Tongue Examination

TCM believes the appearance of your tongue can reveal a lot about your health.

Tongue diagnosis is an important part of the Chinese medical assessment. During an examination, the practitioner usually looks at for three things; the overall tongue coating, shape, and color.

Different areas of the tongue are believed to indicate the health condition of the organ systems. If there is an unusual color, coating, and/or shape in a certain area, he will usually pay special attention to the corresponding organ system.

No thorough doctor relies on tongue diagnosis alone, but uses it to provide a complete picture of a person's health.

Let’s start with some comparative conditions that may appear.

The normal shape of the tongue is an elongated oval, not thick nor thin and located in the center of the mouth. The color is light red, bright with moisture. The tongue should not be furred and it should be capable of moving freely.
A hepatocirrhosis patient would have a "tongue of liver ailment.” This may show a bluish red, pinkish red or lacquer-like red, swollen, too much moisture on the membrane and no obvious fur.

Healthy tongue

Color of the Tongue

One of the factors to look at when diagnosing the tongue is color.


Indications include bright red area at the center of the tongue with scarlet sides of due to heat in the liver. This is often with complicated hypertension, thyroidism, diabetes and like diseases. This is a chain reaction of conditions.

1. The onset condition is exuberance of the vital function of the liver.

2. This is due to deficiency of vital essence.

3. It is caused by deficiency of vital essence of the kidney.

4. This is leading to deficiency of the vital essence of the liver.

5. It will show heat symptom at the early stage and fire symptoms.

6. All this is brought on by deficiency of vital essence and blood at the later stage.

Light Color:

When the tongue has a light in color, there is cold wind due to a deficiency of vital energy, mostly shown in patients suffering from deficiency of the vital energy and vital essence. The light color represents a deficiency of vital essence, vital energy and of the vital essence of the spleen. When it is a serious case of chronic anemia, the tongue is as white as washed, complicated with whitish tongue membrane and conjunctiva, with symptoms of low voice, weak breathing, strenuous throbbing of the heart, dizziness, tinnitus, spontaneous sweating, light color of lips and tired complexion.

Quality of the Tongue

Tongue thick with prints of teeth at side

A chronic hepatitis patient has a type of exuberant dampness and heat. There is generally inflammation and water as a result of the accumulation of antigen-antibody in the human body. Add to this a low level of protein in the blood; it can lead to hepatic edema. A patient with symptoms of hepatic edema often has a swollen tongue with tooth print on the sides and thick round tip of the tongue. If there are prints of teeth on the sides of the tongue, the patient often has swollen lower limbs. The tooth print on the sides of the tongue is most obvious when symptoms of dampness in the liver are clear. Other common symptoms are a swollen body, fatigue, sore muscles all over, sleepiness or insomnia, or feeling heavy and weakness in the lower limbs or even numbness and when pressing on tibia. Depression can be seen on the skin.

Thick Tongue With Teeth Marks Around The Edge



Ecchymosis on the Sides of the Tongue

A patient of chronic hepatic ecchymosis often has dark purplish spots on the tongue with red, purple or black patches. There can also be spots scattered on the tip and sides of the tongue. Patients can have complications of benign tumors (such as hystermyoma) or malignant tumors (such as nasopharyngeal carcinoma).



Tongue Edges Show Some Ecchymosis or bruises (Meridian System Blockage) 

Prickled Tongue Surface and Partial shedding of Fur

Excessive heat in the internal organs will show a prickled tongue surface. TCM has determined it is the result of spent fluid of the vital essence of the stomach and kidneys. If the tongue surface is smooth and scarlet red, the smooth surface is the result of the shedding of fur and lack of moisture.

Tongue Edges Prick and Tongue-Ray Stripping or with bumps

 Fissured Tongue

The fissured tongue is most often an indication of atrophia of the membrane, with the fissures running horizontally or lengthwise. In serious cases it may look like net. If a young child contracts hepatophilic virus, fissured tongue may show up in adolescence or youth.

Tongues Chapped And Crack 

The Furred Tongue 

For thousands of years Chinese medicine has written literature on clinical experience in observing the furred tongue resulting from affection by hepatophilic virus.

Generally, there are four types; thick, white thin fur, yellow, and dark. It is an indication of dampness arising from the spleen under the fire of the stomach. The varying degrees of the swelling and color of the furred tongue indicates which Chinese medication.

White Fur

"The lungs are related to the color of white and are in charge of the skin and hair. So when there is white furred tongue, it relates to exterior syndrome."

White furred tongue may occur in cases of internal and external symptoms, cold or heat, deficiency of the vital energy or vital essence. For example;

Chronic hepatitis with heat in the lungs or dampness and heat, the tongue will show white fur while the thickness of the fur varies in keeping with the severity of the disease.

If the tongue tip is white while the root is red and the fur is smooth, the ailment has penetrated half deep.

If the fur is white and thick and sticky, it is an indication of dampness and cold in the spleen and stomach.

White fur with little saliva is an indication of excessive heat.

Tongues with White Coating

 Yellow Fur

"When noxious factors invade the deep part of the body called Yangming, the internal heat is rife and the fur of the tongue turns yellow."

Yellow sticky fur of the tongue is an indication of deep heat and dampness in the digestive system. There is also an accumulation of disintegrated organic matter in the digestive tracts.

If yellow fur covers the whole of the tongue there is heat in the organs in both the upper and lower trunk. There will be signs of internal heat and complications of bitter taste and dry throat, uneasiness and insomnia, red eyes, yellow turbid urine, or poor appetite, loose bowels, etc.

Tongue With Yellow Coating

 Black Fur

"Could be cold or heat, deficiency of either vital energy or vital essence. All are interior symptom-complex, not exterior symptom-complex”

Dark fur is the result of the filiforms of the tongue turning black or being brownish black, grayish black or charcoal black or even pitch dark. This occurs usually in cases of chronic ailment or serious cases. It is an indication of either cold or heat in the extreme. In the late stage of a chronic hepatitis with excessive heat, the patient may show extreme heat symptoms and deficiency of the vital essence in the liver and kidneys. When saliva is exhausted, the disease becomes extremely serious.

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Tongue With Black Coating, improvement shown on tongue after herbals treatment.

Improvement shown on tongue after herbals treatment.