经曰∶南方生热，热生火，火生心，心生舌，在窍为舌。又曰∶心气通于舌，心和则舌能知五味矣。陈
飞霞曰∶夫舌为心之苗，胃之根。小儿多生舌病，以心脾之积热也。故有重舌、木舌、弄舌、舌胎等证，宜辨其
虚实而治之。重舌者，心脾有热。盖脾之大络，出于舌下，有热则气血俱盛，附舌根下，忽重生一舌，面短小。
内服沆瀣丹，外以针刺去其恶血，以碧血散，竹沥调匀敷之。弄舌者，脾脏虚热，令舌络紧，时时舔舌，俗人称为
蛇丝惊者是也。切勿以寒凉攻下治之，少与泻黄散，服之不效，四君子汤。或渴欲饮水，面无红赤色，此脾胃津
液不足，不可误认为热，宜七味白术散。面黄肌瘦，胸心烦热而弄舌者，此疳证也。须从疳证门参考，宜集圣丸。
大病后精神困惫，饮食少思，而弄舌者，凶候。盖气血两亏、精神脱却，速以十全大补汤挽救之。舌上黑苔，
其热已剧，急以薄荷煎汤洗之。如舌转红色者可治，凉膈散下之。洗之不红者，不治。泄泻后舌上白胎，此津液不
荣，不能上潮于口，为虚热也，理中汤。
《集成》沆瀣丹（见前伤湿方内）
碧雪散（见前口疮方内）
七味白术散（见前泄泻方内）
泻黄散（见前口疮方内）
六君子汤（见前咳嗽方内）
集圣散（见前疳症方内）
十全大补汤（见前头项方内）
凉膈散 治心脾有热，舌上黑苔者。
连翘（一钱） 栀仁（六分） 大黄（五分） 薄荷（一钱） 黄芩（六分） 芒硝（五分） 甘草（四分）
竹叶（七片）
灯心（十茎） 水煎服，加生蜜十匙对服。
理中汤（见前泄泻方内）
涂蔚生曰∶舌上黑苔，必须干燥无津液者，方可断为其热已剧。若舌上虽为黑苔，而有津液油润者，犹是阴
寒至极，外见假热之色。此等精微，未可忽视者也。
The *Yellow Emperor's Inner Canon* states: The South generates heat; heat generates fire; fire corresponds to the Heart; the Heart manifests in the tongue, and among the orifices, it is represented by the tongue. It also states: The Qi of the Heart connects with the tongue; when the Heart Qi is harmonious, the tongue can discern the five flavors. Chen Feixia stated: The tongue is the sprout of the Heart and the root of the Stomach. Children are prone to tongue diseases due to accumulated heat in the Heart and Spleen. Therefore, conditions such as double tongue (Chongshe), wooden tongue (Mushe), protruding tongue (Nongshe), and tongue coating (Shetai) may occur, and treatment should be based on distinguishing deficiency and excess.
Double tongue (Chongshe) results from heat in the Heart and Spleen. The large collateral vessels of the Spleen emerge from under the tongue. When heat is present, both Qi and Blood become hyperactive and attach beneath the root of the tongue, suddenly forming a smaller secondary tongue attached below the main one. Internally administer Huangxie Dan (Huangxie Pill); externally, puncture with a needle to release bad blood, then apply Bixue San (Bixue Powder) mixed with bamboo juice (Zhuli).
Protruding tongue (Nongshe) is caused by deficient heat in the Spleen, leading to tension in the tongue meridians, causing the tongue to frequently protrude and lick the lips. This is commonly known as "snake-thread fright" (She Si Jing). Do not treat with cold and purgative methods. Administer small amounts of Xiehuang San (Xiehuang Powder). If ineffective, switch to Sijunzi Tang (Four Gentlemen Decoction). If there is thirst with desire to drink water, but the face lacks redness, this indicates insufficient fluids of the Spleen and Stomach and should not be mistaken for excess heat; Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is appropriate. If the complexion is sallow, the body is emaciated, the chest is vexed and hot, and the tongue protrudes, this is Gan syndrome (Pediatric malnutrition syndrome). Refer to the Gan syndrome section for reference; Jisheng Wan (Jisheng Pill) is indicated. After a severe illness, if the spirit is exhausted, appetite is poor, and the tongue protrudes, this is an ominous sign indicating depletion of both Qi and Blood and dissipation of the Spirit. Immediately rescue with Shiquan Dabu Tang (Perfect Ten Tonifying Decoction).
If black coating appears on the tongue, the heat pathogen is extreme. Urgently wash the tongue with decoction of Bohe (Menthae Haplocalycis Herba). If the tongue turns red, it is treatable; administer Liangge San (Liangge Powder) to purge heat. If washing does not restore redness, it is untreatable. After diarrhea, if white coating appears on the tongue, this indicates that fluids fail to nourish and cannot ascend to moisten the mouth, constituting deficient heat; Lizhong Tang (Regulate the Middle Decoction) is used.
*Jicheng* records the following formulas:
Huangxie Dan (See previous entry on injury by dampness)
Bixue San (See previous entry on mouth sores)
Qiwei Baizhu San (See previous entry on diarrhea)
Xiehuang San (See previous entry on mouth sores)
Liujunzi Tang (See previous entry on cough)
Jisheng Wan (See previous entry on Gan syndrome)
Shiquan Dabu Tang (See previous entry on head and neck disorders)
Liangge San: Treats heat in the Heart and Spleen with black coating on the tongue.
Qiaoshao (Forsythiae Fructus) 1 qian, Zhiren (Gardeniae Semen) 6 fen, Dahuang (Rhei Radix et Rhizoma) 5 fen, Bohe (Menthae Haplocalycis Herba) 1 qian, Huangqin (Scutellariae Radix) 6 fen, Mangxiao (Natrii Sulfas) 5 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 4 fen, Zhuye (Phyllostachidis Folium) 7 leaves, Dengxincao (Junci Medullae) 10 stems. Decoct in water and take orally. Add 10 spoons of raw honey to mix and take together.
Lizhong Tang (See previous entry on diarrhea)
Tu Weisheng stated: Black coating on the tongue must be dry and devoid of fluids to be diagnosed as extreme heat. If the tongue has black coating but is moist and oily with fluids, it still indicates extreme Yin-cold with false heat appearing on the exterior. Such subtle distinctions must not be overlooked.