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The tongue appears red. This indicates heat accumulating within the interior. Regardless of which meridian is affected, Tou Ding Qing Shen San (Penetrating Top Clearing Spirit Powder) should be used for treatment.

[Commentary by Jie] If the tongue color is pale red, tender red, or white with a hint of red, and the exterior symptoms initially present with slight aversion to cold followed by persistent fever, severe thirst indicates the initial stage of warm pathogen invasion. Treatment should employ acrid-cool clearing and resolving methods. If the tongue is purely red or bright red with prickles, it indicates excessive heat in the Gallbladder Meridian and Ying (Nutritive) Level. Treatment should employ bitter-cold clearing and resolving methods. If there is no relief, it suggests that the warm pathogen is latent in Shao Yin (Lesser Yin) but manifesting on the exterior of Shao Yang (Lesser Yang). Treatment should nourish the fluids of Shao Yin, whereupon the heat of Shao Yang will naturally resolve. If the tongue is crimson and the spirit is dull with disordered speech, accompanied by dark, scanty, and viscous urine, this indicates heat binding in the Bladder. Urgent treatment with Dao Chi Qing Re (Guide Out Redness and Clear Heat) method is required. If the tongue is bright red, accompanied by coma and delirious speech appearing after the eruption of macules and papules, this indicates hot phlegm attacking the Pericardium Collateral. Treatment should clear heat and resolve phlegm. If the tongue is fresh, lustrous, and purely red, with exterior symptoms of coma, delirious speech, and restlessness, this indicates the warm pathogen has entered the Pericardium Collateral. In mild cases, add Guang Yu Jin (Curcuma Aromatica Rhizome) and Xian Shi Chang Pu (Acori Tatarinowii Rhizoma) to clearing and resolving formulas to open the orifices. In severe cases, use Niu Huang Wan (Calculus Bovis Pill) or Zhi Bao Dan (Treasure of Life Pill) to open the orifices with aromatic substances. Furthermore, according to *She Jian Bian Zheng* (Differentiation of Tongue Diagnosis), "Jiang Wen She (Pre-epidemic tongue) is essentially a pure red tongue; not purely uniform, but rather a stasis-red hue." It appears in cases of extreme internal heat, seasonal epidemics, or misapplication of warming and tonifying drugs. Suitable treatments include San Huang Bai Hu Tang (Three Yellows White Tiger Decoction) plus Lian Qiao (Forsythiae Fructus), or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) and Da Cheng Qi Tang (Major Order the Qi Decoction) used as appropriate. This tongue presentation may also accompany exterior syndromes: bilateral facial flushing, whole-body fever, dizziness, vertigo, alternating chills and fever, and a floating-rapid pulse indicate pathogenic heat in the Tai Yang (Greater Yang) Meridian. Treatment should use Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), Ge Gen (Puerariae Lobatae Radix), and Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) to cool and dissipate exterior pathogens. One must not hastily use "cold purgatives." Here, only Tou Ding Qing Shen San (Penetrating Top Clearing Spirit Powder), containing irritating components, is blown into the nose to induce sneezing. Because the condition involves clouded consciousness, this is a temporary emergency measure.

Tou Ding Qing Shen San (Penetrating Top Clearing Spirit Powder)
Zhu Ya Zao Jiao (Gleditsiae Sinensis Fructus Cum Spina), Xi Xin (Asari Radix et Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Dang Gui (Angelicae Sinensis Radix)
Grind all ingredients into a fine powder in equal proportions and mix well. The patient first holds a mouthful of water. Blow a small amount of the powder into the nose, spit out the water, and continue until sneezing occurs. If sneezing does not occur, repeat the application. For households affected by epidemic febrile diseases, whether patients are present or not, this formula is suitable.

[Commentary by Jie] This formula utilizes Xi Xin (Asari Radix et Rhizoma) and Zhu Ya Zao Jiao (Gleditsiae Sinensis Fructus Cum Spina), which effectively stimulate the nerves to open the orifices. Combined with the ascending aromatic nature of Bai Zhi (Angelicae Dahuricae Radix) and the meridian-unblocking and tendon-relaxing properties of Dang Gui (Angelicae Sinensis Radix), it mimics the mechanism of Tong Guan San (Pass Through Gate Powder) to induce sneezing via nasal insufflation. In cases of clouded consciousness or loss of awareness, its temporary use can open the orifices and restore mental clarity.