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Classical texts state: The tongue is the sprout of the Heart, which refers to its orifice aspect. From the perspective of body parts, all five Zang organs have their respective associations; from the perspective of symptoms, all five Zang organs have their respective dominances.

If the tongue is dry with cracks, it indicates deficiency heat due to Yin and Blood deficiency. If there is sore throat and sores on the tongue, dry mouth, hot feet, and worsening symptoms in the afternoon (Shen hour), it indicates deficient fire of the Kidney Meridian. If there are cold limbs, aversion to cold, poor appetite, or excessive phlegm with red eyes, it indicates decline of the Fire of the Gate of Vitality (Mingmen). If there is fever with thirst, preference for cold drinks, and constipation, it indicates excess fire of the Stomach and Intestines. If there is fever with aversion to cold, dry mouth but preference for hot drinks, reduced food intake, and physical fatigue, it indicates deficient heat of the Spleen Meridian. If the tongue body is stiff, with swelling and pain in the cheeks and jaw, it indicates damp-heat of the Spleen Meridian. If there is excessive phlegm with thirst, and swelling and pain in the mouth and tongue, it indicates heat in the Upper Jiao. If excessive thinking leads to sores in the mouth and tongue, and discomfort in the throat, it indicates damage to Spleen blood with stirring up of deficient fire. If excessive anger leads to alternating chills and fever, bitter taste in the mouth, and swelling and pain of the tongue, it indicates damage to Liver blood with stirring up of deficient fire. Etiologies are diverse; treatment should be adapted to the specific situation. For severe tongue swelling, one should first puncture the tip of the tongue, or the surface, or the sides, to bleed and release toxins, thereby addressing the emergency. However, for the Lianquan acupoint under the tongue, which belongs to the Kidney Meridian, although bleeding is suitable, needle insertion is strictly prohibited; caution is advised.

Clinical Cases

Xu Jianzhai, an official in the Ministry of Works, suffered from sores in the mouth and tongue, preferred cold foods and drinks, sometimes had a sore throat, and experienced constipation. This was an excess heat syndrome. It was treated with Qingliang Yin (Cooling Drink Decoction).

Zhong, a Censor, suffered from tongue pain due to excessive thinking. After taking bitter-cold herbs to clear fire, he developed fever, hematochezia, night sweats, dry mouth, and emaciation of the limbs. This was heat due to Qi deficiency of the Spleen and Blood deficiency. It was cured with Jiawei Guipi Tang (Modified Gui Pi Decoction).

A man who neglected abstinence from alcohol and sex, and liked drinking cold water in winter, suffered from frequent tongue pain, frequent urination, cracked tongue, and excessive phlegm. This was exhaustion of Kidney Water with uncontrolled Yin fire, named Xia Xiao (Lower Wasting-Thirst).

If the Guan pulse is surging, rapid, and forceful, with preference for cold drinks, yellow urine, and hard stool with spontaneous sweating, it is named Zhong Xiao (Middle Wasting-Thirst), treated with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) to purge.

Wu Beichuan, an Academician, drank excessively, resulting in a stiff and painful tongue, unclear speech, surging phlegm-Qi, and limb paralysis. I treated it as damp-phlegm of the Spleen Meridian, and he recovered.

Zheng, an official in the Court of Judicature and Revision, drank excessively, resulting in a stiff and swollen tongue and unclear speech. This was Spleen deficiency with damp-heat. He was cured by using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shenqu (Massa Medicata Fermentata), Maiya (Fructus Hordei Germinatus), Gegen (Puerariae Radix), and Zexie (Alismatis Rhizoma).

A person accustomed to rich and greasy food suffered from tongue pain. After applying and ingesting detoxifying medicines, the tongue swelling became urgent. I punctured the tip and both sides of the tongue, releasing about one cup of purple blood, reducing the swelling slightly. Then, one dose of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) was taken. The next morning, the swelling recurred. Puncture again released about one cup of purple blood, reducing the swelling slightly. Continuing with the previous decoction, after a long time, the tongue swelled greatly again. Puncture released about two cups of black blood, and the swelling gradually subsided. Suddenly, chills, fever, vomiting, headache, and dizziness occurred, with a surging, floating, and rapid pulse. This indicated that although the pathogen was gone, the True Qi was further damaged. Buzhong Yiqi Tang was administered with doubled doses of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). After four doses, he stabilized, and after several more doses, he recovered.

A woman prone to anger suffered from tongue pain and irritability. After taking herbs to clear fire and resolve phlegm, the previous symptoms worsened, with distension in the hypochondrium. After taking Liqi Yin (Flowing Qi Decoction), abdominal distension occurred, and menstruation did not stop. This was Liver deficiency failing to store Blood and Spleen deficiency failing to control Blood. She was cured by Jiawei Guipi Tang added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus). If the previous symptoms were caused by sudden anger, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus) was used. For Blood deficiency, Bazhen Tang (Eight Treasure Decoction) added with Renshen, Baizhu, Chaihu (Bupleuri Radix), Zhizi, and Mudanpi was used. For severe deficiency, Pao Fuzi (Prepared Aconiti Lateralis Radix) should be added.

A man suffered from stiffness under the tongue, numbness of the thumb and index finger, or constipation, or red halos on the skin. This was Wind-Heat due to Blood deficiency of the Large Intestine. He was cured by Xiaoyao San (Free and Easy Wanderer Powder) added with Huaijiao (Sophorae Tonkinensis Fructus) and Qinjiao (Gentianae Macrophyllae Radix).

A woman suffered from a brain carbuncle in winter, with swelling, pain, fever, and thirst, and a surging, rapid, and full pulse. I used Qingre Xiaodu San (Clear Heat and Detoxify Powder), leading to suppuration and recovery. In March of the following year, her tongue swelled, and she developed numerous purple ding (carbuncles) like grapes all over her body, especially on the hands and feet. Black blood was pricked out from each. Seven pills of Mingdan (Life-Saving Pill) were taken, resulting in foul-smelling sweat. The carbuncle heat worsened, and she was constipated for two days. Da Huang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma) were given at 3 qian each, along with Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Zhizi, Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructus) at 2 qian each, and Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) at 1 qian. Decocted in water and boiled for three to five boils, large and small amounts of foul-smelling blood were excreted via urine and stool. The lower body symptoms subsided slightly. Then, Xijiao juice (Rhinoceros Horn Juice) was ground in and taken again. Foul-smelling blood was exuded from the root of the tongue and gum margins, and various toxins were eliminated. Finally, Xijiao Dihuang Tang was administered, leading to recovery.

A woman prone to anger suffered from a stiff tongue root and numb arms. I said: The tongue root belongs to Spleen Earth, and this is due to suppression by Liver Wood. It was treated with Liu Junzi Tang (Six Gentlemen Decoction) added with Chaihu and Shaoyao (Paeoniae Radix Alba), leading to recovery.

My elder brother suffered from erosion of the mouth and tongue, with phlegm-saliva obstructing upwards, normal diet, and nearly falling when encountering strong winds. Buzhong Yiqi Tang and Bawei Wan (Eight Flavor Pill) were used, leading to recovery. When medication was interrupted for a few days, symptoms recurred. Every time he worked hard, he had excessive phlegm and red eyes. Rinsing with cold water provided slight relief, but soon the tongue condition worsened. Holding a slice of Fuzi (Prepared Aconiti Lateralis Radix) in the mouth provided immediate relief. Only after taking the previous two medicines did all symptoms fully recover.