Understanding Tongue Diagnosis
 

You may be surprised to find that during an acupuncture appointment, your practitioner will ask to look at your tongue.  This may seem like an odd request, and is probably the first time a health care provider has asked you to stick our your tongue.  However, in Chinese medicine, a practitioner can garner quite a bit of information about you and your condition, simply by taking a look at your tongue.

When your practitioner looks at your tongue, he or she is looking at the shape, color, size, coating and positioning or movement of the tongue, each of which offers a piece to the diagnostic puzzle.

Shape and Size of Tongue
The shape and size of the tongue tends to address the status of fluids in the body.  For example, a very large, puffy, or scalloped tongue suggests that fluids are not being properly metabolized in the body. In contrast, a very small, short tongue may indicate dryness, a deficiency of fluids, or deficiency in general.  In addition to shape and size, any movement of the tongue can indicate a deficiency of energy or the presence of an internal wind pathogen.

Color of Tongue
Tongue color varies widely from person to person, but is a good indicator of the overall nature of what is going on in the body.  A red tongue indicates that there is heat present  in the body, and the redder the tongue, the greater amount of heat present.  A tongue that is pale indicates a deficiency of qi and blood or the presence of cold.  A purple tongue tells your practitioner that there is stagnation somewhere in the body.

Tongue color may also vary on different parts of the tongue.  For example, a tongue that is red at the very tip indicates heat in the Heart, as the tip of the tongue correlates with conditions of the Heart.  Just behind the tip corresponds to the Lungs; the sides of the tongue are associated with the Liver; the center of the tongue with the Spleen/Stomach or digestion; and the back of the tongue is associated with the condition of the Kidney.

Tongue Coating
A coating on the tongue can also give your practitioner information about your health.  The thickness of a coating is an indicator of the severity of the condition being treated.  A thin coating, one in which you can see the tongue through the coating, indicates that any pathogen present is mild or on the exterior.  A thick coating that obscures the tongue tells your practitioner that the condition is deeper and more serious.

The condition of the coating also speaks to the condition of fluids in the body.  A moist or wet coating indicates poor fluid metabolism, and a dry coating indicates depleted fluids.  A coating that is peeled off, either completely or partially, indicates some kind of heat or damage to the Stomach, possibly a depletion of Stomach Yin, or damage to Stomach Qi.

Tongue coatings also vary in color.  In general, a thin white coating is normal, but can also appear in diseases associated with cold conditions.  A yellow or brown coat indicates heat, and a gray or black coat indicates an extreme condition.  It’s also important to note that foods such as red wine, orange juice, and coffee can alter the appearance of the coating.  Needless to say, food dyes can dramatically alter the color of the tongue.  In more than one instance, I have had a young patient stick out their tongue, only to see a bright blue, green, or pink coating!

The condition of your tongue will change as your health changes, but in general those changes appear on the tongue slowly.  One exception is during a cold or flu when the patient has a high fever, a very red tongue will appear fairly quickly.  

Tongue diagnosis can be a subtle art. To try it yourself, observe the variations of your tongue and compare it to that of friends or family members.  After you have looked at a few tongues, you will see that they differ widely, and with a little study can tell you a lot about the overall health of a person.