Tongue Diagnosis: Ever Wonder Why Your Acupuncturist Looks at Your Tongue?

By Maria Chah, DOM, AP & Jennifer Troyan


The tongue is one of many microsystems of the body in which Acupuncturists utilize as a diagnostic tool for creating a treatment plan. Two other major micro-components include pulse and ear diagnostics which we will discuss in future articles. For now, as one of the main barometers for treatment protocols, we will focus on the tongue.

We are going to cover five main diagnostic assessments:

1. Vitality

2. Color

3. Shape

4. Coating

5. Moisture

Interestingly, most of us don’t think of our tongues much but being a sensitive muscle that helps us to talk and swallow food. But, in the clinical world of acupuncture, it provides such important information about the internal systems of our body.

A bit of history

Let’s start with the definition from Merriam-Webster.

Tongue noun

: a fleshy movable muscular process of the floor of the mouths of most vertebrates that bears sensory end organs and small glands and functions especially in taking and swallowing food and in humans as a speech organ

There is an evolution of diagnostics, particularly of the tongue regarding the times of the highest part of warring and economic struggles of China. This was the time when the most positive growth and awareness evolved with naturalism, Taoism, and TCM (Traditional Chinese Medicine). An era in which these laws and principles became the primary measure of the human life force. In the natural world of diagnostics, the pulse beat and vitality of the tongue body provide the best diagnostic accuracy for one’s state of health. So, let's speak more into what it clinically means by vitality.

Life Vitality

Today the principles still hold strong in confirming each patient’s present health condition. Natural observation includes listening to the sound of one's voice, restricted or excessive motions, observing certain types of food cravings, and one’s own color preferences all are types of diagnostic tools in measuring a person’s vitality. Even facial recognition, smell of the breath, and hair health reveal the present state of health. In fact, all the five senses of the body are continuously signaling clues of health. Oftentimes when our health is out of balance, the lack of vitality is provisioned with pain, discoloration of tissue, or weird growth formations. The life force of the microsystems is the natural measure of vitality.

Tongue Vitality

At an earlier time, it was mainly the shape of the tongue that was witnessed. Not yet its coating, but the shape, size, and direction of the tongue were primary state of health indicators. For example, if the tongue was stiff and slightly deviated and the tip of the tongue was rolled up, this would indicate a yin deficiency heat problem.

Indication of a yin deficiency heat problem could come from too much drinking, dehydration, or something to do with intense muscle pain or stress on the heart. The shape is a good way for the physician to understand where the energy is stagnant, or deficient which helps the acupuncturist determine what meridian channels to stimulate. Today, science-based confirmation of the coating or lack of color of the tongue offers an even more concise barometer of what's happening to the vitality of the internal body. Tongue diagnosis has traits and weaknesses. The diagnosis of several distinctions makes it a critical diagnostic tool that practitioners rely on other than the pulse diagnosis.

Color, Shape, Coating and Moisture

The tongue body color almost always reflects the patient's true condition, especially in terms of the eight principles of identification pattern. This is what we mean when referencing the six evils and the four pillars, meaning is it hot or cold, is the pathogen above the body or below the body?

Such as if the tongue body is pale, the patient is experiencing loose stools, chills, and a rapid pulse, a sign of heat and cold possibly due to physical depletion in which the body may have been vulnerable to a bacterial or viral invasion. The color of the tongue body and pulse can pinpoint the location and nature of the condition. The tongue body, moisture, and coating colors also help the Acupuncturist determine the best treatment protocol to advise their patient for self-care.

The tongue body color and lack of moisture are more useful in chronic conditions, while the tongue coating is generally more useful in acute situations. This way we can determine if the chief ailing complaint is deep, superficial, or intermittent where it continues to remain in the body causing lingering issues. Accurate observation of the tongue allows the Acupuncturist to provide a treatment protocol that can either prevent, arrest and rid any pathogenic havoc that diminishes one’s vital health.

If the tongue shows a deficiency, paleness, discoloration, or even fissures (different shapes, colors, and tones), that is an example of a potentially acute condition. One side of your tongue could be thicker, more inflamed, or wider than the other side and that may indicate a specific organ needs support. The important thing to remember is that some shades of the tongue body color can be rather subtle and some very distinct and broad. Also, moisture is important. Sometimes the tongue could be glassy or look shinny like a mirror or very dry and cracked and withered. If you tend to lose taste, you should check with your doctor to make sure there’s no cancer on the tongue.


You can self-assess with proper lighting. It is best to use natural sunlight so get close to a window or go outside. Avoid fluorescent light or light that is too strong or too weak.

Once you're in the right light, gently extend your tongue as much as possible but not too much - you want to keep the natural shape of the tongue (so don’t do it Gene Simmons style!). It shouldn't take more than 15 or 20 seconds to evaluate it.

You are looking for color and shape. Tongue spirit denotes a period of liveliness or withered appearance. A withered appearance may lead to a poor prognosis showing a lack of vital life, denoting relative seriousness or disease. If it appears lively that is a nice indication of good health. How can you tell?

When looking at the tongue, here are the main organs correlating with specific sections of your tongue:

Knowledge of tongue diagnosis is just constant observation. The practice comprises visual viewing using your eyes as a visual aid. It’s just like you would spend time practicing a sport and getting good at it.

Try practicing every day just focusing on the color. Now, when you check your tongue, you want to make sure you don't eat any colored foods, perhaps first thing in the morning or at least an hour after you consume food.

Most importantly, when you evaluate the tongue body, there are five different colors you should be aware of. The subtle changes or shades of color are nothing to be extremely concerned about. But if the tongue, especially a true purple shade or even a light pale purple or bluish purple or reddish purple, a blue tongue will in most cases not appear bright blue, but rather a subtle bluish shade. This can mean something to do with blood circulation or lack of circulation or stagnation.

Spicy foods such as pickles, cayenne pepper and curry will tend to change the color of the tongue for a short time, or smoking tobacco can do the same and turn the tongue yellow. Milk can cause a white film and thick yellow coating especially when combined with hot food like pizza or beverages like coffee and cream. Also, medicine can affect the shade of your tongue and it's important to be aware of these so as to avoid drawing wrong conclusions about what you see.

Antibiotics can also vary in color very quickly so you have to consider the consumption of whatever it is you're taking, food, medicine or recreational activities like chewing tobacco or smoking tobacco that can give you false evaluation.

Parts of the tongue correlate with your major organs and microsystems:

Center of the tongue = stomach

Tip of the tongue = heart

Side of the tongue = liver

Very lateral edges of the tongue = lungs

Front side of the tongue = heart

Very root of the tongue = kidney

These are the five organs and whenever these parts of your tongue are discolored or misshaped, we would say as a practitioner that the anomaly has something to do with that particular organ.

This is not an article to coach you on how to diagnose your tongue so much as a beginner’s guide to observing. For example, it can help if you want to know if you have the beginning of a cold - you may see little speckles on your tongue. If you're tired all the time, you may see your tongue is a little pale. If you have what we call swelling of the abdominal area (bloated) with a pale tongue, you might have what we call spleen deficiency, and your hydrochloric acids are not breaking down food. Then we would ask if it could be from lack of proper chewing, or just not eating enough green leafy vegetables.

There are many reasons for a tongue evaluation to give us indications of whether or not you're dealing with a severe pathogen or just a basic pathogen like a cold, poor food intake, or lack of sleep. This will all be included in analyzing other aspects of your health history. Think about it like this, if you're going to buy steak, you don't get a brown steak, you look for a nice red, healthy, living steak. We're looking for that in the color and shape of your tongue. You are looking for nutritionally red or a nice pink color because the tongue is filled with blood vessels. Then you know your tongue and body are happy.

Lastly, the prognosis of the practitioner is to see patterns and disease and treat or possibly refer you to another practitioner depending on the situation. It’s all in the name of good health!


Information in this article and on this website is intended for informational or educational purposes only. This information does not replace professional medical advice, diagnosis, or treatment. If you have questions about a medical condition, always seek the advice of a doctor or other qualified health professional.

To learn about events and classes for self-assessment training, contact our office at 561-249-0447.

To learn more about our services, please contact our office at 561-249-0447 for a consultation on how to start your annual wellness optimization. During the consultation, we can provide guidance on the best treatment modalities to improve or enhance your state of wellness the TCM way.

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