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TCM Tongue diagnosis

May 1, 2023
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by Michelle Toole: One of the most common questions that people ask about acupuncture is: “Why does my acupuncturist look at my tongue?”

Tongue and pulse diagnosis are two of the more important diagnostic tools in Chinese medicine. They are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Generally the tongue, is much easier to learn and less subjective than pulse diagnosis. It is less meridian specific than the pulse, however, the tongue will show the depth and nature (hot, cold, etc.) of an imbalance and it is less effected by short-term influences such as nervousness. The tongue is also useful as a measurement tool to gauge the progress of a disorder.

Common Tongue Geography and Meridian Correlations

¤ Lower Jiao
The Base of the tongue corresponds to the Kidney, Urinary Bladder, Large Intestine and Small Intestine Meridians.

¤ Middle Jiao
The sides of the tongue correspond to the Liver and Gall Bladder meridians. Some theories place the Gall Bladder on the patients left side and the Liver on the patients right side.

The Middle of the tongue corresponds to the Stomach and Spleen Meridians.

¤ Upper Jiao
The Tip of the tongue corresponds to the Lung and the Heart

How Can the Tongue Change?

TONGUE BODY
Attribute	Characteristic	Indication	Abnormality
Spirit	Vitality of the tongue	Zang, Fu, Qi, Blood, Body Fluids	Flourishing: bright with energetic movement and moist indicates good Stomach Qi
			Withering: dark and dry tongue with sluggish movement indicates exhausted Stomach Qi
Colour	Reflects true condition of body	Thermal nature of the disease	More Red: Blood overfills tongue, more heat
			Less Red: Qi and blood are insufficient, less heat, more deficiency
Texture	Tough or tender	Reflects excess or deficiency	Rough: exuberant antipathogenic Qi and muscle fibers bulge
			Tender: Qi and Blood are deficient and cannot fill fibers; Yang deficiency cannot transform body fluids and cold-damp accumulates
Size	Large or Small	Often reflects constitution	Large: overfilling of Blood, damp accumulation
			Small: lack of nutrition due to Qi, Blood and Body Fluid Deficiency
Surface	Moist, smooth	Body Fluids, heat, stasis	Cracks: malnourishment of Qi, Blood and Body Fluids due to heat or dampness obstructing
			Prickles: heat pushes Qi and Blood up where they overfill the tongue causing papillae to thrust out
Flexibility	How the tongue moves	Condition of muscles and sinews	Stiff: lack of nourishment due to internal organ deficiency or phlegm/Blood stasis obstructing Qi and Blood resulting in stiffening of the tongue
			Limp: sinews lack nourishment of Qi, Blood and Body Fluids and do not have the strength to move
Movement	Abnormal movement	Pathogens or deficiency	Spasm due to internal wind, usually due to hyperactive Liver, internal heat or malnutrition. Can be trembling, deviated or protruding.
Length	How long the tongue is	Pathogens or Internal Organs	Short: excessive cold causes contraction and spasm; malnutrition causes phlegm to stagnate and obstruct; heat injures Body Fluids; Qi and Blood deficiency due to Spleen and Kidney failure
			Long: excess pathogenic heat consumes Qi, Blood and Body Fluids; internal organ failure resulting in the tongue being unable to contract

TONGUE COATING
Attribute	Indications	Abnormality
Colour	Pathogenic factors	White: exterior or cold patterns; targets Lung and Large Intestine
		Yellow: interior or heat patterns; targets Spleen and Stomach
		Gray: interior, heat or cold-damp patterns
		Black: interior, extreme heat or extreme cold patterns
Thickness	Antipathogenic Qi or depth of disease	Thin: impaired Spleen or Stomach cannot evaporate and transform dampness; Kidney and Stomach Yin deficiency cannot send up Body Fluids or damp turbidity is sent up.
		Thick: Spleen and Stomach are stagnated by food or phlegm damp and turbid damp steam rises
Moisture	Condition of Body Fluids	Dry: excessive pathogenic heat injures Body Fluids; internal organ dysfunction leads to Yin deficiency
		Wet: water damp attacks body due to Spleen or Kidney Yang deficiency cannot transform Body Fluids
Stickiness	Distinguishes pathogenic factors, fluid metabolism	Damp, phlegm, water or food stagnates and accumulates and the Stomach Qi produces excess turbidity that steams upwards
Distribution	Location and depth of disease	Even: widespread pathogen, dampness obstructs middle jiao
		Uneven: certain body parts or organs are affected, there will be uneven distribution
Peeling	State of Stomach Qi & Yin	Deficient Stomach Qi or Yin results in exuberant rising of turbid dampness or Stomach Yang, burning fluids.
Rooting	Pathogen severity, condition of Stomach Qi & antipathogens	Rooted: sufficient Stomach Qi that is attached to tongue tightly, difficult to scrape off
		Unrooted: insufficient Stomach Qi due to Qi deficiency in the Stomach or Kidney