舌有黄心色者。必初白苔而变黄色也。皆表而传里。热已入胃。宜急下之。若下迟必变黑色为恶症。为恶亢害鬼贼。
邪气深也。不治。宜用调胃承气汤下之。
\r黄心舌图\pt101a21.bmp\r
【介按】伤寒由表入里。舌苔必然先白后黄。及至纯黄无白。邪已离表入里。即仲景所云“胃家实”也。因舌中属
胃。凡肠中有燥矢。舌心必然黄燥、或黄浓焦老。中心裂纹起刺。腹中硬满胀痛。急用调胃承气汤下之。否则由黄转黑
而燥。大便秘结。犹可以承气下之。如若失治。舌变枯黑燥裂。坚敛焦刺。乃是肾津胃液俱竭。情势危险。是属不治之
症矣。倘如不忍坐视。惟以大剂滋液清热之品。希冀万一而已。原文所谓“宜用调胃承气汤”之句。应在“宜急下之”
之下。非在“不治”之下。古书文法。类多如是。不独此条为然也。
调胃承气汤（见前方）
舌左有白苔而自汗出者。不可下。宜白虎汤加人参三钱服之。
\r左边白苔舌图\pt101a22.bmp\r
【介按】舌左边主胃。故白色在左。其苔必燥。而自汗出。则为胃热炽盛。是以治法宗仲景《伤寒论》“服桂枝汤大
汗出后。大烦渴不解。脉洪大者。白虎加人参汤主之”之例。盖以汗出过多。恐伤阳明之液。故用白虎加人参。急救胃
液而滋阳明之燥也。
白虎汤（方见前）
Those with a yellow center on the tongue must have initially had a white coating that changed to yellow. This indicates that the pathogenic factor has transmitted from the exterior to the interior, and heat has entered the Stomach (Wei). Immediate purgation is indicated. If purgation is delayed, the tongue coating will inevitably turn black, resulting in a malignant syndrome characterized by excessive pathogenic activity and mutual destructive interference (Kang Hai Gui Zei).
This signifies deep-seated pathogenic factors; it is difficult to treat. It is appropriate to use Tiaowei Chengqi Tang (Regulate the Stomach and Descend Rebellion Decoction) for purgation.
[Jie's Commentary] In Shanghan (Cold Damage) diseases, as pathogens move from the exterior to the interior, the tongue coating necessarily changes from white to yellow. When the coating becomes purely yellow without any white, the pathogen has left the exterior and entered the interior. This corresponds to Zhang Zhongjing’s description of "Stomach Fullness/Excess" (Wei Jia Shi). Since the center of the tongue corresponds to the Stomach, whenever there are dry fecal masses in the intestines, the center of the tongue will necessarily be yellow and dry, or yellow, thick, scorched, and aged, with cracks in the center and prickles. The abdomen will be hard, full, distended, and painful. At this stage, Tiaowei Chengqi Tang should be used urgently for purgation. Otherwise, the coating may turn black and dry, accompanied by constipation; in such cases, Chengqi-type formulas can still be used for purgation. If treatment is neglected, the tongue may become withered, black, dry, and cracked, firm, contracted, scorched, and prickle-like. This indicates the exhaustion of both Kidney fluids and Stomach fluids, representing a dangerous condition belonging to untreatable syndromes. If one cannot bear to watch passively, only large doses of herbs that nourish fluids and clear heat can be used, hoping for a slight chance of recovery. The original text's statement "It is appropriate to use Tiaowei Chengqi Tang" should follow "Immediate purgation is indicated," rather than appearing after "untreatable." Ancient texts often employ such grammatical structures, not limited to this specific clause.
Tiaowei Chengqi Tang (See previous formula)
When there is a white coating on the left side of the tongue accompanied by spontaneous sweating, purgation is contraindicated. It is appropriate to consume Baihu Tang (White Tiger Decoction) with three qian of Renshen (Ginseng Radix et Rhizoma).
[Jie's Commentary] The left side of the tongue primarily reflects the Stomach. Therefore, when a white coating appears on the left, the coating must be dry. Spontaneous sweating indicates blazing Stomach heat. Thus, the treatment method follows Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage): "After taking Guizhi Tang, if profuse sweating occurs followed by severe restlessness and unquenchable thirst, with a flooding pulse, Baihu Jiaren Tang (White Tiger Decoction plus Ginseng) is the primary treatment." This is because excessive sweating risks damaging the fluids of the Yangming channel. Hence, Baihu Jiaren Tang is used to urgently rescue Stomach fluids and moisten Yangming dryness.
Baihu Tang (Formula seen previously)