An Introduction to Tongue Diagnosis

By Darren Holman, L. Ac.

Many people often wonder what their acupuncturist is looking for when they are examining their tongues during an office visit. Often people are embarrassed to stick out their tongue for another person. I hope that with this explanation of what we are looking for and what it tells us about the condition in question will help people feel more comfortable with this portion of the examination.

The Chinese have been using the outward appearance and demeanor of a patient to reflect the internal condition of the body since the Warring states period (403-221 B.C.). One of the most important and frequently used systems of evaluation and diagnosis has been the examination of the tongue. The Chinese believe that the tongue works like a mirror reflecting the condition of the organ systems of the body. Numerous reasons exist in the Chinese medical model to justify this belief, including several meridians (channels of energy and blood) that flow directly to the tongue.

  1. The Heart meridian connects to the root of the tongue.
  2. The Spleen meridian has an internal branch that spreads over the lower surface of the tongue, and a divergent channel that penetrates the tongue itself.
  3. The Kidney meridian terminates at the base of the tongue.
  4. The Bladder meridian has a sinew meridian that binds to the root of the tongue.
  5. The Triple Energizer meridian has a sinew meridian branch that links with the root of the tongue.

As you can see, there are many internal connections to the tongue that allow it to show the health of numerous organs in the body. Over the years, clinical examination of the tongue has lead to the development of trends in tongue appearance and their corresponding meanings in the internal state of the body. This observation allows the tongue to be mapped into regions that correspond to their pertaining body organs. The tip of the tongue corresponds to the heart, while the frontal portion just behind the tip corresponds to the lungs. The edges of the sides of the tongue relate to the liver and gallbladder, and the middle portion reflects conditions of the spleen and stomach. The root of the tongue corresponds to the kidney, bladder, and intestines.

When you observe the tongue, there are certain things that you look for including the color, size, shape and texture of the tongue body. You also examine the thickness, texture, and color of the tongue coating.

The color of the tongue body tells the state of the blood, yin organs (non-digestive organs) and the ying or nutritive energy. A normal tongue is pink or light red in color. A pale tongue shows deficiency in either blood or nutritive energy, while a dark or purplish tongue shows that blood or energy are stagnating in the body. Changes in color in different regions of the tongue can show imbalances in different organs systems. For instance, a red tongue tip can demonstrate heat in the heart, which can cause insomnia, restlessness, or anxiety.

The shape of the tongue reflects the state of the blood, nutritive energy, and constitution of the body. Some types of tongue shape are stiff, flaccid, swollen, enlarged, contracted, long, and thin. As a general rule, a stiff tongue is a sign of internal excess, often what the Chinese call internal wind, and can be a sign of impending stroke or can be seen in cases of mental disorders. Internal wind can also present as a trembling tongue body. This form of internal wind is usually less severe, often presenting only as muscular twitches or spasms.

A flaccid tongue usually signifies deficiency of vital energy, blood, or body fluid. The color of a flaccid tongue can help determine which substance is deficient, and what is contributing to the deficiency. A swollen tongue also shows deficiency and the portion of the tongue that is swollen can shed light on which organ system effected. For instance, swollen sides will show spleen deficiency, while a swollen tip shows heart deficiency. Swelling towards the front of the tongue but not at the tip can show phlegm being retained in the lungs.

A short and contracted tongue is most often seen in severe cases, usually presenting as moist and pale, showing stagnation of cold in the meridians or extreme spleen yang (warm vital energy that boosts metabolism and controls digestion) deficiency. If a tongue is extremely long and has difficulty being retracted, this usually shows excess heat often associated with the heart, often presenting in mental disorders such as mania. A thin tongue is not properly nourished and shows damage to energy and blood. Body fluid has been damaged and internal deficient heat is present in a thin red tongue.

The tongue coating indicates the state of the yang organs which are mainly responsible for digestion. It is assessed for its thickness, texture, and distribution on the tongue. A thin white tongue coat is normal, and will also be present in cases of exterior cold pathogen such as arthritis or catching a cold without a sore throat. A thicker coating shows a buildup or invasion of dampness into the body. This can come as result of a bacterial infection, poor dietary choices, or even due to climatic factors. A moist coating shows weakness of spleen yang in water metabolism, and may even lead to drooling.

A dry yellow tongue coating shows that pathogenic heat has damaged the body fluids leading to a dry and sometimes burnt tongue appearance. A thick, greasy, yellow tongue coat shows an accumulation of damp-heat in the body, often in the bladder or intestines. This kind of coating is prevalent in cases of dysentery, severe urinary tract infection, etc. A peeled (one without coating) red tongue, often with cracks in the surface of a thin tongue body is indicative of yin deficiency. Yin deficiency often presents with heat in the palms and chest, night sweating, hot flashes, and thirst. This is prevalent in menopausal women and people recovering from long-term fever.

As you can see, tongue diagnosis is a valuable tool for finding the correct pattern of imbalance and designing the proper treatment plan. Subtle differences in the tongue appearance can be used in combination with pulse diagnosis, examination, and inquiry into the patient’s symptoms to determine the pattern that is affecting the patient. I hope this brief introduction has given you some idea of how tongue diagnosis is utilized, and will help each of you to feel more comfortable at your next acupuncture appointment.

Darren Holman is an Acupuncturist and Chinese Herbalist who is licensed in North Carolina and nationally certified in Oriental Medicine including both acupuncture and Chinese herbal medicine. He graduated valedictorian of his class at the Texas College of Traditional Chinese Medicine and brings his passion for healing and Chinese medicine to Carolinas Natural Health Center in Matthews. Darrren also utilizes cupping, moxabustion, and CranioSacral therapy in his healing work. To make an appointment for treatment or to schedule a free consultation, contact Carolinas Natural Health Center at 704-708-4404.

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