Tongue Diagnosis

Examination of the tongue is one of the two major pillars of diagnosis in Traditional Chinese Medicine.  There is so much information to be gleaned from that fleshy bit of tissue in your mouth that after this little intro, you’ll be springing out of bed in the morning and rushing to the bathroom to see that first peek of your tongue before anything else happens. 

Tongue diagnosis is broken down into four categories--shape, color, coating, & vitality.  Wait!  Before I delve deeper, let’s talk about how you examine your tongue and what a normal tongue looks like.  You open your mouth about half way and gently push your tongue out of your mouth, preferably over the lower teeth and lip.  Forcing your tongue out too fast will send blood rushing to your tongue and immediately change the color to red.  A normal tongue is smooth, flexible, pink in color, neither too big or too small for the mouth, neither slanting left or right, moist but not dripping wet, without cracks (although a central crack down the center maybe normal), and without discolored papillae (taste buds).

Okay, now you’re looking at your tongue and the first thing you notice is the shape and movement.  Is it short, long, thin, thick, concave, teeth-marked, shriveled, swollen, stiff, trembling, flexible? 

The second tongue characteristic you examine is color.  Is it pink, red, pale, blue, grey, purple?  Are there any papillae that are raised or colored on the tongue surface?  Is the tongue different colors along the sides or front?  

Next you look at the coating or tongue fur that coats the top most part of the tongue.  A normal coat is thin, white and evenly dispersed across the tongue.  When looking at the tongue coat it’s important to look at texture as well as color.  Is the fur too thick, absent (peeled), yellow, white, curdy like cottage cheese, black, brown, grey, or greasy? Are there any cracks?

And last of all, you will look for vitality in your tongue.  Is it moist without being overly wet?  Is it flat, limp, dull or does it have luster and hold its shape?

Now that you’ve looked at your tongue, what does it all mean?  Tongue diagnosis reveals the underlying qualities of a disharmony and its location in the body.  The diagnosis itself won’t mean a whole lot to you, but your tongue will say it loud and clear to your practitioner.  Your tongue won’t say, “prone to migraine headaches,” “halitosis,” “kidney infection,” “flu,” or “insomnia,” but it will say, “Deficient Blood,” “Deficient Qi,” “Excess Cold,” “Blood Stagnation,” “Spleen Qi Deficiency with Dampness,” and so on.  As you can see Chinese medicine has its own language for diagnosis.  Many terms here will not be explained including words that sound familiar but mean something different in Chinese  Medicine (these words are capitalized), but you can get the gist without spending four years in Chinese medical school.  Let’s break it down so you can say you learned something about your tongue today. 


Teeth marks—Spleen Qi Deficiency, usually means that you overwork or over worry, don’t have the best of diets, and may be prone to weight gain at some later date in life
Puffy or thick—Dampness; we will discuss your diet.
Puffy or thick all over and pale in color—Spleen Qi Deficiency with Dampness, you probably should stay away from sweets, fried foods, hot spicy foods, and dairy products. 
Puffy or thick all over and red in color—Internal Heat with or without Dampness, you’re probably not feeling too good and running a fever
Thin, slender and smaller than normal—Deficient Blood or Fluids; we may check you for anemia, recommend that you drink more water and consult you on your last illness.
Trembling or wiggling uncontrollably—Deficient Qi or Internal Wind, we have to look at other symptoms to further diagnose.  You may have headaches, facial tics, or seizures, but more than likely you are overworked and need to sleep more; some nutritional counseling to tonify the digestive function would also be recommended.   


Red, dark red, grey, black—variations of Internal Heat.  Black means that the fluids have been scorched.  Red in the center of the tongue suggests Heat in the Stomach and is often found with patients who have acid regurgitation, halitosis, constipation, and other stomach or gastrointestinal problems.  Red at the tip of the tongue in the Heart position refers to insomnia or overwork/exhaustion. 
Pale—Blood Deficiency or Internal Cold.  Location may indicate if it’s general condition or related to a specific organ such as Heart, Liver, or Spleen.
Purple—Blood Stagnation.  Location may indicate a specific organ or it may be generalized.  It’s often seen in cases of pain; examples are menstrual cramping, chronic headaches, and traumatic injury. 


White—normal if thin and evenly spread over tongue.  Internal Cold if especially thick; in which case, you aren’t feeling too good and may be dealing with some pain such as cramping when having a bowel movement.  External Cold if you’ve just caught a cold.
Yellow—External or Internal Heat.  If External Heat, you’ve probably come down with a cold and fever.  Internal Heat can be due to a multitude of things including diet and chronic illness. 
Black—Unless you’ve had a fairly severe illness, I will ask you what recreational drugs you are doing and suggest that you stop them immediately.  Don’t do them; you are burning up your Kidneys!  Black is indicative of severe heat.


A horizontal crack down the mid-line of the tongue may be normal if present from birth.  Little cracks that develop during an illness are a sign of chronic and severe illness.  Cracks in a red tongue are a sign of Heat injuring the Yin Fluids or Deficient Yin.  Cracks in a pale tongue signify Blood or Qi Deficiency. 

Your acupuncturist looks at your tongue every time you go to an appointment.  You’ve looked at your tongue in the mirror afterwards and wondered what’s the big deal anyway?  You even went home and looked at your partner’s tongue and your child’s tongue just to see if there was a difference.  Maybe you didn’t and you’re wondering, should I look?







You’ve looked in the mirror and have either seen a nice pink tongue with a thin fur coat or you’ve seen a lot of little details you never noticed before.  Even before you begin to have symptoms, your tongue may be warning you through its color, shape, coating, and vitality that it’s time to make some lifestyle changes.  What can you do?  Unfortunately for the sake of space and simplicity, I cannot go into detail about nutritional or lifestyle changes in this article.  For each and every person, those changes are unique and individual.  What you can do is make looking in the mirror a daily habit.  Note the changes that occur from day to day, and check in with your body to see how you feel.  Talk with your acupuncturist about the changes you are seeing and ask what things you can do to help rebalance your body.  Congratulations!  You now have a new tool, a yardstick, by which you can begin measuring your health.   











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