Dr. Angelica Kokkalis, O.M.D L.Ac.

Picture of Angelica

Tongue Diagnosis in Chinese Medicine

Tongue Diagnosis

The diagnostic value of observation of tongue can be fully manifested only in clinical treatments in T.C.M. by using differentiation of syndromes. The facts verify that excess or deficiency of Qi and blood in viscera organs, depth of invasion of pathogenic factor, tendency of transmission and change in a disease can be understood through observation of tongue.

It is declared by the modern research work that appearance of tongue looks like a window for seeing into internal organs of the body, can objectively reflect various physiological changes in the interior of the body, manifests the reaction and function of the body at the moment and brings the information of plentiful vital activities.

The content of tongue diagnosis

Observation of tongue proper (body)
Observation is mainly focused on three aspects : color, appearance and mobility of the tongue. A normal tongue is light red in color, lustrous and moist, free in motion, and of proper size which is neither flabby nor thin and neither tough nor too tender.

Tongue color

  • Pale tongue: Is often seen in severe malnutrition, anemia chronic nephritis, etc.
  • Light red tongue: Is often seen in a healthy person or a person with a mild disease. Sometimes it may also seen in a chronic disease which is not so severe.
  • Red tongue: Is often seen in the middle stage of a febrile disease with virus or bacteria in blood.
  • Deep red tongue: Is often seen in the advance stage of a febrile disease in which high fever, septicemia and some other severe conditions are present.
  • Green, blue or purple tongue: Is often seen in severe infection, extreme weakness in respiration or circulation, oxygen difficulty diffuse intravascular clotting, etc

Appearance of tongue

  • Sheen-withered tongue: A sheen tongue indicates vigor of the anti-pathogenic factor and adequacy of the body fluids. Withered tongue is often seen in wasting diseases, severe malnutrition, pernicious anemia, and the advanced stage of infectious febrile diseases.
  • Tough-tender tongue: A tough tongue indicates heat syndrome often seen in the peak stage of acute disease. A tender tongue indicates cold syndrome mostly seen in the advanced stage of chronic disease.
  • Cracked tongue: A cracked tongue is often seen in high fever, dehydration and malnutrition.
  • Thorny tongue: A thorny tongue indicates hyperactivity of pathogenic heat, which is often seen in high fever, severe pneumonia, scarlet fever etc.
  • Spotty tongue: Like red bayberry gathers at the front and in the middle of the tongue. Is often seen in the advanced stage of a febrile disease, burns etc
  • Tooth printed tongue: Tooth prints appearing at the edges of the tongue is often seen in edema, anemia, chronic nephriris etc.
  • Double tongue: The vessels of the underside of the tongue are swollen up like another small tongue. Is often seen in inflammation or abscess of glandula sublingualis, tumor etc.
  • Haemorrhagic tongue: A tongue bleeding on the surface is often seen in leukemia and aplastic anemia.
  • Carbuncle tongue: Is seen in glossitis, tongue tumor and pyogenic infection.
  • Furuncle tongue: Which is hard and painful with a size of a soybean is often seen in glossitis and infections.
  • Boils tongue: Protruding painful boils on the surface of the tongue is often seen in ulcerous glossitis and stomatitis.
  • Fungus tongue

Mobility of tongue

  • Rigid tongue: Difficult to protrude is often seen in cerebrovascular accidents and nerve system damage of various causes.
  • Flaccid tongue: Is often seen in nerve dysfunction of tongue, nerve system damage or extreme weakness in the advanced stage of diseases.
  • Shrunken tongue: Shrunken and unable to protrude denotes a fatal sign. Is often seen in cerebrovascular accidents, severe lingual muscle atrophy, and extreme weakness in the advanced stage of diseases.
  • Deviated tongue: Which is deviated to a side is often seen in facial paralysis, hypoglossus paralysis, and some other nerve damage.
  • Tremulous tongue: Uncontrollable trembling often appears in tremulous paralysis and some severe nerve system damage.
  • Protruding and wagging tongue: Is often seen in high fever, blood disease with bacteria or virus, protruding tongue like dementia.
  • Numb and paralyzed tongue: Is a tongue without ability to move. They are seen in nerve system damage due to various causes

Reproduced with permission from the Lafayette Journal and Courier, LIFE, TUESDAY, NOVEMBER, 28, 2000

Doctor sees promise in combination of Chinese medicine, mainstream methods
By Amy Patterson, Journal and Courier

For the first time in 54 years, Larry E. Horton could see just how red and yellow Indiana’s autumn leaves turned this fall.

Since birth, doctors told Horton, and his parents, that his vision would be limited to dark and light images because of multiple old chorial retinal scars from ocular toxol plasmosis. His improved vision is something his general physicians, surgeons or optometrists couldn’t help him with. The scars on his eyes kept him from seeing clearly to read the hymnal in church or differentiate similar shades.

In his lifelong search for sight, Horton tapped into acupuncture, a treatment from Traditional Chinese Medicine. In January, he found Dr. Angelica Kokkalis, a Western medical doctor and Oriental doctor in private practice in Zionsville. This West Lafayette resident also has a staff position at St. Vincent Hospital’s Center for Complementary Medicine and Pain Management, where she specializes in pain control.

In her private practice, she offers Traditional Chinese Medicine diagnostic tools such as tongue and pulse analysis, individualized herb medicine formulas based on diagnosis and a variety of treatment options including acupuncture and moxibustion.

“Acupuncture is a very safe system of health care when done by a well-trained practitioner,” Kokkalis said.
Seven years ago, Americans made 9 million to 12 million acupuncture patient visits, according to a Food and Drug Administration report.

Dr. Angelica Kokkalis

According to the Centers for Disease Control, traditional medicines including herbal preparations account for 30 percent to 50 percent of the total medical consumption. In the 1990s, one third of the American adult population have used alternative treatment. That percentage is even smaller in the Greater Lafayette area, which means establishing a private practice in the area has been difficult for Kokkalis.

The wellness of the human body depends on keeping all its elements in balance, according to Traditional Chinese Medicine. The basic belief is that humans have a natural flow of energy, known as Qi, which circulates through the body on meridians. Pain and disease are the result of a disruption, deficiency or blockage of this energy. When acupuncture is selected as therapy, tiny needles are placed in proper acupoints along the meridians to help regulate the body’s energy flow.

“My sessions are 45 minutes, and I’ll take a nap every time. Two sessions ago, she came in the room and removed half of the needles before I woke up. So, I’m pretty well relaxed,” said Horton, whose insurance covers acupuncture. Most insurance plans, including Medicare and Medicaid, don’t.

More than 20 acupuncture needles are placed in Horton’s body, including five needles that are inserted in the meridians around each eye.

“I’m impressed with his improvement, because I’m not the only one who thought nothing could be done,” said Dr. Marcia Monroe, Horton’s Lafayette optometrist.

“Medical establishments need to recognize that Western medicine is not a panacea, and they need to combine the best of both worlds.” said Dr. Angelica Kokkalis, who offers Traditional Chinese Medicine. Kokkalis expects that Traditional Chinese Medicine won’t be a mainstream treatment option for some time.

“It will take another generation of physicians — 30 to 40 years. Medical establishments need to recognize that Western medicine is not a panacea, and they need to combine the best of both worlds,” Kokkalis said.

That’s what Kokkalis does. Her dual career has allowed her to combine her talents as a medical and Oriental doctor.

Kokkalis lived in Greece until she received a Sino-Greek Government Student Exchange Scholarship to study medicine in China. She combined her education in conventional medicine with training in Traditional Chinese Medicine from Beijing Medical University. In 1991, she came to the United States after accepting a postdoctoral research fellowship at the University of California at San Diego Medical Center. Following the fellowship, she relocated to Minnesota, where she developed a private practice in Traditional Chinese Medicine and research in immune system reaction to organ transplantation at the Veterans Administration Medical Clinic in Minneapolis.

In addition to acupuncture, moxibustion and herbal formulas have maintained their popularity in many Asian countries, including China, Japan, India and Pakistan. If people are looking for testimony about how well Traditional Chinese Medicine can be practiced, Kokkalis says to observe how China’s population manages under one health care system.

According to Traditional Chinese Medicine, everything has two sides known as Yin and Yang. Yang is attributed to conditions that appear active, external, upward and exciting. Yin portrays the opposite, such as asthenic, internal, cold and inhibitive. Kokkalis said Yin and Yang theory is widely used in Traditional Chinese Medicine for explaining the physiological and pathological phenomena of the human body and for directing the diagnosis and treatment of a disease.

When a patient steps into Kokkalis’ office, she starts the examination with an interview, an in-depth profile. If a patient is in her office for back pain, she wants to talk about their entire lifestyle. ‘You have to treat the whole picture. It’s more than just acupuncture and nerves. It’s adjusting the diet,” Kokkalis said. “I don’t see them as back pain patients, I see them as whole.”

Since Horton started treatment with Kokkalis, he has also incorporated a complete vitamin in his diet. Every patient Kokkalis has seen in her private practice adjusts their lifestyle in some capacity. To evaluate an individual’s all-encompassing health, Kokkalis uses the tongue and pulse diagnosis. “I wish Western medicine was trained to do the tongue diagnostic because they’d save money from doing many diagnostics,” Kokkalis said. The color, appearance and mobility of the tongue are part of Kokkalis’ diagnostic routine. By looking at a tongue, Kokkalis can reveal the history of a person — did they smoke, did they have a stroke, etc. A normal tongue is light red in color, free in motion, lustrous and moist.

“It is declared by the modern research work that appearance of tongue looks like a window for seeing into internal organs of the body,” Kokkalis said.

She also relies on the pulse diagnostic as part of her patient evaluation. The quality and speed of the pulse can indicate an imbalance in the body. For example, a thin pulse is a sign that the blood is deficient and unable to fill the pulse properly.

Even though alternative treatments’ popularity is increasing, not all physicians are part of the movement. Kokkalis said the tendency to denounce Traditional Chinese Medicine is keeping her from practicing in Greater Lafayette.

“Physicians don’t have knowledge and say, ‘You can’t have it,’ because they don’t know about it,” Kokkalis said. “They should open up and do more reading. Can modern and Chinese medicine be combined? Yes. Not only can they be combined, but I believe they can enhance each other’s effects.”