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The tongue has many relationships and connections in the body, both to the meridians and the internal organs. It is therefore very useful and important during inspection for confirming TCM diagnosis. It can present strong visual indicators of a person's overall harmony or disharmony. The tongue has a special relationship with the Heart, in that the Heart opens to the tongue. The tongue is said to be an "offshoot" of the Heart, or "flowers" into the Heart. The normal tongue in Traditional Chinese Medicine has a light red or pinkish body with a thin white coating.
Connections Channels/Meridians Reaching the Tongue
Heart Channel (Hand Shaoyin) - The Luo connecting channel connects to the root of the tongue.
Spleen Channel (Foot Taiyin) - An internal branch of the primary channel spreads over the lover surface of the tongue. - The tongue is penetrated by the Spleen
Divergent channel Kidney Channel (Foot Shaoyin) - An internal branch of the primary channel terminates at the base of the tongue.
Bladder Channel (Foot Taiyang) - A branch of the muscle/sinew channel binds to the root of the tongue.
San Jiao Channel (Hand Shaoyang) - A branch of the San Jiao muscle channel links with the root of the tongue.
Tongue areas as they correspond to internal organs in Chinese Medicine
Tongue Diagnosis Method and Cautions
Sunlight will give the most accurate colour of the tongue body and coat. If sunlight is not available, use a second light source such as a small flashlight to compare the tongue colour to the original light source.
The tongue should be extended in a relaxed manner, and should not be held out for an extended duration.
Food and Drink
Food and drink, such as coffee, green tea, and candy may alter the colour of the tongue coating.
Some patients may brush their tongue to help freshen their breath or as an Ayurvedic practice. Ask the patient not to brush their tongue, at least the day of their TCM tongue diagnosis.
Seasons of the Year
Time of Day
The coating of the tongue usually becomes thinner as the day progresses, while the colour of the tongue body becomes more red and shiny.
Patient's Age and Body Shape
Tongue Feature Indications
Tongue Body Colour
Indicates the state of Blood, Yin organs, and Ying (Nutritive) Qi.
Normal Tongue Body
Pink or light red in colour
Bluish Purple or Reddish Purple Tongue Body
Red Tongue Body
Heat in the Heart Zang
Scarlet Tongue Body
A scarlet tongue that is also peeled or shiny indicates Yin Deficiency, usually of the Heart and/or Lung depending on the area of swelling.
Dark Red Tongue Body
Pale Tongue Body
Green Tongue Body
Tongue Body Shape
Big or Enlarged Tongue
Half the Tongue Is Swollen
A half swollen tongue may indicate general weakness of the Channels
Local Swelling on One Side
A tongue with swelling in Liver and Gallbladder area usually indicates Rising Liver Yang or Liver Fire
Swollen Between the Tip and the Central Surface
Short and Contracted
Tongue Body Features
Rough or Tender Texture
Black spots usually indicate Qi and Blood Stagnation or heat in the Blood
Ulcerated Tongue Body
Deviated Tongue Body
Moving, Lolling, Wagging, Playful Tongue Body
Teeth Marks on Tongue Body (Scalloped)
Quivering or Trembling Tongue Body
Sore Covered Tongue Body
Excess Heat damaging Blood and Yin
Tongue Body Moisture
Reveals the state of Yin and Fluids in the body
Dry Tongue Body
Yin / Blood xu. Yin Xu/ Yang Shi
Slightly Dry Tongue Body
White Tongue Coat
White Like Powder Tongue Coat
White Like Snow Tongue Coat
This may indicate exhaustion of Spleen yang with Damp-Cold in the Middle Jiao
Yellow Tongue Coat
Dirty Yellow Tongue Coat
This tongue coating may indicate Stomach and Intestinal Damp-Heat
Simultaneous White and Yellow Tongue Coating
Grey Tongue Coat
Black Tongue Coat
Half Yellow, Half White (Longitudinally)
This coating may indicate Heat in the Liver and Gallbladder
Yellow Root With A White Tip
This may indicate that exterior Pathogenic Heat is penetrating more deeply into the interior of the body.
Black in the Centre, White and Slippery on the Sides
This may indicate Spleen Yang Deficiency with interior Damp-Cold
Tongue Coat Thickness
Thin Coating Normal
Peeled, Mirrored, Shiny, No Coating
Tongue Body Cracks
Short Horizontal Cracks
Dryneesss in correspnding organ due to Blood or Yin Xu
Long Horizontal Cracks
More severe dryness. Blood or Yin Xu
Transverse Cracks On the Sides of the Tongue
Liver Blood xu
Tongue Coat Root
Tongue Coat Has Root
Tongue Coat Has No Root
Example 1 - NEW
Body colour: Reddish-Purple.
Body shape: Swollen and cracked.
A Reddish-Purple tongue body colour usually indicates Blood stasis deriving from or associated with Heat (whereas a Bluish-Purple colour generally indicates Blood stasis deriving from Cold). In this case, the tongue colour is consistent over the whole tongue so we cannot determine from the tongue alone where the Blood stasis is located. The pulse and the symptoms can tell us this. However, the most likely pattern is that of Liver-Blood stasis.
The tongue body is also Swollen which indicates the presence of Phlegm. The Lung and Heart areas of the tongue are especially swollen which points towards the fact that the Phlegm is predominantly in the Upper Burner. Phlegm and Blood stasis are often seen existing side by side, especially in older patients, as they interact with and "promote" each other. Blood stasis stops fluids from being transported around the body smoothly therefore encouraging the production of Phlegm, while Phlegm blocks the smooth flow of Qi and Blood leading to stasis.
The tongue is totally peeled (without coating) and with many cracks, both signs of chronic Yin deficiency. It is likely that the Yin deficiency preceded the Blood stasis. Chronic Yin deficiency leads to Empty-Heat and we know in this case that the Blood stasis derives from Heat as the tongue is a Reddish-Purple colour. Although we cannot tell conclusively from the tongue only, the Yin deficiency is most likely of the Stomach and Kidneys
Therefore, in conclusion, we can say that this many suffers from Yin deficiency with Empty-Heat, Blood stasis and Phlegm in the Upper Burner.
Body colour: Reddish-Purple, Bluish-Purple in the chest area on the right.
Body shape: Stiff, slightly Swollen.
Coating: sticky coating without root.
The overall body colour of this tongue is Purple, indicating Blood stasis. It is predominantly Reddish-Purple, which indicates Blood stasis deriving from or associated with Heat but the chest area on the right of the tongue is Bluish-Purple which indicates that there is also some Cold which has lead to Blood stasis in the chest.
The tongue is also Stiff. A Stiff tongue indicates either severe Blood stasis or internal Wind. As the tongue is also Purple, in this case it is most likely that it indicates Blood stasis.
The sticky consistency of the coating simply indicates that there is Dampness (or together with the Swollen tongue body Damp-Phlegm), but the fact that it is rootless reflects a deficiency of Stomach-Yin. A rootless coating reflects the beginning stages of Stomach-Yin deficiency.
Example 3 - NEW
Body colour: Slightly Red but Pale on the sides.
Body shape: Swelling in the Spleen area on the sides, Stomach cracks.
This tongue shows clearly a relatively common condition of Stomach-Yin deficiency (leading to some Heat) and Spleen-Yang deficiency. The cracks in the Stomach area indicate Stomach-Yin deficiency and the overall colour of the tongue is slightly Red showing that this Yin deficiency has lead to some Heat, but the sides of the tongue in the Spleen area are Swollen and Pale. This relects Spleen-Qi and Yang deficiency leading to Dampness.
It is important to distinguish between the Liver and the Spleen areas on the sides of the tongue. The Liver area is a longer and thinner strip, covering nearly the whole side of the tongue, whereas the Spleen area is shorter and fatter and in the middle of the side of the tongue.
In the case of this patient, it would therefore be necessary to treat both Yin deficiency (of the Stomach) and Yang deficiency (of the Spleen). Even though the Yin deficiency (and Empty-Heat) seem predominant because the main area of the tongue body is Red and it is peeled, it is likely that the Spleen deficiency came first. As the Spleen and Stomach are so closely connected, a long-standing case of Spleen-Qi and/or Yang deficiency may lead to a deficiency of the Stomach (which has a tendency to become Yin deficient). A suitable remedy for this condition might be Shen Ling Bai Zhu San (Central Mansion in the Three Treasures remedies).
Example 4 - NEW
Body colour: slightly Red.
Body shape: Swollen, especially in the chest area with a Heart crack.
Coating: sticky coating.
This tongue is slightly unusual in that it clearly shows us the exact location of a pathogenic factor. The chest area is clearly more Swollen than the rest of the tongue indicating the presence of Phlegm in the Upper Burner.
As a general rule, the tongue body shows more the presence of Phlegm and the coating reflects the presence of Dampness. When the tongue body is Swollen and the coating is sticky, as in this case, it normally indicates the presence of Damp-Phlegm, in this case clearly in the Lungs.
Body colour: slightly Red.
Body shape: Swollen, especially in the chest area with a Heart crack.
Coating: sticky coating.
The Reddish-Purple coating is more distinct on the sides in the Liver area which points specifically towards Liver-Blood stasis. The Liver area on the sides is also Swollen which usually indicates severe or chronic Liver-Heat. The Liver area being Red and Swollen simply indicates a more severe degree of Liver-Heat than if the Liver area is just Red.
The strips of a slightly thicker, white coating on either side of the tongue indicate a Gall-Bladder pathology, most usually Dampness in the Gall-Bladder.
Although the tongue points towards the Blood stasis being especially in the Liver, treatment of this patient should focus equally on moving Blood in the Heart. The presence of a Heart crack indicates a constitutional tendency to Heart patterns.
Body colour: pale.
Body shape: swollen, central Heart crack, transverse Spleen cracks on the sides.
Coating: thin-white (normal), slightly yellow in the centre.
The pale tongue-bocolour indicates Yang deficiency (it may also indicate Blood deficiency, but in a man, it is more likely to be Yang deficiency). It is not possible from the tongue only to establish which organ is mostly affected in this case by the Yang deficiency: however, since the tongue body is also swody llen, which usually indicates Phlegm, it is more likely to be Spleen-Yang deficiency. The central crack in this case correlates with the Heart.
A "Heart crack" is rather thin and long, extending from near the root of the tongue to near the tip; a "Stomach crack" is rather wide and is situated only in the middle section of the tongue, in the Stomach area. What does a Heart crack indicate? It depends on its depth and on the colour of the tongue tip. Generally speaking, a Heart crack indicates a constitutional propensity to Heart patterns and to emotional problems: the deeper the crack, the stronger this propensity. If, in the presence of a Heart crack, the tongue tip is red, it indicates that there already is a Heart pattern usually from emotional problems. In other words, a change in colour of the tongue body indicates that that particular constitutional tendency to Heart patterns has manifested itself and generated an actual Heart pattern. If we compare two people both with a red tip of the tongue, one with a Heart crack and the other without, the presence of a Heart crack indicates that that person has a constitutional tendency to Heart patterns and that his or her condition is deeper and more difficult to treat than that of the person without a Heart crack.
The small, transverse cracks on the sides usually indicate severe, chronic Spleen deficiency. Thus, we can conclude that this man suffers from a chronic Spleen-Yang deficiency and Phlegm.
Body colour: dark red, redder on the sides.
Body shape: swollen on the sides, Stomach crack.
Coating: white, rootless.
The dark red body colour clearly indicates intense Heat and the redder colour and swelling on the sides shows that the Heat is in the Liver. Thus, this patient has suffered from Liver-Fire for a long time (we can deduce it is a long time from the dark-red colour) and the intense Fire has begun to injure Yin. We know this from the fact that the coating is rootless: this indicates the beginning of Yin deficiency and, since the tongue is dark-red and there is a coating, we can deduce that it is the Fire that is injuring Yin rather than deficient Yin giving rise to Empty Heat.
Body colour: red slightly tending to purple, redder tip.
Body shape: swollen tip, tip curling up, Heart crack.
Coating: normal but there is a slightly peeled patch without coating on the left side towards the root.
The red body colour indicates Heat and the slight purple colour indicates that there is some Blood stasis. The red tip indicates Heart-Fire and the swelling of the tip and its curling up confirm and reinforce this diagnosis. The presence of the Heart crack indicates that this patient had a constitutional tendency to Heart patterns and to emotional problems. The small patch without coating indicates the beginning of Stomach-Yin deficiency.
Body colour: red, tending to purple
Body shape: very swollen, Stomach crack.
Coating: yellow, rootless, dry.
The red body colour indicates Heat while its slightly purple hue indicates that there is some Blood stasis. The very swollen body shape indicates the presence of Phlegm. The red colour, together with the Stomach crack and the yellow coating, indicates that the Heat is located in the Stomach. This is confirmed by the rootless coating which indicates the beginning of Stomach-Yin deficiency, presumably from the Heat injuring Yin. The dryness of the coating confirms both the Heat and the Yin deficiency (it could be due to either).
This tongue has a rootless but relatively thick coating: this is doubly bad. Why? The rootlessness of the coating indicates that there is the beginning of Yin deficiency but the relative thickness of it indicates that there is a pathogenic factor, in this case, Stomach-Heat: thus, this patient suffers from a Full condition occurring against a background of Stomach deficiency. In other words, it would have been better if the coating had been either rootless but thin (indicating Yin deficiency but no pathogenic factor) or thick with root (indicating the presence of a pathogenic factor but also a good state of the Stomach).
Body colour: reddish-purple, red sides
Body shape: very swollen, swollen sides, Stomach crack
Tongue coating: sticky-yellow, sticky-dry-rough-yellow inside the Stomach crack.
The reddish-purple colour of the tongue body indicates Blood stasis deriving from or associated with Heat. The redness on the sides indicates Heat in the Spleen and/or Stomach; in this case, the redness on the sides is not related to the Liver because it occupies a wider area than the Liver are and also because it is associated with a Spleen-type of swelling on the sides. The general swelling of the tongue body indicates the presence of Phlegm, while the swelling on the sides is related to the Spleen and it indicates Dampness occurring against a background of chronic Spleen deficiency.
The sticky-yellow coating confirms the presence of Dampness while the Stomach crack, together with the sticky-dry-rough-yellow coating insides it indicates Phlegm-Heat in the Stomach.
In conclusion, the main location of the disharmony in this case is in the Middle Burner with Stomach and Spleen Heat, Damp-Heat and Phlegm-Heat in the Stomach. The Blood stasis probably derives partly from the Heat and partly from the chronic retention of Phlegm.
Body colour: slightly pale, almost normal
Body shape: very swollen, more so on the (patient's) left side
Tongue coating: thick-white-rootless coating.
The swelling of the tongue body indicates Phlegm while the partial swelling on the left side often indicates a weakness of the channels on that side. Such weakness may derive either from a febrile disease with high temperature or from an accident to that side of the body.
The rootless coating indicates Stomach-Qi or Stomach-Yin deficiency, but its thickness indicates the presence of a pathogenic factor, probably Dampness. A thick-rootless coating is doubly bad because, on the one hand Stomach-Yin is deficient, but, on the other, there is a pathogenic factor. It is better for a rootless coating to be thin (indicating Stomach-Qi deficiency but no pathogenic factor) or for a thick coating to have a root (indicating the presence of a pathogenic factor but also intact Stomach-Qi).
Body colour: reddish-purple
Body shape: swollen sides
Tongue coating: thin-white-rootless coating, peeled in patches.
The reddish-purple colour indicates Blood stasis with Heat. The swelling on the sides indicates chronic Spleen deficiency and the rootless coating missing in patches indicates Stomach-Yin deficiency.
This patient too suffers primarily from a disharmony in the Middle Burner with chronic Spleen-Qi deficiency and Stomach-Yin deficiency. Both the swelling on the sides (related to the Spleen) and the rootless coating missing in patches (related to Stomach-Yin) indicate a chronic condition because this type of swelling and the lack of coating develop over a long period of time.
It is not possible to tell from the tongue only which other organ (apart from the Stomach), if any, is affected by the Blood stasis and the Heat.
Body colour: red, red tip
Body shape: short.
Tongue coating: thin-white.
This slide is presented here mainly as an example of a short tongue body. The patient could not stick the tongue out more than that. The red tip indicates Heart Heat.
Peeled coat red body
Stomach Qi and Yin is severely damaged
Sore covered tongue body
Excess heat damaging Yin and Blood
Carina is available to lecture for your group or institution on this subject.
Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu. is a practitioner of 11 years, complementary medicine lecturer of 4 years and mother of six in Galway, Ireland who practices what she teaches.
For an appointment call Carina directly on 083 34 66 333.
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