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Tongue Diagnosis

Man shows tongue

Observing and interpreting the signs offered by the tongue is one of the more important diagnostic tools in Chinese medicine. The tongue, like other body parts such as the hands, feet and ears, is a hologram of the body in addition to being a highly visible and accessible part of the digestive system. As such, the tongue can reveal the depth and nature of any imbalances and can also be used to gauge the process of recovery. 

In Traditional Chinese Medicine, disease is explained by an imbalance of yin (female or receptive energy) and yang (active male 'doing' energy), and heat (excess/inflammation) and cold (lack/deficiency) in the various organs and systems of the human body.

Interpretation of the signs the tongue offers is a skilled business and is just part of the diagnostic process along with taking meridian pulses and a history that a Traditional Chinese Medicine practitioner will use.

The Chinese barefoot doctors (who were often women) used to travel from village to village and were paid to keep their clients healthy. Payments were suspended if they failed in their duty of care and their customers became ill. And, of course, their reputations and livelihoods were also probably damaged by this sorry state of affairs. Whereas the way current allopathic medical practice is organised, the entire medical and pharmaceutical industry has a huge commercial vested interest in people becoming - and staying - sick.

Allopathic medicine is also very bad at picking up pathology until it is quite advanced. This is the reason why many people go to their doctors complaining of feeling unwell, batteries of tests are ordered and the results often come back negative. It is sometimes only many years later, usually after intervening years of reduced capacity that the patient may finally be diagnosed with some recognised medical condition.

Sometimes too, the tests allopathic medicine offers are so laughably off the mark as to be completely pointless. On a recent edition of a programme entitled 'Embarrassing Bodies' where people present to a team of doctors with conditions they or others might consider shameful, a woman presented with severe constipation. The doctor performed an intimate examination to check her anus was in working order, ordered an MRI and endoscopic examination - but at no stage was diet or drinking sufficient water mentioned! If you asked your neighbour or grandmother they would have been better able to guess at the likely cause than the doctor with 5 years of medical school indoctrination under his belt!

Various aspects of the shape, colour and coating of the tongue can be used to determine the nature of long-standing conditions and, more dynamically, the current health status of the individual. This elegant system has been established over thousands of years of observations of all kinds of conditions and the great advantage is that you can utilise this knowledge yourself using a bathroom mirror or willing friend or family member. Some of the various interpretations are listed below. You might be interested to create a sketch or take a photo that you can refer back to as your health improves.   


Meridian associations of the tongue

In Traditional Chinese Medicine, different areas of the tongue are believed to reflect the health of the different organ systems. If there is an unusual colour, coating, and/or shape in a certain area, special attention is paid to the corresponding organ system. For example, a thick yellow coating at back of tongue may be a sign of damp heat in intestines, bladder or uterus. 


Regions of tongue


The sides of the tongue are associated with the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patient's left side and the Liver on the patient's right side. 


Digestive organs and the tongue

Your tongue also accurately reflects the state of your digestive system from top to bottom (literally!) so that you don't need expensive and invasive tests to monitor your digestive functions - you just need to look in the mirror.



Tongue colour and indications

The ideal tongue colour is a light red, indicating that the person's vital energy (chi) is strong. The colour reflects the health of the internal organs and blood circulation and changes in the tongue colour usually reflect chronic illness.




Image Indications


Health or a mild disorder.

Indicates cold, blood and/or chi deficiency, stagnation of blood, fat and mucous deposits, or a weakness in the blood (Spleen) leading to such conditions as anaemia.


Indicates a disorder of the Liver and Gall Bladder, resulting in an excessive secretion of bile, deposits of animal fats especially in the middle organs of the body, and possible inflammation.


Excess heat ie: inflammation. If red and wet indicates damp heat and if red and dry indicates a problem with internal fluids.

Dark red

Extreme heat, indicates severe inflammation, lesions, ulceration or degeneration of the related organ.


Pale purple indicates stagnation and cold - especially liver stagnation and may be associated with a weakening of the immune system.


Blue indicates severe internal cold and stagnant blood in the region of the digestive system that corresponds to the area of the tongue where the colour appears.


The colour on the underside of the tongue can also be used to determine the condition of the circulation and lymphatic system. If more than 50% is blue, there is stagnation of chi and blood stasis. 



Tongue shapes and indications

The shape of the tongue is taken to represent the individual's basic constitution and overall strengths and weaknesses of their body and mind. The ideal tongue shape is not too thick or thin, and the tongue body should be smooth with no cracks. Changes in the tongue shape usually reflect chronic illness involving blood, chi or body fluids.



Body shape

Image Indications

If the cracks develop during an illness then this indicates the illness is chronic and/or severe. Under other circumstances the location of the cracks relates to pathology in the related organ system.

Cracked and red indicates inflammation and heat and cracked and pale indicates a blood and/or chi deficiency.

Central crack

A crack running from the centre of the tongue to the tip indicates a Heart disorder or a congenital problem


Excess wind either external (infection) or internally generated.


A heat deficiency.


Heat in the Heart.


  Stroke or early signs of stroke.

Serious conditions affecting the blood or a Heart deficiency.


Chi deficiency. 

If swollen and pale with teeth marks indicates a chi deficiency or excess fluids.

If the sides of the tongue are swollen and red, this indicates Liver inflammation. 

Swollen and dark red indicates excess heat usually in the Heart or Spleen.

Curled Sides curled up indicates Liver chi stagnation.

Granular, strawberry-like appearance

Indicates a discharge of fat, protein and sugar in the affected region. If on the tip of the tongue, in the Heart, if on the edges in the Liver and Gall bladder and if in the centre in the Stomach and/or Small Intestines.



Spleen chi deficiency.



Tongue coating and indications

The tongue coating often indicates the health of the Spleen and Stomach. It also provides a good indication of acute illness, such as colds and digestive problems. A healthy tongue should have a light white or pale yellow coating that is thin towards the edges, and thickest at the root. The tongue coating can change quickly, but will be a clear indication of the presence of heat or cold in the body and whether or not the nature of the disease is one of excess or deficiency. For example, a thick yellow coating at back of tongue may be a sign of damp heat in the intestines, bladder or uterus. The coating on the tongue may thicken during any detoxification. 



 Tongue coat

Image Indications
No coating
A deficiency of yin. If on the tip of the tongue of Heart yin.
Thin Normal exterior condition, wind-cold.
Thick Excess damp heat/phlegm, food stagnation or Kidney yin deficiency if it's all over the tongue or at the back of the tongue and the tongue body is red. 
Dry Dry and yellow indicated excess heat or a deficiency of fluids. 

Normal or mild imbalance.


Yang deficiency and dampness.


Dampness or phlegm, retention of food.

Coat colouration

Image  Indications

Internal or external cold.


Internal or external heat affected by coffee, tea and/or smoking.


A condition with retention of internal hot or cold phlegm.


Severe conditions involving hot or cold.
Geographic tongue Not TCM - but a sure sign of mercury allergy/poisoning!

Examples of tongue diagnoses might include:  

  • Menopausal women suffering from hot flashes and night sweats often have a very red tongue with cracks and no coating.
  • People who feel cold all the time, have very little energy and urinate frequently may have a tongue that is pale and wet.
  • Arthritis sufferers, or people with sinus or digestive problems will have a tongue that appears puffy and has a scalloped edge.
  • People who suffer from insomnia often have a red tongue tip.


Further resources

You might also be interested in the following: 

Read button

Traditional Chinese Medicine

Yin and Yang

Acupuncture Meridian: The Proof

Chinese Five Elements Theory

Meridians Reference

Finger- and Toe-Nails and Health


Face Reading

Simple Energy Management Techniques

For a comprehensive approach to detoxifying the mind, body and spirit using diet and supplements, please refer to The Natural Recovery Plan book

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Ben Miller Demonstrates Tongue Diagnosis

Your Tongue is a Good Indicator of Your Overall Health

Alternative Health Diagnosis: Face, Tongue and Nails


Or for all media use the Search facility at the top of the page


Tongue diagnosis: Article summary

This article examines what the tongue can reveal about the health of the body according to the art of tongue diagnosis used as part of Traditional Chinese Medicine.


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The Natural Recovery Plan Ezine August 2011 Issue 20. Copyright Alison Adams 2011. All rights reserved
Dr Alison Adams Dentist, Naturopath, Author and Online Health Coach

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