舌见红色。更有裂纹如人字形。亦有此形者。（介按∶此句指图形而言。）乃君火燔灼。热毒炎上。故发裂也。宜用
凉膈散治之。
\r人裂舌图\pt101a8.bmp\r
【介按】年老之人。辄有舌中开裂。其苔则滑腻。或滑而微白。乃是津液干枯之体。而患寒湿之象。治疗适当。尚
属不妨。惟不论男妇老少。凡患暑温燥热之症。而见苔色焦黄。或兼灰黑燥刺。致有裂纹如人字。或如爻字。外证身热
口渴。甚则神昏、谵语。治宜亟与白虎汤合承气汤。以急下而救液。今治以凉膈散者。是使热降清升。上下通治之义也。
前贤梁特岩云。“不论白、红、黄、黑各舌，若中有裂纹。如川字、爻字、人字不等。或裂字直槽者。多由实热人误服温
补药。热火在脏腑相争所致。大承气虽能下毒。而未能凉沁肠胃。宜以白虎汤合与承气。循环急服。不知者以为太重。
实则力求周密之策也。”凡实热内逼而见此舌。皆宜如此以治之。
凉膈散（方见前）
舌见红色。更有红点如虫蚀之状者。乃热毒炽甚。火在上、水在下，不能相济故也。宜用小承气汤下之。
\r虫碎舌图\pt101a9.bmp\r
【介按】舌绛碎而有深红之点者，是属热毒蕴久不宣。熏蒸上达之候。故宜小承气汤以荡涤之。然亦可用白虎合犀
角地黄汤加减而治之。藉清热毒而滋津液。庶或有济至于红色虫碎舌。是红舌中更有红点如虫碎之状者。热毒炽盛也。
宜用小承气汤下之。如不退，再用大承气汤攻之。惟邵仙根谓。“舌绛碎而有黄白腐点者。此湿热邪毒蕴伏不宣。蒸腐气
血。化为瘀浊。得风木之气化而成虫也。”但《金匮要略》有“蚀于上部则声嗄。甘草泻心汤主之”之证。则邵氏之言。
又为疳蚀之症矣。
小承气汤（从伤寒论新补）
大黄（四两） 浓朴（二两，炙去皮） 枳实（三枚大者炙）
上三味。以水四升。煮取一升二合。去滓，分温二服。初服汤。当更衣。不尔者，尽饮之。若更衣者，勿服之。
【介按】唐容川曰。小承气汤、重在小肠。故仲景提出“腹大满”三字为眼目。盖小肠正当大腹之内。小肠通身、
接连油网。油是脾所司。膜网上连肝系。肝气下行。则疏泄脾土而膏油滑利。肝属木。故枳朴秉木气者。能疏利脾土。
使油膜之气。下达小肠而出也。又用大黄归于脾土者。泻膏油与肠中之实热。此小承气、所以重在小肠也。其不用芒硝。
以小肠不秉燥气。不取硝之滑润也。
The tongue appears red. Furthermore, there are cracks resembling the character "Ren" (人). There are also cases with this shape. (Jie's Note: This sentence refers to the pattern of the crack.) This is due to the blazing of Ministerial Fire (Jun Huo) and the inflammation of heat toxins ascending upwards, thus causing cracking. It is appropriate to treat with Liangge San (Cooling the Diaphragm Powder).
[Jie's Note] In elderly individuals, cracks often appear in the center of the tongue, with a slippery and greasy coating, or slippery and slightly white. This indicates a body with dried-up fluids presenting signs of cold-dampness. If treated appropriately, it is generally not harmful. However, regardless of gender or age, whenever patients suffer from summerheat-warmth or dry-heat syndromes, and present with scorched-yellow coating, or gray-black dry prickles, leading to cracks like the characters "Ren" (人) or "Yao" (爻), accompanied by external symptoms of fever, thirst, and even coma or delirious speech, treatment should urgently employ Baihu Tang (White Tiger Decoction) combined with Chengqi Tang (Cure Qi Decoction) to purge rapidly and preserve fluids. Using Liangge San here embodies the principle of descending heat and raising clarity, treating both upper and lower jiao. The former scholar Liang Teyan stated: "Regardless of whether the tongue is white, red, yellow, or black, if there are cracks in the middle resembling 'Chuan' (川), 'Yao' (爻), 'Ren' (人), etc., or straight grooves, these are mostly caused by excess-heat conditions mistakenly treated with warming and tonifying medicines, resulting in a struggle between fire and heat within the zang-fu organs. While Dachengqi Tang can purge toxins, it cannot cool and moisten the intestines and stomach. It is advisable to use Baihu Tang combined with Chengqi Tang, administered urgently in rotation. Those unaware may consider this too harsh, but it is actually a strategy striving for thoroughness." Whenever such a tongue manifestation arises from internal逼迫 of excess-heat, it should be treated in this manner.
Liangge San (Formula seen previously)
The tongue appears red, with red spots resembling the appearance of insect erosion. This indicates extremely intense heat toxins, where Heart Fire is above and Kidney Water is below, failing to mutually assist each other. It is appropriate to purge using Xiaochengqi Tang (Minor Order the Qi Decoction).
[Jie's Note] A crimson (jiang) tongue with fragmented deep-red spots indicates heat toxins that have been accumulated and unvented for a long time, steaming and reaching upwards. Therefore, Xiaochengqi Tang is suitable to cleanse and purge them. Alternatively, Baihu Tang combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) modified can be used to clear heat toxins and nourish fluids, which may yield results. As for the "insect-bitten red tongue," where red spots on a red tongue resemble insect bites, this signifies intense heat toxins. Xiaochengqi Tang should be used for purging. If symptoms do not subside, Dachengqi Tang (Major Order the Qi Decoction) should be used for attack. Only Shao Xiangen stated: "A crimson tongue with yellow-white putrid spots indicates damp-heat pathogens hidden and unvented, steaming and corrupting qi and blood into turbid stasis, which transforms into insects under the influence of Wind-Wood qi." However, *Jingui Yaolue* mentions the syndrome "erosion in the upper part causes hoarseness, treated with Gancao Xiexin Tang." Thus, Shao's statement pertains to gan-erosion syndromes.
Xiaochengqi Tang (Supplemented from *Shanghan Lun*)
Dahuang (Rhei Radix et Rhizoma, 4 liang) Houpo (Magnoliae Officinalis Cortex, 2 liang, processed, skin removed) Zhishi (Immature Bitter Orange Fruit, 3 large ones, processed)
These three ingredients are boiled in four sheng of water to obtain one sheng and two he of liquid. Strain the dregs and divide into two warm doses. After the first dose, defecation should occur. If not, consume the remainder. If defecation has already occurred, do not take the medicine.
[Jie's Note] Tang Rongchuan said that Xiaochengqi Tang focuses on the Small Intestine. Hence, Zhang Zhongjing highlighted the phrase "abdominal fullness" as the key point. Since the Small Intestine lies within the great abdomen and connects throughout to the fatty membranes (oil network), which are governed by the Spleen, and the membranes connect upward to the Liver system, the downward flow of Liver Qi vents the Spleen Earth and makes the fatty oil slippery. As the Liver belongs to Wood, Zhi Shi and Houpo, inheriting Wood qi, can vent and facilitate Spleen Earth, allowing the qi of the fatty membranes to descend to the Small Intestine for excretion. Additionally, Dahuang returns to Spleen Earth to purge the fatty oil and excess-heat in the intestines. This is why Xiaochengqi Tang emphasizes the Small Intestine. Mangxiao (Natrii Sulfas) is not used because the Small Intestine does not inherit Dryness qi, nor does it require the lubricating property of Mangxiao.