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The tongue is the external manifestation of the Heart, and the Spleen meridian connects to the tongue. When heat pathogens exist in both the Heart and Spleen meridians without an outlet, they manifest on the tongue. If the lingual frenulum is slightly tight and the tongue is frequently extended, it is called "Leng She" (Fidgeting Tongue). A growth appearing under the tongue near the root, shaped like a tongue but smaller, is called "Chong She" (Double Tongue). If the tongue gradually swells and fills the mouth, it is called "Mu She" (Wooden Tongue). [Zeng] All these conditions result from extreme heat affecting the Spleen, Heart, and Liver. The so-called Chong She, Mu She, as well as "She Huang" (Yellow Tongue) and "E Kou" (Goose Mouth), though named differently, all stem from heat. Generally, Chong She arises below the tongue, protruding like a small tongue. The Spleen's collateral vessels connect to the sides of the tongue, the Liver's to the root (Shu Ben), and the Heart's to the base of the tongue. 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 Xiao Huang San (Eliminate Yellow Powder) and Lv Pao San (Green Robe Powder), along with Dang Gui San (Angelica Decoction) and Qiang Huo San (Notopterygium Decoction).
Dang Gui San (for fever) Qiang Huo San (for fever)

[Qian Yi] Leng She (Fidgeting Tongue) is caused by slight heat in the Spleen organ, leading to slight tension in the lingual frenulum and frequent extension of the tongue. Treatment should avoid cold medicines and purgatives; instead, Xie Huang San (Drain the Yellow Powder) should be administered in small doses gradually. [Tian Shi states: For robust and fleshy children, Niu Huang San (Calculus Bovis Powder) should be used.] If the child desires water, and the physician mistakenly suspects heat and uses cold purgatives, this is incorrect. Thirst arises because the fluids of the Spleen and Stomach are insufficient. Combined with sallow complexion, emaciation, and five-palm heat, this constitutes Gan disease (Pediatric Malnutrition Syndrome); herbs such as Hu Huang Lian (Coptidis Rhizoma) should be added. If Leng She appears after medication during an unresolved severe illness, the prognosis is ominous. [Xue Ji] When a child's tongue slightly protrudes and immediately retracts, it is named Leng She (Fidgeting Tongue), belonging to Heart and Spleen deficiency; Wen Pi San (Warm the Spleen Powder) should be used to tonify. When the tongue extends long and fails to retract for a long time, it is named Tu She (Protruding Tongue), resulting from accumulated heat in the Heart and Spleen; Xie Huang San (Drain the Yellow Powder) is indicated. If accompanied by oral ulcers and thirst for cold drinks, it belongs to excess heat in the Stomach meridian, and the aforementioned powder is also used. Thirst for hot drinks indicates deficient heat in the Stomach meridian; Si Jun Zi Tang (Four Gentlemen Decoction) is used. Poor appetite with thirst, or loose stools, indicates Spleen and Stomach weakness; Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is used. Drooling at the corners of the mouth or swelling of the cheeks indicates Stomach deficiency with wind-heat; Ren Shen An Wei San (Ginseng Peace the Stomach Powder) is used first, followed by Qi Wei Bai Zhu San. Symptoms worsening in the afternoon indicate Spleen blood deficiency; Si Wu Tang (Four Substances Decoction) plus Ren Shen (Ginseng), Bai Zhu (Atractylodes macrocephala), and Fu Ling (Poria) is used. If ineffective, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is employed, considering the mutual overcoming relationships among the Five Zang organs. If caused by Gan emaciation, refer to the Gan disease chapters.
Xie Huang San (Spleen) Wen Pi San (Abdominal Distension) Bai Zhu San (Thirst) Ren Shen An Wei San (Spleen) Si Wu Tang (Blood Loss) Bu Zhong Yi Qi Tang (Emaciation/Weakness)