The tongue coating is an important component of TCM “tongue diagnosis,” which can intuitively reflect the strength of spleen-stomach function, the circulation of qi and blood, and the fluctuation of internal dampness and turbidity. TCM holds that “the tongue is the external manifestation of the spleen and stomach” and “the spleen opens to the mouth,” meaning that physiological and pathological changes in the spleen and stomach are directly reflected on the tongue coating.
Physiological Connection
Mechanism of Tongue Coating Formation
The tongue coating is formed by the vaporization of the essence of food and fluids by the stomach qi (the functional ability of the spleen and stomach).
Normal tongue coating: thin, white, uniform, and moderate in moisture, indicating normal spleen-stomach function and harmonious qi and blood.
The Impact of Abnormal Spleen-Stomach Function on Tongue Coating
Spleen deficiency and weak qi → insufficient stomach qi, leading to abnormal tongue coating formation (too thin, peeling, or no coating).
Internal Dampness and Turbidity → decreased ability of the spleen and stomach to transform and transport dampness, resulting in thick and greasy tongue coating.
Food Stagnation/Phlegm Obstruction → the corrupt and turbid qi in the stomach rises, causing the tongue coating to be sticky or yellow.
Symptom Correspondence
Thick white tongue coating
Pathogenesis: cold dampness obstructing the spleen or phlegm-damp stagnation.
Accompanying symptoms: abdominal distension, poor appetite, loose stools, sensitivity to cold.
Regulation direction: warm the middle and disperse cold (e.g., ginger, cardamom), strengthen the spleen and eliminate dampness (Poria, Job’s tears).
Yellow greasy tongue coating
Pathogenesis: damp-heat accumulation in the spleen and stomach (prolonged dampness transforming into heat or food stagnation generating heat).
Accompanying symptoms: bitter taste in the mouth, bad breath, burning sensation in the stomach, constipation or sticky stools. Regulation direction: clear heat and drain dampness (e.g., Coptis, Scutellaria), promote digestion and eliminate stagnation (Hawthorn, Malt).
Thin or absent tongue coating
Pathogenesis: stomach yin deficiency or spleen qi weakness, leading to insufficient generation of qi and blood.
Accompanying symptoms: dry mouth and tongue, dull stomach pain, indigestion, weight loss and fatigue.
Regulation direction: nourish yin and support the stomach (Ophiopogon, Mai Dong), tonify spleen qi (Codonopsis, Astragalus).
Slippery tongue coating
Pathogenesis: spleen yang deficiency, leading to inability to transform water and dampness.
Accompanying symptoms: sensitivity to cold, cold extremities, edema, clear and frequent urination.
Regulation direction: warm yang and strengthen the spleen (dried ginger, Aconite), promote urination and drain dampness (Atractylodes, Alisma).
Cracked tongue coating
Pathogenesis: long-term spleen and stomach weakness, qi and blood deficiency, leading to malnourishment of the tongue body. Accompanying symptoms: chronic fatigue, poor appetite, recurrent diarrhea.
Regulation direction: tonify qi and nourish blood (Angelica, Rehmannia), strengthen the spleen and stomach (Chinese yam, lotus seed).
Regulating the Spleen and Stomach
Dietary Regularity
Eat at regular times and in appropriate amounts, avoiding overeating.
Cooking methods should primarily be steaming and boiling, reducing frying and grilling.
Emotional Management
TCM believes that “worry and overthinking harm the spleen,” and prolonged stress and anxiety can inhibit spleen-stomach function.
Acupoint Health Care
Zhongwan Point (4 cun above the navel): strengthens the spleen and stomach, alleviates abdominal distension.
Stomach 36 (Zusanli) (3 cun below the knee): tonifies qi and blood, enhances digestive function.
Avoiding Behaviors that Harm the Spleen
Excessive dieting or long-term consumption of cold foods (e.g., salads, iced drinks).
Prolonged sitting and lack of exercise (leading to qi stagnation and dampness accumulation).
The tongue coating is a “mirror” of spleen-stomach function. If the tongue coating is abnormal for more than two weeks or accompanied by significant discomfort (such as weight loss, vomiting blood, or black stools), timely medical attention is needed to rule out organic diseases (such as gastritis, gastric ulcers, Helicobacter pylori infection, etc.). By observing the tongue coating, one can timely adjust diet and lifestyle to protect spleen-stomach function and prevent disease before it occurs.
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