Tongue Diagnosis in TCM Acupuncture Theory

One of the most common questions that people ask about acupuncture is: "Why does my acupuncturist look at my tongue?"

Tongue and pulse diagnosis are two of the more important diagnostic tools in Chinese medicine. They are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Generally the tongue, is much easier to learn and less subjective than pulse diagnosis. It is less meridian specific than the pulse, however, the tongue will show the depth and nature (hot, cold, etc.) of an imbalance and it is less effected by short-term influences such as nervousness. The tongue is also useful as a measurement tool to gauge the progress of a disorder.

Below you will find detailed information about tongue diagnosis and the clinical significance of the examination:

Common Tongue Geography and Meridian Correlations

tongue geography
¤ Lower Jiao
The Base of the tongue corresponds to the Kidney, Urinary Bladder, Large Intestine and Small Intestine Meridians.

¤ Middle Jiao
The sides of the tongue correspond to the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patients left side and the Liver on the patients right side.

The Middle of the tongue corresponds to the Stomach and Spleen Meridians.

¤ Upper Jiao
The Tip of the tongue corresponds to the Lung and the Heart Meridians.

Tongue Body Colors and Clinical Indications

Body Color
Pink normal or mild disorder

Pale yang, blood a/or qi def
Deficiency Cold
+ thin & dry = blood def
+ wet = qi def
+ swollen = qi def
+ swollen & wet = yang def

Red heat
+ no coating = yin def empty heat
+ yellow coat = excess heat
+ wet = damp heat
+ dry = injured fluids

Dark Red (Scarlet, Cardinal) extreme heat
more severe conditions than red

Purple stagnation
lv qi stagnation is likely
+ pale = cold

Blue severe internal cold
stagnant blood

Tongue Body Shapes and Clinical Indications

Body Shape
cracked if develops during illness indicates chronic and severe, otherwise normal
location of cracks relates to organ pathology
+ red = empty heat consuming fluids
+ pale = blood & qi def
crack runs from center to the tip = ht disorder or congenital ht problems
horizontal cracks = yin def

deviated (crooked) wind

flaccid deficiency heat
+ pale = blood & qi def
+ dark red = yin collapse

long heat in the ht

rigid stroke or early signs of stroke

short (contracted) serious conditions
blood deficiency
ht deficiency
+ pale or purple = cold or yang def
+ swollen = damp or phlegm
+ red = heat consuming the fluids

stiff heat in the ht
ht/sp heat
phlegm obstructing the ht qi
+ normal & pale = wind, stroke

swollen deficiency
+ pale & wet - yang def
+ teethmarks & pale = qi def or excess fluids
+ dark red = excess heat usually ht/sp

thin blood or fluid def
empty heat consuming fluids
+ pale = blood & qi def
+ red = yin def

thorny (strawberry, granular) heat
congealed blood
+ on tip = ht fire
+ on edges = lv/gb fire
+ on center = st a/or intestines heat

trembling (quivering) wind
+ pale = qi def
+ red = heat producing internal wind

Tongue Coatings and Clinical Indications

The tongue coat is a good indicator of the state of the Stomach and Spleen. It also shows the strength, depth and temperature of pathogenic factors.

A normal tongue coat is thinnest at the edges, thicker in the center and thickest at the root. It is thin and white, slightly moist and has a root.

Tongue Coat
thin normal
exterior condition, wind-cold

thick excess damp/phlegm
food stagnation

dry heat consuming yin
excess yang or fire
deficiency fluids

moist normal or mild imbalance

wet excess fluids from yang def

sticky (greasy, creamy) dampness or phlegm
retention of food

Coat Coloration
white internal or external cold
if coat looks like cottage cheese = ST heat
+ thin coat & body aches = exterior wind-cold
+ thin coat & thorny = wind-heat

yellow internal or external heat
effected by coffee, tea a/or smoke intake

gray hot or cold internal condition
retention of phlegm heat
+ dry = heat consuming body fluids
+ moist = damp cold

black severe condition involving hot or cold
+ pale = excessive cold from yang def
+ dry & possible thorny = consumption of body fluids

Coat Rooting
moss appears firmly implanted
strong st/sp qi

moss appears to float on the surface
st/sp qi def
peeled sp qi def
deficient yin or fluids

Sources and More Information

The information on our site is drawn from our own lecture notes and clinical experience.

For a complete list of valuable resources, see our (TCM) Chinese Acupuncture Resources section. The most recommended texts are below: