Tongue Diagnosis: Revealing Health Secrets through Tongue Changes

Tongue diagnosis, as an important part of traditional Chinese medicine diagnosis, can assist in diagnosing and differentiating various diseases by observing changes in tongue color, shape, and texture. Clear and complete tongue photos are the basis of tongue diagnosis. The following will provide detailed information and techniques related to tongue diagnosis.



Preparation and Photography Techniques for Tongue Diagnosis Before conducting tongue diagnosis, ensure that the environment has sufficient and soft lighting, avoiding direct sunlight or backlighting. During photography, the patient should be seated or lying down, with the head slightly tilted back, mouth wide open, and the tongue naturally extended, allowing the photographer to see the base of the tongue. When taking photos, use a camera or phone to focus and capture the moment the tongue is extended, ensuring that the focus is on the tongue and oral cavity, avoiding exceeding the range from the nose to the neck, which may distort the information and affect diagnosis.


In addition, when taking tongue photos, pay attention to the following points:

Avoid taking photos immediately after eating, drinking, or taking medications. If necessary, wait for at least one hour after eating.

Avoid reflections or color distortions caused by colored objects, ensuring the authenticity of the tongue photos.

Provide basic information such as gender, age, height, weight, etc., to the doctor, which can help with accurate diagnosis.


Tongue Areas and Corresponding Pathological Changes

The tongue can be divided into upper, middle, and lower regions, corresponding to different visceral and organ pathologies:

Tongue base: Lower region, reflecting kidney and bladder conditions.

Middle tongue: Middle region, reflecting spleen and stomach conditions.

Side of the tongue: Middle region, reflecting liver and gallbladder conditions.

Tongue tip: Upper region, reflecting heart, lungs, and head conditions.


Common Tongue Characteristics and Their Meanings

① “Pale red tongue with thin white coating”: The tongue is oval-shaped with a rounded and complete edge. The thickness, size, and plumpness of the tongue are moderate. The tongue surface is flat, medium in size, and not deviated. The coating is thin, white, clean, moist, naturally distributed, without peeling or coating detachment. The tongue is pale red, bright but not overly vibrant, without spots or prickles, with normal taste, and no pain or numbness. The tongue has no cracks, and the coating has no additional markings. The tongue moves flexibly without trembling, it is flexible but not flaccid, allowing clear and fluent speech, and shows vitality. The sublingual and lingual veins underneath the tongue are not purplish or engorged, without any growths.


② White coating on the tongue, indicating coldness: Common symptoms include constipation, coldness in the abdomen, fatigue, pain, pale complexion, reduced appetite, poor digestion, susceptibility to illness, and the occurrence of dampness, edema, and stasis.


③ Red coating on the tongue, indicating heat: Common symptoms include a tender red tongue with almost no coating, night sweats, sweating on the palms and soles, dry cough with little or no phlegm, accompanied by lumbosacral soreness, restlessness, and agitation.


④ Bluish-purple tongue, indicating blood stasis: Common symptoms include memory decline, bruising, darkened lips, a dull complexion, black circles around the eyes, possibly accompanied by pain, inexplicable tingling, etc.


⑤ Blackish tongue, often indicates high risk: A black coating often indicates more severe diseases related to conditions such as liver cirrhosis, renal failure, tumors, etc. Smokers should pay attention to lung health if the coating changes from brown to black.


⑥ Sticky coating in the lower region, indicating constipation: Common symptoms include dry and hard stools, abnormal stool shapes, reduced stool frequency, possibly accompanied by conflicting thoughts, suppressed emotions, mental tension, etc.


⑦ Liver area drooping, indicating liver blood deficiency, liver stagnation tongue: Common symptoms include difficulty falling asleep, abdominal distension, bitter taste, bad breath, fatigue, tiredness, dry and itchy eyes, irritability, abnormal bowel movements, yellowish skin, itching all over the body, etc.


Anterior part smaller than the posterior part, indicating kidney qi deficiency, bladder tongue: Common symptoms include weakness, low energy, abnormal urine due to kidney dysfunction, edema, foamy urine, fatigue, anemia, decreased sex drive, etc.


⑨ Raised area in the breast region on the tongue, indicating breast nodules: Common symptoms include emotional changes, menstrual irregularities, breast lumps, pain, nipple discharge, etc.


⑩ Raised area in the reproductive region on the tongue, indicating cysts, fibroids, etc.: Common symptoms include abdominal abnormalities, digestive system issues, palpable masses during examination, exacerbation of dysmenorrhea, pain during intercourse, etc.


⑪ Cracks and greasy coating in the central region, indicating stomach coldness and weak digestion: Common symptoms include hiccups, abdominal distension, dark stools, weight loss, etc.


⑫ Sunken lung region on the tongue, indicating lung qi deficiency: Common symptoms include cough, weak bowel movements, nasal congestion, dry skin, itching, etc.


⑬ Redness and unevenness in the upper region of the tongue, indicating excessive heart fire: Common symptoms include chest pain, rapid heartbeat, dizziness, insomnia with vivid dreams, etc.


⑭ Curved tongue, indicating scoliosis: Common symptoms include effects on posture, mental health, and spinal function, which may affect the outflow of spinal and cerebral spinal fluid.


⑮ Large tongue, indicating spleen deficiency with dampness: Common symptoms include heavy-headedness, oily scalp, easy sweating, sticky stools, possibly accompanied by edema, itchy skin, etc.


⑯ Cracked tongue, indicating insufficient yin blood: Common symptoms include dry throat, dry mouth, insufficient stomach yin, dry skin, joint stiffness, etc.


⑰ Deviated tongue, often indicating a pre-stroke warning sign: Common symptoms include a hardened base of the tongue, choking cough, weakness, dizziness, etc.


Limitations of Tongue Diagnosis Although tongue diagnosis has significant importance in traditional Chinese medicine diagnosis, it also has certain limitations. The changes in tongue characteristics may be influenced by various factors, such as diet, emotions, environment, etc. Therefore, during tongue diagnosis, doctors need to consider the patient’s overall condition, and integrate other diagnostic methods to make more accurate judgments.


Tongue diagnosis is an important part of traditional Chinese medicine diagnosis. By observing changes in the tongue, it can assist in diagnosing and differentiating various diseases. During tongue diagnosis, attention should be paid to photography techniques and the correlation between tongue characteristics and pathologies, while considering the patient’s overall condition for a comprehensive assessment. Tongue diagnosis also has limitations and needs to be combined with other diagnostic methods for a comprehensive evaluation. Let’s progress together in our learning journey!

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