经义
少阴之脉，贯肾、系舌本。（《素问》）
心气通于舌，心和则舌能知五味矣。○足太阴气绝，则脉不荣肌肉。唇舌者，肌肉之本也。脉不荣则肌肉软，
肌肉软则舌萎。○足厥阴气绝则筋绝。筋者，聚于阴器而脉络于舌本也。故脉弗荣则筋急，筋急则引舌与卵，故
舌卷卵缩。○人之自啮舌者，何气使然？此厥逆走上，脉气使然也。少阴气至则啮舌，少阳气则啮颊，阳明气
至则啮唇。（《灵枢》）
哲言
舌为肉之聚者，何也？舌虽名为心苗，实与脾、胃相维系者
也。脾、胃和则知五味，人以手按舌根则脾动胃翻而呕吐作，非枢纽何以相感？以舌为肉之聚，虽予之创说，
试验舌之形质，非俨然为肉之彰彰者耶？○五脏之精，皆由脾胃而上贯于舌。舌尖属心，舌本属肾，舌中属脾，
舌左属肝，舌右属肺。色白者，肺病也；青者，肝病也；赤者，心病也；黑者，贤病也；黄者，脾病也。软滑
者虚，刚燥者实。不特伤寒，即杂病亦可借以辨之。○足三阴脉皆系舌本，而舌卷独责之肝，且其证必与囊缩
并见，意者舌无骨而有筋为之络乎？筋急则引舌与卵，其理显然，故肝病不可不验舌。（《医参》）
心脉系舌根，脾络系舌傍，肝脉络舌本，肾液出舌端。○气虚则麻纵，阴火则黯黑，湿痰则肿胀，郁热则
衄血，心火则生疮，脾热则干涩，胃热则舌强，肝热则舌卷，肺热则舌燥而声哑，肾热则津竭而舌心干焦。（《证治汇补》）
赤肿为热，青黑为寒，鲜红为阴虚火旺，淡白为气虚。（《四诊抉微》）
舌乃心之苗。心主火，虽其色宜红，然舌上常有淡白苔者，此胃气也。不可见其有苔，以为食而消之。若
病胃气虚、谷气少，舌必光而无苔，进以粥食而苔渐有者，此吉兆也。有满舌浓苔忽然退去光而燥者，此胃气
将绝也。有黑如淡黑色润者，此肾水克心火，阴盛阳衰也。有舌黑芒刺燥裂者，此热极也。又有舌色大红而无
苔者，此君火浮游于外，物极则反，盛极将衰。如火太旺，将化而为灰之象也，宜用附子纳火归原。○舌燥语
言不清，因燥而不清者可治；舌润语言不清，所谓口虽欲言，舌不能前者，死证也。（张锡驹）
舌者，心之苗也。五脏六腑之大主，其气通于此，其窍开于此。查诸脏腑图，脾、肺、肝、肾无系，不根
于心；核诸经络考，手足阴阳，无脉不通于舌。则知经络脏腑之病，不独伤寒发热有苔可验，即凡内、外杂证，
亦无一不呈形着色于其舌。是以验舌一
法，临证者不可不讲也。○凡物之理∶实则其形坚敛，其色苍老；虚则其体浮胖，其色娇嫩。而病之见于舌也，
其形色亦然。故凡病属实者，其舌必坚敛而苍老；病属虚者，其舌必浮胖而娇嫩。如此分别，则虚、实、真、
假，虽未参证、切脉，而一目先了然矣。○舌如去膜猪腰子者危。○舌如镜面者危。○舌糙刺如砂皮，而干枯燥
裂者危。○舌敛束如荔枝，而绝无津液者危。○舌如火柿者危。○舌如烘糕者危。○舌本强直，转动不活，而语言
謇涩者危。○舌起白苔，如雪花片者，脾冷而闭也，不治。○舌竟无苔，胃气绝也，不治。○舌卷而囊缩者不治。
○有舌同一黑色，而一属寒水侮土者，宜用附子理中；一属肾气凌心者，宜用人参八味。其治不同，何也？盖
寒水侮土者，系阴盛于内，逼阳于外，外假热而内真寒，格阳证也，其黑色止聚于舌中；肾气凌心者，系阴盛
于下，逼阳于上，上假热而下真寒，戴阳证也，其黑色直抵于舌尖，然未有不胖且嫩者。干燥、滑润，又在所
不拘也。惟是实火证，则其形必坚敛，色必苍老，而万无胖嫩者耳。（杨乘六）
舌黑虽云火证，然实火、虚火，皆能为黑。盖实热之黑，必兼红紫干渴，或多芒刺。若沉黑少红而带润滑
者，即非实热。再若六脉细弱，形困气倦，则为大虚之候。是必寒水乘心，火不归原。此不救本而但治标，则
万无一生矣。（张景岳）
舌色灰黑，有阴阳之异。若直中阴经者，实时舌便灰黑，而无积苔也。若热传三阴，必四、五日，表证已
罢，而苔始变灰黑也，有在根、在尖、在中者，有浑舌俱灰黑者。大抵传经热证，见灰黑干苔者，当攻下泄热；
若直中阴证，见灰黑无苔者，当温经散寒。○舌边灰黑而中淡紫，时时由啮舌尖为爽者，乃少阴气逆于上，非
药可治。（《舌鉴》）
凡见黑舌，问其曾食酸、甜、咸物，则能染成黑色，非因病而生也。然染成之黑，必润而不燥，刮之即退
为异。又惟虚寒舌润能染，若实热舌苔干燥何能染及耶？凡临诊欲视病患舌苔燥润，
禁饮汤水，饮后则难辨矣。（《正义》）
感证舌白如刺者，此肺病也。生脉散加生地、归、芍、 、草、柴、芩，以生金滋水。○舌黄苔者，补中
益气汤加芩、连。○舌觉转动不活者，防其卷也。逍遥散加黄芩、丹皮、生地，以滋水生肝。○舌色鲜红者，此
心经病也。六味饮合生脉散，以滋水清火。○凡内伤外感、寒热之分，皆从舌苔颜色为准。如黑而滑者，乃肾
水凌心，用八味丸；枯黑不润者，用六味饮，其人必两颧游红，一剂战而汗愈。如灰色，指甲刮下无渣滓者，
方是火证，乃芩、连之对证也。若肾水凌心，误用芩、连，舌见人字纹，必死。黑而不滑者，乃肾水枯干，当
急救其阴。凡烈焰近炙则燔手，渐高则愈冷，缘冷气乃火逼所致。热病之舌黑，即此理也。（《己任编》）
舌见蓝色者，肺气已绝，肝木独盛，来侵土位也。微蓝者，肺气犹在，可生；深蓝者，必死。宜大补肺、
脾而制肝木。○尝见有姜黄色舌苔，及淡松花色舌苔，津润而冷，是皆阳衰土败之征，必不可治。是又古人所
未言及也。（林慎庵）
凡温热病，必验之于舌。或黄、或浊，可与小陷胸汤或泻心汤，随证治之。或白不燥，或黄白相兼，或灰
白不渴，不可乱投苦泄。其中有外邪未解里先结者，或邪郁未伸，或素属中冷，脘中痞满，宜从开泄，宣通气
滞。如杏、蔻、橘、桔等，轻苦微辛，具流动之品可耳。○舌黄或浊，须要有地之黄，若光滑者，乃无形湿热，
中属虚象，大忌前法。或黄甚如沉香色，或如灰黄色，或中有断纹者，皆当下之，如小承气汤。若未见此色，
不宜用此法。○黄苔不甚浓而滑者，热未伤津，犹可清热透表。若虽薄而干者，邪虽去而津伤也，苦重之药当
禁，宜甘寒轻剂可也。○再论其热传营，舌色必绛。初传绛色中兼黄白者，气分邪未尽也，泄卫透营，两和可
也。纯绛鲜泽者，包络受病，宜犀角、鲜生地、连翘、郁金、菖蒲等。延之数日，或平素心虚有痰，外热一陷，
里络就闭，
非前药所能开，须用牛黄丸、至宝丹，急开其闭，恐其昏厥为痉也。○舌绛中心干者，乃心胃火燔，劫灼津液，
可加黄连、石膏。若烦渴躁热，舌心干、边红，中心或黄、或白者，此非血分，乃上焦气热灼津。急用凉膈散，
散其无形之热，再看其后转变，慎勿用血药以滋腻难散。舌绛望之若干，扪之原有津液，此津亏，湿热熏蒸，
将成浊痰蒙闭心包也。○再有热传营血，其人素有瘀伤、宿血在胸膈中，挟热而搏，舌色紫暗，扪之则湿，加入
散血之品，如琥珀、丹参、桃仁、丹皮等。不尔，瘀血与热为伍，阻遏正气，遂变如狂。若紫而肿大者，乃酒
毒冲心；紫而干晦者，肾、肝色泛也，难治。○舌绛粘腻，似苔非苔者，中挟秽浊，急加芳香逐之。舌绛抵齿
难伸者，痰阻舌根，有内风也。绛而光亮者，胃阴亡也，急用甘凉濡润；绛干而燥者，火邪劫营也，凉血清火
为要。舌绛有碎点白、黄者，防生疳也；大红点者，热毒乘心也，用黄连、金汁；绛而不鲜，干枯而萎者，肾
阴涸也，急以阿胶、鸡黄、地黄、天冬等，缓恐涸极无救。舌独中心绛干者，胃热心营受灼也，当于清胃方中
加入清心之品，否则延及于尖，为津干火盛也。尖绛独干者，心火上炎也，用导赤散泻其腑。○舌苔白浓而干
燥者，胃燥气伤也，滋肾药中加甘草，令甘守津还之意。舌白而薄者，外感风寒也，当疏散之。若白干薄者，
肺津伤也，加麦冬、花露、芦根汁等轻清之品，为上者上治之法也。若白苔绛底者，湿遏热伏也，当先泄湿透
热，防其就干也，勿忧之，再从里透于外，则变润矣。初病舌就干，神不昏者，急宜养正，微加透邪之药；若
神已昏，此内溃矣，不可救药。又不拘何色，舌上生芒刺者，是上焦极热也。用青布拭冷薄荷水揩之，即去者
轻，旋去即生者险。舌苔不燥，自觉闷极者，属脾湿盛也；或有伤痕血迹者，问曾经搔挖否？不可以有血便为
燥证，仍从湿治。再有神爽舌胀不能伸出者，此脾湿胃热，郁极化风，而毒延口也。用大黄磨入药内，则舌胀
自消，○舌白苔粘腻，叶出浊浓涎沫者，口必甜味，
为脾瘅病。乃湿热气聚，与谷气相博，土有余也。盈满则上泛，用省头草芳香辛散逐之则退。若舌苔如碱者，
胃中宿滞，挟浊秽郁伏，当急开泄，否则闭结中焦，不能从膜原达出矣。○舌无苔，如烟煤隐隐者，若不渴肢
寒，阴病也，如口渴烦热，胃燥也。不可攻之，燥者甘寒益胃，润者甘温扶中。○舌黑而滑者，水来克火，为
阴证，当温之。若见短缩，此肾气竭也，为难治。欲救之，补肾药中加人参、五味，勉希万一。舌黑而干者，
津枯火炽，急急泻南补北。若燥而中心浓者，土燥水竭，急以咸苦下之。○舌淡红，或干而色不荣者，是胃津
伤而气无以化液也。当用炙甘草汤，不可用寒凉药。○舌白如粉而滑，边色紫绛者，疫病也。邪初入膜原，未
归胃腑，急急透解，莫待传陷为险恶之变，见此者病必凶。（《指南续刻》）
舌出不能入，用蓖麻子油蘸纸作捻，烧烟熏之，即收。（《同寿录》）
《正传》治舌肿大塞口，用蒲黄一味，频刷舌上，其肿自退。煎药以黄连一味，煎浓汁呷之，以泻心火。（《医学六要》）
热病舌苔焦黑，用井水浸生姜擦去，蜜调元明粉涂之。（孙一奎）
舌痛生疮，心火炎盛，凉膈散。○风热口燥，舌裂生疮，甘露饮。○舌强硬如猪脬，针刺两边血出即消。勿
刺中央，令血不止。○舌下复生小舌名子舌，但胀大而强名木舌。内用辛凉药，外砭其血，即平。○劳神失睡，
口舌破者，安神养血，作心虚治。○舌出不收，心经热甚，用珍珠粉、冰片、人中白末敷之。（《张氏医通》）
选案
王生患伤寒，舌黑如炭，芒刺干裂，身热便结，不渴喜冷，脉则无力，神则昏沉。医谓阳证阴脉必死。余
察其形气未脱，以甘温、壮水等药以救其本，间用凉水以滋其标，前后凡用人参、
熟地各一二斤，附、桂各数两，冷水一二斗。然后诸证渐退，饮食渐进，神气俱复，但察其舌黑分毫不减，心
甚疑之。后数日，忽舌上脱一黑壳，内则新肉灿然，始知肤腠焦枯，死而复活。使非大为滋补，安望再生？（张景岳）
潘中建季弟裕青，劳感，寒热时作，杂用表药，热势转炽，改用清火养阴药，热势转甚。舌胎由白而黄，
由黄而焦，干黑如炭，神昏振掉，撮空自汗，危证 集。郡中名手，见其热势炽甚，以为寒之不寒，是无水也，
投以六味饮，不应。见其舌黑焦干，又以为攻伐太过，胃阴干枯也，投以左归饮，又不应。诊脉左关、尺细紧，
右寸、关大缓，舌浮而胖。谓曰∶证乃阳虚火衰证，舌非阴亏火旺舌也。盖缘阴盛于内，而复益之以阴，逼其
虚阳于皮肤、喉、舌间，故其热益炽而振掉昏沉，其苔益浓而焦干燥裂耳。若果阴亏火旺，则未有六味、左归
滋阴猛进，而舌反加黑、苔反加浓、身反加热者也。夫舌有似实而实虚者，审之贵清；苔有似阳而实阴者，验
之宜晰。今以其舌之干燥而责以阴亏，苔之焦黑而责以火旺。就常而论，谁不云是？殊不知∶阴亏而干燥者，
其舌必坚敛；火旺而焦黑者，其舌必苍老。万无干燥焦黑属阴虚火旺，而舌见胖嫩者也。中建大服予论，乃拟
养营汤，用人参五钱，加附子三钱。一剂熟睡竟夜，翌早舌上干燥焦黑之苔尽脱，变为嫩红滑润矣。原方减轻
参、附，连服四剂，阳回作汗而愈。○汪柳亭年近六旬，病腹胀兼痛，饮食不进，服药增甚。诊脉洪大滑盛，重
按有力，面色 白而带萎黄，舌色青黄而兼胖滑。医方皆消导之属。谓曰∶若但据脉证，则诸方殊得当矣。第
面色白上加黄，且 而萎，舌色黄里见青，且胖而滑，证脉皆非实候。此由思虑郁怒，亏损肝脾，气血两虚，
而脏寒生满，且作痛耳。拟养营汤，倍参、附煎服。一剂痛胀随减，再剂痛胀全除。继用补中益气汤加白芍，
调理如旧。友人陈星川问曰∶柳亭胸次洒落，不知子何所据而责其思虑伤脾、郁怒伤肝耶？予曰∶有诸内必形诸
外。肝之志为怒，凡郁怒用事而肝胆病者，其舌必青。脾之志为思，凡思虑用事而脾胃病者，其舌必黄。故知
其为肝脾伤也。星川曰∶形盛脉大，焉知其证属虚寒乎？予曰∶凡物之理∶实则坚，虚则浮，热则燥，寒则湿。
Classical Meaning
The Shaoyin meridian penetrates the Kidney and connects to the root of the tongue. (Suwen)
Heart Qi communicates with the tongue; when Heart Qi is harmonious, the tongue can perceive the five flavors. ○ When the Qi of the Foot-Taiyin (Spleen) meridian fails, the vessels no longer nourish the muscles. The lips and tongue are the roots of the muscles. If vessels do not nourish, muscles become soft; if muscles are soft, the tongue atrophies. ○ When the Qi of the Foot-Jueyin (Liver) meridian fails, the sinews fail. Sinews gather at the genitalia and their collaterals connect to the root of the tongue. Therefore, if vessels do not nourish, sinews become tense; if sinews are tense, they pull the tongue and testicles, causing the tongue to curl and the testicles to retract. ○ Why does a person bite their own tongue? What Qi causes this? This is due to Jue-ni (rebellious Qi) rising upward, caused by abnormal vessel Qi. When Shaoyin Qi arrives, one bites the tongue; when Shaoyang Qi arrives, one bites the cheek; when Yangming Qi arrives, one bites the lip. (Lingshu)
Philosophical Remarks
Why is the tongue an aggregation of flesh? Although the tongue is named the sprout of the Heart, it is actually connected to the Spleen and Stomach. When the Spleen and Stomach are harmonious, one perceives the five flavors; pressing the root of the tongue with the hand causes the Spleen to move and the Stomach to turn over, inducing vomiting. Without a pivot, how could such interaction occur? To consider the tongue as an aggregation of flesh, although my original theory, upon examining its texture, is it not obviously a gathering of flesh? ○ The essence of the Five Zang organs all ascends through the Spleen and Stomach to reach the tongue. The tip of the tongue belongs to the Heart, the root to the Kidney, the middle to the Spleen, the left side to the Liver, and the right side to the Lung. White color indicates Lung disease; blue/green indicates Liver disease; red indicates Heart disease; black indicates Kidney disease; yellow indicates Spleen disease. Soft and slippery indicates deficiency; rigid and dry indicates excess. Not only in Shanghan (Cold Damage), but also in miscellaneous diseases, the tongue can be used for differentiation. ○ The three Yin meridians of the foot all connect to the root of the tongue, yet tongue curling is solely attributed to the Liver, and this syndrome must present with testicular retraction. I speculate that the tongue has no bone but is connected by sinews? If sinews are tense, they pull the tongue and testicles; the principle is clear. Therefore, Liver diseases must be verified by inspecting the tongue. (Yican)
The Heart vessel connects to the root of the tongue; the Spleen collateral connects to the sides of the tongue; the Liver collateral connects to the root of the tongue; Kidney fluids emerge from the tip of the tongue. ○ Qi deficiency leads to numbness and flaccidity; Yin fire leads to dark/black color; damp-phlegm leads to swelling; constrained heat leads to epistaxis; Heart fire leads to sores; Spleen heat leads to dryness and astringency; Stomach heat leads to tongue stiffness; Liver heat leads to tongue curling; Lung heat leads to dry tongue and hoarseness; Kidney heat leads to exhaustion of fluids and dry/scorched center of the tongue. (Zhengzhi Huibu)
Red and swollen indicates Heat; blue/black indicates Cold; bright red indicates Yin deficiency with floating fire; pale white indicates Qi deficiency. (Szhen Juwe)
The tongue is the sprout of the Heart. The Heart governs Fire; although its color should be red, there is often a pale white coating on the tongue, which represents Stomach Qi. One must not see a coating and assume it is food retention to use digestion-promoting herbs. If the disease involves deficient Stomach Qi and scarce Grain Qi, the tongue will be bald without coating; if a coating gradually appears after consuming porridge, this is an auspicious sign. If a thick coating covering the whole tongue suddenly disappears leaving a bald and dry surface, this indicates the impending extinction of Stomach Qi. If the black coating is like a light black color and moist, this is Kidney Water overcoming Heart Fire, indicating Yin excess and Yang deficiency. If the tongue is black with prickles, dry and cracked, this indicates extreme Heat. If the tongue is bright red without coating, this is Minister Fire floating externally; things reverse when they reach extremes, and abundance declines when it peaks. It is like fire being too strong, about to turn to ash; one should use Fuzi (Aconiti Lateralis Radix Praeparata) to guide fire back to its source. ○ A dry tongue with unclear speech due to dryness is treatable; a moist tongue with unclear speech, described as "the mouth wishes to speak but the tongue cannot advance," is a death syndrome. (Zhang Xiju)
The tongue is the sprout of the Heart. The Great Master of the Five Zang and Six Fu organs, its Qi communicates here, its orifice opens here. Examining the organ diagrams, the Spleen, Lung, Liver, and Kidney have no direct connection rooted in the Heart; checking the meridians, no Yin-Yang meridians of the hand and foot lack communication with the tongue. Thus, we know that diseases of the meridians and organs, not only Shanghan fever with coating verification, but all internal and external miscellaneous syndromes, present their form and color on the tongue. Therefore, tongue diagnosis is a method that clinicians must study. ○ The principle of all things: Excess syndromes have firm and contracted forms with aged colors; Deficiency syndromes have floating and swollen forms with tender colors. Diseases manifesting on the tongue follow this rule. Thus, excess diseases have firm, contracted, and aged tongues; deficiency diseases have floating, swollen, and tender tongues. With such distinction, one can clearly see deficiency/excess and true/false even without pulse taking or inquiry. ○ A tongue resembling a defatted pig kidney is critical. ○ A mirror-like tongue is critical. ○ A rough, prickle-covered tongue like sandpaper, dry and cracked, is critical. ○ A tongue contracted like a lychee with absolutely no fluids is critical. ○ A tongue like a roasted persimmon is critical. ○ A tongue like baked cake is critical. ○ A stiff root of the tongue with inflexible movement and slurred speech is critical. ○ White coating like snowflakes indicates cold Spleen closure; untreatable. ○ No coating indicates extinction of Stomach Qi; untreatable. ○ Tongue curling with testicular retraction is untreatable. ○ There are black tongues: one type is Cold Water insulting Earth, treated with Fuzi Lizhong Tang; another is Kidney Qi overwhelming the Heart, treated with Renshen Bawei Wan. Treatments differ why? Cold Water insulting Earth implies Yin excess internally forcing Yang externally (False Heat, True Cold, Ge Yang syndrome); black concentrates in the center. Kidney Qi overwhelming the Heart implies Yin excess below forcing Yang above (False Heat, True Cold, Dai Yang syndrome); black reaches the tip, always accompanied by a puffy and tender tongue. Dryness/moisture is secondary. Real Fire syndromes always have firm/contracted forms and aged colors, never puffy/tender. (Yang Chengliu)
Although black tongue is said to be a Fire syndrome, both Real Fire and Deficient Fire can cause blackness. Real Heat blackness accompanies red/purple, dryness/thirst, or prickles. Deep black with little red and moist/slippery is not Real Heat. If six pulses are fine/weak and the body is fatigued, it is a severe deficiency. This is Cold Water attacking the Heart, Fire not returning to its origin. Treating only symptoms without saving the root guarantees death. (Zhang Jingyue)
Grey-black tongue color differs in Yin/Yang. Direct invasion of Yin meridians causes immediate grey-black tongue without accumulated coating. Heat transmitting to the Three Yin takes 4-5 days after exterior symptoms cease for the coating to turn grey-black. It may be at the root, tip, middle, or entire tongue. Generally, transmitted Heat with grey-black dry coating requires purgation to drain Heat; Direct Invasion Yin syndrome with grey-black no-coating requires warming meridians to scatter Cold. ○ Grey-black edges with pale purple center, relieved by biting the tip, indicates Shaoyin Qi rebelling upward; untreatable by medicine. (Shejian)
When seeing a black tongue, ask if the patient ate sour, sweet, or salty foods, which can stain it black, unrelated to disease. Stained black is moist, not dry, and scrapes off easily. Only moist deficiency-cold tongues can be stained; dry real-heat coatings cannot. To observe tongue moisture/dryness, forbid drinking water before examination. (Zhengyi)
Exterior pathogenic syndrome with white tongue like prickles indicates Lung disease. Use Shengmai San plus Shengdi Huang, Dang Gui, Bai Shao, Gan Cao, Chai Hu, Huang Qin to generate Metal and nourish Water. ○ Yellow coating: Buyi Yiqi Tang plus Huang Qin, Huang Lian. ○ Tongue feels inflexible: prevent curling. Use Xiaoyao San plus Huang Qin, Mu Dan Pi, Sheng Di Huang to nourish Water and benefit Liver. ○ Bright red tongue: Heart channel disease. Liuwei Dihuang Wan combined with Shengmai San to nourish Water and clear Fire. ○ Differentiation of internal injury/exterior contraction, cold/heat relies on tongue coating color. Black and slippery: Kidney Water overwhelming Heart, use Bawei Wan. Dry black: Liuwei Dihuang Wan, patient likely has floating red on malar eminences, one dose induces chills-sweat cure. Grey, no residue when scraped: Fire syndrome, appropriate for Huang Qin, Huang Lian. If Kidney Water overwhelms Heart and Huang Qin/Huang Lian are mistakenly used, a human-character pattern appears on tongue; fatal. Black not slippery: Kidney Water exhausted, urgently save Yin. Extreme heat burns hands, but increases distance makes it colder because cold air is forced out by fire. Black tongue in heat diseases follows this logic. (Jiren Bian)
Blue tongue indicates Lung Qi extinction, Liver Wood flourishing alone invading Earth. Light blue: Lung Qi remains, curable; deep blue: fatal. Tonify Lung/Spleen heavily to control Liver Wood. ○ I have seen ginger-yellow and pale pine-flower colored coatings, moist and cold; these are signs of Yang failure and Earth decay, untreatable. Unmentioned by ancients. (Lin Shen'an)
For warm-heat diseases, always check the tongue. Yellow or turbid: Xiao Xianxiong Tang or Xiexin Tang according to syndrome. White not dry, or yellow-white mixed, or grey-white without thirst: do not indiscriminately use bitter-draining herbs. If exterior pathogen unresolved and interior knotted, or pathogen constrained, or constitutionally cold with epigastric fullness, use opening/draining methods to circulate Qi stagnation. Xing Ren, Kou Ren, Ju Hong, Jie Geng, etc., light bitter/mild acrid, mobile agents suffice. ○ Yellow/turbid coating must have a base; if smooth, it is formless damp-heat, interior deficiency, strictly avoid previous methods. Very yellow like沉香 (Agarwood) or grey-yellow, or with cracks: purge with Xiao Chengqi Tang. If these colors absent, do not use this method. ○ Yellow coating not thick but slippery: Heat has not damaged fluids, still can clear Heat and release exterior. Thin but dry: Pathogen gone but fluids damaged, prohibit heavy bitter drugs, use mild sweet-cold agents. ○ Heat transmitting to Ying level: tongue becomes crimson. Initial crimson with yellow/white indicates remaining Qi-level pathogen; vent Wei and penetrate Ying to harmonize. Pure bright crimson: Pericardium affected, use Xijiao, fresh Sheng Di Huang, Lian Qiao, Yu Jin, Shi Chang Pu. If delayed or chronic phlegm with Heart deficiency, exterior heat sinking closes interior collaterals; former drugs ineffective, use Niuhuang Wan or Zhibao Dan to urgently open closure, preventing coma/spasm. ○ Crimson tongue with dry center: Heart/Stomach Fire blazing, damaging fluids, add Huang Lian, Shi Gao. If irritability/thirst/restlessness, dry center/red edges, yellow/white center: not Blood level, but Upper Jiao Qi Heat burning fluids. Urgently use Liangge San to scatter formless Heat, watch for transformation, avoid cloying blood-invigorating herbs. Crimson looking dry but moist to touch: Fluid deficiency, damp-heat steaming, impending turbid-phlegm clouding Pericardium. ○ Heat transmitting to Ying/Blood with pre-existing blood stasis in chest/diaphragm, clashing with heat: purple-dark tongue, moist to touch, add blood-dispersing herbs like Hupo, Danshen, Tao Ren, Mu Dan Pi. Otherwise, stasis and heat combine, obstructing righteous Qi, leading to manic behavior. Purple-swollen: Wine toxicity rushing Heart; purple-dry/dull: Kidney/Liver colors surfacing, difficult to treat. ○ Crimson sticky, semi-coating: turbid pathogens inside, urgently add aromatic dispersants. Crimson tongue hard to extend against teeth: Phlegm blocking root, internal wind. Crimson bright: Stomach Yin perishing, urgently use sweet-cool moistening. Crimson dry: Fire evil robbing Ying, cool blood/clear fire essential. Crimson with small white/yellow spots: prevent ulcers; large red spots: Heat toxin attacking Heart, use Huang Lian, Jin Zhi. Crimson dull, dry/withered: Kidney Yin exhausted, urgently use Ejiao, Ji Huang, Di Huang, Tian Dong, delay risks irreversible exhaustion. Center-only crimson/dry: Stomach Heat robbing Ying, add Heart-clearing herbs to Stomach-clearing formula, else spreads to tip (fluid dry/fire excess). Tip-only crimson/dry: Heart Fire flaming up, use Dao Chi San to drain its Fu. ○ Thick white dry coating: Stomach dryness/Qi damage, add Gan Cao to Kidney-tonifying herbs for sweet-retention/fluid-return intent. Thin white coating: Exterior Wind-Cold, disperse. White thin/dry: Lung fluid damage, add Mai Dong, Hua Lu, Lu Gen Zhi (light/clear agents for upper treatment). White coating with crimson base: Damp suppressing Heat, first drain damp/vent Heat, prevent drying, then vent from interior to exterior to restore moisture. Early dry tongue without coma: urgently tonify righteousness, slightly add pathogen-releasing herbs; if coma: internal collapse, untreatable. Regardless of color, prickles indicate extreme Upper Jiao Heat. Wipe with green cloth dipped in cold mint water; if prickles disappear lightly, mild; if they regenerate immediately, dangerous. Moist coating but severe stuffiness: Spleen dampness excess. Scratches/blood: ask if scratched; do not assume dryness from blood, treat dampness. Spirit clear but swollen tongue unable to extend: Spleen damp/Stomach heat, extreme constraint transforming into wind/toxin extending to mouth. Add Mo Du Huang to medicine, swelling subsides. ○ White sticky coating exuding turbid frothy saliva: sweet taste in mouth, Pi Dan syndrome. Damp-heat gathering competing with Grain Qi, Earth excess. Fullness floats up, use Sheng Tou Cao (aromatic/acrid-dispersant) to drive away. Coating like alkali: Stomach retained stagnation with turbid pathogens, urgently open/drain, else mid-Jiao closure prevents exit from Membrane Source. ○ No coating, faint coal-smoke appearance: if no thirst/cold limbs, Yin disease; if thirsty/restless, Stomach dryness. Do not purge. Dry: sweet-cold benefit Stomach; Moist: sweet-warm support Middle. ○ Black slippery: Water overcoming Fire, Yin disease, warm it. Shortened/retracted: Kidney Qi exhausted, difficult. Save with Kidney-tonics plus Renshen, Wu Wei Zi, slight hope. Black dry: Fluid exhaustion/Fire blazing, urgently drain South/nourish North. Dry thick center: Earth dry/Water exhausted, urgently purge with salty-bitter. ○ Pale red, dry/lusterless: Stomach fluid damage, Qi unable to transform fluids. Use Zhigancao Tang, prohibit cold-cold drugs. ○ White like powder/slippery, purple-crimson edges: Epidemic disease. Pathogen just entered Membrane Source, not in Stomach, urgently resolve/transmit, do not wait for dangerous transmission; prognosis ominous. (Zhinan Xuke)
Tongue protruding unable to retract: Dip paper in Castor oil, burn smoke to fumigate, tongue retracts. (Tongshou Lu)
Zhengzhuan treats swollen tongue blocking mouth: Use Puhuang alone, frequently brush tongue, swelling recedes. Decoct Huanglian alone, drink concentrated juice to drain Heart Fire. (Yixue Liuyao)
Heat disease scorched-black coating: Soak Ginger well-water, wipe off, apply Yuanming Fen mixed with honey. (Sun Yikui)
Tongue pain/sores: Heart Fire blazing, Liangge San. ○ Wind-Heat dry mouth/cracked tongue/sores: Ganlu Yin. ○ Tongue stiff like pig bladder: Prick sides until blood flows, swelling subsides. Do not prick center to avoid uncontrolled bleeding. ○ Small tongue under tongue called Zi She; swollen/stiff called Mu She. Internal acrid-cool herbs, external bloodletting, calms. ○ Mental fatigue/insomnia/broken mouth-tongue: Calm spirit/nourish blood, treat as Heart deficiency. Tongue protrusion不收 (unretractable): Heart channel heat severe, apply Zhenzhu Fen, Bingpian, Renzhongbai powder. (Zhangshi Yitong)
Selected Cases
Wang suffered Shanghan, tongue black like charcoal, prickles dry/cracked, body heat/constipation, no thirst but likes cold, pulse weak, spirit comatose. Doctor said Yang syndrome with Yin pulse means death. I observed form/Qi not depleted, used sweet-warm/Kidney-nourishing drugs to save root, occasionally cool water for branch. Used Renshen, Shu Di Huang 1-2 jin each, Fuzi, Rougui several liang, cool water 1-2 dou. Symptoms gradually retreated, diet improved, spirit recovered, but tongue remained black. Days later, black shell peeled off, revealing bright new flesh. Skin/flesh scorched/dead revived. Without massive tonification, rebirth impossible. (Zhang Jingyue)
Pan Zhongjian's younger brother Yuqing, labor-induced infection, alternating cold/heat, miscellany exterior drugs, heat intensified, switched to cooling/nourishing Yin, heat worsened. Coating white→yellow→scorched, dry black like charcoal, coma/tremors/grabbing air/sweating, critical. Famous local doctors saw intense heat, thought "cold doesn't cold = no Water", gave Liuwei Dihuang Wan, failed. Saw black/dry tongue, thought "over-purged Stomach Yin dry", gave Zuogui Yin, failed. Pulse: Left Guan/Chi fine/tight, Right Cun/Guan large/slow, tongue floating/puffy. Said: Syndrome is Yang deficiency/Fire decline, tongue is not Yin deficiency/Fire excess. Yin excess internally, added more Yin, forced deficient Yang to skin/throat/tongue, hence heat/tremor/coma/coating thick/dry/cracked. If truly Yin deficiency/Fire excess, Liuwei/Zuogui would not make tongue blacker/coating thicker/body hotter. Tongues look excess but are deficiency (clarify); coatings look Yang but are Yin (verify clearly). Now blaming dryness for Yin deficiency, blackness for Fire excess seems normal. But: Yin deficiency dryness = firm/contracted tongue; Fire excess blackness = aged tongue. Never dry/black deficiency Yin/Fire excess with puffy/tender tongue. Pan accepted theory, prescribed Yangying Tang, Renshen 5 qian, Fuzi 3 qian. One dose slept night, next morning dry/black coating shed, turned tender red/slippery. Reduced Renshen/Fuzi, 4 doses, Yang returned, sweat, cured. ○ Wang Liuting, nearly 60, abdominal distension/pain, no appetite, meds worsened. Pulse large/slippy/prosperous, deep press strong, face pale yellow/withered, tongue blue-yellow/puffy/slippy. Doctors used digestion/promotion. Said: Based on pulse/syndrome, formulas fit. But face pale-yellow/withered, tongue blue-in-yellow/puffy/slippy, pulse/syndrome not excess. Caused by worry/anger, damaging Liver/Spleen, Qi/Blood dual deficiency, organ cold generates fullness/pain. Prescribed Yangying Tang, double Renshen/Fuzi. One dose pain/distension reduced, two doses removed. Then Buyi Yiqi Tang + Bai Shao, regulated. Friend Chen Xingchuan asked: Liuting is cheerful, why blame worry anger? Said: Internal manifests external. Liver emotion is anger, constrained anger/Liver-Gallbladder disease = blue tongue. Spleen emotion is worry, worry/Spleen-Stomach disease = yellow tongue. Hence Liver/Spleen damage. Xingchuan: Strong form/large pulse, how know deficiency-cold? Said: Principle: Excess firm, Deficiency floating, Heat dry, Cold moist.