The Tongue, Untied

If you’d have told me five years ago that one day I’d ask people to stick their tongues out at me in order to gather information about their physical, mental, emotional, and behavioral wellbeing, I probably would have stuck my tongue out at you.

Flower_February 2017
A flower in Monteverde, Costa Rica, that reminded me of lips. Taken February 2017.

But that was before I learned that Chinese medicine practitioners have been doing it for thousands of years. That was before I started doing it myself, as a Chinese medicine student.

Two years into my Chinese medicine education, my health took a turn for the worse. Like any good Chinese medicine student, I looked at my tongue during this time to see what it could tell me.

Three things stuck out to me as I stuck out my tongue in front of the mirror: First, the tip of my tongue was red. Second, this same region had a high concentration of red spots. And third, a midline crack that was wider in the middle extended from the back of the tongue as a whole to the back of the tongue tip.

Combined Heart and Stomach crack
The tongue microsystem, with a combined Heart and Stomach crack (shown in light red). Adapted from reference 2.

The tongue in Chinese medicine is considered a microsystem of the body’s trunk, which means that the condition of each organ in this region manifests in the corresponding part of the tongue: the tip of the tongue corresponds to the organ at the top of the trunk (the Heart); the middle of the tongue to the organs in the middle of the trunk (the Stomach and Spleen); and the back of the tongue to the organs at the bottom of the trunk (the Kidneys, Bladder, Small Intestine, and Large Intestine).1

Redness and red spots at the tip of the tongue therefore relate to the Heart, but what about a crack that extends through multiple organ regions?

The crack of the nature I described is actually two cracks combined, the longer one related to the Heart (a “Heart crack”) and the wider one related to the Stomach (a “Stomach crack”). This doesn’t explain, however, why in the name of (insert clever tongue pun here) a Heart crack extends the whole length of the tongue when the region of the tongue that corresponds to the Heart is the tip.

Well, today is your lucky day, because the explanation is on the tip of my tongue! While all of the organs are important in Chinese medicine, the Heart is considered the emperor. Each of the organs in Chinese medicine has a much broader sphere of influence than its conventional medicine counterpart. The standard way to distinguish between these two understandings of an organ with the same name is to capitalize the name when it refers to the Chinese medicine concept and to begin the name with a lowercase letter when it is used in a conventional medicine context. This letter case distinction also applies to the nomenclature of other concepts that have different meanings, such as Blood (the Chinese medicine concept) versus blood (the conventional medicine concept). A particularly significant way in which the five main visceral organs in Chinese medicine have broader spheres of influence is their relationship with the mind. Each of these organs has a mental aspect in addition to a physical one. The Heart is considered the emperor of all of the organs because its mental aspect is the only one that has insight, and is therefore the only one that can recognize and “feel” emotions.2 While certain emotions can affect the mental aspects of other organs as well, the Heart-mind is the only mental aspect that is affected by all emotions.2 But back to the story of my tongue.

Tongue selfie
A “tongue selfie.” Note the red tip with red spots, and somewhat resolved midline crack. Taken July 2016.

At the time my tongue looked like this, not only was I about to become an intern and start treating real, live patients beyond my fellow students, but I lacked confidence in my treatment skills. Needless to say, I was very stressed.

Sure enough, a combined Heart and Stomach crack usually indicates severe emotional stress, which may or may not manifest physically. For me, my eating habits suffered, hence the Stomach crack. As for the red tip and red spots in the same region, these too indicate emotional stress. Emotional stress causes qì to stagnate, and stagnation of qì generates heat, indicated by the color red. (For a brief explanation of qì, see the Qì Gōng page). The heat in this case is internal, as opposed to external. (For context on this distinction and the description of conditions in the body in terms of natural influences, see my blog post “Chinese Medicine 101.”) The pattern of disharmony indicated by a red tip with or without red spots, which is more severe in cases of the latter, is called “heat in the Heart.”

In sum, features of the tongue that are used in diagnosis include: the color, shape, moisture, and coat. The coat refers to the layer on top of the tongue. It is normal to have some coat because of the tongue’s connection to the Stomach. The Stomach is located just down the esophagus from the tongue, and is responsible for “rotting and ripening” the food we eat.1 This is basically a different way of saying that, like the stomach of conventional medicine, it plays a major role in digestion. The Stomach is akin to our own personal compost. As such, it favors a damp environment. The residual dampness from the Stomach’s digestive process “steams” upward to the tongue and forms the coat.1

So there you have it: the tongue, untied and demystified. You’ve already opened your mind to tongue diagnosis; now you can open your mouth to it!*

(*Yes, it’s okay if you just ate garlic or raw onions or if you “forgot” to brush your teeth the last few days–I am an Equal Opportunity Tongue Interpreter.)


  1. Maciocia G. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. 2nd ed. Edinburgh: Churchill Livingstone/Elsevier; 2005.
  2. Maciocia G. The Psyche in Chinese Medicine: Treatment of Emotional and Mental Disharmonies with Acupuncture and Chinese Herbs. Edinburgh: Churchill Livingstone/Elsevier; 2009.