或谓∶“全书载痧，论治俱备，舌胎仅存其名，岂痧胀舌胎无可治乎”。余曰∶“非也。”盖谓痧胀有别症之舌胎则
可，谓舌胎即痧胀之症，是不识痧胀之适当其然，并不识舌胎之所以然也。诚以舌胎乃足阳明胃腑热病，故治痧胀，先
理其痧，后治舌胎即安；若先理舌胎后治痧胀则危。盖舌胎乃胃腑热极气冲心胸，舌为心苗，故见胎则宜石膏、黄连、
大黄、黄芩、黄柏之类。若不先治痧，恐此等药又寒凝血分，反成大患，故治此者，要看痧毒一退即治舌胎可也。
治验∶
一翁在兹，发热口渴，舌有黑胎，卧难转动，气急痰喘，六脉洪实，放痧三十余针，未愈。用圆红散、砂仁汤微温
饮之，又付必胜汤，大便下黑粪，惟口渴黑胎未愈。加石膏、黄连二剂而瘳。
一曹华宇长子，十一月间，犯伤寒兼痧，舌卷耳聋，舌上黑胎芒刺，大渴昏沉发热，身重不能转侧，胸中迷闷，泻
痢清水，先以圆红散加郁金末，清茶稍冷冻饮料之。放指上痧三十余针，未愈。用阿魏丸付以防风散痧汤，合棱术汤加桃仁、
红花一剂，俱微冷冻饮料之，舌卷耳聋渐愈，泻水即止，大渴稍解，但舌胎不退，胸中饱闷。询其腹中厌冷，痧气已绝。用
和脾宣化饮减前胡，大腹皮加桃仁、红花、枳实、青皮、石膏、黄连、大黄微温饮之，食结饱闷俱消，黑胎芒刺皆退。
惟大便不通，用大黄三钱，芒硝一钱温饮之，大便通而愈。
一张旋庵内室，伤食饱闷，按之则痛，日晡发热，舌心焦黄芒刺。延余，脉微无力。余曰∶“痧也”。放腿弯痧三针，
流紫黑毒血。用紫朴汤，加柴胡、干葛微冷冻饮料之，后加石膏、黄连、大黄、黄柏温饮四剂，大便下宿粪而愈。
一龚云涛，发热呕哕，舌有黑胎芒刺，起二大泡，蜷卧声重，迷闷几死。脉左弦紧，右微细。放腿上痧三十余针，
用三黄石膏汤，微温饮之稍愈，骤进饮食，迷闷复发，用消食顺气之剂，后加大黄、芒硝，大便通而安。
A person asked: "The entire book records Sha (Sha disease), and the discussions on treatment are complete. Why is tongue coating only mentioned by name? Is it that there is no treatable method for tongue coating caused by Sha distension?" I replied: "Not so." It means that if one refers to the tongue coating accompanying other symptoms of Sha distension, it can be treated; but to claim that tongue coating itself is a symptom of Sha distension is to not understand why Sha distension presents as it does, nor to understand the rationale behind tongue coating formation. Indeed, tongue coating is a heat disease of the Foot-Yangming Stomach-Fu organ. Therefore, when treating Sha distension, one must first resolve the Sha toxin, and then treat the tongue coating to achieve recovery; if one treats the tongue coating first and then addresses the Sha distension, the condition will become critical. This is because tongue coating results from extreme heat in the Stomach-Fu organ causing Qi to rush to the heart and chest. Since the tongue is the sprout of the Heart, upon seeing tongue coating, one should use herbs such as Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma), Huangqin (Scutellariae Radix), and Huangbai (Phellodendri Cortex). If the Sha toxin is not treated first, these cold-natured drugs may cause coagulation in the Blood level, leading to major complications. Thus, those treating this condition should wait until the Sha toxin recedes before treating the tongue coating.
Case Records:
An elderly man suffered from fever and thirst, with black coating on his tongue, difficulty moving while lying down, rapid breathing with phlegm wheezing, and full, solid pulses in all six positions. After releasing Sha via thirty-plus needle pricks, he did not recover. He was given Yuanhong San (Round Red Powder) and Chenpi Tang (Tangerine Peel Decoction) to drink slightly warm. Subsequently, Bisheng Tang (Invincible Decoction) was administered. Black stool passed in the bowels, but thirst and black tongue coating persisted. Shigao (Gypsum Fibrosum) and Huanglian (Coptidis Rhizoma) were added, and after two doses, he recovered.
The eldest son of Cao Huayu, in November, contracted Cold Damage (Shanghan) complicated by Sha. His tongue was curled, he suffered deafness, and his tongue showed black coating with prickles. He experienced extreme thirst, lethargy, fever, heavy body unable to turn over, chest confusion and stuffiness, and diarrhea/dysentery with clear water discharge. First, Yuanhong San plus Yujin powder (Curcuma Longa Rhizoma powder) was given, mixed with cold tea and slightly chilled before drinking. Thirty-plus needle pricks were performed on the fingers, but he did not recover. Awei Wan (Asafoetida Pill) was combined with Fangfeng San Sha Tang (Saposhnikovia Dispersing Sha Decoction), and Helingzhu Tang (Combined Atractylodes and Curcuma Decoction) plus Taoren (Persicae Semen) and Honghua (Carthami Flos) were given for one dose, all slightly chilled before drinking. The curled tongue and deafness gradually improved, diarrhea stopped, and extreme thirst alleviated somewhat, but the tongue coating remained, along with chest fullness and stuffiness. Upon asking, he reported aversion to cold in the abdomen, indicating the Sha Qi had ceased. Heping Xuanhua Yin (Spleen-Harmonizing and Transformation-Dispersing Drink) minus Qianhu (Peucedani Radix), plus Dafupi (Arecae Pericarpium), Taoren (Persicae Semen), Honghua (Carthami Flos), Zhishi (Aurantii Fructus Immaturus), Qingpi (Citri Reticulatae Pericarpium Viride), Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), and Dahuang (Rhei Radix et Rhizoma) were given slightly warm. Food stagnation and fullness resolved, and black coating with prickles disappeared. However, constipation persisted. Dahuang (Rhei Radix et Rhizoma) 3 qian and Mangxiao (Natrii Sulfas) 1 qian were taken warm, leading to bowel movement and recovery.
The wife of Zhang Xu'an suffered from food stagnation causing fullness and stuffiness, pain upon pressure, and afternoon fever. Her tongue center was scorched yellow with prickles. When consulted, her pulse was faint and weak. I said: "This is Sha disease." Three needle pricks were performed at the popliteal fossa (leg bend), releasing dark purple-black toxic blood. Zipu Tang (Purple Magnolia Bark Decoction) plus Chaihu (Bupleuri Radix) and Gange (Puerariae Lobatae Radix) was given slightly chilled. Later, Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma), Dahuang (Rhei Radix et Rhizoma), and Huangbai (Phellodendri Cortex) were added, taken warm for four doses. Old feces passed in the bowels, and she recovered.
Gong Yuntao suffered from fever, vomiting, and hiccups. His tongue had black coating with prickles and developed two large blisters. He lay curled up with heavy voice, confused and nearly dead. His left pulse was wiry and tight, and his right pulse was faint and fine. Thirty-plus needle pricks were performed on the legs. Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) was given slightly warm, resulting in slight improvement. Suddenly, after eating too much, confusion recurred. Digestion-promoting and Qi-regulating agents were used, followed by the addition of Dahuang (Rhei Radix et Rhizoma) and Mangxiao (Natrii Sulfas). Bowel movement occurred, and he stabilized.