tongue examDiagnosis: Tongue, Body & Face

Evaluation of the Tongue
Evaluation of Body Language
Evaluation of Facial Color

Evaluation of the Tongue

When examining the tongue, the Chinese medicine doctor looks at the color of the tongue body, its size and shape, the color and thickness of its coating or fur, locations of abnormalities and moistness or dryness of the tongue body and fur. These signs reveal not only overall states of health, but correlate to specific organ functions and disharmonies, especially in the digestive system. Not all tongue irregularities are indications of disharmony, however. Food and drugs may change the coating or color of the body of the tongue. For example, coffee yellows the coating and Pepto-Bismol turns the tongue black.

Furthermore, some people have minor, unchanging cracks on their tongue, which are considered normal. Others are born with what is called a "geographic tongue," which is covered with severe cracks and covered with hills and valleys. This is considered normal by some practitioners, but a sign of congenital disharmony by others.

The way a tongue appears is not an absolute indicator of the location of the disharmony, but when taken as part of an overall pattern that includes a complete evaluation, they offer strong clues to the location of disharmony.

Tongue Body

The tongue body is a fleshy mass and has color, texture and shape independent from the apparent qualities of the tongue coating. (To evaluate the tongue accurately, always do the examination in natural light.)

  • A pale tongue body indicates Deficient Xue or Qi or Yang or Excess Cold.
  • A overly red tongue body indicates Excess Heat.
  • A purple tongue indicates that Qi and/or Xue are not moving harmoniously and are Stagnant.
  • Pale purple means the Stagnation is related to Cold.
  • Reddish purple is related to Stagnation of Heat.
  • When the tongue is black or grey, it indicates extreme Stagnation; if black and dry, that indicates extreme Heat Stagnation; black and wet is an indication of extreme Cold Stagnation.
  • Bright red indicates deficient Yin or Excess Heat. Dark red indicates Excess Heat.
  • Cracks in a red tongue indicate Deficient Yin or Heat injuring the fluids. But if the tongue is pale and cracked, Deficient Qi or Xue is present. Thorny eruptions of the “buds” on the tongue alert the doctor to Heat or Stagnant Xue.
Tongue Fur

The tongue’s coating is best described as moss or fur. It arises when the Spleen causes tiny amounts of impure substances to drift upward to the tongue. When the Spleen and Stomach are in balance, there is a uniform density of fur, with a slightly thicker area in the center of the tongue.

  • Thick fur indicates Excess.
  • Thin fur is related to Deficiency during illness, but is normal if you are well.
  • Fur that is wet indicates Excess fluids and/or a Deficient Yang. Dry fur is a sign of Excess Yang or Deficient fluids.
  • A greasy fur is a sign of Phlegm or Dampness in the body.
  • If the fur looks peeled off or missing, it reveals Deficient Spleen or Yin or fluids.
  • White, moist fur indicates Cold. Yellow fur means Heat. However, white fur, resembling cottage cheese, points to Heat in the Stomach.
  • Grey/black fur with a red body is associated with extreme Heat; grey/black fur with a pale body is a sign of extreme Cold.
Size, Shape and Movement of the Tongue

The healthy tongue rests comfortably in the mouth, neither too small nor too large.

Size and Shape

  • If a tongue is enlarged and flabby it indicates Deficient Qi .
  • If in addition to being enlarged and flabby, the tongue has scalloped (or tooth marked) edges, then it indicates Dampness due to Deficient Qi or Stagnation of fluids.
  • If the tongue is enlarged and hard, it is a sign of Excess.
  • If it swells so that it fills the mouth and is deep red, that means Excess Heat in Heart and Spleen are a problem.
  • A small, thin tongue can mean that Yin or Xue are Deficient.


  • A trembling, pale tongue indicates Deficient Qi .
  • A flaccid tongue that is pale often reveals extreme Qi or Xue Deficiency.
  • A flaccid tongue that is deep red, reveals severe Yin Deficiency.
  • A trembling, red tongue indicates Interior Wind.
  • If the tongue sits off center in the mouth, early or full-blown Wind stroke may be present.
  • A rigid tongue accompanies an Exterior Pernicious Influence and fever and may indicate the invasion of the Pericardium by Heat and Mucous Obstructing the Heart Qi .

The location of disturbances on the tongue gives a vivid indication of where disharmonies in the mind/body/spirit are located. Certain organs are associated with the Upper, the Middle and the Lower Burner, which are in turn associated with the front, middle and back sections of the tongue. For example, if there are red spots on the front third of the tongue, which is associated with the Upper Burner, this indicates that there is Heat in the Lungs. If the tip of the tongue is red, that indicates Heat in the Heart. Menstrual cramps, associated with Stagnant Xue, are often accompanied by purple spots on the edges of the tongue in the Liver/Gallbladder area.


Evaluation of Body Language

Styles of movement, posture and self-presentation:

  • If a person has a heavy-footed walk, loud voice, and sits in a sloppy, spread-out posture, that may indicate they have an Excess condition.
  • If a person acts frail and weak, sits with shoulders slumped and is shy and receding, that may indicate a Deficiency of some Essential Substance such as Qi in an organ system.
  • Fast, jerky, impulsive movement and an outgoing personality indicate Heat. If combined with full red face, high energy and a loud voice, then both Heat and Excess may be at work.
  • Cold, as you might suspect, is associated with slow but not sloppy movements and a pale face. When coupled with a low voice, shortness of breath or passivity, Cold and Deficiency may be at work.


Evaluation of Facial Color

Five colors appear on the face: red, green, yellow, white, and black. Depending on a person’s constitution, a healthy face may have one color that is more predominant than others, but several may be visible. To determine what colors are present in your face, always examine it in natural light. Look for the overall color tone; study at the skin to see what tones appear from under the surface; look at any visible veins. For contrast, hold your hand up alongside your face.

  • If facial color is bright and fresh then the disease is called “floating” and is on a superficial level.
  • If the color is moist, neither wet not dry, the disease is not severe and easy to treat.
  • If the color is shallow and scattered over a large area the number of days of the disease will be short.
  • If the color is dark and cloudy, then the disease is sinking into the inner organs.
  • If the color is dark, cloudy and dry, the disease is severe and is difficult to cure.
  • If the color is deep and accumulated in one spot, the disease is a long-term one.