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Without error in distinguishing deficiency and excess (Deficiency and Excess), tonification and purgation will invariably be effective; without error in distinguishing Yin and Yang, cold and hot treatments will invariably be appropriate. However, only when the Zang-Fu organs are correctly identified can tonification, purgation, cold, and heat therapies precisely target the disease, thereby eliminating its root cause, ensuring the principal prescription is accurate. Therefore, based on deficiency/excess and Yin/Yang to differentiate Zang-Fu organs and determine the principal prescription, clinicians must not confuse these distinctions. The differentiation of Zang-Fu organs does not exceed the tongue colors of green, yellow, white, and black; the matching of principal prescriptions must conform to the flavors sour, bitter, pungent, and sweet. Thus, following the *Neijing*’s classification of Zang and Fu organs, and consulting established formulas, I have deliberated and determined the governing methods as follows.

1. A green tongue indicates a Liver-Gallbladder disorder. (Purple is similar.) Regardless of the symptoms presented, if the tongue is green and firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in the Liver and Gallbladder meridians; treat with Xiehuo Qinggan Yin (Fire-Draining Liver-Clearing Decoction). If the tongue is green, floating, swollen, tender, and delicate, it indicates deficiency of Essence and Qi in the Liver and Gallbladder meridians; treat with Zishui Shengan Yin (Nourishing Water and Nourishing Liver Decoction). If the tongue is green and dry, it indicates either Yin deficiency with Fire stagnation in the Gallbladder Fu organ, or Blood deficiency with vigorous Fire in the Liver Zang organ. (If merely dry but not parched, it specifically points to Yin deficiency; if dry and parched, it indicates Yin deficiency with vigorous Fire. Apply this logic to other Zang-Fu organs.) For Gallbladder Fu Yin deficiency, use Xiaoyao San (Free Wanderer Powder); for Fire stagnation, add Shengdi Huang (Rehmanniae Radix Preparata) and Bo He (Menthae Haplocalycis Herba). For Liver Zang Blood deficiency, use Xiaoyao San; for vigorous Fire, add Mudan Pi (Moutan Cortex) and Shan Zhi (Gardeniae Fructus).

"Yu" (Stagnation) refers to suppressed Qi; suppression leads to obstructed flow, obstruction leads to heat transforming into Fire. Traditionally, Yu-Huo (Stagnant Fire) has always been attributed to the Liver, but I exclusively attribute it to the Gallbladder because the Gallbladder belongs to Shaoyang (Lesser Yang), its Qi is still immature, and as Jia Wood, its substance is tender, making it most susceptible to suppression. Once suppressed, its Qi becomes stifled and unsmooth. In contrast, the Liver belongs to Jueyin (Terminal Yin) and Yi Wood; its Qi is already abundant, its substance firm, and its Fire easily moves and becomes vigorous. Upon any trigger, it erupts uncontrollably; such uncontrollable eruption is "Anger," not "Stagnation." Stagnation primarily causes Qi condensation and stasis internally, whereas Anger causes Qi to expand externally. This formula (Xiaoyao San) generally governs Liver-Gallbladder Yin deficiency. For Gallbladder Fu Fire stagnation, adding Bo He and Shengdi Huang is because Wood delights in wind-like dispersal, and stagnant Fire cannot be cooled without Shengdi Huang. For Liver Fire vigor, adding Mudan Pi and Shan Zhi is because once Liver Blood is deficient, Liver Fire easily becomes vigorous, further depleting Blood; unless the Fire is drained, Yin cannot be nourished; unless one employs a winding downward pathway to unblock it, the Fire cannot be drained. However, if Blood is forced by Fire, transforming into a Dryness syndrome, one should heavily add Shu Di Huang (Prepared Rehmanniae Radix) to moisten the Dryness; in this case, Mudan Pi and Shan Zhi are indeed unnecessary and inappropriate.

A green and slippery/moist tongue indicates either Gallbladder Qi timidity or Liver Qi deficiency. For Gallbladder Qi timidity, use Shiwei Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction), remove Zhi Shi (Aurantii Fructus), and decoct with wine for faster efficacy, as wine enters the Gallbladder meridian and strongly boosts Gallbladder Qi.
For Liver Qi weakness, use Danggui Jianzhong Tang (Angelica Building-the-Middle Decoction), remove Jiaoyi (Maltose).
Jianzhong Tang differs from Guizhi Tang (Cinnamon Twig Decoction) only by the addition of Jiaoyi. Now, fearing that Sweet flavor enters the Spleen first, removing Jiaoyi makes it indistinguishable from Guizhi Tang. Thus, using Danggui Jianzhong Tang aligns with Liver Qi deficiency.

If dry but appearing swollen and tender, it indicates dual deficiency of Liver-Gallbladder Yin and Yang; use Qiwei Yin (Seven-Ingredient Decoction) with doubled Rou Gui (Cinnamomi Cortex). If slippery/moist but not appearing swollen/tender, it indicates deficiency-cold of Liver-Gallbladder Wood Qi; use Yangrong Tang (Nourishing Vigor Decoction) plus Gouqi (Lycii Fructus).
Whenever the Left Guan pulse is fine and tight like a knife edge, regardless of tongue color, it must be swollen and slippery; regardless of symptoms, it indicates Heart deficiency with Cold. I have always used Yangrong Tang with immediate effect. Clinicians must not fear it, and those valuing life must not doubt it.

2. A yellow tongue indicates a Spleen-Stomach disorder. Regardless of symptoms, if the tongue is yellow, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in the Spleen-Stomach meridians; use Xiehuang San (Drain-Yellow Powder).
If there is thick coating, or scorched-yellow/scorched-black, with rough prickles, dryness, and cracking, and symptoms include fullness, blockage, dryness, excess, firmness, and contraction, it is an Excess syndrome. Immediate purgation is required to preserve Body Fluids; Da Chengqi Tang (Major Order the Qi Decoction) is indicated. However, this must be a true Yangming Interior syndrome; Northern Cold Damage cases occasionally present this. Yet, if the tongue is swollen, even in the North, it is not an indication for Chengqi, and one must never recklessly use Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma), which can kill within moments.

Yellow and floating/swollen/tender indicates deficiency of Essence and Qi in Spleen-Stomach meridians; use Yihuang San (Benefit-Yellow Powder). Yellow and dry indicates either Stomach Fu Yin deficiency with vigorous Fire, or Spleen Zang Blood deficiency with excessive Fire. For Stomach Fu Yin deficiency, use Zuogui Yin (Left Return Decoction) removing Fuling (Poria); for vigorous Fire, add Huafen (Trichosanthis Radix), Danggui (Angelicae Sinensis Radix), and Dihuang (Rehmanniae Radix). For Spleen Zang Blood deficiency, use Guipi Tang (Restore the Spleen Decoction) removing Muxiang (Aucklandiae Radix); for excessive Fire, add Baishao (Paeoniae Radix Alba), Mudan Pi, and Shan Zhi.

If dry with thick coating, it indicates retained food stagnating in intestines/stomach with dry accumulation failing to pass. The pulse must be deep and solid, mental state lethargic, face flushed with heat, nasal breathing coarse, and slight pain upon pressing the chest. Use Xiaoyao San with heavily added Shu Di Huang to moisten and purge.

Yellow and slippery/moist indicates either Stomach Qi weakness or Spleen Qi damage. For Stomach Qi weakness, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) plus Banxia (Pinelliae Rhizoma); for Spleen Qi damage, use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) plus Baishao.

If the posterior half of the tongue is slippery/greasy with slight coating, it indicates sinking of Spleen-Stomach deficient Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

If dry but appearing swollen/tender, it indicates dual deficiency of Spleen-Stomach Qi and Blood; use Renshen Bazhen Tang (Ginseng and Eight-Treasure Decoction). If slippery/moist and also swollen/tender, it indicates deficiency-cold of Spleen-Stomach Middle Qi; use Jianggui Yangrong Tang (Ginger-Cinnamon Nourishing Vigor Decoction).

3. A red tongue indicates Heart-Small Intestine disorders. Regardless of symptoms, if the tongue is red, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Heart-Small Intestine; use Xiexin Tang (Drain-Heart Decoction).
According to *Siming Xinfa*: Only when the tongue is gray and scraping with a fingernail yields no residue/juice is it a Fire syndrome, suitable for Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma). Interpreting this, when Yang pathogens scorch, Yin fluids inevitably dry up. However, my verification shows that only when the form is firm/contracted and color aged-looking is it truly suitable for Huangqin/Lianzi. If it appears swollen/tender, even with thick, scorched, dry, cracked coating, it is either Cold Water insulting Earth or Kidney Qi overwhelming the Heart. Cold Water insulting Earth requires Fuzi Lizhong Tang (Aconite Regulate-the-Middle Decoction); Kidney Qi overwhelming the Heart requires Renshen Bawei Wan (Ginseng Eight-Ingredient Pill). Mistakenly using Huangqin/Lianzi will result in a human-character pattern on the tongue, leading to death. I diagnosed Shen Yizhong from Xinshu and declared him untreatable due to this tongue; see medical cases for details. Also, Fire color is originally red; a gray tongue in Fire syndromes is like charcoal glowing red inside covered by floating ash. Theoretically, a gray tongue implies a condition worse than black-as-charcoal tongue. When fire burns fuel to ash, wood becomes charcoal, grass becomes ash; thus charcoal and ash are transformations of extreme Fire. Wood is hard; newly ignited, it hasn't become charcoal yet. Only when Fire is extreme resembling Water does it turn black to charcoal, yet remains fierce. After prolonged burning, extreme Heat turns to Cold, returning to white ash, though the core may not be fully ash. Grass is weak; once burned, it becomes ash immediately, irreversibly. Thus, examining pathology via physics, whether turning to ash instantly or via charcoal, a gray tongue is worse than black-as-charcoal.

Red and floating/swollen/tender indicates deficiency of Essence and Qi in Heart-Small Intestine; use Yangxin Tang (Nourish-Heart Decoction). Red and dry indicates either Small Intestine Yin deficiency with vigorous Fire, or Heart Blood deficiency with excessive Fire. For Small Intestine Yin deficiency, use Zishui Qinggan Yin removing Chaihu (Bupleuri Radix).
To moisten the lower part, avoid dryness.
For vigorous Fire, add Shengdi Huang and Mutong (Akebiae Caulis).
Combine with Daochi San (Guide Out Redness Powder) to drain Fire Qi.
For Heart Blood deficiency, use Jisheng Guipi Tang (Succeeding Generation Restore Spleen Decoction) removing Muxiang.
Fear blood dryness stirring Liver Fire and drying Blood. For excessive Fire, add Mudan Pi and Shan Zhi.
Once the Yin-Blood of the meridian is deficient, the Yang-Fire of the same meridian must be vigorous; one declines, the other prevails. Adding Mudan Pi and Shan Zhi aims to guide Heart Fire downward to reach the Bladder.

Red and slippery/moist indicates either Small Intestine Yang deficiency with Qi sinking, or Heart Yang deficiency with weak Qi. For Small Intestine Yang deficiency with Qi sinking, use Buzhong Yiqi Tang plus Shan Zhi and Chuanwu (Aconiti Lateralis Radix Preparata).
Qi deficiency causes stagnation; stagnation causes sinking. Ginseng, Huangqi, Baizhu, and Gancao in the formula tonify deficiency; Chuanwu and Chenpi break stagnation; Shengma and Chaihu lift sinking. Shan Zhi is added to borrow its winding downward action to guide to the Small Intestine.
For Heart Yang deficiency with weak Qi, use Xuxue Guipi Tang (Whispering Blood Restore Spleen Decoction) plus Mudan Pi and Rou Gui.
Excess Qi is Fire; deficient Qi is Cold. Adding Rou Gui and Mudan Pi to this formula aims to enter the Heart meridian to tonify Heart Qi.

If dry but appearing swollen/tender, it indicates dual deficiency of Heart-Small Intestine Qi and Blood; use Zaoren Yangying Tang (Zizypha Seed Nourishing Vigor Decoction). If slippery/moist and also swollen/tender, it indicates severe depletion of Heart-Small Intestine Fire-Qi; use Fuzi Yangying Tang (Aconite Nourishing Vigor Decoction).

4. A white tongue indicates Lung-Large Intestine disorders. Regardless of symptoms, if the tongue is white, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Lung-Large Intestine; use Xiebai San (Drain-White Powder). White and floating/swollen/tender indicates deficiency of Essence and Qi in Lung-Large Intestine; use Bufei Tang (Tonify-Lung Decoction). White and dry indicates either Large Intestine Blood deficiency with excessive Fire, or Lung Yin deficiency with vigorous Fire. For Large Intestine Blood deficiency, use Runchang Zishui Yin (Moisten-Intestine Nourish-Water Decoction); for excessive Fire, add Shengdi Huang and Danggui.
For dry stool constipation where effort fails to expel, this formula is miraculous.
If accompanied by Qi deficiency and weak propulsion, intermittently use Buzhong, or directly use Bazhen Tang (Eight-Treasure Decoction) plus Taoren (Persicae Semen) and Xingren (Armeniacae Semen Amarum) to nourish Qi and tonify Yin, which will invariably work.
For Lung Yin deficiency, use Shengjin Zishui Yin (Generate-Metal Nourish-Water Decoction); for Fire-Dryness, add Baihe (Lilii Bulbus) and Shashen (Glehniae Radix). White and slippery/moist indicates either Large Intestine Yang deficiency with Qi sinking, or Lung Yang deficiency with weak Qi. For Large Intestine Yang deficiency with Qi sinking, use Buzhong Yiqi Tang administered with Gutang San (Secure-Intestine Powder).
Large and Small Intestines belong to Lower Jiao Fu organs; why match them with Middle Zang formulas? Because intestines and stomach are connected, their Qi is continuous.
For Lung Yang deficiency with weak Qi, use Buzhong Yiqi Tang combined with Shenfu Tang (Ginseng-Aconite Decoction). If dry but appearing swollen/tender, it indicates dual deficiency of Lung-Large Intestine Qi and Blood; use Shiquan Dabu Tang (Ten-Complete Great Tonifying Decoction) removing Rou Gui, adding Paojiang (Prepared Ginger). If slippery/moist and also swollen/tender, it indicates deficiency-cold of Lung-Large Intestine Metal Qi; use Shenfu Yangrong Tang (Ginseng-Aconite Nourishing Vigor Decoction) removing Fuling, adding Paojiang.

5. A black tongue indicates Kidney-Bladder disorders. (Mingmen Water-Fire attaches, treating left/right Kidneys together.) Regardless of symptoms, if the tongue is black, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Kidney-Bladder; use Qinggan Yin (Clear-Liver Decoction). Black and floating/swollen/tender indicates deficiency of Spirit-Essence in Kidney-Bladder; use Buyuan Jian (Tonify-Origin Decoction). Black and dry indicates either Bladder Yin deficiency with excessive Fire, or Left Kidney Yin deficiency with vigorous Fire. For Bladder Yin deficiency, use Liuwei Yin (Six-Ingredient Decoction); for excessive Fire, combine with Zishen Wan (Nourish-Kidney Pill). For Left Kidney Yin deficiency, use Liuwei Yin; for vigorous Fire, combine with Shengmai San (Generate-Pulse Powder). Black and slippery/moist indicates either Bladder Yin excess with Fire decline, or Right Kidney Yang deficiency with Fire loss. For Bladder Yin excess with Fire decline, use Jin Kui Shenqi Wan (Golden Cabinet Kidney Qi Pill).
The Bladder is the Official of the Capital, storing Body Fluids; its ability to excrete relies on Qi transformation. Yin deficiency with Fire vigor means Heat forces the Bladder, preventing Qi transformation; Yin excess with Fire decline means Cold forces the Bladder, preventing Qi transformation. Bladder dysfunction termed Long (Retention) excludes Spleen-Lung Qi deficiency failing to regulate water passages, mostly falling into these two categories. Although both are Taiyang Long/Bi, one stems from Fire vigor, the other from Fire loss. The diseases differ like heaven and earth, treatments like ice and charcoal. Such opposites allow analogy.
For Right Kidney Yang deficiency with Fire loss, use Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill). If dry but appearing swollen/tender, it indicates dual deficiency of Kidney-Bladder Yin and Yang; use Gouqi Yangrong Tang (Goji Nourishing Vigor Decoction) as primary, followed by Shiquan Dabu Tang made into pills.

Furthermore, tongues changing from white to yellow, yellow to scorched, then to withered-black and dry-cracked, with swollen edges and slippery base, or even completely dry bases with no fluid, rough as sandpaper, and constricted like lychee seeds. These result from labor injuring Spleen-Lung, Qi deficiency generating Heat, mistaken use of diaphoretics increasing deficiency and heat, followed by cold herbs causing heavy Yin internal pressure, leading to deficient Fire flaming upward. Thus white adds yellow, yellow adds scorched, becoming withered-black and dry-cracked. Regardless of pulse or symptoms, large doses of Shenfu Yangrong Tang given frequently often save lives. I saved Pan Zhongjian’s brother from Wucheng, Zhang Xuehai from Gui’an, and Zhu Shengji from Tongxiang, all with this tongue; see medical cases for records.

Slippery/moist and also tender indicates severe exhaustion of Kidney-Bladder Yuan Qi; use Fuzi Yangrong Tang as primary, followed by Yougui Wan (Right-Restore Pill).

Moreover, although tongues are both black, one belongs to Cold Water insulting Earth, requiring Fuzi Lizhong Tang; the other belongs to Kidney Qi overwhelming the Heart, requiring Renshen Bawei Wan. Why different treatments? Cold Water insulting Earth is Yin excess internally forcing Yang outward, false Heat outside and true Cold inside, Ge Yang (Gridlock Yang) syndrome; black gathers only in the tongue center. Kidney Qi overwhelming the Heart is Yin excess below forcing Yang above, false Heat above and true Cold below, Dai Yang (Floating Yang) syndrome; black extends to the tongue tip. However, none are firm/hard; they are swollen and tender. Dryness or slipperiness is secondary. Only for True Fire syndromes is the form firm/contracted and color aged-looking, never swollen/tender.