How does a Naturopath review a patient? Stick out your tongue and see!

OK so I get some weird looks from my colleagues and patients when I ask them to stick out their tongue. Embarrassment should be low on the list when you hang around veterinarians who talk about poo, anal glands, sexual organs (or lack of them- as  a lot of the time they are preoccupied with castrations and ovariectomies). Tongue sticking out is more of a human past-time, an acupuncturist/Naturopath’s pride of their knowledge base.   Generally there is little resistance to obeying this request, and no, its  NOT because they want to give me a raspberry! People are mostly curious, and usually interested enough about their health to oblige. Very often they make up some excuse about their tongue coating, such as “I just drank a cup of coffee” or “I was just sucking on a coloured lolly”. Even given this pre-examine information, the tongue never lies! (Well the words that come out of a mouth might, but the patterns on the tongue cannot be hidden).

As a veterinarian who has a special interest in dentistry, I have spent a considerable length of time looking in, and at, mouths. Tongues and teeth give me a LOT of information about  health. TCM (Traditional Chinese Medicine) uses the tongue as a map of dis-ease and weaknesses in the body.This party trick is awesome. So what can I see in the tongue map? The tip of the tongue represents the heart, the area just behind maps the lungs and the body of the tongue is about spleen (pancreas) and stomach- ie. digestion. If the digestive system is inflammed or not working well the tongue will be somewhat swollen and will have tooth marks or indentations along the border. The sides of the tongue are about the liver and gall bladder function. If the area is red it is said to describe heat, or a deficiency of cooling fluids in that organ system. Therefore a stomach ulcer might show up as a red patch on the tongue. In Naturopathic prescription terms if the tongue is very red it may mean that the body is deficient in iron, or inflammation so check the conjunctiva. A very pale tongue could mean anemia. If there is a quiver when the tongue is shown the patient is likely to have a magnesium deficiency.  Raised strawberry dots on the tongue indicate a calcium and phosphorous deficiency. Here is a blog with a case study and picture of a tongue and here is a picture of the tongue map:

As a Naturopath and health practitioner of over 30 years there are other signs and symptoms that give a great clue to what is going on in the body, so a bunch of clues can be picked up relatively quickly. Nails are another great source of information. White spots indicate either injury or zinc deficiency, and will show up on individual nails which will also represent certain organ systems. For instance the little finger represents heart on the inside part of the finger  and spinal column on the outside. Ridges on nails represent a silicate deficiency, which might be from an inability to absorb these minerals, or a gut problem. It might also be linked to a sluggish interstitium secondary to hypothyroidism- if this is suspected check for oedema, cloudy thinking, loss of the lateral third of the eyebrow, and if you are a doggie the tip of the tail will look like a rat’s tail. Humans have more hair loss and dry itchy skin. (I have a lot of fun comparing human pathology to canines or felines! My weird veterinary sense of humour…and don’t get me started on Anal gland scents of humour…bwhaha)

The advantage of having been a veterinarian for sooooo many years is that I can cut to the centre of problems relatively quickly. I am a surgeon, after all. This means I have bad handwriting, but accurate scalpel procedures. I prefer to type, and get bored when a pen is in my hand. Too slow!This detailed examination can be done relatively quickly with a well trained eye. Naturopaths can “sum up” multiple signs at one glance! Yep, even walking down the street, a quick glance can see who is likely to be predisposed to  prostate cancer or  to mammary cancer- it’s about the midline creep/waist to hip ratio which is  linked to the obesity epidemic, which in turn is linked to the pro- inflammatory state of nutrition.

You may have guessed by now that Naturopaths are very focussed on lifestyle changes and nutrition. This means they will ask some detailed questions about faeces. Yep, poo!. The Bristol stool chart is our friend. You need to look in the loo.You want to aim for 2-3 bowel movements a day and they should be a number 4 on the chart.

Once we have that poo regime questionnaire established, we need to review your sleep patterns. 8-10 hours of sleep from an early to bed early to rise point of view is recognised as healthy. Some lucky few need less hours, and balancing the body and its essential nutrients, stress levels, reducing caffeine, and fixing the exercise regime will also complement the night-time rest period.

Exercise is also very important, and studies have shown that weight bearing helps with bone density, and short high intensity amounts (20 seconds running up a hill) followed by equal amounts of rest and recovery repeated 3 times in quick succession may be all that you need to maintain fitness.  Range of motion stretches, like your cat does, is also helpful to keep the joints lubricated and healthy.

I thought you might like to read how we take notes for a  shortened patient summary on our computerised system. Its pretty obvious how nails, tongue, iris and skin examination can give us great clues as to our health.

When we write our shorthand differentials we often abbreviate the organ systems with a letter, for instance T = Tongue exam. C=calcium, P= phosphorous. ACV is Apple Cider vinegar

Here are some notes from one of my patient files who came in with a viral illness, you can see that the signs and symptoms showed an underlying nutritional and personal stress causes which allowed the virus to take hold. We know that there are a few essential minerals that keep “the system booted”. Personal stresses, such as too much work, no relaxation and no exercise will elevate the body’s requirement for certain nutrients, particularly zinc and magnesium. When this is not met our immune systems fail and we are prone to getting infections. A detailed look at nails and tongue can tell the practitioner what is lacking and when it occurred, as the nail grows out from the nail bed approximately 1 mm per week, therefore the ridges and white marks are a chronological (yes Sherlock Holmes trick!) map. 

Patient exam:

T: white coating, strawberry dots, quiver, tooth impressions (swollen) –> CP deficient, Mg deficient, digestion problems low stomach acid

Skin_Rosacea and rash , skin dry.

Iris: ANW dark, irregular. white wash, radii solaris–> digestion/constipation , acidic

Nails: Zn def 3 wks ago (white spots) WITH Ridges (SCF)

Hx exhausted, works 7 d, does not “feel stressed” and says “has great diet” all joints ache (Rx Lympholytix and omega 3’s 1 tbs bds)

Diet recall: B- muesli, L-corn wrap with salad, D- meat, potatoes, veges, Drinks- 2 coffees/d. snacks? pastry?

Poo _ every second day

DDx constipated, dehydrated, low Zn, stress.

Rx: ACV/lemon/honey to taste first thing in am,

Go to bed EARLY have 10 hours sleep, soak in Mag S04 bath to absorb Mg++ for 30 min NOW. Take Zn supp 50 mg, watch movie “fat sick and nearly dead” and have 6-8 glasses of vege juice/day for 2 weeks and stop ALL GLUTEN. NO BREAD, NO PASTA, NO MUESLI.  Breakfast of 2 eggs and spinach and cheese, no bread. Go Paleo. plus vege juices.

Viral illness so make chicken soup with garlic and drink this 3x/d as well as take Lysine

advised to check vit D3 levels, revisit/ph check in 1 wk.


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