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A few months ago, I was having tea with a Chinese medicine professor, discussing my plans about making the ancient tongue diagnosis texts available in English. His first reaction was quite negative and disapproving. His arguments were that “nobody in China reads these books, why would the ‘foreigners’ wish to study them?”, and also “the classics lack photographic illustrations”.

Instead of answering these questions, in this entry I will briefly discuss about how the modern TCM tongue method managed to replace the old established classical tongue diagnosis system.

Traditionally, since the Yuan Dynasty, tongue diagnosis was intimately intertwined with herbal medicine. Therefore, the Gold Mirror Records, the Tongue Reflection in Cold Damage, and all the monographs up until the late Min Guo period, such as the Tongue Diagnosis in the National Medicine (which I think was the last important tongue text published pre-1960) all discuss tongue theory together with formulae. This approach survived until the late 1950’s because the transmission of this skill was still strongly adhering to the tradition. Around 1955-8 appeared the last standardized and annotated versions of the Gold Mirror Records and Tongue Reflection in Cold Damage quite signifying the end of this era.

The 1960 first edition of the Chinese Medicine Tongue Diagnosis

The modern Tongue Diagnosis –as we know it today- began in July 1960, with the publication of the book Chinese Medicine Tongue Diagnosis.

Chen Ze-lin and Li Nai-min both describe this as being “the first specialist work on tongue Diagnosis after the formation of the P.R.C.” – Li Nai-min was also quoted to have said that: “The book inherited the substance and essence of tongue diagnosis in Chinese Medicine, and new concepts were put forward”.

Anyhow, it appears that the “new ideology” wished to convert the tongue into a universal diagnosis method, applicable in every branch of TCM. This book was therefore produced by “summarizing and organizing” the ancient bibliography. Three years later, in May 1963, the Tongue Fur Illustrated Manual offered a large collection of tongue photographs together with a brief TCM syndrome differentiation.

The back cover of the Chinese Medicine Tongue Diagnosis

These books quite deviated from the established traditions. Herbal medicine was removed and there were no more illustrations pointing to clinical subtleties. Also, these books were not the outcome of clinical experience and did not offer a significant development following classic knowledge. However, they soon became the cornerstone tongue texts for the new era.

Either-way, by severing the links with the past immediately appeared a much bigger problem: the younger doctors soon became incapable of prescribing by looking at the tongue (according to the traditional system, a doctor could – more or less – form an idea about what formula to apply by just observing the tongue). Eventually the ancient skill transmuted into a mere “confirmation tool” for verifying the state of the pulse and symptomatology, thus denying 800 years of tongue diagnosis development.

Author’s copy of the Tongue Diagnosis in the National Medicine

Sadly, most tongue books and monographs published since then strictly adhere to the ideas and the format brought forward in 1960-63.

The Cultural Revolution which followed a couple of years later, the abolition of the master-disciple system in Medicine, and the way TCM was taught in Colleges after 1977, made this silent change permanent.

In the west we were only introduced to the modern approach through the established textbooks and popular tongue manuals, never really knowing that the tongue had a much different and colourful past.

Only in recent years I have seen a few volumes published in China presenting non-photographic illustrations together with formulary, which I believe is a good indication about the future.

The description page of the 1963 edition of the Tongue fur Illustrated Manual

I will close this entry with a short anecdote: In the early 80’s, the BUCM wished to produce a tongue diagnosis book, for western readers. Some teachers were approached to write the text, first in Chinese, and then others would do the translation. Nevertheless, when younger professors suggested translating the 1960 edition of the Chinese Medicine Tongue Diagnosis (which is thought as the established classic), the old-timers replied that it cannot be used. The explanation given was that the original authors had to produce a comprehensive tongue summary in a very short time, by “copy-pasting” stuff from classics and putting together a collage in accordance to the ideology of the realm.

I am not really sure if such a book was ever published, but the story clearly depicts how the ancient tongue diagnosis was massacred, in order for a universally applicable comprehensive summary to be produced.

All illustrations come from the author’s private collection of tongue manuscripts.

For more on the historical, theoretical and cultural aspects of the tongue theory see Ioannis Solos’ blog: http://ioannissolos.blogspot.co.uk/

By Ioannis Solos

In pre-modern China, outbreaks of infectious/communicable diseases such as typhoid, plague, influenza, smallpox etc. were terribly common and dangerously contagious. Therefore, during such times, taking the pulse, speaking with the patient and even using acupuncture would often be a reckless way to interact with the sick.

For remedying this situation there was a great need for the development of a new approach in diagnosis, so physicians would be able to provide appropriate treatment while having minimal physical contact with the patient.

The first systematic Tongue Diagnosis system first appeared during the Jin and Yuan Dynasties, as an alternative to the Pulse method. It derived from the works of Scholar Ao (real name and period unknown) who was perhaps the first doctor to produce an ensemble of 12 tongue illustrations, in which appeared the common ailments of his era. Along with every image he also suggested a formula which – in his opinion – would be sufficient to appropriately manage each condition.

However, his manuscript, known as Little pieces of Gold (Shang Han Dian Dian Jin) was never meant to be public, and it appears that it has only been transmitted from teacher to selected disciples within closed circles, for centuries. This fact is also well described in Xue Li-zhai’s preface to the Scholar Ao’s Gold Mirror records, where it is said that:

‘Gentleman Ao set his own rules on the tongue diagnosis, and he thought that [they summarized] the essence for this special system. At the same time he wrote two books, the Little Pieces of Gold and the Gold Mirror Records, both [to be kept] as a secret and not be passed on. During [Emperor] Zheng De’s Wu-Chen year (1508) I met a person who was able to observe the tongue and prescribe [accordingly], and always with good clinical results. So I invited him to my home and tried to inquire about his method, but he refused to further elaborate about it.’

Page from "Scholar Ao's Gold Mirror Records"

A page from the Imperial compilation of the “Scholar Ao’s Gold Mirror Records” Underneath each illustration there is a short explanation and a treatment approach including an herbal formula. Qing Dynasty circa 1850.

Historically, in 1341, a scholar from the Hanlin Imperial Academy named Du Qing-bi acquired a copy of Ao’s manuscript. He edited the original text and further contributed to it, with an additional 24 illustrations to a total of 36. He therefore presented a more complete overview of the various tongue reflections according to his own ideas. His book was eventually named Scholar Ao’s Gold Mirror records (Ao Shi Shang Han Jin Jing Lu) (Illustration 1). This book was very easy to use, but also extremely profound. It demanded that the doctors work out the essence of the tongue differentiation system by studying the 36 tongues and then further developing their own personal understanding via clinical practice and meticulous research.

Du Qing-bi in his original introduction summarizes this as follows:

‘The earliest twelve tongues [in Ao’s manuscript] unfortunately did not cover all the [possible] patterns [and therefore] I [personally] added twenty four illustrations and [the appropriate] treatment method on the left side, containing the formula. From each section, [you should] advance progressively, in order to determine the subtleties of life and death.’

However, in rural areas where there were no doctors, common people could also match the patient’s tongue to the appropriate illustration (much like in Ao’s original system), and prescribe medicine in the hope that the patient could be saved.

Ma Chong-ru records this in his endnote as follows:

‘Although some places may lack good doctors, however they should have some reference materials to assist the situation. For those who have no [such materials to provide some] cure; only the destiny may determine their life and death. [Therefore] the easiest path to treat the cold damage is by using cut-blocks for printing and to spread [the knowledge].’

Illustration from “Essential Teachings on Tongue Observation in Cold Damage”

A tongue illustration from the “Essential Teachings on Tongue Observation in Cold Damage” and part of the summary on the grey tongue theory. Rare handwritten copy in the author’s possession, late Qing Dynasty, Guangxu era.

During the Ming Dynasty, and following the popularity of the Scholar Ao’s Gold Mirror Records, appeared the Essential Teachings on Tongue Observation in Cold Damage (Shang Han Guan She Xin Fa) (now lost in the print version). This book was a lot more detailed, and containing a total of 137 tongues. (Illustration 2) The Essential Teachings on Tongue Observation in Cold Damage provided each tongue with a lengthy explanation, formulae, and a poem to assist memorization. Although significantly more detailed than Ao’s manuscript, it never surpassed its predecessor in popularity. It appears that matching up the patient’s tongue to one of the 137 illustrations was a much harder task, and the lengthy explanations ultimately confused the doctors who wanted to fathom the author’s “root” methodology.

Eventually, during the Qing Dynasty, Zhang Deng edited/simplified the Essential Teachings on Tongue Observation in Cold Damage down to 120 tongues. Like he states in his introduction to The Tongue Reflection in Cold Damage:

‘[In this work] I corrected the mistakes appearing on the text of Guan She Xin Fa, dismissed all of its disordered inaccuracies, and thrown away the information that was not concerned with the cold damage. I have also added materials from my father’s case studies and notes on treatment, as well as materials from my own personal experiences. In total there are one hundred and twenty illustrations.’

A handwritten version of “Tongue Reflection in Cold Damage”

A handwritten version of the “Tongue Reflection in Cold Damage” with coloured illustrations. This variation also fully presents the structure of the formulae mentioned in the text, in accordance with the tradition in “Scholar Ao’s Gold Mirror Records”. Late Qing or early Min Guo manuscript.

The Tongue Reflection in Cold Damage (Illustration 3) was much simpler and easier to use, and it was reprinted continuously until the 1960’s, when it was finally replaced by modern tongue manuals.

To summarize, the Scholar Ao’s Gold Mirror records and the Tongue Reflection in Cold Damage have intimately influenced the development of modern Tongue Diagnosis, and they are still regarded as the core materials for exploring the theory of tongue diagnosis in depth.

These days, I believe that in order to better facilitate the westward transmission of Chinese Medicine, scholars should present complete ideas about their specialty, and provide a functional understanding of both the content and the history of their chosen field. In my opinion, the best way to accomplish this is not by randomly translating famous books or by providing many alternative translations of the same texts over and over again, but by presenting collections of important manuscripts arranged in such a way that can clearly demonstrate how each branch of TCM was developed.

In my humble book the Gold Mirrors and Tongue Reflections, I provide a translation of both the Scholar Ao’s Gold Mirror records (Ao Shi Shang Han Jin Jing Lu) and the Tongue Reflection in Cold Damage (Shang Han She Jian).

Having been researching classical tongue diagnosis for nearly a decade, I now wish to present my modest collection of influential tongue monographs, not only with the publication of this book but also through a companion volume currently in progress. I hope that my work will positively contribute to the further development of tongue research in the west, and assist my fellow TCM practitioners to develop a proper understanding on the academic origins of Tongue Diagnosis before accessing modern manuals.

All illustrations come from the author’s private collection of tongue manuscripts.

hot and cold syndromes

The Origins of the Modern Tongue Diagnosis, with Ioannis Solos

Gold Mirrors and Tongue Reflections – A Brief Introduction to the Academic Beginnings of the Tongue Diagnosis Tradition

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