Understanding Tongue Diagnosis in Chinese Medicine

September 12, 2016 Updated: September 12, 2016

The art of tongue diagnosis in Chinese Medicine may be one of the most interesting tools in my field. It isn’t the oldest technique, pulse diagnosis has that honor, but tongue diagnosis might be more famous.

It was put into use around 1350, a date that’s almost modern considering how long Chinese Medicine has been practiced.

I find tongue diagnosis to be informative; I learn a lot about a patient’s health from examining their tongue. Of course, years of experience looking at tongues has taught me much, but in fact, you can learn a lot about yourself using the basic information in this article!

Many changes in the state of your health and balance of your body can appear in your tongue. As an example, stick out your tongue, and if you notice a thick, greasy coating, you may be experiencing digestive problems or be on the verge of a nasty cold. Keep reading for more details on the coating of your tongue and other indicative signs.

The tongue is an important diagnostic tool in Chinese Medicine because it is the only part of our body that is both interior and exterior. Therefore, it provides a window from the outside to learn about the inside.

A tongue examination consists of observing color, shape, size, and coating. In general, a healthy tongue is pink, not too dry or wet, not too thin or swollen, and without teeth marks or discoloration, and the coating is thin, clear or lightly white.

This idea of learning about the body’s interior through observing outward signs is a common theme in Chinese medicine that makes sense when we remember that this ancient medicine began to emerge thousands of years ago; X-ray machines and MRIs were not even imagined. So, Traditional Chinese Medicine developed many techniques to learn about the interior by observing and investigating the exterior.

Below, I have more details. However keep in mind that when a practitioner is analyzing your tongue, she is putting all these pieces of information together and does not only focus on one aspect of the tongue.

3 Basic Tongue Observations:

(Jesse Kunerth/Shutterstock)
(Jesse Kunerth/Shutterstock)

1) The Color of the Tongue Body 

Tongue color varies widely from person to person, but it provides a good picture of the overall state of an individual’s wellness. Whenever the tongue body changes from a healthy pink to another color, it indicates an imbalance existing within the body. Here are some common examples.

*A red tongue indicates that there is too much heat in the body; the redder the tongue, the hotter the disease. A few common symptoms of excessive heat include: inflammation, migraines, night sweats, a tendency toward anger or irritability, infection, red eyes or a skin rash.

*A pale tongue indicates a deficiency of qi and blood or the presence of cold; the paler the tongue, the colder and/or more deficiency existing within the body. Common symptoms associated with a pale tongue are: weakness, anemia (especially if accompanied with a pale face and lips), lassitude, and fatigue.

*A purple tongue represents stagnation somewhere in the body or perhaps in more than one place. Think of stagnation as blockages in the body. For example, if someone has bad knee pain, the fluids, including blood, are not flowing properly in that area causing the knee to be both painful and inflamed.

Stagnation is not only related to joint pains. It could be related to circulatory issues, emotional pain or other physical discomforts such as chest pain or PMS. If it is a gynecological problem, the woman will often experience darker blood and clots with her monthly cycle.

2) The Shape and Size of the Tongue Body

Puffy or thin in shape and size, teethmarks? These are important signs to observe when looking at the tongue body. The shape and size of the tongue address the fluid metabolism in the body.

*Swollen tongue indicates that a body’s fluid transportation is not moving smoothly. You might see this in a person with digestive problems; if the tongue is puffy and purple, the problem probably lies more with blood circulation.

A swollen tongue will often be accompanied by teethmarks on the sides. This can indicate a tendency toward insomnia and/or even more impaired flow of bodily fluids.

*Very thin, short tongue may indicate dryness or a lack of fluids in the body. Often when a woman goes through menopause her tongue may become drier as well as redder. This happens because during that time when blood is ceasing to flow (blood is a fluid), she is ‘heating up’- think hot flashes.

3) Tongue Coating

The thickness of the tongue coating and its color are important to note.

*Thick coating often indicates an illness that invaded the body from the outside environment, such as a flu, virus or cold. If the coating is increasingly thick towards the back, it is probably a longer standing issue.

*Thin coating is often due to dryness. Women in menopause may have a thin or no coating accompanying a thin, red tongue body because of changing hormones and depleted fluids.

The color of the tongue coating alerts you to other disturbances.

*Thick white coating indicates a disease of a colder nature. Examples include fatigue, loose stools, or bloating, a cold with chills and clear phlegm.

*A yellow coating indicates heat. So if a person has a nasty cold plus a sore throat, the sweats, yellow phlegm and a fever, their illness would be related to heat.

*A gray or black coat is rare and indicates an extreme condition; call your M.D..

The tongue coating is the far quicker to change then the tongue body.  Also, keep in mind that food and drink will influence the color off the tongue coating temporarily, and smokers are easily detected because of the dry yellow coating of their tongues.

Bonus: The Tongue Contains a Map of Our Organs!

(Antonio Guillem/shutterstock; jens almroth/epoch times/photo illustration)
(Antonio Guillem/shutterstock; jens almroth/epoch times/photo illustration)

You can refer to the diagram to view which area of the tongue is related to which organ(s).

Let’s put some of these puzzle pieces together. Earlier, I explained about color of the tongue. If the tip of your tongue is very red, it is a sign of emotional upset.

Connecting this information to an organ, we note that the darker the red, the worse the emotional upheaval. This is because the tip is related to the heart and in this case (according to Chinese medicine), the heart is representative of your emotional well-being.

Here’s another example: a pale tongue with a crack in the middle. Since the middle of the tongue is related to the stomach this indicates a disturbance in the digestive system. The deeper and more severe the indentation, the worse and/or more chronic the problem.

This just begins to touch on the complexity of tongue diagnosis. There are hundreds of permutations wen you put together the map of our organs, color, shape, size, and coating.

I hope you are now impressed with your tongue; it is pretty amazing! The tongue offers us a great deal of information when we learn how to observe the changes.

Jennifer Dubowsky, LAc, is a licensed acupuncturist with a practice in downtown Chicago, Illinois, since 2002. Dubowsky earned her Bachelor of Science degree in Kinesiology from University of Illinois in Chicago and her Master of Science degree in Oriental Medicine from Southwest Acupuncture College in Boulder, Colorado. During her studies, she completed an internship at the Sino-Japanese Friendship Hospital in Beijing, China. Dubowsky has researched and written articles on Chinese medicine and has given talks on the topic. She maintains a popular blog about health and Chinese medicine at Acupuncture Blog Chicago. Adventures in Chinese Medicine is her first book. You can find her at www.tcm007.com.