Tongue Diagnosis in East Asian Medicine

If you have ever had acupuncture or are thinking about setting up an appointment, get ready to be asked what might seem like a strange request:

“Go ahead and stick out your tongue.”

If your eyebrow is raised in confusion, I get it.

I mean, what medical professionals ever ask to look at your tongue? Not many.

Yet in East Asian Medicine (EAM), Tongue Diagnosis is an essential part of our assessment and evaluation.

This is because the tongue is like a road map for your health — a mirror of what’s taking place in the body. It offers observable, objective information about the state of blood circulation, hydration, digestion, energy levels, and so much more.

In fact, each area of the tongue corresponds to the acupuncture meridians where your vital energy or Qi (pronounced “chee”) flows through, and the internal organ systems themselves.

As you see from this diagram, the key organ systems depicted on the tongue include the Heart, Lungs, Spleen/Stomach, Liver/Gallbladder, plus the Kidneys/Bladder/Intestines. Each governs a section of the tongue much like how they are laid out in the body: the front of the tongue represents the organs in the upper body, the middle of the tongue represents the digestive center, and so on and so forth.

For EAM practitioners, Tongue Diagnosis (Tongue Dx) is a cornerstone for understanding your current health (like a snapshot of the present), while also providing a peek into the past to detect what underlying imbalances lead to your present concerns.

What’s In A Tongue

There are several defining characteristics your acupuncturist will look for when observing your tongue, like:

  • Shape — is it small, enlarged, puffy, pointed?
  • Color — is it pale, red, purple, gray?
  • Texture — is it dry, wet, glossy, or greasy?
  • Body Features — are there cracks, spots, ulcers, raised speckles, or deviations?
  • Coating/Fur — is it thick or thin?
  • Fur Features — where is the fur distributed?

A “normal” and relatively healthy looking tongue is a fresh pink color and a medium thickness with a rooted, light white coat on it (rooted meaning it cannot be scraped off easily). It is free of cracks, spots, ulcers, or teeth marks.

What Does Yours Say?

Qi Deficiency

Pale tongue with thin white coating, a few spots, and teeth marks.

Qi Deficiency is typical if someone struggles with low energy, poor appetite, shortness of breath with exertion, bloating/gas, and worry.

Blood Deficiency

Pale tongue with little to no coating, there could also be teeth marks.

Blood Deficiency is typical in someone who struggles with dizziness, fatigue, dry/thinning hair, brittle/ridged nails, palpitations, poor memory and concentration, insomnia, or light/absent menstrual periods.

Yin Deficiency

Red to crimson tongue, usually thin, little to no coating and cracks.

Yin Deficiency is typical in someone who struggles with irritability, night sweats, insomnia, hot flashes due to menopause, joint/muscle stiffness (dryness), or ear ringing.

Yang Deficiency

Pale tongue that is puffy or enlarged, usually with a thick, white coating.

Yang Deficiency is typical in someone who feels cold easily, has chronic knee and/or back pain, low spirits, is emotionally apathetic or depressed, low libido, feels exhausted/burnt-out, thyroid issues (usually hypo-thyroid).

Damp Retention

Swollen or puffy tongue with a white, greasy (think oily versus glossy wet) coating.

Dampness is typical in people who have issues with indigestion, bloating, gas, loose stools, nausea, pain or muscle aches that are worse with wet/humid/damp weather.

Damp Heat

Swollen, red tongue with a yellow-greasy coating.

Damp Heat is often seen in those who experience chronic inflammatory conditions such as IBS/IBD, skin eruptions (acne, psoriasis, eczema), UTIs, are easy to anger, have pain or muscle aches that are worse in hot/humid weather.

Qi Stagnation

Tip of the tongue will be red, sometimes the sides too, with a thin, white coating.

Qi Stagnation is evident in those who are easily stressed or emotionally upset; there is a tendency towards mood swings, muscle tension and pain patterns worse with emotional stress, premenstrual tension, etc.

Blood Stasis

Purple or mauve tongue with dark red or black spots “speckles.” Veins underneath the tongue are likely dark, enlarged, or distended.

Blood Stasis is common in those who have varicose veins, leg pain, certain types of headaches, chest pain, liver spots, cold limbs, skin dryness or scaling (lacks moisture/luster), pain patterns will have a sharp or stabbing quality.


Red tongue with a thin and yellow coating, can be red spots on tongue body too.

Heat is often seen in those who subjectively feel or “run hot,” sweat easily, high thirst, constipated, short tempered, easily agitated, have skin issues (red-painful acne).

A Word to the Wise

Of course, these are generalizations and very basic diagnostic patterns.

Everyone’s tongue is just as unique as their body’s constitution. Depending on the person, there can be a mixture of features on the tongue — and patterns in their diagnosis! With that said, noticing variations on your tongue is normal and should not be a cause for alarm. These features alone do not definitively mean something is wrong or pathologically awry in those organ systems.

So please, a word to the wise: don’t panic looking at your tongue.

Accurate tongue diagnosis is a skill that acupuncturists spend four years mastering in school and sharpening in practice.

So if you have questions or concerns, consult with a Licensed Acupuncturist (LAC) who is trained to decipher the nuances present on your tongue—but more importantly, detect the underlying root issues to the symptoms you are facing.

To Scrape or Not To Scrape

Oh and one more thing! If you do decide to meet with an acupuncturist — your first visit or a follow up — please do not brush or scrape your tongue beforehand! We need to be able to see the full picture — tongue coating and all.

It will help make our evaluation of what’s taking place internally more accurate.

Now find yourself some good lighting, a mirror, and go ahead—stick out your tongue.

*This article was syndicated with permission and was originally published on Rune Acupuncture. All credit is given to the original source and author.*

Dr. Lauren Renee Dyer is the Founder of Rune Acupuncture in New Gloucester, Maine where her approach to care can best be described as a merging of medicine and mysticism. Dr. Dyer addresses her client’s needs with a holistic and integrative approach. Her specialty lies in offering Acupuncture for emotional health and pain management, guiding patients towards a state where the body and mind are re-integrated, allowing one to reclaim the essence of who they are, as well as a more harmonized state of health. Book a session with Dr. Lauren through Rune Acupuncture or follow her on the ’gram for daily inspiration and wisdom.

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