The tongue frequently protrudes out of the mouth and immediately retracts, extending and retracting incessantly in all directions, resembling a snake's flicking, known as waggling tongue.

In ancient medical literature, waggling tongue is also referred to as "protruding tongue," "舒舌," or "頻餂舌." The "Shenyan Yizong Shejing" states: "The tongue frequently protrudes and constantly flicks," which refers to waggling tongue. Yizong Jinjian and "Bian She Zhinan" describe the tongue extending long and retracting slowly as "protruding tongue," while the tongue slightly protruding and immediately retracting is called "waggling tongue." Clinically, there is no significant difference in the mechanism of disease and treatment between the two, making it unnecessary to mechanically distinguish them, hence they should be collectively categorized under waggling tongue.

This condition mostly occurs in children, but it can also occur in adults.

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1. Excessive Heat in the Spleen︰The tongue protrudes and immediately retracts, moving left and right, with body heat and a flushed face, frequent dysphoria, thirst and a preference for cold drinks, parched lips and dry mouth, mouth and tongue sores, severe constipation or passing thick and foul stools, a red tongue texture, yellow and dry coating, and a wiry-rapid or surging-rapid pulse. This often occurs in children with fever, mostly due to pathogenic heat accumulating in the heart and spleen meridians, exuberance of heart fire disturbing mental activity and causing internal wind; spleen heat in excess damages body fluids. The heart connects to the root of the tongue, and the spleen's collateral affects ankyloglossia. Wind governs movement, so a waggling tongue is a sign of stirring wind; when fluids are depleted, the tongue also becomes dry and uncomfortable, hence the protrusion and movement to relieve it. Cao Bingzhang's "Guide to Tongue Differentiation" states: "Exuberance of heart fire cannot be restrained upward by kidney yin, so the tongue protrudes outward; liver fire fuels the flames, wind governs movement, and stomach heat fans the agitation, making it hard for the tongue to stay still, hence it moves like a snake's lick, left and right, up and down, extending and retracting." The key diagnostic points are: the tongue protrudes and immediately retracts, moving quickly, appearing red and swollen with a yellow, dry coating, accompanied by symptoms of up-flaming heart fire (body heat, flushed face, dysphoria) and spleen heat scorching fluids (dry mouth, preference for cold drinks, constipation). Treatment should focus on clearing heart fire and draining spleen heat. The prescription of choice is Heart-Draining and Red-Guiding Decoction combined with Yellow-Draining Powder; for severe heat, a small amount of borneol can be applied under the tongue for quick relief.
2. Spleen-kidney Yin Deficiency︰The tongue frequently protrudes from the mouth, with drooling at the corners, vexing heat in the chest, palms, and soles, thirst with a preference for hot drinks, a red tongue with scant coating, and a thin, rapid pulse. This differs from the previous syndrome and generally occurs in the Rebing late stage [third stage], where the pathogenic factors have receded but the yin of the spleen and kidneys is already depleted; or it may result from other chronic sexually transmitted diseases gradually leading to spleen and kidney deficiency and damage. The depletion of yin and consumption of fluids cause the tongue's network vessels to lose their nourishment, hence the frequent protrusion of the tongue to seek relief. Key points of differentiation: the tongue extends and retracts slowly, is not red or swollen, has scant coating, and presents with symptoms of yin deficiency (vexing heat in the chest, palms, and soles, and a thin, rapid pulse). Treatment should focus on fortifying the spleen and boosting the kidneys, enriching yin and clearing heat. The recommended formulas are Four Gentlemen Decoction combined with Anemarrhena, Phelloendron and Rehmannia Pill, and Yellow-Draining Powder may also be used in conjunction.
3. Epilepsy Syndrome︰This disease manifests episodically, with primary clinical symptoms including sudden collapse, unconsciousness, frothing at the mouth, staring eyes, limb convulsions, head shaking, and tongue wagging, returning to normal upon waking. It is caused by emotional disturbances, dietary irregularities, excessive fatigue, or head trauma, and in children, it is often related to congenital factors. The condition primarily involves the liver, spleen, and kidneys. Kidney deficiency leads to insufficient nourishment of liver wood, resulting in a weak constitution but hyperactive function. Spleen deficiency causes internal accumulation of phlegm and saliva, while liver wind combines with phlegm, causing qi to rise rebelliously and cloud the seven orifices, leading to sudden attacks. Tongue wagging is also caused by wind-phlegm and counterflow qi disturbing the upper body. Diagnosis is based on past medical history, episodic nature, and return to normalcy after episodes, distinguishing it from other causes of tongue wagging. The *Guide to Tongue Differentiation* states: "Those who wag their tongues and shake their heads have epilepsy; patients who frequently roll their eyes and protrude their tongues have goat epilepsy." The key diagnostic points are tongue protrusion and wagging accompanied by epileptic symptoms (collapse, frothing at the mouth, convulsions, and staring eyes). Treatment should focus on resolving phlegm to restore consciousness and calming wind to stabilize epilepsy. The formulas "Epilepsy-Settling and Pain-Relieving Mixture" combined with "Scorpion-Centipede Tablets" taken orally can yield certain effects.
4. Malnutritional Disease︰According to the "General Treatise on Pediatric Hygiene," waggling tongue accompanied by sallow complexion, emaciation, and vexing heat in the chest, palms, and soles is generally caused by dietary irregularities, spleen and stomach injury, leading to retention of food, which over time develops into malnutrition. Symptoms include emaciation, dry and withered hair, or a distended abdomen with prominent veins, along with frequent waggling tongue. Treatment should focus on strengthening the spleen and resolving malnutrition, with prescriptions such as Xiaogan Li Pi Tang or Ginseng, Poria and White Atractylodes Powder.
5. Phlegm-fire Stirring Wind︰The disease "waggling tongue throat wind" manifests as swollen and painful throat, phlegm congestion, hoarse voice, protruding and unrestrained tongue, frequent spitting and playing with the tongue, and a constant urge to touch it with hands. It is caused by the binding of phlegm-heat combined with wind disturbing the throat. Treatment should focus on clearing heat and removing toxin, as well as dispelling wind. For internal use, Throat-Clearing and Diaphragm-Disinhibiting Decoction is recommended, while externally, Borneol and Borax Powder should be blown onto the tongue.

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1. Youyou Jicheng: "After a serious illness, if the spirit is exhausted, appetite is poor, and the tongue is waggling, it is a dire sign. This is due to the deficiency of both qi and blood, and the spirit is about to collapse. Quickly use Ten Major Tonics Decoction to save it."
2. Chinese medicine Clinical Essentials: "If a child frequently sticks out their tongue, moving it up, down, left, and right, like a snake licking, it is mostly due to heat accumulation in the heart and stomach, accompanied by liver wind. Use Stomach-Clearing Powder internally, and apply a small amount of Cow-Bezoar externally on the tongue."
3. National Medicine Tongue Inspection: "If the tongue is extended and frequently licks the lips, moving incessantly, and the color is purple and dark, it indicates epidemic toxin attacking the heart." "If the tongue occasionally sticks out to play with the lips, it is due to snake venom."
4. General Treatise on Pediatric Health: "Waggling tongue has two causes: one is heart heat, as the heart connects to the tongue root, and heat causes the tongue root to dry and become stiff, so the tongue is frequently protruded to relieve it. The other is spleen heat, as the spleen connects to the tongue, which also becomes dry and tight, and the tongue is frequently protruded to relieve it, both causing a desire to drink water. Heart heat causes thirst, while spleen heat consumes body fluids. Although both conditions lead to similar drinking behaviors, heart heat is accompanied by a red face, hot breath during sleep, frequent dysphoria, and a preference for cold and teeth grinding. Treatment should focus on clearing heart heat. For spleen heat, the body and face are slightly yellow, and the stool is thick and hard, with a reddish-yellow color. Treatment should involve mild purgation."