Tongue Diagnosis

Tongue diagnosis is used all the time by acupuncturists and practitioners trained in Chinese medicine.

It is an important way to diagnose a patient's health and sometimes can be crucial in deciding what to do first.

In fact, I'm surprised when acupuncturists don't use it. 

Many don't use pulse diagnosis either, which is another vital way to understand what is going on, often displaying factors that the patient doesn't know about or that he or she isn't telling you.

Is it difficult? Yes and no!

Six Week Baby

© Marcin Okupniak

Dreamstime Stock Photos

It is easy to understand the outline, but to be able to distinguish all the many parts of the picture and integrate them with other parts of the diagnosis takes experience.

So, in use, tongue diagnosis is not always so easy.

By the way, if you're interested more in where tastes are detected on your tongue, click here.

What does the Tongue represent?

Like the sole of the foot (used in Reflexology) and the ear (auriculotherapy), it is a kind of holographic microcosm of the body.

Often what the tongue tells you about a patient's health exceeds in importance what other ways of diagnosing tell you.

Tongue diagnosis, if you are experienced in using it, is also fast: you just look, whereas in other holographic microcosms you usually have to probe or palpate.

When to do tongue diagnosis

  • in good light, preferably daylight, because you can see the natural colours and coating more easily then
  • when the patient hasn't just 'cleaned' his tongue: in fact, ask him not to clean his tongue when he comes to see you
  • do tongue diagnosis either before meals or well after them
  • not when the patient has just eaten or drunk something, because what he's eaten may remain on the tongue or colour it so that it is harder to discern the natural colour and coating
  • every time the patient comes for treatment, before treatment
  • preferably not when the patient has just taken vigorous exercise or a hot bath which can sometimes alter the tongue

For Tongue Diagnosis, you need a Map

Nearly all the zang-fu energy organs have a place on the tongue. That means you can often 'see' how they are performing just by looking at the tongue for a few moments.

For example, the back of the tongue represents the Kidney function, whereas the front and tip represent the Heart.

In front of the Kidney area is the Spleen and Stomach area and between that and the Heart at the front is the Lung area.

The sides of the tongue show the Liver and Gallbladder but where the sides curl forwards to the tip represents the chest area, including a woman's breasts, the heart and the lungs.

In tongue diagnosis how and if the tongue moves also has meaning, as also its shape, colour, coating and how moist or dry it is.

Tongue Shape

What does the shape tell you in tongue diagnosis?

Cracks on tongue

Cracks on the tongue occur in different places.

Most common is the longitudinal mid-line crack running up the centre or the tongue from back to front. If wide and not deep it points to Stomach Yin deficiency usually.

If it reaches to the tip from the back, it points to Heart energy problems, probably from intense worry and anxiety: the redder the tip here, the worse the sleep.

Cracks anywhere suggest Yin deficiency in the related zang-fu. So if cracks appear towards the front of the tongue in the chest area, Lung Yin deficiency might be a problem.

Swollen tongue

Swollen tongues, like swelling anywhere in the body, point to Damp or Phlegm

If one part of the tongue only is swollen, that suggests problems in that area, which may be Damp but more likely also suggest Heat

If the tip is swollen, for example, it means Heart Fire; if the sides are swollen, Liver Fire: all the more so if the area is red.

Swollen tongue, in a patient who had had a stroke. The tongue is much better ie less swollen than it was before he commenced treatment with acupuncture.

Swollen tongue of a stroke patient. Note the swelling mainly in the Spleen area, denoting Phlegm, and the deep centre line suggesting a history of un-conducive nutrition. Also the bare, redder area at the tip, representing the patient's poor sleep, and anxiety.

Toothmarks on tongue

This tongue is swollen in the Lung area: a bit pale, with teethmarks on one side. Suggests some Blood deficiency, Damp or Phlegm in the Lungs and Spleen deficiency. Lines point to chronic Stomach Qi deficiency.

Tooth-marks point to Spleen Qi deficiency, because when healthy the Spleen keeps things moving along in the body.  

If tooth indentations appear, it means the Spleen isn't able to perform fully.

Teeth-marks on the sides can also arise when there is Liver Qi stagnation.

Thin tongues

Thin tongues can be either Blood deficiency if pale, and if red and without coating, Empty Heat.

Deviated tongue

If the tongue points to one side, without the patient knowing that he is doing it: Internal Wind.


For accurate tongue diagnosis the colour of the surface of the tongue is also important and can represent various factors such as

What are the normal colours seen in clinic?

  • normal: a natural pink colour. Many syndromes don't initially change the colour of the tongue, including Yin deficiency and Qi Stagnation
  • pale: often suggests lack of Blood, ie Blood deficiency or,as you might expect, Yang deficiency (because Yang energy makes the colour go red.) If the colour is pale only in certain areas, it points to deficiency in that area. However, this isn't the end of the story because it also depends on  how much moisture there is. Blood provides moisture so if the tongue is dry, and pale, it points more certainty to Blood deficiency whereas Yang is warming and drying, so if the tongue is moist and pale, it confirms Yang deficiency.
  • Red: suggests Heat. This could be Yang excess heat, when the coating would be thick or Empty Heat, when the coating would be thin or non-existent. Redness in one area points to Heat in that area only. Little raised red dots, looking like the seeds on the surface of strawberries, also suggest Heat..
  • purple: suggests slow moving Blood, Blood Stasis. The more blue the purple is, the more Cold there is. The more red the purple is, the more Heat.

Tongue Coating

The coating of the tongue is equally important for tongue diagnosis. It mainly represents the Stomach's health and more generally how the health of the Yang organs.

  • thin, white. This is what you want to see on a normally healthy tongue. It shows that the Stomach has enough fluid to keep the tongue moist and protected and so the Stomach is OK.
  • thick coating: this means the Stomach energy, and or that of the Yang organs, has been disturbed. Either there is an exterior factor disturbing them, such as Wind or Cold or Damp, or there is an interior factor such as Cold or Food Retention of Phlegm or Heat. The colour of the coating tells you more.
  • yellow: Full Heat
  • black: usually Cold but can be Heat if very dry.
  • patchy: meaning that some bits of the tongue are bare, raw. These patches suggest deficient Yin in either Stomach and/or Kidney.
  • absent: ie when you see just the raw surface of the tongue, nearly always means a lack of Yin, ie Yin deficiency.

Tongue moisture

How moist or dry the tongue is can be important for tongue diagnosis.

  • Dryness suggests a lack of fluids, especially of Blood but also can point to Heat. In full Heat the coating will be thick, in Empty Heat there will be little or no coating.
  • A very moist tongue suggests a deficiency of Yang, which probably points to Spleen Yang deficiency in the first place, and consequently a build-up of Damp.
  • There is also another kind of coating, described as 'slippery',which looks oily or greasy. It means there is Damp or possibly Phlegm in the system which itself suggests at least Spleen deficiency.

Tongue Movement

Movement can suggest various factors.

  • Slight quivering means that Spleen Qi cannot hold it steady.
  • If it quivers a great deal, it suggests Wind, which could be either external Wind or internal Wind.
  • If it keeps being stuck out of the mouth as the patient speaks, or at other times, it suggests excess Yang, probably Heat affecting the Heart.

Tongue Diagnosis Warning!

It's easy to look at a tongue. Reading through the above you may think 'Eureka, this is a Doddle!'

I wish it were. There are hundreds of variations and it takes quite a while to become quick at diagnosis.

If you are examining yourself or a friend in a mirror, do beware of making pronouncements and diagnoses with certainty: we are all sensitive about our health and appearance and whatever you say may be taken more seriously than you mean.

And of course you might be wrong, causing unnecessary worry.

In any case, even if you get it right, are you knowledgeable enough to make the right suggestions for your friend to follow for better health?

It is better, I humbly suggest, to seek professional help from someone with experience!

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