In the world of Traditional Chinese Medicine, the tongue is like a barometer for the inner pathologies of the body. All practitioners will give special attention to its presentation. When interpreted correctly, the tongue presentation can be incredibly informative for designing a therapeutic intervention. In this brief article, we will try to introduce one of the most important features of the tongue exam - the color of the tongue. 

Understanding the Basics: A "Normal Tongue"

A normal tongue should have a pink glow with a thin white coating. Typically, this tongue presentation represents a body in good health, with a robust digestion and good flow of Qi and Blood. But when a patient becomes sick, the tongue presentation can change, sometimes quite quickly. The first order of business for practitioners is to assess the color of the tongue.

In this aspect of the exam, it is important to realize that we are only considering the body of the tongue and not its coating, which has a different pattern of color variations that we will discuss separately.

Interpreting Tongue Color: Hot or Cold / Deficient or Replete?

Practitioners use the color of the tongue to assess some of the most fundamental imbalances in the body. At the risk of oversimplifying, we can consider these imbalances to present along two axes. One refers to pathologies of temperature, whether the patient is too "Hot or Cold", and the other refers to the nature of the pathology itself, whether the patient is "Deficient or Replete".

If the patient is Deficient, then the body is weakened and vulnerable; if the patient is in a state of Repletion, the body is robust but it is being attacked by a pathogen, usually something external but not always.

In Chinese Medicine theory, assessing patients along these two axes - Hot and Cold, Deficiency and Repletion - is essential for designing a treatment.

The color of the tongue can be an essential guide for analyzing these basic aspects of an illness. Although there can be a lot of minute changes in the color of the tongue, we will focus on two of its most basic color variations to help laypersons understand the secrets of the tongue exam.

• Pale Tongue: A pale tongue, where the tongue lacks a healthy pinkness, almost always represents Cold. How will the patient experience this pathology? One may notice a tendency to have cold hands and feet, or perhaps a desire to put on an extra layer, or perhaps an aversion to iced drinks and chilled foods. The stools may also be loose. Conversely, this individual may prefer hot weather and climates, or have a strong preference for warm foods over raw foods. For the practitioner, the next step will be to assess whether this cold is caused by a state of Deficiency or Repletion (due to the nature of modern living, it is more often the former). Next, the practitioner must assess where in the body the Cold is located. The tongue exam can sometimes help with assessment too, particularly in the case of a red tongue.
• Red Tongue: A bright red tongue, where the tongue clearly is redder and brighter than a normal pink glow, indicates excess Heat. How will the patient experience this pathology? One may feel hot, agitated, and thirsty. Perhaps there is a desire to take off excess clothing. The stools may tend to be dry. A practitioner will next need to assess whether the Heat is caused by a Deficient or Replete pathology. The former tends to be related to chronic conditions; the latter is associated with acute ones, such as infections. With a red tongue, the location of the redness can also be significant, if the rest of the tongue is a normal pink color. For example, redness on the tip or sides of the tongue can correspond to heat in the upper or mid body respectively.  

The tongue exam is one of the most useful ways for a practitioner to begin to interpret the inner pathological processes of a patient. A practitioner usually examines the color of the tongue to identify condition as Hot or Cold, Deficient or Replete

But this is just the beginning. It is essential to consider other aspects of the tongue presentation in order to refine one’s diagnosis. The next step is to examine the coating of the tongue, which we will explore in the next blog posting.

What About Your Tongue?

Interested in learning what your tongue says?  DAO Labs offers a free "tongue consultation": answer a few questions, snap a picture of your tongue, and we'll give you a quick overview.  

Dr. Eric Karchmer is a practicing Chinese medical doctor, medical anthropologist, and co-founder and Chief Doctor of Chinese Medicine for DAO Labs. From 1995-2000, Eric studied at the Beijing University of Chinese Medicine and today is both a licensed acupuncturist and professor at Appalachian State University. Eric can be reached at drkarchmer@mydaolabs.com.