Photo by Wini Lao
Tongue diagnosis has been used for centuries by practitioners of ancient medicine, but why is it still relevant today? Until there are some wild and major evolutionary changes, the tongue remains the only internal organ visible without a scalpel. The tongue may not seem like an organ in the traditional sense, but it is 100% pure muscle, fed directly by blood and nerves, with cells that regenerate every 10 days (much like the cells lining your digestive tract). So looking at it can give us clues about what is happening with the other organs and the general internal environment. Practitioners of chinese medicine look at specific aspects of the tongue in order to make a determination about the state of your health. These categories include color, moisture, shape, and strength. Let’s take a deeper dive into the elements of tongue diagnosis so that you can start to interpret what your tongue may be saying about your health.
As a necessary disclaimer, there is a lot of terminology in chinese medicine that doesn’t translate perfectly to western/ conventional terminology. Saying that there is is heat in the body does not necessarily indicate an increase in body temperature. It more so refers to a function and indicates how we treat with either acupuncture or herbs. It’s important to note that this article will give you tools to interpret the picture of your health shown on your tongue, it’s absolutely vital that you consult with a doctor (western or eastern) about how best to move forward with your health journey.
Let’s break the tongue down into some categories that will help us digest this info a little more simply:
If a tongue body is pale, it indicates that energy and blood flow are deficient. Energy and blood nourish our skin, muscles, and hair. They root our emotions and are the driving force for all functions of the body. When weakend, symptoms can show up as dry skin, thinning hair, numbness, dizziness, poor memory, very heavy or very light periods, bloating, fatigue, and/or loose stools. Some potential disorders include: chronic diarrhea, anemia, asthma, infertility or frequent miscarriage.
If a tongue body is red, it indicates that there is heat in the body. The heat can be constitutional (the norm for that person’s body) or can be acquired externally in the form of a toxin (such as a medication or alcohol) or disease. In this scenario, fluids are improperly metabolized, generally burning up too quickly, resulting in signs of the heat such as constipation, insomnia or vivid dreams, dry throat, increased body temp or easily sweat, and/ or excessive hunger. The person could be experiencing menopause, an autoimmune disease, hypertension, or a febrile disease.
A purple tongue always indicates lack of proper blood circulation. Blood flows through the body providing nourishment and taking away build up of old waste. When this process is dysfunctional, there is stasis of blood resulting in pain. Symptoms include: painful periods with dark blood clots, irregular periods, headaches, neck or back pain, abdominal pain, etc. Potential disorders include physical trauma, endometriosis, PCOS, migraine, or arthritis
When the tongue body changes shape, this confirms that what you learned from the color of the tongue and can indicate that the condition has increased.
Short or Thin:
When the tongue body is short or thin, it indicates that body fluids are being improperly metabolized and used up too quickly (such as in the red tongue above) or not made in the first place (as in the pale tongue).
When the tongue body is swollen or has impressions of teeth on the side, body fluids are poorly metabolized and distributed. This can be due to lack of energy to process or a problem with the processing itself. It results in the fluids being deposited and stored in areas where they are not meant to be.
The tongue coating consists of the tips of the filiform papillae, which are epithelial projections on the dorsum of the tongue. In Traditional Chinese Medicine (TCM), the tongue coating is the physiological byproduct of the metabolism of food and fluids. When you see a TCM doctor or take a picture of your tongue for our health questionnaire, never scrape or brush your tongue. It is vital to tongue diagnosis!
A thick greasy coating can indicate improper digestion of foods. Generally this is due to the overconsumption of foods that are greasy or cloying, in which case there is build up of waste that your body cannot eliminate. This coating can also arise if your digestive system is in a state of dysfunction, where food and fluids are unable to be transformed into usable elements and stagnate on the tongue. People with this tongue coating, may see signs such as constipation and/or loose stools with strong odor, bloating, heavy body, fatigue. These people may chronically overeat or over drink, have high cholesterol or fatty liver.
When a coat is dry, it indicates that the state of the body fluids is insufficient. This could arise due to not having enough fluids to start with (dehydration) or improper metabolization of the fluids that are consumed. A wide variety of symptoms can be apparent, such as: constipation, cough or dry throat, insatiable hunger, insomnia. These patients could have hyperthyroidism, eczema, tremors, or anxiety.
When a tongue is trembling, it shows us that a long-standing condition has drained the body of its energy. Much like in an intense workout when your muscles start to fatigue they shake, when your body’s energy is zapped, the muscles of your tongue begin to fail. This quivering can be a result of any chronic issue which has depleted the body.
So what does a NORMAL tongue look like, anyway?!
A “normal” tongue is hard to come by… but then again, it’s also rare to find any one of the above extremes on their own. A tongue that would be considered normal would be in the neutral position between all the elements that are part of tongue diagnosis. Not too red but not too pale: pink. Not too dry, but not greasy: moist. A shape that’s not overly puffy, but not too small for the mouth. It is when practitioners see changes one way or another that we start to pick up on the clues about the state of a person’s health.
So now, take all that info and jumble it up, because no tongue is only one of these things. It is important to note that not all tongue traits were mentioned here. There are also infinite combinations that can be created between each category and beyond. Only practitioners who have dedicated their lives to the study of the patterns and manifestations of tongue diagnosis will truly be able to make a determination on your health.
You can help your practitioner by regularly checking your tongue and making note of any changes between visits. See the below illustration for some examples of the different tongue manifestations so you know what to look for!
Nicole Glathe is a Doctor of Acupuncture and Oriental Medicine, California board certified licensed acupuncturist and herbalist, Diplomate of Oriental Medicine (NCCAOM), Certified Classical Five Elements Practitioner and Instructor, and co-founder of #periodpainfree. Her passion is women's health and her mission is to empower women to live their healthiest and happiest life. She is always delighted to talk to women on their health journey - shoot her a note: firstname.lastname@example.org.