“What are you looking at?” is the most common question I hear after I ask a patient to stick his or her tongue out during a visit. While bizarre to someone who is unfamiliar with Traditional Chinese Medicine (TCM), this technique is one of the most essential diagnostic tools used by a trained practitioner.
TCM is an ancient form of medicine that was developed over 2000 years ago. In TCM, a practitioner observes many physical characteristics when assessing a patient including their general demeanor, tone of voice, eyes, face structure, skin quality and tone, pulse, and the appearance of their tongue. In TCM, these are seen as some of the most telling qualities of someone's health.
The tongue is a great tool to understand what is going on inside your body. With some basic knowledge, you too can begin to understand what your tongue says about you.
Note: There are many nuances associated with tongue diagnosis. This article barely begins to scratch the surface of this ancient technique. This is a very basic outline of a very complex system.
Firstly, the tongue is best assessed in natural light. The tongue must not be assessed directly following a meal or drink, although water and most herbal teas are okay. Or, if a person has brushed/scraped his or her tongue that day or within the two to three days prior.
The tongue in Chinese medicine provides a map for the body, with the tip of the tongue representing organs higher in the body (i.e. the heart and lungs), the middle representing the organs in the mid section of the body (i.e. the sides of the tongue represent the liver and gallbladder, and the middle represents the spleen and stomach), and the back of the tongue represents organs lower in the body (i.e. intestines, kidney, and bladder). What you see on the tongue is as important as where you see it on the tongue as this can tell a practitioner where the imbalances are in your system.
When looking at the tongue, you are looking at the body, shape, and colour (whether it is pale, red, purple, small, puffy, enlarged, or pointy), the coating (the colour and whether it is thick or thin), the texture (whether it is dry, glossy, or greasy), along with other features such a spots and cracks. While some characteristics can be genetic or present from birth, others develop as we age based on lifestyle habits, diet, one’s mental-emotional state, and the health of our internal organs.
A normal tongue is pink in colour, glossy, smooth with very few bumps (or none), has smooth sides, has no coating, or a very mild white coat towards the back. For reference, most babies are a great example of healthy tongues.
Below are some common tongue characteristics and what they may indicate about your internal health.
A pale tongue indicates a state of deficiency in Chinese medicine. This individual usually has low energy overall. The most common specific diagnosis from this tongue colour is Qi deficiency, especially if the tongue has a thin white coat and jagged edges, or teeth marks along the sides. A person with Qi deficiency is depleted, fatigued, suffers from bloating and/or gas, and possibly has low appetite or difficulty concentrating. This may be accompanied by anxiety or worry.
Another diagnosis that may come from a pale tongue is blood deficiency - this is more common in women. Blood deficiency suggests a person does not have enough circulating blood and it is similar to what is diagnosed as iron deficiency or anemia in Western medicine. Symptoms include lethargy, pale skin, dizziness, poor memory and difficulty with concentration, thinning hair, brittle nails, insomnia, cold hands and feet, and sometimes shortness of breath or heart palpitations.
A pale tongue may also indicate a yang deficiency. This tongue usually has a thicker white coat and is more puffy in appearance. This individual will have low mood and apathy, feelings of burn-out, low libido and low overall spirit. They will also be very sensitive to cold and may suffer from lower back pain. This diagnosis is common in those who have a Western diagnosis of hypothyroidism.
A red tongue accompanied by a yellow coating and/or red spots can indicate heat in the body. This tongue profile will present in people who get hot and sweaty easily. He or she may be irritable, easy to anger or have a short-temper. Painful and red acne can be associated with this condition. Depending on where the redness is located, there may be heat in a certain organ. For example, if the center of the tongue is red, this may indicate heat in the stomach which can present as heartburn or indigestion. Heat can be a sign of a deeper imbalance, for example, a Yin deficiency. A person with a Yin deficiency will experience irritability, joint concerns, hot flashes, insomnia, and/or night sweats.
When accompanied with veins under the tongue that are dark purple or distended, this tongue indicates blood stasis. This condition may present as cold limbs, headaches, varicose veins, achey or painful legs, and dry or scaling skin. If this person ever suffers from pain, the pain is typically sharp or stabbing in nature.
A variable colour pattern may indicate Qi stagnation. This tongue will have a red tip and possibly red sides, while the centre and back can be normal or lighter in colour. A person with Qi stagnation is emotional, suffers from mood swings, and becomes stressed easily.
A swollen or enlarged looking tongue can indicate a condition in TCM called dampness. Individuals with dampness have a greasy or oily looking tongue, which may have a white or yellow coating. If the coating is yellow, this indicates “damp heat” which is usually accompanied by IBS type symptoms, skin concerns, or being easier to anger. If the coating is white, there may be "damp retention" and a person can present with loose stools, indigestion and gas. A damp person will be aggravated by hot, humid or damp weather.
Lines or grooves on the tongue are also important. Depending on where they are located, lines or demarcations on the tongue can indicate an imbalance in a specific organ. For example, if you have a deep crack in the tongue down the midline, this may indicate a digestive imbalance.
Remember, any of these patterns are not a cause for alarm - they simply provide insight into your current state and what your body may need to feel more balanced.
Tongue diagnosis is a complex art that is refined after years of practice and study. A trained practitioner has viewed hundreds of tongues before even beginning to practice. If you are curious, find a TCM Doctor, licensed acupuncturist or trained naturopathic doctor in your area who is qualified to assess and treat you.