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
- Body Colors and Indications
- Body Shape and Indications
- Body Sublingual Veins and Indications
- Tongue Coatings and Indications
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 | Indications |
| 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 | Indications |
| 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 | Indications |
| 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 | Indications |
| 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 dampness |
| sticky (greasy, creamy) | dampness or phlegm retention of food |
Coat Coloration | Indications |
| 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 | Indications |
| rooted moss appears firmly implanted | strong st/sp qi |
| rootless moss appears to float on the surface | st/sp qi def |
| peeled | sp qi def deficient yin or fluids |
