In East Asian Medicine, tongue analysis is an important and significantly useful tool when determining a diagnosis. By observing the many aspects of a patient’s tongue, practitioners are able to monitor and assess progression of treatment and severity of disease in the body.

The tongue, which is considered a muscular organ, gives us a first hand view of what is happening internally. As practitioners, we observe the shape and color of the body, the coat and moisture level, as well as look for any movement, landmarks or deviation of the tongue itself. The appearance of the tongue reflects the state of your vital energy, also known as qi.

Naturally, patients frequently look at me skeptically when I ask to look at their tongue and they are curious about what I can possibly tell by looking at it.  A good analogy is plants. You can tell a great deal about the health of a plant, even the roots that are underground, by looking at the leaves. You can tell if the plant needs water. You can tell if maybe there has been too much water. You can determine information about light conditions, fertility, age, exposure to pollution and even nutrient deficiency, all by observing the leaves. The tongue is similar.  Acupuncturists have been trained to look for signs of excesses or deficiencies in things ranging from digestion to fertility to energy to mood to immune function to disease processes, all by observing the tongue.

Different areas of the tongue correspond with different organs. The top 1/3 corresponds with the lung and heart, the middle 1/3 with the stomach and spleen and the back 1/3 with the intestines and bladder. The edges correspond to the liver and gallbladder.  Having a “map” gives the acupuncturist a clue as to where the issue may lie, as well as its severity.  Also, the tongue reveals secrets about the relationship to the inside of the body.  The color and shape of the tongue reflects the quality of the circulation of qi and blood in the body.  A pale tongue, for example, may indicate that the body is lacking some of the qi / blood nourishment it needs to flourish. The tongue coating is indicative of the fluids (or lack thereof) in the body.  There is a lot to be learned from just looking at the tongue.  Here are some of the qualities that are observed during a tongue diagnosis.

Color – The color of the tongue holds great clues about the body’s environment. In EAM, a red tongue body would indicate heat. The tip of the tongue is associated with the heart and the lungs. Redness at the tip of the tongue can indicate emotional issues like stress and anxiety or it can be an indication that the lungs are being compromised by an infection.  A pale tongue can indicate poor circulation or issues like anemia or deficiency of qi (energy) or blood.  While a purple or dusky tongue can indicate the stagnation of energy or blood.  The tongue body color alone can be quite telling.

Cracks – Many patients will have a crack running down the center of the tongue. The center of the tongue is associated with the spleen and the stomach (think digestion). Excess heat and / or lack of fluids, can lead to cracks  This person may also have other dryness symptoms, such as dry itchy skin, dry eyes, a tendency toward heartburn (especially after drinking alcohol or consuming coffee, both of which can dry out fluids) or constipation with dry stools. There may be other digestive issues like bloating or poor digestion of cold and raw foods.

Coating – A coating on the tongue is another major clue for acupuncturists. Ideally, there shouldn’t be any. A thick coat indicates a retention of dampness and where this coat appears is also an important clue. Dampness is typically generated from the gut and appears in the middle of the tongue. However, when the coat is thicker in the back of the tongue, it is a sign that the dampness has descended into the intestines and bladder. The color of the coat also indicates the type of dampness. A white tongue coat indicates dampness, while a more yellow coat shows dampness mixed with heat. Also, coating can be peeled in certain patches which would indicate areas that have more heat in relation to other channels.

Scalloping – Another common presentation is a swollen tongue with scallops (teeth marks) along the edges. This is another sign of the retention of dampness. A person with a swollen tongue is likely to exhibit body swelling, excess mucus or diarrhea.

Sublingual Veins – Taking a look at the sublingual veins can also be helpful to the acupuncturist.  If the sublingual veins are dark, thick and engorged, it is a safe bet that there is stagnation somewhere in the body.  This can be caused by numerous issues and therefore, examining the underside of the tongue is also pertinent.

While it’s true that a diagnosis can be made just by looking at the tongue, most practitioners use tongue observation as a way to confirm what they already diagnosed based on your answers to their questions. Also, two people may have similar tongues but different symptoms because no two people have the same underlying contributing factors to their ailment.

What does this all mean for you? Take a look in the mirror: If your tongue isn’t light red, with a thin clear to light white coat, it may be time to book an acupuncture appointment. The tongue can show an imbalance before symptoms start to appear, making it a great signal to start preventative treatments.

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