If the eyes are the windows to the soul - or in the case of Chinese Medicine, a reflection of the Shen - then the tongue is a window to the body. Like a medical mirror, your tongue reflects the state of your internal health. Next to palpating the pulse, observing the tongue in all its glory is one of the most valuable and reliable diagnostic techniques in Chinese Medicine. And admittedly, it’s also one of the strangest; many first-time acupuncture patients are surprised (and often a bit reticent) when asked to stick out their tongue during the consultation. Their surprise effortlessly morphs into wonder, however, when they learn of the secrets told by the tongue.

Like the ear, the tongue is a microsystem of sorts, a condensed map of the entire body utilized clinically for diagnostic purposes. The only internal organ that we’re able to glimpse (surgery and medical imaging aside… move over MRI), the tongue reveals that which cannot otherwise be seen with the naked eye. Each aspect of the tongue holds its own piece of valuable information, and each region of the tongue corresponds with a particular Organ System.

“It is often the clearest indication of the nature of a disharmony and its pattern, reliable even when other signs are vague and contradictory.“

So, what are we looking for when admiring, I mean examining, the tongue? The body of the tongue and the coating on the tongue are of equal interest. There are several aspects of the tongue body to consider, including: vitality, color, size, shape, texture, movement, and moisture. When it comes to the tongue coating, we examine: thickness, color, texture, distribution, and general appearance. Changes or abnormalities in the tongue body typically arise from chronic imbalances, whereas changes in the coating arise more rapidly as a result of short-term dysfunction (primarily of digestion). 

“A healthy tongue fits comfortably in the mouth and is smooth, moist, bright, pink, and firm, with a thin white fur that covers the upper surface.”

What can each aspect of the tongue tell us and what does a healthy tongue look like?

Vitality of Color, or Tongue Spirit: Regardless of what else is transpiring on the tongue, when it has a vital color, a conspicuous zest and dynamism, the patient’s prognosis is hopeful. If, on the other hand, the tongue body is reminiscent of a withered plant, the overall prognosis is grim.

Healthy = Vital spirit and vibrant color, especially at the root (in other words, the base)

Tongue Body Color: The color of the tongue itself, absent any coating, mirrors the state of the Yin Organs, Blood, and Nutritive Qi. This is the most essential aspect to consider in determining the true state of one’s long-term health. A pale tongue indicates Deficient Blood, Qi, or Yang. A red or scarlet tongue is a sign of Heat in the body. A purple tongue reflects Stagnant Qi or Blood Stasis, i.e., poor circulation. 

Healthy = pink and “fresh-looking” (indicating balanced Heart Blood and Stomach Fluids).

Tongue Body Shape: The shape and texture of the tongue, the features on its surface, and any spontaneous movements mirror the relative state of excess or deficiency in the Organs, Qi, and Blood. 

Healthy = supple, smooth, stable, and moderately sized

“The color and shape of the tongue body ... reflect the intrinsic strength and functional capacity of the individual.”

Tongue Coating: The coating or “moss” on the surface of the tongue is intimately tied to our digestive health. It is created by the Stomach and Spleen Organ System in the process of digestion, so can change more frequently and rapidly than aspects of the tongue body itself. 

“The tongue fur primarily mirrors the Qi of the Stomach. Quite Yang, this Qi is referred to as the ‘digestive Fire,’ the ‘smoke of the Stomach.’”

Heat and Cold factors in the body are reflected in the color (yellow points to Heat, white to Cold); the force of pathogenic factors is shown in the thickness (the stronger the thicker); the distribution mirrors the progression and position of a pernicious influence; and how rooted the coating is depends on the robustness of one’s Qi. 

Healthy = thin white coating (a bit thicker at the root), reflecting normal digestive function

Tongue Moisture: The relative moisture or dryness of the tongue reflects the body fluids, as well as the relative condition of Yin and Yang.

Healthy = slightly moist

Organ Correspondences - Tongue as a Microsystem

“Each part of the tongue corresponds to the condition or state of an Organ Network.” 

The most common way of mapping Organ Systems onto tongue topography is as follows:

• Heart: tip of the tongue
• Lungs: region between the tip and center
• Stomach and Spleen: center of tongue
• Liver: left edge
• Gallbladder: right edge
• Kidneys, Intestines, Bladder and Womb: root of tongue

So, next time you’re feeling out of sorts and you’re unsure why, stick out your tongue - you may find some clues to help guide you back to health. And, if you need help interpreting what you see, give your acupuncturist a call (or text them a tongue selfie)!

Hannah Fries is a California-based licensed acupuncturist and herbalist (L.Ac.), writer, and Integrative Body Psychotherapy allied professional. She seeks to discover & alchemize the psycho-emotional and spiritual roots of disharmony in the physical body to help her clients transform the obstacles that interfere with their innate healing capacity. Find out more about Hannah and her work on her website at https://www.friespirit.com or on Instagram @friespirit.