What is Chinese Tongue Diagnosis?

When you come to see me for Acupuncture, I usually ask to see your tongue. Why? Because Chinese tongue diagnosis helps make acupuncture more effective. 

Here are some of the reasons. . .

What can I tell from looking at your tongue?

When I look at your tongue I am look at different things. I ask to see your tongue for a couple of seconds, 2 or 3 times. I look at your tongue’s body colour, shape, coating and markings. I also ask to see under your tongue and look at the very tip of your tongue. In Chinese Medicine all of these things relate to different aspects of your health. 

Tongue Body Colour
In Chinese medicine, the tongue body colour reflects the state of your vital energy, also called Qi (Chee). This indicates the overall state your blood, your organ health and also your circulation. Optimally, in a healthy tongue, this is dark pink / light red.

If the tongue is purple it signifies Blood Stagnation or clotting. When pale it can indicate a Blood Deficiency imbalance, or in some instances the presence of Cold. If the tongue is bright red this tells me that there is Heat present – either Excess Heat or Deficient Heat. These are the names of two different patterns of disharmony that can be treated with acupuncture.  

Tongue Body Shape
The shape of your tongue lets me know about substances Acupuncturists refer to as Xue (Blood), Qi (Energy) and Jin Ye (Fluid). Ideally your tongue should fit in your mouth without pressing against your teeth and creating tooth marks around the edges. 

When I see tooth marking around the edge of your tongue it suggests a digestive imbalance that is causing you to have a puffy or swollen tongue.  Other examples are a thin tongue, which can indicate a fluid and blood deficiencies, and a quivering tongue, which can relate to digestive problems or imbalances affecting your Liver energy. 

Tongue Coating and Markings
A healthy tongue has a thin white tongue coating. 
Presence of a thick coating can be a sign you have or are getting a cold. It can also indicate different kinds of digestive energetic imbalance. 

A white covering on the surface of your tongue (especially if the coating is thick and seems like it could be scrapped off) or maybe the coat is greasy or sticky, indicates energy patterns termed Damp or Phlegm. When the coating is thick and yellow, I know to use acu-points that treat the energy pattern called Damp-Heat. 

So, now you know a bit more what your tongue coatings tell me, let me explain a little bit about what the markings on your tongue can tell me. 

Cracks on your tongue often indicate an internal Heat imbalance Acupuncturists refer to as Yin Deficiency. I sometimes see red dots on your tongue and this signifies the energy pattern of Empty Heat – this often accompanies a Yin Deficiency pattern.

I understand all these energy patterns and imbalances may seem a little confusing. And, you might be thinking “but how do they actually tell Lucy how to treat me using acupuncture?”  Read on and I explain how I map the energy imbalances I see to specific areas of your tongue, and by doing this I know the best way to treat you. 

Specific Areas of the Tongue

In Chinese medicine certain areas of the tongue relate to different organs and areas of your body. The markings and coatings that I observe in particular areas often guide acupuncture treatment and which acu-points to place needles. 

The following image provides a good overview of how specific areas correspond to each of the organ systems in Chinese medicine – 

Image of tongue with Chinese tongue diagnosis markings
Image of tongue and areas corresponding to energetic organs

When your tongue coating, colour and markings are somewhat mapped over these specific areas, it allows me to build a picture of your internal health; i.e. your tongue tells me what the balance of the Qi, Blood and fluid is in different energy systems which effect your health.  

An example of this mapping is Spleen Qi Deficiency – an energy pattern I frequently see in clinic that presents with sluggish digestion, tiredness and stomach bloating. Another example is Heart Yin Deficiency – which can have symptoms of anxiety, poor concentration, insomnia or palpitations. 

So, there is more to looking at your tongue than you may initially think. It not only informs my Acupuncture diagnosis, but let’s me know how best to treat you; it lets me know where to place needles and also whether Moxibustion or Chinese cupping will be beneficial for your health. 

9 Things to know about Chinese tongue diagnosis – 

1. Your tongue is unique; everybody’s tongue print is as individual as their fingerprint

2. Tongue diagnosis is used in other medical systems such as Ayurveda and even by the historical Greek physicians Galen and Hippocrates

3. I only look at your tongue – no touching or poking! 

4. Brushing your tongue can alter the natural tongue coating – it is important to let me know if you brush your tongue as part of your dental care routine

5. It is normal for me to ask 3-4 times to see your tongue because when you extend your tongue for prolonged periods the body colour and shape can change

6. Certain food & drink and smoking can discolour your tongue – tell me if you have eaten or drank anything that may have done this 

7. Some features on your tongue change from week to week but many features do not change or change very slowly

8. In Chinese Medicine particular tastes relate to organs and elements; bitter relates to Fire and the Heart, salty to Water and the Kidneys, Sweet to Earth and the Spleen (often thought of as the Pancreas) and Pungent to Metal and the Lung. 

9. Tongue diagnosis is never used alone. An acupuncturist always incorporates a combination of Pulse Diagnosis, questioning and when required, physical examination. 

If you have any symptoms or concerns about the appearance of your tongue, it is important to see your doctor.

29 comments on “What is Chinese Tongue Diagnosis?

    • Hi Vera,

      Thanks for your comment.

      Is it the tongue body or the sublingual veins? Usually the colour purple relates to Blood Stagnation but can be for different reasons. Treatment depends on differential dx to see which of the ZangFu are involved and in what way. Then treat Ben (root cause) and Biao (symptoms).

      Kind regards

  • Hello I have noticed the last few weeks I have a very thick yellowish brown coating on my tongue from the very back to the tip. I tongue scrape every morning and night and it removes so much thick gunk but never all of it. How would you treat this? I am not in UK what kind of practitioner would offer treatments for this in the US? I work in the dental field and the dental treatments (scraping, hydrogen peroxide) aren’t working. And I’d like to solve it and find the root cause.

    • Hello,

      Thank you for your comment.

      The coating on your tongue can change for different reasons. If you are concerned at all, I would visit your doctor and share your concerns.

      A Chinese Medicine Practitioner would treat this based on your presenting health imbalances. During a consultation they would ask you lots of questions to learn more about why this may be happening and how they can best treat you. They would then treat with acupuncture and possibly herbs. You would also be asked about your diet and lifestyle and they may recommend you make adjustments to support your health. This would be addressing the root cause of the disharmony.

      Look for a registered and licensed TCM practitioner and give them a call. Explain what is happening and take it from there.

      Kind regards

        • Hi Lin
          Thank you for getting in touch and highlighting what you can see on your tongue.

          Patterns, marks, spots on the tongue all contribute to a TCM Dx and changes to these can indicate that your body and health are changing. Firstly, it is really important to make sure if you are concerned about your health you speak to your medical provider. If you want to find out more about Chinese Tongue Diagnosis, I would make an appointment to see a qualified TCM Acupuncturist who will be able to give you much more detail. They will take a full history and ask questions to help them understand at what is going on with different organ systems. This will include different TCM patterns including Yin / Yang, Hot / Cold, Interior / Exterior and Excess / Deficient. When you stat working with them, it is very common that you will be able to see changes in how your tongue looks as your health changes.

          It is worth noting though that everyones tongue is unique – much like a fingerprint. You can observe slight changes, sometimes major, but some marks on your tongue are not going to change and don’t always indicate particular imbalances.

  • Hi Lucy, can the appearance of the tongue be altered? For example I have a deep line down the centre of my tongue and the surface of my tongue looks quite weathered, is this something that can be healed? Many thanks

    • Hi Rebecca,

      Thanks for leaving a question. The answer is Yes! Your tongue changes all the time. Sometimes small gradual changes which occur over a span of a few months. The deep line down the centre could well be related to a digestive imbalance and by strengthening the Spleen and Stomach Zang Fu, the line may start to diminish. The weathering could be for different reasons too. Sometime Blood and Yin Deficiency. Obviously to tell you more I would need to see you in clinic.

      When you book for a consultation with an Acupuncturist they will be able to go through tongue diagnosis in detail. With treatment and lifestyle / diet changes, as a persons body returns to balanced health, this can be seen as the tongue body, colour and coat also begin to change.

      Hope this helps,

    • Hello Kriti
      Many thanks for your message and information.
      I am unable to tell you more specifically what this means without a full consultation. The tip of your tongue relates to the Heart energy in TCM. Do you have a local TCM practitioner you can book an appointment with? They will be able to do a full assessment and then tell you how they can best help to balance your health.

      You can find further information on how TCM views the Heart and Heart energy in the Chinese Clock blog – https://www.lucyclarkeacupuncture.co.uk/the-chinese-body-clock/

      Kind regards

    • Hello Kiran
      Thank you for your message. It depends on what the coating is like, how thick it is and which areas of the tongue it covers. Very often a white coat is related to Damp / Phlegm. The red tip signifies heat in the Heart and is often linked to anxiety. If you are in pain or have concerns about your tongue I would recommend you see a doctor to get things checked out. For a full tongue diagnosis and treatment an acupuncturist will be able to help you.
      Good luck!

  • I have sore tongue my taste is sour bitter metallic… sweet taste is normal. Mornings
    A yellow / white coating on tongue. Throat
    Pain & ear pain.ENT …. Cannot figure it out.

    • Hi Joyce
      If you are in any pain with your tongue I suggest going to see you doctor to get it checked out. In Chinese medicine the tastes and coverings indicate different imbalances are possibly impacting different energetic organ systems (Heart energy, Spleen energy, and depending where the coat is, Damp and maybe some Heat. I would book in with a TCM Acupuncturist for assessment and treatment to start to rebalance your energies. Good luck!

    • Hi Christine
      If you are in pain or discomfort with your tongue, it is good to get this checked out with your Dr. In Chinese medicine this could indicate different imbalances. These may include Spleen/Stomach imbalance and Heat in the system. Book in with an TCM Acupuncturist for assessment and treatment. Good luck!

    • Hello

      Bite marks on the sides of the tongue usually relate to the TCM pattern Spleen Qi Deficiency. Is the skin actually peeling or does it feel like it is peeling? Peeled skin and top of tongue and thirst are aspects of the pattern Yin Deficiency. I would suggest you see a TCM Acupuncturist so they can pin point which organ energies are involved eg. Examples are Heart, Liver and Kidney Yin Deficiency. Then you can received personalised treatment.

      If you are in pain or worried about your tongue or mouth then book and appointment with your dentist or doctor.

  • I have always brushed my tongue with baking soda to help remove the white coating but lately that no longer works and it is happening more and more and it now gives me the taste of smoke. It is making me crazy

    • Hello Christina
      In TCM a white coating often refers to Damp / Phlegm in the system. A taste of burning / smoke commonly links to Heart Energy imbalance. Ways to help reduce this are to identify any Damp / Phlegm foods in your diet that could be exacerbating things. Also, adopting diet and lifestyle changes to support your Stomach and Spleen function are recommended. An Acupuncturist would be able to tell you more in a consultation and provide Acupuncture to support your digestive function. They can also assess the presence of other imbalances they could target with Acupuncture.

    • Hello Nora
      Thank you for your post. That is great you are now cancer free! There are interesting links between Chinese Tongue Diagnosis and identifying cancer in the body. There are even some research papers which support this e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864042/.

      Diagnosing and discussing cancer in outwith my scope of practice. I would however be interested to know exactly where on your tongue the cancer was located and the presentation of your tongue coat, body and shape. In TCM we then interperate this information and use TCM principles to balance your body energies.

  • hi

    I wonder if you can help clear this confusion.

    i am reading that bitter herbs like dandelion and burdock drain dampness, they are drying.

    they are also cooling. cooling is not good for dampness so how is this good for dampness?

    and if its drying how does it help secrete enzymes in spleen pancreas?

    i also have what feels like little raised spots at the back of the tongue – i think they are the same colour as the tongue.

    what would this mean in chinese medicine?

    many many thanks

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