Acupuncturist Philippa Summers shares what you can learn from looking at a tongue and why she might ask you to 'stick out your tongue' when you go to see her!
Tongue Diagnosis provides a clear contribution to overall diagnosis in Chinese Medicine.
Here’s a look at how it fits in with other information, what you can tell from a tongue and
how it relates to treatment.
Your first session with a Traditional Acupuncturist, like myself, is usually quite lengthy. I
allow 90 minutes for most initial appointments* with about half that time set aside for
gathering information and half for the treatment itself. Alongside understanding the
problem with which you are seeking help, whether it is headaches, low mood, anxiety,
period pain, fertility, tiredness, eczema or something else, it is important to get a picture of
the background against which it has arisen and a more rounded picture of your health and
wellbeing. Digestion, sleep, your monthly cycle for women, reactions to heat and cold and
feelings, among other things, all contribute to a holistic diagnosis. Also important is the
context - your life and lifestyle, what is working well and supporting you and what is not.
Two additional contributions to the overall diagnosis and hence direction of treatment are
pulse and tongue diagnosis. Pulse diagnosis is subjective and is easily affected by what is
going on at that moment or that day. Tongue diagnosis gives a more objective clear picture
and provides a very reliable contribution to your diagnosis and subsequent treatment
strategy. I will almost always ask you to stick out your tongue, although I know that might
seem a little odd!
What do I look for on the tongue?
The tongue gives a glimpse of your insides and although it is a part of the digestive system it
gives clues that relate to the whole body. It can of course be affected by diseases of the
tongue itself and also affected by medication but here I am focussing on situations where
they are not influences. A healthy tongue is pink with a very thin white coating.
Fig 1 A generally healthy looking tongue. Even this healthy tongue gives some clues – there is slight
swelling indicated by the dip in the centre and toothmarks at the edges.
When I look at your tongue I am observing several aspects which include:
• The Tongue Body (the tongue itself beneath the coating) - the colour, shape, texture
• The Tongue Coating - the colour, thickness and consistency.
• Points and Spots - their colour and size (distinct from the normal taste buds)
• Cracks and fissures
• Areas of the tongue and their correlation with parts of the body – see Fig 2.
How do these relate to physiology?
Some aspects of the tongue give clear indications on their own, but generally it is the
combined information that provides insight and gives meaning.
So, for example, the tongue body colour (ranging from pale to deep red) gives information
about relative heat and cold in the body, also about the state of the blood and whether it is
well nourished. Spots on the tongue (red or white) and the colour of the coating (white, to
various shades of yellow and even black) give further clarity to influences of heat and cold. A
very slight purplish tinge to the tongue, whether on a pale or red tongue generally indicates
The relative moisture of the tongue gives the most direct indication of internal body fluids
which is further refined by the relative shape of the tongue and the consistency of the
coating. A very wet, swollen tongue, with a thick greasy coating is a usually a sign that body
fluids have accumulated which hampers function by congesting and blocking. A thin, dry
tongue with no coating may indicate a deficit in fluids which hampers function through lack
of lubrication and nourishment.
Cracks and fissures are more complex and can mean different things depending on their
location, appearance and other aspects of the tongue, but are often associated with a
depletion of body fluids and also with heat.
Different areas of the tongue also relate to different parts of the body. If we divide the
tongue roughly into thirds, the front portion relates to the chest area, the middle third to
the digestive organs above the navel, and the rear third to the area below the navel.
Fig 2 Areas of the tongue as they relate to organs. Note: These are the organs as they are understood in Chinese Medicine and don’t relate exactly to the physical organs although there is considerable overlap.
It is worth noting that the Spleen in Chinese Medicine includes pancreatic function, so is
very closely connected with digestion. The reproductive organs, especially in women, are
influenced by findings in all areas of the tongue despite their location below the navel.
Putting it all together.
Traditional Acupuncturists seek out the patterns that weave signs and symptoms together
and treatment is focused on bringing harmony, so that everything works together more
supportively. In doing so we aim to improve your health overall, including of course the
main issue that you are seeking help with. An important part of treatment is also working
out what factors are influencing and contributing to the imbalances, so that they too can be
Almost without exception the picture painted by gathering together all the signs and
symptoms will not be textbook patterns, but an individualised interaction of the patterns,
sometimes with some contradictions and some patterns masking others. Everyone is
different and at times the picture can be very confusing. The tongue can give real clarity
and help to prioritize treatment and the most important factors to focus on. Over time the
effects of treatment are reflected in the tongue.
It really is an invaluable tool and it is amazing how different each tongue is. So, when I ask
you to stick out your tongue, please don’t be shy!
*The exception would be when treating a simple muscle of joint problem, like an ankle
sprain, where going into your background health and looking at things from a more holistic
perspective is not as important. An hour is then usually long enough for the first session, but I
may still ask to see your tongue as it can still be helpful.