What is tongue diagnosis in Chinese Medicine?

By: Dr Jason Chong (Traditional East Asian Medicine Physician)

For a practitioner of Chinese Medicine, tongue diagnosis is a fundamental diagnostic tool.

The tongue reflects the material state of our body. Especially we can check the condition of blood and body fluids. It reveals information about the chronicity and severity of a particular pathology.

We take the findings from the diagnosis of the tongue in the context of all diagnostic methods. Together they help determine the state of balance of Qi / Blood / Yin / Yang within the patient.

What is the tongue map?

Different regions of the tongue represent a different organ system. Abnormal findings in each region show the dysfunction of the related organ system. The Chinese Medicine tongue map is similar to that in ancient Greek medicine as practised by Hippocrates.

In East Asian Medicine the body can be viewed as three jiaos or regions of the body.

Lower Jiao

The back of the tongue corresponds to the Kidney, Bladder, Large and Small Intestine.

Middle Jiao

The sides of the tongue correspond to the Liver and Gall Bladder. The middle of the tongue corresponds to the Stomach and Spleen.

Upper Jiao

The front of the tongue relates to the Lung, the tip to the Heart.

What should a normal tongue look like?

The normal body colour should be pale red. The body should be soft, with a flexible body which is evenly shaped. It should be moist and bright with a thin white and clear coat.

What does an acupuncturist look at when making a diagnosis of the tongue?

When practising Chinese tongue diagnosis, we focus on three primary characteristics: body colour, body shape and coating/moisture.

Tongue colour

Refers to the colour of the flesh of tongue itself. It reflects the internal condition, not affected by temporary emotional or physical factors.

Some colours we may observe include:

  • Red: indicating the presence of heat
  • Pale: indicating a lack of Blood or Yang energies
  • Purple: indicating a lack of healthy circulation of Blood

Tongue Shape

The normal tongue shape is moderate, neither too thin nor too swollen. It is soft and supple and tapers toward the tip. It has an unbroken surface and can extend easily.

The tongue shape reflects the state of Yin substances such as blood and fluids in the body. Examination of the tongue shape involves observing the consistency, texture and mobility.

When observing the tongue shape, the findings contextualised by the tongue body colour.

The tongue shape changes with persistent pathology. This means we can get information about the severity and chronicity of the pathology.

Some observations we may make regarding the shape of the body of the tongue include:

  • Thin: indicates that the Blood or fluids are insufficient in the body
  • Swollen: indicates that fluids are accumulating and not circulating freely
  • Long: indicating heat
  • Cracks in the body: indicating damage to the fluids and Yin aspects of the body
  • Swollen or purple sublingual veins: indicating fluids or Blood is not circulating well

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Tongue Coating

The tongue coat is a by-product of digestion. Turbidity ascends to the tongue, where it rests and forms a tongue coating.

The coating reflects the strength of the digestive function (Stomach Qi). It also reflects the presence of pathogenic factors and the condition of the fluids in the body. By observing changes in the tongue coating, we can track the progress and depth of disease.

When examining the tongue coat, we observe the quantity, colour, moisture, quality and distribution.

A normal tongue coat should be thin, translucent white and slightly moist. Variations reflect the state of our internal organs, the status of fluids, and the presence of pathogenic factors.

Scraping of the tongue is a common practice; ensure you are not doing this before a consultation. It is an Ayurvedic practice to scrape the tongue first thing in the morning to improve health. In modern-day, it is often also practised as a cosmetic routine and to keep the breath fresh.

Some descriptions used for the tongue coat include:

  • Thick: indicates the presence of pathogenic factors
  • Thin: indicates damage to fluids and Yin substances
  • White: the presence of cold
  • Yellow: the presence of heat
  • Wet: fluids not circulating properly
  • Dry: damage to fluids


It can be an interesting exercise to monitor your own tongue. Check it first thing in the morning to ensure it is not tainted by foods etc you have consumed. You can monitor the effects of certain dietary or lifestyle changes.

Remember that it is one tool of diagnosis. A complete picture of your health involves bringing multiple pieces of information together to obtain an accurate diagnosis. Only then can a proper treatment plan be developed to help you reclaim health and restore vitality.

What else would you like to know?

Thanks for reading this far. Have I missed your question? Was something unclear? Let me know in the comments below, I read and respond to everyone!

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Dr Jason Chong (Traditional East Asian Medicine Physician)

Traditional East Asian Medicine Physician. Educator.

Jason is the owner and principal practitioner at Dantian Health, providing consultations for Classical Chinese Herbal Medicine and Japanese Acupuncture in Melbourne, Australia.

He is a qualified acupuncture physician, Classical Chinese herbal medicine clinician, shiatsu practitioner and tuina therapist, Oriental therapies educator and director at the Australian Shiatsu College.

Jason's qualifications include:

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