Tongue Diagnosis


Click on Pic for more detail

Tongue Body Color




Qi and/or Blood unable to fill tongue body

deficiency of Qi

Qi too deficient to guide Blood to tongue to give it pink color.

deficiency of Blood

Lack of Blood can’t give tongue pink color

deficiency of Yang

Lack of Yang can’t lift Qi and Blood to tongue to give it pink color.



Pink means adequate Qi and Blood.



Heat accelerates and expands movement of Blood which fills tongue with more red color.

excess heat

Often found with a thicker tongue coating, likely yellow.

deficiency heat

Often found with a thin or scanty tongue coating.

Crimson (dark red)

Ying or Blood level heat.

Blood stagnation with heat

Heat damages yin, causes the red to become more concentrated and darker.

Blood stagnation with heat Blood stagnation causes purple color, heat makes it more red.


Blood stagnation

The slower the Blood moves, the more depleted of oxygen it will become, giving rise to a tendency toward the blue color. Purple is a transitory color between pink and blue.


Blood stagnation with, or due to cold.

Cold (blue) impedes movement which causes Blood stagnation (purple)

Pale Purple (“dusky”)

Blood stagnation with or due to deficiency of Qi, Blood, or Yang

Blood stagnation is purple, pale is deficiency.


Internal cold

Cold impedes movement which allows red blood to lose its oxygen giving rise to the blue color. (western explaination)


Tongue Body Shape


Small tongue body

deficiency of Blood or Yin

Lack of fluids causes tongue to shrink in size.

Swollen tongue body (vertically enlarged)

excess heat or alcohol/drug toxicity

Heat pushes more Blood into tongue body to increase its size.

Flabby tongue body (horizontally enlarged)

damp or phlegm

fluids fill tongue and enlarge it horizontally.

Teeth marks

damp or phlegm

a continuation of the flabby tongue in which the teeth indentations are visible.


Tongue Body Cracks


Cracks in tongue body

Blood or Yin deficiency

Fluids unable to moisten and nourish tongue body giving rise to cracks like dried earth.


Yin deficiency

Fluids unable to moisten and nourish tongue body.


Blood deficiency

Fluids unable to moisten and nourish tongue body.

+teeth marks
cracks on lateral sides, look like fish’s gills


Damp prevents fluids from rising up to tongue to nourish it.


Prickles, dots, spots


Prickles, dots, spots

heat or stagnation



Heat causes too much Qi and Blood to rise to the tongue where it causes the body to develop dots, points, spots, etc.

+purple (brown, dark)

Blood stagnation

Blood stagnation always looks purple.





Tongue Bearing Issues


Stiff tongue

Spasm due to internal wind

Excess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to become stiff.

Limp tongue

deficiency of Qi, Blood, or Yin.

Lack of nutrients cause the tongue to become limp.

Trembling tongue

Spasm due to internal wind

Excess heat, or a deficiency of Liver Yin or Blood can cause wind causing the tongue body to tremble. NOTE: all tongues move, this sign is EXCESSIVE movement.

Deviated tongue

Internal wind, phlegm in channels

Something is blocking the channels and collaterals on one side of the tongue preventing its movement. This is also a “check in with a neurologist” indication due to the possibility of a tumor impinging a cranial nerve.

Engorged Sublingual Veins

Qi and/or Blood stagnation

Blood flow is impeded, giving rise to the appearance of backed-up Blood beneath the tongue.


Coating Color




White and clear things in TCM are dilute and cold.



Yellow things in TCM are more concentrated due to heat damaging the Yin.


interior cold or heat

heat or cold is damaging the interior.


extreme interior cold or heat

a further exasperation of the gray coating


Coating thickness


Thin coating

exterior syndrome or normal

If you can see through the coating to the body of the tongue, it is thin.

Thick coating

excessive condition, interior, damp, phlegm, food stagnation

Coating is the “smoke” of the stomach. Pathological factors rise with the Stomach Qi to the tongue coating.




Coating Moistness


Moist coating


the coating is neither excessively wet, dripping, or dry

Glossy (excessively shiny or wet) coating

internal cold, Yang deficiency

Yang deficiency or cold that damages Yang impedes the transformation of fluids giving rise to the accumulation of dampness or phlegm which shows up on the tongue in the form of the excessively wet coating.

Dry coating

dryness, heat, Yin deficiency, Yang deficiency

Here, we have a variety of factors that damage the body fluids including heat and dryness. Yin deficiency is obviously a form of internal dryness, and Yang deficiency can give rise to dryness in the body if the Yang is too weak to transform dietary water into body fluids.


Coating Distribution


Even coating

phlegm-damp accumulation in the middle Jiao

The tongue indicates the conditions throughout the entire body, but also focuses on the Spleen and Stomach in particular. One map that is laid atop the tongue suggests that the entire tongue indicates the condition of the Spleen and Stomach only. So, a coating that covers the entire tongue can sometimes indicate only a pathology of the middle Jiao.

Coating on the anterior third (front third)

superficial invasion of pathogenic factor

The anterior third of the tongue is related to the Lungs and Heart. When a pathogenic factor enters the body, it generally enters through the Lungs, and so this thick coating on the anterior third of the tongue indicates this superficial invasion.

Coating in the middle only.

Phlegm and/or damp in the middle Jiao

Middle of the tongue is related to the middle Jiao.

Coating on one side or the other.

Shao Yang disease

Most pathologies that are one-sided or have symptoms that flip-flop between opposites (i.e. alternating chills and fever) indicate that the pathological factor has found its way to the Shao Yang channel, level, or organ (GB).


Stomach Yin or Kidney Yin deficiency

Because the tongue coating is the smoke of the Stomach, and this smoke requires some Yin to evaporate up toward the tongue, a lack of Yin will cause a lack of smoke to rise and a lack of coating.

Geographic coating

Stomach Yin or Stomach Qi deficiency

Coating is the smoke of the Stomach. The Yin is what is heated to cause the smoke, while the Qi is that heating activity. In the absence of either of these factors, the coating can appear missing on portions of the tongue.