A colleague of mine helped run a study on the use of acupuncture to treat depression. As part of the record-keeping, each patient’s file included photos of their tongue, along with other information from the intake and follow-up assessments.
This acupuncturist found herself at a table with a bunch of researchers, psychiatrists, and medical doctors, who were puzzled by this. My friend picked up a tongue photo without looking at the file, and said: “She has a weepy, sad kind of depression, with lots of worry and obsessive thinking that keeps her awake at night. She also has fatigue, a heavy, stuck feeling where it feels physically hard to move. There are issues about nurturing – she feels like no one is taking care of her, yet she overextends for other people. She probably also has some digestive problems and chronic sinus congestion.”
She went onto predict how the patient responded to treatment: The sleep improved right away, and the depression got somewhat better, but the fatigue is still a problem. Digestion also improved. Everyone at the table stared. They knew the patient, and she was spot on. “It’s not magic,” she told them. “It’s all right there, in the tongue. You just have to know how to read it.”
So What Are We Looking At?
When the doctor asks you to stick out your tongue, she’s usually looking right past it to see down your throat. For us acupuncturists, the tongue itself is one of our best sources of information about what’s happening in your body.
Think about it: 3000 years ago, when Chinese medicine was being developed, there were no x-rays or lab tests. They needed another way to “see” what’s going on inside the body by observing the outside of the body. Turns out, the tongue is a tissue that changes as the state of your health changes.
When acupuncturists do tongue diagnosis, we’re looking at three things:
The tongue should be a fresh, light red color. If a person is very depleted, the tongue may be more pale. A bright red tongue is caused by excess heat in the body. A dark red, bluish or purplish tongue indicates stagnation or poor circulation.
Different areas of the tongue correspond with different parts of the body. If, say, just the tip of the tongue is red, we know the heat is mainly in the upper body.
There is more variation in this than you might think! Some tongues are very thin, or short, or pointy. Many peoples’ tongues appear a little puffy or swollen, and may be scalloped around the edges. This mainly indicates the state of fluid metabolism in the body.
We also look at cracks on the surface of the tongue, indicating heat or dryness, again using the different areas of the tongue to see which body systems are affected.
It is normal to have a thin white coat on the surface of the tongue. Sometimes that coating gets thicker, and may change color. Diagnosis is based on the thickness of the coating, the texture and color, whether it is “rooted” to the tongue or sitting on top. The coating may also “burn off” entirely, leaving the tongue looking peeled.
While in treatment, it’s helpful if you don’t brush your tongue when you brushing your teeth. This allows your acupuncturist to see the natural state of your tongue coating.
Keeping Track of Progress
The tongue is also a good way to evaluate the effectiveness of treatment. As you start to feel better, and your body gets stronger and better-regulated, the imbalances reflected in the tongue will start to disappear.
This is especially helpful in cases where it’s hard to evaluate progress: say, with a condition that is very variable or intermittent; or with fertility treatment, where it’s hard to know how fertile you are until you are actually pregnant.
Check Out Your Own Tongue
It takes time and practice to start to see subtle changes in the tongue. In school they made us draw color pictures of 100 peoples’ tongues. I still have mine. It’s quite a work of art.
You can start by just looking at your tongue every day and see what you notice. You can also compare your tongue with someone else’s, if you know someone who’s up for that! It’s a good way to learn about your body and understand your own health. Plus it’s just kind of cool.
Next time you get sick, watch how your tongue changes. A bad, phlegmy cold will usually build up a good bit of tongue coating, which will slowly dissipate as you get better.
I have an entire book on tongue diagnosis, with color plates, if you want to see pictures of a wide range of tongue colors, shapes and coatings. Just ask next time you come in!