Abstract:Objective To explore the correlation between health behaviors and characteristics of tongue manifestations in Traditional Chinese Medicine（TCM）among young students，and to provide a reference for health promotion of young people. Methods A cross - sectional survey was conducted among healthy young students aged 17 - 22 from Anhui College of Traditional Chinese Medicine（2023 - 2024 enrollment）. Questionnaires were used to investigate and assess the students' tongue manifestations（tongue color，tongue shape）and health behaviors（physical exercise，dietary habits，sleep routines，etc.）. Univariate analysis and multivariate logistic regression analysis were applied to explore the independent associations between various health behaviors and tongue characteristics. Results A total of 373 students were included in the survey. Among them，a light red tongue was the most frequently identified tongue color， accounting for 74.2%（277/373），followed by pale tongue，red tongue，and bluish-purple tongue. Thin white tongue coating was predominant（312 cases，83.6%）. Among abnormal tongue shapes，enlarged tongue had the highest detection rate（35.1%，131/373），followed by teeth-marked tongue，petechiae/ecchymosis tongue，and fissured tongue. Multivariate logistic regression analysis indicated that being male was a protective factor against pale tongue（OR =0.151，95%CI ：0.042-0.537），while lower frequencies of physical exercise（'never'or'sometimes'）were risk factors for the appearance of red tongue（OR = 14.609，12.565）；and a preference for salty food was a protective factor against teeth-marked tongue （OR =0.456，95%CI ：0.241-0. 865）；being male was a protective factor against petechiae/ecchymosis tongue（OR = 0.283，95%CI ：0.097-0. 824），while screen time of 3-5 hours was a risk factor for petechiae/ecchymosis tongue（OR = 8.669，95%CI ：1.042-72. 141）. Conclusion Regular physical exercise has a positive significance for maintaining normal tongue manifestations in young students. Tongue manifestations show significant gender differences in young students. The relationship between dietary preferences and specific tongue signs may be complex， requiring consideration of organismal adaptability and confounding factors. Advocating regular exercise combined with personalized health guidance tailored to gender differences can help improve suboptimal health status among young students.