Objective To investigate the relationship between the clinical features and tongue manifestations of corona virus disease 2019（COVID-19）cases.Methods The symptoms,signs,laboratory examinations and imaging examinations of 40 COVID-19 patients together with tongue manifestations were analyzed.Results（1）Tongue manifestations: among 40 cases,all cases（100%）had red tongue,among which 19 cases（47.5%）had dark red tongue.There were 5 cases（12.5%）with little tongue coating,27 cases（67.5%）with white and sticky tongue coating,and 8 cases（20.0%）with yellow and sticky tongue coating.（2）Clinical manifestations: among the 40 patients,27 cases（67.5%）had fever,among them,18 cases（45.0%）had low fever（37.3-37.9℃）,8 cases（20.0%）had moderate fever（38-38.9℃）,and 1 cases（2.5%）had high fever（≥39℃）.There were 25 cases of cough（62.5%）,13 cases of fatigue（32.5%）,6 cases of pharyngeal pain（15.0%）,12 cases of muscle pain（30.0%）,and 2 cases of diarrhea（5.0%）.Those with red tongue with little tongue coating were milder,with only cough,pharyngeal pain,fatigue and so on,and pharyngeal pain were more common in those with thick and greasy tongue coating,the difference was statistically significant（P,<,0.05）.The patients with white greasy and yellow greasy coating on the tongue were mainly characterized by cough and fever,among which the patients with white greasy coating on the tongue were mainly characterized by low fever,while the patients with yellow greasy coating on the tongue mostly had medium and high fever above 38℃,the difference was statistically significant（P,<,0.05）.（3）Imaging findings: chest X-ray showed that among 40 cases,13 cases had bilateral pulmonary inflammation（32.5%）,18 cases（45.0%）had unilateral pulmonary inflammation,including 7 cases（17.5%）of left pneumonia and 11 cases（27.5%）of right pulmonary inflammation,the remaining 9 cases（22.5%）showed no significant abnormality on chest X-ray examination.Most of the patients with red tongue with little tongue coating showed no abnormality in the imaging examination,and the chest X-ray indicated that the pulmonary inflammation was mostly those with thick and greasy coating on the tongue,among which bilateral sides of pneumonia was more common in those with red tongue with yellow greasy coating,the difference was statistically significant（P,<,0.05）.（4）Laboratory examination: the white blood cell count of 40 cases was（5.17±1.55）×10,9,/L,among which 3 cases were abnormally decreased（7.5%）.The lymphocyte count was（1.39±0.75）×10,9,/L,among which 8 cases（20.0%）were abnormally decreased.With the change of thickness and stickiness of tongue coating,the number of white blood cells increased gradually,while the number of lymphocytes decreased gradually,the difference was statistically significant（P,<,0.05）.Conclusion COVID-19 patients with red tongue and little coating were more seen at the early stage with short course of disease（1-2 d）,and milder symptoms,along with the progression（course of 3 d or more）,the tongue coating become more in some patients,characterized by thick greasy coating,and the clinical manifestations are manifested by cough and fever,reflecting the progress of the infection,therefore,to sum up the therapeutic principle for the COVID-19 cases is heat clearing,lung dispersing and removing dampness without overuse too bitter cold herbal drugs.