Traditional Chinese medicine — Vocabulary for diagnostics — Part 1: Tongue

This document specifies the basic terminology and classification of tongue diagnostic methods. Each term of tongue diagnosis includes the English name, the classical Chinese characters and its definition. The classification structure of tongue diagnosis terms is shown in Figure 1.

Médecine traditionnelle chinoise — Vocabulaire pour les diagnostics — Partie 1: Langue

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Status
Published
Publication Date
03-Nov-2021
Current Stage
6060 - International Standard published
Start Date
04-Nov-2021
Completion Date
04-Nov-2021
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INTERNATIONAL ISO
STANDARD 23961-1
First edition
2021-11
Traditional Chinese medicine —
Vocabulary for diagnostics —
Part 1:
Tongue
Médecine traditionnelle chinoise — Vocabulaire pour les
diagnostics —
Partie 1: Langue
Reference number
ISO 23961-1:2021(E)
© ISO 2021
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ISO 23961-1:2021(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2021

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting on

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Published in Switzerland
© ISO 2021 – All rights reserved
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ISO 23961-1:2021(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction .................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ..................................................................................................................................................................................... 1

3 Terms and definitions .................................................................................................................................................................................... 1

4 Terms related to tongue body ........................................................................................................................................... .....................2

5 Terms related to tongue coating .........................................................................................................................................................8

Annex A (informative) Typical tongue images .......................................................................................................................................12

Annex B (informative) Tongue diagnosis terms — Chinese, Japanese and Korean characters ........29

Bibliography .............................................................................................................................................................................................................................35

iii
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ISO 23961-1:2021(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www.iso.org/patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to

the World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see

www.iso.org/iso/foreword.html.

This document was prepared by Technical Committee ISO/TC 249, Traditional Chinese medicine.

A list of all parts in the ISO 23961 series can be found on the ISO website.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www.iso.org/members.html.
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ISO 23961-1:2021(E)
Introduction

Traditional Chinese medicine has become increasingly popular all over the world. Traditional Chinese

medicine education has developed rapidly. Traditional Chinese medicine has obtained legal status in

the United States, Singapore, Australia, Thailand and other countries and regions. Academic activities

of traditional Chinese medicine are increasingly active. International communication of traditional

Chinese medicine and medical activities, scientific research, management rules and regulations are in

urgent need of International Standards.

First, standardized terminology is essential to standardized products and services. Traditional

Chinese medicine diagnostic devices are one of the important contents of traditional Chinese medicine

diagnosis. This document aims to encourage improvement of tongue-equipment-related industrial

and research fields. All traditional Chinese medicine tongue diagnostic instrument can use the same

vocabulary, which is very important for international trade and communication. With standardized

terminology, the versatility of tongue-equipment-related products or service can be improved to benefit

international technical cooperation.

Secondly, the use of standardized terminology in diagnosis helps to avoid confusion among researchers

in the field of tongue diagnosis. But more importantly, the use of standardized terminology in tongue

diagnosis also helps manufacturers to deliver standardized meaning with measured tongue images

for products. Considering the close association between the traditional Chinese medicine diagnosis

and diagnostic medical devices, it is not only necessary but also urgent to standardize the diagnostic

terminologies.

Third, the purpose of the project is for the use of traditional Chinese medicine diagnostic instruments

and artificial intelligence (AI) medicine. As internet-based medicine is developing very quickly, a

standardized terminology is not only important for computerized information but also necessary for

successful communication between physicians and patients from different countries. With advances in

AI, medical AI doctors also need standardized terminology.

Therefore, it is necessary to standardize tongue diagnostic terminology, which will bring benefits to

scholars, governments and enterprises all over the world.
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INTERNATIONAL STANDARD ISO 23961-1:2021(E)
Traditional Chinese medicine — Vocabulary for
diagnostics —
Part 1:
Tongue
1 Scope

This document specifies the basic terminology and classification of tongue diagnostic methods. Each

term of tongue diagnosis includes the English name, the classical Chinese characters and its definition.

The classification structure of tongue diagnosis terms is shown in Figure 1.
Figure 1 — Classification structure of tongue diagnosis terms
2 Normative references
There are no normative references in this document.
3 Terms and definitions

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at http:// www .electropedia .org/
3.1
tongue diagnosis

diagnosis through inspection of the size, shape, colour and moisture of the tongue body and its coating,

which helps with understanding the physiological functions and pathological changes of the body

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ISO 23961-1:2021(E)
3.2
tongue tip
frontal end of the tongue body
3.3
tongue centre
middle part of the tongue body
3.4
tongue root
back part of the tongue
3.5
tongue edge
bilateral edge of the dorsal surface of the tongue
3.6
tongue midline groove
vertical groove in the midline of the tongue body
3.7
lingual frenum
vertical fold in the midline of the bottom of the tongue
3.8
tongue papillae

layer of semi-transparent mucosa and tiny projections on the mucosal fold on the tongue surface

4 Terms related to tongue body
4.1
tongue body
tongue muscles and vessels
Note 1 to entry: The first origin is The Xing Se Wai Zhen Jian Mo (《形色外診簡摩》).

Note 2 to entry: The Zhong Yi She Zhen (《中醫舌診》, Traditional Chinese Medicine Tongue Diagnosis) states, “The

tongue body refers to the musculature of the tongue, including lingual mucosa, intrinsic muscles and extrinsic

muscles.” The Bian She Zhi Nan (《辨舌指南》, The Guide to Differentiation of Tongue Conditions) states, “The tongue

body refers to the muscles of the tongue.”
Note 3 to entry: For further information, see B.1.
4.1.1
tongue spirit
general vitality of the tongue manifest in its moisture, lustre and flexibility
Note 1 to entry: For further information, see B.1.1.
4.1.1.1
lustrous tongue
tongue that is red, luxuriant and moist, with flexible movement

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A lustrous tongue is moist and lustrous.”

Note 3 to entry: A typical lustrous tongue image is shown in Figure A.2.1.1 in Annex A.

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ISO 23961-1:2021(E)
Note 4 to entry: For further information, see B.1.1.1.
4.1.1.2
withered tongue
tongue that is dry, dull, lustreless and grey-dark with inflexible movement

Note 1 to entry: The first origin is The Shang Han Zhi Zhang (《傷寒指掌》, A Handbook on Cold Damage).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A withered tongue is dry and has no

spirit.”

Note 3 to entry: A typical withered tongue image is shown in Figure A.2.1.2 in Annex A.

Note 4 to entry: For further information, see B.1.1.2.
4.1.2
tongue colour
visual hue of the tongue body

Note 1 to entry: The five tongue colours are light-red, pale, red, dark-red and blue-purple.

Note 2 to entry: The first origin is The Ao Shi Shang Han Jin Jing Lu (《敖氏傷寒金鏡錄》, The Ao’s Golden Mirror

Records for Cold Damage).
Note 3 to entry: For further information, see B.1.2.
4.1.2.1
light-red tongue
淡紅舌
tongue with redness hidden in the whiteness

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “A light-red tongue is pale red, moist

and lustrous. It indicates normal functioning of the heart in dominating blood vessels and of the stomach in

moistening the tongue.”

Note 3 to entry: A typical light-red tongue image is shown in Figure A.2.2.1 in Annex A.

Note 4 to entry: For further information, see B.1.2.1.
4.1.2.2
pale tongue
淡白舌
tongue lighter or less red than a normal tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “A pale tongue appears more whitish

and less red, or even entirely without red colour.” The She Tai Tong Zhi (《舌胎統誌》, Outlines of Tongue Coating)

states, “A pale tongue is usually seen in pathological conditions. It is paler than a normal tongue and slightly

redder than a withered white tongue.”

Note 3 to entry: A typical pale tongue image is shown in Figure A.2.2.2 in Annex A.

Note 4 to entry: For further information, see B.1.2.2.
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ISO 23961-1:2021(E)
4.1.2.3
red tongue
tongue redder than a normal tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “Light-red is the normal tongue colour.

A red tongue is deeper than normal colour. It can be fresh red or dark red.” The She Zhen Yuan Jian (《舌診源鑒》,

The Source and Differentiation of the Tongue Conditions) states, “A red tongue is redder and deeper than a normal

light-red tongue, appearing red like blood.”

Note 3 to entry: A typical red tongue image is shown in Figure A.2.2.3 in Annex A.

Note 4 to entry: For further information, see B.1.2.3.
4.1.2.4
dark-red tongue
tongue deep red in colour

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Outlines of Tongue Coating states, “A dark-red tongue appears crimson, just like the colour

of the fire.” The Guide to Differentiation of Tongue Conditions states, “A dark-red tongue is deep red.” The Source

and Differentiation of the Tongue Conditions states, “A dark-red tongue is darker than a red tongue, appearing

cinnabar.”

Note 3 to entry: A typical dark-red tongue image is shown in Figure A.2.2.4 in Annex A.

Note 4 to entry: For further information, see B.1.2.4.
4.1.2.5
blue-purple tongue
青紫舌
tongue appearing bluish or purple in the whole tongue or parts of the tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “A blue or purple tongue is pale-blue or

pale-purple and moist.”

Note 3 to entry: A typical blue-purple tongue image is shown in Figure A.2.2.5 in Annex A.

Note 4 to entry: For further information, see B.1.2.5.
4.1.3
tongue shape
shape of the tongue body

Note 1 to entry: Tongue shape includes such aspects as tough or tender, enlarged or thin, spots or thorns, cracks

and teeth marks.
Note 2 to entry: The first origin is The Handbook on Cold Damage.
Note 3 to entry: For further information, see B.1.3.
4.1.3.1
tough tongue
tongue with a rough or crimpled texture

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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ISO 23961-1:2021(E)

Note 2 to entry: A typical tough tongue image is shown in Figure A.2.3.1 in Annex A.

Note 3 to entry: For further information, see B.1.3.1.
4.1.3.2
tender tongue
tongue with a delicate and fine texture

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: A typical tender tongue image is shown in Figure A.2.3.2 in Annex A.

Note 3 to entry: For further information, see B.1.3.2.
4.1.3.3
enlarged tongue
胖大舌
tongue that is bigger and thicker than a normal tongue
Note 1 to entry: The first origin is The Wan Jin Zhi Bao (《萬金至寶》).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “An enlarged tongue is so swollen and

enlarged that it cannot be extended out of the mouth.” The Wan Jin Zhi Bao states, “An enlarged tongue is just like

the swim bladder.”

Note 3 to entry: A typical enlarged tongue image is shown in Figure A.2.3.3 in Annex A.

Note 4 to entry: For further information, see B.1.3.3.
4.1.3.4
thin tongue
瘦薄舌
tongue that is smaller and thinner than a normal tongue

Note 1 to entry: A typical thin tongue image is shown in Figure A.2.3.4 in Annex A.

Note 2 to entry: For further information, see B.1.3.4.
4.1.3.5
tongue with spots or thorns
點刺舌

tongue with red or purple stars (bigger ones) or spots (smaller ones) as well as awn-shaped thorns

higher above the tongue surface

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Ao’s Golden Mirror Records for Cold Damage states, “A red-star tongue refers to the tongue

with big red spots.” The Shang Han She Jian (《傷寒舌鑒》, Differentiation of the Tongue Conditions in Exogenous

Febrile Diseases) states, “Sometimes the tongue may have big red stars (bigger ones) or big red spots (smaller

ones); sometimes the tongue may have red or purple thorns.”

Note 3 to entry: A typical tongue with spots and thorns image is shown in Figure A.2.3.5 in Annex A.

Note 4 to entry: For further information, see B.1.3.5.
4.1.3.6
tongue with cracks
裂紋舌
tongue with a variety of shallow or deep cracks

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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ISO 23961-1:2021(E)

Note 2 to entry: The Cha She Bian Zheng Xin Fa (《察舌辨癥新法》, New Methods in Syndrome Differentiation

through Tongue Observation) states, “A tongue with cracks may have sagittal straight grooves on the surface of

the tongue, just like imprinted by the back of a knife blade. Sometimes, the tongue may have transverse cracks

on the surface of the tongue.” The She Jian Bian Zheng (《舌鑒辨正》, Syndrome Differentiation through Tongue

Observation) states, “A cracked tongue may have herringbone fissures.” The Guide to Differentiation of Tongue

Conditions states, “Cracks on the surface of the tongue may resemble the shapes of Chinese characters ‘人’, ‘川’and

‘爻’, or sometimes just like straight grooves.”

Note 3 to entry: A typical tongue with cracks image is shown in Figure A.2.3.6 in Annex A.

Note 4 to entry: For further information, see B.1.3.6.
4.1.3.7
tongue with teeth marks
齒痕舌
tongue with dental indentations at the edges

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A tongue with teeth marks means there

are teeth marks at both sides of the tongue.”

Note 3 to entry: A typical tongue with teeth marks image is shown in Figure A.2.3.7 in Annex A.

Note 4 to entry: For further information, see B.1.3.7.
4.1.4
motility of the tongue
ability of the tongue to move spontaneously
Note 1 to entry: For further information, see B.1.4
4.1.4.1
flabby tongue
痿軟舌
tongue that is limp, wilting and cannot extend or retract freely

Note 1 to entry: The first origin is The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases.

Note 2 to entry: The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A flabby tongue

is floppy, soft and unable to move flexibly.” The Syndrome Differentiation through Tongue Observation states, “A

flabby tongue is floppy, soft and unable to move flexibly.”

Note 3 to entry: A typical flabby tongue image is shown in Figure A.2.4.1 in Annex A.

Note 4 to entry: For further information, see B.1.4.1.
4.1.4.2
stiff tongue
強硬舌
tongue that is unable to do flexion, extension or rotation

Note 1 to entry: The first origin is The New Methods in Syndrome Differentiation through Tongue Observation.

Note 2 to entry: The New Methods in Syndrome Differentiation through Tongue Observation states, “A stiff tongue is

unable to move flexibly, coupled with slurred speech.”

Note 3 to entry: A typical stiff tongue image is shown in Figure A.2.4.2 in Annex A.

Note 4 to entry: For further information, see B.1.4.2.
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ISO 23961-1:2021(E)
4.1.4.3
deviated tongue
歪斜舌
tongue that inclines to either the left side or the right side when extended

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A deviated tongue is deviated towards

either the left or right.”

Note 3 to entry: A typical deviated tongue image is shown in Figure A.2.4.3 in Annex A.

Note 4 to entry: For further information, see B.1.4.3.
4.1.4.4
trembling tongue
顫動舌
tongue that quivers or twitches uncontrollably

Note 1 to entry: The first origin is The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases.

Note 2 to entry: The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A trembling

tongue quivers or twitches uncontrollably.” The Syndrome Differentiation through Tongue Observation states, “A

trembling tongue keeps quivering or twitching uncontrollably.” The Guide to Differentiation of Tongue Conditions

states, “A trembling tongue uncontrollably quivers or twitches.”
Note 3 to entry: For further information, see B.1.4.4.
4.1.4.5
tongue with involuntary movement
吐弄舌

pathological condition in which the tongue extends out of the mouth and does not retract for a long

period of time or a playful tongue that is extended and licks the lips (and then is quickly retracted)

Note 1 to entry: The first origin is The Yi Zong Jin Jian (《醫宗金鑒》).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A tongue with involuntary movement

includes the following two conditions: a protruding tongue that is extended out of the mouth and not retracted

for a long period of time and a playful tongue that is extended and licks the lips (and then is quickly retracted).”

The Yi Zong Jin Jian states, “Tongue with involuntary movement is extended out of the mouth but not retracted for

a long period of time.” The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A playful

tongue is repeatedly extended and quickly retracted.” The Syndrome Differentiation through Tongue Observation

states, “… So the tongue is frequently extended out of the mouth and quickly retracted, or sometimes it repeatedly

licks the lips, corners of the mouth and nasal tip.”

Note 3 to entry: Typical tongue with involuntary movement images are shown in Figure A.2.4.4 in Annex A.

Note 4 to entry: For further information, see B.1.4.5.
4.1.4.6
shortened tongue
短縮舌

tongue that is contracted with a tightened tongue frenum and unable to extend out of the mouth

Note 1 to entry: The first origin is The New Methods in Syndrome Differentiation through Tongue Observation.

Note 2 to entry: The New Methods in Syndrome Differentiation through Tongue Observation states, “A shortened

tongue is unable to extend out of the mouth.” The Guide to Differentiation of Tongue Conditions states, “A shortened

tongue is contracted with tightened tongue frenum and unable to extend out of the mouth.”

Note 3 to entry: A typical shortened tongue image is shown in Figure A.2.4.5 in Annex A.

Note 4 to entry: For further information, see B.1.4.6.
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ISO 23961-1:2021(E)
4.1.5
sublingual vessels
舌下絡脈

big vertical vessels on the two sides of the lingual frenum, which are pale purple

Note 1 to entry: A typical sublingual vessels image can be seen in Figure A.2.5 in Annex A.

Note 2 to entry: For further information, see B.1.5.
5 Terms related to tongue coating
5.1
tongue coating
fur-like substance covering the tongue body

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Handbook on Cold Damage states, “The tongue coating is just like lichen. Lichen grows on

damp surfaces. The tongue coating is engendered by stomach qi steaming water and grains transformed by the

spleen.”

Note 3 to entry: A typical tongue coating image is shown in Figure A.3 in Annex A.

Note 4 to entry: For further information, see B.2.
5.1.1
property of tongue coating
texture and form of tongue coating

Note 1 to entry: Properties include such aspects as thinness or thickness, moistening or dryness, greasiness or

rottenness, peeling.
Note 2 to entry: For further information, see B.2.1.
5.1.1.1
thick tongue coating
tongue coating through which one cannot see the tongue body

Note 1 to entry: A typical thick tongue coating image is shown in Figure A.3.1.1 in Annex A.

Note 2 to entry: For further information, see B.2.1.1.
5.1.1.2
thin tongue coating
tongue coating through which one can see the tongue body

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: A typical thin tongue coating image is shown in Figure A.3.1.2 in Annex A.

Note 3 to entry: For further information, see B.2.1.2.
5.1.1.3
less tongue coating
excessively small or scanty tongue coating

Note 1 to entry: The first origin is The Traditional Chinese Medicine Tongue Diagnosis.

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ISO 23961-1:2021(E)

Note 2 to entry: A typical less tongue coating image is shown in Figure A.3.1.3 in Annex A.

Note 3 to entry: For further information, see B.2.1.3.
5.1.1.4
moist tongue coating
moderately moistened tongue coating

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A moist tongue coating indicates

sufficient body fluids.”

Note 3 to entry: A typical moist tongue coating image is shown in Figure A.3.1.4 in Annex A.

Note 4 to entry: For further information, see B.2.1.4.
5.1.1.5
slippery tongue coating
tongue coating that looks watery and wet

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A slippery tongue coating is wet,

indicating sufficient body fluids.”

Note 3 to entry: A typical slippery tongue coating image is shown in Figure A.3.1.5 in Annex A.

Note 4 to entry: For further information, see B.2.1.5.
5.1.1.6
dry tongue coating
tongue coating with scanty fluids

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A dry tongue coating indicates

insufficient body fluids”; “A dry tongue coating is dry with scanty fluids.”

Note 3 to entry: A typical dry tongue coating image is shown in Figure A.3.1.6 in Annex A.

Note 4 to entry: For further information, see B.2.1.6.
5.1.1.7
rough tongue coating
tongue coating that feels coarse when touched

Note 1 to entry: A typical rough tongue coating image is shown in Figure A.3.1.7 in Annex A.

Note 2 to entry: For further information, see B.2.1.7.
5.1.1.8
greasy tongue coating

tongue coating containing small and thin granules sticking on the tongue surface, which are not easy to

scrape off

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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ISO 23961-1:2021(E)

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A greasy tongue coating has roots

and cannot be scraped away.” The She Zhen Yan Jiu (《舌診研究》, Research on Tongue Diagnosis) states, “When

you observe a greasy tongue coating with a magnifying glass, you can see that the number and branches of the

filiform papillae increase, including saliva and food residues.” The New Methods in Syndrome Differentiation

through Tongue Observation states, “A thick and greasy tongue coating is thick in the centre but thin on the sides,

without pores and loose granules. A thick and greasy tongue cannot be scraped away.”

Note 3 to entry: A typical greasy tongue coating image is shown in Figure A.3.1.8 in Annex A.

Note 4 to entry: For further information, see B.2.1.8.
5.1.1.9
rotten tongue coating

tongue coating containing big, loose and thick granules staying on the tongue surface, which is easy to

scrape off

Note 1 to entry: The first origin is The New Methods in Syndrome Differentiation through Tongue Observation.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A rotten tongue coating has no roots and

can be easily scraped away.” The Fu Xie Xin Shu (《伏邪新書》) states, “A rotten tongue coating is just like residue of

soy bean curd…” The Yi Yuan (《醫原》, The Origin of Traditional Chinese Medicine) states, “A rotten tongue coating

is loose and not sticky.” The New Methods in Syndrome Differentiation through Tongue Observation states, “A rotten

tongue coating is just like being covered with a layer of residue of soy bean curd.”

Note 3 to entry: A typical rotten tongue coating image is shown in Figure A.3.1.9 in Annex A.

Note 4 to entry: For further information, see B.2.1.9.
5.1.1.10
peeled tongue coating
花剝苔
tongue coating that is partially peeled off

Note 1 to entry: A typical peeled tongue coating image is shown in Figure A.3.1.10 in Annex A.

Note 2 to entry: For further information, see B.2.1.10.
5.1.1.11
mirrored tongue coating
光剝苔
tongue coating that is completely peeled off

Note 1 to entry: A typical mirrored tongue coating image is shown in Figure A.3.1.11 in Annex A.

Note 2 to entry: For further information, see B.2.1.11.
5.1.2
colour of tongue coating
visual hue of tongue coating
Note 1 to entry: The three t
...

FINAL
INTERNATIONAL ISO/FDIS
DRAFT
STANDARD 23961-1
ISO/TC 249
Traditional Chinese medicine —
Secretariat: SAC
Vocabulary for diagnostics —
Voting begins on:
2021-08-09
Part 1:
Voting terminates on:
Tongue
2021-10-04
RECIPIENTS OF THIS DRAFT ARE INVITED TO
SUBMIT, WITH THEIR COMMENTS, NOTIFICATION
OF ANY RELEVANT PATENT RIGHTS OF WHICH
THEY ARE AWARE AND TO PROVIDE SUPPOR TING
DOCUMENTATION.
IN ADDITION TO THEIR EVALUATION AS
Reference number
BEING ACCEPTABLE FOR INDUSTRIAL, TECHNO-
ISO/FDIS 23961-1:2021(E)
LOGICAL, COMMERCIAL AND USER PURPOSES,
DRAFT INTERNATIONAL STANDARDS MAY ON
OCCASION HAVE TO BE CONSIDERED IN THE
LIGHT OF THEIR POTENTIAL TO BECOME STAN-
DARDS TO WHICH REFERENCE MAY BE MADE IN
NATIONAL REGULATIONS. ISO 2021
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ISO/FDIS 23961-1:2021(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2021

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
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Email: copyright@iso.org
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Published in Switzerland
ii © ISO 2021 – All rights reserved
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ISO/FDIS 23961-1:2021(E)
Contents Page

Foreword ........................................................................................................................................................................................................................................iv

Introduction ..................................................................................................................................................................................................................................v

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 Terms related to tongue body ................................................................................................................................................................. 2

5 Terms related to tongue coating .......................................................................................................................................................... 8

Annex A (informative) Typical tongue images ........................................................................................................................................12

Annex B (informative) Tongue diagnosis terms — Chinese, Japanese and Korean characters ............29

Bibliography .............................................................................................................................................................................................................................35

© ISO 2021 – All rights reserved iii
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ISO/FDIS 23961-1:2021(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/ directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/ patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso .org/

iso/ foreword .html.

This document was prepared by Technical Committee ISO/TC 249, Traditional Chinese medicine.

A list of all parts in the ISO 23961 series can be found on the ISO website.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/ members .html.
iv © ISO 2021 – All rights reserved
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ISO/FDIS 23961-1:2021(E)
Introduction

Traditional Chinese medicine has become increasingly popular all over the world. Traditional Chinese

medicine education has developed rapidly. Traditional Chinese medicine has obtained legal status in

the United States, Singapore, Australia, Thailand and other countries and regions. Academic activities

of traditional Chinese medicine are increasingly active. International communication of traditional

Chinese medicine and medical activities, scientific research, management rules and regulations are in

urgent need of International Standards.

First, standardized terminology is essential to standardized products and services. Traditional

Chinese medicine diagnostic devices are one of the important contents of traditional Chinese medicine

diagnosis. This document aims to encourage improvement of tongue-equipment-related industrial

and research fields. All traditional Chinese medicine tongue diagnostic instrument can use the same

vocabulary, which is very important for international trade and communication. With standardized

terminology, the versatility of tongue-equipment-related products or service can be improved to benefit

international technical cooperation.

Secondly, the use of standardized terminology in diagnosis helps to avoid confusion among researchers

in the field of tongue diagnosis. But more importantly, the use of standardized terminology in tongue

diagnosis also helps manufacturers to deliver standardized meaning with measured tongue images

for products. Considering the close association between the traditional Chinese medicine diagnosis

and diagnostic medical devices, it is not only necessary but also urgent to standardize the diagnostic

terminologies.

Third, the purpose of the project is for the use of traditional Chinese medicine diagnostic instruments

and artificial intelligence (AI) medicine. As internet-based medicine is developing very quickly, a

standardized terminology is not only important for computerized information but also necessary for

successful communication between physicians and patients from different countries. With advances in

AI, medical AI doctors also need standardized terminology.

Therefore, it is necessary to standardize tongue diagnostic terminology, which will bring benefits to

scholars, governments and enterprises all over the world.
© ISO 2021 – All rights reserved v
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FINAL DRAFT INTERNATIONAL STANDARD ISO/FDIS 23961-1:2021(E)
Traditional Chinese medicine — Vocabulary for
diagnostics —
Part 1:
Tongue
1 Scope

This document specifies the basic terminology and classification of tongue diagnostic methods. Each

term of tongue diagnosis includes the English name, the classical Chinese characters and its definition.

The classification structure of tongue diagnosis terms is shown in Figure 1.
Figure 1 — Classification structure of tongue diagnosis terms
2 Normative references
There are no normative references in this document.
3 Terms and definitions

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at http:// www .electropedia .org/
3.1
tongue diagnosis

diagnosis through inspection of the size, shape, colour and moisture of the tongue body and its coating,

which helps with understanding the physiological functions and pathological changes of the body

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ISO/FDIS 23961-1:2021(E)
3.2
tongue tip
frontal end of the tongue body
3.3
tongue centre
middle part of the tongue body
3.4
tongue root
back part of the tongue
3.5
tongue edge
bilateral edge of the dorsal surface of the tongue
3.6
tongue midline groove
vertical groove in the midline of the tongue body
3.7
lingual frenum
vertical fold in the midline of the bottom of the tongue
3.8
tongue papillae

layer of semi-transparent mucosa and tiny projections on the mucosal fold on the tongue surface

4 Terms related to tongue body
4.1
tongue body
tongue muscles and vessels
Note 1 to entry: The first origin is The Xing Se Wai Zhen Jian Mo (《形色外診簡摩》).

Note 2 to entry: The Zhong Yi She Zhen (《中醫舌診》, Traditional Chinese Medicine Tongue Diagnosis) states, “The

tongue body refers to the musculature of the tongue, including lingual mucosa, intrinsic muscles and extrinsic

muscles.” The Bian She Zhi Nan (《辨舌指南》, The Guide to Differentiation of Tongue Conditions) states, “The tongue

body refers to the muscles of the tongue.”
Note 3 to entry: For further information, see B.1.
4.1.1
tongue spirit
general vitality of the tongue manifest in its moisture, lustre and flexibility
Note 1 to entry: For further information, see B.1.1.
4.1.1.1
lustrous tongue
tongue that is red, luxuriant and moist, with flexible movement

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A lustrous tongue is moist and lustrous.”

Note 3 to entry: A typical lustrous tongue image is shown in Figure A.2.1.1 in Annex A.

2 © ISO 2021 – All rights reserved
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ISO/FDIS 23961-1:2021(E)
Note 4 to entry: For further information, see B.1.1.1.
4.1.1.2
withered tongue
tongue that is dry, dull, lustreless and grey-dark with inflexible movement

Note 1 to entry: The first origin is The Shang Han Zhi Zhang (《傷寒指掌》, A Handbook on Cold Damage).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A withered tongue is dry and has no

spirit.”

Note 3 to entry: A typical withered tongue image is shown in Figure A.2.1.2 in Annex A.

Note 4 to entry: For further information, see B.1.1.2.
4.1.2
tongue colour
visual hue of the tongue body

Note 1 to entry: The five tongue colours are light-red, pale, red, dark-red and blue-purple.

Note 2 to entry: The first origin is The Ao Shi Shang Han Jin Jing Lu (《敖氏傷寒金鏡錄》, The Ao’s Golden Mirror

Records for Cold Damage).
Note 3 to entry: For further information, see B.1.2.
4.1.2.1
light-red tongue
淡紅舌
tongue with redness hidden in the whiteness

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “A light-red tongue is pale red, moist

and lustrous. It indicates normal functioning of the heart in dominating blood vessels and of the stomach in

moistening the tongue.”

Note 3 to entry: A typical light-red tongue image is shown in Figure A.2.2.1 in Annex A.

Note 4 to entry: For further information, see B.1.2.1.
4.1.2.2
pale tongue
淡白舌
tongue lighter or less red than a normal tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “A pale tongue appears more whitish

and less red, or even entirely without red colour.” The She Tai Tong Zhi (《舌胎統誌》, Outlines of Tongue Coating)

states, “A pale tongue is usually seen in pathological conditions. It is paler than a normal tongue and slightly

redder than a withered white tongue.”

Note 3 to entry: A typical pale tongue image is shown in Figure A.2.2.2 in Annex A.

Note 4 to entry: For further information, see B.1.2.2.
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ISO/FDIS 23961-1:2021(E)
4.1.2.3
red tongue
tongue redder than a normal tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Traditional Chinese Medicine Tongue Diagnosis states, “Light-red is the normal tongue colour.

A red tongue is deeper than normal colour. It can be fresh red or dark red.” The She Zhen Yuan Jian (《舌診源鑒》,

The Source and Differentiation of the Tongue Conditions) states, “A red tongue is redder and deeper than a normal

light-red tongue, appearing red like blood.”

Note 3 to entry: A typical red tongue image is shown in Figure A.2.2.3 in Annex A.

Note 4 to entry: For further information, see B.1.2.3.
4.1.2.4
dark-red tongue
tongue deep red in colour

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Outlines of Tongue Coating states, “A dark-red tongue appears crimson, just like the colour

of the fire.” The Guide to Differentiation of Tongue Conditions states, “A dark-red tongue is deep red.” The Source

and Differentiation of the Tongue Conditions states, “A dark-red tongue is darker than a red tongue, appearing

cinnabar.”

Note 3 to entry: A typical dark-red tongue image is shown in Figure A.2.2.4 in Annex A.

Note 4 to entry: For further information, see B.1.2.4.
4.1.2.5
blue-purple tongue
青紫舌
tongue appearing bluish or purple in the whole tongue or parts of the tongue

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The traditional Chinese medicine Tongue Diagnosis states, “A blue or purple tongue is pale-blue or

pale-purple and moist.”

Note 3 to entry: A typical blue-purple tongue image is shown in Figure A.2.2.5 in Annex A.

Note 4 to entry: For further information, see B.1.2.5.
4.1.3
tongue shape
shape of the tongue body

Note 1 to entry: Tongue shape includes such aspects as tough or tender, enlarged or thin, spots or thorns, cracks

and teeth marks.
Note 2 to entry: The first origin is The Handbook on Cold Damage.
Note 3 to entry: For further information, see B.1.3.
4.1.3.1
tough tongue
tongue with a rough or crimpled texture

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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ISO/FDIS 23961-1:2021(E)

Note 2 to entry: A typical tough tongue image is shown in Figure A.2.3.1 in Annex A.

Note 3 to entry: For further information, see B.1.3.1.
4.1.3.2
tender tongue
tongue with a delicate and fine texture

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: A typical tender tongue image is shown in Figure A.2.3.2 in Annex A.

Note 3 to entry: For further information, see B.1.3.2.
4.1.3.3
enlarged tongue
胖大舌
tongue that is bigger and thicker than a normal tongue
Note 1 to entry: The first origin is The Wan Jin Zhi Bao (《萬金至寶》).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “An enlarged tongue is so swollen and

enlarged that it cannot be extended out of the mouth.” The Wan Jin Zhi Bao states, “An enlarged tongue is just like

the swim bladder.”

Note 3 to entry: A typical enlarged tongue image is shown in Figure A.2.3.3 in Annex A.

Note 4 to entry: For further information, see B.1.3.3.
4.1.3.4
thin tongue
瘦薄舌
tongue that is smaller and thinner than a normal tongue

Note 1 to entry: A typical thin tongue image is shown in Figure A.2.3.4 in Annex A.

Note 2 to entry: For further information, see B.1.3.4.
4.1.3.5
tongue with spots or thorns
點刺舌

tongue with red or purple stars (bigger ones) or spots (smaller ones) as well as awn-shaped thorns

higher above the tongue surface

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Ao’s Golden Mirror Records for Cold Damage states, “A red-star tongue refers to the tongue

with big red spots.” The Shang Han She Jian (《傷寒舌鑒》, Differentiation of the Tongue Conditions in Exogenous

Febrile Diseases) states, “Sometimes the tongue may have big red stars (bigger ones) or big red spots (smaller

ones); sometimes the tongue may have red or purple thorns.”

Note 3 to entry: A typical tongue with spots and thorns image is shown in Figure A.2.3.5 in Annex A.

Note 4 to entry: For further information, see B.1.3.5.
4.1.3.6
tongue with cracks
裂紋舌
tongue with a variety of shallow or deep cracks

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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Note 2 to entry: The Cha She Bian Zheng Xin Fa (《察舌辨癥新法》, New methods in syndrome differentiation through

tongue observation) states, “A tongue with cracks may have sagittal straight grooves on the surface of the tongue,

just like imprinted by the back of a knife blade. Sometimes, the tongue may have transverse cracks on the surface

of the tongue.” The She Jian Bian Zheng (《舌鑒辨正》, Syndrome Differentiation through Tongue Observation) states,

“A cracked tongue may have herringbone fissures.” The Guide to Differentiation of Tongue Conditions states,

“Cracks on the surface of the tongue may resemble the shapes of Chinese characters ‘人’, ‘川’and ‘爻’, or sometimes

just like straight grooves.”

Note 3 to entry: A typical tongue with cracks image is shown in Figure A.2.3.6 in Annex A.

Note 4 to entry: For further information, see B.1.3.6.
4.1.3.7
tongue with teeth marks
齒痕舌
tongue with dental indentations at the edges

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A tongue with teeth marks means there

are teeth marks at both sides of the tongue.”

Note 3 to entry: A typical tongue with teeth marks image is shown in Figure A.2.3.7 in Annex A.

Note 4 to entry: For further information, see B.1.3.7.
4.1.4
motility of the tongue
ability of the tongue to move spontaneously
Note 1 to entry: For further information, see B.1.4
4.1.4.1
flabby tongue
痿軟舌
tongue that is limp, wilting and cannot extend or retract freely

Note 1 to entry: The first origin is The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases.

Note 2 to entry: The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A flabby tongue

is floppy, soft and unable to move flexibly.” The Syndrome Differentiation through Tongue Observation states, “A

flabby tongue is floppy, soft and unable to move flexibly.”

Note 3 to entry: A typical flabby tongue image is shown in Figure A.2.4.1 in Annex A.

Note 4 to entry: For further information, see B.1.4.1.
4.1.4.2
stiff tongue
強硬舌
tongue that is unable to do flexion, extension or rotation

Note 1 to entry: The first origin is The New methods in syndrome differentiation through tongue observation.

Note 2 to entry: The New methods in syndrome differentiation through tongue observation states, “A stiff tongue is

unable to move flexibly, coupled with slurred speech.”

Note 3 to entry: A typical stiff tongue image is shown in Figure A.2.4.2 in Annex A.

Note 4 to entry: For further information, see B.1.4.2.
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4.1.4.3
deviated tongue
歪斜舌
tongue that inclines to either the left side or the right side when extended

Note 1 to entry: The first origin is The Guide to Differentiation of Tongue Conditions.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A deviated tongue is deviated towards

either the left or right.”

Note 3 to entry: A typical deviated tongue image is shown in Figure A.2.4.3 in Annex A.

Note 4 to entry: For further information, see B.1.4.3.
4.1.4.4
trembling tongue
顫動舌
tongue that quivers or twitches uncontrollably

Note 1 to entry: The first origin is The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases.

Note 2 to entry: The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A trembling

tongue quivers or twitches uncontrollably.” The Syndrome Differentiation through Tongue Observation states, “A

trembling tongue keeps quivering or twitching uncontrollably.” The Guide to Differentiation of Tongue Conditions

states, “A trembling tongue uncontrollably quivers or twitches.”
Note 3 to entry: For further information, see B.1.4.4.
4.1.4.5
tongue with involuntary movement
吐弄舌

pathological condition in which the tongue extends out of the mouth and does not retract for a long

period of time or a playful tongue that is extended and licks the lips (and then is quickly retracted)

Note 1 to entry: The first origin is The Yi Zong Jin Jian (《醫宗金鑒》).

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A tongue with involuntary movement

includes the following two conditions: a protruding tongue that is extended out of the mouth and not retracted

for a long period of time and a playful tongue that is extended and licks the lips (and then is quickly retracted).”

The Yi Zong Jin Jian states, “Tongue with involuntary movement is extended out of the mouth but not retracted for

a long period of time.” The Differentiation of the Tongue Conditions in Exogenous Febrile Diseases states, “A playful

tongue is repeatedly extended and quickly retracted.” The Syndrome Differentiation through Tongue Observation

states, “… So the tongue is frequently extended out of the mouth and quickly retracted, or sometimes it repeatedly

licks the lips, corners of the mouth and nasal tip.”

Note 3 to entry: Typical tongue with involuntary movement images are shown in Figure A.2.4.4 in Annex A.

Note 4 to entry: For further information, see B.1.4.5.
4.1.4.6
shortened tongue
短縮舌

tongue that is contracted with a tightened tongue frenum and unable to extend out of the mouth

Note 1 to entry: The first origin is The New methods in syndrome differentiation through tongue observation.

Note 2 to entry: The New methods in syndrome differentiation through tongue observation states, “A shortened

tongue is unable to extend out of the mouth.” The Guide to Differentiation of Tongue Conditions states, “A shortened

tongue is contracted with tightened tongue frenum and unable to extend out of the mouth.”

Note 3 to entry: A typical shortened tongue image is shown in Figure A.2.4.5 in Annex A.

Note 4 to entry: For further information, see B.1.4.6.
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ISO/FDIS 23961-1:2021(E)
4.1.5
sublingual vessels
舌下絡脈

big vertical vessels on the two sides of the lingual frenum, which are pale purple

Note 1 to entry: A typical sublingual vessels image can be seen in Figure A.2.5 in Annex A.

Note 2 to entry: For further information, see B.1.5.
5 Terms related to tongue coating
5.1
tongue coating
fur-like substance covering the tongue body

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Handbook on Cold Damage states, “The tongue coating is just like lichen. Lichen grows on

damp surfaces. The tongue coating is engendered by stomach qi steaming water and grains transformed by the

spleen.”

Note 3 to entry: A typical tongue coating image is shown in Figure A.3 in Annex A.

Note 4 to entry: For further information, see B.2.
5.1.1
property of tongue coating
texture and form of tongue coating

Note 1 to entry: Properties include such aspects as thinness or thickness, moistening or dryness, greasiness or

rottenness, peeling.
Note 2 to entry: For further information, see B.2.1.
5.1.1.1
thick tongue coating
tongue coating through which one cannot see the tongue body

Note 1 to entry: A typical thick tongue coating image is shown in Figure A.3.1.1 in Annex A.

Note 2 to entry: For further information, see B.2.1.1.
5.1.1.2
thin tongue coating
tongue coating through which one can see the tongue body

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: A typical thin tongue coating image is shown in Figure A.3.1.2 in Annex A.

Note 3 to entry: For further information, see B.2.1.2.
5.1.1.3
less tongue coating
excessively small or scanty tongue coating
Note 1 to entry: The first origin is The Zhong Yi She Zhen.
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Note 2 to entry: A typical less tongue coating image is shown in Figure A.3.1.3 in Annex A.

Note 3 to entry: For further information, see B.2.1.3.
5.1.1.4
moist tongue coating
moderately moistened tongue coating

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A moist tongue coating indicates

sufficient body fluids.”

Note 3 to entry: A typical moist tongue coating image is shown in Figure A.3.1.4 in Annex A.

Note 4 to entry: For further information, see B.2.1.4.
5.1.1.5
slippery tongue coating
tongue coating that looks watery and wet

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A slippery tongue coating is wet,

indicating sufficient body fluids.”

Note 3 to entry: A typical slippery tongue coating image is shown in Figure A.3.1.5 in Annex A.

Note 4 to entry: For further information, see B.2.1.5.
5.1.1.6
dry tongue coating
tongue coating with scanty fluids

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A dry tongue coating indicates

insufficient body fluids”; “A dry tongue coating is dry with scanty fluids.”

Note 3 to entry: A typical dry tongue coating image is shown in Figure A.3.1.6 in Annex A.

Note 4 to entry: For further information, see B.2.1.6.
5.1.1.7
rough tongue coating
tongue coating that feels coarse when touched

Note 1 to entry: A typical rough tongue coating image is shown in Figure A.3.1.7 in Annex A.

Note 2 to entry: For further information, see B.2.1.7.
5.1.1.8
greasy tongue coating

tongue coating containing small and thin granules sticking on the tongue surface, which are not easy to

scrape off

Note 1 to entry: The first origin is The Ao’s Golden Mirror Records for Cold Damage.

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Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A greasy tongue coating has roots

and cannot be scraped away.” The She Zhen Yan Jiu (《舌診研究》, Research on Tongue Diagnosis) states, “When

you observe a greasy tongue coating with a magnifying glass, you can see that the number and branches of

the filiform papillae increase, including saliva and food residues.” The New methods in syndrome differentiation

through tongue observation states, “A thick and greasy tongue coating is thick in the centre but thin on the sides,

without pores and loose granules. A thick and greasy tongue cannot be scraped away.”

Note 3 to entry: A typical greasy tongue coating image is shown in Figure A.3.1.8 in Annex A.

Note 4 to entry: For further information, see B.2.1.8.
5.1.1.9
rotten tongue coating

tongue coating containing big, loose and thick granules staying on the tongue surface, which is easy to

scrape off

Note 1 to entry: The first origin is The New methods in syndrome differentiation through tongue observation.

Note 2 to entry: The Guide to Differentiation of Tongue Conditions states, “A rotten tongue coating has no roots and

can be easily scraped away.” The Fu Xie Xin Shu (《伏邪新書》) states, “A rotten tongue coating is just like residue of

soy bean curd…” The Yi Yuan (《醫原》, The origin of traditional Chinese medicine) states, “A rotten tongue coating

is loose and not sticky.” The New methods in syndrome differentiation through tongue observation states, “A rotten

tongue coating is just like being covered with a layer of residue of soy bean curd.”

Note 3 to entry: A typical rotten tongue coating image is shown in Figure A.3.1.9 in Annex A.

Note 4 to entry: For further
...

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