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  • Writer's pictureAndrew Clark L.Ac, LMT


Tongue diagnosis in acupuncture

Great question! We are generally not going about our day-to-day sticking our tongues out at each other in greeting and generally western doctors don’t ask you to stick out your tongue except to look past it and check out your throat. So why is your acupuncturist asking to look at your tongue? In this article we will discuss what the tongue can tell us about a person’s health and we will look at some basic examples of tongue diagnosis in action. We’ll start with the question: What are we looking at and why?


It is important to state, before we start, that we are never taking tongue diagnosis on its own and it is necessary to fit this amazing diagnostic tool in with the larger picture of your health. In other words, if you have questions about your tongue ask your acupuncturist, don’t think that something is necessarily wrong! Tongues are strange little beasties, each one unique, and it takes a lot of practice to know what to look for.


Tongue diagnosis in acupuncture
no tongue is truly "perfect" but this one is looking pretty good!

The “perfect” tongue: Ideally, the tongue should be a vital, even pink color. People with lighter skin will of course have a different “pink” than people with darker skin, and there are other variations that we can expect between different groups of people, but the generalization mostly holds true. The tongue body should sit comfortably between the teeth without being so large that it presses on them to make marks or so small that there is significant room between it and the teeth. It should have a moist surface, not too wet, and the coating should be thin, even and white. There should be an even covering of small bumps all over the tongue that are the same color as the tongue body. The tongue should be easily moveable but not shaking or trembling and when stuck out of the mouth should be straight and not deviating to the side. Underneath the tongue the color should again be a healthy vibrant pink and the veins should be barely visible. If you want to see a "perfect" tongue, look at a healthy child.


Tongue diagnosis in acupuncture

The tongue body: Here we are looking at the overall shape, size, symmetry, texture, color and movement of the tongue. The tongue is the only part of the internal digestive system that we can see externally which makes it a fascinating trove of information about stomach and gut health. Further, the digestive system communicates with all the other systems in the body and we can see changes to the whole body reflected in appearance of the tongue body.

A puffy large tongue that has toothmarks on the sides from being pressed against the inside surface of the teeth speaks to fluid metabolism and retention in the body or an over taxed digestive system. It may prompt us to ask questions about appetite, energy level, feelings of bloat or retention, and diet. A thinner tongue body on the other hand will lead us to think about decreases in vital substances such as blood and fluids and we might then ask questions about symptoms of dryness, thinning hair or nails, sleep issues, feeling abnormally hot or cold and we might suspect resources are being depleted from excess activity, chronic illness or menstruation. The size of the tongue should generally be symmetrical left-to-right and should taper evenly from front-to-back. Cracks in the tongue body can be normal or can suggest a more chronic depletion of resources or substance in the body. If there are dark purple or red spots or bumps on the tongue this can hint at things being “stuck” and will prompt us to ask about the movement of your digestion, your menstrual cycle and your emotions or mood. The color of the tongue body tells us a lot about temperature and the quality of the blood and circulatory system. A decreased quality of the blood will show in the tongue as paleness or as an orange hue underneath. Red areas may indicate the presence of heat or inflammation in the body and dusky paleness or a blue tint may lead us to suspect cold symptoms or pain from cold pathologies. If there is a tremor to the tongue, if the tongue has trouble moving in certain directions or deviates to the side as it is stuck out we might suspect the involvement of “Wind”. Wind is a term that generally describes irregular movement in the body and can be present in patterns of light headedness, numbness or tingling sensation, headache, tremor, vertigo, dizziness or even stroke.


Tongue diagnosis in acupuncture
The red spots and the thick yellowish coat are interesting diagnostic features on this tongue.

The tongue coating: The coating on the tongue tells us very generally about the state of the digestive system, what we call "stomach qi", and body-wide metabolism. It is roughly analogous to the biomedical concept of gut-flora and the gut biome and is therefor getting a lot of attention from the research community right now. It can also tell us a little about temperature based issues or, in the case of an infection, where the pathogen has lodged itself amongst the layer of the body. A thick coat may indicate retention of food or a recent large carb heavy meal, or it might speak to a deficiency in some aspect of metabolism. The absence of a coat might speak to deficient fluids or to a chronic inflammatory process. If there is heat or inflammation either in the digestive or respiratory systems the coat may be more on the yellow side and if there is what we call “Cold” present the coat will be white. Certain states of internal toxicity will present with dark brown or black coatings and we see this a lot with some families of medications and especially in the case of chemotherapy where that toxicity is therapeutic. We may also see this in long term chronic illness. Our use of the tongue coating as a diagnostic tool is just one reason why TEAM practitioners will often suggest that you don’t use a tongue scraper.


Tongue diagnosis in acupuncture

The Tongue is of the Heart:

Primarily we have discussed the tongue relative to the digestive and metabolic functions of the body, but the tongue is also one of the most important organs of communication. Communication is the connection of our internal landscape with the outside world and is relative to the heart-spirit (Shen). In one of our oldest texts we see the axiom “the tongue is the flower of the Heart”. This means that the tongue is the outward expression of the heart and relates to the tongue's function in communication and also to its appearance being useful in diagnosing conditions that are associated with the heart and spirit. Even in the west we say “speak from the heart” when we are urging someone to be genuine in their expression, and the tongue is the organ of that clear expression. For these reasons we look at discolorations in the tongue, especially at the tip, to give us hints about the state of the spirit. What we see may prompt us to ask about the emotional or mood experiences of a patient. Further, the heart is called the "emperor" in Chinese Medicine and everything that happens to the body or spirit effects the heart and is communicated to the tongue. We can therefor see evidence of long-term holding patterns that are often a part of more complicated presentations.


Clearly we could go on discussing the tongue forever, but try this: When you are watching a movie and some star is monologuing, or when you are talking to a friend or family member, take a peak at their tongue. Notice how there are differences in size, color, coat and movement. Individual as a fingerprint and as informative as an expression on your friend's face; the tongue truly is a marvel and that is why we ask to see yours!

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