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The tongue is the sprout of the Heart. The Spleen meridian connects to the root of the tongue and scatters beneath it. The Kidney meridian flanks the root of the tongue. The Bladder and Sanjiao (Triple Burner) sinews both knot at the root of the tongue. The Liver meridian links to the root of the tongue.

Tongue coating is discussed in detail under the section "Four Diagnostic Methods: Inspecting the Tongue." Lingnu (bleeding from the tongue) is detailed under the "Blood" category. Swelling and pain of the tongue, where swelling beneath the tongue resembles a newly formed small tongue, is named Chongshe (double tongue). If the tongue is swollen, hard, and inflexible, it is named Mushe (wooden tongue). These conditions are all caused by accumulated heat in the Heart, Spleen, and Stomach meridians. Treatments include Liangge San (Cool the Diaphragm Powder), Zhizi Jinhua Tang (Gardenia Golden Flower Decoction), and Xuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction). In cases with abundant phlegm due to heat, Qingre Huatan Tang (Clear Heat and Resolve Phlegm Decoction) is used. For external treatment of Chongshe, apply mulberry bark (Sangbai), silkworm (Jiangcan), and hair ash mixed with vinegar to the sublingual area; blowing Jin Dan (Golden Pill) into the lesion is even more effective. Internal medications include Coptidis Rhizoma (Huanglian), Cornu Rhinocerotis (Xijiao), Gardeniae Fructus (Shanzhi), Moutan Cortex (Danpi), Rehmanniae Radix (Shengdi), Akebia Caulis (Mutong), Paeoniae Radix Rubra (Chishao), Ophiopogonis Radix (Maidong), Forsythiae Fructus (Lianqiao), and Glycyrrhizae Radix et Rhizoma (Sheng Gancao). If Mushe is severely swollen with a color resembling pig liver and causing fullness and blockage in the mouth, prick the tip or sides of the tongue first to bleed. Then inspect if there are protrusions like mole crickets or silkworms under the tongue; if so, prick them to release purple blood. Moisten the area with cotton dipped in Licorice water, then apply finely ground Carbonis Herba (Baicaoshuang) mixed with vinegar to the upper and lower surfaces of the tongue, or mix equal parts with salt and well water (Jinghua Shui) for application. Generally, for tongue swelling, it is advisable to prick the tip, surface, or sides to induce bleeding. However, the Lianquan acupoint (Ren-23) beneath the tongue belongs to the Kidney meridian; pricking must be done cautiously to avoid excessive bleeding which may lead to aphonia. Note: Some cases of Mushe are painless, caused by phlegm-dampness overwhelming heat. There is also Ma She (numb tongue), caused by fire stirring up phlegm or by blood deficiency and qi stagnation; principles are detailed under the "Bi Syndrome" category. Tongue stiffness (She Jiang) occurs when tongue swelling leads to rigidity, i.e., the inability of Mushe to remain flexible. Niuhuang San (Calculus Bovis Powder) is used. Additionally, burn snake skin until carbonized but retaining its nature, mix equally with Scorpion (Quanxie), grind into fine powder, and apply. Stiffness can also result from phlegm-saliva obstructing the sinews, preventing movement (see Stroke category). It can also result from extreme heat drying blood, failing to nourish sinews, leading to spasms and stiffness (see Stroke category). Severe cases result in retraction. Tongue retraction is caused by extreme heat in the Liver meridian and blood depletion failing to nourish sinews. Direct transmission of cold pathogens to Yin meridians in Cold Damage diseases causes severe cold, drawing in sinews and causing retraction (see Cold Damage). However, the Classic states that when pathogens invade the collaterals of the Sanjiao, symptoms include throat obstruction, tongue retraction, dry mouth, and irritability. It also states that Large Intestine meridian pathology causes muscle twitching and tongue retraction. Thus, it is not limited to the Liver meridian alone, nor solely to Cold Damage patterns. For tongue stiffness and retraction caused by Wind-Cold-Dampness, Xiao Xuming Tang (Minor Continue Life Decoction) is used (see Stroke). If accompanied by heat, use Shengma Tang (Cimicifugae Decoction) with Platycodonis Radix (Jiegeng) for gargling, and Bixue (Green Snow) for external application. For tongue protrusion that cannot retract due to severe heat (protrusion and swelling share the same pathological basis of severe heat), apply Zhumo (Pearl End) and Borax (Bingpian) in equal parts externally. Internally, administer Scutellariae Radix (Huangqin), Bombyx Batryticatus (Jiangcan), Arisaematis Cum Bile (Danning), Linderae Radix (Wuyao), and Bamboo Sap (Zhuli) to resolve phlegm and clear heat. When Cold Damage heat-toxin attacks the Heart, or after recovery from Cold Damage due to improper care (common in Yin-Yang Exchange), or in cases of poisoning, great fright, or postpartum conditions, the tongue may protrude several inches. Use one Bean, Viciae Semen (Badou), remove oil to obtain frost, roll in paper twist, insert into nose; the tongue will naturally retract. This treats post-Cold Damage mismanagement. For postpartum cases, apply Cinnabar (Zhusha) powder to the tongue to simulate childbirth posture, have two women support the patient, then secretly stack pots outside the wall and knock them over to make noise; upon hearing the sound, the tongue retracts. Other methods include soaking the tongue in Rooster Comb Blood (Xiongji Guanxue) or Wintergreen Juice (Dongqing Nongzhi). Tongue laxity with salivation occurs when saliva flows from the Lianquan acupoint beneath the tongue, caused by excessive Kidney fire forcing fluids upward. Shen Gui Ziyin Wan (Divine Turtle Nourishing Yin Pill), Huanglian, Shanzhi, Huangbai, Zhuli, and Jiangzhi are applicable. Dry and cracked tongue is treated with Huafen San (Trichosanthis Radix Powder) and Xiexin Tang (Drain the Heart Decoction). Tongue ulcers are treated with Ganlu Yin (Sweet Dew Drink). Mouth and tongue ulcers with fatigue and poor appetite are treated with Qingre Buchi Tang (Clear Heat and Nourish Blood Decoction). If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Wuweizi. For excessive worry damaging blood and stirring fire, use Guipi Tang (Restore the Spleen Decoction) with Chaihu, Shanzhi, and Danpi. Sublingual blisters starting as one and increasing to seven or eight are named Lianzhu Gan (String Pearl Caries); use Kougan Yao (Mouth Ulcer Medicine).