Tongue Diagnosis for Quick Self-Diagnosis

Chinese Medicine Tongue
  • Your tongue! An image of how your body works
  • Every bit means something:
  • Shape, size, moisture, colour, lines, marks …
  • Changes as your health changes

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!

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 shapecolourcoating 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 of the tongue from back to front. If wide and not deep it points to Stomach Yin deficiency usually.

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

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


Swollen Tongue


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.

Tooth-marks on tongue


Tongue with Tooth-marks


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 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?

Tongue colour is important in tongue diagnosis!
Photo by Nick Fewings
  • 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.
  • Also, research reported in the Journal of Chinese medicine Vol4, No.1 March 1984 found an increase in the number of fungiform papillae, with swelling and redness that often occurred with excess Yang heat, perhaps signifying a strong reaction of the body’s disease-resisting process.
  • Conversely, a decrease in the number of fungiform papillae or which appeared atrophic, small and flat suggested a weak disease-resistance reaction, reflecting a deficiency of qi – a weaker immune system.
  • 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 Diagnosis and 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

In tongue diagnosis a very moist tongue may lead to fungi though maybe not an actual mushroom!
Excess Moisture leads to growth! Photo by John Toulis

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

  • 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.
  • 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.
  • 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 Diagnosis and 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.


How fast does your Tongue change?

How fast does your tongue change in tongue diagnosis?
Photo by Saffu

Nothing like as fast as your pulse, or somewhere on your body that’s sore, when the correct treatment is done.

What that means is that when, say, I insert an acupuncture needle at the right place, the pulse often changes immediately, and so does the place that was previously sore, or sensitive or tight.

Your tongue, however, may take a few hours to alter.

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!

Jonathan Brand colours

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  3. i get a red tongue in morning when i wake up and after swilling with water it goes away, it happens most mornings, anything to be worried about?

    1. Red tongue at any time means Heat of some kind.

      If externally caused you might expect other symptoms to back it up, such as fever, rash, sore throat, rapid pulse, possibly a nosebleed, etc. See our page on Heat for more. This red discolouration wouldn’t normally disappear from swilling your mouth with water.

      For more on the theory of how external Heat penetrates, see our page on the four levels: how ‘warm’ diseases penetrate.

      Another cause of Heat is dietary. This is an internal cause. After a night’s sleep, without anywhere to go, this heat from digestive processes could lead to a red tongue. In this case, you might expect smelly stools and/or bad breath and thirst as supporting symptoms. You might also have perspired during your sleep. If digestion is the problem, it could be from something eaten (see possible foods under Hot foods). Usually this kind of heat wouldn’t lead to a rapid pulse unless there were more extreme symptoms leading to what is called Stomach Fire.

      Of course, none of the ‘hot’ foods listed may be your particular problem if your digestion just tends to run naturally ‘hot’, but if this were the case you’d know you tended to be hot from normally wearing less clothes than others and always complaining about the heat indoors! This cause of heat might well be improved by water, which is yin and therefore has a cooling effect. But moving around on rising a.m will also tend to dissipate internal heat.

      Another possible cause is yin deficiency which you can read about via that link. However, I doubt if redness from this would disappear as quickly as you say from just swilling some water around your mouth.

      So, unless the redness is caused by a dye in something you’ve eaten, or possibly blood from your gums (which is often related to Stomach Heat or Fire) the most likely cause is dietary or from heat generated internally.

      Of course, you do not mention the coating on your tongue which might lead down various other paths of conjecture. For example, if your tongue is red but has no coating, this suggests empty Heat.

      Equally, where the redness is on your tongue opens up another range of possibilities.

      Sorry for this long answer to what seems like a simple question, but Chinese medicine usually comes up with an initial diagnosis which is then refined according to other signs and symptoms.

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