夫医者何。犹防之将也。凡视人疾。在究其浅深之异而疗之。且疾之袭人。若寇之侵境。方其至也。必瞰其势之强
弱。先以安抚，次以讲和。戒严守御。以防其逆也。如坚然不退。至再至三。恣强肆侮。意谋土地也。当此之际。奈何
必选将练兵。克期攻战。寇灭乃已。若怆惶无措。则地土陷矣。岂非将者。不识韬略。不知合变。以致误也。可胜叹哉。
夫今之医。不阅方书。不察脉理。临症茫然。当解而不解。当吐下而不吐下。畏首畏尾。颠倒错乱。助病日深。殊不知
医乃司命。其可轻忽如此。大抵病之轻浅者。即为和解。深重者。即便攻击。故曰用药之时。胆欲大而心欲小。毋使君
臣失职。佐使不当。反嫁疾焉。苟能如将之用兵。进退合宜。操存有法。何疾之不知也。余每察脉用药。觉有疑滞。幸
承先师之诲。故姑撮其要领。以告后人云。
至正改元一阳吉日
永和三仙至人萧璜鸣书
舌见白苔滑者。邪初入里也。丹田有热。胸中有寒。乃少阳半表半里之证也。宜用小柴胡汤、栀子豉汤治之。
\r白胎舌图\pt101a1.bmp\r
【介按】白色为寒。表症有之。里症有之。而虚症实症亦有之。凡风寒湿邪。国中皮腠。即为白苔。寒湿本系阴邪。
白为凉象。故舌苔白色。如白滑而腻者。湿与痰也。白滑浓腻者。湿痰与寒也。惟薄白如无，则为虚寒。白如积粉。则
湿热或痰热也。因肺主卫、主气、又主皮毛。而太阳经亦主一身之表。凡受风寒。先入皮毛。内应于肺。其舌无苔而润。
或微白而薄。或浮白薄滑。外证必恶寒发热。而口不渴。此是风寒初感也。治宜辛温解表。如苔白而燥刺者。外证初在
微寒。继即发热不已。此是温邪在肺。治宜辛凉清解。如苔白而粘腻者。外证必发热、头重。身痛而口不渴。此是湿邪
在于气分也。治宜解肌去湿。如舌苔白燥、或白而边红。外证见发热口渴。咳嗽喉痛。此是风温入肺。治宜轻清凉解。
如苔白中带红。外证头痛身热。口苦、眼赤、胁痛、耳鸣、脉象浮弦而数者。太阳之邪已入少阳也。治宜清解少阳。或
白苔浮滑。带腻、带涨。刮之有净、有不净者。亦有尖白根黄者。是邪在少阳经之半表半里也。至若此苔系是白滑而边
淡红，邪在半表半里膈膜之间。即《金匮要略》所谓“舌上如苔。丹田有热。胸上有寒。渴欲得饮而不能饮。则口燥烦
也”之候。故用小柴胡汤以达膈膜之邪。即栀子豉汤亦为清热达邪之良剂也。
小柴胡汤
柴胡（四钱） 黄芩 甘草 人参（各二钱） 半夏（二钱）
上 咀，每服一两。水一钟半。姜三片。枣一枚。煎至一钟，温服。
【介按】程应旄曰。方以柴胡疏木。使半表之邪得从外宣。黄芩清火，使半里之邪得从内攻。半夏豁痰饮。降里气
之逆。人参补久虚。助生发之气。甘草佐柴、芩、调和内外。姜枣佐参、夏、通达营卫。相须相济。使邪无内向而外解
也。
栀子豉汤（从金匮要略新补）
栀子（十四枚） 香豉（四合绵裹）
上二味。以水四升。先煮栀子得二升半。纳豉煮取一升半。去滓，分二服。
【介按】山栀味苦性寒。其子色赤象心。其花色白象肺。故为从肺入心。以治心中烦热而导之下行。兼除上下之邪
热。豆形色黑象肾。蒸发为豉。其性轻浮。能引肾中水液上升，以降心中之热。而除胃外之邪。夫心肾相济。阴阳相和。
则烦热懊 等证俱解。而为清热退邪之良剂也。
Background Information:
Book: Ao's Record of the Golden Mirror of Shanghan (Cold Damage)
Author: Du Ben
Dynasty: Yuan
Chapter: On Medication for Cold Damage / First: White Coated Tongue
Category: Cold Damage
Original Text:
What is a physician? Like a general defending a territory. Whenever examining a patient's illness, one must investigate the differences in its depth and superficiality to treat it. Moreover, when an illness attacks a person, it is like bandits invading a border. When they arrive, one must observe the strength or weakness of their momentum. First, use pacification; next, use negotiation. Guard strictly and defend well to prevent their counterattack. If they firmly do not retreat, again and again, arrogantly bullying and intending to seize land, at this moment, why must one not select generals, train soldiers, set a date for battle, and fight until the bandits are destroyed? If one panics without knowing what to do, then the territory will be lost. Is this not because the general does not understand military strategy or adapt to changes, thus causing error? How lamentable!
As for physicians today, they do not read medical texts, nor do they examine pulse patterns. Facing symptoms, they are bewildered. When they should resolve the exterior, they do not; when they should induce vomiting or purgation, they do not. Fearful and hesitant, confused and disordered, they help the illness deepen day by day. They do not realize that physicians hold the fate of life and death; how can they be so negligent? Generally, for mild and superficial illnesses, use harmonizing methods; for severe and deep illnesses, use attacking methods immediately. Thus it is said: when using medication, one must have great courage but a cautious mind. Do not let the sovereign and minister herbs fail in their duties, nor the assistant and envoy herbs act improperly, which would instead transfer the disease to others. If one could use medicine like a general uses troops, advancing and retreating appropriately, operating with method, what illness would one not know? Each time I examine pulses and prescribe medication, feeling doubts and obstacles, fortunately receiving teachings from my former master, I hereby summarize the essentials to inform future generations.
On the auspicious day of the first Yang month in the first year of Zhizheng [1341 AD],
Xiao Huangming, the Immortal of Yonghe, wrote.
When the tongue shows a slippery white coating, the pathogen has just entered the interior. There is heat in the Dantian (lower abdomen) and cold in the chest. This is a Shaoyang syndrome (a condition involving both the exterior and interior). It is appropriate to treat with Xiaochaihu Tang (Minor Bupleurum Decoction) or Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
[Image: Diagram of White-Coated Tongue]
[Commentary by Jie]: White indicates cold. There are exterior syndromes with white coating, interior syndromes with white coating, and also deficiency and excess syndromes with white coating. Whenever wind-cold-dampness pathogens invade the skin and pores, a white coating appears. Cold-dampness is inherently Yin pathogenic factors; white is the image of coolness, hence the tongue coating is white. If it is white, slippery, and greasy, it indicates dampness and phlegm. If it is white, slippery, thick, and greasy, it indicates damp-phlegm and cold. Only if it is thin and white, almost non-existent, is it deficiency-cold. If it is white like accumulated powder, it indicates damp-heat or phlegm-heat. Because the Lung governs Wei (Defensive Qi), Qi, and the skin/hair, and the Taiyang Meridian also governs the exterior of the whole body, whenever wind-cold is received, it first enters the skin/hair and internally corresponds to the Lung. The tongue has no coating or is moist, slightly white and thin, or floating white and thinly slippery. Exterior symptoms must include aversion to cold and fever, with no thirst. This is initial contraction of wind-cold. Treatment should employ acrid-warm exterior-resolving methods. If the coating is white and dry with prickles, exterior symptoms initially show slight aversion to cold, followed by continuous fever. This is warm pathogen in the Lung. Treatment should employ acrid-cool clearing and resolving methods. If the coating is white and sticky/greasy, exterior symptoms must include fever, heavy head, body pain, and no thirst. This is dampness pathogen in the Qi level. Treatment should employ muscle-releasing and dampness-dispelling methods. If the tongue coating is white and dry, or white with red edges, and exterior symptoms show fever, thirst, cough, and sore throat, this is wind-warmth entering the Lung. Treatment should employ light-cool clearing and resolving methods. If the coating is white with traces of red, and exterior symptoms show headache, body heat, bitter taste, red eyes, hypochondriac pain, tinnitus, and a floating, wiry, and rapid pulse, the Taiyang pathogen has entered the Shaoyang. Treatment should employ clearing and resolving Shaoyang. Or if the white coating is floating and slippery, with greasiness and distension, scraping reveals some clean and some unclean areas. There are also cases with white tip and yellow root; this indicates the pathogen is in the half-exterior/half-interior of the Shaoyang Meridian. As for this coating being white, slippery, with pale red edges, the pathogen is between the half-exterior/half-interior and the diaphragm membrane. This is exactly the manifestation described in "Jin Gui Yao Lue" (Essential Prescriptions of the Golden Cabinet): "A coating on the tongue as if present, heat in the Dantian, cold in the chest, desire to drink but unable to drink, resulting in dry mouth and restlessness." Therefore, Xiaochaihu Tang is used to reach the pathogen in the diaphragm membrane. Zhizi Chi Tang is also an excellent agent for clearing heat and expelling pathogens.
Xiaochaihu Tang (Minor Bupleurum Decoction)
Chai Hu (Bupleuri Radix) - 4 qian
Huang Qin (Scutellariae Radix) - 2 qian
Gan Cao (Glycyrrhizae Radix et Rhizoma) - 2 qian
Ren Shen (Ginseng Radix) - 2 qian
Ban Xia (Pinelliae Rhizoma Preparatum) - 2 qian
Grind all ingredients. Take 1 liang per dose. Add 1.5 zhong of water and 3 slices of ginger, 1 jujube. Decoct until 1 zhong remains, take warm.
[Commentary by Jie]: Cheng Yingmao said: The formula uses Chai Hu to soothe the Liver Wood, allowing the half-exterior pathogen to be dispersed from the exterior. Huang Qin clears fire, allowing the half-interior pathogen to be attacked from within. Ban Xia resolves phlegm-fluids and directs rebellious Interior Qi downward. Ren Shen tonifies long-standing deficiency and assists the generating Qi. Gan Cao assists Chai Hu and Huang Qin to harmonize the interior and exterior. Ginger and Jujube assist Ren Shen and Ban Xia to circulate Ying (Nutritive) and Wei (Defensive) Qi. They complement each other, ensuring the pathogen does not move inward but is resolved outward.
Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) [Newly supplemented from Jin Gui Yao Lue]
Zhi Zi (Gardeniae Fructus) - 14 fruits
Xiang Chi (Sojae Semen Preparatum) - 4 he, wrapped in silk
Take these two ingredients. Add 4 sheng of water. First decoct Zhi Zi until 2.5 sheng remain. Add Chi and decoct until 1.5 sheng remain. Strain, divide into two doses.
[Commentary by Jie]: Shan Zhi (Gardenia) is bitter in flavor and cold in nature. Its fruit is red, resembling the Heart; its flower is white, resembling the Lung. Thus, it moves from the Lung to the Heart to treat vexation and heat in the Heart, guiding it downward, while simultaneously eliminating heat pathogens above and below. Soybeans are black in color, resembling the Kidney. Fermented into Chi, their nature is light and floating, capable of drawing Kidney fluids upward to descend Heart heat, thereby eliminating pathogens outside the Stomach. When Heart and Kidney assist each other, and Yin and Yang harmonize, symptoms such as vexation and restlessness are resolved, making it an excellent agent for clearing heat and retreating pathogens.