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Luo Taiwu treated a patient whose neck was extended and the temporomandibular joint (TMJ) was dislocated, with the mouth open and unable to close. Luo gave him wine until he was heavily intoxicated, then blew powder of *Saposhnikovia divaricata* (Zaojiao, 皂角) into his nose while he slept. The resulting sneeze caused the jaw to automatically return to its proper position. (From *Yixue Gangmu*.)

Gong Zicai treated a patient who suffered a mandibular dislocation after shouting in anger; no matter how others tried to push it back, it would not stay. Gong had people pound *Vinegar Plum* (Wumei, 乌梅) into cakes and stuff them into both cheeks up to the end of the teeth where the jaw controls. As the patient opened his mouth and drooled, within moments the jaw could be easily pushed back into place by hand.

Zhang Sanxi treated a woman with a dislocated mandible. Ancient texts call this "dislocated golden hook." Her pulses in both hands were weak. He used Bazhen Tang (Eight Treasure Decoction) augmented with Shengma (Cimicifugae Rhizoma, 升麻) and Chaihu (Bupleuri Radix, 柴胡), resulting in a complete recovery. Manual reduction should be performed first; orthopedic practitioners should know this method.
Commentary: I once treated a patient who recovered using large doses of Shudi (Rehmanniae Radix Preparata, 熟地黄), Huangbai (Phellodendri Cortex, 黄柏), Gouqi (Lycii Fructus, 枸杞), and Longyanrou (Longan Aril, 龙眼肉).

Zihe Zheng treated an old man named Zhu from the south neighbor, aged over sixty, who had a persistent fever for several days. His tongue root swelled up, along with the tip, filling his entire mouth, twice the size of the original tongue. A surgeon pierced the sides of the tongue below the Lianquan acupoint (CV23, 廉泉) with red-hot needles, which worsened the condition, nearly leading to death. Zihe said, "When blood is excessive, it should be drained." He sharpened a needle to a fine point and lightly pricked the tongue to bleed, doing this eight or nine times a day, draining about one or two cups of blood. After three such sessions, the bleeding decreased, pain subsided, and swelling went down. The tongue is the external manifestation of the Heart; the Heart governs blood, so releasing blood leads to recovery. He further stated, "All pain, itching, sores, and ulcers belong to Heart Fire. What is the meaning of using red-hot needles and moxa?"

The Prince Consort of the Eldest Princess under Emperor Shun of Yuan contracted a strange disease after falling from a horse. Both pupils disappeared, and his tongue extended to his chest. Physicians did not know what to do. Nie Jier, Minister of Guanghui Si and a native of Yifanglekun, recognized the condition and cut off the protruding tongue. Soon, a new tongue grew, which was also cut off. He then cut away about one finger's width from both sides of the true tongue, applied medicine, and the patient recovered. (From *Chenggeng Lu*.)

Emperor Duzong of Song wanted to view flowers but suddenly woke up with his tongue swollen to fill his mouth. Imperial Physician Cai used equal parts of Puhuang (Typhae Pollen, 蒲黄) and Ganjiang (Zingiberis Rhizoma, 干姜) as dry powder applied topically, resulting in recovery. Since the tongue is the external manifestation of the Heart, and the Ministerial Fire of the Hand-Jueyin Pericardium acts as the minister to the Heart, Puhuang invigorates and cools blood. Combined with Ganjiang, this represents the mutual assistance of Yin and Yang. (This prescription originates from Zhiyin, based on *Bencao Gangmu*.)

*Xianchuan Waike* records: Someone accidentally held a knife in their mouth, cutting the tongue so it hung loose but was not completely severed. Another person wrapped the tongue in egg white skin, sprinkled hemostatic powder on the tongue root, mixed melted wax and honey into a paste, and applied it over the egg skin. After three days, it adhered, the skin was removed, and only frequent application of honey and wax was needed. Full recovery occurred in seven days. If there was no rapid effect, trauma medicines could be added. Egg white skin is used because it is soft, thin, protects the tongue, and allows drug permeation. (From *Bencao Gangmu*.)

Ling Hanzhang treated a man whose tongue protruded after illness. Ling's brother, also knowledgeable in medicine, said, "This is due to engaging in sexual activity too soon after illness. The tongue is the sprout of the Heart. Kidney Water is exhausted and cannot control Heart Fire. The disease is Yin deficiency. The relevant acupoint is on the left thigh in the Taiyang channel [Note: Text says 'Left股Taiyang', likely referring to specific points or a textual variant, interpreted here as lower limb related]. One should attack Yang with Yin." Ling said, "Correct." He needled that acupoint, but the tongue protrusion persisted. Ling said, "This shows knowledge of purging but not tonifying." After several doses of tonifying herbs, the tongue gradually returned to normal. (From *Mingshi*.)

He Shouyong treated General Lai, the Vanguard Commander, whose tongue root was swollen and could not retract. He said, "Heart Qi is extremely hot. If prolonged, death will result from inability to eat or drink." He cauterized the area with a heated drinking vessel. The swelling subsided, and subsequent decoction therapy led to immediate recovery. (From *Yunnan Tongzhi*.)

Gong Zicai treated a patient with a swollen tongue that protruded outside the gate. The tongue is the sprout of the Heart, and the Spleen meridians connect to the tongue root and scatter under the tongue. The heat should be attributed to the Heart and Spleen meridians, as the classics state, "Excessive heat causes swelling." He used *Ricinus communis* seeds (Bimaizi, 蓖麻子), shelled, pounded in paper until oil penetrated, made into a burning wick to smoke the affected area. Internally, he administered herbs to clear and drain Heat from the Heart and Spleen, resulting in recovery. (Essentially Yi Yuan San combined with Dao Chi San.)

Another patient had a blue-black tongue with prickles, indicating severe Heat. He found slight relief pressing his tongue against a dirt wall. This was caused by excessive worry and anger. A formula named Qingxin San (Clear Heart Powder) was prepared. It contained Chifuling (Poria Cocos with Red Skin, 赤茯苓), Zaoren (Ziziphi Spinosomi Semen, 枣仁), Maidong (Ophiopogonis Radix, 麦冬), Humaren (Hemsi Semen, 胡麻仁), and Huanglian (Coptidis Rhizoma, 黄连) each at 1 qian; Yuanzhi (Polygalae Radix, 远志) at 5 fen; Mutong (Akebiae Caulis, 木通) and Lianqiao (Forsythiae Fructus, 连翘) each at 8 fen; and Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) at 3 fen. Decocted in clear water.

A gourmet patient suffered from tongue swelling. Topical and internal anti-swelling drugs failed as the swelling intensified. Pricking the tongue tip and sides released a cup of purple blood, reducing swelling. At the second double-hour, two doses of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) were given, but swelling recurred the next morning. Pricking again released a cup of purple blood, reducing swelling slightly. Continuing the previous decoction, the tongue swelled greatly later. Pricking released two cups of black blood, and swelling gradually subsided. Suddenly, chills, fever, vomiting, headache, and dizziness appeared with a floating, surging, and rapid pulse. Although the pathogen was gone, the Healthy Qi was further damaged. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen (Ginseng Radix, 人参), Danggui (Angelicae Sinensis Radix, 当归), and Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) was given for four doses, stabilizing the condition, followed by several more doses for full recovery.

Official Zheng Qiu drank excessively, resulting in a stiff and swollen tongue root and unclear speech. This was Spleen deficiency with Damp-Heat. Bu Zhong Yi Qi Tang augmented with Shenqu (Medicated Leaven, 神曲), Maiya (Hordei Fructus Germinatus, 麦芽), Gegen (Puerariae Lobatae Radix, 干葛), and Zexie (Alismatis Rhizoma, 泽泻) resulted in recovery.

Chai Yuqing treated Manzu Shaonong Zhao Hui, an Inner Cabinet Reader serving in the Grand Council, who suffered from a swollen and painful double tongue (Chongshe). He asked, "You took Tongjing San to purge Fire, yet the illness persists. Why?" The patient replied, "Fire exists in various meridians; how can one treat indiscriminately without punishing the innocent? Fortunately, you are young, so no major harm has been done." The right Guan pulse was surging and solid, indicating extreme Stomach Fire. It was late evening. One dose of Qingwei San (Clear Stomach Powder) led to sudden recovery the next morning.

Xue Lizhai treated a woman who was prone to anger, suffering from tongue pain and irritability. Using herbs to descend Fire and resolve Phlegm worsened these symptoms and caused distension in the hypochondrium. Taking Liqi Yin (Flowing Qi Decoction) caused abdominal distension and continuous menstruation. This was Liver deficiency failing to store Blood and Spleen deficiency failing to control Blood, exacerbated by previous medications. Jiawei Guipi Tang (Modified Return to the Spleen Decoction) augmented with Wuweizi (Schisandrae Fructus, 五味子) resulted in recovery.

Academician Wu Beichuan drank excessively, causing Phlegm obstruction, a stiff tongue root. Taking herbs to descend Fire and resolve Phlegm worsened the Phlegm and Qi stagnation, leading to limb paralysis. Xue treated this as Spleen deficiency with Damp-Heat and achieved recovery.

Magistrate Han Zongqi neglected his daily routine, resulting in a mushroom-like swollen tongue, surging Phlegm, and constipation. Taking Huangqin (Scutellariae Radix, 黄芩), Huanglian (Coptidis Rhizoma, 黄连), and Erchen Tang (Two-Aged Phlegm Decoction) resulted in a floating and rapid pulse, prompting a desire to needle and bleed. Xue stated this was a deficiency of the Three Yin channels of the Foot. Although有形 (having form) and painless usually indicates Yang [Note: Classical theory often associates painless masses with Yin/Yang imbalance differently, but translating literally], the method should be to vigorously tonify Yin without damaging Blood, especially with a floating and deficient pulse. Thus, tonifying Spleen and Lung in the morning and nourishing Kidney and Liver in the evening led to recovery. Later, due to overexertion, his face and eyes turned red, and his whole body itched. It was mid-winter. Xue said, "Extreme heat that does not respond to cooling indicates lack of Water (Kidney Yin)." Treatment with herbs to subdue Fire and strengthen Water resulted in recovery.

Jin Yunwen from Yaocheng suffered from tongue swelling and expectoration. Taking herbs to descend Fire and resolve Phlegm, plus needle bleeding, worsened constipation and Phlegm. Diagnosis showed surging and rapid pulses at the left Chi and Guan positions, and wiry and rapid pulses at the right Cun and Guan positions. Herbs to nourish Kidney Water, generate Liver Blood, and benefit Spleen and Stomach improved symptoms slightly. Proximity to fire caused redness of head and face and body itching, with wiry and rapid pulses in all six positions. Xue said, "This is a sign of exhausted Water and rising Fire. Death is inevitable in the second month of Spring." Indeed, he died on Qingming Festival the following year.

County Magistrate Wang Rulin suffered from hot feet and profuse expectoration, with a rapid and forceless Chi pulse on the left. This was deficiency of the Three Yin channels of the Foot. Instead, he took Siwu Tang (Four Substance Decoction), Erchen Tang, Zhimu (Anemarrhenae Rhizoma, 知母), and Baidu (Phellodendri Cortex, 黄柏), causing throat and tongue pain. Taking clearing Heat and detoxifying herbs made his tongue look like a red peach, with a surging, rapid, and forceless pulse. This indicated weak Spleen and Lung, severe Kidney deficiency, deflected Deficient Fire flaming upward, and Water flooding creating Phlegm. The source of transformation should be nourished to generate Kidney Water. Bu Zhong Yi Qi Tang combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) resulted in recovery.

Li Mo Anfu's wife suddenly lost her voice at midnight. Upon lighting a candle, a second tongue was found growing under her tongue. Urgently, a formula from *Waitai Mibi* was taken: fresh Zhen Puhuang (True Typhae Pollen, 真蒲黄) sifted into fine powder and applied. Repeating this five or seven times led to recovery. Must spit out before reapplying. (From *Baibai Fang*.)

Someone accidentally fell and severed the center of their tongue, with unceasing bleeding. Rice vinegar was brushed onto the severed area with a chicken feather, stopping the blood immediately. Then, Zhen Puhuang (True Typhae Pollen), Xingren (Pruni Armeniaci Semen, 杏仁) peeled and cored, and a small amount of Pengsha (Borax, 硼砂) were ground into a fine powder, mixed with refined honey to the appropriate consistency, and held in the mouth to dissolve, leading to safety. (From *Defang Fang*.)

Feng Chuzhan treated Li Gongbu, who suddenly developed fever, swollen and ulcerated gums, large blisters on the tongue, thick white coating, and unbearable pain. Using clearing and resolving herbs worsened the oral and tongue ulcers, causing sleeplessness for several nights, mental confusion, and extreme distress. The pulses at both Guan and Chi positions were very faint, only the Cun positions were slightly surging. Feng said, "Dragon and Thunder Fire can also burn grass and trees; must it always be Excess Heat to cause mouth and tongue sores?" This was due to weakness of Spleen Yuan and Middle Qi, failing to anchor Lower Jiao, allowing Yin Fire to ascend and cause swelling and ulceration. Clearing the Stomach would further weaken Middle Qi and intensify Yin Fire. Urgently warming and tonifying the Middle and Lower Jiao allowed the Fire to retreat. Bai Zhu (Atractylodis Macrocephalae Rhizoma, 白术) 8 qian and Pao Jiang (Prepared Zingiberis Rhizoma, 炮姜) 3 qian warmed the Middle as Sovereign; Chao Maidong (Stir-fried Ophiopogonis Radix, 炒麦冬) 3 qian cleared the Upper as Minister; Niuxi (Achyranthis Bidentatae Radix, 牛膝) 3 qian and Wuweizi (Schisandrae Fructus, 五味子) 1 qian descended and gathered as Assistant; Fuzi (Aconiti Lateralis Radix Preparata, 附子) 1.5 qian directly warmed the Dantian as Envoy. After several doses, spirit recovered, swelling subsided, and ulcers healed. (Selected by Lai.)

Another patient suddenly had a retracted tongue and could not speak. Mustard seed powder mixed with vinegar was applied to the neck, restoring speech. Decoctions to clear Spleen and descend Fire were taken, followed by Zixue Bingpian San (Purple Snow and Borneol Powder) blown into the mouth, leading to stability.

Qian Guobin treated Liu Er, a servant of the Li family in Banqiao, who had an illicit affair with a tenant woman for over a year without paying rent. One day, the master demanded payment, and Liu sat逼 (pressuring) her. In hatred, she bit off two inches of Liu's tongue. Examination showed root swelling preventing swallowing. Trauma medicine was prepared: Baiguiban (Testudinis Carapax et Plastrum, 败龟板) smoked until black, 1 liang; Xuexue (Draconis Sanguis, 血竭) 1 qian; Bingpian (Borneolum Syntheticum, 冰片) 3 fen. Ground together and sprinkled on the wound. Bleeding and pain stopped, but swelling remained. The patient was unconscious, dreaming of Lord Guan Di instructing him to swallow a half-red, half-white bean-sized pill with unrooted water, promising life. Waking up, he could not speak but wrote with a pen. People realized the swelling gradually subsided, allowing liquid diet progression to thin porridge. The tongue fully regenerated to its original size. Daily intake of Shen Gui Zhu Tang (Ginseng, Angelica, and Atractylodes Decoction) led to recovery.

Jiang Zhongfang treated a classmate, over twenty years old, suffering from mumps. The doctor used cooling and dispersing Fire herbs. Within one night, the tongue suddenly swelled to block the mouth, life hanging in the balance. Knocking for help, the pulse was faint, fine, and rapid. Bowel movements had not occurred for four or five days. Although faint and rapid suggests Deficient Fire, constipation indicates Excess. Baicaoshuang (Soot from Hundred Herbs, 百草霜) was blown onto the tongue. Internally, Jiu Zheng Dahuang (Wine-processed Rheum Palmatum Radix, 酒蒸大黄) 5 qian and Rougui (Cinnamomi Cortex, 肉桂) 1 qian were used to guide Fire downward. One dose resulted in recovery.