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When asking about the illness and the patient does not answer, it must be due to deafness. At this time, one should inquire: Is this congenital deafness, or has it been long-standing due to the illness, or has excessive damage occurred to Yuan Qi (Original Qi) after sweating or purging treatments? If the patient is reluctant to answer upon inquiry and merely nods, this indicates deficiency of Middle Qi (Middle Jiao Qi). If the patient is confused and unaware, one must distinguish whether it is a sudden Jue syndrome (syncope/collapse) or a result of chronic illness. In women presenting with stiff collapse, it is mostly related to Middle Qi, so one must ask if anger was involved. For any illness in women, one must inquire about menstruation, specifically whether it is early or late. For nuns, widows, etc., where Qi and Blood are stagnant, the two Chi pulses are often slippery; pregnancy should not be diagnosed based on this alone, and the same applies to unmarried girls. For abdominal distension and pain, one must ask if it is an old ailment or a new onset. After childbirth, one must ask about the ease or difficulty of labor, the amount of lochia, timing of diet intake, survival of the infant, and dietary irregularities. When asking about the site of pain, if pressing stops the pain, it is a deficiency pattern; if pressing exacerbates the pain, it is an excess pattern. Pain that is fixed indicates blood stasis; pain that moves without location indicates Qi stagnation. Generally, for various illnesses, if symptoms worsen during the day and are quiet at night, it is a Qi disease rather than Blood disease; if they worsen at night and are quiet during the day, it is a Blood disease rather than Qi disease. Fever during the day and quiet at night indicates Yang Qi is exclusively flourishing and entering the Yang aspect; quiet during the day and fever at night indicates Yang Qi has sunk and entered the Yin aspect. Fever both day and night indicates extreme Yang without Yin, requiring urgent draining of Yang and tonifying Yin; cold both day and night indicates extreme Yin without Yang, requiring urgent draining of Yin and tonifying Yang. Pain in the four limbs worsening with cloudy weather requires asking if the patient previously suffered from syphilis (Mei Chuang).

Zhang Sanxi said: "The *Jing Jian Lu* records thirty-six tongue appearances to differentiate the depth and prognosis of Shang Han (Cold Damage), which can be called detailed and complete. However, upon careful investigation, it essentially boils down to Yin-Yang, Exterior-Interior, Cold-Heat, and Deficiency-Excess." Tao Jie'an said: "When Shang Han pathogen is in the Exterior, there is no coating on the tongue. When Heat pathogen is in the Exterior, the coating gradually forms, turning from white to yellow, and from yellow to black; severely, it becomes black and cracked. Black coating is mostly ominous. If the root, middle, or tip is black, it may belong to Interior Heat; full blackness indicates extreme heat and is difficult to treat. Commonly, a dry white coating with thirst indicates deficiency with slight heat, or inability to sweat, or slight fluid retention in the Stomach preventing movement; warm resolution is appropriate."

White slippery coating: Deficiency-cold with exposure to cold, Yang Qi is not vigorous; warm method is appropriate.
White coating with prickles: Insufficiency of Body Fluids, accumulation in the Stomach; moving/dispersing method is appropriate.
Yellow coating: Slight heat, heat gradually entering the Interior, or signs of dryness and thirst; clearing and resolving method is appropriate.
Gray coating: Accumulation in the Stomach, deficiency-heat of Middle Qi, thirst but inability to consume fluids; warm resolution is appropriate.
Black coating: Heat entering the Interior with solid, dry, and thick accumulation; purgative method is appropriate. Slippery and moist indicates Water trapping Fire; warm method is appropriate. Although black and moist, this is what is called 'extreme Water resembling Fire'; lack of dryness is its distinguishing feature.
In differentiating tongues in Shang Han, since the tongue belongs to the Heart and governs Fire, and Cold belongs to Water. Water-Cold overwhelming Heart-Fire, external contraction combined with internal injury, where retained food is heavy and knots below the heart, after five or six days the tongue coating gradually turns yellow, or dry in the middle and moist on the edges, named 'Zhong Bei Tongue' (Middle Roasted Tongue). This indicates Interior Heat is still shallow. If fully dry, regardless of yellow or black, it belongs to Interior patterns, treated according to severity with purgatives. If purgatives have been used once or repeatedly without reduction, it is retained stagnation knotting in the Central Palace. Inquire about the Excess/Deficiency of the pulse and the state of Middle Qi. In Excess patterns, use moistening purgatives. In deficient persons with insufficient Shen Qi (Spirit/Energy), one should generate fluids and secure Middle Qi. Some have been cured using Sheng Mai San (Generate the Pulse Powder) combined with Jie Du Tang (Detoxify Poison Decoction), while others have been cured by taking Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) cold. One case represents Extreme Yin resembling Yang, the other Extreme Yang resembling Yin; they must not be confused.
White coating belongs to Cold. With exterior symptoms of irritability, wanting to sit or lie in mud-water, this is caused by Yin-Cold forcing the rootless, unguarded Fire outward. The pulse is large but does not beat strongly against the fingers; treat as a Yin pattern. If not very irritable, with vomiting, treat as Food-Stagnation Yin pattern.
Differentiating tongues postpartum, because the Heart governs Blood. The Classics say: "When Shaoyin Qi perishes, Blood does not flow." Therefore, a purple-black tongue indicates Blood death first.
Whenever seeing a black tongue, ask if the patient has eaten sour, sweet, or salty foods, as these can stain the tongue black. Whenever observing tongue color, even if preconceptions exist, one must carefully examine accompanying symptoms and the Excess/Deficiency of the pulse. Otherwise, there may be an error of miles despite a difference of inches.