Objective:To observe the changes of tongue image parameters in patients with early non-small cell lung cancer(NSCLC) treated by Chinese herbal medicine(CHM) combined with chemotherapy. MethodsTotally 149 postoperative NSCLC patients with stage Ib-IIIa were randomly divided into two groups with 79 cases in the treatment group and 70 in the control group. Both groups were treated with chemotherapy after operation. Based on syndrome differentiation, the treatment group was also treated with CHM and the control group with placebo. Twenty-eight days was considered as one course of treatment,and the treatment consisted of 4 courses. Before the treatment and after the first, second, and third chemotherapy, tongue image data was collected by the TDA-1 small tongue imager to observe the change of tongue image.  Results:①After the first course of treatment, compared with the group before chemotherapy, there was no significant difference in tongue parameters in the treatment group (P> 0.05); the tongue coating index taiClrL taiClrR, taiClrG, taiClrB, taiClrI, and taiClrY increased (P<0.05), and the tongue quality index zhiClrY increased (P<0.05) in the control group. After the second course of treatment, compared with the group before chemotherapy, there was no significant difference in tongue parameters between the two groups (P> 0.05). After the third course of treatment, compared with the group before chemotherapy, there was no significant difference in tongue parameters in the treatment group (P> 0.05);the tongue quality index zhiClrL, zhiClrB, zhiClrG, zhiClrI and zhiClrY increased (P<0.05), and the values of zhiClrLa, zhiClrS decreased in the control group (P<0.05); the tongue coating indexes taiClrL, taiClrR, taiClrG, taiClrB, taiClrI, and taiClrY increased (P<0.05), and the values of taiClrLa and taiClrS decreased in the control group (P<0.05). ②Compared between groups after the first course of treatment, the values of taiClrLb and taiClrH in the treatment group were lower than those in the control group (P<0.05), and the values of zhiClrCb and taiClrCb were higher than those in the control group (P<0.05). There was no significant difference in tongue parameters between the groups after the second course and after the third course (P>0.05).③In the subgroup analysis of patients with qi deficiency syndrome, after the first course of treatment and compared with those before chemotherapy, the values of ZhiR and TaiR decreased in the treatment group (P<0.05),the values of taiClrL,TaiG, zhiClrB, zhiClrG, taiClrR, taiClrG, taiClrB, taiClrI and taiClrY increased (P<0.05), and the values of taiClrLa, ZhiR, TaiR, zhiClrS and taiClrS decreased in the control group (P<0.05); after the second course of treatment, there was no significant difference in tongue parameters in the treatment group compared with those before chemotherapy (P>0.05); in the control group, the values of ZhiGr and TaiG were higher than those before chemotherapy (P<0.05),and the values of zhiClrLa, taiClrLa, ZhiR, zhiClrS, zhiClrCr, and taiClrCr were lower than those before chemotherapy (P<0.05); after the third course of treatment, compared with those before chemotherapy, there was no significant difference in the parameters of tongue in the treatment group (P>0.05); after the third course of treatment, the values of zhiClrL,taiClrL,ZhiG,TaiG,zhiClrB, zhiClrR, zhiClrG, taiClrR, taiClrG, taiClrB, zhiClrI, taiClrI, zhiClrY and taiClrY increased (P<0.05), and the values of zhiClrLa, taiClrLa, ZhiR,TaiR, zhiClrS, taiClrS and taiClrCr decreased (P<0.05) in the control group .④In the subgroup analysis of the patients qi deficiency syndrome, the values of zhiClrL, zhiClrR, zhiClrI, zhiClrY, zhiCon, zhiENT, zhiMEAN, taiClrH, taiCon, taiENT and taiMEAN were lower (P<0.05), and zhiASM value was higher in the treatment group than in the control group after the first course of treatment (P<0.05); After the second course of treatment, the values of TaiG and taiClrH in the treatment group were lower than those of the control group (P<0.05),and taiClrLa value of the red tongue coating was higher than that of the control group (P<0.05); after the third course of treatment, the value of ZhiClrI was lower than that of the control group (P<0.05).  Conclusion:After chemotherapy, the tongue quality of early NSCLC patients became pale and purple and tongue coating thickened . The treatment based on traditional Chinese medicine (TCM) syndrome differentiation can increase the red component of tongue quality, reduce the brightness of tongue quality, and make tongue color change from light to light red, tongue quality, tongue coating texture become more delicate, tongue coating change from thick to thin.