Tongue Diagnosis

by Marcie Bower |

Tongue Diagnosis

If you have ever had a Traditional Chinese Medicine (TCM) acupuncture treatment, your acupuncturist probably asked to look at your tongue.  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 individuals!

In acupuncture and Chinese medicine, 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 on the right 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 teeth marks 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 find!


  • 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 stress.
  • 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 swollen.
  • Thin tongue: A very thin tongue often indicates a deficiency of certain energetic substances that has been going on for a very long time.
  • 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.

Tongue Texture:

  • 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 tongue.)
  • 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.)

Tongue Coat:

  • 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.

As mentioned, this is just a brief introduction to the very complicated art of tongue diagnosis! 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 are working.

The tongue reflects what is going on within your body. After all, it is the only muscle in the body that we can see.


This piece was written by Bethany Hauch, Lic.Ac. for Marcie Bower's clinic Stepping Stone Acupuncture.

Marcie Bower, LIC.AC, MAOM, DIPL. OM received her Masters in Acupuncture and Oriental Medicine from the New England School of Acupuncture, and is a winner of the Tsay Fellowship Award for Excellence in the Art and Science of Traditional Chinese Medicine. Marcie has a passion for and extensive experience in alternative medicine research. Her ultimate goal is to better integrate Chinese Medicine into the dominant medical system, thereby making it more available to more patients who will benefit from its use. Outside of the office, Marcie enjoys spending time with her husband Karl and their two young children, as well as running, doing yoga, reading, and networking with other entrepreneurs. You can learn more about Marcie at

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