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What Does Your Tongue Say about You?

August 27, 2021

Ever look at your tongue and think: “That isn’t NORMAL?!”
“What in the world does that mean?”
“I haven’t seen that before!”

If you have never looked at your tongue with intrigue and curiosity, start! Check out your tongue before reading further. Is it red, cracked, and thin with little to no coat? If so, you may be experiencing hot flashes, night sweats, insomnia, and irritability. Or if are you experiencing fatigue, loose stools, spontaneous sweating, and worry, your tongue likely has teeth marks and is pale with a thin white coat.

The Tongue as a Diagnostic Tool
Your tongue’s muscle body shape and color, as well as the coat quality and color, can tell you a lot about your current health condition. Since changes to its appearance are easily visible, the tongue is a simple way to help monitor health improvements or decline over the course of treatment. The tongue body is most useful in tracking chronic conditions, while the coat tracks acute condition states.

Before measurable blood markers, specific organ diagnostic tests and advanced imaging existed, health professionals relied on the five senses to identify, treat, and cure disease. Imagine having only sight, sound, smell, taste, and touch available to identify, diagnosis, and treat disease with great accuracy. Listening to the tone, quality, and language of the voice; looking at the overall essence and appearance of the patient; smelling and often tasting bodily excretions; and palpating the pulse, muscles, and abdomen were a few of the limited diagnostic tools needed to accurately identify and treat ailments prior to the invention of modern technologies.

Traditional Chinese Medicine (TCM) is one of the health practices that used the five senses to diagnosis and treat disease in patients. Today, TCM practitioners continue to use tongue and pulse diagnoses, along with ten specific diagnostic questions, to identify and treat unwelcome symptoms in the body—the same as was done 3,000 years ago. For TCM practitioners, examination of the tongue can instantly clarify a main cause in a complex disorder that are often full of contradictions. In TCM, there are few but complex causes for disease states, and identifying the root cause is extremely important to avoid adverse side effects from treatments. Tongue diagnosis is often the one identifiable marker that can indicate a favorable treatment from a less beneficial protocol, as it is used to select appropriate acupuncture points, herbal formula combinations, and help determine treatment duration/frequency.

The Tongue Body
The tongue body is the muscle under the coating on top. Unlike the pulse, it is relatively unaffected by short-term events. For example, a stressful drive to an appointment can change the pulse quality and affect blood pressure and heart rate readings, but the tongue will remain true to the patient’s health condition.

Tongue color almost always reflects the true health of the patient and is the definitive indicator when contradictions are seen between symptoms and tongue appearance.

Body color:

  • Pale: Cold, and qi, yang or blood deficiency
  • Red: Heat, excess (coat), deficient (no coat)
  • Dark red: Extreme heat
  • Purple: Blood stasis
  • Blue: Blood stasis due to internal cold

Shape reflects the state of the organs, energy (qi) and blood, as well as differentiating a deficient or excess disease state in the body.

Body shape—deficient conditions:

  • Thin: Lack of fluids in the body
  • Cracked: Dryness from exhaustion of body fluids or yin deficiency
  • Toothmarks: Qi deficiency

Body shape—excess conditions:

  • Swollen: Dampness or phlegm
  • Stiff: Heat or wind
  • Long: Heat
  • Moving: Internal wind

Organ systems are represented on specific areas of the tongue body. This allows TCM practitioners to identify the organ systems to treat in relation to where changes to the tongue are occurring. Starting at the very tip of the tongue is the heart, followed by the lungs. The spleen and stomach are the center of the tongue with the kidneys, bladder and intestines at the back of the tongue. The sides represent the liver and gallbladder.

The Tongue Coat
The tongue coat’s color and thickness are examined during tongue diagnosis to help differentiate between hot or cold states and deficient or excess disease states. Coat/fur is reflective of yang organs and can change more quickly than the tongue body. Color indicates if a condition is hot or cold:

Coat color:

  • White: Cold, exterior, LU/LI disease
  • Yellow: Heat, interior, St-Sp disease
  • Gray: Long duration state of heat or cold
  • Black: Long duration state of heat or cold

Thickness of the coat indicates how strong the pathogenic factor present in the patient is or how weak the body’s qi is, as well as if a deficient or excess condition. The distribution/location of the coat shows the progression of external factors or location of interior conditions. It is important to identify whether the tongue coat is with or without root, meaning whether the coat is coming out of tongue or if it look stuck on, as though it could be scraped off. The “root” of the coating directly reflects the patient’s energy (qi).

Coat thickness/distribution:

  • Thick: Pathogenic/excess
  • Thin: Pathogenic weak; initial stage of disease
  • Externally contracted: Changes on front and sides of tongue coat
  • Internally generated: Distribution reflects location of problem

The moisture of the tongue coating provides information about fluid status in the body and reflects if a disease state is relatively yin/yang and hot/cold.

Coat moisture:

  • Wet: Excess fluids, stagnation of fluids from external cold, or internal cold from yang deficiency
  • Dry: Insufficient fluids from excess heat or yin deficiency
  • Slippery: Shiny/oily appearance (damp)
  • Greasy: Thicker on central surface, can’t be scraped off, rougher and more sticky than oily (phlegm, yang deficient)
  • Moldy: Thick, patchy, crumbly, can be scraped off (excess heat)

Other differentiations:

  • Short: Internal cold stiffens or excess heat exhausts fluids
  • Deviated: Presence of wind, internal or external
  • Quivering: Qi or blood deficient, extreme heat
  • Ulcerated: Heat from yin deficiency or “Heart fire blazing upwards”
  • Prickles: Heat

The Tongue
A “normal” tongue is pink, vibrant, and “fresh-looking”; supple, no cracks or ulcers, no movement, with a thin, white-rooted coat. There are numerous variations to the tongue’s appearance, and the tongue presentation must be considered in relation to the pulse diagnosis and symptom presentation when uncovering the Traditional Chinese Medicine diagnosis.

Differential Diagnosis of Symptoms in Relation to TCM Tongue Diagnosis
The data in this table are the basic tongue diagnosis criteria in TCM, which can be more complex and mixed in nature.

Kerr Tongue Chart

So next time you brush your teeth, check out your tongue and see if it correlates to your symptoms. Keep an eye on how it looks when you are sick to see how it changes, and consider visiting a TCM practitioner to learn how you can improve your health holistically and naturally.

Dr. Nicole Kerr, ND, LAc operates an all-natural fertility clinic in Wallingford CT, Fertility Oasis. At Fertility Oasis, Dr. Kerr teaches her patients the importance of preconception care and about all treatment options available to couples struggling to conceive. Male and female infertility factors are addressed by Dr. Kerr to offer comprehensive fertility care for her patients.

Fertility Oasis is located at 857 N Main St Ext Suite 1, Wallingford CT. Visit: or call 203.265.0459.

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