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If the tongue surface has no coating but shows a faint, smoke-like blackish hue, and the patient is not thirsty with cold limbs, it indicates a concurrent Yin-cold syndrome. If there is thirst accompanied by irritability and heat, it is due to chronic stomach dryness; purgatives must not be used. If the tongue is dry, use sweet-cold herbs to nourish the Stomach Yin; if moist, use sweet-warm herbs to support the Middle Jiao. This explains why symptoms appear external while the interior lacks true heat.

If the tongue is black and slippery, it signifies Water overcoming Fire, constituting a Yin syndrome, which should be treated with warming methods. If the tongue body is short and contracted, this indicates exhaustion of Kidney Qi, making it difficult to treat; emergency rescue is required. Add Ren Shen (Ginseng Radix) and Wu Wei Zi (Schisandrae Fructus) to strive for a slim chance of recovery. If the tongue is black and dry, it indicates exhaustion of fluids and blazing fire; urgently apply "clearing the South and tonifying the North" (clearing Heart Fire and nourishing Kidney Water). If black, dry, and with a thick, concentrated center, it indicates Earth dryness leading to water exhaustion; urgently use salty-bitter purgatives.

If the tongue is pale red without color, or dry and lusterless, it suggests damage to Stomach fluids and failure of Qi transformation to generate fluids. Zhi Gan Cao Tang (Honey-fried Licorice Decoction) should be used; cold-cooling medicines must be avoided.

If the tongue is white like powder and slippery, but the edges are purple-red, this indicates that warm-pestilence pathogens have just entered the Mu Yuan (semi-exterior/semi-interior region) and have not yet reached the Stomach Fu organ. Urgently resolve and vent the pathogen; do not wait for transmission into the interior, which would become a perilous disease. Seeing this tongue coating indicates a severe prognosis, requiring utmost caution. When macules (ban) and papules (zhen) first appear, one must examine the chest, back, and hypochondrium using a paper torch. Large spots on the skin surface are macules (ban); cloud-like faint patches or small granular clusters are papules (zhen). Fewer lesions are preferable to many. Medical texts state: red macules indicate Stomach heat; purple indicates extreme heat; black indicates rotting of the Stomach. However, diagnosis must be confirmed by correlating with external symptoms. During spring and summer, warm diseases often manifest prominently with papules. If they are pale red, with cool limbs, slight thirst, and a pulse that is neither flooding nor rapid, it is either deficiency or Yin syndrome. If only a few points appear on the chest, with a red face and cold feet, or diarrhea with undigested food, this is Yin excess repelling Yang to the upper burner; warming treatment is indicated. Purple small points indicate heat in the Pericardium. Large purple spots indicate heat in the Stomach. Black and shiny lesions indicate excessive heat and toxicity; although generally considered incurable, if the patient's Qi and Blood are robust, following proper treatment may save them. Black and dull lesions indicate certain death. Black and faint lesions with red surroundings indicate suppressed fire within; large doses of cooling and venting herbs may turn them red and potentially save the patient. Macules and papules represent the exteriorization of pathogens. Pathogens vary, so treatment should drain them according to their location. Macules mostly involve the Blood level, while papules mostly involve the Qi level. Both are signs of pathogens emerging externally. After emergence, the spirit should be clear, indicating external resolution and internal harmony. If confusion occurs after emergence, it means righteous Qi cannot overcome pathogens, leading to internal invasion, or due to depletion of Stomach fluids.
Another type is Bai Pu (white pruritic miliary rash), small grains like crystal color. This indicates damp-heat injuring the Lung; although pathogens exit, Qi and fluids are exhausted, requiring sweet-tonifying herbs. If the duration is not long and Qi/fluids are not yet damaged, it is due to dampness injuring the Defensive level and incomplete sweating; regulate Qi-level pathogens. If Bai Pu becomes dry and bone-like, the prognosis is mostly poor, due to exhaustion of Qi and fluids...