经言∶舌乃心之苗，此以窍言也。以部分言之，五脏皆有所属；以症言之，五脏皆有所
主。
，为阴血虚热；若咽痛舌疮，口干足热，日晡益甚，为肾经虚火；若四肢厥冷，恶寒饮食，
或痰甚眼赤，为命门火衰；若发热作渴，饮冷便闭，为肠胃实火；若发热恶寒，口干喜汤，
食少体倦，为脾经虚热；若舌本作强，腮颊肿痛，为脾经湿热；若痰盛作渴，口舌肿痛，为
上焦有热；若思虑过度，口舌生疮，咽喉不利，为脾经血伤火动；若恚怒过度，寒热口苦，
而舌肿痛，为肝经血伤火动。病因多端，当临时制宜。凡舌肿胀甚，宜先刺舌尖，或舌上，
或边傍，出血泄毒，以救其急。惟舌下濂泉穴，此属肾经，虽宜出血，亦当禁针，慎之。
治验
工部徐检斋。口舌生疮，喜冷冻饮料食，或咽喉作痛，大便秘结。此实热也。用清凉饮，治
仲侍御多思虑，舌作痛，用苦寒降火药，发热便血，盗汗口干，肢体日瘦。此脾气亏损
，血虚之热，用加味归脾汤而愈。
一男子不慎酒色，冬喜饮冷，舌常作痛，小便频数，舌裂痰盛。此肾水枯涸，阴火无制
，名
，名上消，是心移热于肺，用白虎汤加人参治之。若关脉洪数有力，喜饮冷，小便黄，大便
硬而自汁者，名中消，调胃承气汤下之。
学士吴北川过饮，舌本强痛，言语不清，痰气涌盛，肢体不遂。余作脾经湿痰治之而愈
秋官郑过饮，舌本强肿，言语不清。此脾虚湿热。用补中益气加神曲、麦芽、干葛、泽泻而愈。
一膏粱之人患舌痛，敷服皆消毒之药，舌肿势急。余刺舌尖及两傍，出紫血杯许，肿消
一二。更服犀角地黄汤一剂，翌早复肿胀，仍刺出紫血杯许，亦消一二。仍服前汤，良久舌大肿
，又刺出黑血二杯许，肿渐消。忽寒热作呕，头痛作晕，脉洪浮而数，此邪虽去而真气愈伤
。与补中益气倍加参、 、归、术，四剂而安，又数剂而愈。
一妇人善怒，舌痛烦热，用降火化痰等药，前症益甚，两胁作胀；服流气饮，肚腹亦胀
，经行不止。此肝虚不能藏血，脾虚不能统血。用加味归脾加麦门、五味而愈。若因暴怒，而患
前症，用小柴胡加丹皮、山栀；血虚者，用八珍加参、术、柴胡、山栀、丹皮；虚甚须加炮
一男子舌下牵强，手大指次指不仁，或大便秘结，或皮肤赤晕。此大肠血虚风热。用逍遥散加槐角、秦艽而愈。
一妇人冬患脑疽，肿痛热渴，脉洪数实。余用清热消毒散，溃之而愈。次年三月，其舌肿大
，遍身患紫疔如葡萄，不计其数，手足尤多，各刺出黑血，服夺命丹七粒，出臭汗，疮热益
甚，便秘二日，与大黄、芩、连各三钱，升麻、白芷、山栀、薄荷、连翘各二钱，生草一钱
，水煎三五沸服，大小便出臭血甚多，下体稍退，乃磨入犀角汁，再服，舌本及齿缝出臭血
，诸毒乃消，更与犀角地黄汤而愈。
一妇人善怒，舌本强，手臂麻。余曰∶舌本属脾土，肝木克之故耳。治以六君子加柴胡、芍药而愈。
先兄口舌糜烂，痰涎上壅，饮食如常，遇大风欲仆地。用补中益气汤，及八味丸即愈。间药
数日仍作，每劳苦则痰盛目赤，漱以冷水，舌稍愈，顷间舌益甚，用附子片噙之即愈。服前二药诸症方痊。
古籍记载：舌是心的外候，这是从孔窍的角度而言。从身体部位来说，五脏各有其所属；从症状表现来看，五脏各有其主治。
若出现舌体干燥、裂纹，属于阴血亏虚产生的内热；如果咽喉疼痛、舌面生疮，口干且足心发热，下午（申时）症状加重，属于肾经的虚火；如果出现四肢冰冷，怕冷且食欲减退，或者痰多且眼睛发红，属于命门之火衰微；如果出现发热并感到口渴，喜欢喝冷水且大便闭塞，属于肠胃的实火；如果出现发热怕冷，口干但喜欢喝热水，食量减少且身体疲倦，属于脾经的虚热；如果舌体僵硬不灵活，腮帮和脸颊肿痛，属于脾经的湿热；如果痰多且感到口渴，口舌肿痛，属于上焦有热；如果思虑过度，导致口舌生疮，咽喉不利，属于脾经血液受损、虚火妄动；如果愤怒过度，出现寒热往来、口苦且舌体肿痛，属于肝经血液受损、虚火妄动。病因多种多样，应当根据具体情况灵活制宜。凡是舌体肿胀严重的，应当先刺破舌尖，或舌面，或舌边，放出血液以泄毒，从而挽救危急情况。唯独舌下的濂泉穴，此穴属于肾经，虽然适宜放血，但也应当禁止针刺，务必谨慎。
治疗案例
工部官员徐检斋，口舌生疮，喜欢食用冷饮冷食，有时咽喉疼痛，大便秘结。这是实热证。使用清凉饮治疗。
侍御官仲某多思虑，舌头痛，服用苦寒降火的药物后，出现发热、便血、盗汗、口干，肢体日渐消瘦。这是脾气亏损，血虚引起的内热，使用加味归脾汤治愈。
一名男子不慎于酒色，冬天喜欢喝冷水，舌头经常疼痛，小便频数，舌裂且痰多。这是肾水枯竭，阴火无法制约，名为“下消”。
如果脉象洪大而数且有力，喜欢喝冷水，小便黄，大便干硬且有自汗出，名为“中消”，用调胃承气汤攻下治疗。
学士吴北川饮酒过量，舌体僵硬疼痛，言语不清，痰气涌盛，肢体活动不便。我将其作为脾经湿痰治疗而痊愈。
秋官郑某饮酒过量，舌体僵硬肿胀，言语不清。这是脾虚湿热。使用补中益气汤加入神曲、麦芽、干葛、泽泻而痊愈。
一位饮食肥甘厚味的人患舌痛，敷药和内服都是解毒的药物，导致舌肿势态紧急。我刺破舌尖及两侧，放出约一杯紫黑色的血，肿胀消退一二分。再服用一剂犀角地黄汤，第二天早晨又肿胀，再次刺破放出约一杯紫黑色的血，也消退一二分。继续服用前面的方剂，过了很久舌体又大肿，又刺破放出约两杯黑血，肿胀逐渐消退。突然发生寒热、呕吐、头痛眩晕，脉象洪浮而数，这是邪气虽去但真气更加受伤。给予补中益气汤，加倍人参、黄芪、当归、白术，四剂后安稳，又服几剂后痊愈。
一名妇人容易发怒，舌痛烦热，服用降火化痰等药物，前面的症状更加严重，两胁胀满；服用流气饮后，肚腹也胀满，月经淋漓不止。这是肝虚不能藏血，脾虚不能统血。使用加味归脾汤加入麦冬、五味子而痊愈。如果是因暴怒引发前述症状，用小柴胡汤加入牡丹皮、山栀；血虚者，用八珍汤加入人参、白术、柴胡、山栀、牡丹皮；虚损严重者需加入炮附子。
一名男子舌下牵拉僵硬，手的大拇指和次指麻木不仁，或者大便秘结，或者皮肤出现红色晕斑。这是大肠血虚风热。使用逍遥散加入槐角、秦艽而痊愈。
一名妇人在冬天患脑疽，肿痛、发热、口渴，脉象洪数实。我使用清热消毒散，使疮疡溃破后痊愈。次年三月，她的舌体肿大，全身患上如葡萄状的紫色疔疮，数量不计其数，手足尤其多，分别刺破放出黑血，服用夺命丹七粒，排出臭汗，疮热更加严重，便秘两天，给予大黄、黄芩、黄连各三钱，升麻、白芷、山栀、薄荷、连翘各二钱，生甘草一钱，水煎煮三五沸后服用，大小便排出大量臭血，下半身症状稍退，于是磨入犀角汁，再服用，舌根及齿缝排出臭血，各种毒邪乃消除，再给予犀角地黄汤而痊愈。
一名妇人容易发怒，舌体僵硬，手臂麻木。我说：舌根属于脾土，是被肝木克制所致。治疗使用六君子汤加入柴胡、芍药而痊愈。
我的兄长口舌糜烂，痰涎上壅，饮食正常，遇到大风时几乎要跌倒。使用补中益气汤，以及八味丸即愈。间断服药几天后仍发作，每次劳累辛苦则痰多目赤，用冷水漱口，舌症稍好，一会儿舌症更严重，用附子片含在口中即愈。服用前两种药物诸症才完全康复。
Classical texts state: The tongue is the sprout of the Heart, which refers to its orifice aspect. From the perspective of body parts, all five Zang organs have their respective associations; from the perspective of symptoms, all five Zang organs have their respective dominances.
If the tongue is dry with cracks, it indicates deficiency heat due to Yin and Blood deficiency. If there is sore throat and sores on the tongue, dry mouth, hot feet, and worsening symptoms in the afternoon (Shen hour), it indicates deficient fire of the Kidney Meridian. If there are cold limbs, aversion to cold, poor appetite, or excessive phlegm with red eyes, it indicates decline of the Fire of the Gate of Vitality (Mingmen). If there is fever with thirst, preference for cold drinks, and constipation, it indicates excess fire of the Stomach and Intestines. If there is fever with aversion to cold, dry mouth but preference for hot drinks, reduced food intake, and physical fatigue, it indicates deficient heat of the Spleen Meridian. If the tongue body is stiff, with swelling and pain in the cheeks and jaw, it indicates damp-heat of the Spleen Meridian. If there is excessive phlegm with thirst, and swelling and pain in the mouth and tongue, it indicates heat in the Upper Jiao. If excessive thinking leads to sores in the mouth and tongue, and discomfort in the throat, it indicates damage to Spleen blood with stirring up of deficient fire. If excessive anger leads to alternating chills and fever, bitter taste in the mouth, and swelling and pain of the tongue, it indicates damage to Liver blood with stirring up of deficient fire. Etiologies are diverse; treatment should be adapted to the specific situation. For severe tongue swelling, one should first puncture the tip of the tongue, or the surface, or the sides, to bleed and release toxins, thereby addressing the emergency. However, for the Lianquan acupoint under the tongue, which belongs to the Kidney Meridian, although bleeding is suitable, needle insertion is strictly prohibited; caution is advised.
Clinical Cases
Xu Jianzhai, an official in the Ministry of Works, suffered from sores in the mouth and tongue, preferred cold foods and drinks, sometimes had a sore throat, and experienced constipation. This was an excess heat syndrome. It was treated with Qingliang Yin (Cooling Drink Decoction).
Zhong, a Censor, suffered from tongue pain due to excessive thinking. After taking bitter-cold herbs to clear fire, he developed fever, hematochezia, night sweats, dry mouth, and emaciation of the limbs. This was heat due to Qi deficiency of the Spleen and Blood deficiency. It was cured with Jiawei Guipi Tang (Modified Gui Pi Decoction).
A man who neglected abstinence from alcohol and sex, and liked drinking cold water in winter, suffered from frequent tongue pain, frequent urination, cracked tongue, and excessive phlegm. This was exhaustion of Kidney Water with uncontrolled Yin fire, named Xia Xiao (Lower Wasting-Thirst).
If the Guan pulse is surging, rapid, and forceful, with preference for cold drinks, yellow urine, and hard stool with spontaneous sweating, it is named Zhong Xiao (Middle Wasting-Thirst), treated with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) to purge.
Wu Beichuan, an Academician, drank excessively, resulting in a stiff and painful tongue, unclear speech, surging phlegm-Qi, and limb paralysis. I treated it as damp-phlegm of the Spleen Meridian, and he recovered.
Zheng, an official in the Court of Judicature and Revision, drank excessively, resulting in a stiff and swollen tongue and unclear speech. This was Spleen deficiency with damp-heat. He was cured by using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shenqu (Massa Medicata Fermentata), Maiya (Fructus Hordei Germinatus), Gegen (Puerariae Radix), and Zexie (Alismatis Rhizoma).
A person accustomed to rich and greasy food suffered from tongue pain. After applying and ingesting detoxifying medicines, the tongue swelling became urgent. I punctured the tip and both sides of the tongue, releasing about one cup of purple blood, reducing the swelling slightly. Then, one dose of Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) was taken. The next morning, the swelling recurred. Puncture again released about one cup of purple blood, reducing the swelling slightly. Continuing with the previous decoction, after a long time, the tongue swelled greatly again. Puncture released about two cups of black blood, and the swelling gradually subsided. Suddenly, chills, fever, vomiting, headache, and dizziness occurred, with a surging, floating, and rapid pulse. This indicated that although the pathogen was gone, the True Qi was further damaged. Buzhong Yiqi Tang was administered with doubled doses of Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma). After four doses, he stabilized, and after several more doses, he recovered.
A woman prone to anger suffered from tongue pain and irritability. After taking herbs to clear fire and resolve phlegm, the previous symptoms worsened, with distension in the hypochondrium. After taking Liqi Yin (Flowing Qi Decoction), abdominal distension occurred, and menstruation did not stop. This was Liver deficiency failing to store Blood and Spleen deficiency failing to control Blood. She was cured by Jiawei Guipi Tang added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus). If the previous symptoms were caused by sudden anger, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus) was used. For Blood deficiency, Bazhen Tang (Eight Treasure Decoction) added with Renshen, Baizhu, Chaihu (Bupleuri Radix), Zhizi, and Mudanpi was used. For severe deficiency, Pao Fuzi (Prepared Aconiti Lateralis Radix) should be added.
A man suffered from stiffness under the tongue, numbness of the thumb and index finger, or constipation, or red halos on the skin. This was Wind-Heat due to Blood deficiency of the Large Intestine. He was cured by Xiaoyao San (Free and Easy Wanderer Powder) added with Huaijiao (Sophorae Tonkinensis Fructus) and Qinjiao (Gentianae Macrophyllae Radix).
A woman suffered from a brain carbuncle in winter, with swelling, pain, fever, and thirst, and a surging, rapid, and full pulse. I used Qingre Xiaodu San (Clear Heat and Detoxify Powder), leading to suppuration and recovery. In March of the following year, her tongue swelled, and she developed numerous purple ding (carbuncles) like grapes all over her body, especially on the hands and feet. Black blood was pricked out from each. Seven pills of Mingdan (Life-Saving Pill) were taken, resulting in foul-smelling sweat. The carbuncle heat worsened, and she was constipated for two days. Da Huang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma) were given at 3 qian each, along with Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), Zhizi, Bohe (Menthae Haplocalycis Herba), Lianqiao (Forsythiae Fructus) at 2 qian each, and Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) at 1 qian. Decocted in water and boiled for three to five boils, large and small amounts of foul-smelling blood were excreted via urine and stool. The lower body symptoms subsided slightly. Then, Xijiao juice (Rhinoceros Horn Juice) was ground in and taken again. Foul-smelling blood was exuded from the root of the tongue and gum margins, and various toxins were eliminated. Finally, Xijiao Dihuang Tang was administered, leading to recovery.
A woman prone to anger suffered from a stiff tongue root and numb arms. I said: The tongue root belongs to Spleen Earth, and this is due to suppression by Liver Wood. It was treated with Liu Junzi Tang (Six Gentlemen Decoction) added with Chaihu and Shaoyao (Paeoniae Radix Alba), leading to recovery.
My elder brother suffered from erosion of the mouth and tongue, with phlegm-saliva obstructing upwards, normal diet, and nearly falling when encountering strong winds. Buzhong Yiqi Tang and Bawei Wan (Eight Flavor Pill) were used, leading to recovery. When medication was interrupted for a few days, symptoms recurred. Every time he worked hard, he had excessive phlegm and red eyes. Rinsing with cold water provided slight relief, but soon the tongue condition worsened. Holding a slice of Fuzi (Prepared Aconiti Lateralis Radix) in the mouth provided immediate relief. Only after taking the previous two medicines did all symptoms fully recover.