THE TONGUE IN THE ELDERLY

Tongue diagnosis plays a very important role in the prevention of disease especially in the elderly. Middle-aged and elderly patients often show abnormal signs on the tongue in the absence of any obvious disease.
Elderly people often suffer from Internal Wind, Blood stasis, Phlegm, Heat or Yin deficiency or a combination of these. For example, it is common to have Blood stasis with Phlegm; or Phlegm with Yin deficiency; or Internal Wind with Phlegm; or a combination of the above. In the elderly, Blood stasis and Phlegm are so common that there is a saying in Chinese medicine which states “In the elderly, when in doubt, invigorate Blood and resolve Phlegm”.
In such cases, the tongue often shows clear signs of these pathogenic factors and it therefore allows us to treat them before they give rise to disease.
In particular, stroke in the elderly usually derives from a complex pathology involving Internal Wind, Yin deficiency with Empty Heat, Phlegm, and Blood stasis. The tongue of the elderly often points to such a complex pathology years before they may get a stroke. Therefore, if I see a tongue with those signs in an elderly person, I take active steps to treat them.
An example of a complex pathology showing on the tongue would be as follows:

- Deviated, Moving, Stiff = Internal Wind
- Red without coating = Yin deficiency with Empty Heat
- Swollen tongue body, sticky coating = Phlegm
- Purple = Blood stasis

The tongue illustrated here is Reddish-Purple (Blood stasis with Heat), Deviated and Stiff (internal Wind), lacking a coating in the centre, Red body (Yin Xu with Empty Heat), Swollen (Phlegm).
The remedy Peaceful Sunset was formulated to treat such a complex pathology in the elderly.

Chest and breast area on the tongue

The “chest” area is on the sides of the tongue, between the centre part and the tip.
The chest area reflects a pathology of three organs: heart, lungs or breast in women.
Changes in this area to look for are:
1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
3) Red points

The chest area reflects pathologies of the lungs, heart or breast but in a Western medical sense. A change in the chest area may involve a change in colour or body shape. How to differentiate when a change in the chest area indicates a problem of the lungs or heart or of the breasts in women? A change in the chest area indicates a pathology of the breast in women rather that of lungs/heart when:
- In the absence of an obvious lungs/heart pathology
- Especially when it is unilateral

Examples of lung pathology manifesting in the chest area are chronic asthma or chronic emphysema (in which case the chest area would be swollen and possibly purple). An example of heart pathology is chronic coronary heart disease (in which case the chest area would be purple). As the area on the sides between the centre and the tip reflects the condition of heart/ lungs/ breast, I shall call this the “chest area”.

Apart from a purple colour and a swelling, other possible changes in the chest area are teeth marks that are confined only to the chest area, red points or a peeling of the chest area.

- Teeth marks only in the chest area indicate usually a problem in the breast in women (possible carcinoma) occurring against a background of severe Qi deficiency
- Red points in the chest area indicate Toxic Heat in thelungs or breast
- A peeling (absence of coating) in the chest area indicates a possible problem in the breasts in women occurring against a background of Yin deficiency.

A purple colour in the breast area in women is a potentially serious sign as Blood stasis in the breast may cause cancer. If I see this sign is a woman without symptoms, I would still treat her for Blood stasis in the breast. If I see a woman after she had breast cancer and surgery, I carefully examine the breast area: if it is purple it is not a good sign; vice versa, if it is not purple, it is a good prognostic sign.

In conclusion, as far as the Heart is concerned, we can say that the tip reflects a pathology of the Heart in a Chinese sense, i.e. problems of the Shen, while the chest area reflects a pathology of the heart in a Western sense (e.g. coronary heart disease

Stomach crack on the tongue

The Stomach crack on the tongue is rather wide and it is in the central section of the tongue (corresponding to Middle Burner). To contrast and compare the Heart and Stomach cracks, the former is rather narrow and runs all along the tongue from near the root to near the tip, while the latter is rather wide and is only in the middle of the tongue. Please see previous posts to see pictures of a Heart crack.
A Stomach crack indicates the tendency to Stomach-Yin deficiency. People with such a crack often have no digestive symptoms but I always recommend treating it by using Ren-12, ST-36 and SP-6.

Clinical tip of the day no. 2 - Heart crack

The Heart crack on the tongue is relatively common. This crack is in the midline extending from near the root to near the tip; it therefore extends nearly the whole length of the tongue. The Heart crack indicates the constitutional tendency to mental-emotional problems: the deeper the crack, the stronger this tendency. If the Heart crack is accompanied by a change in the tongue-body colour and a red tip, it then indicates actual mental-emotional problems.

The two tongues presented here both have a Heart crack. The worst is the one on the bottom because the crack is deeper.