The first part of this series focused on tongue color, the most important feature in tongue diagnosis. We now focus on tongue shape, the second most important feature. Tongue shape is a good indicator of excess and deficiency-related imbalances in the body. An example of excess is too much heat in the body. This, in turn, leads to a deficiency in fluids, essentially burning them off.
Another example is a deficiency of heat leading to an excess accumulation of fluids (“dampness”). A normal tongue should be soft without being overly floppy. You should easily be able to extend the tip beyond the mouth but it shouldn’t flop out like Rin Tin Tin. It should taper towards the tip…not being too blunt-ended like the Rolling Stones emblem, or too pointy as in Gene Simmons from Kiss.
Several more obvious aspects of tongue shape are covered here. For those wanting to delve in further, check out the references at the end.
Tongue thickness reflects the status of blood and fluids in the body. In Chinese medicine, fluids are all liquids other than the Blood: digestive secretions, tears, mucus, sweat, urine, saliva, etc. A thick tongue indicates fluid accumulation or “dampness.” The tongue may be so swollen that it presses into the teeth, resulting in scalloped edges along the sides of the tongue. For an example of a swollen tongue, check out the Rolling Stone’s emblem (!) or visit Giovanni Maciocia’s “Tongue Gallery” and look at examples 6 and 9.
A swollen tongue with normal tongue body color indicates “Spleen qi deficiency,” a common pattern in the west (1, 2). The Spleen in Chinese medicine controls fluid and nutrient metabolism and transport. (It’s capitalized to distinguish it from the western medical idea of the spleen.) If the Spleen lacks the vital energy (qi) to regulate fluids in the body—due to chronic stress, poor diet, irregular eating habits, or other influences—it’s reflected in excess fluid accumulation in the tongue. Spleen qi deficiency results in fatigue, bloating, loose stools, weakness in the arms and legs, and with progression, more serious issues (1).
A swollen tongue may also indicate yang deficiency, with yang being the heating and motivating principle in the body (1,2). This is often seen in folks with long-term illnesses. Yang deficiency leads to dampness, reflected in a pale (cold), wet tongue.
For either Spleen qi deficiency or yang deficiency, avoiding cold, raw foods is key. Some helpful foods are those that clear dampness, are warming and/or are qi moving (3).
- sweet potatoes
- button mushrooms
- aduki beans
There are other reasons for a swollen tongue. Sorting through these also depends on tongue body color. Sometimes only a part of the tongue is swollen, with the location of the swelling pointing towards the body system(s) impacted by dampness.
The thickness of the tongue depends on both Blood and fluids. Deficiency in either will result in a thin tongue (1,2). A thin tongue that is pale-colored indicates Blood deficiency. If, instead, the tongue is red, this indicates fluid (yin) deficiency. Fluid deficiency results in heat, hence the redness.
For causes and symptoms of Blood and fluid deficiency, as well as supportive foods, visit the first article in this series.
A long tongue sticks out farther than normal from the mouth and will generally be red with a red, pointed tip. (Refer back to Gene Simmons, here.) This indicates excess heat, more specifically, in the Heart (1). Interestingly, this heat often originates elsewhere—for instance, in the Liver—then impacts the Heart as it progresses. This makes the Heart a bit harder to work with, as imbalances elsewhere (Liver, Kidneys, etc.) need to be addressed first.
In Chinese medicine, the Heart is involved not only in circulation, but also mental state. The Heart houses our awareness and emotional thoughts, and is the seat of joy (1). Heart heat may manifest in insomnia, restlessness, incoherent speech, mania, dry mouth, thirst, dark yellow urine, and other signs (2).
Eat cooling, moistening and/or calming foods like (3,4):
- mung beans
- brown rice
- goat milk
A short tongue is one where the tip doesn’t extend or barely extends beyond the mouth when you stick it out. For an example of a short tongue, click over to the Tongue Gallery again and look at example 13. Contraction of the tongue may result from coldness, heat, or improper fluid metabolism in the body. A pale and short tongue points to coldness from qi and yang deficiency. This contracts the tongue.
Use the warming, qi-moving foods referred to earlier for support. A swollen and short tongue is from improper fluid metabolism. This leads to fluid accumulation in the muscles and sinews, in turn, interfering with the ability of the tongue to be extended. Again, warming and qi moving foods may help here. If a tongue is short and red, dryness from excess heat may be contracting the tongue. Think of an old dried up piece of leather. Again, revisit the cooling/moistening foods mentioned in the first article in this series. In other cases, a short red tongue may indicate serious health issues that are beyond the scope of this article (2).
OK, so this isn’t actually a shape…A quivering tongue is one that shows rapid small movements when extended. Often the tongue will be pale. There is usually accompanying fatigue and digestive issues, as well as a history of stress. Use the foods already discussed for supporting qi and Blood. If the quivering tongue is red and dry, it indicates that excess heat in the body is generating a pathogenic factor called “wind.” As its name implies, wind is associated with movement. Wind may cause tremors (or seizures in extreme cases), other irregular body movements, pains and aches that keep changing locations, and other signs (4). More serious issues require the skills of a practitioner, but for milder symptoms, bump up the cooling and moistening foods in the diet.
2. Pitchford, P (2002) Healing with whole foods. Asian traditions and modern nutrition. 3rd edition. North Atlantic Books, Berkeley, CA.
3. Maciocia, G (1995) Tongue diagnosis in Chinese medicine. Revised Edition. Eastland Press, Seattle, WA
4. Beinfield, H & E Korngold (1991) Between heaven and earth: A guide to Chinese medicine. Ballantine Books, NY.