A Map of the Inside: Tongue Diagnosis in Traditional Chinese Medicine

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As we discussed in our recent post, “Treating the Whole Body in the Ear,” different body parts can be microsystems of the larger body. The ear, for example, is a tiny, reverse mirror of the body, with points relating to the head and neck at the bottom end of the lobe, and correspondence to the limbs and feet at the top. Similar to the ear, the tongue is a tiny map of the whole body, but significantly, it is a map of the inside of the body. The tip of the tongue relates to the heart and lungs; the middle part correlates to the spleen and stomach; the tongue root points to the kidneys; and the sides of the tongue correspond to the liver and gall-bladder. But Eastern medicine practitioners are not only looking at the body of the tongue; we are also looking at the texture, or coating of the tongue, that so-called fur that covers the muscle (or doesn’t, as the case may be). Both of these togetherthe body and the coatingare known as the tongue sign, and can help us diagnose different imbalances and diseases within the body.

The tongue is so effective as a pathology tool because it doesn’t lie!  Whether you’re aware of some anxiety within you or not, whether you know you’re at the beginning stages of a cold or not, the tongue will tell. Of course, the tongue can’t diagnose everything. And a practitioner being able to correctly diagnose also depends on the habits of the patient: patients should avoid certain foods that cause discoloration (beets, coffee, food coloring), and refrain from using a tongue scraper/brush for usually a day prior to diagnosis. Given all that, tongue diagnosis can be extremely helpful in identifying issues such as rheumatoid arthritis, digestive issues, menstrual conditions, colds, anxiety, blood stasis, different deficiency or excess dysfunctions in the liver and kidney, and even the early stages of breast cancer.

So what are we looking for when we ask you to stick out your tongue?

A healthy tongue has a light red color, is smooth with no cracks, is neither too thick and puffy/swollen or too thin, and has a thin, white coating. All of these factors together indicate a strong and vital qi, with balance in the internal organs.

What does an unhealthy tongue look like and what does it mean?

Different tongue signs indicate different imbalances. Read on for some common ones, and for a more exhaustive analysis, check out tongue diagnosis master, Giovanni Maciocia, a celebrated practitioner and professor of Chinese medicine.


Pale: Yang deficiency or blood deficiency in TCM. Indicates possible anemia or adrenal energy imbalances, issues with the pancreas and/or digestive function. Diet modifications, herbal medicine and acupuncture are commonly used to treat a pale tongue.

Reddish purple: Indicates blood stasis deriving from heat, a condition of hyperactivity in the TCM conception of the body that comes from yin-yang imbalance. If the tongue is uniformly reddish purple, you won’t be able to tell where in the body this blood stasis is, but pulse diagnosis can help narrow it down. But if certain distinct areas of the tongue show a more reddish/purple or purple color, then we can see exactly where the stasis is occurring in the body. Emotional stress, diet and lifestyle are a common cause for blood stasis. Diet modifications, herbal medicine and acupuncture, lifestyle modifications are commonly used to treat a reddish/purple or or purple tongue.


Swollen: Indicates the presence of phlegm in the body, a result of qi deficiency or qi stagnation.

Rippled Edges/Teeth Marks: Corresponds to a qi deficiency, which may manifest as fatigue, anxiety, poor appetite, digestive conditions, and shortness of breath.


  • If there are many cracks all over, this points to chronic yin deficiency, which leads to empty heat.
  • If there are cracks in specific areas, for example, the stomach area of the tongue, this would point to a stomach yin deficiency.
  • If there is a heart crack, a crack extending from the root of the tongue down towards the tip, this could indicate a tendency toward heart issues and emotional problems. The deeper and more pronounced the crack, the stronger this tendency will be. Cracks on the sides of the tongue point to spleen yang deficiency.

You may be asking, so what does that mean?! When we talk about a yin deficiency in TCM this means that the energy of the body that is used for moistening and cooling bodily functions is lacking, or is depleted. When we talk about a yang deficiency in the body, it means that the energy that warms the bodily functions is lacking or depleted. Empty heat refers to that lacking of yin energy (moistening and cooling energy), creating a false heat in the body, that typically manifests as night sweats, hot flashes or insomnia.


Yellow or Brown Coating:

  • A thin yellow coating indicates wind-heat in the system, which can manifest as fever, sore throat, feelings of agitation, and feeling warm.
  • A thick, sticky, greasy yellow coating is the result of dampness, often caused when the spleen (digestive system) is not functioning correctly and the body experiences an excess of fluid. This commonly manifests as feeling “puffy,” bloating, stubborn weight gain, brain fog or nausea.

Peeled or Absent Coating: Correlates to kidney yin and/or stomach yin deficiency, associated with lower back pain or tinnitus. Manifesting as a feeling of overwhelm, of not being able to keep it all together as well as hot flashes, night sweats, insomnia.

Tongue diagnosis is only one tool of many in a TCM practitioner’s arsenal. We will often look at your tongue (for a short period of around 15 secondsany longer than that and the tongue can change shape and/or color, essential factors in diagnosis!), in addition to checking your pulse, examining your ears and eyes, and pressing certain acupuncture points; we will also listen to how your voice sounds and ask you questions to get a sense of your daily routine and wellbeing: sleep, eating, and exercise habits, any experience of pain or stress, etc. But tongue diagnosis is an extremely effective tool, and is even gaining traction in the Western medicine worldnot to mention the thousands of years of effectiveness in Eastern medicine practice! If you have any questions about your tongue and what it means for your health, reach out to us for a virtual health consult or an in-office acupuncture session and we’ll be able to read your tongue and help create a wellness plan that is just right for you!