二”）。亦要（唐本作“须”）验之于舌，或黄甚，或如沉香色，或如灰黄色，或老黄色或中有断纹，皆当下之，如小承气
汤，用槟榔、青皮、枳实、元明粉、生首乌等（唐本此下有“皆可”二字）。若未见此等舌，不宜用此等法（唐本作“药”）。
恐其中有湿聚。太阴为满，或寒湿错杂为痛，或气壅为胀，又当以别法治之（唐本有“矣”字）。
舌苔如地上初生之草，必有根，无根者为浮垢，刮之即去，乃无形湿热，而胃无结实之邪，故云有中虚之象。若妄
用攻泻伤内，则表邪反陷，为难治矣。即使有此等舌苔，亦不宜用攻泻之药。又如湿为阴邪，脾为湿土，故脾阳虚，则
湿聚腹满，按之不坚，虽见各色舌苔而必滑，色黄为热，白为寒，总当扶脾燥湿为主，热者佐凉药，寒者非大温，其湿
不能去也。若气壅为胀，皆有虚实寒热之不同，更当辨别以利气和气为主治也。
雄按∶上第五章，唐本移作第六章，今订正之。章氏所释，白为寒，非大温其湿不去是也。然苔虽白而不燥，还须
问其口中和否？如口中自觉粘腻，则湿渐化热，仅可用浓朴、槟榔等苦辛微温之品。口中苦渴者，邪已化热，不但大温
不可用，必改用淡渗苦降微凉之剂矣。或渴喜热饮者，邪虽化热，而痰饮内盛也，宜温胆汤加黄连。杨云∶原论已极郑
重周详，此更辨别疑似，细极毫芒。可见心粗胆大者，必非真学问人也。
再黄苔不甚浓而滑者，热未伤津，犹可清热透表；若虽薄而干者，邪虽去而津受伤也，苦重之药当禁，宜甘寒轻剂
可也（唐本“可也”作“养之”）。
热初入营，即舌绛苔黄，其不甚浓者，邪结未深，故可清热，以辛开之药，从表透发，舌滑而津未伤，得以化汗而
解。若津伤舌干，虽苔薄邪轻，亦必秘结难出，故当先养其津，津回舌润，再清余邪也。
雄按∶上第六章，唐本移作第七章，今订正之。此二章论黄苔各证治法之不同。
再论其热传营，舌色必绛。绛，深红色也。初传，绛色中兼黄白色，此气分之邪未尽也，泄卫透营，两和可也。纯
绛鲜色者，包络受病（唐本作“邪”）也，宜犀角、鲜生地、连翘、郁金、石菖蒲等（唐本此下有“清泄之”三字）。延
之数日，或平素心虚有痰，外热一陷，里络就（唐本作“即”）闭，非菖蒲、郁金等所能开，须用牛黄丸、至宝丹之类以
开其闭，恐其昏厥为痉也。
何报之曰∶温热病一发便壮热烦渴，舌正赤而有白苔者，虽滑即当清里，切忌表药。绛者，指舌本也。黄白者，指
舌苔也。舌本通心脾之气血，心主营，营热故舌绛也。脾胃，为中土，邪入胃则生苔，如地上生草也。然无病之人，常
有微薄苔如草根者，即胃中之生气也。杨云∶论舌苔之源甚佳。若光滑如镜，则胃无生发之气，如不毛之地，其土枯矣。
胃有生气而邪入之，其苔即长浓，如草根之得秽浊而长发也。故可以验病之虚实寒热，邪之浅深轻重也。脾胃统一身之
阴阳，营卫主一身之气血。故脾又为营之源，胃又为卫之本也。苔兼白，白属气，故其邪未离气分，可用泄卫透营，仍
从表解，勿使入内也。纯绛鲜泽者，言无苔色，则胃无浊结，而邪已离卫入营，其热在心包也。若平素有痰，必有舌苔。
雄按∶绛而泽者，虽为营热之征，实因有痰，故不甚干燥也。间若胸闷者，尤为痰据，不必定有苔也。菖蒲、郁金
亦为
此设，若竟无痰，必不甚泽。其心虚血少者，舌色多不鲜赤，或淡晦无神，邪陷多危而难治，于此可卜吉凶也。若邪火
盛而色赤，宜牛黄丸。痰湿盛而有垢浊之苔者，宜至宝丹。略参拙意。
雄按∶上第七章，唐本移为第八章，今订正之。连下二章，辨论种种舌绛证治，是统风温、湿温而言也。
再色绛而舌中心干者，乃心胃火燔，劫烁津液，即黄连、石膏，亦可加入。若烦渴烦热，舌心干，四边色红，中心
或黄、或白者，此非血分也。乃上焦气热烁津，急用凉膈散，散其无形之热，再看其后转变可也。慎勿用血药，以滋腻
难散。至舌绛望之若干，手扪之原有津液，此津亏湿热熏蒸，将成浊痰，蒙闭心包也。
热已入营则舌色绛，胃火烁液则舌心干，加黄连、石膏于犀角生地等药中，以清营热而救胃津，既白虎加生地之例
也。
雄按∶此节章氏无注，今补释之。
其舌四边红而不绛，中兼黄白而渴，故知其热不在血分，而在上焦气分，当用凉膈散清之。勿用血药引入血分，反
难解散也。盖胃以通降为用，若营热蒸其胃中浊气成痰，不能下降，反上熏而蒙蔽心包。望之若干，扪之仍湿者，是其
先兆也。
雄按∶上第八章，唐本与第九章颠倒窜乱，今订正之。
再有热传营血，其人素有瘀伤宿血在胸膈中，挟热而搏，唐本无此四字。其舌色必紫而暗，扪之湿，当加入散血之
品，如琥珀、丹参、桃仁、丹皮等。不尔，瘀血与热为伍，阻遏正气，遂变如狂、发狂之证。若紫而肿大者，乃酒毒冲
心。若紫而干晦者，肾肝色泛也，难治。
何报之曰∶酒毒内蕴，舌必深紫而赤，或干涸。若淡紫而带青滑，则为寒证矣。须辨。舌紫而暗，暗即晦也，扪之
潮湿不干，故为瘀血。其晦而干者，精血已枯，邪热乘之，故为难治。肾色黑，肝色青，青黑相合，而见于舌，变化紫
晦，故曰肾肝色泛也。
雄按∶此舌虽无邪热，亦难治。酒毒冲心，急加黄连清之。
雄按∶此节，唐本作第十章。
舌色绛而上有粘腻，似苔非苔者，中挟秽浊之气，急加芳香逐之。舌绛欲伸退场门而抵齿，难骤伸者，痰阻舌根，有
内风也。舌绛而光亮，胃阴亡也。急用甘凉濡润之品。若舌绛而干燥者，火邪劫营，凉血清火为要。舌绛而有碎点白黄
者，当生疳也。大红点者，热毒乘心也。用黄连、金汁。其有虽绛而不鲜，干枯而痿者，肾阴涸也。急以阿胶、鸡子黄、
地黄、天冬等救之。缓则恐涸极而无救也。
尤拙吾曰∶阳明津涸，舌干口燥者，不足虑也，若并亡其阳则殆矣。少阴阳虚，汗出而厥者，不足虑也，若并亡其
阴则危矣。是以阳明燥渴，能饮冷者，生；不能饮者，死。少阴厥逆，舌不干者，生；干者，死。挟秽者，必加芳香，
以开降胃中浊气，而清营热矣。痰阻舌根，由内风之逆，则开降中又当加辛凉咸润以息内风也。脾肾之脉，皆连舌本，
亦有脾肾气败而舌短不能伸者，其形貌面色亦必枯瘁，多为死证，不独风痰所阻之故也。其舌不鲜，干枯而痿，肾阴将
涸，亦为危证，而黄连、金汁，并可治疳也。
雄按∶光绛而胃阴亡者，炙甘草汤去姜、桂，加石斛，以蔗浆易饴糖。干绛而火邪劫营者，晋三犀角地黄汤加玄参、
花粉、紫草、银花、丹参、莲子心、竹叶之类。若尤氏所云，不能饮冷者，乃胃中气液两亡，宜复脉汤原方。
汪按∶以蔗浆易饴糖，巧妙绝伦。盖温证虽宜甘药，又不可滞中也。
其有舌独中心绛干者，此胃热心营受灼也。当于清胃方中，加入清心之品，否则延及于尖，为津干火盛也。舌尖绛
独干，此心火上炎，用导赤散泻其腑。
其干独在舌心舌尖，又有热邪在心兼胃之别。尖独干，是心热。其热在气分者必渴，以气热劫津也。热在血分，其
津虽耗，其气不热，故口干而不渴也。多饮能消水者为渴，不能多饮，但欲略润者为干。又如血分无热而口干者，是阳
气虚不能生化津液，与此大不同也。
雄按∶上第九章，唐氏窜入第八章，今厘正之。舌心是胃之分野，舌尖乃心之外候，心胃两清，即白虎加生地、黄
连、犀角、竹叶、莲子心也。津干火盛者，再加西洋参、花粉、梨汁、蔗浆可耳！心火上炎者，导赤汤入童溲尤良。
再舌苔白浓而干燥者，此胃燥气伤也，滋润药中加甘草，令甘守津还之意。舌白而薄者，外感风寒也，当疏散之。
若白干薄（唐本作“白薄而干”）者，肺津伤也，加麦冬、花露、芦根汁等轻清之品，为上者上之也。若白苔绛底（唐本
作“苔白而底绛”）者，湿遏热伏也。当先泄湿透热，防其就（唐本作“即”）干也。勿忧之（唐本作“此可勿忧”），再
从里（唐本下有“而”字）透于外，则变润矣。初病，舌就（唐本作“即”）干，神不昏者，急加养正透邪之药。若神已
昏，此内匮矣（唐本“矣”字在下句之末），不可救药。
苔白而浓，本是浊邪，干燥伤津，则浊结不能化，故当先养津而后降浊也。肺位至高，肺津伤，必用轻清之品，方
能达肺。若气味浓重而下走，则反无涉矣。故曰“上者上之也。”
雄按∶此释甚明白，何以第二章释为因地制宜？而讥他
人效颦也。湿遏热伏，必先用辛开苦降以泄其湿，湿开热透，故防舌干，再用苦辛甘凉从里而透于外，则胃气化而津液
输布，舌即变润，自能作汗，而热邪亦可随汗而解。若初病舌即干，其津气素竭也。急当养正，略佐透邪。若神已昏，
则本元败，而正不胜邪，不可救矣。
雄按∶有初起舌干而脉滑脘闷者，乃痰阻于中，而液不上潮，未可率投补益也。
又不拘何色，舌上生芒刺者，皆是上焦热极也。当用青布拭冷薄荷水揩之。即去者轻，旋即生者险矣。
生芒刺者，苔必焦黄或黑。无苔者，舌必深绛。其苔白或淡黄者，胃无大热，必无芒刺。或舌尖、或两边，有小赤
瘰，是营热郁结，当开泄气分以通营清热也。上焦热极者，宜凉膈散主之。
雄按∶秦皇士云∶凡渴不消水，脉滑不数，亦有舌苔生刺者，多是表邪挟食，用保和加竹沥、莱菔汁。或栀豉加枳
实，并效。若以寒凉抑郁，则谵语发狂愈甚，甚则口噤不语矣。有斑疹内伏，连用升提而不出，用消导而斑出神清者，
若荤腥油腻，与邪热斑毒纽结不解，唇舌焦裂，口臭牙疳，烦热昏沉，与以寻常消导，病必不解，徒用清里，其热愈甚，
设用下夺，其死更速。惟用升麻葛根汤以宣发之。重者，非升麻清胃汤，不能清理肠胃血分中之膏粱积热，或再加山楂、
槟榔，多有生者。愚谓病从口入，感证夹食，为患者不少。秦氏着《伤寒大白》，于六法外，特补消导一门，未为无见，
所用莱菔汁，不但能消痰食，即燥火闭郁，非此不清，用得其当，大可起死回生。郭云台极言其功，余每与海蛇同用，
其功益懋。
舌苔不燥，自觉闷极者，属脾湿盛也。或有伤痕血迹者，必问曾经搔挖否。不可以有血而便为枯证仍从湿治可也。
再有神情清爽，舌胀大不能退场门者，此脾湿胃热，郁极化风，而毒延口也。用大黄磨入当用剂内，则舌胀自消矣。
何报之曰∶凡中宫有痰饮水血者，舌多不燥，不可误认为寒也。三焦升降之气，由脾鼓运，中焦和，则上下气顺。
脾气弱则湿自内生。湿盛而脾不健运，浊壅不行，自觉闷极，虽有热邪，其内湿盛而舌苔不燥。当先开泄其湿，而后清
热，不可投寒凉以闭其湿也。神情清爽而舌胀大，故知其邪在脾胃。若神不清，即属心脾两脏之病矣。邪在脾胃者，唇
亦必肿也。
雄按∶上第十章，唐氏析首节为第五章，次节为第十二章，末节为第十三章，今并订正。
再（唐本作“又有”）舌上白苔粘腻，吐出浊浓涎沫，口必甜味也（唐本作“其口必甜”），为脾瘅病（唐本作“此为
脾瘅”）。乃湿热气聚，与谷气相搏，土有余也。盈满则上泛，当用省头草（唐本作“佩兰叶”），芳香辛散以逐之则退（唐
本无此二字）。若舌上苔如碱者，胃中宿滞挟浊秽郁伏，当急急开泄，否则闭结中焦，不能从膜原达出矣。
脾瘅而浊泛口甜者，更当视其舌本，如红赤者为热，当辛通苦降以泄浊；如色淡不红，由脾虚不能摄涎而上泛，当
健脾以降浊也。苔如碱者，浊结甚，故当急急开泄，恐内闭也。
雄按∶浊气上泛者，涎沫浓浊，小溲黄赤。脾虚不摄者，涎沫稀粘，小溲清白。见证迥异，虚证宜温中以摄液，如
理中或四君加益智之类可也。何亦以降浊为言乎？疏矣！上第十一章，唐氏并入第四章，今订正之。
此二章辨别种种白苔证治之殊，似兼疫证之舌苔而详论之，试绎之，则白苔不必尽属于寒也。
若（唐本无此字）舌无苔，而有如烟煤隐隐者，不渴，肢寒，知挟阴病（唐本移二句在若润者上）。如口渴烦热（唐
本下有“而燥者”三字），平时胃燥舌（唐本无“舌”字）也，不可攻之。若燥者（唐本作“宜”），甘寒益胃。若（唐本
此下有“不渴肢寒而”五字）润者，甘温扶中，此何（唐本此下有“以”字）。故外露而里无也。
凡黑苔，大有虚实寒热之不同，即黄白之苔，因食酸味，其色即黑，尤当问之。
雄按∶此名染苔，食橄榄能黑，食枇杷白苔能黄之类，皆不可不知也。其润而不燥，或无苔如烟煤者，正是肾水来
乘心火，其阳虚极矣。若黑而燥裂者，火极变水色，如焚木成炭而黑也。虚实不辨，死生反掌耳。
雄按∶虚寒证虽见黑
苔，其舌色必润而不紫赤，识此最为秘诀。
雄按∶更有阴虚而黑者，苔不甚燥，口不甚渴，其舌甚赤，或舌心虽黑，无甚苔垢，舌本枯而不甚赤，证虽烦渴便
"Two"). It is also necessary to verify through tongue examination. If the coating is deeply yellow, or like the color of agarwood, or like grayish-yellow, or old yellow, or has cracks in the middle, all indicate the need for purgation, such as Xiao Cheng Qi Tang (Minor Order the Qi Decoction), using Arecae Semen (Binglang), Citri Reticulatae Pericarpium (Qingpi), Immature Bitter Orange (Zhishi), Mirabilite (Yuanmingfen), and Raw Polygoni Multiflori Caulis (Sheng Shouwu) etc. (Tang edition has "all are suitable" here). If these tongue signs are not seen, these methods (Tang edition: "medicines") should not be used. One must fear that dampness has gathered within. Taiyin spleen dysfunction leads to fullness, or cold-damp complexity causes pain, or qi stagnation causes distension; in such cases, other methods should be employed (Tang edition has "particle indicating completion").
The tongue coating is like grass newly sprouting on the ground; it must have roots. Rootless coating is floating dirt, which can be scraped off easily. This indicates formless damp-heat without solid pathogenic factors in the stomach, hence described as a sign of middle jiao deficiency. If one recklessly uses purgatives to damage the interior, the exterior pathogen will instead sink inward, becoming difficult to treat. Even if such tongue coatings appear, purgative medicines should not be used. Furthermore, dampness is a yin pathogen, and the spleen belongs to wet earth. Therefore, when spleen yang is deficient, dampness gathers causing abdominal fullness that is not hard upon pressure. Although various colored tongue coatings may appear, they will certainly be slippery. Yellow indicates heat, white indicates cold. The primary treatment should always be to support the spleen and dry dampness. For heat, cool medicines should be added as assistants; for cold, strongly warming medicines are necessary, otherwise the dampness cannot be eliminated. If distension is caused by qi stagnation, there are differences in deficiency/excess and cold/heat; differentiation is required, with regulating qi being the main treatment principle.
Wang Shixiong notes: The above Chapter 5 was moved to Chapter 6 in the Tang edition, now corrected. Zhang's explanation that "white indicates cold, and without strong warming the dampness will not disperse" is correct. However, although the coating is white and not dry, one must ask if the mouth feels normal/moist? If the mouth feels sticky, dampness is gradually transforming into heat; only bitter-pungent slightly warm substances like Magnoliae Officinalis Cortex (Houpo) and Arecae Semen (Binglang) can be used. If the mouth is bitter and thirsty, the pathogen has transformed into heat; strongly warming medicines must not be used, but rather light-leaching, bitter-descending, slightly cooling formulas should be adopted. If thirst prefers hot drinks, although the pathogen has transformed into heat, phlegm-fluid retention is abundant internally; Wendan Tang (Warm the Gallbladder Decoction) with Coptidis Rhizoma (Huanglian) added is appropriate. Yang states: The original theory is already extremely solemn and detailed; this further distinguishes doubtful cases with extreme subtlety. It shows that those who are careless and bold are certainly not true scholars.
Again, if the yellow coating is not very thick but slippery, heat has not damaged body fluids, and clearing heat while venting from the exterior is still possible. If it is thin but dry, although the pathogen has left, body fluids are injured; heavy bitter medicines should be prohibited, and light sweet-cold agents are suitable (Tang edition "suitable" reads "nourish").
When heat first enters the Ying (Nutrient) level, the tongue becomes crimson with yellow coating. If the coating is not very thick, the pathogen binding is not deep, so clearing heat is possible. Using pungent-opening medicines to vent from the exterior, if the tongue is slippery and fluids are undamaged, sweat can transform and resolve the condition. If fluids are damaged and the tongue is dry, even with thin coating and mild pathogen, obstruction makes exit difficult; thus, nourishing fluids must come first. Once fluids return and the tongue becomes moist, remaining pathogens can then be cleared.
Wang Shixiong notes: The above Chapter 6 was moved to Chapter 7 in the Tang edition, now corrected. These two chapters discuss the different treatments for various yellow coating syndromes.
Regarding heat transmitting to the Ying level, the tongue color must be crimson. Crimson is deep red. In early transmission, crimson color mixed with yellow-white indicates that Qi-level pathogens are not yet exhausted. Venting the Wei (Defensive) level and penetrating the Ying level, harmonizing both is sufficient. Pure bright crimson indicates the Pericardium is affected (Tang edition: "pathogen"); Rhinoceros Horn (Xijiao - note: substitute with water buffalo horn in modern practice), Fresh Rehmanniae Radix (Xian Shengdi), Forsythiae Fructus (Lianqiao), Curcumae Aromatica Rhizoma (Yujin), and Acori Tatarinowii Rhizoma (Shichangpu) etc. are suitable (Tang edition has "clear and drain" here). After several days, or if the patient usually has heart deficiency with phlegm, once external heat sinks, the interior collaterals close. Shichangpu and Yujin alone cannot open this; Niuhuang Wan (Calculus Bovis Pill) or Zhibao Dan (Precious Treasure Pill) types must be used to open the closure, fearing coma turning into convulsions.
He Baozhi says: When warm-heat disease begins with high fever, restlessness, and thirst, and the tongue is truly red with white coating, even if slippery, internal clearing is indicated; exterior-releasing medicines must be strictly avoided. "Crimson" refers to the tongue body; "yellow-white" refers to the coating. The tongue body connects to the Qi and Blood of the Heart and Spleen. The Heart governs Ying; Ying heat causes the tongue to be crimson. Spleen and Stomach belong to Central Earth; when pathogen enters the Stomach, coating forms, like grass growing on ground. However, healthy people often have a thin coating like grass roots, which is the vital energy of the Stomach. Yang states: The discussion on the origin of tongue coating is excellent. If smooth as a mirror, the Stomach lacks generative energy, like barren land where soil is dried up. If the Stomach has generative energy and pathogen enters, the coating grows thick, like grass roots getting filthy and growing luxuriantly. Thus, it can verify the deficiency/excess and cold/heat of the disease, and the depth/severity of the pathogen. Spleen and Stomach unify Yin and Yang of the whole body; Ying and Wei govern Qi and Blood. Thus, Spleen is the source of Ying, and Stomach is the root of Wei. Coating includes white; white belongs to Qi, so the pathogen has not left the Qi level. One can use venting Wei and penetrating Ying, still resolving from the exterior, preventing entry inward. Pure bright crimson luster means no coating color, so Stomach has no turbid binding, and pathogen has left Wei and entered Ying; the heat is in the Pericardium. If one usually has phlegm, there must be a tongue coating.
Wang Shixiong notes: Crimson and lustrous, although a sign of Ying heat, is actually due to phlegm, hence not very dry. Occasional chest stuffiness especially indicates phlegm obstruction, not necessarily requiring a coating. Shichangpu and Yujin are set for this purpose; if there is absolutely no phlegm, it will certainly not be lustrous. Those with heart deficiency and blood scarcity often have tongues that are not bright red, or pale and dull without spirit; pathogen sinking is mostly critical and difficult to treat; fortune and misfortune can be predicted here. If evil fire is abundant and color is red, Niuhuang Wan is suitable. If damp-phlegm is abundant with dirty coating, Zhibao Dan is suitable. I add my humble opinion.
Wang Shixiong notes: The above Chapter 7 was moved to Chapter 8 in the Tang edition, now corrected. Connecting with the next two chapters, discussing various crimson tongue treatments, covers both Wind-Warmth and Damp-Warmth generally.
Again, if crimson with dry center of tongue, it is blazing Fire of Heart and Stomach consuming fluids; Coptidis Rhizoma (Huanglian) and Gypsum Fibrosum (Shigao) can be added. If restless, thirsty, and hot, with dry tongue center, red sides, and yellow or white center, this is not Blood level pathology. It is Heat of Upper Jiao scorching fluids; urgently use Liang Ge San (Cool the Diaphragm Powder) to scatter formless heat, then observe subsequent changes. Carefully avoid Blood-invigorating medicines because they are cloying and hard to disperse. As for tongue crimson looking dry but moist to touch, this is fluid deficiency with damp-heat steaming, about to become turbid phlegm clouding the Pericardium.
When heat has entered Ying, tongue color is crimson; Stomach fire scorching fluids makes tongue center dry. Adding Huanglian and Shigao to Xijiao and Shengdi etc. clears Ying heat and saves Stomach fluids, following the example of Baihu Jia Shengdi Tang.
Wang Shixiong notes: This section has no annotation by Zhang, now supplemented.
If tongue sides are red but not crimson, middle has yellow-white and thirst, we know heat is not in Blood level but in Upper Jiao Qi level; Liang Ge San should be used to clear it. Do not use Blood medicines to introduce into Blood level, making resolution harder. The Stomach functions through descending and unblocking. If Ying heat steams turbid Qi in Stomach into phlegm, unable to descend, it steams upward and clouds Pericardium. Looking dry but moist to touch is its precursor sign.
Wang Shixiong notes: The above Chapter 8 was confused with Chapter 9 in Tang edition, now corrected.
Furthermore, when heat transmits to Ying and Blood, if the person usually has stasis/blood retention in chest/diaphragm, clashing with heat (Tang edition lacks these four characters), the tongue color must be purple and dark, moist to touch. Blood-dispersing items like Succinum (Hupo), Salviae Miltiorrhizae Radix (Danshen), Persicae Semen (Taoren), and Moutan Cortex (Danpi) should be added. Otherwise, stasis associates with heat, obstructing righteous Qi, leading to manic-like or manic symptoms. If purple and swollen, it is Wine-Toxin rushing to Heart. If purple and dry/dull, it is Kidney-Liver colors manifesting, difficult to treat.
He Baozhi says: Internal wine-toxin accumulation makes tongue deep purple and red, or dry. If pale purple with green slipperiness, it is Cold syndrome. Must differentiate. Tongue purple and dark, dark means dull; moist to touch and not dry indicates stasis. Dull and dry indicates Essence-Blood exhaustion, pathogen heat taking advantage, hence difficult. Kidney color is black, Liver color is green; green-black combined appearing on tongue changes to purple-dull, hence called Kidney-Liver color manifestation.
Wang Shixiong notes: Although this tongue has no evil heat, it is also difficult to treat. Wine-toxin rushing to Heart, urgently add Huanglian to clear.
Wang Shixiong notes: This section is Chapter 10 in Tang edition.
If tongue is crimson with sticky substance on top, resembling coating but not quite, it harbors turbid foul Qi; urgently add aromatic substances to expel it. If tongue is crimson wanting to extend but hitting teeth at the gate, difficult to extend suddenly, phlegm blocks tongue root, indicating internal Wind. If tongue is crimson and glossy, Stomach Yin is perished; urgently use sweet-cool moistening substances. If tongue is crimson and dry, Fire pathogen robs Ying; cooling Blood and clearing Fire is essential. If tongue is crimson with small white/yellow spots, Chan (parasitic ulcer) will likely form. Large red dots indicate Heat-Toxin attacking Heart; use Huanglian and Jinzhi (Gold Juice). If crimson but not fresh, dry and flaccid, Kidney Yin is exhausted; urgently save with Cornu Bubali (Niuhuang substitute/Water Buffalo Horn - *Note: Text says Ejiao*, see below correction based on text: Ejiao, Egg Yolk, Rehmanniae Radix Preparata (Shu Dihuang), and Asparagi Radix (Tian Dong). Delay risks exhaustion beyond saving.
You Zhuowu says: Yangming fluid exhaustion, dry tongue and mouth, is not worrying; if Yang is also lost, it is dangerous. Shaoyin Yang deficiency, sweating and cold limbs, is not worrying; if Yin is also lost, it is critical. Thus, Yangming dry thirst, able to drink cold, lives; unable to drink, dies. Shaoyin cold limbs, tongue not dry, lives; dry, dies. With turbidity, must add aromatics to open/descend Stomach turbid Qi and clear Ying heat. Phlegm blocking tongue root due to internal Wind reversal requires adding pungent-cool salty-moist substances to extinguish internal Wind during opening/descending. Spleen/Kidney meridians connect to tongue root; Spleen/Kidney Qi failure causing short tongue unable to extend, with withered appearance/color, is mostly death syndrome, not just wind-phlegm blockage. Tongue not fresh, dry/flaccid, Kidney Yin nearly exhausted, is also critical; Huanglian and Jinzhi can also treat Chan.
Wang Shixiong notes: Glossy crimson with Stomach Yin perished: Zhigancao Tang remove Ginger/Cinnamon, add Dendrobii Caulis (Shihu), replace Maltose with Sugarcane Juice. Dry crimson with Fire robbing Ying: Jin San Xijiao Dihuang Tang add Scrophulariae Radix (Xuanshen), Paeoniae Radix Alba (Baishao - *Text says Huafen/Glehniae Rhizoma*), Trichosanthis Radix (Guazhong), Arnebiae Radix et Rhizoma (Zicao), Lonicerae Japonicae Flos (Jinyinhua), Danshen, Nelumbinis Plumula (Lianzixin), and Bambusa Takahei Takenoko (Zhuyeqian) etc. If You states unable to drink cold, it is Stomach Qi and Fluid dual loss; Fumai Tang original formula is suitable.
Wang An notes: Replacing Maltose with Sugarcane Juice is exquisitely clever. Warm diseases suit sweet medicines, but must not cause stagnation.
If only the center of tongue is crimson and dry, this is Stomach Heat burning Ying nutrients. Add Heart-clearing substances to Stomach-clearing formulas; otherwise it spreads to tip, causing fluid dryness and fire abundance. If only tongue tip is crimson and dry, this is Heart Fire flaming upward; Daochi San (Guide Out Redness Powder) drains its Fu organ.
Dryness only in tongue center/tip distinguishes Heat in Heart vs Heart/Stomach. Tip dry is Heart Heat. Heat in Qi level causes thirst due to Qi heat robbing fluids. Heat in Blood level consumes fluids but Qi is not hot, hence dry mouth but no thirst. Drinking much and digesting water is thirst; drinking little just to moisten is dryness. Again, dry mouth without Heat in Blood is Yang Qi deficiency failing to generate fluids, greatly different from this.
Wang Shixiong notes: The above Chapter 9 was inserted into Chapter 8 by Tang, now rectified. Tongue center is territory of Stomach; tongue tip is exterior indicator of Heart. Clearing both Heart and Stomach involves Baihu Jia Shengdi Tang plus Huanglian, Xijiao, Zhuye, Lianzixin. For fluid dryness/fire abundance, add American Ginseng (Xiyangshen), Glehniae Rhizoma (Huafen), Pear Juice, Sugarcane Juice! For Heart Fire flaming upward, Daochi Tang with Child's Urine (Tongxiao) is best.
Again, thick white coating but dry indicates Stomach dryness and Qi injury; add Licorice (Gancao) to moistening medicines to achieve "Sweet preserves, fluids return". Thin white coating indicates Exterior Cold-Wind; disperse it. If thin white and dry (Tang: "thin white but dry"), Lung fluids are injured; add Ophiopogonis Radix (Maidong), Flower Dew, Phragmitis Rhizoma Juice (Lugen汁) etc., light/clear substances, treating upper with upper approach. If white coating with crimson base (Tang: "coating white, base crimson"), Dampness suppresses Heat hiding. First drain dampness and vent heat, preventing drying. Do not worry (Tang: "this can be disregarded"), vent from interior to exterior, then it becomes moist. Early disease, tongue immediately dry, spirit not confused, urgently add supporting righteousness and venting pathogen medicines. If spirit is confused, interior is depleted (Tang "particle" at end of next sentence), incurable.
Thick white coating is originally turbid pathogen; dryness injures fluids, so turbid binding cannot transform; thus nourish fluids first then descend turbidity. Lung position is highest; Lung fluid injury requires light/clear substances to reach Lung. If flavors are heavy and go downward, they fail to reach. Hence "treat upper with upper".
Wang Shixiong notes: This explanation is clear; why did Chapter 2 interpret it as adapting to local conditions? And mock others imitating blindly. Damp suppressing heat must first use pungent-opening bitter-descending to drain damp; once damp opens and heat vents, prevent tongue dryness, then use bitter-pungent-sweet-cool to vent from interior to exterior, Stomach Qi transforms and fluids distribute, tongue becomes moist, sweat naturally forms, and heat resolves with sweat. If tongue is dry at onset, fluids/Qi were originally exhausted. Urgently support righteousness, slightly assist venting pathogen. If spirit is confused, primal essence fails, righteous Qi cannot overcome pathogen, incurable.
Wang Shixiong notes: Some have early dry tongue with slippery pulse and epigastric stuffiness; this is phlegm blocking middle, fluids not rising, do not rashly give tonics.
Regardless of color, prickles on tongue indicate extreme Heat in Upper Jiao. Wipe with blue cloth dipped in cold mint water. Prickles disappearing quickly are mild; regenerating immediately are dangerous.
Prickles forming require scorched yellow or black coating. No coating means deep crimson. White or pale yellow coating means Stomach has no major heat, definitely no prickles. Small red bumps on tip or sides indicate Ying heat stagnation; open/drain Qi level to unblock Ying and clear heat. Extreme Upper Jiao heat is treated with Liang Ge San.
Wang Shixiong notes: Qin Huangshi says: Thirst not quenching water, slippery non-rapid pulse, tongue prickles often indicate exterior pathogen with food retention; Bahe San plus Bamboo Sap and Raphani Semen Juice. Or Zhizi Chih Tang plus Zhishi, both effective. If using cold/cool depressants, delirium/mania worsens, even jaw lock/speechlessness. Spots/rash hidden inside, lifting fails to bring out, digestion brings out spots and clears spirit: if greasy/meaty food knots with heat/toxin, lips/tongue crack, bad breath/gum rot, restlessness/coma, ordinary digestion fails, clearing interior increases heat, purging accelerates death. Only Shengma Gegen Tang to ventilate/heave. Severe cases require Shengma Qingwei Tang to clean grease/heat in Stomach/Blood levels, possibly adding Hawthorn and Arecae Semen; many survive. I believe disease enters via mouth; infection with food retention is common. Qin's "Shanghan Dabai" adds Digestion category outside Six Methods, not without merit. Raphani juice not only digests phlegm/food but clears dry-fire closure; used correctly, it saves lives. Guo Yuntai extols its merit; I often use it with Haisha (Sea Snake), efficacy increases.
Coating not dry, feeling extremely stuffy, belongs to Spleen Dampness abundance. If scars/blood traces exist, ask if scratched. Do not assume dryness due to blood; still treat as damp.
Again, clear spirit but swollen tongue unable to retract, this is Spleen Damp/Stomach Heat, extreme stagnation transforming to Wind, toxin spreading to mouth. Grind Rhubarb (Dahuang) into appropriate dose; tongue swelling subsides.
He Baozhi says: Phlegm/fluid/water/blood in Middle Palace usually results in non-dry tongue, do not mistake for Cold. Three Jiao ascending/descending Qi moves by Spleen; Middle Jiao harmonized, upper/lower Qi flows smoothly. Weak Spleen generates internal damp. Abundant damp, weak Spleen transport, turbid stagnation, feeling extremely stuffy; despite Heat, internal damp makes coating non-dry. First open/drain damp, then clear heat; do not use cold/cool to close damp. Clear spirit/swollen tongue indicates pathogen in Spleen/Stomach. If spirit unclear, it is Heart/Spleen disease. Pathogen in Spleen/Stomach implies lip swelling too.
Wang Shixiong notes: Above Chapter 10, Tang split first section to Ch5, second to Ch12, last to Ch13; now consolidated and corrected.
Again (Tang: "Also have") sticky white coating on tongue, spitting thick turbid saliva, mouth tastes sweet (Tang: "mouth definitely sweet"), is Pi Dan (Spleen Heat/Dampness) disease (Tang: "This is Pi Dan"). Damp-Heat gathers, combats Grain Qi, Earth is excessive. Fullness overflows upward; use Shengtou Cao (Prostrate Pearlwort - Tang: Peilan Ye/Patchouli Leaf), aromatic/pungent dispersing to expel, then retreats (Tang lacks these two words). If coating looks like alkali/soda, Stomach old stagnation with turbid foulness郁伏 (depressed/hidden); urgently open/drain, otherwise Middle Jiao closes, cannot reach Mo Yuan (Membrane Source).
Pi Dan with turbid overflow/sweet taste: view tongue body. Red/bright indicates Heat; pungent-unblocking bitter-descending to drain turbid. Pale/non-red indicates Spleen deficiency failing to control saliva overflowing; strengthen Spleen to descend turbid. Alkali-like coating means severe turbid binding; urgently open/drain, fear internal closure.
Wang Shixiong notes: Turbid Qi overflowing: saliva thick/turbid, urine yellow/red. Spleen deficiency failing control: saliva thin/sticky, urine clear/white. Manifestations differ greatly; deficiency suits warming middle to capture fluids, like Lizhong or Sijunzi plus Yizhi Ren. Why does He speak of descending turbid? Superficial! Above Chapter 11, Tang merged into Chapter 4; now corrected.
These two chapters distinguish various white coating treatments, seemingly discussing epidemic tongue coatings in detail. Interpreting them, white coating does not solely belong to Cold.
If (Tang lacks "If") tongue has no coating, but faint smoke-black color visible, no thirst, cold limbs, know accompanied by Yin disease (Tang moves two sentences before "If moist"). If thirsty/restless/hot (Tang adds "and dry"), usually Stomach dry tongue (Tang lacks "tongue"), do not purge. If dry (Tang: "Suitable"), sweet-cold benefits Stomach. If (Tang adds "no thirst, cold limbs and" five chars) moist, sweet-warm supports Middle, this is why (Tang adds "because") exterior shows but interior lacks.
All black coatings have great differences in deficiency/excess and cold/heat. Even yellow/white coatings turn black after eating sour foods; must inquire.
Wang Shixiong notes: This is named Dyed Coating. Eating olives turns black, eating loquat turns white coating yellow; all must be known. Moist not dry, or no coating like smoke-black, is exactly Kidney Water overcoming Heart Fire, extreme Yang deficiency. If black and dry/cracked, Fire extreme transforms to Water color, like burning wood to charcoal black. Not distinguishing deficiency/excess, life/death flips in palm.
Wang Shixiong notes: Although deficiency-cold presents black coating, tongue color must be moist not purple-red; knowing this is the secret.
Wang Shixiong notes: Also Yin deficiency presenting black, coating not very dry, mouth not very thirsty, tongue very red, or tongue center black but little coating dirt, tongue body dry not very red, syndrome though restless/thirsty...