六淫感症有真传。临症先将舌法看。察色分经兼手足。营卫表里辨何难。
邵评∶白苔主表。黄苔主里。足经之邪。分表里治之。白苔主卫。绛苔主营。手经之邪。分心营肺卫治之。
凡诊伤寒。当先察舌之形色。分别足经手经。卫分营分。在表在里。再参脉症施
治。无不获效。若拘定足六经治病。非但无效。且病亦鲜有合六经者。伤寒兼六气言。故曰六淫感症。
邵评∶伤寒邪在足经。故从足六经分表里而施治。温热暑疫。邪入手经。当辨明心营肺卫。从上中下三焦
施治。不可拘定足六经认症也。
白肺绛心黄属胃。红为胆火黑脾经。少阴紫色兼圆浓。焦紫肝阳阴又青。
邵评∶此条统论手经足经。以舌之形色辨之。
此以形色分六经。兼心肺两手经。足六经不言太阳者。以太阳初感。舌未生苔也。故凡临症。见舌无苔而润。
或微白而薄。即是太阳。黄苔阳明。红色少阳。黑苔太阴。紫色少阴。焦紫厥阴阳邪。青滑厥阴阴邪。俱见前。
邵评∶上二条总论舌苔。太阳与肺。同主表。邪尚在表。故舌无苔而或薄白。
表白里黄分汗下。绛营白卫治天渊。次将津液探消息。泽润无伤涩已亏。
此以下辨营卫表里治法。白苔属表。当汗。黄苔属里当下。绛苔营分之热。宜清忌表。白苔卫分之邪。
宜汗忌清。治法天渊。再以舌之燥润。验其津液存亡。不拘何色。但以润泽为津液未伤。燥涩为津液已耗。
热病以存津液为主。故宜深察。
邵评∶伤寒邪从肌表而入。以舌之黄白。分表里而汗下。温暑从口鼻吸入。以舌之绛白。分营卫而用
清解。以舌之润燥。辨其津液之存亡。分际极清。
白为肺卫仍兼气。绛主心营血后看。白内兼黄仍气热。边红中白肺津干。
邵评∶卫之后方言气。营之后方言血。卫气营血。逐层递进。须认明此四层施治。邪之入先到卫分。
不解。然后入气分。营分不解。然后入血分。白内兼黄。仍属气分之热不可用营分药。白苔边红。此温邪
入肺。灼干肺津。不可辛温过表。清轻凉散为当。
邵评∶此经辨邪入之路。有卫分气分营分血分之不同。临症时最宜细审。
卫邪可汗宜开肺。气分宜清猛汗难。入营透热羚犀妙。到血惟清地与丹。
邵评∶此条辨邪之在卫。在气。在营。在血。分层治法。
凡舌苔白润而薄。邪在卫分。可汗。开肺即是开太阳。如麻黄、羌活之类。如舌苔白而浓。或兼干。
是邪已到气分。只宜解肌清热。如葛根、防风、连翘、薄荷之类。不可用辛温猛汗也。若寒邪化热。过卫
入营。或温邪吸入。竟入营分。则舌苔红绛
而燥。惟羚、犀为妙品。以能透热于营中也。邪在营分不解。渐入血分。则发热不已。宜清血分之热。
鲜生地、牡丹皮之类。
邵评∶此条以舌苔之黄白红绛。辨卫分营分之表里。界限极清。
白黄气分流连久。尚冀战汗透重关。舌绛仍兼黄白色。透营泄卫两和间。
邵评∶邪在气分。日数虽多。可从战汗而解。若邪入营。则不作战。如初入于营。尚在营卫之间。
犹可透营以达至卫耳。
凡舌苔白中带黄。日数虽多。其邪尚在气分流连。可冀战汗而解。若舌红绛中仍带黄白等色。是邪
在营卫之间。当用犀、羚以透营分之热。荆、防以散卫分之邪。两解以和之可也。
邵评∶此条是透营泄卫之要法。惟荆、防不如薄荷、连翘为稳。
白而薄润风寒重。温散何妨液不干。燥薄白苔津已少。只宜凉解肺家安。
邵评∶风寒在表。舌薄白而润。可从足经用温散药。如燥白尖红。此风热入肺而津亏。当从手
经用轻清凉解。
此辨风寒与风热治法不同。凡风寒初入太阳。则舌无苔。或生苔白润而薄。此
寒邪重。津液不亏。辛温汗之可也。如白苔虽薄而燥。或舌边舌尖带红。此风热之邪。伤于气分。病在
太阴手经。津液已少。不可过汗。只宜清轻凉解肺分。如前胡、苏子、杏仁、连翘、黄芩、薄荷、
桔梗、淡竹叶之类。
苔若纯黄无白色。表邪入里胃家干。更验老黄中断裂。腹中满痛下之安。
邵评∶舌苔纯黄无白。邪入胃经。热而未实。宜白虎等汤。清热凉润。若焦黄断裂。热入胃腑而燥
实。症必腹满坚痛。故可下之。
凡治病。先要辨清营卫表里。上文辨营卫。此论表里。然表证即属卫分。故此专论里症。伤寒由表
达里。故舌苔先白后黄。至纯黄无白。邪已离表入里。即仲景所云胃家实也。然舌苔虽黄。而未至焦
老裂纹起刺。大便虽秘。而未至痞满硬痛。尚属胃家热而未实。宜清不宜攻。必再验其舌形黄浓焦老。
中心裂纹。或起刺。腹中硬满胀痛。方用承气。下之则安。
邵评∶邪入阳明。有在经在腑之分。有已实未实之别。治法有宜清宜下之异。临症切宜详察。
舌中心属胃。凡肠中有燥矢。舌心必有黄燥黑燥等苔。然腹无硬满攻痛之状。
亦只须养阴润燥。不可妄用承气攻之。
邵评∶二条论外邪。以舌之黄白分表里。惟舌燥有津亏邪实之不同。须分别施治。
太阴腹满苔粘腻。苍朴、陈苓、湿结开。黄燥若还胸痞闷。泻心小陷二方裁。
邵评∶湿邪结于太阴。症必胸腹满闷。湿阻气机。宜以苦温开之。若痰热湿邪结于心下而痞痛者。
邪滞中宫。宜泻心陷胸。以开痞涤痰。阳明实满。舌苔老黄燥裂。太阴湿满。舌苔白而粘腻。阳明实满。
满及脐下少腹。太阴湿满。满在心下胃口。
邵评∶此数句辨症确切。当熟记之。
湿邪结于太阴。则胸腹满闷。宜苦温以开之。苍朴、二陈、二苓之类。若黄苔而燥。
胸中痞满。此阳邪结于心下。按之痛者。热痰固结也。（小结胸症）小陷胸法。呕恶溺涩者。湿热
内结也。泻心法。
微黄粘腻兼无渴。苦泄休投开泄安。热未伤津黄薄滑。犹堪清热透肌端。
邵评∶舌微黄薄滑。邪在肺卫。结于上焦气分。宜杏、蔻、桔、橘。轻苦微辛。开泄上焦
气分以达邪。不可用陷胸、泻心苦泄之法。
病有外邪未解。而里先结者。如舌苔粘腻微黄。口不渴饮。而胸中满闷是也。此湿邪结于气分。
宜白蔻、橘红、杏仁、郁金、枳壳、桔梗之类。开泄气分。使邪仍从肺分而出。则解矣。不可用泻心苦
泄之法。黄苔虽主里。如苔薄而滑者。是热邪尚在气分。津液未亡。不妨用柴、葛、苓、翘。或栀、豉、
翘、薄之类。轻清泄热透表。邪亦可外达肌分而解也。此两条。舌色似里而实表。不可作里症治。
湿留气分苔粘腻。小溺如淋便快联。湿结中焦因痞满。朴陈温苦泄之痊。
邵评∶舌苔粘腻。湿之证据。当以苔之黄白分寒湿湿热。寒湿用苦温以开泄之。
湿热用苦寒以开泄之。
此以粘腻舌苔。为湿邪之验。白而粘腻者寒湿。黄而粘腻者湿热。更验其小便不利。大便反快。为湿
邪痞满。乃湿邪结于中焦。宜浓朴、苍术、二苓、二陈之类。苦温以开泄之。若舌黄粘腻。痞闷呕恶。
大小便俱不利。此湿热结于中焦。宜泻心之类。苦寒以开泄之。
上焦湿滞身潮热。气分宣通病自痊。湿自外来肌表者。秦艽、苏、桂解肌先。
邵评∶湿滞上焦。宣通气分则愈。以湿邪从外来。上焦气分先受也。非若内生之湿。恒结中焦而痞满也。
凡看舌苔。或白或微黄而粘腻不渴者。总属湿邪。但湿自内出。恒结于中焦。而成痞满。若湿自外来。
上焦气分受之。每见潮热自汗。医者表之不解。清之不应。不知热自湿中来。只要宣通气分。如淡豆豉、茯苓
皮、滑石粉、半夏、猪苓、米仁、广皮、白蔻、黄芩之类。气分湿走。热自止矣。若冒雨雾湿邪。留于
太阴肌分之表。发热自汗不解。口不渴饮。身虽热。不欲去衣被。舌苔灰白粘腻。宜桂枝、秦艽、紫苏、
茯苓皮、二陈、姜皮之类。解肌和表。湿邪自去。
湿热久蒸成内着。浓黄呕吐泻心权。若兼身目金黄色。五苓、栀、柏共茵煎。
邵评∶湿热结于中焦。呕吐痞满。舌苔黄浓。宜泻心开泄中焦。若误治迁延而成黄胆。宜茵陈、五苓、
栀子柏皮等方。
湿热内着。从饮食中得之。嗜酒人多此。苔必浓黄粘腻。痞满不饥。呕吐不纳。惟泻心最效。川连、
干姜、赤苓、半夏、枳实、茵陈、通草之类。湿热内结。若错治必致成疸。宜五苓、加茵陈、栀、柏之类。
邵评∶以上论黄白舌苔。前二条论风寒。后四条论湿症。
舌绛须知营分热。犀、翘、丹、地、解之安。若兼鲜泽纯红色。胞络邪干菖、郁、攒。素有火痰成
内闭。西黄、竺、贝、可加餐。
邵评∶舌红绛。邪入营分也。宜犀、翘、等清透之。舌纯红鲜泽。邪入胞络也。轻用菖蒲、郁金、开之。
重用牛黄丸、至宝丹、紫雪丹。芳香开秘。若痰热结秘。加西黄、川贝、天竺黄。清火化痰。
邪入营中。宜泄营透热。故用犀角。以透营分之热邪。翘、丹、鲜地。以清营分之热邪。邪入心胞络。则神
昏内闭。须加川郁金、石菖蒲、以开之。若兼有火痰。必致痰涎内闭。更当加西黄、川贝、天竺黄之类。清火豁痰。
心承胃灼中心绛。清胃清心势必残。君火上炎尖独赤。犀兼导赤泻之安。
邵评∶黄苔而中心绛者。胃火灼心也。宜川连、石膏、以清心胃。舌尖赤而有刺。心火上炎也。宜犀角、川
连、合导赤散。泻小肠火府。
如黄苔而中心绛者。心受胃火蒸灼也。于清胃药中。加清心药。其势必孤矣。如舌尖独赤起刺。心火上炎
之故。犀角合导赤散以泻之。若见边红中燥白。上焦气热血无干。但清膈上无形热。滋腻如投却病难。
邵评∶舌苔边红。中心燥白。乃上焦气分无形之热。其邪不在血分。切勿妄投滋腻血分之药。宜轻
清凉解为治。
凉膈散去芒硝、大黄、加石膏。能清膈上无形客热。其邪不在血分。妄投滋腻。必增病矣。
绛舌上浮粘腻质。暑兼湿浊欲蒸痰。恐防内闭芳香逐。犀、珀、菖蒲、滑、郁、含。
邵评∶舌绛粘腻上浮。暑湿酿蒸。痰浊蒙闭心包也。急用芳香逐秽。宣窍涤痰之法。痰多。可用西
黄、天竺黄之属。
暑蒸湿浊则成痰。暑湿兼秽。恐蒙闭心胞。故用菖蒲、郁金、藉其芳香逐秽。犀角以透营分暑邪。琥珀、
滑石清暑利湿。
白苔绛底因何事。热因湿伏透之难。热毒乘心红点重。黄连、金汁乱狂安。
邵评∶舌苔白底绛者。热被湿遏。不得外透也。用犀角、滑石等药。泄湿透热。湿去则热自解矣。
热因湿邪遏伏。宜泄湿以透热。如犀角、滑石、茯苓皮、猪苓、米仁、茵陈、黄柏之类。
若湿温症。舌现红星点点。此热毒乘心。必神昏谵语。宜苦寒之品治之。狂乱者。非黄连、
金汁不解。如无金汁。以人中黄代之。
邵评∶舌苔有大红点子者。此湿温症热毒乘心也。症必昏谵狂乱。故用黄连清心火。金汁解热毒。
舌绛碎生黄白点。热淫湿 欲生疳。古名狐惑皆同此。杂症伤寒仔细探。
邵评∶舌绛碎而有黄白腐点者。此湿热邪毒。蕴久不宣。蒸腐气血。化为瘀浊。得风木之气。化而成虫也。
狐惑。即牙疳、下疳之古名也。近时惟以疳名之。牙疳。即惑也。蚀咽腐龈。脱牙。穿腮。破唇。
下疳即狐也。蚀烂肛阴。由伤寒余毒。与湿 为害。若胃强能食。可任苦寒重药者。可治。（参金鉴）
邵评∶金鉴以牙疳、下疳分狐惑。与金匮所言似异。
按狐惑。虫症也。上唇有疮。虫食其脏。兼咽烂。名惑。下唇有疮。虫食其肛。兼声哑。名狐。面
色乍白。乍黑。乍赤。恶闻食气。情志嘿嘿。此其候也。（参准绳）
邵评∶此参准绳与金匮之言相同。又云狐惑。虫病也。惑当作蜮。看其上唇内生
疮如粟。唾血。心内懊 而痛。此虫在上。食其五脏。下唇内生疮者。其人不寤。此虫食下部是也。
金匮蚀于上部则声嗄。甘草泻心汤。蚀于下部则咽干。苦参汤洗之。蚀于肛者。雄黄熏之。
舌绛不鲜枯更萎。肾阴已涸救之难。紫而枯晦凋肝肾。红泽而光胃液干。
邵评∶紫绛不鲜。枯晦且痿。为肝肾阴涸而败。药难救治。若淡红光润鲜明者。乃胃津干也。急用甘
凉濡润之药。以救胃阴。舌形紫晦如猪肝色。绝无津液者为枯。舌形敛缩。伸不过齿为萎。此肝肾已败。
不治。若舌色红泽而光。其色鲜明者。属胃阴干涸。犹可滋养胃阴。甘凉纯静之品主之。如鲜生地、鲜石
斛、蔗浆、梨汁之类。
邵评∶以上论红绛舌苔。
黄浓方知邪入里。黑兼燥刺热弥深。屡清不解知何故。火燥津亡急救阴。
邵评∶舌苔黑燥。阳明热极。然无痞满之症。不宜下而宜清。清之不应。肠中燥屎
与热邪固结。土燥水亏。胃液已干。急宜甘寒凉润。以救胃阴。阴回。二便自通不可妄下。
黑燥为阳明之热。腹无痞满硬痛。非承气症。只宜清解。若清之不应。是肠中燥矢与热邪
固结。胃土过燥。肾水不支。胃中阴液已干。宜大小甘露饮。以救胃汁。阴液充溢。阳邪自解。二便自通。
黑滑太阴寒水侮。腹痛吐利理中寻。更兼粘腻形浮胖。伏饮凝痰开逐斟。
邵评∶舌苔黑滑。寒水侵侮脾土。宜理中汤温之。若兼粘腻浮胖。是湿痰寒饮。伏于脾中。宜
温运药以开逐痰湿。
The transmission of diseases caused by the six excesses (Liu Yin) has authentic principles. In clinical practice, one must first examine the tongue. Observing the complexion helps differentiate the meridians involved, and distinguishing between Ying-Wei (Nutritive-Defensive) and Exterior-Interior is not difficult.
Shao's Commentary: White coating indicates an exterior syndrome; yellow coating indicates an interior syndrome. For pathogens affecting the foot meridians, treatment should be differentiated by exterior and interior. White coating relates to the Wei (Defensive) level; crimson coating relates to the Ying (Nutritive) level. For pathogens affecting the hand meridians, differentiation should be made between Xin-Ying (Heart-Nutritive) and Fei-Wei (Lung-Defensive).
When diagnosing Shanghan (Cold Damage), one must first observe the color and shape of the tongue, distinguishing between foot and hand meridians, Wei and Ying levels, and exterior and interior locations. Treatment based on pulse and symptoms will invariably be effective. If one rigidly adheres only to the Six Foot Meridians for diagnosis, it will not only be ineffective but also rare for diseases to strictly conform to these patterns. "Shanghan" discusses the six Qi (Atmospheric influences), hence termed "Six Excesses Induced Diseases."
Shao's Commentary: Shanghan pathogens reside in the foot meridians, so treatment differentiates exterior and interior among the Six Foot Meridians. Warm, summer-heat, and epidemic pathogens enter the hand meridians; thus, one must distinguish Xin-Ying and Fei-Wei levels and treat according to the Upper, Middle, and Lower Jiao (Triple Burners). One must not rigidly rely solely on the Six Foot Meridians for symptom recognition.
White coating belongs to the Lung; crimson coating to the Heart; yellow to the Stomach; red to Gallbladder fire; black to the Spleen meridian. Shaoyin (Lesser Yin) presents with purple, round, and thick coatings; scorched purple indicates Liver Yang; green indicates Yin cold.
Shao's Commentary: This section generally discusses hand and foot meridians, identified by tongue color and shape.
This method uses tongue color and shape to differentiate the Six Meridians, including the Hand-Lung and Hand-Circle Pericardium. The Taiyang (Greater Yang) meridian is omitted from the foot meridians list because, upon initial contraction, no coating forms on the tongue. Therefore, clinically, if the tongue has no coating and is moist, or slightly white and thin, it indicates Taiyang disease. Yellow coating indicates Yangming (Bright Yang) disease; red indicates Shaoyang (Lesser Yang); black indicates Taiyin (Greater Yin); purple indicates Shaoyin; scorched purple indicates Jueyin (Terminal Yin) Yang pathogen; green and slippery indicates Jueyin Yin pathogen. These were mentioned previously.
Shao's Commentary: The previous two sections summarize tongue coatings. Taiyang and the Lung both govern the exterior; since the pathogen remains in the exterior, the tongue lacks a coating or has a thin white one.
White coating indicates the exterior, requiring sweating methods; yellow coating indicates the interior, requiring purgation methods. Crimson coating indicates heat in the Ying level, suitable for clearing but contraindicated for sweating. White coating indicates pathogenic factors in the Wei level, suitable for sweating but contraindicated for clearing. The therapeutic approaches are worlds apart. Next, probe the moisture of the tongue to assess fluids: moistness indicates unharmed fluids; dryness and roughness indicate depleted fluids.
Below this point, we differentiate treatments for Ying-Wei and Exterior-Interior. White coating belongs to the exterior, warranting diaphoresis. Yellow coating belongs to the interior, warranting purgation. Crimson coating indicates heat in the Ying level, which should be cleared, avoiding exterior-releasing methods. White coating indicates pathogenic factors in the Wei level, which should be released via sweating, avoiding clearing methods. The treatments are vastly different. Furthermore, check the dryness or wetness of the tongue to verify the survival of body fluids. Regardless of color, moistness means fluids are intact; dryness and roughness mean fluids are consumed. In febrile diseases, preserving body fluids is paramount, so deep observation is necessary.
Shao's Commentary: Shanghan pathogens enter from the muscle surface; tongue yellow/white coatings differentiate exterior/interior for sweating/purging. Warmth and summer-heat pathogens enter via mouth/nose; tongue crimson/white colors differentiate Ying/Wei for clearing/resolving. Tongue dryness/moistness distinguishes fluid survival/depletion. The boundaries are very clear.
White coating governs Lung-Wei, still involving the Qi level; crimson governs Heart-Ying, with Blood level conditions seen subsequently. White coating internally mixed with yellow still indicates Qi-level heat. Red edges with a white center indicate dried Lung fluids.
Shao's Commentary: After the Wei level comes the Qi level; after the Ying level comes the Blood level. Wei, Qi, Ying, and Blood progress layer by layer. One must clearly recognize these four layers for treatment. Pathogens enter the Wei level first; if unresolved, they enter the Qi level. If Ying level is unresolved, they enter the Blood level. White coating mixed with yellow internally still belongs to Qi-level heat; Ying-level medicines must not be used. Red edges with white coating indicate warm pathogens entering the Lung and burning Lung fluids; acrid-warm strong sweating is contraindicated. Light, cool, and dispersing methods are appropriate.
Shao's Commentary: This section differentiates the pathway of pathogen entry, noting differences between Wei, Qi, Ying, and Blood levels. Careful examination is crucial in clinical practice.
Wei-level pathogens can be treated by sweating, preferably by opening the Lung Qi. Qi-level pathogens require clearing; violent sweating is difficult to cure. Entering the Ying level, penetrating heat with Antelope Horn (Lingyangjiao) and Rhinoceros Horn (Xijiaojiao) is excellent. Reaching the Blood level, only clearing with Rehmannia (Dishengdi) and Moutan Bark (Mudanpi) works.
Shao's Commentary: This section differentiates layered treatments for pathogens in the Wei, Qi, Ying, and Blood levels.
Whenever the tongue coating is white, moist, and thin, the pathogen is in the Wei level and can be treated by sweating. Opening the Lung is equivalent to opening the Taiyang meridian, using herbs like Ephedra Herb (Mahuang) and Notopterygium Root (Qianghuo). If the white coating is thick or dry, the pathogen has reached the Qi level; only muscle-relieving and heat-clearing methods are suitable, such as Kudzu Root (Gegen), Saposhnikovia Root (Fangfeng), Forsythia Fruit (Lianqiao), and Mint Leaf (Bohe). Acrid-warm violent sweating must be avoided. If cold pathogens transform into heat, passing the Wei level into Ying, or if warm pathogens are inhaled directly into the Ying level, the tongue coating becomes crimson and dry. Only Antelope Horn and Rhinoceros Horn are excellent products, as they can penetrate heat from the Ying level. If pathogens remain unresolved in the Ying level and gradually enter the Blood level, fever persists; clearing blood-level heat with Fresh Rehmannia Root (Xiashengdi) and Tree Peony Bark (Mudanpi) is indicated.
Shao's Commentary: This section uses yellow, white, red, and crimson tongue coatings to differentiate exterior/interior in the Wei and Ying levels, with very clear boundaries.
White and yellow coatings indicate pathogens lingering in the Qi level for a long time; one may still hope for resolution through battle-sweat. If the tongue is crimson but still retains white/yellow hues, it indicates a state between penetrating Ying and releasing Wei, requiring harmonization.
Shao's Commentary: When pathogens are in the Qi level, even after many days, resolution may occur via battle-sweat. If pathogens enter the Ying level, battle-sweat does not occur. If newly entered into Ying, remaining between Ying and Wei, it is still possible to penetrate Ying to reach Wei.
Whenever the tongue coating is white with yellow in the middle, despite many days, the pathogen lingers in the Qi level; resolution via battle-sweat may be expected. If the tongue is red/crimson but still carries yellow/white colors, the pathogen is between Ying and Wei. Use Rhinoceros Horn and Antelope Horn to penetrate Ying-level heat, and Schizonepeta Spike (Jingjie) and Saposhnikovia Root (Fangfeng) to disperse Wei-level pathogens. Dual resolution to harmonize is appropriate.
Shao's Commentary: This section describes the essential method of penetrating Ying and releasing Wei. However, Mint and Forsythia are more stable than Schizonepeta and Saposhnikovia.
Thin, moist white coating indicates heavy Wind-Cold; warming dispersion is permissible as fluids are not yet dry. Dry, thin white coating indicates depleted fluids; only cool resolving is suitable to calm the Lung.
Shao's Commentary: Wind-Cold at the exterior presents with thin, moist white coating; warming dispersive drugs from the foot meridians can be used. If dry white with red tip, this is Wind-Heat entering the Lung with fluid deficiency; light, cool, and resolving drugs from the hand meridians should be used.
This section differentiates treatments for Wind-Cold and Wind-Heat. When Wind-Cold initially enters Taiyang, the tongue has no coating, or a thin, moist white coating; this indicates heavy cold pathogens without fluid depletion, allowing acrid-warm sweating. If the white coating is thin but dry, or the tongue edges/tip are red, this is Wind-Heat damaging the Qi level, affecting the Hand-Taiyin meridian, with depleted fluids. Strong sweating is contraindicated; only light, cool, and Lung-resolving methods are suitable, such as Peucedanum Root (Qianhu), Perilla Fruit (Suzi), Apricot Seed (Xingren), Forsythia Fruit (Lianqiao), Scutellaria Root (Huangqin), Mint Leaf (Bohe), Platycodon Root (Jiegeng), and Bamboo Leaf (Dan Zhuye).
Pure yellow coating without white indicates exterior pathogens have entered the interior, drying the Stomach. Further verification of old yellow coating with cracks indicates abdominal fullness and pain, resolvable by purgation.
Shao's Commentary: Pure yellow coating without white indicates pathogens entering the Stomach meridian, heat without excess. Baihu Decoction (White Tiger Decoction) and similar formulas should be used to clear heat and cool moisten. Scorched yellow with cracks indicates heat entering the Stomach fu-organ with dryness and excess; symptoms must include abdominal fullness and hard pain, thus purgation is applicable.
In treating diseases, one must first differentiate Ying-Wei and Exterior-Interior. The previous text differentiated Ying-Wei; this discusses Exterior-Interior. Since exterior syndromes belong to the Wei level, this specifically discusses interior syndromes. Shanghan progresses from exterior to interior, so tongue coatings change from white to yellow. When purely yellow without white, pathogens have left the exterior and entered the interior, what Zhang Zhongjing called "Stomach House Excess" (Wei Jia Shi). However, if the yellow coating is not old, scorched, cracked, or prickly, and although stool is constipated, there is no epigastric stuffiness, fullness, hardness, or pain, it belongs to Stomach heat without excess. Clearing is preferred over attacking. Only when verifying a thick, old, scorched yellow coating with central cracks or prickle-like projections, accompanied by abdominal hardness, fullness, distension, and pain, should Chengqi Decoctions be used. Purgation will bring relief.
Shao's Commentary: Pathogens entering Yangming have distinctions between meridian and fu-organ involvement, and between excess and non-excess states. Treatments vary between clearing and purging. Clinical observation must be detailed.
The center of the tongue corresponds to the Stomach. Whenever there are dry fecal masses in the intestines, the tongue center must show yellow-dry or black-dry coatings. However, if there are no signs of abdominal hardness, fullness, or attacking pain, only nourishing Yin and moistening dryness is required. Wangfully using Chengqi Decoctions for purging is contraindicated.
Shao's Commentary: These two sections discuss external pathogens, differentiating exterior/interior by tongue yellow/white, and noting that dry tongues differ in fluid deficiency versus pathogen excess. Treatments must be distinguished accordingly.
Taiyin abdominal fullness with sticky coating: use Atractylodes Rhizome (Cangzhu), Magnolia Bark (Houpo), Tangerine Peel (Chenpi), and Poria (Fuling) to open dampness accumulation. If yellow-dry coating accompanies chest stuffiness, choose between Xiexin Decoction (Drain the Epigastrium Decoction) or Xiaoxianxiong Decoction (Small Trap-the-Chest Decoction).
Shao's Commentary: Dampness accumulating in Taiyin causes chest and abdominal fullness due to Qi mechanism obstruction; bitter-warm opening is suitable. If phlegm-heat-dampness accumulates in the epigastrium causing stuffiness and pain, with pathogens stagnating in the Middle Palace, Xiexin and Xiaoxianxiong decoctions should be used to open stuffiness and purge phlegm. Yangming excess fullness presents with old, yellow, dry, cracked coating; Taiyin damp fullness presents with white, sticky coating. Yangming excess fullness extends to the umbilicus and lower abdomen; Taiyin damp fullness is confined to the epigastrium and stomach entrance.
Shao's Commentary: These sentences differentiate symptoms accurately and should be memorized.
Dampness accumulating in Taiyin causes chest and abdominal fullness; bitter-warm opening is suitable, using Atractylodes, Magnolia, Erchen Decoction (Two-Aged Decoction), and Erling (Poria and Polyporus). If yellow-dry coating accompanies chest stuffiness, this is Yang-pathogen accumulation in the epigastrium; tenderness on pressure indicates solidified heat-phlegm (Minor Trap-the-Chest Syndrome). Use Xiaoxianxiong method. Vomiting, nausea, and scanty urine indicate internal damp-heat accumulation; use Xiexin method.
Slightly yellow, sticky coating with no thirst: do not administer bitter-draining; use opening-draining for peace. Heat has not damaged fluids; thin, slippery yellow coating allows for clearing heat and penetrating the muscle layer.
Shao's Commentary: Slightly yellow, thin, slippery coating indicates pathogens in Lung-Wei, accumulated in the Upper Jiao Qi level. Use Areca Seed (Baidu Kou), Citrus Peel (Ju Hong), Apricot Seed (Xingren), and Aurantium Fruit (Zhi Ke) with light bitter and slight acrid properties to open and drain Upper Jiao Qi to expel pathogens. Do not use the bitter-draining methods of Xiaoxianxiong or Xiexin.
Diseases may have unresolved exterior pathogens while the interior is already bound, such as sticky, slightly yellow coating, no thirst, but chest stuffiness. This is dampness accumulating in the Qi level. Use Areca Seed, Tangerine Peel, Apricot Seed, Curcuma Tuber (Yujin), Aurantium Fruit, and Platycodon Root to open and drain the Qi level, allowing pathogens to exit via the Lung. Then resolution occurs. Do not use Xiexin bitter-draining methods. Although yellow coating mainly indicates interior, if the coating is thin and slippery, heat pathogens remain in the Qi level, fluids are not lost. It is acceptable to use Bupleurum Root (Chaihu), Kudzu Root (Gegen), Poria, Forsythia, or Gardenia Fruit (Zhizi), Fermented Soybean (Chiji), Forsythia, and Mint to lightly clear heat and release the exterior. Pathogens can also reach the muscle layer and resolve. These two cases show tongue colors resembling interior but actually being exterior; do not treat as interior syndromes.
Dampness remaining in the Qi level presents with sticky coating; urine resembles strangury, stool is loose/frequent. Dampness binding in the Middle Jiao causes stuffiness/fullness; Magnolia, Two-Aged Decoction, bitter-warm opening-draining cures it.
Shao's Commentary: Sticky coating is evidence of dampness. Differentiate cold-damp vs. damp-heat by yellow/white coating. Cold-damp uses bitter-warm opening-draining; damp-heat uses bitter-cold opening-draining.
This uses sticky tongue coating as evidence of dampness. White and sticky indicates cold-damp; yellow and sticky indicates damp-heat. Further verify if urination is difficult and stool is loose, indicating dampness-related stuffiness. This is dampness binding in the Middle Jiao. Use Magnolia Bark, Atractylodes, Polyporus, and Two-Aged Decoction, bitter-warm to open and drain. If yellow sticky coating, stuffiness, vomiting, nausea, and difficulty in both urination and defecation occur, this is damp-heat binding in the Middle Jiao; use Xiexin-type formulas, bitter-cold to open and drain.
Upper Jiao damp stagnation causes tidal fever; ventilating the Qi level leads to recovery. Dampness coming from outside to the muscle surface: use Gentian Root (Qinjiao), Perilla Leaf (Suzi), and Cinnamon Twig (Guizhi) to relieve the muscle layer first.
Shao's Commentary: Upper Jiao damp stagnation resolves by ventilating the Qi level. Since dampness comes from outside, the Upper Jiao Qi level is affected first. Unlike internally generated dampness, which often binds in the Middle Jiao causing stuffiness.
Generally, observing tongue coating: whether white or slightly yellow, sticky, and without thirst, it always belongs to dampness. Dampness originating internally often binds in the Middle Jiao, causing stuffiness. If dampness originates externally, it affects the Upper Jiao Qi level, often presenting with tidal fever and spontaneous sweating. If physicians attempt exterior-releasing without success, or clearing without response, they fail to realize heat arises from dampness. Simply ventilate the Qi level using Fermented Soybean, Poria Skin, Talcum Powder, Pinellia Tuber (Banxia), Polyporus, Coix Seed (Yiren), Tangerine Peel, Areca Seed, and Scutellaria Root. As Qi-level dampness moves, heat stops. If exposed to rain/fog dampness, leaving it in the Taiyin muscle-surface exterior, presenting with fever, spontaneous sweating unrelieved, no thirst, body heat but aversion to removing clothes, and grey-white sticky coating, use Cinnamon Twig, Gentian Root, Perilla Leaf, Poria Skin, Two-Aged Decoction, and Ginger Peel to relieve the muscle layer and harmonize the exterior; dampness will depart naturally.
Long-term steaming of damp-heat creates internal adherence; thick yellow coating with vomiting requires Xiexin Decoction authority. If accompanied by golden-yellow skin and eyes, use Wuling Decoction (Five-Ingredient Powder with Poria), Gardenia, Phellodendron Bark (Huangbai), and Yinchen (Artemisia Capillaris) together.
Shao's Commentary: Damp-heat binding in the Middle Jiao causes vomiting, stuffiness, and thick yellow coating; use Xiexin to open and drain the Middle Jiao. If mistreated and prolonged leading to jaundice, use Yinchen, Wuling Decoction, Zhizi-Baipi Decoction, etc.
Internal damp-heat adherence comes from diet, common in those who drink alcohol. Coating must be thick, yellow, and sticky; stuffiness, lack of appetite, vomiting, inability to eat. Xiexin is most effective. Use Coptis Rhizome (Chuanlian), Dried Ginger (Ganjiang), Red Poria (Chiling), Pinellia, Aurantium Fruit, Yinchen, and Tongcao. Internal damp-heat binding, if mistreated, inevitably leads to jaundice. Use Wuling Decoction plus Yinchen, Zhizi, Huangbai.
Shao's Commentary: Above discusses yellow/white tongue coatings. First two sections discuss Wind-Cold; latter four discuss dampness syndromes.
Crimson tongue indicates heat in the Ying level; Rhinoceros Horn, Forsythia, Moutan, and Rehmannia resolve it peacefully. If fresh and glossy pure red, pathogens dry the Pericardium Collateral; use Acorus Rhizome (Shichangpu) and Curcuma Tuber (Yujin) to gather/open. If prone to fire-phlegm causing internal closure, add Buffalo Musk (Xihuang), Bamboo Honey (Tianzhuhuang), and Fritillaria Bulb (Beimu).
Shao's Commentary: Red/crimson tongue indicates pathogens entering the Ying level. Use Rhinoceros Horn and Forsythia to clear and penetrate. Pure red and glossy indicates pathogens entering the Pericardium Collateral. Lightly use Acorus and Curcuma to open. Heavily use Niuhuang Wan (Calculus Bovis Pill), Zhibao Dan (Precious Treasure Pill), or Zixue Dan (Purple Snow Pill) for aromatic opening of closure. If phlegm-heat causes closure, add Buffalo Musk, Fritillaria, and Bamboo Honey to clear fire and transform phlegm.
Pathogens entering Ying require draining Ying and penetrating heat; thus use Rhinoceros Horn to penetrate Ying-level heat pathogens. Forsythia, Moutan, and Fresh Rehmannia clear Ying-level heat pathogens. Pathogens entering the Heart Pericardium cause spirit confusion and internal closure; add Curcuma and Acorus to open. If accompanied by fire-phlegm, leading to phlegm saliva internal closure, further add Buffalo Musk, Fritillaria, and Bamboo Honey to clear fire and expel phlegm.
Heart receives Stomach scorching, center is crimson; clearing Stomach and Heart simultaneously risks failure. Sovereign Fire flares up, tip alone is red; Rhinoceros combined with Daochi Decoction clears it peacefully.
Shao's Commentary: Yellow coating with crimson center indicates Stomach fire scorching the Heart. Use Coptis and Gypsum to clear Heart and Stomach. Tip alone red with prickles indicates Heart Fire flaring up. Use Rhinoceros Horn and Coptis combined with Daochi Decoction to drain Small Intestine Fire Mansion.
If yellow coating has a crimson center, the Heart is steamed/scorched by Stomach fire. Adding Heart-clearing drugs to Stomach-clearing drugs makes the force isolated. If the tip alone is red with prickles, it is due to Heart Fire flaring up; Rhinoceros Horn combined with Daochi Decoction drains it. If edges are red and center is dry white, Upper Jiao Qi is hot but Blood is not dry. Only clear formless heat above the Diaphragm; administering cloying/nourishing drugs will hinder disease resolution.
Shao's Commentary: Tongue coating with red edges and dry white center indicates formless heat in the Upper Jiao Qi level; pathogens are not in the Blood level. Do not rashly administer cloying Blood-nourishing drugs. Light, cool, and resolving methods are appropriate.
Liangge Decoction remove Mangxiao (Mirabilite) and Dahuang (Rhubarb), add Shigao (Gypsum); it can clear formless guest heat above the Diaphragm. Pathogens are not in the Blood level; rashly administering cloying drugs will surely increase illness.
Crimson tongue floating with sticky texture: Summer-heat combined with damp turbidity desires to steam phlegm. Fear of internal closure, use aromatic expulsion; Rhinoceros Horn, Amber (Hupo), Acorus, Talcum (Huashi), Curcuma contained.
Shao's Commentary: Crimson tongue with sticky floating texture indicates Summer-heat/Dampness brewing, phlegm-turbidity clouding the Pericardium. Urgently use aromatic expulsion of filth, ventricular orifice clearing, and phlegm purging. If much phlegm, use Buffalo Musk and Bamboo Honey.
Summer-heat steams damp turbidity to form phlegm; Summer-heat/dampness combined with filth fears clouding the Pericardium. Thus use Acorus and Curcuma for their aromatic expulsion of filth. Rhinoceros Horn penetrates Ying-level Summer-heat pathogens; Amber and Talcum clear Summer-heat and promote dampness drainage.
Why white coating with crimson base? Heat trapped by dampness is hard to penetrate. Heat toxin attacks Heart, red spots severe; Coptis and Jinzhi (Gold Juice) calm mania.
Shao's Commentary: White coating with crimson base indicates heat suppressed by dampness, unable to penetrate outward. Use Rhinoceros Horn and Talcum to drain dampness and penetrate heat. Once dampness leaves, heat resolves.
Heat trapped by dampness pathogens requires draining dampness to penetrate heat, using Rhinoceros Horn, Talcum, Poria Skin, Polyporus, Coix Seed, Yinchen, and Phellodendron. If Wet-Warmth syndrome presents with red star-like spots on the tongue, this is heat toxin attacking the Heart,必定 (necessarily) causing spirit confusion and delirious speech. Bitter-cold products should be used. For mania/raving, only Coptis and Jinzhi (Gold Juice) can resolve it. If Jinzhi is unavailable, Renzhonghuang (Human Waste Charcoal) substitutes.
Shao's Commentary: Tongue coating with large red dots indicates Wet-Warmth syndrome heat toxin attacking the Heart. Symptoms necessarily include confusion, delirium, and mania. Thus Coptis clears Heart Fire, and Jinzhi resolves heat toxin.
Crimson tongue fragmented with yellow/white spots: Heat excess and dampness desire to generate Gan (ulcers). Ancient name Huhu (Fox-Charm) is all the same; miscellaneous diseases and Shanghan require careful exploration.
Shao's Commentary: Crimson tongue fragmented with yellow/white putrid spots indicates damp-heat toxin, accumulated long without release, steaming/burning Qi and Blood, transforming into stasis-turbidity. Obtaining Wood wind energy, it transforms into worms. Huhu is the ancient name for Ya Gan (Tooth Ulcer) and Xia Gan (Genital Ulcer). Recently only named Gan. Ya Gan is Huo (Charm), eroding throat, rotting gums, losing teeth, piercing cheeks, breaking lips. Xia Gan is Hu (Fox), eroding anus and genitals. Caused by Shanghan residual toxins and dampness harming. If Stomach is strong and able to eat, capable of bearing heavy bitter-cold drugs, it is treatable. (Refer to Jinjian)
Shao's Commentary: Jinjian differentiates Huhu into Ya Gan and Xia Gan, seemingly differing from Jingui statements.
According to Zhunsheng, Huhu is a worm syndrome. Sores on upper lip, worms eat viscera, accompanied by throat rot, named Huo. Sores on lower lip, worms eat anus, accompanied by hoarseness, named Hu. Complexion alternates white, black, red; aversion to food smell, silent mood, these are its signs.
Shao's Commentary: This references Zhunsheng agreeing with Jingui. Also states Huhu is a worm disease. 'Huo' should be 'Yu'. Look at sores inside upper lip like millet grains, spitting blood, heart restlessness and pain; this worm is above, eating five viscera. Sores inside lower lip, person cannot wake; this worm eats the lower part. Jingui: Erosion above causes hoarseness, Gancao Xiexin Decoction. Erosion below causes dry throat, Kushen Decoction wash. Erosion at anus, Xionghuang (Realgar) fumigate.
Crimson tongue not fresh, withered and shriveled: Kidney Yin exhausted, saving is difficult. Purple withered and dull withers Liver/Kidney; Red glossy and bright indicates Stomach fluid dry.
Shao's Commentary: Purple/crimson not fresh, withered/dull and shriveled indicates Liver/Kidney Yin exhaustion and failure; drugs are hard to save. If pale red, glossy, and bright, it is Stomach fluid dry; urgently use sweet-cool moistening drugs to save Stomach Yin. Tongue shape purple/dull like pig liver color, absolutely no fluids is "withered". Tongue shape contracted, extension not past teeth is "shrivelled"; this indicates Liver/Kidney failure, untreatable. If tongue color red/glossy/bright, color vivid, it belongs to Stomach Yin dryness; still possible to nourish Stomach Yin, using sweet-cool pure quiet products like Fresh Rehmannia, Fresh Dendrobium, Sugarcane Juice, and Pear Juice.
Shao's Commentary: Above discusses red/crimson tongue coatings.
Thick yellow confirms pathogen entered interior; Black combined with dry prickles heat deepens repeatedly. Frequent clearing fails, why? Fire dryness fluid death urgently save Yin.
Shao's Commentary: Black dry coating indicates extreme Yangming heat. However, without stuffiness/fullness symptoms, purging is unsuitable, clearing is suitable. If clearing fails, dry feces bind with heat pathogens in intestines, Earth dry/Water deficient, Stomach fluids dry. Urgently use sweet-cold cool-moist to save Stomach Yin. Once Yin returns, bowel/bladder movements pass naturally; do not rashly purge.
Black dry is Yangming heat; abdomen no stuffiness/hard pain, not Chengqi syndrome, only clearing suitable. If clearing fails, dry feces bind with heat, Stomach Earth too dry, Kidney Water unsupported, Stomach Yin dry. Use Da/Xiao Ganlu Yin to save Stomach juice. Yin fluids fill, Yang pathogens resolve, bowels/bladder pass naturally.
Black slippery Taiyin cold water insults; Abdominal pain vomiting diarrhea seek Lizhong. Plus sticky floating fat shape; Hidden drinking congealed phlegm open/draining斟酌.
Shao's Commentary: Black slippery coating indicates Cold Water insulting Spleen Earth; Lizhong Decoction warms it. If plus sticky floating fat shape, it is damp-phlegm cold drinking hidden in Spleen; use warm-moving drugs to open/draining phlegm-dampness.