Tongue Diagnosis Chart (Plus How to Read It) - Huwe Acupuncture (2024)

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When you go to an acupuncturist or Chinese herbalist, chances are the practitioner will ask you to stick out your tongue for their inspection. That’s because one of our diagnostic techniques is tongue diagnosis. We’re looking for the color, size, coating, moisture level, and any bumps, lines, cracks, or divots.

What the what, and why is your acupuncturist so interested in the looks of your tongue?

There are many reasons Chinese medicine practitioners are interested in their clients’ tongues, which I’ll tackle below. Moreover, odd though it may sound, you can inspect your own tongue. I’ll give you a tongue diagnosis chart so you can next-level your at-home self-care moves like a boss with all those hyphens. Let’s go down the rabbit hole!

Diagnosis in Pre-Modern Times

These days, if we want to know what’s going on inside our bodies, we have many modern options at our disposal.

Physicians can order a lipid panel, connect you up for a nerve conduction test, stick a camera into many a nook and cranny, check kidney and liver functions, pop you into an MRI tube, snap a quick X-ray, and/or choose from any other number of diagnostic tests. Not only can they do these things, they can do most of them before lunch on a Tuesday. NBD.

But what happened before these types of tests were available? Were people bumping around in dark caves, completely unaware of their insides right up until the moment Prometheus stole the liver panel tests from the gods? Of course not. Everything we have today was built incrementally — and, yes, sometimes exponentially — by the brilliant people who came before us.

As we’ve covered in a previous post, Chinese medicine is, to use a technical term, super-duper OLD. Ergo, its diagnostic tools developed without the convenient benefits modern imaging affords us. Let’s pause here for a moment to think about that.

The radical changes that modernity has wrought upon the human experience are staggering to try to conceive of. It’s like thinking about the formation of the Grand Canyon, or trying to understand the distance between the sun and Alpha Centauri.

If you, like me, were alive pre-internet, you have an experiential, practical memory of how different life was before that thing showed up. I’m not here to yap either way about the internet’s pros and cons; rather I want to point out that the internet was a sea change. Love, hate, or love/hate it, the internet redefined how we interact with ourselves, our minds, each other, and our collective. Humans had a lot more room for reflection and downtime before the internet made incessant productivity, busyness, and reachability not only available, but expected.

The internet is just one example of a radical shift brought by a technological innovation, but there are lots more: cars, faster cars, guns, machine guns, electricity, major home appliances, TV, and mobile phones — just to name a few. Imagining life on Earth before these things is challenging and beyond the scope of these words.

Safe to say, pre-modernity, people had a different relationship to time. On the one hand, we might think they had less time because so much was tied up in the labor of daily life: starting a fire, boiling the water, curing the meats, et cetera ad infinitum. On the other hand, we might think they had way more time because (a) they had fewer distractions and (b) they had fewer demands outside daily life.

For the purposes of this essay, I’m going with the tried-and-true idea that privileged people had more freedom of movement and schedule than the people toiling in manual and domestic labor. I’m also going with the idea that privileged people in those days had fewer distractions, and as a result were likely to either go stark-raving unpleasant, or to go stark-raving interesting.

What was it like, then, all those years ago, for the people of privilege who were developing Chinese medicine? Well, I don’t actually know. It’s easy to romanticize or disparage a time I can barely contextualize in reasonable terms.

My most neutral sense is that such folks had a lot more time on their hands to pay attention to stuff, and that their capacity for observation and contemplation was likely superior to ours. Because there were fewer distractions, they were well-practiced observers and contemplators. Also, shorter life spans and different types of health problems may have meant that cause and effect were more proximally related in days of yore.

Anthropological musings and realities aside, the people studying medicine made connections between the inside and outside, and these findings were based on their observations. And sure, many of them were probably wrong or bunk. But many were not, and held up to the tests of time and scrutiny.

One such diagnostic technique is tongue diagnosis.

Tongue Diagnosis: Straight From the Source’s Mouth

Tongue diagnosis shows up in some of the very old aspects of Chinese medicine. This article by Chen Ze-lin¹ says depictions of tongue diagnosis can be found on bones and tortoise shells from the Shang dynasty (circa 1600–1050 BCE).I can barely wrap my mind around walkie-talkies and ear crystals, so please excuse me if I simply goggle at that.

Sometime in the Qin and Han dynasties (221 BCE–220 CE), the Neijing, a medical classic of Chinese medicine, was written. The Neijing, as the Library of Congress succinctly states, is “a summation of Chinese medical knowledge up to the time of the Han dynasty.”

The Neijing mentions the tongue as a consideration in medicine, name-dropping it here and there in diagnostic terms. For example, “Patients… feel chilly, have cold limbs… the tongue has a yellow coating, and the patient is feverish.” This type of talk continues throughout various texts in the subsequent centuries, but without the full-on tongue diagnosis charts and detailed inspections we know today.

Sometime in the 13th century (Song or Yuan dynasty), a practitioner named Ao Shi made the first illustrated books about tongue inspection. These books, Golden Mirror Extracts and Every Point Is Golden, weren’t terribly popular, which I find somewhat baffling. I don’t know if you’ve ever looked at tongue pictures, but they are fascinating.²

A little bit later on, another practitioner (Du Qing Bi) added more illustrations to Ao Shi’s. About 100 years or so after that, a practitioner named Xue Ji included the tongue pics in his own book, and they took off in popularity and recognition. So in comparison to the deep history of Chinese medicine, tongue inspection as a specific diagnostic tool is somewhat recent, having become more specifically studied and absorbed into the mainstream in the 1200s–1400s. Subsequent centuries have seen tongue diagnosis become even more enfolded into the medicine.

These days, as Dr. Nancy Holroyde-Downing³ states in her 264-page thesis about tongue diagnosis (bravo!), the inspection of the tongue is very prominent in Chinese medicine:

“The inspection of the tongue, initially associated with portents of impending death or with the presence of febrile illness known as shanghan 傷寒 (cold damage), is now a pervasive aspect of a traditional diagnosis, and, as noted above, it is a fundamental part of the curriculum in most colleges of Chinese medicine. It is discussed in diagrammatic and theoretical detail in contemporary Chinese medical textbooks and is a feature of the ‘signs and symptoms’ used in planning or discussing acupuncture and herbal medicine treatment.”

True story! And as with everything in Chinese medicine, there are lots of ways to understand it. You can run a search for “Chinese medicine tongue diagnosis chart” and find pretty different — and nonetheless correct — results.

Open Up and Say Ahhhhhh

The most circulated tongue diagnosis chart, taught in both TCM and classical Chinese medicine, looks something like this:

You’ll see that the tongue is a map, with areas of it linked to various internal organs. Over millennia and/or centuries of tongue observation as it relates to states of health, this is the generally accepted orientation guide of what to look for, and where. The heart is at the tip; just behind that is the lungs; in the center of the tongue is the stomach; the far back, or root, is the kidney area; the sides are the liver.

In our estimation, this chart is not useful for the lay person in terms of self-diagnosis. It’s easy to look at it and think either This is ridiculous! or Saints preserve us! I have a sore on my tongue! Is my heart diseased or is it my lungs? HELP.

Not helpful. Connecting the tongue to the internal landscape of the body is much more nuanced than the above italicized sentences suggest. There are many theoretical and clinical underpinnings the practitioner must learn and practice for tongue diagnosis to be meaningful and effective. In fact, it doesn’t even necessarily imply there’s involvement with your organs at all. It’s subtle and layered, which is pretty much another way of saying, it’s Chinese medicine.

So what is useful for you in terms of that at-home self-care I referenced way back at the beginning of this rabbit hole? If you examine your own tongue in the mirror, what would Chinese medicine suggest you look for, and what would it suggest you do about it?

At Huwe Acupuncture, we suggest looking for two main things: scallops and coat. We also find that small dietary changes can change the state of the tongue a good deal.

Scallops

The source: A scalloped tongue is the result of the tongue’s sides pushing against the teeth. Now, you might think that’s simply a result of tongue size. And you’d be sort of right — but the tongue’s size changes depending on what’s going on with your digestion.

The main takeaway: A scalloped tongue is typically an indication of sluggish or bogged down digestion. The body’s ability to transform food and drink into energy becomes compromised. We often suggest to clients that they incorporate fresh ginger and cooked scallions to aid in digestion and appetite.

Coat

The source: Tongue coat can indicate all kinds of things related to yin and yang — for example, is the situation primarily rooted in heat or cold? Absence of tongue coat is also informative.

The main takeaways:

1. Lack of coat or thin coat both suggest the need to build fluids. This can be achieved through fluids, probiotics, fermented foods, juicy foods like zucchini or okra, and soups.
2. Thick coat typically indicates food stagnation. Chinese medicine suggests diversifying the diet in these cases.

   For example, an overabundance of carbohydrates can be mitigated with sprouts. Too much protein can be leavened by a pineapple marinade, which helps break down protein. Excess fat can be aided by spices such as pepper. Or, digestive enzymes can handle any of the above.

Conclusion to Tongue Diagnosis Charts

Because Chinese medicine didn’t disappear with the advent and development of biomedicine, the diagnostic system of tongue inspection remains. While we do caution against oversimplification when applying this system to your own health, it can be helpful to familiarize yourself with your tongue.

Hilarious as it sounds, staring at your tongue in the mirror can help you gain an understanding of how it changes. Check it out when you’re feeling great (energized, well-rested, not stressed, happy, etc.), when you’re feeling not-so-great (hungry, hangry, sleep-deprived, stressed, hungover, etc.), and also whenever you feel like it.

Noticing the change in scallops and coat structure can give you insights into what you need. And knowing is half the battle.

by Mary Beth Huwe

These writings are an exploration of what it means to be human – to be sick, to be well, and to heal – viewed through the lens of classical Chinese medicine. My words aren’t medical advice, and these essays don’t constitute a practitioner-client relationship. They also aren’t meant to be the final word on… well, anything. Rather, I hope they are the beginning of a conversation you have with someone in your life. Thanks for reading!

Footnotes

1. Ze-lin, Chen 1987, “Brief history of tongue inspection,” Chinese Medical Journal, pp. 38-44, accessed December 2023 from https://mednexus.org/doi/pdf/10.5555/cmj.0366-6999.100.01.p38.01. ↩︎
2. Also gross! Have you ever looked up black hairy tongue (BHT)? ↩︎
3. Holroyde-Downing, Nancy 2017, “Tongues on fire: on the origins and transmission of a system of tongue diagnosis, a dissertation submitted to the faculty of University College London,” accessed December 2023 from https://discovery.ucl.ac.uk/id/eprint/10040369/1/Holroyde-Downing_10040369_thesis.pdf ↩︎

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