Tongue Diagnosis in TCM Acupuncture Theory

TCM Theory

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

¤ 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 Body Sublingual Veins and Clinical Indications

Vein Appearance


normal moderate length, light blue color, thin
distended blood stasis
+ more dark, deeper stasis

+ generally involves upper warmer
+ if single vein then problem is likely that side
thin stasis from deficiency
red/purple possibly shiny - damp-heat middle warmer
yellow turbid dampness
white possibly slippery - damp-cold/painful obstruction
long veins to tip possibly heart disease
possibly further confirmed with dark petechia lateral to the vein

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

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