What your tongue says about your health

  • Wellness
  • Wednesday, 23 Jun 2021

Tongue scraping can help clear bacteria from the mouth, improving your tongue’s appearance and overall sensation. — 123rf.com

It's pink, moist and highly sensitive to touch.

I’m not sure what you are thinking of, but I’m referring to the tongue!

As the sensory organ responsible for taste, the versatile tongue enables us to speak, eat, suck and swallow in a coordinated manner.

It comprises an extremely moveable set of muscles with a lot of nerves that are sensitive to pain – that’s why it hurts when you bite your tongue.

But it is hopeless at sensing temperature, which explains why it is easy to burn your mouth when you put something hot inside.

That aside, the tongue also provides many tell-tale signs of possible ailments and is used as a diagnostic tool by both traditional Chinese medicine (TCM) and Ayurvedic practitioners.

According to TCM practitioner and International Medical University lecturer Dr Wong Hon Foong, the tongue is not merely an organ with many functions, but also reflects the human body as a whole.

“We emphasise on qualitative diagnosis, i.e. talking to the patient, observing, listening and smelling, palpation, pulse, and tongue diagnosis.

“Mainly, we look at the tongue’s body and coating to give us clues, ” he explains.

Dr Wong, who holds a doctorate in TCM Clinical Foundation from the Shanghai University of Traditional Chinese Medicine, China, says a healthy tongue should be light red or pink, with a layer of thin, white coating and the right amount of moisture, as well as being nimble in moving around.

“Often, we look at the top of the tongue, but at certain points, we look underneath at the sublingual veins located on both sides – specifically at the colour to evaluate if there is any blood stasis or impeded blood flow in the body.

“This can also be seen on top of the tongue, which may have blue-black bruises.

“Sometimes, taking certain medications or food might stain the tongue, and to distinguish between this and a symptom, we would have to scrape the tongue.

“But generally, this is not practised in TCM as the tongue can be kept clean if the patient follows proper oral hygiene by brushing their teeth and gargling after meals, ” he says.

A normal, healthy tongue should be pink in colour. — Photos: International Medical UniversityA normal, healthy tongue should be pink in colour. — Photos: International Medical UniversityAnd yes, size and length do matter!

Normal, healthy individuals should be able to stick out their tongue such that the centre and root parts are visible, along with their teeth.

If only the tip can be seen, then it is considered a short tongue.

Dr Wong says: “This can be congenital – maybe there is a ‘wind’, qi and ‘blood’ deficiency, which leads to a lack of energy, presence of cold in the body, etc.

“If it is not congenital, then it is a sign of a critical condition that needs to be probed.

“A long tongue that can stick out, but retracts quickly like a snake’s, is also a sign of very strong ‘heat’.”

When the tongue is enlarged or swollen horizontally and vertically such that you cannot see the teeth or the whole mouth, it is abnormal.

This is usually rare and only seen in children.

It is a sign of strong “heat” in the heart and spleen areas, explains Dr Wong.

“This could be caused by dehydration, or the child may be born with this type of ‘heaty’ body constitution, especially if the mother took a lot of hot foods, e.g. curries, and deep fried items during pregnancy.

“If the child is easily prone to having seizures, then we’ve to check for strong ‘heat’ in the body, which will be reflected in a swollen and yellow, crimson or pomegranate-coloured tongue, ” he says.

If the tongue is only enlarged horizontally and there are tooth marks on the sides, it’s an indication of poor digestion.

Being able to curl your tongue and touch your nose is a congenital ability, and like having a longer second toe than your big toe, is not a cause for concern.

As for bad breath, it is often related to remnants of food stuck in between the teeth or from having pus on the tongue.

Dr Wong advises: “Every morning before brushing your teeth, stick your tongue out and look at it.

“If the tongue was pinkish and has suddenly changed to a pale, purplish or yellow colour, it’s a sign that something has changed in your body.

“Be alert and ask yourself if you have taken any food or medication that could result in this.

“Try scraping, and if doesn’t come off, seek help.”

Dosha imbalance

A yellow coating on the tongue indicates 'heat' in the body, according to TCM.A yellow coating on the tongue indicates 'heat' in the body, according to TCM.In Ayurveda, methods to assess a person’s disease status include checking the pulse, condition of the eyes and vision, and sound of the voice.

“But the most crucial one is Jihwa Pariksha or examination of the tongue.

“This protocol helps a practitioner understand if there is presence of a disease, how far the disease has progressed, and to create an appropriate treatment plan, ” explains Ayurvedic practitioner Dr C. D. Siby.

The presence of a disease in Ayurveda is identified when there are imbalances in the three functional and organising principles (dosha) of Vata, Pitta and Kapha.

They are made up of a combination of the basic elements (earth, water, fire, air and ether), and each dosha has a specific character based on the elements that rule it.

Dr Siby says: “When a patient is healthy, his tongue is neither too dry nor too wet.

“It does not emit a bad odour and the veins underneath are not distended.

“It is pink all over, has an even width or is oval in shape.

“When the patient sticks his tongue out, it should be straight, rather than veering to one side.”

Like TCM practitioners, Ayurvedic practitioners also observe the thin coating on the tongue.

If this coating is coloured, there is a possibility of poor digestion and buildup of toxins in the tissues.

“Where this coating appears on the tongue tells us which organ is affected.

“For example, the front of the tongue is related to the upper gastrointestinal tract, lungs and heart; the middle part of the tongue is connected with the liver, spleen and stomach; the back with the large intestines and kidneys; the tip with the thyroid gland; and the vertical line in the middle of the tongue with the spinal column, ” he explains.

Next, the practitioner will look at the colour of the tongue to determine the dosha that is in a state of imbalance.

A grey, black or brown coating reflects an accumulation of Vata toxins and Vata imbalance; yellow, orange, red or green coating indicates Pitta imbalance; and whitish coating correlates to Kapha imbalance.

Dr Siby says: “The presence of cracks on the tongue is typical of Vata imbalance.

“When there are multiple cracks on the tongue, it is often a clear indication that the imbalance is chronic and the patient could be suffering from conditions such as insomnia, nervousness, excessive fear, insecurity and other such disorders.”

A swollen tongue is indicative of inflammation, and again, the location of such swelling relates to a particular organ in the body.

“The presence of red dots on the surface of the tongue tells us that the body is ‘heaty’ or that the Pitta is imbalanced.

“On the other hand, a pale tongue is a typical sign of low red blood cells, poor circulation, or possibly anaemia.

This may happen due to low haemoglobin levels, excessive blood loss, iron/B12 deficiency, parasitic infection or drug side effects.

“When there are teeth marks on the tongue, there is a suspicion that the body is not absorbing nutrients, which can lead to malnutrition, ” he shares.

Non-healing sores

Dr Wong says a tongue with purplish spots on it is a sign of blood stasis. Dr Wong says a tongue with purplish spots on it is a sign of blood stasis.In allopathic or modern medicine, common general ailments are obvious when looking at the tongue, although the signs may not pinpoint the exact cause of the affliction as it may not be specific to a particular disease.

Says consultant otolaryngologist Dr Anura Michelle Manuel: “A pale smooth tongue is seen in iron deficiency anaemia and a whitish patch on the tongue indicates oral candidiasis (fungal infection), which is seen in immunocompromised patients or with prolonged antibiotic use.

“We would then need to determine the cause of the iron deficiency or the cause of the immunocompromised state.

“An abnormal-looking tongue could be due to diseases of the tongue itself or a general disease.”

There are many warning signs on the tongue that need prompt medical attention.

For example, canker sores are among the most common type of oral lesions and can be irritated further by eating citrus fruits, acidic vegetables and spicy foods.

However, the pain can be alleviated by applying salt to the wound.

But when sores and ulcers are prolonged, it’s wise to head to the doctor, as according to Dr Anura, a chronic non-healing or recurring tongue ulcer could indicate cancer.

“One should also not leave a sharp tooth or ill-fitting denture that causes constant abrasion on the tongue, unattended.

“A whitish plaque should also not be left unattended.

“Usually, these coatings are not easily scraped off, and if scraped off, may leave a reddish area that may bleed slightly, ” she adds.

Blocking your breath

According to TCM, an enlarged tongue with tooth marks on the sides indicates that either the digestive system is not functioning optimally or there is fluid retention in the body.According to TCM, an enlarged tongue with tooth marks on the sides indicates that either the digestive system is not functioning optimally or there is fluid retention in the body.As part of a comprehensive dental examination, most dentists also check the tongue and the surrounding soft tissue for signs of oral cancer.

But dentists will tell you that the tongue’s rest posture (i.e. the position when you are not speaking or eating) is equally important to determine how well you are breathing.

For many people, the position of their tongue can present a problem to their breathing while sleeping, resulting in snoring, restless sleep, teeth-grinding, sleep apnoea, or snorting, gasping or choking sounds, for example.

Often, they are not even aware that they have this condition.

Dentist Dr Larry Au-Yong says: “The tongue occupies a fixed volume in the mouth.

“Directly behind the tongue is the upper airway space (oropharynx).

“Where and how the tongue positions itself will either widen or narrow this upper airway tube.

“When the tongue is forwards and upwards in the mouth, the upper airway space is wider and the flow of breath is easier.

“If the tongue position is low, it will block part of the upper airway, making breathing more laborious.”

This may be one reason why tai chi, qigong and yoga practitioners advocate the practice of breathing while holding the tongue up on the palate, with the tip of the tongue just behind the upper front teeth.

To prevent or to reduce the suboptimal and dysfunctional modes of breathing described above, he suggests we adopt a proper “oral rest posture”.

“This posture simply means the default position that our tongue, lips and lower jaw return to when we are at rest.

“Breathe in and out through the nose; keep the lips lightly together; the upper and lower teeth should be lightly touching, or very close to touching; and the whole tongue is upwards touching the palate, with the tongue tip resting on the spot just behind the upper two front teeth, ” he says.

For better sleep and to prevent the tongue from falling down and back while sleeping, a consultation with a myofunctional therapist is recommended.

These practitioners can diagnose and treat tongue, lip and facial muscle imbalance and dysfunction.

Some dentists are also trained in this area.

Dr Au-Yong says: “One of the simplest tongue exercises that anyone can start with is pressing the tongue fully and widely up on the palate, with the tongue tip resting on the spot just behind the upper two front teeth.

"Do this repeatedly multiple times a day.

“To give the tongue a better workout, try doing this exercise with a pre-chewed chewing gum between your tongue and palate.”

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