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Tongue diagnosis is an important part of the Chinese medical assessment. During an examination, the overall tongue coating, shape, and color is taken into account.

The tongue reflects the health of the internal organs and blood circulation. Changes in the tongue color usually reflect chronic illness. As your health changes, the condition of your tongue will change as well.

A normal tongue is pink in color, medium thickness, has no cracks, ulcers, or teeth marks and has a light white coat on it.

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.

Pale:  Excess cold, especially if thick white coating.          
          Spleen Qi deficiency, especially if thin white coating
          Blood deficiency, especially if dull, pale face and lips

Red:  Excess heat, especially if there is a thick yellow tongue coating.
         Yin deficiency, especially if tongue body is thin and coating is thin,
         absent or peeled.

Purple:  Stagnant Qi or Stagnant blood if dark purple tongue body and/or
             red spots on the tongue

A Red Tipped Tongue

Different areas of the tongue are believed to reflect the health of the different organ systems. If there is an unusual color, coating, and/or shape in a certain area, special attention is paid to the corresponding organ system.

The tip of the tongue is related to the heart and fire element. When the tip of the tongue is red, it is an indication that emotional distress is causing an imbalance. Today's fast paced lifestyle has created an epidemic of stress and anxiety. It is very common to see red tipped tongues in our culture.

In addition to a red tipped tongue, other symptoms of a heart imbalance can include insomnia or frequent nightmares, restlessness, agitation, mouth ulcers, heat sensation in the chest, palpitations with anxiety, dry mouth and a rapid pulse.

Each area of the tongue is connected to specific internal organs.

Sides of the tongue:  Liver

Tip of the tongue:  Heart

Center of the tongue:  Spleen

Back of the tongue:  Kidney

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.

Swollen or puffy:  Spleen Qi deficiency, especially if teeth marks on the sides or Damp heat

Thin:  Blood deficiency or Fluid deficiency

Trembling:  Spleen Qi deficiency

Elongated:  Heart heat

Sides curled up:  Liver Qi stagnation or, if the sides are swollen and red, it may indicate Liver Fire

Cracks:  Excess heat or yin deficiency or Heart imbalance, especially if there is a crack down the middle of the tongue to the tip.

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!        

Thick:  Excess

Yellow, thick, glossy:  Damp Heat

Dry, yellow:  Excess heat

Peeled or absent:  Deficient yin

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.  

As with any assessment method, acupuncturists never rely on tongue diagnosis alone, but use it to provide a complete picture of a person's health.

Tongue diagnosis can be a subtle art. To try it yourself, observe the variations of your tongue's shape, color, size, and coating 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!

Resources: Understanding Tongue Diagnosis by Lynn Jaffee, L.Ac., Dipl.OM, MAOM

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