Yang is deficient, it leads to a preponderance of Yin and cold in the interior, which may impair the kidney Yang and cause deficiency. A swollen tongue, therefore, that is delicate in quality and pale in color with tooth marks on the border—remembering that tooth marks is another way to say scalloped—indicates Yang deficiency of the spleen and kidney. This condition is due to impaired circulation of body fluids, producing harmful water, retained fluid, phlegm, and damp. So when there's a deficiency of spleen and kidney Yang, there is a tendency for the body to create dampness, and it would be a cold dampness since it's Yang deficiency.
However, it's important to remember that the primary diagnosis with a pale and scalloped tongue is Yang deficiency of the spleen and kidney. So if we come back to the question, a pale and scalloped or tooth-marked tongue indicates not cold damp stagnation because there's not a thick, greasy coat; not blood deficiency because the tongue is not pale and dry, but it's swollen and scalloped; not Chi deficiency precisely because it's swollen; a Chi-deficient tongue would have a thin white coat and be pale but not swollen and with tooth marks, according to the textbooks and the exam. So that leaves us with a pale and scalloped or tooth-marked tongue indicating Yang deficiency.
I just wanted to add a quote from um Dr. Andrew Tung, who was the district physician of Shanghai and later a well-known Chinese doctor in San Francisco. He said, "You can study medical texts for 10 years and find no such patient in the clinic, and you can work in the clinic for 10 years and find no such patients in any medical book." I brought this quote in because there's a distinct difference between academic study and clinical experience. Of course, they both contribute to having a strong medical practice. We can't exchange clinical experience um for only having academic study, but for the exams you really don't want to get distracted by uh clinical experience. We need to focus on the medical texts.
So I saw a number of places online um and other sources indicate that a pale and scalloped tongue might indicate cold damp stagnation, but when we come to the source texts for our exams—you know, Macha and Cam—a pale, scalloped tongue indicates Yang deficiency, not cold damp [Music] stagnation.
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