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After three or four days of Taiyang disease (disease of the Taiyang channel), a membrane appears on the tongue, white and slippery like coating; in severe cases, it may be rough, yellow, or black, all indicating the depth of heat pathogen.
When the pathogenic factor is at the exterior, there is no coating on the tongue; when the pathogenic factor transmits to the interior and body fluids struggle with the pathogen, a coating forms on the tongue. When cold pathogen first transmits and has not fully transformed into heat, residing between the exterior and interior, or when there is heat in the Dantian and cold in the chest, this indicates the pathogen is just beginning to transmit inward. Chills indicate an urge to vomit; abdominal pain indicates an urge for diarrhea.

[Harmonizing Method] In Yangming disease, with hardness and fullness under the hypochondrium accompanied by wheezing, fever, sweating, constipation, and vomiting, along with a white tongue coating, use Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is tight in both Yin and Yang positions, and the tongue has a slippery coating, use Xiaochaihu Tang with Banxia (Pinellia Rhizome) removed, and Renshen (Ginseng Root) and Gualou (Trichosanthes Fruit) added. For abdominal pain, use Lizhong Tang (Regulate the Middle Decoction).

[Vomiting Method] In Yangming disease, with a floating and tight pulse, dry throat, abdominal fullness, wheezing, fever, sweating, aversion to heat, mental restlessness, and tongue coating, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).

[Purgative Method] If heat gathers in the Stomach, the tongue turns yellow, indicating deep heat. The *Jin Gui Yao Lue* states: "If the tongue coating is yellow and purgatives have not been used, apply purgation; the yellow coating will naturally disappear. This applies similarly to black and slippery coatings." The classics state: "If the tongue is black, it indicates extreme heat." It also says: "In heat diseases, if the mouth is dry and the tongue is black, the prognosis is fatal."

[Clearing Heat Method] After seven or eight days without resolution, with heat结 (knotting) in the interior, heat in both exterior and interior, occasional aversion to wind, extreme thirst, dry tongue, irritability, and desire to drink several liters of water, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).

Scholar Du Qingbi stated: The pathogenic factors transmitted through meridians in Shanghan (Cold Damage) febrile diseases differ from miscellaneous diseases. One must examine the pulse, symptoms, and tongue simultaneously. Only then can methods of exterior/interior, sweating/purgation be applied correctly, avoiding treatment failure and saving lives. Regarding the pulse, it is the mansion of blood and belongs to Yin. At the onset of illness, when pathogen and healthy Qi struggle equally, the pulse must be slippery and forceful. With prolonged illness, intense heat, and depleted Qi, the pulse becomes faint, fine, and weak. When using numerous formulas, one should only nourish Yin to subdue Yang. This is the subtlety of pulse diagnosis. Regarding symptoms, initial illness involves chills and fever, later progressing to thirst, desire for water, and dryness/heat. Some present with inverted cold limbs and mania; these are heat pathogens transmitting through meridians. Always heat syndromes, being excess heat, thus lack cold signs. Shanghan begins with headache, inevitably accompanied by fever, chills, and thirst for water. If a disease presents with no inversion or diarrhea, only cold without fever, it is a cold syndrome.

Regarding the subtlety of recognizing syndromes: Fire corresponds to the Heart's function, opening into the tongue. The Heart belongs to Fire, governs heat images, and corresponds to the Li trigram (brightness). At the onset of illness at the exterior, the tongue is naturally red without white coating. When exterior pathogen enters the half-exterior/half-interior, the tongue color changes to white and slippery. One must clearly understand exterior syndromes. During transmission, the tongue initially shows white coating; as pathogen enters the interior, the tongue shows yellow, representing Stomach pathogen. Use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge; the yellow coating will disappear and the disease will resolve. If doctors fail to follow the sequence and misuse decoctions/pills, delaying purgation, the coating turns black, leading to complex syndromes that are difficult to treat. If the coating looks like black lacquer, nine out of ten die; this is Heart Fire combined with pathogenic heat, two fires multiplying, reaching extremity and turning black, like fire scorching objects until charred. Viscera are deeply affected by toxic heat, and Stomach accumulated heat is extreme. Rapid purgation is needed to drain Stomach excess fire to save life; delayed purgation leads to death. Below are the Thirty-Six Tongue Methods and their origins, useful for determining life and death.

Thirty-Six Tongue Methods.
[White Coating Tongue] Treat with Xiaochaihu Tang or Zhizi Chi Tang.
[Fire-Branded Tongue] Use Liangge San (Cool the Diaphragm Powder) or Da Chaihu Tang (Major Bupleurum Decoction) to purge.
[Red Star Tongue] Jaundice is impending; use Yinchenshao Tang (Artemisiae Scopariae Decoction).
[Spotted Tongue] Use Xuanshen Shengma Tang (Scrophulariae and Cimicifugae Decoction) or Huaban Tang (Resolve Spots Decoction).
[Black Charcoal Tongue] Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). For high fever, use Tiaowei Chengqi Tang to purge.
[Black Ring Tongue] Pathogen has passed the meridian but remains unresolved; use Dachengqi Tang (Major Order the Qi Decoction) to purge.
[Human-Crack Tongue] Use Liangge San with Huanglian (Coptis Rhizome).
[Worm-Broken Tongue] Use Xiao Chengqi Tang (Minor Order the Qi Decoction) to purge.
[Jueyin Tongue] Use Lizhong Wan (Regulate the Middle Pill) or Sini Tang (Reverse the Cold Decoction).
[Interior Black Tongue] Purge with Tiaowei Chengqi Tang or regulate with Jiedu Tang (Detoxify Toxin Decoction).
[Epidemic Toxin Tongue] Black indicates death.
[Dead Clam Tongue] White indicates no survival, definitely fatal. If tip is white and root is yellow, exterior syndrome is unresolved; resolve exterior first, then attack interior. For constipation, use Liangge San with Niao (Niter) and Dahuang (Rhubarb Root) soaked, taken hot. For dysuria, use Wuling San (Five-Ingredient Powder with Poria) plus Mutong (Akebia Stem), mixed with Yiyuan San (Benefit Origin Powder) and Ginger Juice, taken with warm water.
[Tongue with White Sides and Black Center] Faint pulse indicates difficult treatment; floating/slippery pulse allows sweating; deep/solid pulse allows purgation. If seen at onset, it is critical; purge with Tiaowei Chengqi Tang.
[Tongue with 2 parts White Tip and 1 part Black Root] Accompanied by chills and body ache; if drinking water, use Wuling San. If spontaneous sweating and thirst, use Baihu Tang. For dysentery, use Jiedu Tang. (This is also critical.)
[Tongue with White Coating and Random Small Black Dots] Exterior syndrome exists. Though severe, use Liangge San to mildly release exterior, then purge with Chengqi Tang after reduction.
[Tongue with Two Gray Stripes and Black Halos] Heat invading Kidney; urgent purgation needed. Use Jiedu Tang with Jiuhuang (Wine-soaked Rhubarb) powder mixed.
[Tongue with Slight Yellow] Seen at onset; changing from white to yellow indicates delirium due to missed sweating allowing exterior pathogen to enter interior. Use sweating and purging together with Shuang Jiedu Tang (Double Detoxification Decoction).
[Tongue with White Coating and Yellow Tinge] Diarrhea expected; take Jiedu Tang. For chills, use Wuling San.
[Tongue with Sauce-Yellow, Thick and Glossy] Exterior unresolved; use Xiaochaihu Tang combined with Tianshui San (Heavenly Water Powder). If purgable, use Da Chaihu Tang.
[Tongue with Black Coating in Center] Treat as above.
[Tongue with Yellow Color] Must progress from white to yellow, indicating transmission from exterior to interior. Heat entered Stomach; purge urgently with Tiaowei Chengqi Tang. Delay leads to black and incurability. White with black treated similarly.
[Tongue with White Coating and Spontaneous Sweating] Do not purge; use Baihu Jia Renshen Tang.
[Tongue with Slippery White Coating] Pulse felt in muscle layer indicates pathogen in half-exterior/half-interior; alternating chills and fever expected; harmonize with Xiaochaihu Tang.
[Tongue with White and Slippery Coating] Frequent diarrhea, lower abdominal pain radiating to genitals; named Zangjie Syndrome (Visceral Knotting), pathogen deeply merged into viscera, difficult to treat.
[Tongue with Four White Rings and Yellow Center] Irritability, thirst, vomiting expected. If exterior signs exist, use Wuling San + Yiyuan San. Once yellow clears, then purge.
[Tongue with Yellow and Small Black Dots] Heat is deep; pathogen transmitted to Six Fu organs, entering Five Zang organs. Urgent purgation with Tiaowei Chengqi Tang, followed by Jiedu Tang. Survival rate 40-50%.
[Tongue with Yellow Root and White Tip] Less exterior, more interior. Mix Tianshui San (1 he) and Liangge San (2 he) and take. If not resolving, use Fangfeng Tongsheng San (Siler and Peucedanum Powder for Unblocking the Universal).
[Tongue with Dry and Rough Texture] Diaphragm pathogen transmitted to Stomach, toxin extremely deep; irritability and thirst expected. Urgent purgation with Dachengqi Tang. If jaundice, use Yinchenshao Tang. Blood syndrome, use Didang Tang (Resist Accumulation Decoction). Exterior edema in hypochondrium, use Shizao Tang (Ten Jujube Decoction). Juxiong (Chest Binding), use Daxiexiong Tang (Major Chest Binding Decoction). Pi Man (Fullness Obstruction), use Dahuang Xiexin Tang (Rhubarb Heart-Draining Decoction).
[Tongue with Red Sides and Black-Grey Walking Trace in Center] Due to missed purgation; heat retreats and recovers. Requires 4-5 purgations to resolve, use Dachengqi Tang. If color doesn't change after 5 purgations, untreatable.
[Tongue with Yellow and Random Black Dots] Thirst and delirium expected. Slippery pulse indicates life; rough pulse indicates death. Grasping clothes and bed indicates death. Purging black stool indicates death; use Dachengqi Tang.
[Tongue with Yellow and Black Reaching Tip] Heat toxin/pathogen is deep. Lianggan (Dual Feeling) syndrome: purgation leads to 9 deaths out of 10. Use Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). No chills/diarrhea, use Tiaowei Chengqi Tang.
[Tongue with Red Sides and Black Center] Wind injury, exterior unresolved. Use Shuang Jiedu San + Shuang Jiedu Tang to induce mild sweat. After exterior resolves, purge. If Juxiong with irritability and fixed gaze, purge. Non-Juxiong cannot be purged.
[Tongue with Dark Black Root and Yellow Tip] Faintly visible, gray-black. Although black/yellow lines exist, if pulse is solid, purge with Dachengqi Tang. Floating pulse with thirst, use Liangge San. Survival rate 30-40%.
[Tongue with Gray Color] No chills/aversion to wind; even with floating pulse, purgation is allowed. If chills/aversion to wind, use Shuang Jiedu Tang. Purging black stool is untreatable.
[Tongue with Black Root and Yellow Tip] Slippery pulse allows purgation; floating pulse requires nourishing Yin/subduing Yang. If chills/aversion to wind, induce mild sweat with Shuang Jiedu San then purge. If no diarrhea results, use Jiedu Tang.
[Tongue with Large Black and Random Patterns] Slippy/solid pulse; urgent purgation, 1 in 10 survives. Floating/rapid/weak pulse is untreatable.