bubble_chart Concept

The tongue color is deeper than the normal light red, appearing bright red or deep red, and is called a crimson tongue.

Strictly speaking, red tongue and crimson tongue are two different tongue colors, and the diseases they indicate also have certain differences. As stated in "Tongue Differentiation and Correction": "A deep red (i.e., crimson) color indicates heat in the qi and blood; a bright red (i.e., bright red) color indicates zang - fu organs are all hot." However, both red tongue and crimson tongue generally indicate a heat pattern, differing only in the degree of severity. Crimson tongue is a further development of red tongue, and their formation mechanisms and clinical significance are similar, so they are discussed together in this section.

bubble_chart Pattern Analysis

1. Exuberant Yang Heat︰It is commonly seen in the stage of exuberant pathogenic heat during warm febrile diseases, where the pathogen is strong and the healthy qi has not yet declined. The main clinical manifestations include: {|###|}red or deep-red tongue texture{|###|}, bright in color, {|###|}fever (mostly high fever){|###|}, {|###|}cardiac dysphoria{|###|}, and in severe cases, {|###|}unconsciousness with delirious speech{|###|}, {|###|}macula and papule{|###|} appearing faintly, {|###|}thirst with a preference for cold drinks{|###|}, and a {|###|}full and rapid pulse{|###|}. The cause is the rampant pathogenic heat: nutrient heat steaming upward, scorching the nutrient yin. The tongue texture changing from red to deep-red indicates a gradual worsening of the heat condition. A {|###|}red or deep-red tongue texture{|###|} is generally considered a sign of heat entering the nutrient-blood level. The *Guide to Tongue Differentiation* states: "Whenever pathogenic heat transmits to the nutrient level, the tongue color must be deep-red. Deep-red is a dark red color. The heart governs the nutrient and blood levels; a dry, deep-red tongue coating indicates that the pathogen has already entered the nutrient-blood level." The key points for pattern identification are: a red or deep-red tongue, relatively bright in color, possibly accompanied by red prickles, a dry and cracked tongue surface, and a tongue coating that is mostly yellow and rough or scorched black. The heat condition is far more severe than the yin deficiency pattern and may be accompanied by symptoms such as {|###|}thirst with a desire to drink{|###|}, {|###|}unconsciousness with delirious speech{|###|}, and a {|###|}full and forceful pulse{|###|}. The treatment should focus on {|###|}clearing the nutrient aspect and cooling the blood{|###|}, with formulas such as Nutrient-Clearing Decoction or Rhinoceros Horn and Rehmannia Decoction selected.
2. Yin Deficiency with Deficient Heat︰It is commonly seen in warm febrile diseases and certain chronic sexually transmitted diseases in the late stage [third stage], characterized by deficiency of healthy qi and decline of pathogens. The main clinical manifestations include: red-crimson tongue texture with a dull luster, tidal fever with a flushed face, palpitations and night sweats, vexing heat in the chest, palms, and soles, mental fatigue, and a thin, rapid pulse. The causes include prolonged retention of pathogenic heat scorching yin fluids; or prolonged delay and lack of treatment in certain chronic sexually transmitted diseases, leading to depletion of yin and fluids; or excessive use of diaphoresis or purgation, or mistaken administration of dryness-heat medications, resulting in damage to yin fluids and deficiency fire flaming upward. These factors cause yin damage, which is reflected in tongue manifestations as a red-crimson tongue texture. A red-crimson tongue in yang exuberance and excess heat also indicates damage to yin, but in analyzing the overall condition, the primary contradiction is the exuberance of pathogenic heat, which differs from the red-crimson tongue in yin deficiency and deficiency heat, where yin deficiency is the main issue, marking a distinction between deficiency and excess. Further analysis of tongue manifestations reveals that the red-crimson tongue in the pattern of yin deficiency and deficiency heat often appears dull and lusterless, generally without coating, and dry with scant moisture. Clinically, it is accompanied by symptoms of yin-deficiency fever, such as afternoon tidal fever, thirst without a desire to drink, and a thin, rapid, and weak pulse, which can aid in differentiation. Treatment should follow the principle of "strengthening the source of water to restrain yang's brilliance." For warm diseases, "preserving even a fraction of body fluids ensures a fraction of vitality." Prescriptions such as Stomach-Tonifying Decoction and Modified Pulse-Restoring Decoction may be selected. If the tongue texture is red-crimson, with a smooth surface resembling pig liver, dry and withered, it often indicates impending exhaustion of stomach and kidney yin fluids. As stated in the *Guide to Tongue Differentiation*: "If the tongue is crimson but not bright, dry, and withered, it signifies exhaustion of kidney yin." "If the tongue is crimson and glossy, it signifies the demise of stomach yin." Immediate administration of large doses of yin-tonifying remedies is imperative; otherwise, the prognosis is generally poor.

The above discussion pertains to the differentiation of syndromes where the entire tongue presents a deep red color. Clinically, the appearance of a deep red color in different parts of the tongue indicates different primary diseases, which should also be differentiated. For example, a deep red tip of the tongue indicates excessive heart fire. Ye Tian-shi advocated "using Redness-Removing Powder to purge the fu organs"; a deep red edge of the tongue indicates liver heat, and one might choose Green-Blue-Draining Pill to clear and purge liver fire; a deep red root of the tongue indicates kidney fire, and Anemarrhena, Phelloendron and Rehmannia Pill should be used to nourish the kidney and clear fire; a deep red tongue with a dry center indicates stomach fire damaging fluids, as Ye Tian-shi stated in "On Warm Diseases": "A deep red color with a dry center of the tongue indicates exuberant fire of the heart and stomach, consuming body fluids, and Coptis Rhizome and Gypsum can also be added." A deep red tongue with large red spots indicates heat toxin attacking the heart, and one might choose Coptis Detoxification Decoction to clear heat and remove toxin.

bubble_chart Documentation

1. Wenre Jingwei．Ye Xiang-yan external contraction "Wenre Pian": "Pure crimson and bright color indicates the pericardium is affected by disease, suitable for Rhinoceros Horn, fresh Unprocessed Rehmannia Root, Forsythia, Curcuma Root, Acorus, etc."
2. "Tongue Coating Comprehensive Records": "Crimson tongue with white coating is due to dietary apoplexy cold, or due to heat accumulation and cold drinks, white and thick coating indicates internal retention of food, apoplexy cold, Pueraria Decoction , accumulation of cold drinks, Bamboo Leaf Gypsum plus Two Old Ingredients Decoction ; crimson tongue with thick, greasy, dry coating, white indicates combined external and internal pathogens, yellow indicates internal binding of pathogenic heat, combined pathogens Coptis Decoction , internal binding removing toxin decoction plus Rhubarb Rhizoma and Areca Peel; crimson tongue with gray-black coating, soy-colored coating, even if there is spontaneous diarrhea and astringent pulse, it is still appropriate to purge, until the accumulation of feces is achieved, the coating is dry, suitable for cooling blood and purging, with dry petal cracks and prickles is difficult to treat, even with great cooling and purging, it may still be incurable."