Essential Takeaways

  • Looking at your tongue can give Chinese medicine practitioners clues about what’s happening with the other organs and general internal environment in order to make a diagnosis, which is why we require a picture of your tongue in the Elix Health Assessment 
  • Qualities such as color, moisture, coating, & strength are evaluated 
  • A "normal" tongue is pink with a thin moist coat

For centuries, practitioners of ancient medicine have considered the tongue a key clue in any diagnosis—but why is it still relevant today? Until humans drastically evolve otherwise, the tongue remains the only internal organ visible without a scalpel. The tongue may not seem like an organ in the traditional sense, but it is 100% pure muscle, fed directly by blood and nerves, with cells that regenerate every 10 days (much like the cells lining your digestive tract). Looking at it can give us clues about what’s happening with the other organs and general internal environment. Specifically, Chinese medicine looks at the color, moisture, shape, and strength of your tongue in order to determine the state of your health. Let’s take a closer look at the elements of tongue diagnosis so that you can start to interpret what your tongue may be saying about your health.

As a necessary disclaimer, there’s a lot of terminology in Chinese medicine that doesn’t perfectly translate into Western terms. For instance, saying that there is heat in the body doesn’t necessarily indicate an increase in body temperature. It more so refers to how the body functions, and indicates the type of herbs or acupuncture needed. It’s important to note that while this article will give you the tools to interpret the picture of health shown on your tongue, it’s absolutely vital that you consult with a doctor (Western or Eastern) about how best to move forward.

Let’s take a closer look at the different categories we consider when examining the tongue:



If the tongue is pale, it indicates that energy and blood flow are deficient. Energy and blood nourish our skin, muscles, and hair. They root our emotions and are the driving force for all functions of the body. When energy and blood flow are weak, you might experience dry skin, thinning hair, numbness, dizziness, poor memory, very heavy or very light periods, bloating, fatigue, and/or loose stools. Some potential disorders include: chronic diarrhea, anemia, asthma, infertility, or frequent miscarriage. 


If the tongue is red, it indicates that there is heat in the body. The heat can be constitutional (the norm for that person’s body) or can be acquired externally in the form of a toxin (such as a medication or alcohol) or disease. In the second scenario, fluids are improperly metabolized (e.g., they burn up too quickly), resulting in signs of heat such as constipation, insomnia or vivid dreams, dry throat, increased body temp or perspiration, and/or excessive hunger. This person could be experiencing menopause, an autoimmune disease, hypertension, or a febrile disease. 


A purple tongue always indicates a lack of proper blood circulation. Blood flows through the body, providing nourishment and removing waste. When this process is dysfunctional, there is stasis of blood resulting in pain. Symptoms include: painful periods with dark blood clots, irregular periods, headaches, neck or back pain, abdominal pain, etc. Potential disorders include physical trauma, endometriosis, PCOS, migraine, or arthritis. 


Short or Thin:

When the tongue is short or thin, it indicates that fluids are being improperly metabolized and used up too quickly (such as in the red tongue above) or not made in the first place (as in the pale tongue).


When the tongue is swollen or has impressions of teeth on the side, body fluids are poorly metabolized and distributed. This can be due to lack of energy to process or a problem with the processing itself. It results in the fluids being deposited and stored in areas where they are not meant to be.

When the tongue body changes shape, this confirms what you learned from the color of the tongue and can indicate that the condition has increased.


 The tongue coating is made up of the tips of the filiform papillae, which are the small bumps on the top side of the tongue. In Chinese Medicine, the tongue coating is the physiological byproduct of the metabolism of food and fluids. When you see a Chinese medicine practitioner or take a picture of your tongue for our health assessment, never scrape or brush your tongue. The coating is vital to tongue diagnosis!

Greasy Coating:

A thick, greasy coating can indicate improper digestion of foods. Generally this is due to the overconsumption of foods that are greasy or cloying, in which case there is build-up of waste that your body cannot eliminate. This coating can also arise if your digestive system is in a state of dysfunction, where food and fluids are unable to be transformed into usable elements and stagnate on the tongue. People with this tongue coating may experience symptoms such as constipation and/or loose stools with strong odor, bloating, heavy body, or fatigue. These people may chronically overeat or over-drink, and/or have high cholesterol or fatty liver.

Dry Coating:

When the coating is dry, it indicates that the body’s fluids are insufficient. This could arise due to not having enough fluids to start with (dehydration) or improper metabolization of the fluids that are consumed. A wide variety of symptoms can be apparent, such as: constipation, cough or dry throat, insatiable hunger, or insomnia. These patients could have hyperthyroidism, eczema, tremors, or anxiety.


When a tongue is trembling, it shows us that a long-standing condition has drained the body of its energy. Much like how your muscles start to shake after an intense workout, the muscles in your tongue begin to fail when your body’s energy is zapped. This quivering can be a result of any chronic issue which has depleted the body.

So, what does a “normal” tongue look like?

A “normal” tongue is hard to come by… but then again, it’s also rare to find any one of the above extremes on their own. A tongue that would be considered normal would be in the neutral position between all the elements described above. Not too red, but not too pale: pink. Not too dry, but not greasy: moist. A shape that’s not overly puffy, but not too small for the mouth. When we see changes one way or another is when we start to gather clues on the state of a person’s health. 

How to use this information 

It’s important to note that not all tongue traits were mentioned here. Plus, there are infinite combinations that can be created between each category. Only practitioners who have dedicated their lives to the study of the patterns and manifestations of tongue diagnosis will truly be able to make a determination on your health. 

You can help your practitioner by regularly checking your tongue and making note of any changes between visits. See below for some examples of the different tongue manifestations so you know what to look for!

Every tongue is unique, revealing important clues about our health. Click here to take our Health Assessment and discover the personalized herbal formula that's best suited to your body's needs. 


This article was reviewed by Dr. Elizabeth Fine.

Dr. Elizabeth Fine is currently the Dean of Clinical Education at Emperor’s College, the #2 ranked colleges for TCM. She has been practicing Acupuncture and Herbal Medicine for over 20 years, with a specialization in women’s reproductive health.

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