Exertional Dyspnea in Traditional Chinese Medicine

Empty (Xu), Weak (Ruo), Fine (Xi)

The tongue is typically pale, soft, and slightly puffy, reflecting the insufficiency of Qi to push blood to the tongue surface. A thin white coating is normal for this pattern. In more pronounced or longer-standing cases, a midline crack extending toward the tongue tip (the Heart zone) may develop, sometimes with slight puffiness on either side of the crack. Teeth marks along the edges may appear if Qi deficiency also affects fluid metabolism. The tongue tip area, which corresponds to the Heart, generally lacks redness — if the tip becomes distinctly red, this suggests Heat developing and a possible transformation toward a different pattern.

Fine (Xi), Weak (Ruo)

The tongue is typically pale, slightly puffy, and tender-looking, often with teeth marks along the edges. The coating is thin and white. The pale colour reflects insufficient Blood failing to nourish the tongue body, while the puffiness and teeth marks indicate Spleen Qi weakness with mild fluid accumulation. In more pronounced cases, the tongue may appear almost colourless. The tip of the tongue (corresponding to the Heart area in tongue diagnosis) does not show redness, distinguishing this from patterns involving Heart Fire or Yin deficiency with heat.

Fine (Xi), Weak (Ruo)

The tongue is typically pale, slightly puffy, and tender-looking, often with teeth marks along the edges. The coating is thin and white. The pale colour reflects insufficient Blood failing to nourish the tongue body, while the puffiness and teeth marks indicate Spleen Qi weakness with mild fluid accumulation. In more pronounced cases, the tongue may appear almost colourless. The tip of the tongue (corresponding to the Heart area in tongue diagnosis) does not show redness, distinguishing this from patterns involving Heart Fire or Yin deficiency with heat.

Deep (Chen), Weak (Ruo), Knotted (Jie)

The tongue is characteristically pale, puffy, and moist or even wet-looking, reflecting the body's inability to transform and move fluids due to weakened Yang. Teeth marks along the edges are common due to the swollen tongue pressing against the teeth. The coating is typically white and slippery, indicating internal Cold from Yang deficiency. In more pronounced cases, the tongue may appear slightly purplish at the tip or edges, hinting at early blood stagnation from poor circulation, though this belongs more to a transitional stage toward Heart Blood Stasis.

Fine (Xi), Rapid (Shu)

The tongue body is red and thin, reflecting the depletion of Yin fluids and the presence of deficiency heat. The surface is dry, and the coating is either entirely absent (mirror tongue) or peeled in patches (geographic tongue), indicating severe Yin and fluid depletion. Cracks may appear on the tongue body, particularly in the centre or at the tip, reflecting long-standing dryness. The tip area (corresponding to the Lung and Heart) may show slightly deeper redness. In less severe cases there may be a very thin, patchy coating remaining rather than complete peeling.