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Tongue diagnosis, also known as wang she (observing the tongue), is an important method for understanding the physiological functions and pathological changes of the body through observing the changes in tongue appearance, used for diagnosing and understanding diseases.
During tongue diagnosis, observation is conducted in the order of tip of the tongue – middle of the tongue – root of the tongue – sides of the tongue. First, observe the tongue body, then the tongue coating, for about 30 seconds. If the diagnosis is unclear after one observation, allow the patient to rest for 3-5 minutes before re-examining.
The WeChat public account of Meridian Techniques has compiled a high-definition color atlas of common tongue coatings in clinical Chinese medicine, hoping to be helpful to everyone.
Tongue Shape and Surface
1Red spots on the tongue – Internal Heat Accumulation
If there are red spots or prickles on the tongue, it indicates excessive internal heat.
Red spots or prickles on the tip, middle, and sides of the tongue represent excessive heart fire, gastrointestinal heat, and liver-gallbladder fire, respectively.
2Cracked tongue – Deficiency of Essence and Blood
Cracks on the tongue generally have no coating, indicating deficiency of essence and blood.
A white tongue coating with cracks indicates deficiency of essence and blood; a crimson dry tongue with cracks indicates heat damaging body fluids.
3Teeth marks on the tongue – Yang Qi Deficiency
A pale tongue body with a pale coating indicates spleen and kidney Yang deficiency, with internal dampness and phlegm.
This tongue appearance is very soft, indicating deficiency of Yang Qi and decline in physical strength.
4Pale white tongue – Internal Deficiency of Sweating
A pale and plump tongue indicates deficiency of Yang Qi; a pale and thin tongue indicates deficiency of Qi and blood.
A pale tongue belongs to the tongue appearance of deficiency and cold.
5Red tongue – Presence of Heat Evil
A red tip with prickles indicates heart fire rising; a tongue that is red with a yellow and dry coating indicates internal excess heat; a red tongue body with little or no coating indicates Yin deficiency and internal heat.
This is a heat syndrome, which may indicate excessive accumulation of heat in the body, while also observing if there are red spots on the tongue surface.
6Crimson tongue – Strong Heat Evil
A crimson tongue with a dry body and prickles or cracks indicates intense internal heat; a crimson tongue without coating and smooth indicates exhaustion of stomach and kidney Yin.
This tongue appearance indicates that the heat evil has penetrated deeply into the blood, usually having consumed body fluids, with deeper colors indicating more severe heat evil and symptoms.
7Purple tongue – Poor Blood Circulation
A bluish-purple tongue indicates poor blood circulation. A purple tongue with a reddish hue may indicate excessive internal heat accumulation.
Cold syndrome, heat syndrome, or blood stasis syndrome may all present this tongue appearance, primarily caused by poor blood flow.
Tongue Size
1Fat tongue – Internal Cold Deficiency
Pay attention to the color of the tongue, the coating, and whether there are red spots on the tongue surface.
A yellow tongue coating often indicates excessive heart and spleen heat; a swollen tongue with a dark purple color often indicates blood stasis obstructing the channels.
2Fat pale tongue – Weak Yang Qi
Due to weak Yang Qi, the warming and promoting functions are affected, and the distribution of fluids is weakened, resulting in a plump and pale tongue.
A fat pale tongue is a manifestation of weak Yang Qi and retention of dampness.
3Thin red tongue – Nutritional Deficiency
A red tongue indicates internal heat or inflammation; prolonged heat damages body fluids, leading to nutritional depletion.
A thin tongue is evidence of a lack of nutrition and moisture in the body.
4Thin pale tongue – Deficiency of Qi and Blood
A thin pale tongue with obvious coating often accompanies mild colds or digestive issues, indicating a weak constitution.
This primarily reflects a pathological state of deficiency of both Qi and blood, indicating malnutrition of the body.
5Old tongue – Confrontation of Zheng and Xie
The tongue coating is yellowish-white or gray-black, often indicating a solid or heat syndrome.
An old tongue is commonly seen in the stage of confrontation between Zheng (righteous Qi) and Xie (evil Qi), where the pathogenic Qi is strong, but the body’s resistance is also strong.
6Tender tongue – Low Metabolic Function
This often indicates deficiency, cold, or dampness.
Weak internal organ function, low nutritional metabolism, and weakened resistance are often seen in sub-healthy individuals.
Thickness of Tongue Coating
1Thin coating – Mild Condition
A thin white tongue coating with a pale red tongue is a normal tongue appearance; a thin yellow coating primarily reflects the pathological characteristics of initial heat syndrome.
This indicates a normal tongue coating or an early stage of disease, or shows a mild condition.
2Thick coating – Gastrointestinal Accumulation
If the tongue body is red, with a yellow, thick, and dry coating, it indicates excessive heat damaging Yin; if it is pale red with a thick, white, greasy coating, it indicates phlegm, dampness, or food stagnation.
This indicates a transition from mild to severe condition, or the presence of gastrointestinal accumulation.
3Dry coating – Vomiting and Diarrhea Damaging Body Fluids
If the tongue coating is merely dry and white, it indicates poor circulation of body fluids; if the coating is dry and yellow, it indicates intense stomach heat damaging body fluids; if the coating is dry and black, it indicates extreme heat damaging Yin.
This generally indicates high fever and vomiting or diarrhea damaging body fluids. It is also important to check the color of the tongue itself.
4Rough coating – Fluid Deficiency
If the dryness in the body becomes severe, it raises concerns about chronic diseases such as hyperlipidemia or diabetes, and individuals with asthma may experience difficulty breathing.
Rough coating indicates severe fluid deficiency.
5Slippery coating – Mental Fatigue
If the body is easily fatigued, with mental fatigue and lack of energy, it indicates a state of various functional declines and reduced immunity.
This indicates deficiency syndrome or cold syndrome. It is also important to pay attention to the size of the tongue and the teeth marks on the edges.
6Greasy coating – Dampness and Turbidity Accumulation
A white tongue coating that adheres to the surface of the tongue indicates internal cold and dampness; if the coating is yellow, it indicates internal dampness or phlegm turbidity accumulating and transforming into heat.
This indicates dampness and turbidity accumulation, with Yang Qi being restrained, primarily indicating phlegm dampness and food accumulation.
7Putrid coating – Excessive Internal Heat
Be cautious of discomfort and infections caused by overeating.
Putrid coating often belongs to heat syndrome, primarily indicating food accumulation and phlegm dampness.
Color of Tongue Coating
1White coating – Dampness and Phlegm Accumulation
A thin white tongue coating is a normal tongue coating or indicates the initial stage of an exterior syndrome. A thin white and slippery coating indicates internal cold syndrome; a thin white and greasy coating indicates dampness and phlegm accumulation.
2Yellow coating – Transformation of Cold into Heat
A thin yellow coating indicates mild heat; a yellow coating indicates severe heat; a scorched yellow coating indicates extreme heat; a yellow greasy coating indicates damp-heat syndrome.
Yellow coating indicates disease, primarily indicating spleen and stomach disease, internal syndrome, and heat syndrome.
3Gray coating – Dampness and Turbidity Obstruction
Once the tongue coating turns gray, it indicates that the disease has taken root in the body, and the condition has become serious.
A gray-white coating indicates internal cold dampness or dampness and turbidity obstruction.
4Black coating – Intensified Evil Heat
Black dry coating indicates the influence of chronic diseases or inflammation; black greasy coating indicates excessive accumulation of heat evil and dampness in the body.
Black coating indicates a more severe condition or a tendency towards chronicity.
1Typical Tongue Appearance of Qi Deficiency Constitution
1Pale fat tongue with stasis spots
Tongue Quality: Dull and fat
Tongue Coating: Thin
Tongue Surface: Obvious stasis spots on the front half of the tongue
This tongue appearance is often seen in patients with fatigue, easy tiredness, cold intolerance, abdominal distension due to weak transformation, and lack of appetite.
2Dull tongue with thin greasy coating
Tongue Color: Dark red
Tongue Coating: Thin greasy coating
Tongue Surface: Moist
This tongue appearance is often due to deficiency of Zheng Qi and poor transformation in the middle burner. Patients may experience general fatigue, memory decline, poor appetite, and abnormal bowel movements.
3Fat tender tongue, mirror-like
Tongue Color: Slightly red
Tongue Quality: Tender
Tongue Body: Fat
This tongue appearance is typical of both Qi and Yin deficiency, and such patients may experience fatigue, shortness of breath, mental fatigue, and poor digestion.
4Pale dark tongue with stasis spots
Tongue Quality: Dull
Tongue Coating: Few and thin white
Tongue Body: Red tip with slight stasis spots
This tongue appearance is often due to complex conditions, resulting from long-term deficiency of both Qi and blood.
5Pale fat tongue with white coating
Tongue Body: Pale and large
Tongue Quality: Tender
Tongue Coating: White
This tongue appearance is often caused by Qi deficiency, with lung and spleen Qi deficiency leading to a tender and fat tongue with a white coating.
6Pale fat tongue with teeth marks
Tongue Quality: Pale
Tongue Coating: White
Tongue Body: Fat with teeth marks on the edges
This tongue appearance is often seen in sub-healthy individuals. Patients may experience indigestion, fatigue in the limbs, and unformed stools.
7Pale red tongue with stasis spots
Tongue Quality: Pale red
Tongue Body: Slightly fat
Tongue Tip: Has scattered stasis spots
This tongue appearance is often seen in chronic consumptive diseases, resulting from long-term deficiency of Zheng Qi and Qi and blood stasis.
8Pale red tongue with thin white coating
Tongue Quality: Pale
Tongue Coating: Thin and white
Tongue Body: Thin
This tongue appearance is often due to weak spleen Qi, combined with weak middle Qi, leading to the spleen not controlling blood. Patients with this tongue appearance are prone to fatigue.
9Pale white tongue with tender quality
Tongue Color: Pale
Tongue Quality: Tender
Tongue Coating: Thin
This tongue appearance is often seen in individuals who are overworked, under mental stress, or have poor spleen and stomach function.
10Pale thin tongue with white coating
Tongue Body: Slightly thin
Tongue Quality: Pale
Tongue Coating: White
This tongue appearance is often due to lung and kidney Qi deficiency, leading to improper descending function. Long-term lung Qi deficiency can damage the kidneys. The kidneys are the root of Qi; if the kidneys do not control Qi, it can lead to coughing.
11Pale red tongue with thin white coating
Tongue Quality: Pale red
Tongue Coating: Thin and white
Tongue Surface: Relatively moist
This tongue appearance is often due to Qi deficiency, with external invasion of wind-cold, leading to lung Qi failure to disperse and obstruction of the upper orifices.
12Dark red tongue with yellow greasy coating
Tongue Quality: Dark red
Tongue Coating: Yellow greasy
Tongue Body: Teeth marks on the edges
A yellow greasy coating with teeth marks indicates heavy phlegm dampness with a tendency to transform into heat, with teeth marks located at the back of the tongue indicating that the disease is located in the lower burner.
13Thin small tongue with thin greasy coating
Tongue Quality: Small
Tongue Coating: Thin greasy
Tongue Surface: Abundant body fluids
This tongue appearance often indicates a pale complexion, shoulder and back pain, lack of appetite, dizziness, and bone density loss.
14Dark red tongue with fat tongue
Tongue Quality: Dark red
Tongue Coating: Thin white, slightly dry
Tongue Body: Teeth marks on the edges
This tongue appearance may indicate mental fatigue, heat in the hands and feet, fullness in the stomach, lack of appetite, pale complexion, and irritability.
15Dark dull tongue with yellow greasy coating
Tongue Coating: Yellow greasy
Tongue Quality: Dark dull
Tongue Body: Teeth marks on the edges
This tongue appearance may indicate a pale complexion, cold hands and feet, fatigue, and poor appetite.
16Pale red tongue with yellow greasy coating
Tongue Quality: Pale
Tongue Coating: Yellow greasy
Tongue Body: Teeth marks on the edges
This tongue appearance may indicate damp-heat accumulation in the liver and gallbladder, leading to symptoms such as abdominal distension and pain.
17Gray-black greasy coating
Tongue Color: Dark purple
Tongue Quality: Slightly fat
Tongue Coating: Yellow greasy, gray-black
This tongue appearance often indicates damp-heat accumulation in the liver and gallbladder, leading to symptoms such as abdominal distension and pain.
18Dark red tongue with yellow greasy coating
Tongue Coating: Yellow greasy
Tongue Quality: Dark red
Tongue Body: Normal
This tongue appearance often indicates damp-heat accumulation, leading to symptoms such as fever, irritability, and abdominal pain.
19Pale red tongue with thin yellow greasy coating
Tongue Body: Small with teeth marks
Tongue Color: Red
Tongue Coating: Thin, yellow
This tongue appearance reflects damp-heat accumulation in the lower burner, often accompanied by symptoms such as irregular menstruation, weakness, and irritability.
20Cracked tongue with thin white coating
Tongue Body: Thick with cracks
Tongue Coating: Thin white
Tongue Color: Relatively red
This tongue appearance indicates Shaoyang wind-heat and phlegm dampness disturbance. Cracks in the middle of the tongue indicate heat in the spleen and stomach; red on the sides indicates heat in the liver and gallbladder.
21Cracked red tongue with thin white coating
Tongue Quality: Red and stiff
Tongue Coating: Relatively dry
Tongue Surface: Deep cracks
This tongue appearance indicates excessive internal heat and lack of moisture or fluids. Patients with this tongue appearance may also experience dry mouth, fatigue, and lack of energy.
22Fat tongue with deep yellow greasy coating
Tongue Body: Fat with teeth marks
Tongue Coating: Deep yellow, thick, greasy
Tongue Surface: Cracked with stasis spots
This tongue appearance may indicate fever, heat in the body, heavy head, body aches, dry mouth, and yellow urine.
23Thin red tongue with yellow thick greasy coating
Tongue Coating: Yellow greasy, slightly thick
Tongue Quality: Slightly red
Tongue Body: Slightly thin, with stasis underneath
This tongue appearance may indicate fever, heavy head, and symptoms such as bitter mouth, dry mouth, and thin stools.
Six, Typical Tongue Appearance of Blood Stasis Constitution
1Dark red tongue with stasis spots
Tongue Body: Has stasis spots and cracks
Tongue Quality: Dark red
Tongue Coating: Yellow greasy
This tongue appearance is often seen in patients with long-term phlegm turbidity obstruction, leading to blood stasis and damage to Yin fluids.
2Purple dark tongue with pale white coating
Tongue Body: Has stasis spots, dry
Tongue Color: Purple dark
Tongue Coating: White, old
This tongue appearance often indicates internal stasis of toxins, leading to purple dark tongue quality and dry coating, indicating long-term heat toxins damaging body fluids.
3Teeth marks tongue with white greasy coating
Tongue Quality: Dark red
Tongue Coating: White greasy
Tongue Body: Has teeth marks and stasis spots
This tongue appearance may indicate dull complexion, pigmentation, easy bruising, dark lips, irritability, and forgetfulness.
4Blue-purple tongue with stasis spots
Tongue Color: Purple dark
Tongue Coating: Thin white
Tongue Body: Has stasis spots
This tongue appearance often indicates pain in the hypochondrium, like a needle, dull complexion, fatigue, and abdominal distension.
5Purple dark tongue with stasis spots
Tongue Quality: Purple dark
Tongue Coating: Thin white
Tongue Body: Moderate with stasis spots
This tongue appearance often indicates blood stasis obstructing the channels, leading to purple dark tongue quality and stasis spots.
6Purple dark tongue with stasis spots
Tongue Color: Purple dark
Tongue Body: Has stasis spots
Tongue Coating: Slightly yellow
This tongue appearance often indicates blood stasis obstructing the channels, leading to symptoms such as irritability, abdominal distension, and constipation.
7Pale red tongue with small cracks
Tongue Quality: Relatively pale
Tongue Coating: Thin, yellow
Tongue Surface: Has cracks, moist
This tongue appearance often indicates dull complexion, pigmentation, easy bruising, dark lips, irritability, and forgetfulness.
8Purple dark tongue with white greasy coating
Tongue Quality: Purple dark
Tongue Coating: White greasy
Tongue Body: Normal
This tongue appearance often indicates symptoms such as irritability, abdominal distension, excessive phlegm, cold limbs, and cold intolerance.
9Purple dark tongue with stasis spots on the edges
Tongue Quality: Purple dark
Tongue Coating: Thin white
Tongue Body: Has stasis spots
This tongue appearance often indicates symptoms such as cold hands and feet, emotional distress, and irritability.
10Dark red tongue with thin white coating
Tongue Quality: Relatively red
Tongue Coating: Thin white
Tongue Body: Has small cracks
This tongue appearance often indicates symptoms such as bitter mouth, dry mouth, fatigue, and thin stools.
11Dark red tongue with thin yellow greasy coating
Tongue Coating: Thin, yellow greasy
Tongue Quality: Dark red
Tongue Body: Has teeth marks
This tongue appearance may indicate symptoms such as abdominal pain, belching, and constipation, as well as irritability and anger.
Seven, Typical Tongue Appearance of Qi Stagnation Constitution
1Dark red tongue with yellow greasy coating
Tongue Body: Fat
Tongue Quality: Dark dull
Tongue Coating: Thin greasy
Patients often experience fatigue, mental fatigue, irritability, and head heaviness.
2Fat tongue with white greasy coating
Tongue Body: Fat
Tongue Surface: Has cracks
Tongue Coating: Thick greasy in the middle and back
Patients may also experience dizziness, irritability, anxiety, palpitations, shortness of breath, fear, tinnitus, insomnia, and vivid dreams.
3Dull tongue with greasy coating
Tongue Color: Dull
Tongue Body: Fat
Tongue Coating: Thick greasy, slippery
This tongue appearance is often seen in patients with Qi stagnation and water retention, phlegm dampness obstructing the channels, and may also present with mental fatigue and heaviness in the limbs.
4Dark red tongue with a red tip
Tongue Body: Dark red
Tongue Tip: Red
Tongue Surface: Has stasis
This tongue appearance indicates that the patient has a weak constitution, and surgery has exacerbated the deficiency of liver and kidney, leading to dysfunction of the internal organs and excessive heart fire.
5Dark red tongue with greasy coating
Tongue Body: Fat with teeth marks
Tongue Color: Dark red
Tongue Coating: Greasy in the middle
This tongue appearance often indicates gastrointestinal discomfort, loose stools or constipation, and poor appetite.
6Dark red tongue with greasy coating
Tongue Quality: Dark red
Tongue Body: Has stasis spots
Tongue Coating: Greasy, with mucus
This tongue appearance often indicates that patients experience emotional repression, difficulty in expressing emotions, or excessive thinking, often accompanied by heaviness in the limbs and slow movements.
7Pale red tongue with thick white greasy coating
Tongue Coating: White greasy, thick
Tongue Color: Pale red
Tongue Body: Fat
This tongue appearance often indicates symptoms such as depression, chest tightness, fullness in the hypochondrium, and a sensation of obstruction in the throat.
8Dark red tongue with stasis spots on the edges
Tongue Quality: Dark red
Tongue Coating: Thin white
Tongue Body: Has stasis spots
This tongue appearance often indicates symptoms such as hidden pain in the chest and hypochondrium, chest tightness, abdominal distension, belching, and irregular menstruation in women.
9Thin white coating with small tongue
Tongue Body: Small
Tongue Coating: Thin white
Tongue Surface: Relatively dry
This tongue appearance often indicates fatigue, dull complexion, and symptoms such as poor appetite.
10Fat tongue with white greasy coating and stasis spots
Tongue Body: Pale red
Tongue Coating: White greasy
Tongue Body: Fat with stasis spots
This tongue appearance may indicate symptoms such as emotional depression, emotional fragility, irritability, and difficulty in expressing emotions.
11Dark red tongue with thin white coating and stasis spots
Tongue Quality: Dark red
Tongue Coating: Thin white
Tongue Surface: Has stasis spots
This tongue appearance may indicate symptoms such as fever, heavy head, and symptoms such as bitter mouth, dry mouth, and thin stools.
Eight, Typical Tongue Appearance of Special Constitution
1Teeth marks tongue with thick white greasy coating
Tongue Quality: Dull, slightly red
Tongue Body: Fat
Tongue Edges: Has teeth marks
This tongue appearance may indicate symptoms such as oily complexion, easy acne, bitter mouth, dry mouth, heaviness, and difficulty in bowel movements.
2Red tongue with little coating
Tongue Coating: Little
Tongue Quality: Dark red
Tongue Surface: Has cracks
This tongue appearance may indicate symptoms such as low fever, heat in the hands and feet, afternoon tidal fever, night sweats, dry mouth, and insomnia.
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