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In observing the transmission and transformation of Shanghan (Cold Damage), one must first differentiate the tongue color, so that the principles of cold, heat, deficiency, and excess become clearly visible. For instance, whether there is thirst or not in the mouth, whether body fluids are present or absent, dry or moist, whether the tongue color is red, crimson, pale, or white, whether the coating is yellow, white, scorched, or black, the number of prickles on the tongue, whether they are easily scraped off or difficult to scrape and prone to regrowth, the size and thickness of tongue swelling, the ease or difficulty of tongue extension and retraction, and whether the patient prefers hot or cold drinks, all these require careful examination. Zhang Zhongjing stated: When pathogenic factors are in the exterior, there is no thirst; when transmitted to the interior, there is thirst; when directly invading the Three Yin meridians, there is no thirst; in cases of blood stasis accumulation, there is also no thirst. This explains why it is necessary to distinguish between thirst and no thirst. Excessive sweating leads to loss of fluids and a dry tongue; indiscriminate use of drying and heating herbs also causes a dry tongue; in patients with dampness, impaired Qi transformation also results in a dry tongue. Extreme heat leads to exhaustion of body fluids; exhaustion of Yin also leads to fluid depletion. Thus, it is essential to distinguish the presence, absence, dryness, and moisture of body fluids. Hyperactive Heart Fire results in a red or crimson tongue; Spleen Qi deficiency results in a pale white tongue. Thus, it is essential to distinguish between red/crimson and pale/white tongue colors. Cold in the chest leads to a white and slippery coating; food retention leads to a yellow coating; extreme heat leads to a black coating; exhaustion of Kidney Water leads to a scorched black coating. Thus, it is essential to distinguish between yellow, white, and scorched black coatings. Superficial pathogenic heat results in few prickles; deep pathogenic heat results in many prickles; decline of True Yin also results in many prickles. Furthermore, prickles that are easily scraped off indicate a treatable condition; those that cannot be scraped off and regenerate easily indicate a difficult-to-treat condition. Thus, it is essential to distinguish the number and ease/difficulty of prickles. Severe damp-heat leads to tongue swelling; loss of Kidney fluids also leads to tongue swelling. If the tongue is dry, thick, and accompanied by unclear speech, it is difficult to treat. Thus, it is essential to distinguish the size and thickness of tongue swelling. Although the tongue is dry, if it can extend normally, it is treatable; if the tongue is retracted, unable to extend or speak, it is untreatable. Thus, it is essential to distinguish the ease or difficulty of tongue extension. Excess heat thirst leads to a preference for cold drinks, consumed greedily without satiety; deficiency heat thirst leads to a preference for hot drinks, stopping after small amounts. Thus, it is essential to distinguish the temperature and quantity of drink intake. The above distinctions should be made in detail. Most importantly, one must combine pulse diagnosis and symptoms to differentiate deficiency and excess, and apply tonification or purgation methods accordingly; other matters are not discussed here. Consider, for example, a black, scorched, and dry tongue, possibly with swelling or prickles. Many practitioners fail to differentiate this, assuming it is merely a heat syndrome, and prescribe Huanglian Jiedu Tang (Coptis Decoction for Detoxification) or Da Chengqi Tang (Major Order the Qi Decoction) / Xiao Chengqi Tang (Minor Order the Qi Decoction) for purgation. Little do they know that if the pulse is deficient and rapid, or fine and minute, and the chest and abdomen are free of distension and fullness, even if the tongue is black, scorched, dry, swollen, or prickle-covered, this indicates exhaustion of True Water failing to control Fire. In such cases, one should administer Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) in large doses. If it is a deficiency-cold pattern, add Rougui (Cinnamon Bark), Fuzi (Prepared Aconite Root), and Wuweizi (Schisandra Fruit). Then, the scorched black, swollen, and prickle-covered tongue will dissipate like melting ice. Conversely, using cooling herbs like Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Huafen (Trichosanthes Root) will exacerbate the condition. I have witnessed this repeatedly and am convinced of its certainty.

I once treated two patients who developed fever after entering water, with overwhelming dampness, resulting in a dry tongue lacking fluids. I prescribed Pingwei San (Regular Stomach Powder) with Gegen (Kudzu Root), and their tongues subsequently produced fluids. This confirmed that when the Spleen and Stomach are affected by dampness, Qi transformation fails, and fluids cannot be generated. Using Cangzhu (Atractylodes Rhizome) to dry dampness restores Qi transformation and generates fluids.

Case Record 1: A woman suffered from fever for over ten days, with a dry tongue covered in prickles. Her pulse was fine, minute, and soft. Palpation of her chest and abdomen revealed no discomfort. I said, "This is due to excessive use of draining and attacking herbs, leading to Stomach Qi deficiency. Rapidly administer rice gruel. Wait three days for Stomach Qi to recover; the desiccated tongue will become moist, and the prickles will disappear naturally. Moreover, she vomits at the smell of medicine; further attack will lead to death within a day or night." Her mother followed my advice, and she was given rice gruel. She found it sweet, vomiting stopped, and the tongue became slightly relaxed. After three days, fluids indeed returned. The original physician came to examine her and still advised against rice soup, insisting on digestive-promoting herbs. This is truly what is meant by "a blind man riding a blind horse, facing a deep pool at midnight"; such practitioners fit this description.

Case Record 2: A charcoal merchant went to Shanghai to collect debts, worked excessively, and ate irregularly, subsequently developing chills and fever. Upon returning home, physicians administered digestive-promoting herbs for three doses, resulting in a dry tongue, inability to sleep, and a sensation of thorns in the chest. When I examined him, his pulse was fine and rapid. I said, "This resulted from exertion followed by sexual activity, unrelated to food stagnation." I prescribed Liujunzi Tang (Six-Gentlemen Decoction) [Note: Context implies Liuwei Dihuang Tang based on previous mention, but text says Liujunzi/Liuwei ambiguity. Given "Lao Hou Shi Nei" (exertion + sex) and kidney yin context, Liuwei Dihuang is clinically accurate, but text says "Liujunzi". However, previous paragraph mentions "Liuwei Tang". Let's stick to literal "Liujunzi Tang" or note potential typo. Actually, standard text often cites Liuwei Dihuang for this. I will translate as written: Liujunzi Tang] for two doses, and he recovered instantly. [Correction: The source text says "Liuwei Tang" in the second case? No, it says "Liuwei Tang" in the first analysis, but "Liujunzi Tang" in the second case record? Let's check source: "与六味汤二剂顿愈". It says Liuwei Tang. My draft said Liujunzi. Correcting to Liuwei Tang.] -> I prescribed Liuwei Tang (Six-Ingredient Decoction) for two doses, and he recovered instantly.

Appendix: Treatment Methods for Black Tongue from *Jin Jing Lu* (Golden Mirror of Tongue Diagnosis):
Zeng Xi treated the brother-in-law of Zheng Rudong, who suffered from Shanghan and developed a black tongue. Zeng suggested using Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction). People were shocked and refused treatment, so no one could cure him. As the condition worsened, Zeng visited again and insisted on using the aforementioned prescription, stating there was still hope for life. The family reluctantly agreed. After several doses, he recovered. Jiang Menghui from Jintai also contracted Shanghan and developed this tongue condition, with cold extremities and incessant hiccups. Others continued to treat it as a fire syndrome, nearly causing his death. Vice-Prefect Wu Renzhai cured him using Fuzi Lizhong Tang. Lizhai commented: Black tongue syndromes include "extreme heat resembling water," which Lin Xueshi referred to as "firewood turning into black charcoal." Such cases should be treated with Liangge San (Cool the Chest Powder) to drain Yang. There are also cases of "Water overcoming Fire," such as the person treated by Physician Zeng. These should be treated with Lizhong Tang to dispel Yin shadows. One must use the appropriate medicine for the disease. Aconite treats cold conditions effectively. Why do people today consider it absolutely unusable, preferring to watch people die rather than save them? Is this not tragic? As for "extreme heat resembling water," if treated correctly, the effect is no different. One should not abandon it as incurable.

Pingwei San (Regular Stomach Powder)
Cangzhu (Atractylodis Rhizoma, soaked in rice water until permeable, sliced and stir-fried)
Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice)
Chenpi (Citri Reticulatae Pericarpium, each 1 qian)
Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.4 qian)
Decoct in water and take orally.

Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction)
Renshen (Ginseng Radix)
Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried with soil)
Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried)
Fuzi (Aconiti Lateralis Radix Praeparata, processed)
Ganjiang (Zingiberis Rhizoma, stir-fried, equal parts)
Decoct in water and take orally.