Tongue diagnosis form

Patient name: Symptoms:

Patient ID
Consultation date:
Body colour Body swelling
Teeth marks at edges T.

Very swollen

Moderately
Deep purple
Reddish/red

Light purple
- nil
Deep blue-

White pink

Scarlet red
Light blue-

Dusky red
Pale pink

swollen

swollen

Normal
volume
Pink red
+ slight

Slightly
white

white

++moderate

red

red
+++ severe
Constitutionally swollen C
Acquired swollen A

Localised points/spots & colour

Coating colour Surface moisture

Clear
Brown/yellow
Normal white

Slight yellow
Excess white

Excess white

Excess white

Black-brown
Light yellow

Mid-yellow

Normal moisture
Moderately wet

Moderately dry
white +1

Turbid-sticky
Brown

Severely wet

Severely dry
Slightly wet

Slightly dry
+2

+3

+4

+6
-3

-2

-1

Slippery

Greasy
Thick coat Thinned coat
Peeled, dry shiny appearance
Missing coat & location
Body thinness Surface cracks
Rolled/curled lateral Length of cracks Depth of cracks
Slightly thin
Moderately

edges R
thickness
Very thin

Normal

Severity

Superficial
Indented, contracted

Medium

Medium
thin

lateral edges I
Short

Deep
Long
Indented, contracted tip T
No. of cracks
Localised depressions on
surface D Orientation
- nil; + slight; ++moderate; +++ severe
Crack orientation: Horizontal H; Vertical V; Diagonal D; Sides S

Tongue body symmetry Tongue deviation

Asymmetry from Deviation at rest
Slight deviation
asymmetry -3

asymmetry -2

asymmetry -1

swelling
deviation -3

deviation -2
symmetry 0

Moderate

Normal 0
Moderate

Severe
Normal

Deviation on
Severe

Asymmetry from
Slight

protrusion
-1

wasting/contracture
Tongue tied into
retracted position

Tongue shape Tongue diagram/photo

Scoring:
Hammer

Pointed
Narrow

- nil
Broad

Short

Long

+ slight
++moderate
+++ severe

Sublingual veins
Colour of veins Distension of veins
Mild dusky /

dusky / blue

dusky / blue

distension

distension

distension
Moderate

Moderate
Severely
Normal

Normal

Severe
Mild
blue

Tongue diagnosis: