Objective: To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease (CHD) according to the acute cardiovascular events (ACEs) in one-year follow-up which based on the pathogenesis hypothesis of "blood-stasis and toxin causing catastrophe". Methods: Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2:1 according to the gender, age (+/- 2.5 years), diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared. Results: Fifteen cases manifested with bluish tongue (including bluish-grounding or bluish purple tongue), among which 11 cases (37.9%) in the ACEs group and four cases (7.4%) in the non-ACEs group, and there was significant difference (P < 0.002). Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group (48.1 vs. 10.3%, P=0.001). The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group (66.7% vs. 41.4%, P=0.026). The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group (41.4% vs. 20.4%, P=0.041). Odd ratio (OR) analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one-year follow-up (OR: 11.67, 95%CI: 3.34-40.81, P < 0.001; OR: 2.76, 95%CI: 1.02-7.44, P < 0.05; OR: 3.12, 95%, CI: 0.89-10.92, P=0.066). Conclusions: The bluish tongue (including bluish-grounding or bluish purple tongue) and purplish-red sublingual vessel were potential tongue manifestations of blood-stasis and toxin. The tongue coating changing from sticky greasy to dry greasy or dirty greasy was also probably a tongue manifestation of "transforming toxin", which need demonstration by further study.