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Purple tongue with coating: This is caused by contracting cold damage after drinking alcohol. It may result from sleeping outdoors in the wind while heavily intoxicated, continuing to drink alcohol after illness onset, or failing to take medicine for a cold and instead using scallion, ginger, and hot wine to induce sweating. Although sweat is produced, the heat of the wine remains in the Pericardium (Xinbao), rushing through the meridians and collaterals, thus causing the tongue to appear purple with a slight white coating. The coating may adhere to the root or tip of the tongue, varying in length, thickness, density, and moisture (slippery vs. dry/scorched). These manifestations differ greatly; one must investigate the source of the pathology to treat accordingly.

Pure Purple Tongue:
When treating cold damage with scallion and wine to induce sweating, wine toxin enters the Heart; similarly, contracting cold damage after drinking alcohol presents this tongue sign. Use Shengma Gegen Tang (Bupleurum and Kudzu Decoction) added with Shigao (Gypsum Fibrosum) and Huashi (Talcum). If there is mental restlessness and vexation (Ao Nu), use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Otherwise, macules (Ban) will inevitably erupt.

Purple Tongue with Red Spots:
If the tongue is uniformly purple with red spots covering the entire surface, or if red spots appear all over the body, use Huaban Tang (Macule-Resolving Decoction) or Jiedu Tang (Detoxification Decoction), both added with Gegen (Puerariae Lobatae Radix), Huanglian (Coptidis Rhizoma), and Qingdai (Indigo Naturalis). If there are indications for purgation, use Liangge San (Cooling the Diaphragm Powder).

Purple Tongue with White Slippery Coating:
A purple tongue with a white coating in the center indicates catching cold after drinking alcohol or mistakenly drinking cold wine. Symptoms include headache, aversion to cold, and fever. Treat by resolving the exterior according to the specific syndrome.

Pale Purple Tongue with Cyan Veins:
A pale purple tongue that is cyan and moist, with cyan-black veins crossing the center, indicates direct invasion of the Yin meridians. Symptoms include coolness of the body, cold extremities (Jue Ni), deep pulse, and dark complexion. Treat with Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Regulate the Middle Decoction).

Purple Tongue with Red Swelling and Dry/Scorched Surface:
A purple periphery with a red, swollen center indicates pathogenic invasion of the Foot Yangming Meridian, or recurrence of pathogenic heat due to consuming wine and meat after purgation. If the swelling is moist, use Da Chaihu Tang (Major Bupleurum Decoction) to mildly promote bowel movement. If there is irritability, cold extremities, and a hidden pulse, first use Zhishi Lizhong Tang (Immature Bitter Orange Regulate the Middle Decoction), followed by Xiao Chengqi Tang (Minor Order the Qi Decoction).

Purple Tongue with Yellow Dry Coating:
In alcoholics injured by cold, on the fourth or fifth day, if the tongue is purple with accumulated dry yellow coating, urgently use Dachengqi Tang (Major Order the Qi Decoction) to purge. If exterior signs remain unresolved, use Da Chaihu Tang.

Short Purple Tongue:
A short, contracted purple tongue indicates food stagnation in the Middle Jiao generating heat, which transmits to the Jueyin Meridian. Urgently use Dachengqi Tang to purge. If heat subsides, the pulse becomes calm, and the tongue becomes soft after purgation, the patient lives; otherwise, death ensues.

Purple Tongue with Yellow Wet Coating:
A pale cyan-purple tongue with a yellow wet coating in the center indicates dietary injury to the Taiyin Spleen. The pulse will be deep and fine. Hardness and pain upon pressing below the heart or beside the umbilicus, or passage of flatus, indicate using Xiao Chengqi Tang added with Sheng Fuzi (Prepared Aconite Lateral Root) or primarily using Huanglong Tang (Yellow Dragon Decoction).

Purple Tongue with Bud-like Tip:
After catching cold, if one does not abstain from alcohol and rich food, symptoms such as cough with phlegm and mental restlessness may occur. A pale purple tongue with bud-like protrusions at the tip indicates lung injury from wine-dampness and stomach injury from rich flavors. Treat with Xiaochaihu Tang (Minor Bupleurum Decoction) modified.

Cooked/Old Dry Purple Tongue:
A tongue entirely purple like cooked meat indicates heat pathogen transmitting to the Jueyin Meridian, a sign of critical illness. Use Danggui Sini Tang (Angelica Frigid Extremities Decoction).

Pale Purple with Cyan Tongue:
A cyan-purple tongue without coating, slippery and thin/small, indicates direct invasion of Kidney and Liver Yin syndromes by cold. Warm urgently with Wuzhuyu Tang (Evodia Decoction) or Sini Tang.

Pale Purple Tongue with Ashy Center:
A pale purple tongue with an ash-gray, or cyan-black center, neither dry nor wet, indicates pathogen injuring the Blood level. Even if there are indications for purgation, only use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Jiuhuangjiu (Wine-processed Rheum Radix et Rhizoma) to mildly promote bowel movement.