The tongue is a window to health, as its appearance can reflect a person’s health status. It is often said that “the tongue is a mirror of the body’s health.” Through this window, ordinary people can monitor their physical condition in a timely manner, allowing for prompt medical attention!
In Traditional Chinese Medicine (TCM), there are four diagnostic methods: observation (望), listening (闻), inquiry (问), and palpation (切). Among these, observation is the foremost and most important aspect of TCM diagnosis. As the ancients said, “To know by observation is called spirit (神).”
Tongue diagnosis, also known as tongue observation (望舌), is one of the key components of observation (望诊) (along with the face, eyes, nose, ears, and body posture).
By observing changes in the tongue’s appearance, one can understand the physiological functions and pathological changes of the body. It is a simple, effective, and direct method for diagnosing and understanding diseases.
The normal tongue appearance can be summarized in six words: “light red tongue with thin white coating”. Specifically, the tongue color is light red and bright, the tongue body is moist, of moderate size, soft and flexible, and the coating is even, thin, white, and moist. If your tongue does not appear this way, it indicates that there are issues with your body, at least at this stage.
The analysis of tongue appearance mainly revolves around four aspects: tongue color, shape, texture, and sublingual veins. The tongue is directly related to the heart, liver, spleen, kidneys, stomach, bladder, and sanjiao (三焦) through the meridian system, while the lungs, gallbladder, small intestine, and large intestine are indirectly connected to the tongue’s appearance.
It is particularly evident that the internal organs of the body can be linked to the tongue through the meridian system. If there are pathological changes in the internal organs, it will be reflected on the tongue. Therefore, by examining the state of the tongue, one can understand the condition of the internal organs. Here, I will provide examples of how different tongue states can indicate various diseases (please do not self-diagnose; seek medical advice promptly!).
Tongue Color
For example, if the tongue coating is thick, greasy, and yellow, it suggests the presence of internal heat; if the tongue is purplish and swollen with large red spots on the surface, it indicates heat toxin attacking the heart; if the tongue color is pale, resembling white, it is often seen in cases of deficiency and qi-blood deficiency.
Tongue Shape
For instance, if the tongue is pale and swollen, with teeth marks along the edges, it indicates spleen deficiency. If accompanied by cold hands and feet, fear of cold, excessive salivation, and poor mental state, it suggests kidney deficiency.
Tongue Texture
For example, if the tongue coating is white, it indicates insufficient yang qi in the middle jiao (中焦) of the spleen and stomach, often accompanied by indigestion and excessive dampness in the body; if the tongue coating is yellow and thick, it suggests the presence of damp-heat, which was also discussed in yesterday’s lesson to help reinforce understanding.
Sublingual Veins
For example, under healthy conditions, there should be no prominent blue veins. If the sublingual veins are prominent, it suggests the presence of blood stasis; if this occurs in young women, it indicates poor menstrual flow; if it occurs in middle-aged and elderly individuals, it may suggest dyslipidemia and abnormal blood pressure.
The diagnosis based on tongue appearance is clear and can intuitively reflect the body’s cold-heat, deficiency-excess, and internal-external conditions. Moreover, tongue appearance is more stable and less influenced by external factors and the subjectivity of the doctor. For instance, in severe cases where the pulse cannot be felt, the tongue appearance is primarily observed, leading to relatively objective diagnostic results. A skilled TCM practitioner can generally assess your physical condition through observation.
Additionally, I emphasize that you should not self-diagnose based on images because some friends may have previously looked at related materials online and then checked their tongue color after drinking cold beverages. Some may find their tongues appear purplish, while others may find them red, which can affect the diagnostic process. There is no need to scare yourself unnecessarily!
Common Questions
1. Question: Why is my tongue coating white and greasy in the morning, but much better after eating and during the day? Is this normal for everyone? Also, when I went to the hospital, the doctor did not emphasize the need to check the morning tongue coating.
Answer: The morning tongue coating is the most complete and best reflects our current physical condition. Moreover, any food intake can disrupt the tongue coating and affect the doctor’s judgment. Most hospitals today primarily use modern medical technology, and relatively younger doctors generally do not examine tongue appearance. Many experienced TCM practitioners usually ask patients not to eat anything, or at most drink water, before the morning examination.
2. Question: Why can tongue diagnosis reveal physical conditions? I have not encountered doctors who require checking the morning tongue coating.
Answer: This also relates to the doctor’s habits. In-person consultations often involve pulse diagnosis, which is one reason we recommend finding a local doctor for treatment. However, if you have eaten or just had a cold drink, it can affect the judgment. Therefore, online consultations require even more caution! The tongue is directly related to the heart, liver, spleen, kidneys, stomach, bladder, and sanjiao through the meridian system, while the lungs, gallbladder, small intestine, and large intestine are indirectly connected to the tongue’s appearance.
Students can refer to this image to understand how different tongue conditions correspond to physical conditions.
3. Question: Is it true that people with good health in the morning will have a whiter and greasier tongue coating than during the day? After all, there is overnight metabolism, so should I not be overly concerned if my morning tongue coating looks bad?
Answer: This is not the case; individuals with normal tongue coatings will also have a light white coating in the morning, not thick. Just like the one below.
4. Question: Can we know our health status without pulse diagnosis?
Answer: Actually, as the teacher just mentioned, the four diagnostic methods (望闻问切) are arranged in a specific order, with “切” (palpation) being the last and least important step. When old friends come for a check-up, they usually only need to compare the pulse with previous changes. In fact, listening and inquiry are also forms of diagnosis, and even understanding your recent emotional state is part of the diagnostic process!
“切” refers to pulse diagnosis, while “望” refers to observing various subtle changes in the patient, which is the first and most important step. Tongue diagnosis is a branch of observation, and the order of the four diagnostic methods indicates that observation is more important than palpation! Therefore, pulse diagnosis can only serve as an auxiliary method for judging diseases. Purely relying on pulse diagnosis without tongue diagnosis or inquiry is generally not accurate. Moreover, when you go to see a doctor in person, they will always observe your complexion. As long as the symptoms from observation, inquiry, and palpation are consistent, the accuracy of the diagnosis in clinical practice is very high.
Some friends have also reported to me: “Brother, our local TCM hospital can also conduct online consultations, and they diagnose based on tongue appearance and inquiry, and the results are quite good!”
Yes, I have always emphasized that TCM diagnosis and treatment are customized based on the patient’s constitution. Everyone is different, and everything must be based on actual conditions and be pragmatic!
In the past three years of the pandemic, when people wanted to go to the hospital, it was overcrowded, and severe cases could not be accommodated, leading to a shortage of medical resources. Online consultations became a means of “rescuing the situation,” and now some delivery apps even have doctors available to assist patients in obtaining good diagnoses and medication suggestions from home, and they can even provide online prescriptions.
(The following image is excerpted from the 2020 notice by the National Health Commission regarding the further promotion and regulation of internet medical services)
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