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。
《黄帝内经》说：南方产生热气，热气生火，火对应心脏，心脏外应于舌，在孔窍中表现为舌。又说：心气通于舌，心气调和则舌能辨别五味。陈飞霞说：舌是心的苗窍，也是胃的根本。小儿容易患舌部疾病，这是因为心和脾有积热所致。因此会出现重舌、木舌、弄舌、舌苔等证候，应当辨别虚实进行治疗。
重舌，是因为心和脾有热。因为脾的大络脉出于舌下，如果有热，气血就会亢盛，附着在舌根之下，突然长出一个小舌，贴在原舌下面。内服沆瀣丹（Huangxie Dan），外用针刺放出恶血，再用碧雪散（Bixue San）以竹沥调匀敷贴患处。
弄舌，是脾脏虚热，导致舌部脉络拘急，舌头不时伸出舔舐嘴唇，俗人称为“蛇丝惊”。千万不要用寒凉攻下的方法治疗，可少量给予泻黄散（Xiehuang San），如果服用无效，改用四君子汤（Sijunzi Tang）。如果口渴想喝水，但面色没有红赤，这是脾胃津液不足，不可误认为是实热，宜用七味白术散（Qiwei Baizhu San）。如果面色发黄、身体消瘦，胸中烦热且弄舌，这是疳证（Gan syndrome，一种小儿慢性营养障碍性疾病）。需要参考疳证章节的内容，宜用集圣丸（Jisheng Wan）。大病之后精神疲惫，饮食减少，却出现弄舌的，是凶险的征候。这是因为气血两亏、精神涣散，必须迅速用十全大补汤（Shiquan Dabu Tang）来挽救。
舌上出现黑苔，说明热邪已经极盛，紧急时用薄荷煎汤清洗舌面。如果舌色转为红色，还可以治疗，用凉膈散（Liangge San）泻下清热。清洗后舌色不红的，无法治愈。泄泻之后舌上出现白苔，这是津液不能滋养，不能上潮于口，属于虚热，用理中汤（Lizhong Tang）。
《集成》方剂记载：
沆瀣丹（见前文伤湿方剂条目内）
碧雪散（见前文口疮方剂条目内）
七味白术散（见前文泄泻方剂条目内）
泻黄散（见前文口疮方剂条目内）
六君子汤（见前文咳嗽方剂条目内）
集圣丸（见前文疳症方剂条目内）
十全大补汤（见前文头项方剂条目内）
凉膈散：治疗心脾有热，舌上出现黑苔者。
连翘（一钱）、栀子仁（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）、灯心草（十茎）。水煎服，加入生蜂蜜十匙混合服用。
涂蔚生说：舌上出现黑苔，必须是干燥无津液的，才可以断定是热邪极盛。如果舌上虽然是黑苔，但有津液油润的，仍然是阴寒至极，外表显现假热的颜色。这种精微的细节，不可忽视。
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.