Neurasthenia in Traditional Chinese Medicine

Fine (Xi), Choppy (Se), Weak (Ruo)

The tongue body is characteristically pale, sometimes described as pale-white or lacking lustre, reflecting the insufficiency of Blood to fill the tongue's vessels. It may appear slightly thinner than normal. The coating is typically thin and white, which is normal and reflects the absence of pathological Heat or Dampness. In more pronounced cases the tongue may appear slightly dry, but generally moisture is preserved. The key feature to note is the overall pallor of the tongue body itself, especially compared to a normal pinkish-red, and the similarly pale colour of the lips.

Rapid (Shu), Fine (Xi), Empty (Xu)

The tongue body is typically red, particularly at the tip (which corresponds to the Heart area). The coating is scanty or entirely absent, reflecting depleted Yin fluids that can no longer produce a normal tongue coat. A midline crack extending toward the tip is commonly seen, indicating long-standing Heart Yin insufficiency. The tongue surface tends to appear dry and lacking moisture. In milder or earlier cases, the tongue body may be closer to normal colour but will still show a thin or partially peeled coating. The degree of redness and coating loss reflects how far the Yin depletion has progressed.

Fine (Xi), Rapid (Shu), Wiry (Xian)

The tongue body is red, reflecting deficiency heat from depleted Yin fluids. It tends to be thin and may show cracks, particularly in the centre or at the root, indicating long-standing fluid depletion. The coating is scanty or absent (peeled), sometimes entirely mirror-like. The sides of the tongue may appear redder than the rest, corresponding to Liver heat. The tongue surface is dry and lacks moisture. In some cases there may be geographic peeling at the root area, pointing to Kidney Yin exhaustion.

Fine (Xi), Weak (Ruo), Deep (Chen)

The tongue body is typically pale, slightly puffy and tender in texture, often with tooth marks along the edges reflecting the body's inability to properly move fluids due to Qi weakness. The coating is thin and white, usually evenly distributed and rooted, which indicates the pattern has not yet progressed to Yin depletion (where the coating would begin to peel). The tongue tip area may appear slightly paler than normal, reflecting Heart Qi insufficiency. Overall the tongue looks damp and soft rather than dry or red.

Deep (Chen), Slow (Chi), Weak (Ruo)

The tongue in Kidney Yang Deficiency is characteristically pale and puffy, often with a soft, tender quality and visible indentations from the teeth along its edges. The surface tends to be wet or slippery, reflecting the body's inability to properly transform and move fluids. The coating is white and may appear moist or slippery. In more severe cases, the tongue can become quite swollen and waterlogged in appearance. The root of the tongue (corresponding to the Kidney area) may appear particularly pale or enlarged.