bubble_chart Concept

A tongue with a light and pale color, where there is less red and more white or entirely white without any red, is called a pale tongue.

The pale tongue color is quite common in clinical practice, but it is not frequently documented in ancient literature. The first detailed description of the pale tongue color in a dedicated section can be found in the book "She Tai Tong Zhi" (舌胎統志) by Fu Songyuan of the Qing Dynasty. Fu categorized the pale tongue into two types: one is "slightly paler than the tongue color of a healthy person, this withered white tongue color is slightly reddish"; the other is the withered white tongue, "even the gums and shoulders are devoid of blood color". Post-victory publications such as "Chinese Medicine Tongue Inspection" and "Tongue Coating Atlas" have also provided specialized discussions on this topic.

A pale white tongue is more commonly seen in injuries Zabing and can also appear in the late stage [third stage] of external-contraction febrile diseases. Whether in external contraction or internal damage diseases, a pale white tongue generally indicates a deficiency pattern, often suggesting a prolonged course of illness that is not easily cured quickly.

In clinical practice, the pale white tongue, depending on the accompanying tongue coating color, indicates different diseases. This section will only discuss the common disease patterns associated with a pale white tongue.

bubble_chart Pattern Analysis

1. Deficiency of Both Qi and Blood︰The tongue color is pale yet moist, the tongue body is normal in size or slightly small, the lips are pale, the complexion lacks luster, with symptoms such as dizziness, tinnitus, mental fatigue, limb weakness, low voice and weak breathing, palpitation, spontaneous sweating. In women, menstruation may be scanty and pale or there may be amenorrhea. The pulse is weak, thin, and soft. There are many causes, such as congenital deficiency, lack of postnatal care, prolonged illness, excessive loss of blood, etc. Among them, qi deficiency may lead to insufficient blood production, or blood deficiency may result in subsequent qi decline, ultimately leading to dual deficiency of qi and blood, which fails to nourish the tongue, resulting in a pale tongue. The key points of differentiation are: the tongue color is lighter than normal but slightly pale red, the tongue body is similar in size to normal or slightly smaller, the tongue is moist but not excessively watery, accompanied by symptoms of qi and blood deficiency (such as dizziness, lack of strength, spontaneous sweating, palpitation, etc.). Treatment should focus on replenishing both qi and blood, such as Ten Major Tonics Decoction, aiming for gradual improvement. Causes include...
2. Spleen Deficiency with Dampness Retention︰The tongue color is pale, moist, and excessively wet with fluid. The tongue body is swollen and tender, with tooth marks on the edges. The complexion appears withered and fatigued, with cold knees and fear of cold. There is diarrhea with clear and thin stools, undigested food, loss of appetite, abdominal distension and fullness, and edema in the limbs that does not rebound when pressed. The pulse is deep and slow or deep and thin. The cause of the syndrome, as pointed out in the "Tongue Coating Comprehensive Records," is: "due to blood loss, excessive consumption of cold and cooling foods by a deficient constitution, abdominal pain, diarrhea, cold in the middle, and cold-dampness injury." This leads to deficiency of spleen yang and insufficiency of spleen transformation, resulting in a lack of nourishment for the zang-fu organs and meridians, which manifests as a pale and lusterless tongue. Spleen deficiency fails to control water, leading to impaired transportation and transformation of dampness, which soaks the tongue, hence the swollen and tender tongue body. In this syndrome, spleen yang deficiency is the root, while cold-dampness retention is the branch. The key points for differentiation are: a pale tongue that is not red, a noticeably enlarged tongue resembling edema, usually accompanied by a slippery and greasy coating, tooth marks on the edges, and symptoms of spleen yang deficiency (loose stools, abdominal distension and fullness, anorexia, cold limbs) and water-dampness retention (edema that does not rebound when pressed for a long time). The treatment should focus on warming the spleen to support yang and dispelling cold and dampness. Prescriptions such as Spleen-Strengthening Powder and Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction can be modified accordingly.

The symptom of a pale white tongue, apart from the two aforementioned pattern types being more common, should be carefully differentiated in clinical diagnosis according to its color and vitality. For example, a tongue color that is pale white and lacks moisture is due to yang qi deficiency that cannot generate and transform body fluids, or yang deficiency causing water retention and body fluids failing to ascend. Clinically, this is often seen in patients with water retention in the abdomen, where the mouth and tongue are dry, and there is a desire to drink water but not much is consumed. Treatment can be done with methods that warm yang and replenish qi, and produce fluids to moisten dryness. If the tongue color is pale white and the tongue surface is smooth and without coating, it mostly belongs to dual damage of qi and yin, and in severe cases, it is a sign of impending exhaustion of yin essence, which should be given sufficient attention. It is highly advisable to greatly tonify qi and yin, and the prescription can be selected from Pulse-Reinforcing Powder (Ginseng should be replaced with American ginseng). Another example is a tongue color that is withered white and lacks luster, even to the extent that the gums and lips are completely devoid of blood color, indicating yang qi decline and a poor prognosis.

bubble_chart Documentation

1. 《Methods of Tongue Diagnosis in Clinical Practice》: "When the tongue appears white, swollen, and tender, it indicates deficiency of the essential qi of the lung and large intestine. Lung-Nourishing Decoction should be used to treat it." "When the tongue appears white and moist, it indicates deficiency of the yang qi of the large intestine. Middle-Tonifying Qi-Replenishing Decoction combined with Intestine-Securing Powder should be used to treat it." "When the tongue appears white and dry, it indicates excessive fire in the lung. Shengjin Zishui Drink with Bupleurum Skullcap Root should be used to treat it."
2. 《Correct Identification of Tongue Diagnosis》: "A pale, transparent tongue, regardless of age, indicates deficiency and cold. Middle-Tonifying Qi-Replenishing Decoction with ginger, cinnamon, and aconite should be used to treat it. Wind-cold and cold-damage diseases do not present with this transparent tongue. A transparent tongue is clean and free of coating, pale and moist, sometimes slightly swollen with a white appearance that resembles but is not a coating. This is the natural color of a tongue indicating deficiency and cold. If affected by cold pathogens, there will be a thin, slippery coating, hence cold-damage diseases do not present with this tongue."