How to check your health according to your tongue

Ayurveda and Traditional Chinese (TCM) healing modalities have been using the tongue as a diagnostic tool for thousands of years, and the practice is becoming popular in Western naturopathy. Some of the ancient beliefs around tongue-to-health correlations have been scientifically researched and found to be linked with a deficiency or health condition, yet much of it is still theoretical and the area requires more research. It is best to check with your healthcare provider, such as a GP or naturopath, if you are at all worried about changes in how your tongue and mouth appear; however, you can look at your tongue and observe the shape, colour, and coating to get an idea of what your tongue may be saying about your health as a whole and whether you might need to get further support.

Any change in the colour of the tongue may indicate an issue with the circulation of the blood and internal temperature, often related to the thyroid and metabolism. A pale or whitish tongue could be indicative of poor circulation, cold temperature, and a lack of healthy red blood cells. A pale tongue may signal nutritional deficiencies, including iron, folate, and vitamin B12. If you are suffering from a lack of energy, fatigue, dizziness, and brain fog, your red blood cells may need support. In TCM, a pale tongue can indicate a lack of qi or blood and a “cold” condition, potentially related to poor circulation or a yang deficiency. 

A healthy tongue is rosy/pink in colour; however, if your tongue is red, you may need to pay extra attention. A red tongue can suggest heat and an exaggerated immune response in the body and, like a pale tongue, can indicate a lack of iron and reduced circulation. A purple tongue indicates blood stasis, or an extreme lack of circulation. Common nutritional deficiencies found with a beefy, red tongue include iron, folate, and vitamin B12, and if your tongue is burning, you may need more zinc. A beefy red tongue is where your tongue appears swollen and often smooth. This can be triggered by several health conditions, so check with your GP if you have a continually swollen or hot tongue.

In TCM, a beefy red tongue can indicate various imbalances, often related to heat or inflammation in the body. It could signify excess heat, yin deficiency, or blood stagnation, depending on the specific characteristics and accompanying physical manifestations. A red tip might suggest heart heat; with cracks, it could indicate liver heat and/or yin deficiency; and a swollen tongue could point to Spleen Qi deficiency or dampness.

Teeth marks are often found where the teeth are literally pressing against the tongue because it is too swollen for the oral cavity. In TCM tongue diagnosis, teeth marks reflect the dysfunction of the spleen and is associated with tiredness, poor appetite, shortness of breath, or worry. Teeth marks can also be an indication of poor nutrient absorption and assimilation, which may lead to exhaustion, poor digestion, and even waste accumulation in the digestive tract. It is essential to absorb nutrients from food for the maintenance of good health. Support your digestive system with glutamine for healthy growth and repair of the intestinal lining, pre- and probiotics to replenish stores of good bacteria and support immune health, and apple cider vinegar or other digestives to support stomach acid for better digestion. A liver or kidney tonic may help, as can addressing any issues with your spleen/stomach. The spleen in TCM plays a crucial role in digestion and transportation of fluids. When the spleen Qi is deficient, it struggles to process food and fluids properly, leading to dampness accumulation and the resulting physical manifestations. 

A white coating is the most common discoloration of the tongue. In TCM theory, it is believed that tongue coating can reflect the condition of the body’s zang-fu (internal organs), qi-xue (energy and blood), and jinye (fluids), as well as the nature and severity of disease. There could be dietary nutrient deficiencies impacting your body’s ability to metabolise carbohydrates, which can influence the type of coating on your tongue. See your regular health professional if you would like to check for any nutritional deficits.

The ideal is to have a thin, white coat on your tongue. This indicates healthy gut flora and a normal, well-functioning gut wall and mucosa. Sluggish digestion appears as a thick tongue coat. A yellow tongue coating indicates a “heat” condition in the digestive tract, whereas a thick white coating indicates “cold.” A thick coating in the centre of the tongue is a common sign of an overloaded digestive system. You may find you are feeling heavy or lethargic and that your digestive system needs a good dose of friendly pre- and probiotics. A thick coating may also be indicative of fungal issues. If this is you, probiotics may be helpful.

A shaky tongue is commonly found when people are suffering from stress and an inability to relax. You may be unable to sleep, feel stressed and worried, and have a restless mind, yet feel exhausted. A shaky tongue can be supported by taking calming herbs to nourish the nervous system, as well as magnesium to support relaxation and sleep and release muscle tension. In TCM, a shaky tongue can be indicative of “wind,” which can be either external (due to external pathogens like heat) or internal (often linked to Blood deficiency in the heart and spleen). A shaky tongue can also be associated with digestive problems, liver imbalances, and even emotional factors, hence the nervous system connection in a more “scientific” sense.

Grooves, cracks, or fissures along the surface of the tongue surface may be due to an iron, biotin, or vitamin B12 deficiency, as these nutrients are required to mature the tongue’s papillae. It is important to look out for fungal overgrowth in the fissures of the tongue and take a pre-and-probiotic, as a preventative. No coating, or a peeled/cracked tongue coat, indicates insufficient lining or flora in the digestive system. In TCM, tongue cracks may indicate a deficiency of Yin, Qi, or Fluids, or an organ imbalance and is considered to be relatively serious depending on the size and position of the crack/s.

A deep, prominent mark in the middle of the tongue known as a fissure can be a result of malnutrition. While the exact cause is unknown, genetics, aging, and certain medical conditions are thought to play a role. In TCM it is indicative of imbalances causing digestive issues, particularly in the stomach, and can also indicate chronic worry or stress. A long central crack can indicate heat in the stomach due to factors like stress, overconsumption of spicy foods, alcohol, or coffee. It may also be a sign of Yin deficiency (lack of nourishing fluids) or blood deficiency, depending on the tongue’s color and coating. Ayurveda considers a long central tongue fissure to be an issue with the spine or nervous system.

Papillae (small, raised bumps) can form over the tongue, appearing in a patchy, map-like (geographic) configuration. Symptoms may appear for a few days and then disappear, or the location of the “maps” may move. A vitamin B deficiency can cause swelling and many tongue symptoms, especially a geographic tongue. If patches appear on the sides of the tongue, your liver may need extra support through detoxification and liver-specific herbs. If the patches appear on the middle of the tongue, you may be able to support your digestive system with digestive supplements, pre- and probiotics, and fermented foods like apple cider vinegar, sauerkraut, and kefir, but check with a registered natural health practitioner.

In TCM, a geographic tongue surface is often associated with a Yin deficiency, night sweats, dizziness, palpitations, or even panic attacks.

1. Use natural light
2. Stick your tongue out as far as you can
3. Note the colour, shape, movement, etc.
4. Photograph changes on a weekly basis
5. If in doubt, see your health professional

Your body is always dropping clues about your health, and you can learn a lot by opening your mouth. The health of your teeth, gums, tongue, and digestive system is inextricably linked to your overall health. The microbiome of the mouth is key. You can prevent many tongue problems by practicing gentle oral hygiene, such as flossing and using a tongue scraper and learning when and how to brush properly. Avoiding tobacco and alcohol, drinking plenty of water, and eating a nutrient-rich diet can do wonders for your oral hygiene and help to flush out microbial debris from your whole digestive system. You shouldn’t need any chemical sterilisers in your oral hygiene routine—these can adversely affect the balance of your oral microbiome.

It is important to regularly check your tongue to recognise any changes and notice what you may not be able to feel. Unexplained patches, bumps, swelling, numbness, hotness, etc., or an excessively dry mouth or bad breath, need to be presented to your health professional. Check your tongue in the mirror each morning, notify your healthcare provider if you’re worried, and stay on top of your health.