Understanding Tongue Diagnosis

You may be surprised to find that during a visit to your acupuncturist, he or she may ask to look at your tongue.  This may seem like an odd request, and is probably the first time a health care provider (or anybody, for that matter) has asked you to stick out your tongue.  In Chinese medicine, however, a practitioner can gather quite a bit of information about you and your condition simply by taking a look at your tongue.

When an acupuncturist looks at your tongue, he or she is checking out the shape, color, size, and coating, each of which offers a piece to the diagnostic puzzle.

The shape and size of your tongue tends to address the status of fluids in your body.  For example, a very large, puffy tongue, or one with scalloped edges suggests that fluids are not being metabolized properly in your body.  In contrast, a very small, short tongue may indicate dryness, a deficiency of fluids, or a deficiency in general. 

Tongue color varies widely from person to person, but is a good indicator of the overall nature of what is going on in your body.  A red tongue indicates that there’s some kind of heat present, and the redder the tongue, the greater the heat.  A pale tongue suggests a deficiency of energy and blood or the presence of cold.  A purple tongue indicates that there’s some kind of stagnation in your body.

Tongue color may vary indifferent areas.  A tongue that’s red at the very tip indicates heat in the Heart (possibly anxiety or some kind of emotional disturbance), as the tip of your tongue correlates with conditions of the Heart.  Just behind the tip corresponds to the Lungs; the sides of the tongue are associated with the Liver; the center of the tongue with the Spleen/Stomach or digestion; and the back of the tongue is associated with the condition of your Kidneys.

A coating on your tongue can also offer up information about your health.  The thickness of a tongue coating is an indicator of the severity of the condition being treated.  A thin coating (one in which you can see the tongue through the coating), indicates that any pathogen present is mild or on the exterior (like a cold).  A thick coating that obscures the tongue body suggests that the condition is deeper and more serious.

The condition of the coating also speaks to the condition of fluids in your body.  A moist or wet coating indicates poor fluid metabolism, and a dry coating means that your body fluids are depleted.  A coating that’s peeled off, either partially or completely, indicates some kind of heat or damage to the Stomach, possibly depletion of Stomach Yin, or damage to Stomach energy.

Tongue coatings also vary in color.  In general a thin white coating is normal, but can also appear in diseases associated with cold conditions.  A yellow or brown coating is one that has  been “cooked” by heat in the body (indicating heat), and a gray or black coating indicates an extreme condition.  It’s also important to note that foods such as red wine, orange juice, and coffee can alter the appearance of the coating.  Needless to say, food dyes can dramatically alter the color of the tongue.  In more than one instance, I’ve had a patient stick out their tongue, only to see a bright blue, green, or orange coating!

The condition of your tongue will change as your health changes, but in general changes appear on the tongue slowly.  One exception is when you have a cold or the flu and are running a high fever, a very red tongue will appear fairly quickly.

Tongue diagnosis can be a subtle art.  To try it yourself, take a look at the variations of your tongue and compare it to that of friends or family members (and hope they don’t think you’re nuts!).  After you’ve looked at a few, you’ll see that they differ widely, and with a little practice can tell you a lot about someone’s overall health.