What is Your Tongue Saying About You?

Stefania Allegrini
Jul 9
5 min read

Precise diagnostic tools that feel wacky

I still remember the first time I saw a Traditional Chinese Medicine practitioner. Shortly after a brief chat about my health concerns I was asked:

"can you show me your tongue?"

I was completely unprepared and still remember, as if it was yesterday, the awkward feeling of sticking out my tongue - something I used to do as a child when I wanted to be naughty!

The TCM practitioner would have a very quick look and conclude with an: "Okay, thank you". So there I was, retracting my tongue and feeling even more awkward: is my tongue okay!?

Maybe because I was shy, maybe because it is often typical of medial professionals to share as little information as possible, I was left wondering what had just happened.

That is until I found myself looking at an image like the above on one of my TCM books.

Although the introduction was awkward, what came of it turned out to be beyond valuable.

The Tongue as a Map of The Body

First of - the tongue represents a geographical map of the entire body.

Center → Spleen and Stomach
Sides → Liver and Gallbladder
Front → Lungs
Tip → Heart
Back → Kidneys, Bladder, and Intestines

Colours, Shapes, Coatings and...Cracks

In traditional Chinese Medicine, the key is to gain a full picture not only from the consultation, but also, directly from the body.

And the way that information is collected is often surprising, but incredibly accurate.

Looking at the tongue allows the practitioner to understand what is happening inside the body, and diagnose with definitive precision the nature of the imbalance, as well as where the imbalance is.

So, if you are intrigued by the idea, here is a simple breakdown of what we are looking for when examining the tongue:

The Colour: Blood, Nutritive Qi and Yin organs

Before we start, in TCM blood is intended as one of the body's key fluids (it has nothing to do with the western understanding of it!).

Blood is understood as a vital substance, deeply tied to energy, nourishment, and consciousness.

It is responsible for nourishing and moistening the body, housing the Mind, determining menstruation and circulating Nutritive Qi.

"Blood is itself a form of Qi, a very dense and material one, but Qi nevertheless" -Maciocia, The Foundations of Chinese Medicine.

So, when we look at the tongue and its colour, we are looking to find out if the blood is sufficient, if it's flowing well and if it's stored and released correctly.

For example

Purple tongue → Indicates blood stasis.
- If the sides are purple: likely Liver blood stasis.
- If the whole tongue is purple: more general blood stagnation.
Red tongue → Typically indicates heat.
- If the tip is red: suggests Heart Fire.
- If the whole body is red: generalised heat in the body
Pale tongue → Suggests blood deficiency.
- If it's also thin: points to Heart Blood Deficiency.
- If it's generally pale: generalised blood deficiency.

Shapes: Blood and Nutritive Qi

Looking at the tongue's shape gives useful information not only on the state of the blood, but also the Nutritive Qi. Nutritive Qi is closely related to blood, it is responsible for nourishing the internal organs and flows through the channels.

Some shapes are:

Thin tongue → Blood or Yin deficiency
- Pale means blood deficiency
- Red without coating means Yin deficiency
Swollen tongue → Dampness or Phlegm
- Partially swollen: Heat
- Tooth-marked: Spleen-Qi deficiency

On the topic of shapes, we also look at tongue...cracks. Whacky? Yes. Precise diagnosis? Also, yes!

For example:

Long central crack → Stomach crack → Stomach pathology, chronic and long standing
Crack on the tip of the tongue → Heart Crack → longstanding anxiety or emotional struggles
Crack extending from the tip to the middle of the tongue → combined heart and stomach pathology

Coating & Moisture - The Yang Organs, and Body Fluids

Coating and moisture tell a story about how the yang organs are doing. The Yang organs are Stomach, Gall Bladder, Small Intestine, Bladder, Triple Burner.

It also talks to us about the state of body fluids.

Some examples are:

Thick white coating→ Dampness
- On a swollen tongue, we are looking at Spleen deficiency with Dampness
Yellow coating → Dampness and Heat → Damp Heat
No coating → Heat and Yin Deficiency
Peeled patches → Yin Deficiency
Dry tongue → Heat or Yin deficiency
Wet tongue → Dampness or Yang deficiency (if the tongue is also pale)

An Example

In the example below, we can observe that the tongue in question displays the following qualities

Colour: The tongue displays a deep purple hue, which is a classic sign of blood stasis. If we look closely, the left side appears more purple than the right, which gives us a clue: the stagnation is likely affecting the Liver, which sits on the left side of the tongue map.
Coating: There’s a thick, almost infected-looking white coating at the back of the tongue. This points to Dampness in the Lower Burner—the region related to the Kidneys, Bladder, and Intestines. To determine exactly which organ is involved, we would rely on a deeper conversation (interrogation) and the person’s symptoms.
Crack: We see a deep central crack extending from the tip of the tongue toward the middle. This is a strong indicator of both Heart and Stomach pathology, and it’s often present in cases of chronic stress, anxiety, or digestive imbalance.
Moisture: The tongue looks peeled and somewhat wet—a sign of severe Yin deficiency, often involving the Stomach or Kidneys. A peeled tongue usually indicates a long-standing depletion of fluids and internal resources.

A single glance at the tongue—paired with attentive questioning—can reveal imbalances that may not be visible in blood tests or physical exams.

This is one of the gifts of TCM: it listens to what is trying to communicate quietly before it shows up as symptoms (or it helps us to confirm a diagnosis, with precision and certainty).

Seemingly Silly, Definitely Insightful

So, looking at the tongue might feel silly, but, the rewards are definitely worth it! As we have explored above, the tongue gives valuable information on what is happening inside the body, often even before symptoms start to appear.

So, that's why we look at tongues. Yes, the information collected might be used to confirm a certain pattern or confirm the diagnosis, but it could also offer insights on underlying conditions missed during the consultation phase.

So, next time someone asks you to look at their tongue, do it with a smile...you are about to discover secrets unrevealed!

Want to learn more about how acupuncture could help with your symptoms? Find out more here.