Since the earliest times, Greek physicians like Hippocrates and Galen have always considered the tongue to be an important indicator or barometer of health and disease.  Other great traditional medical systems of the world, such as Ayurveda and Chinese Medicine, also have sophisticated systems of tongue diagnosis.


The Tongue

     Before learning the specific diagnostic signs that present on the tongue, we must first understand how Greek Medicine views the tongue, and its role in the overall physiology and pathology of the organism.  This will place the art of tongue diagnosis in its proper holistic context.
     The tongue is the organ of the sense of taste.  According to Greek Medicine, taste, or the Gustatory Faculty, has an inherently Sanguine temperament, being warm and moist.  Being Sanguine in temperament, the sense of taste has an Attractive Virtue; when we say that we have a taste for something, that means we're attracted to it. 
     Through its sense of taste, the tongue signals to the body, particularly to the digestive organs, which digestive juices to secrete, and how much.  For example, the taste of fried food signals to the liver and gall bladder to release a lot of bile in order to digest its fats. 
     Through its sense of taste, the tongue has close, intimate reflex relationships with all the internal organs, but especially with the digestive tract and Natural Faculty.  In other words, the tongue is a mirror that reflects the condition of the body's internal organs, particularly the organs of digestion and metabolism.  The tongue also reflects the overall digestive, nutritive and metabolic condition of the entire organism. 

Tongue Body and Tongue Coat

     The examination of the tongue is divided into two parts: examination of the tongue body; and examination of the tongue coat, which is also sometimes called the moss. 
     Examination of the tongue body yields information on the temperament and general nutritive and structural condition of the internal organs and their tissues.  It also provides information on the condition of the blood and the bloodstream, which infuses and supplies the internal organs with the humors, nutrients and vital principles they need. 
     Examination of the tongue coat yields information on the existence of humoral excesses, imbalances and superfluities prevailing in the body, particularly in the digestive tract and Natural Faculty.  It also provides information on the overall state of the patient's pepsis, or digestion and metabolism, as well as the presence of toxins, or metabolic wastes, generated by a faulty or deficient pepsis.
Generally, the tongue body portrays conditions that are more deep seated, systemic or chronic, whereas the tongue coat portrays conditions that are more acute, transient, superfluous or superficial. 


Examination of the Tongue

     The patient is asked to stick out his/her tongue as far as possible while opening his/her mouth as wide as possible.  The physician examines the tongue in a sufficiently bright light, which is free of any undue tinting or shading.  The best and most natural light is, of course, sunlight.  The physician must be able to examine the whole tongue, from the root, or base, to the tip. 


Reflex Zones on the Tongue

     The tongue, through its sense of taste, is endowed with millions of sensitive nerve endings that connect its various regions, or zones, with the different internal organs of the body.  Through centuries of clinical practice and experience, the holistic physicians of Greek Medicine and other traditional healing systems have mapped out various reflex zones on the tongue. 
     The tongue is the external extension or projection of the body's interior, and its various internal organs.  The tongue is principally the external projection of the digestive tract and Natural Faculty; its Sanguine temperament also links it to the blood and the Vital Faculty.  The organs of the other two faculties, Psychic and Generative, are not very well represented on the tongue.
     The general schema or layout of the various organ reflex zones on the tongue is quite simple and straightforward:
     The core organs of the Vital Faculty, located in the thoracic cavity, are represented on the anterior section of the tongue, towards the tip.  These organs are principally the heart and lungs, with the heart at the very tip and the lungs more posteriorly.
     The core organs of the Natural Faculty, located in the epigastric region of the abdominal cavity, are represented in the middle section of the tongue, about midway between the base or root of the tongue and its tip.  These organs are principally the liver and gall bladder, located on the right and left sides, or flanks of the tongue's midsection, and the stomach, located in the very center of the tongue.  The spleen areas lie lateral to the stomach zone, but inside or medial to the liver/gall bladder areas.  The pancreas area lies on the tongue's midline, just slightly posterior to the stomach zone.

     The excretory organs of the pelvic cavity are represented on the posterior section of the tongue, towards the root, or base.  The kidney zones are located on the right and left sides of the tongue's base.  The intestines are represented on the central posterior region of the tongue, just behind the stomach and pancreas.  The bladder zone is at the very base of the tongue, right on the midline.
     How are these reflex zones used in the art of tongue diagnosis?  They are used, basically, in two ways:
     If an abnormality of the tongue coat appears in a certain reflex zone of the tongue, it indicates a buildup of morbid or superfluous humors, or a disturbance of pepsis going on in the corresponding organ or region of the body.
     If an abnormal lesion or discoloration of the tongue body occurs in a certain reflex zone of the tongue, it indicates a corresponding or analogous structural or nutritive change in the corresponding internal organ.


Tongue Body Color

     The overall color of the tongue body shows the general condition of the blood and the bloodstream, and its basic balance or makeup of humors, nutrients and vital principles as these vital fluids infuse and nourish the tongue and the other organs and tissues of the body.  A discoloration of the tongue body localized in a particular reflex zone of the tongue indicates an imbalance occurring in its corresponding organ.
     The normal color of a healthy tongue is a nice, robust, Sanguine pink - a perfectly balanced blend of red and white.  Any deviation from this perfect Sanguine pink denotes a deviation from this ideal state of health and balance; the greater the deviation, the more severe the imbalance.  In order to get a true reading of tongue body color, it's important that inspection of the tongue body be done in a natural, full-spectrum light, free from any undue tinting or shading. 
     What follows is a discussion of the more commonly seen discolorations or deviations of tongue body color and what they indicate:
     White, Pale:  Generally indicates coldness and deficiency, as well as an excess of cold Phlegmatic humors in the bloodstream.  Can also indicate anemia or blood deficiency, if supported by other signs and symptoms.
     Red:  Generally indicates an excess of heat in the body - systemic if the whole tongue body is affected, or localized in a particular organ or part if only certain reflex zones are affected.  The heat and choler are more acute, excessive or vehement if the tongue is bright red.  A dark red tongue is often a sign of chronic consumptive or deficiency heat, or a consumptive fever or dyscrasia of the blood.  A red, sore, swollen tongue generally indicates an excess of blood. 
     Purple:  Indicates either blood stagnation or cyanosis, which is a deficiency of vital principles - Vital Force and/or Innate Heat - in the blood.  With a reddish purple, stagnation of the blood is indicated; with a light purple, stagnation of the Vital Force.  Purple spots on the tongue indicate a severe stagnation or congellation of blood in the corresponding organ.  Lighter or subtler shades of purple indicate a stagnation of the Vital Force that guides the blood; darker shades of purple indicate a stagnation of the blood itself.
     Yellow:  Generally indicates jaundice, or an excess of bilious, Choleric residues backed up into the blood.
     Brown:  Indicates an excess of black bile or Melancholic residues in the bloodstream.

Tongue Body Size

     A normal, healthy tongue should be sufficiently fleshy and robust, and neither too fat nor too thin.  A good feel and understanding for what exactly constitutes normal tongue size comes mainly from the accumulation of clinical experience and observing many different tongues.
     Basically, diseases or conditions of repletion or excess will present with an enlarged or swollen tongue; the greater the swelling or enlargement, the greater the excess.  Usually, this involves an excess of wetness, or moisture. Conversely, a thin, emaciated tongue indicates a disease or condition of depletion, or deficiency, and a generalized malnourishment of the organs and tissues. 
     One telltale sign of an enlarged, swollen tongue is the presence of scalloped edges.  These scalloped indentations are caused by the enlarged tongue pressing against the inside edges of the teeth.  Conversely, a deficient, emaciated tongue will often look thin and leathery, and can have an upper surface that's concave, or hollowed out;  the emaciated tongue may also be thin laterally as well.

Tongue Body Texture

     What is the general texture of the tongue body - is it smooth or rough, rumpled or flat?  In Greek Medicine, the general texture of the tongue body indicates deep-seated, systemic conditions of dryness or wetness prevailing in the organism.  Basically, roughness or dryness indicate a Dry temperament, whereas smoothness and wetness indicate a Wet temperament.  However, there are certain other idiosyncratic signs associated with tongue body texture. 
     A wet, glossy tongue surface indicates a Wet or moist temperament.  If the tongue is also swollen or enlarged, this indicates that the body is retaining excess fluids, that body fluid metabolism has become sluggish or obstructed, and fluid excretion deficient.  It can also be a sign of a cold, wet Phlegmatic temperament. 
     A dry tongue, especially when accompanied by severe thirst, indicates a condition of dryness in the organism. 
     A rumpled tongue, dimpled with numerous rises, dips, and depressions like a rocky road filled with potholes, generally indicates a sluggish, inefficient digestion and pepsis.  Such a tongue will often have a thick, greasy coat, indicating the presence of toxins due to deficient or defective pepsis. 
     A rough, grainy tongue surface generally indicates a Dry temperament, and can show a  constitutional deficiency of the Radical Moisture and the moist, flourishing Phlegmatic and Sanguine humors.  Such tongue conditions are usually inherited  or congenital, and are not acute, serious or critical.  Such constitutional shortcomings can be offset or compensated for by one's lifestyle, hygiene and regimen. 
     A raw tongue, that looks like a slab of raw meat, and is dark red in color, is generally a sign of advanced consumption, deficiency heat, and a severe depletion of the vital fluids and Radical Moisture of the organism. 
     A cracked tongue is generally a sign of chronic nervous stress and tension.  Most cracks are located on the midline of the tongue, which represents the spinal column. 

Other Tongue Body Signs

     Ulcers or cold sores on the tongue are generally a sign of hot, Choleric or ulcerative conditions occurring in the organ(s) that correspond(s) to the reflex zones in which they are located. 
     Red spots on the upper surface of the tongue, usually on the papillae or taste buds, are a sign of excess heat and choler in the blood.  Often, the papillae will be enlarged or raised. 
     A quivering tongue is generally a sign of acute nervous stress and tension.
     A deviated tongue that doesn't stick out straight, but veers unduly to the right or left, generally indicates internal wind and a dystonia of the autonomic nervous system.  A deviated tongue is often associated with facial palsy or paralysis, and may presage apoplexy, convulsion or stroke.

The Tongue Coat

     The coating or moss on the tongue's surface indicates the current condition of the patient's pepsis, or digestion and metabolism, as well as the presence of toxins and/or morbid, superfluous humors in the body, especially in the digestive tract.  Generally, the thicker and heavier the tongue coat, the more severe this buildup will be.
     Some say that the perfectly healthy tongue should show absolutely no coat.  Others say that a very small, fine coat, or moss, located in the central stomach area of the tongue, is also permissible in a healthy tongue. 
     It's generally a good idea, as part of an oral hygiene regimen, to scrape off the tongue coating, with all its accumulated morbid humors and toxic residues, with a spoon in the morning upon arising.  If you're going to see a physician for a tongue diagnosis, however, don't scrape that coat off your tongue - leave it there for the doctor to examine.
     The astute physician is fully aware that certain strongly colored foods will color the tongue and alter the natural color of its coat.  These foods will tend to impart an unnaturally bright or vivid color to the tongue coat, which will usually prompt the physician to inquire about what the patient recently ate or drank. 
     Basically, tongue coats can vary in four different ways.  Here are the four primary vectors along which tongue coats can vary:
     1)  Thickness or heaviness;
     2)  Color;
     3)  Texture, moisture and consistency;
     4)  Size, location and distribution.
     The basic interpretation of these four dimensions, or vectors, of tongue coat variation is as follows:
     Thickness:  A thick, heavy tongue coat, also called a greasy coat, is a sign of considerable buildup or accumulation of toxins and/or morbid, superfluous humors.  A thin tongue coat, besides indicating a toxic buildup that is only light to moderate, can also be indicative of catching a cold, or a superficial dystemper, also known as the grippe.  A thin white tongue coat will indicate a cold due to catching a chilly draft, whereas a thin yellow coat indicates a cold due to catching a hot draft.  These grippe-related tongue coats will be so thin as to be transparent.
     Color:  White indicates that the buildup of toxins and morbid humors is of a cold, damp Phlegmatic nature.  Yellow indicates that the buildup of toxins and morbid humors is of a hot, Choleric nature and temperament.  Off-white, vanilla, or cream colored shades in between these two extremes indicate a balance or intermixture of hot and cold influences, and general toxicity and turbidity.  A brown or black tongue coat indicates the presence of extreme metabolic heat and hyper-pepsis charring the humors into ash-like residues of
morbid black and yellow bile.  Green is associated with certain morbid forms of yellow bile. 
     Texture:  The texture and consistency of the tongue coat generally tell about conditions of dryness or moisture prevailing in the organism, and the functioning of its pepsis.  A moist creamy or greasy coat is, of course, indicative of moisture.  A dry coat is often one that has been baked by excessive fever or metabolic heat; such a dry coat, if it is also thick, may crack or show fissures due to its being dried out.  A frothy texture is usually due to the presence of wind.  Careful clinical observation of tongue coat texture will reveal the relative toxicity or turbidity of the superfluous humors associated with it, as well as whether the coat is fresh and new, or old, changed, and/or eroded over time, indicating a more chronic condition. 
     Distribution:  The general distribution pattern of the tongue coat and the organ reflex zones it covers will show the distribution or localization areas of toxic or superfluous humoral buildup in the organism.  With the coat located in the very center of the tongue, for example, the toxic humoral buildup will be centered mainly in the stomach.  If the tongue coat covers the entire tongue surface, the buildup will be systemic. 
     A certain peculiar, idiosyncratic tongue coat distribution pattern is that of the peeled or geographic tongue coat.  The tongue coat is peeled off to create stark, wiggly lines similar to the lines on a map.  Located in the central stomach area, this can indicate a deficiency of the stomach's Radical Moisture and/or injury to the stomach's protective mucous coat.  In the stomach and/or intestinal area, a peeled coat can indicate the presence of parasites, with the location and distribution of the peeled areas indicating where the parasites are concentrated.  If the basic tongue coat is thin or light, these peelings can be quite subtle, and deserve careful scrutiny.




The material presented here is for educational purposes only, and is not intended to substitute for personal diagnosis and treatment by a physician or licensed holistic healthcare professional.