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The tongue surface appears red, with dry and hard black coating inside. The shape resembles a small long tongue with prickles. This indicates that heat-toxin is extremely vigorous, firmly accumulating in the large intestine. Metal (Lung) is controlled by Fire, unable to balance Wood (Liver). Treat with Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) to purge downward.

[Commentary by Jie] When the coating turns black with prickles, the tongue surface must be dry without fluids, the umbilical and abdominal regions must be hard, full, and painful, and the stool must be constipated. This signifies that stomach fluids are about to be exhausted, and heat is结 (accumulated) in the large intestine. Therefore, Tiaowei Chengqi Tang is used to resolve pathogenic heat and regulate stomach fluids. However, given such severe symptoms, it would be better to use Dachengqi Tang (Major Order the Qi Decoction) for faster efficacy.
Tiaowei Chengqi Tang (Formula seen previously)

The tongue surface appears black; this clearly demonstrates Water overcoming Fire. Among those suffering from this condition, not one in a hundred can be cured. Regarding the tongue image on the right front, although there is a color diagram, it is feared that over time the color will fade and become indistinguishable, so it is noted here.

[Commentary by Jie] The appearance of black coating indicates a serious illness. Regardless of cold, heat, deficiency, or excess patterns, this color may appear. Only when the entire tongue is black does it indicate that the pathogen has entered the interior; this is either extreme heat in the Zang-Fu organs or extreme cold in the Zang-Fu organs. If it is a deficiency-cold pattern with a black tongue, the surface must be wet, slippery, and devoid of coating. If it is a true-cold false-heat pattern with a black tongue, the entire tongue will be black without distinct meridian distribution. If the entire tongue is black, without coating, but the underlying texture is rough, astringent, dry, and scorched, and cannot be scraped clean, this is a sign of extreme heat. If the entire tongue is black, without coating, without cracks or spots, dry with little fluid, yet glossy, this is a variation of the crimson tongue, indicating kidney Yin exhaustion. If the entire tongue is black with cracks and prickles, it is an excess pattern of extreme heat. Only if the black coating is rotten does it indicate the exhaustion of both Heart and Kidney; if the tongue is black and curled/shrunk, it indicates the exhaustion of the Liver function. These are all incurable conditions. The statement "Water overcomes Fire, and not one in a hundred can be cured" refers specifically to patterns of extreme cold and extreme deficiency in the Zang-Fu organs.

The tip of the tongue is white and the root is yellow, indicating that the exterior syndrome has not yet resolved. One should first release the exterior before proceeding to purge the interior. If there is fecal impaction, use Liangge San (Cool the Diaphragm Powder) with Rhubarb and Mirabilite taken as a decoction infusion. If urination is difficult and painful, use Wuling San (Five-Ingredient Poria Powder) combined with Mutong (Akebia Caulis), mixed with Yiyuan San (Benefit Origin Powder) and a small amount of ginger juice, taken at any time with boiled water.

[Commentary by Jie] Generally, exterior syndromes such as wind-heat, summerheat, and dryness present with yellow tongues. Only when Shanghan (Cold Damage) transmits from the exterior to the interior, reaching the Yangming Fu-organs, does the tongue necessarily turn yellow, indicating the disease progressing from shallow to deep. Now, seeing a white tip and yellow root, this belongs to Taiyang cold invasion with Yangming internal heat, or wind-heat pathogens lodging in the Yangming exterior. All these cases should be treated with cooling and dispersing methods. White coating governs the exterior, while yellow coating governs the interior; Taiyang governs the exterior, and Yangming governs the interior. Hence, the tongue coating shows a white tip and yellow root, or white mixed with yellow. If slightly yellow and thin, the tongue must be yellow and dry, which is a sign of pathogenic factors just entering the interior. Exterior symptoms must include aversion to cold and fever; treatment should employ acrid-cool methods to release the exterior. If the root is yellow and the tip is white but not very dry, and the tongue is short and shrunk unable to extend, it indicates retained food. Purging methods should be used. If aversion to cold has ceased, leaving only fever and constipation, this indicates pathogenic heat entering the Stomach, so Liangge San should be used. Using Rhubarb and Mirabilite as an infusion takes advantage of their focused medicinal power. As for scanty and painful urination with a yellow-greasy tongue coating, this is a sign of damp-heat not yet cleared. Therefore, Wuling San combined with Mutong and modified Yiyuan San is used to promote diuresis and clear damp-heat.
Liangge San (Formula seen previously)
Wuling San (Formula seen previously)
Yiyuan San (Newly supplemented from Famous Physician Formulas)
Talcum (Six liang, processed by water flotation) Licorice Root (One liang) Cinnabar (Three qian)
Grind the above into fine powder. Mix three qian with a bowl of fresh drawn water and take orally.
[Commentary by Jie] This formula is Liu Yi San (Six-to-One Powder) plus Cinnabar. It benefits Qi without aiding the pathogen and expels the pathogen without damaging healthy Qi, hence the name "Benefit Origin". Ke Yunbo stated: The Heart is the master of the five Zang organs. Summerheat and heat disturb the middle jiao, causing the Spirit to be unsettled. It requires Cinnabar to anchor it, so that Spirit Qi can recover rapidly; using cool water to nourish it allows pathogenic heat to be quickly eliminated. This clears Heart Yang, allowing heat to circulate freely.