Understanding Chinese Medicine Tongue Diagnosis

In traditional Chinese medicine (TCM), examination of the tongue and pulse encompasses two of the principal diagnostic methods. Compared to palpation of the pulses, which by itself can give your Chinese medicine practitioner an incorrect clinical impression if you are a little hurried or stressed, tongue diagnosis is generally more stable and objective. But it can be no less tricky. Antibiotics, oral steroids, bronchodilators, statins, and antineoplastics (e.g., chemotherapy drugs), among others, can change the tongue picture, either slightly or drastically, as can certain foods or beverages (e.g., hard candies, creamy latte, etc.) consumed just prior to TCM treatment.


Tongue and pulse diagnosis require a bit of time and concentration on the part of your acupuncturist. Correctly diagnosing the pulse generally requires more attention than the tongue; it’s a kind of tactile listening. But assessing the tongue also requires attention to lots of little details. This article describes just a few.

Inspection of the tongue dates back to the Shang dynasty (c. 16th century – 1066 B.C.) and it remains a central element of TCM diagnostics to this day.

The tongue is composed of skeletal muscle covered with mucus membrane. Several muscles originating in various cranial bones insert into the tongue. The little bumps on the surface of your tongue are composed of five different papillae; folds in the surface cellular layer of your tongue.

As a TCM practitioner, it is not unusual for me to diagnose a pattern of “yin vacuity,” (a reduction or loss of blood and other body fluids) among my older patients. Their tongues may be rather red, perhaps dry, and will have little or no coating. Interestingly, this phenomenon parallels a reduction in the epithelial cell layer (by up to 30% in old age). There are seemingly endless combinations of tongue and tongue coating images, and a patient’s tongue may well (and even should) change during a course of treatment.

Want to see some tongues and case studies for yourself?  Look here ...

When looking at / assessing your tongue, your acupuncturist considers all of the following:

Tongue body color
Tongue body moisture
Tongue body shape
Tongue coating color
Tongue body cracks / fissures
Tongue coating thickness
Tongue body movement
Tongue coating location and distribution
Tongue body papillae
Tongue coating root


All of these provide clues to the location, nature, duration, and severity of disease, as well as the progression and prognosis of the disease. As important, the tongue can provide a sense of the body’s current health status for fighting the disease and achieving recovery. Finally, the tongue picture is very helpful in indicating the effects of treatment – be it acupuncture or Chinese herbal formulas.

Unlike the pulse, the tongue body and coating are relatively unaffected by short term health events or changes. Therefore, the tongue body color offers clues regarding chronic conditions, while the tongue coating is a bit more helpful regarding acute conditions.

A licensed acupuncturist seldom relies solely on either tongue or pulse diagnosis. Rather, we contrast and compare the tongue and pulse images with each other over time. Tongue and pulse examination represent the “looking and palpating” pair of the Four Pillars of TCM diagnosis. As such they must be compared to and incorporated with other findings such as listening (to the patient’s breathing, voice, GI sounds, etc.), and asking the patient about their various symptoms which, unlike signs, may not be observable by the practitioner and must be described to us by the patient.
When comparing the usefulness of tongue diagnosis to pulse diagnosis, the tongue is generally considered to provide a more objective assessment. Most acupuncturists will be in agreement regarding the color, shape, coating and other tongue features. On the other hand, there can be some disagreement among practitioners (or even occasional confusion on the part of a given practitioner) about which of the nearly 30 basic pulses one is feeling at a patient’s wrist. Pulse diagnosis is a wholly tactile skill and takes years to master.

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