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.