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Zhang Sanxi stated: The Heart opens into the tongue. When Heart Fire is excessive, the tongue becomes dry or develops lesions. If the pulse is surging (Hong), full (Shi), and forceful, Huanglian Xiexin Tang (Coptis Decoction to Drain the Heart) should be modified and administered. If the right pulse is deficient and large, accompanied by fatigue in the four limbs, and oral ulcers fail to heal, this belongs to overexertion where deficiency fire flares upward; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be used. Pain and ulceration of the mouth, tongue, and lips are all due to blazing Heart Fire; Liangge San (Cooling the Diaphragm Powder) is indicated. For tongue ulcers caused by wind-heat, with dryness in the mouth and fissures on the tongue, Ganlu Yin (Sweet Dew Drink) is appropriate. For those who consume alcohol and rich, greasy foods, internal accumulation of heat is excessive, and phlegm-fullness obstructs the Upper Jiao, leading to tongue swelling; Liangge San should be used to purge the heat. However, this is only suitable for patients with a full, forceful pulse and robust constitution.

If the tongue is stiff and swollen like a pig bladder, pricking the major vessels on both sides of the tongue to release blood will resolve the condition immediately. Do not prick the center, as this may cause uncontrolled bleeding. This pathology is often unrecognized by patients; if treatment is delayed, death may ensue. In cases of tongue swelling, there is invariably a worm-like structure under the tongue with a head and tail. Cauterizing the head with a red-hot nail will eliminate it. If phlegm-heat obstructs the Upper Jiao and is compounded by Ministerial Fire, the disease progresses rapidly and becomes critical. If toxic factors knot beneath the tongue and generate an additional small tongue, it is named Zisheng Zhang (Child Tongue Swelling). If the tongue is merely swollen and stiff without an additional small tongue, it is named Mushe Zhang (Wooden Tongue Swelling). Most such conditions are caused by phlegm-fire. Mild cases are treated with acrid-cooling herbs that regulate qi and transform phlegm; severe cases are resolved by bloodletting using a bi stone (Bian Shi).

Mental exertion and insomnia leading to oral lesions should be treated by calming the spirit and nourishing the Heart, diagnosed as Heart Qi Deficiency. The primary meridian of the Heart connects to the root of the tongue; the collateral meridians of the Spleen connect to the sides of the tongue; the Liver meridian connects to the root of the tongue; and the Shaoyin meridian also connects to the root of the tongue. If Wind-Cold injures the Heart and Spleen, causing aversion to cold and high fever, floating gums, and painful swollen tongue, Jinfeicao San (Boiling Water Herb Powder) can be used for gargling, swallowing half and spitting out half. This is an empirical formula. To treat massive tongue swelling blocking the mouth and preventing eating, use genuine Puhuang (Lygodii Spora) alone, frequently brushing it onto the tongue. In severe cases, add Ganjiang powder (Dried Ginger) as a counter-treatment. If oral medication is possible, use Chuanlian (Coptidis Rhizoma) alone, decocted into a concentrated liquid to be sipped slowly to drain Heart Fire. In severe cases, add Ganjiang (Dried Ginger) as a counter-treatment.

If there are orifices on the tongue with continuous bleeding, apply fried Huaihua powder (Sophorae Flos) to the tongue. For Zhongshe (Heavy Tongue), Sanhuang Wan (Three Yellows Pill) and raw Puhuang powder should be applied. If the tongue protrudes and cannot retract, it is due to extreme Heat in the Heart Meridian, or Heat-Toxin attacking the Heart in Shanghan (Cold Damage), or improper care after Shanghan. Pearl powder, Bingpian (Borneolum Syntheticum), and Renzhongbai (Calcinata Urinae Humanus) should be applied. For sudden tongue swelling, Baodoushuang (Croton Seed Frost) rolled in paper can be inserted into the nostril to cause the tongue to retract naturally. This utilizes the acrid and pungent nature to open orifices, dissipate fire, and guide toxins to disperse, similar to the method of applying patches to the fontanelle for pediatric mouth sores.

In healthy individuals, if thick black coating adheres to the tongue and cannot be wiped off, persisting for a long time, accompanied by a sweet taste in the mouth and foul breath, this indicates an abscess forming in the Stomach region. This is distinctly different from acute Shanghan diseases with excess pathogens in the Fu organs. It urgently requires Liangge San to purge via the bowels.