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I have read the works of Zhang Zhongjing. He only mentioned white tongue coating and slippery coating, without mentioning yellow, black, prickly, or cracked coatings. It was not until *Jin Jing Lu* (Golden Mirror Record) that thirty-six tongue images were collected. Later, *Guan She Xin Fa* (Observing Tongue Core Method) expanded this to one hundred and thirty-seven.

Why are there so many variations in syndromes in later generations? One should know that in Shanghan (Cold Damage), as pathogenic factors transmit from the exterior to the interior, the tongue coating must change from white and slippery to other colors. This is unlike latent pathogens and epidemics where heat toxins manifest from the interior to the exterior, presenting with yellow and black coatings immediately upon disease onset. Observing Zhang Zhongjing’s discussions, once a white tongue and slippery coating appear, he states the condition is difficult to treat. How could there be changes caused by mismanagement? Thus, Zhang Zhongjing only spoke of white coating, revealing a part of the whole, without being trivial. Later generations lacked the ability of the sages to "treat disease before it arises," so they were forced to repeatedly analyze and discuss to enlighten the ignorant. Generally, when pathogenic factors enter the interior, the mechanisms of deficiency/excess and cold/heat must manifest on the tongue, unlike pulse diagnosis which can be obscure. Moreover, in cases of Yin excess repelling Yang and latent pathogenic heat, there are often false signs and false pulses. Only by examining the moisture, dryness, thickness, and thinness of the tongue coating can the truth be clear as ice, leaving no place for the pathology to hide. Therefore, I selected *Guan She Xin Fa*, corrected its errors, deleted its redundancies, eliminated content irrelevant to Shanghan, and incorporated records from my father’s medical cases and my own experiences. Together, we obtained one hundred and twenty tongue images, named them *Shanghan She Jian* (Compendium of Tongues in Cold Damage), had them engraved and published, to serve as an aid for colleagues in clinical practice.

Written by Zhang Deng, born in the autumn month of the Wushen year of the Kangxi reign, at Yongtang.

When Shanghan pathogenic factors are in the skin and hair, initially there is white foam on the tongue, followed by white saliva and slippery coating, then white flakes and pricks. Differences exist between the center, tip, and root of the tongue, indicating the depth of cold pathogen invasion into the meridians. The tongue is the sprout of the Heart; the Heart belongs to Fire in the South and should be red. Seeing white instead indicates that Fire fails to control Metal (Lung). Initially, cold stagnates in the skin, pores do not open, and heat cannot escape, causing aversion to cold and fever. If in the Taiyang Meridian, symptoms include headache, body heat, stiffness of the neck and back, and pain in the waist and spine. When transmitting to the Yangming Meridian, there may be white flakes covering the tongue. Although irritability may occur, if the pulse is floating and tight, sweating therapy should still be used. In Shaoyang Meridian cases, white coating and slippery texture appear, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) to harmonize. For Spleen/Stomach deficiency, Li Zhong Tang (Regulate the Middle Decoction) warms the interior. If the white color slightly turns yellow, Da Chai Hu Tang (Major Bupleurum Decoction), Da Cheng Qi Tang (Major Order the Qi Decoction), or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are used for purging according to severity. White tongues can also indicate fatal conditions and must not be ignored.

[Micro-white Slippery Coating Tongue]
Cold pathogen newly enters Taiyang: headache, body heat, aversion to cold, tongue color micro-white with fluid. Use Xiang Su San (Fragrant Perilla Powder) or Qiang Huo Tang (Notopterygium Decoction) to disperse externally.

[Thin White Slippery Coating Tongue]
This is a Taiyang interior syndrome tongue. After two or three days without sweating, the pathogen has entered the Dantian deeply. Urgent sweating therapy is needed. Or in combined Taiyang and Shaoyang diseases with this tongue, Zhu Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is the main formula.

[Thick White Slippery Coating Tongue]
On the third or fourth day, the pathogen remains in Taiyang, so the coating is purely white and thick but not dry. Symptoms include headache and fever, pulse floating and tight. Resolving the exterior leads to self-healing.

[Dry Thick White Coating Tongue]
On the fourth or fifth day, without prior sweating, pathogenic heat deepens slightly, causing mild thirst. Overconsumption of cold/raw foods causes stagnation in the chest, leading to Ying-level heat and Stomach cold. This results in fever, irritability, cold limbs, while the tongue coating is white, dry, and thick, with white flakes filling the mouth. Use Si Ni San (Frigid Extremities Powder) added with Gan Jiang (Dried Ginger).

[White Coating with Yellow Center Tongue]
This is the tongue for Taiyang transmitting to Yangming Fu-organ disease. If slightly yellow and moist, use sweating again. Wait for the coating to become dry and interior signs to appear, then purge. If accompanied by irritability and vomiting, modify Da Chai Hu Tang. Some may pass pale yellow watery froth without loose stool; treat with Da Cheng Qi Tang.

[White Coating with Yellow Edges Tongue]
White coating in the center with slight yellow on the periphery indicates impending diarrhea. Use Jie Du Tang (Detoxification Decoction). If aversion to cold exists, use Wu Ling San (Five-Ling Powder).

[Dry White Coating with Black Center Tongue]
This is a Yangming Fu-combined Taiyang tongue. The edges are white, the center is dry and black, caused by incomplete sweating leading to transmission to Yangming. If accompanied by slight sweating, no aversion to cold, and sinking pulse, purging is possible. If no sweating occurred in two or three days and this tongue appears, death is certain.

[White Slippery Coating with Grey Pricks on Tip Tongue]
This is a Yangming Fu-combined Shaoyang tongue. Diarrhea after three or four days with a long pulse indicates survival; a wiry and rapid pulse indicates death. If food retention exists, use Da Cheng Qi Tang to purge; five out of ten may survive.

[White Coating Fully Covered with Dry Black Pricks Tongue]
Dry black thorns growing fully within white coating indicate Shaoyang interior syndrome. Symptoms include aversion to heat rather than cold. Use Da Chai Hu Tang added with Mang Xiao (Mirabilite) for urgent purging. This is also a critical condition.

[White Slippery Coating with Black Center Tongue]
Black in the center of white coating indicates exterior pathogen entering the interior. High fever and delirium require purging with Cheng Qi Tang variants. If relapse due to diet causes fever, or unceasing diarrhea, treatment is difficult.

[Half-Side White Slippery Tongue]
White coating on one side, left or right, belongs to half-exterior half-interior. Use Xiao Chai Hu Tang. Add Ge Gen (Kudzu Root) for the left side, Fu Ling (Poria) for the right. If coughing pulls pain in the hypochondrium with this tongue, use Xiao Qing Long Tang (Minor Blue Dragon Decoction). In summer, with excessive sweating and spontaneous diarrhea, use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction).

[Viscera Knotting White Slippery Tongue]
Left or right half-white coating, the other half black or old yellow, indicates cold pathogen knotting in the Zang organs. Use Huang Lian Tang (Coptis Decoction) added with Fu Zi (Aconite). If knotting in the throat prevents speech, use Sheng Mai San (Generate the Pulse Powder) combined with Si Ni Tang, saving one or two out of ten.

[White Coating with Black Spots Tongue]
Random small black spots appearing in white coating indicate Water overcoming Fire. Without severe symptoms, use Liang Ge San (Cool the Diaphragm Powder) and Cheng Qi Tang to purge; one or two out of ten may survive.

[Dry Cracked White Coating Tongue]
Shanghan with cold in the chest and heat in the Dantian results in white tongue coating. Excessive sweating damages Ying, leaving no fluid on the tongue, causing dryness and cracking. No interior excess heat exists, hence no yellow or black. Use Xiao Chai Hu Tang added with Mang Xiao for mild purgation.

[White Coating with Black Root Tongue]
White coating with a black root indicates Fire overcome by Water. Purging will likely be ineffective.

[White Tip with Yellow Root Tongue]
Although pathogen enters the interior, the white tip has not turned yellow; Cheng Qi Tang is contraindicated. Use modified Da Chai Hu Tang. After purging, if no other symptoms exist, quiet sleep and clear spirit indicate survival. Further changes suggest fatality.

[White Coating with Double Yellow Tongue]
This is a Yangming interior syndrome tongue. Yellow is the color of Earth; pathogenic heat attacking upward causes double yellow on the tongue. If pulse is long, aversion to heat, passing gas, and irritability exist, use Da Chai Hu Tang combined with Tiao Wei Cheng Qi Tang to purge.

[White Coating with Double Black Lines Tongue]
Two black lines in white coating indicate Taiyang and Shaoyang pathogens entering the Stomach. Due to衰竭 of Earth Qi, cold hands and feet and chest knotted pain occur. Select Li Zhong Tang or Xie Xin Tang (Drain the Epigastrium Decoction). If pathogen knots at the tongue root preventing speech, it is a fatal sign.

[White Coating with Double Grey Tongue]
This tongue indicates mixed cold food. Appearing after seven or eight days with fluid present is treatable. Select Li Zhong Tang or Si Ni Tang. Absence of fluid is untreatable. If dry, thick, and showing interior signs, purge. If grey disappears the next day after taking medicine, safety ensues.

[White Tip, Red Center, Black Root Tongue]
White tip and grey-black root indicate Shaoyang pathogenic heat transmitting to Fu organs, extreme heat injuring cold fluids. If water retention and congealed fluids cause thirst, use Wu Ling San. Spontaneous sweating with thirst requires Bai Hu Tang. Diarrhea with thirst requires Jie Du Tang. If black root is extensive, white tip is scarce, and center is not very red, treatment is difficult.

[White Coating with Red Tip Tongue]
Full tongue white and slippery but tip bright red indicates internal excess heat combined with external cold invading Shaoyang. Use modified Xiao Chai Hu Tang.

[White Coating with Red Center Tongue]
This is the tongue for early transmission in Taiyang. No sweat requires sweating therapy; existing sweat requires releasing the muscle layer. Some belong to Shaoyang, treated with modified Xiao Chai Hu Tang.

[White Coating Turning Yellow Tongue]
Shaoyang syndrome resolves, first signs of Yangming interior appear, so coating turns yellow. With passing gas, use Da Chai Hu Tang to purge.

[White Tip with Red Root Tongue]
White coating on the tip indicates pathogen in half-exterior half-interior. Symptoms include alternating chills and fever, deafness, bitter taste, hypochondriac pain, and wiry pulse. Use Xiao Chai Hu Tang to harmonize.

[White Coating with Grey Tip and Yellow Root Tongue]
Taiyang damp-heat combining with Yangming. If root is yellow and moist, with yellow eyes and urine, use Yin Chen Hao Tang (Artemisia Capillaris Decoction) modified.

[White Coating with Black Tip and Root Tongue]
Black tip and root with white center indicate excessive Metal and Water, with衰竭 of Fire and Earth internally. Even without severe symptoms, death is certain.

[Ripe White Tongue]
Extremely aged white coating resembling cooked flesh indicates Heart Qi exhaustion with Lung color overriding above. Caused initially by eating melons, fruits, or ice water, preventing Yang Qi from dispersing. This is a fatal sign. Using Zhi Shi (Immature Bitter Orange) and Li Zhong Tang occasionally yields survival.

[Pale Transparent White Tongue]
In elderly with weak Stomach, even with wind-cold, heat transformation fails. Or excessive herbal intake damages Stomach Qi, resulting in pale transparent appearance, looking like coating but not quite. Treat with modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).

[White Coating Like Accumulated Powder Tongue]
This tongue indicates plague pathogen initially attacking the Mu Yuan (Source). Use Da Yuan Yin (Great Origin Decoction). If Three Yang exterior signs appear, add Chai Hu, Ge Gen, Qiang Huo along the meridians. If interior signs appear, add Da Huang (Rhubarb).