Congo red (CR) is the most popular dye used as a probe for diagnosing amyloidosis, a very heterogeneous group of diseases with more than 23 chemically different amyloid syndromes of men and animals, leading to more than 400 different individual diseases. Congo red binding increases the natural anisotropy of amyloid, indicating that the elongated and planar CR molecules are aligned parallel to the axis of the amyloid α fi brila and to each other, thereby revealing a structure of amyloid. This structure was established to represent fi brils of similar dimensions, although the amyloid fi brils can be composed of many unrelated proteins. This CR-induced (positive) anisotropy displaying a green color is the hallmark of all amyloids, and is therefore used in the diagnosis of amyloidosis. The specifi city of this criterion, however, is based on very stringent conditions of staining and evaluation. This review will focus on the understanding of the CR staining procedure, its mechanism and, in particular, on its recent practical improvements by increasing the sensitivity of the CR procedure, so that minute and the earliest amyloid deposits in the course of amyloidosis can now be reliably detected in patients. This enables a very early diagnosis in the course of the disease before irreversible organ damage might have occurred, and widens the options for a successful therapy. In addition, the central role of the CR diagnostic procedure and evasion of common pitfalls in arriving at a pathogenetically exact classifi cation must only be based on the chemical nature of the amyloid deposits and not on the soluble precursors of the many different amyloidoses will be highlighted. The proposed bench-tobedside algorithm will enable the physician to arrive at the exact diagnosis for therapeutic considerations. Finally, some possible future applications of CR and analogues will be presented.