Skip to main content

Photography in the TCM Tongue Diagnosis Education

Modern books on Chinese Tongue Diagnosis typically contain photographs of various tongues as they manifest during the course of a variety of diseases.  This ability to record and demonstrate was undeniably one of the most important contributions of modern technology to the field of medicine.   
Today, modern tongue research tries to objectively standardize a variety of variables, including comparison of the tongue colours, testing the tongue pH, measuring the dry-wet state of the tongue surface, and even looking into such stuff as the incubation of bacteria and mildew on the surface of the tongue, among many others things.
Researching the tongue colours and standardizing a variety of important aspects, in a way that they can be measured and examined objectively by many, may assist doctors to draw lines marking the beginning and the end of colours, so people will know for example where the red stops and the crimson begins.
The idea behind this type of research was to assist physicians in different parts of the world to accurately debate on various issues pertaining to diagnosis and treatment, even if the patient cannot be physically present at both locations. Therefore if a doctor in the UK decides to ask a doctor in China for advice on a formula for a patient, the existence of standards will assist them both to communicate effectively even if they are located half a planet away.
A Qing Dynasty handwritten copy of  Scholar Ao's book
with coloured tongues (My personal collection)
However, when it comes to education, in my opinion, this brilliant idea was applied quite erroneously. Besides the obvious benefits of photography, some adverse effects were inflicted on TCM tongue education over the last fifty years. 

A Qing Dynasty handwritten copy of "Shen Yan Yi Zong
She Jing" (My personal collection)
49 shades of yellow
It is said that the earliest of the Chinese tongue diagnosis monographs such as the “Scholar Ao’s thirty-six methods”(敖氏伤寒三十六舌法), the "Dian Dian Jin" (伤寒点点金) etc, contained colour illustrations. Unfortunately later works such as the now lost “Shang Han Guan She Xin Fa” (伤寒观舌心法), the lesser known “Shen Yan Yi Zong She Jing” (神验医宗舌镜), the famous “Shang Han She Jian” (伤寒舌鉴), and even the “She Jian Bian Zheng” (舌鉴辨正), all contained black and white illustrations, probably because it was (at the time) very expensive to produce colour pictures. Therefore, during the Ming and Qing Dynasties, colour illustrations were found mostly in handwritten manuscripts and in certain Japanese comparisons of Chinese tongue works. The colours finally returned in 1917 with the publication of the “Bian She Zhi Nan” (辨舌指南).


This makes one wonder, did ultimately the lack of colour illustrations inhibit the progress of Chinese tongue diagnosis in ancient China?


Actually, not at all, in fact the lack of colours assisted the development and application of the various tongue theories in daily practice, because the illustrations were produced in a way that pointed directly to the clinical subtleties, provided focus, and assisted the comparison among theories and viewpoints.  The publication of tongue poetry and non-illustrative theory essays, as well as the various secret manuscripts that circulated around, reveal a vibrant development of various tongue traditions which continued almost undisturbed through to the late 1950’s.

The "normal tongue" from the 1963 edition
of "She Tai Tu Pu"
Regrettably, after the 1950’s, the TCM scholars of “New China” believed that only photographs best represent what is being observed, and they deemed that the ancient books were inaccurate and served no purpose in the integration of the medical systems. Eventually reproduction of tongue classics steadily declined after 1962. The publication of books such as the “She Tai Tu Pu” (舌苔图谱) in 1963, signified the beginning of the photographic era in tongue diagnosis. And eventually it became easier to photograph (or video) a tongue rather than explaining it. 
This trend persists strongly even today and in my opinion it has now become a carbuncle for the development of clinical expertise, ultimately impeding the personal development and growth of individual doctors. 
And therefore, these are the reasons why today: a) we see books containing plenty of photos but very little in depth theory b) nobody ever mentioning the tongue classics, and c) why there is a fierce competition among authors on who will offer more pictures, signifying a trend which favours quantity over quality. 


Even more disturbingly, this situation has opened the way for certain individuals who mingle their superficial Chinese tongue understanding with a heavy dosage of western diagnosis and pathology, and then propagate some of these Frankenstein ideas as "orthodox" Traditional Tongue Diagnosis.
Black and white illustrations of various tongue patterns
from a modern tongue manual
Photographs with arrows pointing to clinical subtleties,
according to the author's  ideas. From a modern tongue manual

On the bright side, over the last few years, some scholars have again started using diagrams (often alongside photographs), researching into the ancient classics, and discovering the wealth of knowledge which was denied to them since the ‘60’s. I post a couple of such pics from this kind of modern manuals on the right. 


I am not sure if this will develop into a trend, or if it will eventually be halted again by politics within the field, but I certainly hope that at least in education, more people both in China and the West will become aware that there is a wealth of knowledge in the tongue classics that cannot be fully replaced by, no matter how many, photographs.


Finally, one does not deny the obvious benefits of photography in the TCM tongue education. Never the less it is not uncommon for a student to buy a photographic tongue diagnosis encyclopaedia and even after meticulous study to be unable to decipher a tongue in clinic. I believe that in the future an approach should be applied where classic texts are introduced alongside modern photos, in order for people to learn to recognise the traditional patterns, thus gaining better focus about what is being observed, and effectively enhance their treatment strategy in clinic.   

Comments

Post a Comment

Popular posts from this blog

Historical traumatology and making wooden splints at the hospital

I t was back in 2018, and I was still working at the Sports Trauma Hospital in Guangzhou, China. That day, a young gentleman comes to the clinic with a martial arts injury. Physical examination/palpation of the limb and also an x-ray revealed a fractured ulna. Typically, in these types of situations, the standard of care at the hospital, required that the patient moves to the inpatient department for further evaluation, processing and to await surgery. During the surgery, the specialist would open a small incision, realign the bone and then secure it in place with pins or metal implants. However, this approach is not always necessary. In the not-so-distant past, for a simple fracture of the ulna with less than 50% displacement and less than 10% angulation, a simple cast and plenty of rest would be sufficient.  In any case, the patient outright refused surgery and casting. He simply asked that we use traditional bone-setting to realign the bone, and then secure it in place with wood...
Post a Comment
Read more

How to explain Chinese medicine to your patients

Most new patients at the hospital, regularly ask for an explanation of  Chinese medicine , so that they understand how the treatment works. In the United States, the religious, or those with a background in science are often very suspicious of a system that is being frequently advertised as the product of  vague eastern practices , or is  surrounded by mystery  and/or encompassing  near occult methods.   Many of my acupuncture students, sometimes also find it difficult to come up with a clear definition that doesn’t include the keywords:  qi, energies, yin and yang, five elements , and  5000 years of TCM history . An attempt to explain it as a method of using needles to stimulate  “channels and meridians” , or using herbs to access the internal organs according to  ancient experiences  of the Chinese people, again doesn’t sound scientifically convincing.    From my experiences in a hospital setting, when the religious or t...
Post a Comment
Read more

Fearing Integrative Medicine? -Why? It might just save your tradition!

Chinese Medicine is a medical system that prides 15 centuries of continuous development. And it has not only managed to remain relevant and current, but has also successfully acculturated itself in the mainstream healthcare, becoming a global phenomenon.   Yet, there is a misconception among some acupuncturists, that other modalities are now aggressively appropriating parts of their practices (i.e., "scope creep"). I think that this viewpoint, although sometimes valid, should become an opportunity for reflecting back on the reasons why this is happening.    But let’s start with a true story:  In 2017, an amateur MMA fighter in China, knocked out a famous Taiji master in 30 secs. All sentiments aside, in recent decades Taiji stopped being a martial art (for the most part), and has reached a point where it is now taught as a dance routine with health benefits. As such it has lost its original scope, purpose and application.   Chinese medicine in recent years ...
Post a Comment
Read more