张三锡曰。心开窍于舌。心火盛则舌干或破。脉洪实有力者。黄连泻心汤加减。右脉虚大。
四肢倦怠。而舌疮破不愈。属劳役过度。虚火上炎为患。补中益气汤。口舌唇疼有疮。皆心火炎
盛。凉膈散。舌疮风热。口中干燥。舌裂生疮。甘露饮。酒客膏粱。积热内盛。上焦痰实。舌胀
肿。凉膈散泻之。须脉实有力。气壮乃可。舌强硬如猪脬。以针刺舌两边大脉血出即消。勿刺中
央。令人血不止。此病患多不识。失治则死。凡舌肿。舌下必有如虫形。有头有尾。可烧钉烙头
即消。上焦痰热壅遏。势挟相火。则病速而危。毒瓦斯结于舌下。复生一小舌。名子舌胀。但胀大
而强无小舌者。名木舌胀。大都痰火为患。缓者用辛凉利气化痰药。重者砭去其血即平。劳神不
睡。口舌破者。自当安神养心。作心虚治。心之本脉。系于舌根。脾之络脉。系于舌傍。肝脉络
于舌本。少阴脉系舌本。风寒伤于心脾。憎寒壮热。齿浮舌肿痛。金沸草散漱口。吞一半。吐一
半。经验方。治舌胀大。塞口不能饮食。用真蒲黄一味。频刷舌上。甚则加干姜末从治之。若能
服药。即以川连一味。煎浓汁呷之。以泻心火。甚者。加干姜从治。舌上有窍。出血不止。炒槐花末掺
舌重舌。宜三黄丸。及生蒲黄掺之。舌出不收。心经
热甚。及伤寒热毒攻心。与伤寒后不调摄。往往有之。宜珍珠末、冰片、火 人中白敷之。舌暴
肿退场门。用巴豆霜。以纸卷纳鼻中。舌自收。此取辛烈开窍散火。引毒流散之意。与小儿口疳贴
囟同法。平人舌上稠黑胎垢。拭之不净。经久不退。且口甜气秽。便是胃脘发痈之候。与伤寒暴
病。府邪内实迥异。急宜凉膈散下之。
张三锡说：心开窍于舌。心火亢盛则导致舌体干燥或出现破损。若脉象洪大、实而有力，可用黄连泻心汤进行加减治疗。若右脉虚大，伴有四肢倦怠无力，且舌部疮疡破损久不愈合，这属于过度劳累所致，是虚火上炎引发的病变，应使用补中益气汤。口、舌、唇疼痛并生疮，皆因心火炎盛所致，宜用凉膈散。若舌疮由风热引起，伴口中干燥、舌裂生疮，可用甘露饮。嗜酒及饮食肥甘厚味者，体内积热炽盛，上焦痰实阻滞，导致舌体肿胀，需用凉膈散泻下清热；但必须脉象实而有力、体质壮实者方可使用。
若舌体僵硬如同猪膀胱（状如猪脬），可用针刺舌两侧的大血管使其出血，症状即可消除；切勿刺破舌中央，否则会导致出血不止。这一病症患者大多不了解，若延误治疗则会致死。凡是舌肿，舌下必然有类似虫形的脉络，有头有尾，可用烧红的铁钉烙其头部，症状即可消除。若上焦痰热壅塞遏阻，病势挟带相火，则病情发展迅速且危险。毒气结聚于舌下，又生出一个小舌，称为“子舌胀”。仅见舌体肿大强硬而无小舌者，称为“木舌胀”。这类疾病大多由痰火引起，病情较轻者使用辛凉理气化痰的药物；病情重者，通过砭石放血即可平复。
因劳神过度且失眠，导致口舌破损的，应当安神养心，按心气虚论治。心的本经脉络系于舌根，脾的络脉系于舌旁，肝的脉络系于舌本，少阴经脉也系于舌本。若风寒侵袭心脾，出现怕冷高热、牙龈浮动、舌体肿痛，可用金沸草散含漱，吞下一半，吐出一半，此为经验方。治疗舌体肿大堵塞口腔不能进食，单用真蒲黄一味药，频繁涂抹于舌上；严重时加入干姜末作为反佐治疗。若能服药，则单用川黄连一味，煎煮浓汁慢慢呷服，以清泻心火；病情严重者，加入干姜作为反佐治疗。
若舌上有孔窍且出血不止，可炒槐花末外敷于舌上。若患重舌，宜用三黄丸，并撒生蒲黄粉。若舌体伸出不能收回，多因心经热盛，以及伤寒热毒攻心，或伤寒后调养不当所致，往往会出现这种情况。宜用珍珠末、冰片、人中白敷贴患处。若舌体突然肿胀，可将巴豆霜用纸卷成条纳入鼻中，舌体自然收缩，这是取辛烈之品开窍散火、引导毒气流散的意思，与小儿口疳贴囟门的方法相同。
普通人舌上出现稠密的黑苔垢腻，擦拭不净，经久不退，且口中有甜味、气息秽浊，这是胃脘发生痈脓的征兆，与伤寒暴病、腑邪内实的证候截然不同，急需使用凉膈散通下泻热。
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.