What Your Tongue Can Say About Your Health


Not just for taste, the tongue is a vital organ in the body that plays key roles in facilitating digestion, forming speech, and providing the ability to taste. It contorts to assist swallowing, repositions to form phonetic sounds, and receives and relays salty, sweet, bitter, sour, and umami sensations from the foods we eat. While most people are cognizant of the kinetic and sensory functions of the tongue, many are unaware of the role that the tongue’s appearance can play in the evaluation of one’s health.

Remember your last doctor’s visit? Chances are, your practitioner asked you to “stick out your tongue.” In Western medicine, this is a common practice that allows a quick evaluation of the tongue and throat. Physicians and dentists usually look at the tongue for signs of nutritional deficiencies or more serious signs of cancer. The tongue is an important determinant of health in medical practices from around the world too. In traditional Chinese medicine, practitioners place emphasis on the tongue for diagnostic evaluations, believing that the tongue actually reflects all the diseases of the body. Visit the UCLA Center for East-West Medicine to learn more about tongue diagnosis’s role in traditional Chinese medicine.


What Traditional Chinese Medicine Has to Say

In traditional Chinese medicine, the tongue is a very indicative organ. It is seen as a “map” of the internal body. Its surface is divided into five-element zones: fire, wood, metal, earth, and water that correspond to one’s internal organ networks.

1. The tip 

Fire element, which corresponds to the heart/small intestine network

2. The sides

Wood element, which corresponds to the liver network

3. Behind the tip

Metal element, which corresponds to the respiratory-immune network

4. The center

Earth element, which corresponds to the stomach-spleen-pancreas network

5. The back

Water element, which corresponds to the kidney-bladder-hormonal network

Because it contains water, electrolytes, mucus, and enzymes, the tongue’s appearance is said to change with many physical changes in the body [1].

illustration by KARIN YUEN


Tongue Color


A deviation from normal pink to a darker red or purple indicates increasing heat in the body. In traditional Chinese medicine, heat may mean inflammation, infection, hyperactivity of the organ network or blood stasis. The color of the tongue may appear darker in different parts of the tongue relating to various organs in the body. For example, deep colored spots in the liver zone point to stagnation in the liver network, most commonly a serious issue of liver cirrhosis or cancer [1].


A deviation from normal pink to a pale or paper white indicates a “cold symptom,” which can mean anemia, a sign of infection, or low energy and can give information as to the function of the corresponding organ network [1].


Tongue Coating

A coating that is too thick is a sign of imbalance in the digestive system and decreased     immune system.

A yellow coating signifies a pathogenic factor or inflammation in the body.

A peeling coat is usually a sign of damage or weakening to certain systems of the body.

The appearance of numerous distinctly red prickles on the tip of the tongue coupled with a red tongue and thick yellow/white coating has been found to indicate appendicitis [2].

illustration by KARIN YUEN


Regardless of which practice a person ascribes to, both Western medicine and traditional Chinese medicine agree that a healthy tongue shares these four qualities:

  1. Pink or light red in color
  2. Smooth in texture with raised papillae (the visible bumps on the tongue in which taste buds are embedded) 
  3. Proportionate in size (not inflamed or swollen), with a
  4. Thin, clear-white coating [3].

Anything out of the normal range for these four characteristics could indicate something wrong with your overall health. Here are a few distinct case examples.

“Fiery, Beefy, Red”

Color: Very Red

Texture: Shiny and Smooth, or “Bald” (missing normal papillae)

Size: Swollen with Painful Burning Sensation

Coating: Normal

This combination of appearances indicates a nutritional deficiency, most likely of the vitamin B12. B-vitamin deficiencies often manifest themselves as a type of oral condition known as “glossitis” whose symptoms vary, but include the tongue’s: loss of papillae, change of color, swelling, burning or pain. In the case of B12 deficiency, these are the specific symptoms of glossitis, often described as “fiery, beefy, and red” [4].

“Smooth, Tender, Pale”

Color: Pale

Texture: Shiny and Smooth, or “Bald” (missing normal papillae)

Size: Normal

Coating: Normal

These symptoms point to glossitis caused by iron deficiency anemia. In this case, the lack of hemoglobin in the blood gives the tongue its pallor. Other symptoms of anemia-induced glossitis may include oral ulcerations, burning, and lesions [5].

“Pasty, Patchy, White”

Color: Normal

Texture: Normal with Patchy Lesions

Size: Normal

Coating: Thick, Pasty, White

When the tongue looks white and pasty—in patches or in its entirety—it’s an indication that there’s probably some sort of infection present on the tongue, such as an overgrowth or an autoimmune-related inflammatory disease. One possible cause is thrush, which is an overgrowth of the fungus Candida (or yeast). Thrush can occur as a result of long-term or high dose antibiotic use, during which the healthy bacteria that help keep Candida from growing too much under normal circumstances are eliminated [6].

If thrush is not the cause of a patchy, white tongue, the answer may be leukoplakia, a reaction to chronic irritation of the mucus membranes of the mouth. Among the causes of this chronic irritation are rough teeth or dental devices that rub against the cheek and gum, chronic smoking and general tobacco use. Leukoplakia is usually harmless, however it can be an early signifier of oral cancer [7].

“Pasty, Smelly, Yellow”

Color: Normal

Texture: Bumpy/Normal

Size: Normal

Coating: Pasty, Yellow

A tongue with a pasty, yellow coating could indicate signs of bacteria, which produce hydrogen sulfide and cause halitosis [8], or bad breath. It is the type of bacteria and not the amount of bacteria that link the yellow coating to halitosis. According to a 2003 article published in the Journal of Clinical Microbiology, Solobacterium moorei, Eubacterium sulci, and Atopobium parvulum are the most probable culprits of bad breath when present on the tongue, while tongue coatings with Streptococcus salivarius and Rothia mucilaginosa present did not cause halitosis [9]. If you want to learn more about how to conquer bad breath, check out “Hocus Pocus Halitosis” in our Issue 3, Volume 13.  

“Black Hairy Tongue”

Color: Normal

Texture: Black, “Hairy”

Size: Normal

Coating: Brown, Yellow

"Black Hairy Tongue" is a harmless, temporary, but unsightly overgrowth of tongue papillae that traps bacteria and other debris to create the appearance of black “hair.” The cause of this tongue condition could be anything from poor oral hygiene, mouth-breathing, excessive use of tobacco, mouthwashes, some antibiotics, or bismuth-based medications. Along with the appearance change, sufferers of black hairy tongue might notice a metallic taste in the mouth and generally bad breath [10].

“Strawberry Tongue”

Color: Dark Red

Texture: Bumpy with enlarged papillae

Size: Normal or Swollen

Coating: White or None

These symptoms are indicative of “Strawberry Tongue,” which can either appear as “White Strawberry Tongue” (with a  or “Red Strawberry Tongue” (note to design: include images).  “Strawberry Tongue” is another type of glossitis which occurs as a result of toxic shock syndrome (a staph infection that can affect anyone, but is commonly associated with tampon use in menstruating women)[11], scarlet fever (a strep infection commonly affecting children ages 5 to 12)[12], or kawasaki disease (an auto-immune disorder most common in children under 5)[13].


Bottom line

The external appearance of your tongue is a little-known indicator of the state of one’s internal health. The conditions described demonstrate how a combination of features can reveal different conditions, ranging from harmless to serious. Whether it’s through the techniques of Western medicine or traditional Chinese medicine, examine your tongue regularly to check for signs of ailment and upkeep your self-care!


Winter 2014 | Vol. 14 | Issue 2


  1. “Tongue Inspection: How’s Your Health?” acupuncture.com. (2010).
  2. “Tongue image analysis for appendicitis diagnosis.” Inf Sci. (2005).
  3. “Integrating next-generation sequencing and traditional tongue diagnosis to determine tongue coating microbiome.” Sci Rep. (2012).
  4. “The Clinical Features of Chronic Vitamin Deficiency.” Geront clin. (1986).
  5. “Glossitis.” nlm.nih.gov. (2013).
  6. “Thrush.” nlm.nih.gov. (2012).
  7. “Leukoplakia.” nlm.nih.gov. (2011).
  8. “Hydrogen sulfide-producing bacteria in tongue biofilm and their relationship with oral malodour.” J Med Microbiol. (2005).
  9. “Diversity of Bacterial Populations on the Tongue Dorsa of Patients with Halitosis and Healthy Patients.” J Clin Microbiol. (2003).
  10. “Black, hairy tongue.” mayoclinic.com. (2011).
  11. “Prolonged use of a diaphragm and toxic shock.” Fertil Steril. (1982).
  12. “Scarlet Fever: A Group A Streptococcal Infection.” cdc.gov. (2013).
  13. “Kawasaki Disease.” nlm.nih.gov. (2013).