Tongue Diagnosis in TCM
Tongue diagnosis is one of the main diagnostic tools in Traditional Chinese Medicine. Various parts of the tongue correspond to different bodily organs, such as kidneys, spleen and lungs, and a TCM doctor can determine their state of health and any pathological changes by observing the condition of the body (muscular tissue), known as tongue proper, and the coating of the tongue. Although an accurate analysis needs the well trained eye of an experienced practitioner, it can be useful to take a look at your own tongue each day to gain a general idea of what is considered normal and abnormal. So what does a normal tongue look like?
A normal tongue is defined as being soft, slightly red in color, moist and agile in stretching, withdrawing and rolling. The tongue coating is a thin white layer, clean and with moderate moisture.
Points to consider in self observation:
Look at your tongue in sunlight. This will give the most accurate color and coating. Extend the tongue and relax. Check for body color as soon as you put your tongue out, as it will change color to purple after about fifteen seconds and this will give a false diagnosis. Don’t drink or eat anything that might affect the color before you look at your tongue. Don’t brush the tongue, you want to see its natural coating.
Our tongues change with age. In infants it is more common to see a white, thick coating and a peeled tongue. Qi and blood deficiency are more common with the elderly, resulting in a dry tongue with cracks. Overweight people will tend to have more dampness and phlegm and a tongue proper which is larger and lighter.
The tongue coating will be thinner as the day progresses and the color will become slightly more red and shiny.
The season of the year affects the coating. In spring it will look more normal than at other times of the year; in summer it may look damper, slightly thicker and light yellow in color; in fall the coating tends to be thinner and dryer; and in winter it is more moist.
Try and observe the tongue proper and the tongue coating at the same time.
The tip of the tongue corresponds with heart and lung meridians
The middle corresponds with spleen and stomach meridians
The edges correspond with liver and gallbladder meridians
The root corresponds with kidneys, urinary bladder, large and small intestine meridians
Tongue Proper/Body
What is its spirit? Is the general appearance lively, vital and bright? Or is it stiff, dark and dull? If the spirit is dull, treatment will be prolonged; if it is lively, healing will be faster.
What is its color? The color of the tongue proper reflects the state of blood and qi of the organs and conditions of deficiency or excess.
What is its shape? Is it thin or swollen, supple or stiff, flabby, long or short? Are there any cracks or teeth marks on the edges?
What is its movement? Does it quiver or tremble or have any involuntary movement?
| stiff | heat in the heart |
| pale | yang, blood/qi deficiency |
| red | excess heat |
| purple | stagnation |
| blue | internal cold |
| thin | blood/fluid deficiency |
| swollen | accumulation of fluids |
| cracked | yin deficiency, or normal |
| teeth marks on edges | qi deficiency |
| long | heat |
| short | cold |
| quivering or trembling | internal wind |
Tongue coating
The tongue coating gives a good indication of the condition of stomach and spleen.
What is its quality? Is it thin or thick, dry or moist, full or partial, sticky/greasy, or peeled like a map?
What is its color? Is it white, yellow, grey or black?
| too thin | exterior cold |
| thick | excess damp or phlegm |
| dry | heat |
| too moist | excess fluid |
| sticky, greasy | excess damp, phlegm |
| peeled | spleen qi deficiency |
| glossy, no coating | excessive stomach/spleen qi deficiency |
| white | exterior or interior cold |
| yellow | interior heat |
| gray | cold/damp or interior heat |
| black | excessive interior heat/cold |