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Tongue Diagnosis
We all rely on our bodies to tell us when something is
wrong. Besides the skin, hair and nails as indicators of
internal imbalance, the tongue can also provide us with
vital clues. In fact, in Chinese and Indian medicine,
observation of the tongue plays a fundamental role in
determining a persons state of health. Although not
backed by scientific research, tongue diagnosis dates
back several thousand years, and has long been used
as an investigative tool by practitioners of such schools
of medicine. As an introduction, Edward Thompson MA,
LCH, CH, Dip.BSS, Dip AC, Dip.CHM, RCST provides
the basics into this ancient diagnostic art.

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Modern Western medicine recognises that the tongue can be a mirror of illnesses
which are systemic and not just local to the tongue. But unlike Chinese or Indian
medicine it does not develop observation of the tongue into a general system of
diagnosis. For example, glossitis (inflammation of the tongue) causes a red sore
tongue which can occur as a result of vitamin B deficiency, especially vitamin B12 or
as a result of a lack of iron. A swollen tongue can be a sign of hypothyroidism, as
well as of acromegaly, a disease of the anterior pituitary gland where too much
growth hormone is produced. It is also commonly observed that children suffering
from a fever may develop tongue ulcers.
In Chinese and Indian medicine the tongue is seen to reflect the degree of health or
imbalance of the body. The tongue is examined to assist in diagnosis and to the
extent in which the tongue changes with treatment can indicate how successful the
treatment has been. It is important to emphasise that neither Chinese nor Indian
medicine rely only on the tongue for diagnosis, seeing it as an important but not
exclusive part of the diagnostic process.
To understand the concept of tongue diagnosis in relation to Chinese and Indian
medicine, a basic knowledge of the principles of each system is necessary.
TRADITIONAL CHINESE MEDICINE (TCM)
TCM is the traditional system of medicine of China and has evolved over a period of
more than 2,500 years. At the centre of TCM is the concept of yin and yang, two
opposites which are totally interdependent, existing only in relationship to each other.
They are responsible ultimately for the appearance and the rhythms of life both in the
external environment and in the internal environment of the body.
Also fundamental to Chinese medicine are the organ and energy (qi) systems of the
body. The organ systems of the body are collectively referred to as the zang fu. Each
of these zang fu are responsible in health for specific functions in the body and if
they become imbalanced they produce specific symptoms and signs.

The zang fu are said to be affected by what are called the pathogenic factors - fire,
cold, dampness, dryness, wind and summer heat. They can come from either
outside of the body, or with the exception of summer heat can be generated from
within the body. Each of the pathogenic factors will cause specific symptoms
depending on which of the zang fu they affect.
AYURVEDA
Ayurveda is the traditional system of medicine of India and is at least 5,000 years
old. As with Chinese medicine it has its own understanding of body function and the
imbalances which cause disease. At the heart of Ayurvedic medicine is what are
called the tridosha. These tridosha are to some degree similar to the old European
medieval idea of the humours. The tridosha are vata, pitta and kapha. In health they
are responsible for the function and structure of the body. However, if they become
excessive or deficient either individually, or in combination, then they cause illness.
Vata, pitta and kapha are made up of the five elements of Ayurvedic medicine which
are ether, air, fire, earth and water. Imbalance of the tridosha can cause the following
symptoms:
VATA PITTA KAPHA
constipation with dry stool
hyperacidity
excess mucus production
dryness of the skin
inflammatory conditions
overweight
anxiety and insecurity peptic ulcer
greed and attachment tremors
liver and gallbladder imbalances
slow elimination with heavy pale stool
dizziness
hives and rashes
dull, heavy deep pain
sciatica anger and irritability

 bronchitis, sinusitis and lung congestion

paralysis excessive appetite sensations of heaviness
neuralgia
oily yellow loose stool
gas
burning and piercing pain
variable appetite dizziness
pain which changes location and is tearing
THE TONGUE MAP
The tongue is seen as a map of the body, and in both TCM and Ayurveda, the tip of
the tongue represents the upper part of the body and the base of the tongue the
lower part of the body. However, they do not entirely agree on where the organs are
located on the map! Organs in Chinese medicine do not necessarily have the same
function as the organs in Ayurvedic medicine. The area of the tongue that exhibits a
change in appearance, corresponds to the organ which the tongue mirrors in that
area. For example, in Ayurvedic medicine discolouration towards the centre of the
back of the tongue indicates an imbalance in the colon, whilst markings along the
mid line of the tongue indicate the spine is affected.
THE TONGUE BODY
Tongue diagnosis can be simply divided into the examination of the tongue body and
the tongue coat. A normal tongue is seen as being a healthy reddish pink with a very
thin white coat which may be more pronounced in the morning. Any deviation from
this norm is caused by an imbalance within the system. Both the colour and the
shape of the tongue are important in diagnosis.
Red tongue
A red tongue in Chinese medicine indicates heat in the body. Heat can be caused
either by excess of yang which causes excess heat and creates one set of
symptoms or by a deficiency of yin which causes deficient heat and creates another
set of symptoms. Excess heat often relates to inflammation and possibly infection in
Western medicine. Some tongues have red spots on them and this too is a sign of
heat. It is possible for a tongue to be of normal colour but have small red spots.
Where there is excess heat in the body, foods which are considered to be warm in
nature should be avoided - these include red meat, excess refined sugar, spicy food,
chicken, alcohol and coffee. The diet should be light with increased portions of
vegetables, and little or no meat. Food should be raw, steamed or boiled and not
fried in oil or butter.
Excess heat - excess yang
Fever, a red face and flushing, thirst, sweating, a feeling of heat, constipation, dark

and scanty urine, dryness in the mouth and throat and a strong rapid pulse.
Deficient heat is due to a lack of yin in the body. Yin is cool and moist in quality and
so when it becomes deficient it is unable to balance the hot and dry nature of yang
produced:
Deficient heat - deficient yin
Low grade fever worse in the late afternoon and evening, night sweats, sensation of
heat and burning in the palms of the hands, soles of the feet and the centre of the
chest, thirst quenched in sips which becomes more pronounced in the late afternoon
and evening, a weak and rapid pulse.
Deficient yin usually occurs as a result of over work and a hectic stressful lifestyle. It
needs to be treated by foods that are nourishing, build up the body and increase
fluids. The following foods might be chosen to assist healing in someone with either
excess or deficient heat. They all have a cooling action on the body. However, those
which work on yin deficiency are more building and strengthening in effect.
Foods for deficient heat - yin deficiency Foods for excess heat - yang excess
Asparagus - Watermelon - Pears - Lettuce
Cucumber - Wheat - Soya milk - Rice
Barley - Grapes - Seaweed - Banana
Mung beans - Tofu - Coriander leaf juice - Green beans
Where there is a red tongue due to yin deficiency there is very little or no coat at all,
the tongue may have a shiny mirror-like appearance and may also be cracked. If the
cracks are in a particular area of the tongue then the yin deficiency affects that area
of the body that the tongue corresponds. In most cases of excess heat the tongue
will have a yellow coat. In both cases because there is heat in the body the tongue
may appear dry; the drier the tongue the more extreme the heat.
In Ayurveda a red tongue indicates a pitta imbalance whilst a cracked tongue
indicates a chronic imbalance of vata affecting the colon.
Pale tongue
A pale tongue always indicates deficiency. Which type of deficiency will depend on
other factors revealed on the tongue, as well as the presenting symptoms. A pale
tongue indicates a deficiency of yang, qi (energy) or blood. If the tongue is pale and
moist it indicates a deficiency of yang which is also sometimes called deficient cold
as it causes cold symptoms in the body.
Yang deficiency - deficient cold
The person feels easily cold especially in the limbs and tends to wear more clothes,
desire for hot drinks, loose stools, exhaustion, lack of motivation, depression,
sensitivity to the cold, a slow and weak pulse.

Yang deficiency needs to be treated with foods which are warm and tonifying in
nature. In qi (energy) deficiency the tongue is pale and is often scalloped in
appearance although it may be scalloped in yang deficiency too. The scalloped
tongue is slightly larger than normal and so presses onto the teeth which then
causes the tongue to have indentations. The spleen qi is of special importance in qi
deficiency and of particular interest to nutritional therapists because the function of
the spleen is the digestion and absorption of food. It can be seen from this that it is a
mistake to assume that the Chinese understanding of the zang fu is similar to that of
Western Medicines understanding of the organs, as the spleen has no part to play in
digestion in Western physiology.
Qi deficiency
Shortness of breath, easy sweating, tiredness, poor appetite, apathy, abdominal
bloating, weakness of the muscles, a sallow complexion.
Finally a pale tongue may also indicate blood deficiency, which is not the same as
the Western disease of anaemia but has similarities in some of the symptoms which
are produced.
Blood Deficiency
Pallor, dizziness, dry skin, palpitations, scanty periods, dry eyes, weak pulse.
The foods which may be used to help to treat blood, qi or yang deficiency are:
Foods for yang deficiency Foods for qi deficiency Foods for blood deficiency
Garlic - Red grapes - Cloves
Dates - Raspberries - Cinnamon bark
Sweet potato - Chicken - Dry ginger
Malt - Egg yolk - Walnuts - Rice - Red meat
Lamb - Chicken Liver - Beef
In Ayurveda a pale tongue is said to be due to a lack of blood in the system. Blood
forms one of the dhatus (body tissues) of Ayurvedic medicine and is called rakta. A
scalloped tongue is seen as it is in Chinese medicine to be caused by poor
assimilation of foods.
Blue or purple tongue
A blue tongue is caused by coldness, whilst a purple tongue is caused by failure of
blood to move properly - which the Chinese refer to as blood stagnation. It however
can also be caused not by a lack of yang but by too much cold. A purple tongue with
a bluish tinge is due to coldness causing blood to stagnate, whilst a reddish purple
tongue is due to heat causing the blood to stagnate. Where there is excess cold, the
tongue has a thick white coat.

Excess Cold
Pale, often overweight, water retention, normal energy levels, excess mucus, cold
hands and feet, copious and clear urination, abdominal pain better for heat but worse
for pressure, loose stools and a strong pulse.
Blood stagnation
Sharp, fixed stabbing pain which is worse for pressure, irregular periods with clotted
purple blood, purple lips and complexion.
Parsley leaf - Barley - Mushrooms
Grapefruit and tangerine peel

Foods for blood stagnation Foods for excess cold

Leeks, Chives Onions, Leeks, Chives
White pepper, Cayenne, Nutmeg Cinnamon bark, Cloves, Cumin, Caraway, Fennel,
Chilli, Pepper, Ginger
Vinegar Oats
Ginger Walnuts
Aubergine Parsnip
Butter Lamb
Rice Chicken
Basil, Rosemary Beef
Garlic Anchovy
Trout
Dates
Citrus peel
THE TONGUE COAT
A yellow coat indicates internal heat in the body, a white coat indicates cold. If the
coat is thick then the degree of heat or cold is more pronounced than if the coat is
thin. If the coat appears greasy it is due to dampness accumulating in the body.
Dampness
Fluid retention, swelling, heavy sensation in the head and muscles, lethargy, sticky
mucus discharge, a feeling of fullness in the abdomen and loss of appetite.
Dampness may occur either with heat or cold. Foods which reduce damp work by
stimulating the digestion to improve absorption and often cause increased urination
to drain the dampness from
the body.
Foods which reduce dampness
Parsley leaf - Barley - Mushrooms

 Grapefruit and tangerine peel

Corn - Broad beans - Hops
In Ayurveda, a thick tongue coat is caused by ama, which is a toxic sticky residue
that builds up in the body and causes obstruction and heaviness. A thick greasy
yellow coat indicates what is called ama jvara which is ama accompanied by fever,
whilst a simple yellow coat indicates increased pitta. A white coat with mucus on it is
caused by an excess of kapha.
BALANCING FOODS IN AYURVEDA
Vata balancing foods Pitta balancing foods Kapha balancing foods
Sweet fruits such as bananas, Sweet fruits as for vata, Apples, apricots, prunes,
coconuts, cherries, grapes but sour fruits should raisins
and figs be avoided.
Cooked vegetables such as Sweet and bitter vegetables Pungent and bitter
asparagus, carrots, garlic, such as broccoli, Brussels vegetables such as green
beans, onion and sprouts, cauliflower, lettuce broccoli, cabbage, sweet potato and
cabbage Brussels sprouts, aubergine and lettuce. Oats, rice and wheat Barley, oats
and rice Barley, oats, corn, millet,
basmati rice. Beef, chicken and eggs Chicken and eggs Chicken and eggs
No legumes All legumes except lentils All legumes except
kidney, soya and mung
beans
All nuts in small quantities No nuts except coconuts No nuts
All seeds in small amounts No seeds but for sunflower No seeds except and
pumpkin sunflower and pumpkin
All natural sweeteners but All natural sweeteners but Raw honey only
not white sugar not molasses or honey
All spices Coriander, turmeric, fennel, All spices except salt
cinnamon and cardamom
All dairy products Unsalted butter, cottage No dairy products
cheese and milk except goats milk
All oils Coconut, sunflower and Almond, corn, sunflower
olive oils oils in small amounts.
Finally it is important to emphasise that the use of foods in Chinese and Ayurvedic
medicine is different from the modern nutritional use of foods, which is based on
understanding the vitamin, mineral, protein, phytochemical, carbohydrate and fat
content. In Chinese or Ayurvedic medicine foods are understood in terms of taste whether they are sweet, bitter, sour, pungent or salty - and whether they are
warming, cooling or neutral in their affect on the body. The opposite quality to the
condition is always chosen, hence for someone with coldness in the body, warming
foods are used, whilst if someone is weak and deficient, sweet tasting foods which
are strengthening are used.
Edward Thompson has 11 years of training in natural medicine. He is a herbalist
practising both Western and Chinese herbalism, an acupuncturist, homeopath,

shiatsu and craniosacral practitioner and has studied Ayurveda at the Ayurvedic
Institute in London with Dr Vasant Lad. Edward works full-time from a GP's practice
in Cambridge and can be contacted on t 01223 811 928.
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Wiseman N, Ellis A, Zmiewski P, Fundamentals of Chinese Medicine, Paradigm
Publications, 1985.
Hart FD, Frenchs Index of Differential Diagnosis, Wright, 1989.
Lad V, Ayurveda The Science of Self-Healing, Lotus Press, 1984.
Lad V, Lad U, Ayurvedic Cooking for Self Healing, The Ayurvedic Press, 1994.
Lu C, Chinese System of Food Cures, Sterling, 1986.
Morningstar A, The Ayurvedic Cookbook, Lotus Press, 1990.
Pitchford P, Healing with Whole Foods, North Atlantic Books, 1993.
Tierra L, The Herbs of Life,
The Crossing Press, 1992.