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Assistance with a tongue diagnosis


About a month ago I began treating a friend for low energy, stress, anxiety, depression, and problems with menstruation occurring only once every 2-3 months since teenage years–generally hormonal imbalances. My friend works on average 50-60 hours each week as a restaurant manager for an airport. Based on all of the symptoms she disclosed to me (and for being close friends with her for a very long time) I have an in-depth look at her diet and living habits. I told her to stop taking OTC pain killers, antacids, and sleeping aids. She needed to eat less conventional meat (especially chicken) and more organic, free-range pork and fresh fish caught off the coast (she lives in New England). In the past she’s taken progesterone in order to induce her period.

Based on all of the information gathered from her and an understanding on how she lives I concluded she has spleen qi deficiency from a faulty diet, liver blood deficiency, and weakened kidneys (but not to the point of harboring any cold pathogens or heat from vacuity). I figure the way she used to eat contributed to the spleen damage (she craved sweets but once eating them felt off-put and weighed down), and without transformation of food to qi the blood cannot be nourished adequately–and when combined with chronic stress and hormonal imbalances (kidney deficiency) the blood is too little in volume and too stagnant in mobility.

I made her some pills–each around 3 grams–to be taken x3 daily on an empty stomach. She started with x2 daily and then graduated to x3 after a week, and after this dropped back to only two for the past month or so. She’s been taking them for almost 2 consecutive months. The pills I gave her contain all of the following in equal portion:

  • Shan Yao
  • Bai Zhu
  • Bai Shao
  • Dang Gui
  • Dang Shen
  • Yin Du Ren Shen (Ashwagandha)
  • Nv Zhen Zi
  • Xiang Fu

My big question is this: She told me that she’s been sleeping a lot more for the past week. In addition to getting tired around 9 PM and waking at 5 AM for her shift, she goes to sleep immediately–sometimes never remembering that she fell asleep in the first place. This wasn’t alarming but rather promising to hear only a few weeks ago. However, it’s this detail that has me take notice: since Tuesday she has been sleeping 8 hours each night with an additional 4 hours with naps where her memory is a bit hazy as to when she started getting tired, as well as sleeping the entire day on her days off. She says when she’s awake she’s alert, but when she gets home she can quite literally pass out anywhere she happens to be (on the sofa or the bed), and she tends to want to lie down instead of sit up straight.

She gave me a picture of her tongue, and I notice that she is still spleen deficient (note the rough edges on the sides) and that she has what looks like heart heat. I’m not sure if the tip is red only in relation to the rest of the tongue or if it is indeed indicative of heat signs. However, if she were to really have heart fire (no matter big or small) she would be having insomnia and anxiety–yet she exhibits just the opposite. It would appear liver blood is still not where it needs to be but far improved, if indeed the majority of the tongue is just pale and causing the tip to look particularly red. Just wondering if there’s something I’m missing here as to why the heart is particularly red on the tip of her tongue. Maybe she has vacuity heat and not true heat? Then again, if the heart is vacuous then the symptoms would be different. I’m not sure if spleen vacuity can manifest heat up to the heart channel, or if this heat is actually coming from elsewhere and being collected in the heart. However, yet again symptoms would likely be different.

I believe to have resolved her liver blood deficiency, however does it seem likely that there still remains deficiency and/or stagnation in the liver channel as the primary constituent of this newfound selective–yet extensive–sleeping habit? Could it be just a sign that everything is adjusting well and her body is recuperating? She doesn’t admit to feeling temperature fluctuations and she doesn’t exhibit any signs of cold pathogens anywhere. If anything the coating on her tongue is a pale yellow, not particularly moist or slippery in coating. I wish I could take pulses but I live hundreds of miles away.


In my clinical experience the tongue reflects degrees or progression of an imbalance. Maybe its just the quality of the picture but I don’t really see the tip being significantly red. Noticeably red, yes, but not anywhere near the cherry bright red I generally see with heart fire. Also the tip of the tongue, while reflecting the heart, can also be an reflection of the upper part of the body in general. Just from her work schedule of 50-60 hours a week I would expect to see the stress from that manifesting as a redder tip. Also from my clinical experience seeing a red tip that relates to stressful (diet, work, lifestyle, etc) does not always translate into seeing symptoms of the heart channel at all. Finally I would also point out that you can show signs of a pattern without seeing symptoms of the pattern i.e. seeing the sign of red tongue tip without seeing clinical manifestations of heart heat (whether from excess or deficiency). Hope that helps!


Yes it does Stephen! Thank you.


The tongue looks pale in comparison to the tip. The tip if a little red could be actually a healthy color and just looks red bc the rest of the tongue looks pale, swollen and a little soggy “scalloped”. Sounds like she is feeling sleepy due to overworking and the acupuncture might just be telling her to rest bc it’s the true amount of qi she is left with. Tongue looks spleen, blood, liver blood, yin def. Tip looks close to normal to me.

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