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The tongue shows a white coating around the periphery and a yellow coating in the center. This indicates symptoms of irritability, thirst, and vomiting. If accompanied by exterior syndrome, Wuling San (Five-Ingredient Poria Decoction) and Yiyuan San (Benefit Origin Powder) may be taken concurrently. One must wait until the yellow coating completely disappears before employing purgative methods.

[Jie's Commentary] When exterior pathogens have not yet resolved and are about to transform into heat, the tongue presents with a white periphery and yellow center. The coating is necessarily sticky due to fluid retention in the chest obstructing the ascent of body fluids, leading to irritability and thirst; in severe cases, there is an intense desire to drink water, but vomiting occurs immediately after ingestion. Treatment should employ Wuling San (Five-Ingredient Poria Decoction) to induce sweating, thereby restoring the Qi transformation of the Bladder (Bladder organ), generating body fluids, and naturally stopping vomiting and thirst. Since the Bladder transforms water into urine for excretion or transforms Qi outward to the skin and hair—and the skin and hair are governed by the Lung—Yiyuan San (Benefit Origin Powder) is used concurrently to clear the Lung and promote diuresis to assist this process. The original text’s statement "wait until the yellow [coating] is gone" refers to waiting until the tongue coating becomes purely yellow. Only if the tongue coating turns purely yellow, thick, and dry can purgative formulas be used. However, during episodes of vomiting, combining the principles of Xiexin Tang (Gallbladder Bitter Decoction) yields particularly rapid results.

The tongue coating appears yellow with black spots. This indicates that pathogens have spread throughout the Six Fu Organs and are about to enter the Five Zang Organs. Administer Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) to purge. Subsequently, administer Hejie San (Harmonizing Powder). Four out of ten patients may be saved.

[Jie's Commentary] A yellow coating indicates interior syndrome. If black spots and prickles are observed, it signifies old, yellow, scorched, and dry coating. Exterior signs must include thirst, fever, delirium, and constipation. This represents extreme heat in the Stomach, where pathogens are transitioning from the Fu organs to the Zang organs. Urgently use Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) to clear heat pathogens and preserve Stomach Yin. Once the yellow coating recedes slightly and the heat intensity subsides, then administer Hejie San (Harmonizing Powder). However, the medicinal properties in Hejie San (Harmonizing Powder) are overly acrid, warm, ascending, and dispersing. In my humble opinion, using Liangge San (Cool the Diaphragm Powder) is more prudent.

Hejie San (Harmonizing Powder)
Chenpi (Tangerine Peel, 1 qian) Houpo (Magnolia Bark, processed with ginger, 1 qian) Gaoben (Ligusticum sinense, unspecified amount) Jiegeng (Platycodon Root, each 5 fen) Gancao (Licorice Root, honey-fried, 5 fen) Cangzhu (Atractylodes Rhizome, 3 qian)
Crush the above ingredients. Add one and a half zhong of water, three slices of fresh ginger, and two jujubes. Decoct until reduced to seven-tenths. Strain and remove dregs. Take at any time.

[Jie's Commentary] This formula is Pingwei San (Stomach-Pacifying Powder) plus Gaoben (Ligusticum sinense) and Jiegeng (Platycodon Root). It utilizes the bitter-sweet nature of Cangzhu (Atractylodes Rhizome), which excels at inducing sweating and drying dampness; Houpo (Magnolia Bark) is bitter-warm, capable of dispersing damp-fullness and harmonizing the Stomach. Since dampness stagnation is caused by Qi obstruction, Chenpi (Tangerine Peel) is added to regulate Qi. Sweet flavors enter the Spleen first, so Gancao (Licorice Root) is used to tonify the Spleen. Named "Pingwei" (Pacifying the Stomach), ancient sages stated it means "cultivating the deficient Earth element to bring it to balance." Now, adding the acrid-warm upward-reaching nature of Gaoben (Ligusticum sinense) dispels wind pathogens and moves dampness; Jiegeng (Platycodon Root), bitter and acrid and ascending, carries the other herbs upward. Thus, this formula serves to dispel wind, move dampness, regulate Qi, and strengthen the Spleen.