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The tongue is the manifestation of the Heart, and the Spleen meridian connects to the tongue. When heat exists in both meridians without an outlet, it manifests on the tongue. If the lingual frenulum is slightly tight and the tongue protrudes intermittently, it is called "protruding tongue" (Nong She). A small structure resembling a tongue but smaller, growing under the tongue near its root, is called "double tongue" (Chong She). When the tongue gradually swells and fills the mouth, it is called "wooden tongue" (Mu She). [Zeng] All these conditions result from extreme heat affecting the Spleen, Heart, and Liver. Double tongue, wooden tongue, as well as "yellow tongue" and "goat's mouth," though named differently, are all caused by heat. Generally, double tongue arises below the tongue, protruding like a small tongue. The Spleen collateral connects to the sides of the tongue, the Liver collateral connects to the root of the tongue, and the Heart collateral also connects to the root. If these three meridians are invaded by damp-heat, wind-cold, or other pathogens, the tongue may curl up, extend long, or become swollen and full. Treatment should primarily employ Xiaohuang San (Coptis Decoction) and Lv Pao San (Green Robe Powder), along with Danggui San (Angelica Decoction) and Qianghuo San (Notopterygium Decoction).
Danggui San (for fever) Qianghuo San (for fever)

[Qian Yi] Protruding tongue is caused by slight heat in the Spleen organ, making the lingual frenulum tight and causing intermittent protrusion. Do not use cold medicines or purgatives; instead, administer Xiehuang San (Spleen Heat-Purging Decoction) in small doses gradually. [Tian] For robust children, Niuhuang San (Calculus Bovis Decoction) may be used. If the child desires water, and the physician mistakenly assumes heat and uses cold purgatives, this is incorrect. Thirst indicates insufficient fluids in the Spleen and Stomach. Combined with sallow complexion, emaciation, and five-palm heat, it constitutes "infantile malnutrition" (Gan Ji), and herbs such as Huhuanglian (Coptidis Rhizoma) should be added. If protruding tongue appears after medication during a severe illness, the prognosis is ominous. [Xue Ji] When a child's tongue protrudes slightly and immediately retracts, it is called "protruding tongue," attributed to deficiency and damage of the Heart and Spleen; treat with Wenpi San (Spleen-Warming Decoction). When the tongue extends for a long time without retracting, it is called "prolapsed tongue" (Tu She), caused by accumulated heat in the Heart and Spleen; treat with Xiehuang San. If accompanied by oral ulcers and thirst for cold drinks, it indicates excess heat in the Stomach meridian, treated with the aforementioned powders. Thirst for hot drinks indicates deficient heat in the Stomach meridian; treat with Sijunzi Tang (Four Gentlemen Decoction). Poor appetite with thirst or loose stools indicates Spleen and Stomach weakness; treat with Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Decoction). Drooling at the corners of the mouth or swelling of the cheeks indicates deficient Stomach with wind-heat; first use Renshen Anwei San (Ginseng Stomach-Calming Decoction), followed by Qiwei Baizhu San. Symptoms worsening in the afternoon indicate Spleen blood deficiency; use Siwu Tang (Four Substances Decoction) plus Renshen, Baizhu, and Fuling. If ineffective, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and assess the overcoming relationships among the Five Zang organs. If caused by malnutrition-related emaciation, refer to the chapters on various types of Gan Ji.
Xiehuang San (for Spleen) Wenpi San (for abdominal distension) Baizhu San (for thirst) Renshen Anwei San (for Spleen) Siwu Tang (for hemorrhage) Buzhong Yiqi Tang (for emaciation)