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My student, Wu Hongxun, a *Xiucai* (scholar) from Shexian, transmitted a prescription for treating acute throat conditions, named "Yan Hou Ji Zheng Yi Gong San" (Extraordinary Efficacy Powder for Acute Throat Emergencies). He stated it was obtained from Suzhou and possessed extraordinary efficacy.

*Xuanshen* (Radix Scrophulariae, 6 fen), *Zhen Shexiang* (Real Musk, 3 fen), were ground together into a fine powder, stored in a porcelain bottle with the seal tight to prevent the loss of medicinal qi. Regardless of whether it is *Lan Hou Feng* (Rotting Throat Wind), *Hou Bi* (Throat Closure), or *Shuang Dan Hou E* (Bilateral or Unilateral Tonsillitis), apply a piece of ordinary plaster, place a dose of this powder the size of a soybean on it, and adhere it to the neck: if the affliction is on the left, apply to the left; if on the right, apply to the right; if in the center, apply to the center. After three to four hours, a blister will form. Puncture it with a silver needle, and it will heal. For *Yin* syndrome types, the blister forms even faster. (This prescription is also recorded in *Yi Sha Cao*).

The prescription for *Lan Hou Sha* (Rotting Throat Plague) found in *Jin Kui Yi* is most miraculous. It uses *Xi Niu Huang* (Western Calculus Bovis, 5 li), *Bingpian* (Borneol, 3 li), *Xiangya Xie* (Ivory Chips, 3 li, roasted), and *Ren Zhijia* (Human Nail, 5 li—those grown on bricks are usable, those on woodboards are not). These are ground into an extremely fine powder and blown into the affected area. For any throat affliction caused by external pathogenic factors, there is no case that does not heal promptly. It is not only revered as a divine pill for *Lan Hou Sha*. However, the preparation and acquisition of these medicines are difficult and hard to obtain suddenly. Those with means should prepare them in advance for emergency use. If preparation is not possible in time, there is another simple method: take five or six *Bi Qian* (House Spider/Weaver's Tent insect), roast them on a tile until dry, grind into powder, add *Ren Zhijia* powder (5 li) and *Xi Niu Huang* (3 li); this is also effective. Another prescription for *Hou E* (Tonsillitis): cut several strands of *Dengcao* (Juncus Effusus Stamen), wrap them around a fingernail, and smoke/burn over fire until yellow and dry. Grind these two substances finely. Then, using fire, extract ten *Bishi* (Bedbugs), and crush them together with the previous mixture into a powder. Place in a silver tube and blow into the affected area; the effect is miraculous. This was recorded by Huang Jiqing (Prefect An Tao Xianyi compiled it).

Observing the tongue during clinical practice is the most reliable basis, yet one must not be dogmatic. *Zhengyi* states: Whenever a black tongue is seen, ask if the patient has consumed sour, sweet, or salty foods, as these can stain the tongue black, which is not due to disease. However, blackening from Liangcheng (a type of food) must be moist and not dry, and scrapes off easily, which is abnormal. Furthermore, only tongues with deficiency-cold and moisture can be stained; if it is excess-heat with dry tongue coating, how can it be stained? When observing the dryness or moisture of a patient's tongue coating, forbid drinking soup or water, as drinking makes differentiation difficult. *Chongqing Tang Suibi* states: A pale tongue with white coating may indicate heat syndrome; a thick, full yellow coating may indicate cold syndrome; a crimson tongue without fluids may indicate phlegm syndrome. One must cross-reference with pulse and symptoms, as well as urination and defecation. Additionally, eating olives turns white coating black (all acidic foods do this); eating loquats turns the coating yellow; looking at a yellow coating under lamplight often makes it appear white. Thus, while the tongue can be relied upon, it is not entirely reliable. Without careful examination, misdiagnosis and mistreatment are inevitable.

Black tongue coating is divided into cold and heat types. Imprecise differentiation leads to immediate determination of life or death. Wang Lingyou stated that although the tongue coating is black, if it is cold and slippery without prickles, it is undoubtedly a *Yin* syndrome. This is indeed a concise and essential statement. (Shu Chiyuan in *Shanghan Jinzhu*) stated that black coating with dryness and prickles represents two syndromes: one is Yangming heat accumulation where yin fluids perish instantly; the treatment focuses on *Dahuang* (Rhei Radix et Rhizoma) and *Mangxiao* (Natrii Sulfas) to urgently purge yang heat to save yin fluids; once yin returns, fluids return. The other is Shaoyin internal cold where true yang is obscured, unable to vaporize fluids, leading to dryness and prickles; the treatment focuses on *Fuzi* (Aconiti Lateralis Radix Praeparata) and *Paojiang* (Zingiberis Rhizoma Preparatum) to urgently dispel yin cold to restore yang; once yang returns, fluids return. Based on this, black coating that is cold and slippery definitely excludes yang syndrome, whereas black coating that is dry and pricky involves both yang and yin syndromes. Can clinicians afford to be careless?

A "Ren" (human character) shaped crack on the tongue is mostly caused by the erroneous administration of cold medicines. Yang Chengliu treated a Mr. Shen who suffered from a severe exogenous condition. His tongue was black and withered, covered with cracks forming the character "Ren". He said: "There is no need to diagnose the pulse. This is Kidney Qi rushing to the Heart, indicating the Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) syndrome. The erroneous use of Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma) makes it incurable." The patient died the next day.

Cheng Xingxuan treated a farmer who had suffered from Shanghan (Cold Damage) for several days, with alternating chills and fever, profuse spontaneous sweating like rain, weak pulse, and mental fatigue. The tongue coating was white and slippery, split into two branches, resembling a knife cut. Upon inquiry, it was learned that he had erroneously taken cooling medicines. He was given Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang), which proved effective. Subsequently, he took Zuo You Er Gui Yin (Left and Right Two Guipi Decoctions) for several doses. The tongue coating gradually receded, and he recovered. Additionally, *Shanghan Jinjing Lu* records cracks like the character "Ren", caused by the blazing of Minister Fire and upward flare of heat toxins. In such cases, Liang Ge San (Cool the Chest Powder) should be used. Here, the tongue appears red, so one must carefully differentiate the pulse and symptoms and treat accordingly.

The son of the Miao family, aged sixteen, had a small tongue growing anew on his tongue, swollen and unable to eat. A doctor cut it with a knife and applied medicine, but it grew back after some time. Multiple treatments failed, and his vitality declined daily. He sought medicine from me. I consulted medical texts and used She Tui (Ophichthidae Exuvies) burned to ash and ground into powder for application (without cutting). He healed immediately, and it did not recur.