If you have ever had a Traditional Chinese Medicine (TCM)
acupuncture treatment, your acupuncturist probably asked to look at your
tongue. As any of our patients will
attest to, at Stepping Stone Acupuncture, we always want to look at your tongue
before your treatment. Why do we do this?
The tongue provides us with valuable information that helps
us to correctly diagnose the energetic pattern in your body, the root cause of
whatever sickness or pain you are experiencing, and how to treat it. We look at the color, shape, texture, and
thickness of the tongue, as well as the color, thickness, and quality of the
tongue coat. You would be amazed at how different tongues can look between two
In acupuncture and TCM, we are working to balance different
systems of energy in the body. Each energetic system has a meridian running
along the surface of the body, and it is along those meridians that the
acupuncture points are located. All the energetic systems in the body are also
represented on a particular area of the tongue, which is why we can get so much
information from looking at your tongue. The image below depicts the
different tongue regions and which energetic system they correspond to.
While tongue diagnosis is a very complicated process that
takes years to perfect, we can tell you some of the basics here. The normal
healthy tongue is a light “fresh red”, with a thin white tongue coat. The
tongue coat is not sticky, but does not look like it can be brushed off easily
(we say it is “rooted”.) The tongue itself does not appear swollen, and there
are no teethmarks along the sides of the tongue.
However, few people have a perfectly healthy-looking tongue,
as few people are in a state of perfect health! Here are some common features
that we see on people’s tongues. Take a look at your tongue and see what you
- Deep red tongue: This indicates heat in the
body. This heat may manifest in various ways, depending on the dominant
energetic systems involved. If the sides of the tongue are deep red, this
indicates heat in the Liver energetic system, which may manifest as
irritability and anger, headaches, impatience, PMS, or high blood pressure.
Heat in the Lung energetic system can cause the whole front area of the tongue
to be red. This may happen in the case of chronic cough with sticky phlegm or
to long-term smokers. If just the very tip of the tongue is red, this indicates
heat in the Heart energy. This frequently occurs with any sort of emotional
- Pale tongue: This indicates a deficiency of
either qi (energy) or blood (deeper energy) in the body. This may manifest as
fatigue, sleep problems, feelings of weakness, digestive problems, scanty
periods for women, dizziness, or dull and chronic pain.
- Dark red/purplish tongue: This indicates that
energy is not flowing smoothly in the body. This frequently occurs with pain.
Tongue Shape and Thickness:
- Swollen tongue: This indicates a deficiency of
qi energy and possibly a build-up of Dampness in the body. Dampness is an
abnormal buildup of fluids and energy, which can cause such symptoms as nasal
congestion, heavy limbs, digestive problems, and weight gain. Qi deficiency causes fatigue, trouble concentrating,
loose stools, and trouble with digestion. If you notice that there are
teethmarks along the side of your tongue, this indicates that it is slightly
- Thin tongue: A very thin tongue often indicates
a deficiency of certain energetic substances that has been going on for a very
- Center crack that goes all the way to the tip:
This gives us information about your baseline constitution, telling us that you
have a tendency towards problems with respiratory system or the emotions.
- Lots of horizontal cracks: This suggests what we
call “Yin” deficiency. TCM is based on trying to maintain a balance of Yin and
Yang, two fundamental forces in the body. Yin is heavy, watery, passive, cool,
and moves inward. Yang is light, fiery, active, warm, and expansive. When there
is a shortage of Yin (causing horizontal cracks), this can manifest as feelings
of heat, menopausal symptoms, trouble with digestion such as chronic acid
reflux, or insomnia, depending on the location of the cracks.
- Wet: If the tongue appears very wet, we often
assume this is due to a shortage of Yang forces in the body. (For example,
there is not enough Yang – not enough heat – to burn off the wetness on the
- Dry: If the tongue appears very dry, it
indicates the opposite of a wet tongue – this time, it shows us there is a lack
of Yin in the body. (For example, there is not enough of the cool and
moistening Yin energy to adequately moisten the tongue.)
- Thick and sticky tongue coat: This indicates the
presence of dampness or phlegm in the body. Depending on where the sticky coat
is located on the tongue, these symptoms will manifest in different ways. For
example, if there is a sticky coat in the Lung area, this may show up as a
cough or sinus problems. If there is a sticky coat in the very rear of the
tongue, this may show up as problems with reproductive health (such as uterine
fibroids or painful periods), urination, or bowel movements.
- No tongue coat: If there is no tongue coat, this
often indicates a deficiency of the yin energy in the body. A decline in yin
energy is a natural part of menopause in women. Therefore, many menopausal
women do not have very much of a tongue coat.
- Yellow tongue coat: This is another indication
of heat in the body.
- Thick white tongue coat: This is an indication
of cold in the body. A thick white tongue coat in the stomach/spleen area of
the tongue (center) may appear as symptoms such as stomach cramps that get
better when heat is applied.
A thick white tongue coat in the rear of the tongue may manifest as frequent urination, intense menstrual cramps, or low back pain.
As mentioned, this is just a brief introduction to the very
complicated art of tongue diagnosis! Remember that most symptoms can be caused by any number of energetic patterns - this is partially why looking at the tongue is so helpful! It can help us determine whether your fatigue, for example, if from a deficiency of energy (pale tongue) or because energy is not flowing properly (dark tongue). Moreover, your tongue is unique to you, just as your particular energetic make-up is unique.
To help your acupuncturist correctly
diagnose you, refrain from brushing your tongue on the day of an acupuncture
appointment. Also, try not to consume food or drink that will change the color
of your tongue within a few hours of your treatment. Examples include candy
with artificial coloring, coffee, and blueberries.
The tongue will change over time to reflect the changes in
the balance of your energetic system. However, the tongue takes a long time to
change, so don’t expect to see a difference after your acupuncture appointment!
We acupuncturists use the tongue to help us diagnose your underlying condition,
and we use the pulse (another important diagnostic tool) to diagnose how your
energy is acting in that moment. Taken together, these tools provide us with
very important and useful information to understand how your body and energy
The tongue reflects what is going on within your body. After
all, it is the only muscle in the body that we can see.