（归安吴坤安先生撰。越医何廉臣增订。）
六淫感症有真传。临证先将舌法看。察色分经兼手足。营卫表里辨何难。
【廉勘】吴氏曰。凡诊伤寒。当先察舌苔形色。分别足经手经。在表在里。卫分营
分。再参脉症施治。此为辨症真传。
白肺绛心黄属胃。红胆灰黑主脾经。肾脏紫赤兼圆嫩。焦紫肝阳阴又青。
【廉勘】吴氏曰。凡临症。见舌无苔而润。或微白而薄。即是太阳表症。若黄苔阳
明里症。鲜红少阳胆火。灰黑太阴脾湿。绛主手少阴心经。紫赤属足少阴肾经。焦紫厥
阴阳邪。青滑厥阴阴邪。
表白里黄分汗下。绛营白卫治更歧。次将津液探消息。润泽无伤涩已亏。
【廉勘】吴氏曰。白苔主表。当汗。黄苔主里。当下。舌绛主营分之热。宜清。忌
表。舌白主卫分之邪。宜汗。忌清。再辨其舌之燥润。验其津液之存亡。不拘何色。但
以润泽为津液未伤。燥涩为津液已耗。最宜深察。
白为肺卫仍兼气。绛主心营血后看。白内兼黄多气热。边红中白肺津干。
【廉勘】吴氏曰。凡外邪之入。先到卫分。不解。然后入气分而营分。不解。然后
入血分。白内兼黄。仍属气分之热。不可早用清营药。白苔兼红。乃温邪犯肺。灼伤肺
津。不可辛温过表。只须轻清凉散。此即叶氏所谓卫之后方言气。营之后方言血。在卫
汗之。到气始可清气。乍入营分。犹可透营泄热。转出气分而解。至入于血。就恐耗血
动血。直须凉血清火是也。
白黄气分留连久。尚冀战汗透重关。舌绛仍兼黄白色。透营
泄卫两和间。
【廉勘】吴氏曰。凡舌苔白中带黄。日数虽多。尚在气分留连。可冀战汗而解。若
舌红绛仍带黄白等色。是邪在营卫之间。当用犀羚以清透营热。葱豉荷翘以辛散卫分。
两解以和之可也。以上三歌。总论舌苔之白黄红绛。邪之在表在里。卫分营分。此为
叶氏独得之心法。吴鞠通、王孟英、林佩琴、石芾南。悉遵此以辨症。窃思卫行脉外而
主气。营行脉中而主血。凡全体手足六经。奇经八脉。十五大络。一身孙络。贯乎脏腑
之内。运乎躯壳之中。连续贯通。为之道路以传变周流者。皆卫与营气与血之作用也。
故外邪之入。无不先到营卫。亦无不先伤气血。必营卫气血之功用失。而后脏腑之体质
乃伤。此必然之理。叶先生以此辨症。真独出心裁。活法推求之捷诀矣。
白而薄润风寒重。温散何妨液不干。燥薄白苔津已少。只宜凉解肺家安。
【廉勘】吴氏曰。此辨风寒与风热治法不同。凡风寒初入太阳经。舌多无苔。或
生苔白润而薄。此津液不亏。可从足经用辛温药。轻如羌、防、苏叶。重如麻黄、桂枝
之类。如白苔虽薄而燥。或舌边舌尖带红。此风热犯肺。先伤气分。津液已少。不可过
汗。当于手经用轻清疏解药。如桑叶、杏仁、焦栀、豆豉、连翘、薄荷、前胡、桔梗、
栝蒌皮、淡竹叶之类。
苔白而粘风湿重。解肌通气自然安。苔干薄白边红色。润燥清金救肺看。
【廉勘】此辨风湿与风燥治法迥殊。凡舌苔白而粘腻。或灰白而粘。必因身冒雨雾
。湿着上焦气分。症必发热头重。一身尽痛。口腻不渴。先宜解肌去湿。如桂枝、秦艽
、羌活、防风、白芷、二陈、二苓之类。次宜宣通气分。如藿梗、半夏、广皮、白蔻、
滑石、通草、苡仁、枯芩、浙苓皮之类。使气分湿走。热自止矣。如苔白薄而干。或
舌边兼红。气咳痰少。此风燥伤肺。津液已亏。急宜清燥救肺。如霜桑叶、甜杏仁、南
沙参、栝蒌仁、川贝、生甘、柿霜、梨汁、竹沥之类。以上两歌。总论舌苔之白润白燥
白粘白干。辨症之风寒风热风湿风燥。此为外感风邪之首要。但其中又须活变。如同
为舌白口渴之症。若湿邪内聚。津液不主上承者。当以舌白为主。而用辛温开湿。不以
口渴为忌也。若燥邪上受。津液不司通降者。当以口渴为主。而用清润化燥。不以舌白
为据也。
舌苔粘腻分寒热。色白色黄要辨明。湿结中焦多痞满。辛开淡泄自然平。
【廉勘】吴氏曰。此以舌苔粘腻为湿邪之验。白而粘腻者寒湿。其症胸腹痞满。小
便不利。大便反快。乃寒湿结于中焦。宜苦辛温淡药以开泄之。如苍术、川朴、半夏、
陈皮、赤苓、猪苓之类。黄而粘腻者湿热。其症
脘闷呕恶。二便不利。乃湿热结于中焦。宜苦辛凉淡药以开泄之。如黄芩、川连、半夏
、枳实、滑石、通草、茵陈、冬瓜皮子之类。以予所验。吾绍寒湿症少。湿热最多。湿
热者。湿与热互结不解也。其先受湿。后化热。在春秋冬三时。但名湿热。先受湿。后
冒暑。在夏令即名暑湿。其实皆湿热之症也。其间因湿而蒸热者。必化其湿而热方退。
因暑而蒸湿者。必清其暑而湿方行。此即先其所因。伏其所主之经旨也。
暑伤气分苔多
白。渴饮烦呕咳喘连。身热脉虚胸又满。无形气分热宜宣。
【廉勘】暑伤气分。舌苔多白。固已。但要辨其白糙者多挟秽。宜轻清芳透。如焦
栀、豆豉、连翘、薄荷、茵陈、滑石、通草、青蒿脑、鲜淡竹叶、鲜枇杷叶、西瓜翠衣
、鲜荷叶边之类。白腻者必挟湿。参看后条歌诀可也。
暑湿合邪苔浊腻。三焦受病势弥
漫。脘闷头胀多呕恶。腹痛还防疟痢干。
【廉勘】吴氏曰。暑邪挟湿。从口鼻空窍触入。则三焦气分受病。其舌苔白而浊腻
。其症头胀脘闷呕恶。此邪初入。其势尚轻。只用栀、豉、杏、橘、郁、朴、滑、通等
。以清宣气分。余如鲜枇杷叶、鲜佩兰、鲜竹叶之类。亦可酌加。若暑湿之邪。留于膜
原则变疟。结于肠中则成痢。又当随症施治。
微黄粘腻兼无渴。苦泄休投开泄安。热未伤津黄薄滑。尤堪清热透肌端。
【廉勘】吴氏曰。病有外邪未解而里先结者。如舌苔粘腻微黄。口不渴饮。胸中痞
满是也。此湿阻气分。宜开泄气郁。使邪仍从肺卫而出。如白蔻、橘红、杏仁、郁金、
枳壳、桔梗之类。不可用陷胸泻心苦泄之法。逼邪入里。即纯黄苔虽主里热。若苔薄而
滑。是热尚在气分。津液未亡。最好用轻清泄热。芳透表邪。亦可外达肌分而解。如栀
、豉、翘；薄、芦笋、细辛之类。
若见边红中燥白。上焦气热血无干。但清膈上无形热。滋腻如投却疾难。
【廉勘】邵氏曰。舌苔边红。中心燥白。乃上焦气分无形之热。其邪不在血分。切
勿妄投滋腻血分之药。宜轻清凉解。故吴氏主凉膈散去硝、黄、加石膏。
湿热久蒸成内着。浓黄呕痞泻心权。若兼身目金黄色。五苓栀柏共茵煎。
【廉勘】吴氏曰。湿热内着。多从饮食中得之。嗜酒人尤多此苔。苔必浓黄粘腻。
症必痞满不饥。呕吐不纳。惟泻心法最效。如川连、干姜、黄芩、半夏、枳实、竹茹、
广皮、茵陈、通草、赤苓之类。湿热内结。若误治必致成疸。宜五苓散加减。如赤苓
、猪苓、泽泻、桂枝、滑石、茵陈、焦栀、川柏、伐木丸之类。但有阳黄阴黄之别。湿
热结胃。其胆必热。则成阳黄。黄色鲜明。宜茵陈蒿汤加枳、朴、猪胆汁。湿热蕴脾。
其肾多寒。则成阴黄。黄色灰黯。宜茵陈附子汤加半硫丸。
太阴腹满苔粘白。苍朴陈苓湿结开。黄燥还兼心烦热。泻心陷胸二方裁。
【廉勘】吴氏曰。太阴湿盛。则痞而满。满在脐间大腹。苔多白而粘腻。阳明热结
，则烦而闷。闷在心下胃口。苔多老黄燥裂。湿盛者。宜苦辛温以开之。如苍朴、二陈
、四苓之类。热结者。因于热痰固结。宜小陷胸法。如栝蒌仁、姜半夏、川连、枳实、
竹沥、姜汁之类。因于湿热内结。宜泻心法。如川连、半夏、黄芩、广皮、白蔻、滑石
、赤苓、通草之类。
苔若纯黄无白色。表邪入里胃家干。更验老黄中断裂。腹中满痛下之安。
【廉勘】吴氏曰。伤寒由表入里。故舌苔先白后黄。至纯黄无白。邪已离表入里。
即仲景所云胃家实也。然舌苔虽黄。而未至焦老裂纹起刺。大便虽秘。而未至痞满硬痛
。尚属胃家热而未实。宜清不宜攻。必再验其舌
苔黄浓焦老。中心裂纹。或尖起刺。腹中硬满胀痛。方用承气。下之则安。凡舌中心属
胃。如肠中有燥矢。舌心必有黄燥黑燥等苔。若腹无硬满耕痛之状。亦但须养阴润燥。
不可妄用承气法攻之。
黄浓方知邪入里。黑兼燥刺热弥深。屡清不解知何故。火燥津亡
急救阴。
【廉勘】吴氏曰。舌苔由黄转黑。黑而且燥。虽为阳明之热。而腹无痞满硬痛。非
承气症。但宜清解。若清之不应。是肠中燥矢。与热邪固结。胃土过燥。肾水不支。胃
液已干。宜大小甘露饮。以救胃汁。使阴液充溢。阳邪自解。二便自通。
舌见边黄中黑腻。热蒸脾湿痞难禁。吐呕便秘因伤酒。开泄中焦有泻心。
【廉勘】舌苔边黄。中心黑腻。较黄浓尤为深重。呕痞便秘。较痞满呕吐症尤加重
。嗜酒及恣食油腻者。尤多此症。泻心者。苦泻心下之胃肠积热也。故仲景立三黄泻心
汤。极苦泄热。荡涤胃肠。拙见仍拟加枳、朴、姜汁。苦与辛合。能降能通。病患如畏
大黄。可用清宁丸缓通法以代之。
黑滑太阴寒水侮。腹疼吐利理中宜。更兼粘腻形浮胖。伏饮凝痰开逐之。
【廉勘】吴氏曰。舌苔黑滑。为太阴之寒。所谓寒水侮土。理中症也。若兼粘腻浮
胖。是湿痰寒饮。伏于太阴。当用温药和脾。如二陈、浓朴、姜汁合五苓之类。开之逐
之。痰饮自去。以上十一歌。总论舌苔之白黄灰黑。及其燥刺粘腻。辨症之寒湿、湿热
、暑湿、酒湿、燥火、寒水。此为外感六淫之总要。
伤寒入里阳明主。热病阳明初便缠。先白后黄寒化热。纯黄少白热蒸然。热病无寒
惟壮热。黄芩栀豉古今传。恶寒发热伤寒症。发汗散寒表剂先。
【廉勘】吴氏曰。伤寒由表达里。故在表属太阳。入里即属阳明腑病。热病自内发
外。借阳明为出路。故初
起即在阳明。但看舌苔先白后黄者。伤寒由表入里。寒化为热也。若初起纯黄少白。或
黄色燥刺。是病发于阳明。由里出表。热势蒸然内盛也。更参外症。初起恶寒发热为伤
寒。可用表剂发汗。壮热无汗为热病。按其胸腹热蒸灼手。如仲景阳明病之栀豉汤。少
阳病之黄芩汤。皆可通治。以上一歌。论舌苔之白黄。辨时病新感伏气之总诀。
少阳温病从何断。舌绛须知木火然。目赤耳聋身热甚。栀翘犀角牡丹鲜。
【廉勘】吴氏曰。凡温病热病。皆纯热无寒。热病发于阳明。温病发于少阳。当从
柯韵伯法断之。但看舌苔黄燥为阳明热病。舌色绛赤为少阳温病。温病宜用犀角、栀、
翘、丹皮、鲜地之类。以清解木火之郁。大忌汗散。
舌绛须知营分热。犀翘丹地解之安。若兼鲜泽纯红色。胞络邪干菖郁攒。素有痰火
成内闭。西黄竺贝可加餐。
【廉勘】吴氏曰。温邪入营。舌即绛赤。急宜清营透热。如犀角、鲜地、连翘、丹
皮之类。若邪入心包络。舌色鲜泽纯红。症必神昏内闭。轻加广郁金、石菖蒲等以开之
。重则用牛黄丸、至宝丹、紫雪等。芳香开闭。如素有痰火。邪热内陷。里络就闭。更
当加西黄、川贝、竹沥、竺黄之类。清火豁痰。
心承胃灼中心绛。清胃清心势必残。君火上炎尖独赤。犀兼导赤泻之安。
【廉勘】吴氏曰。凡黄苔而中心绛者。心受胃火蒸灼也。当于清胃药中加清心药。
如川连、鲜地、竹叶卷心之类。如舌尖独赤起刺。心火上炎也。犀角合导赤以泻之。
绛舌上浮粘腻质。暑兼湿浊欲蒸痰。恐防内闭芳香逐。犀珀菖蒲滑郁含。
【廉勘】吴氏曰。暑蒸湿浊则成痰。痰迷则神昏谵语。宜于清暑药中加竹沥、竺黄
之类。暑湿兼秽。恐蒙闭
心包。酿成昏厥不语之危候。故用鲜石菖蒲、广郁金等。藉其芳香逐秽。犀角以透营分
暑邪。琥珀、滑石、清暑利湿。
白苔绛底因何故。热因湿遏透之难。热毒乘心红点重。黄连金汁狂乱安。
【廉勘】吴氏曰。热因湿邪遏伏。舌苔白而底绛。恐防其变干。急宜泄湿透热。如
犀角、滑石、茯苓皮、猪苓、苡仁、茵陈、青蒿、芦笋、细辛之类。若湿温症。舌现红
星点。此热毒乘心。必神昏谵语。宜苦寒之品泻之。狂乱者。非黄连、金汁不解。如无
金汁。以人中黄代之。
暑入心营舌绛红。神呆似寐耳如聋。溺淋汗出原非鲜。失治邪干
心主宫。犀滑翘丹元地觅。银花竹叶石菖同。本成内闭多昏昧。再入牛黄即奏功。
【廉勘】吴氏曰。暑邪直入心经。上蒙清窍则耳聋。乘于胞络则神昏。宜清心开闭
。紫雪、行军散最妙。其次至宝丹、牛黄丸等。最忌柴、葛。
湿温气分流连久。舌赤中黄燥刺干。咯血毋庸滋腻入。耳聋莫作少阳看。三焦并治
通茹杏。金汁银花膏滑寒。若得疹痧肌肉透。再清痰火养阴安。
【廉勘】吴氏曰。湿温症。初尚气分郁结。肺气不得宣畅。则酿成脓血。故咯血。
湿热上蒙清窍。则耳聋无闻。重则三焦俱病。变症百出。治当急清三焦。气分一松。则
(Written by Mr. Wu Kun'an of Gui'an, revised and added to by He Lianchen, a physician from Yue.)
There is a true transmission regarding the patterns caused by the Six Evils (Liu Yin). When treating clinically, one must first examine the tongue. By observing the color to differentiate meridians and distinguishing between the Hand and Foot meridians, differentiating Ying (Nutritive) and Wei (Defensive), Exterior and Interior becomes not difficult.
[He Lianchen's Commentary] Mr. Wu said: Whenever diagnosing Shanghan (Cold Damage), one should first observe the color and shape of the tongue coating, distinguishing whether it belongs to the Foot or Hand meridians, whether the pathogen is in the Exterior or Interior, and whether it is in the Wei (Defensive) or Ying (Nutritive) level. Only then should treatment be administered based on the pulse and symptoms. This is the true transmission for pattern differentiation.
A white tongue surface indicates Lung involvement; crimson indicates Heart; yellow indicates Stomach; red indicates Gallbladder; grey and black indicate Spleen meridian involvement. The Kidney corresponds to a purple-red tongue that appears round and tender. A scorched-purple color indicates Liver involvement; a cyan color indicates Jueyin cold pathogen.
[He Lianchen's Commentary] Mr. Wu said: In clinical practice, if the tongue has no coating and is moist, or is slightly white and thin, it is a Taiyang Exterior pattern. If there is a yellow coating, it is a Yangming Interior pattern; fresh red indicates Shaoyang Gallbladder fire; grey-black indicates Taiyin Spleen dampness; crimson indicates the Hand Shaoyin Heart meridian; purple-red indicates the Foot Shaoyin Kidney meridian; scorched-purple indicates Jueyin Yang heat pathogen; cyan and slippery indicates Jueyin Yin cold pathogen.
White indicates Exterior patterns requiring sweating methods; yellow indicates Interior patterns requiring purging methods. Crimson indicates Ying-level heat, while white indicates Wei-level pathogens, making the treatment approach more complex. Next, one must probe the condition of body fluids: moisture indicates uninjured fluids, while dryness/astringency indicates depleted fluids.
[He Lianchen's Commentary] Mr. Wu said: White coating indicates an Exterior pattern, which should be treated with sweating. Yellow coating indicates an Interior pattern, which should be treated with purging. A crimson tongue indicates heat in the Ying level, suitable for clearing heat but contraindicated for exterior-releasing methods. A white tongue indicates pathogens in the Wei level, suitable for sweating but contraindicated for clearing heat. Furthermore, distinguish the dryness or moisture of the tongue to verify the presence or absence of body fluids. Regardless of color, moisture means body fluids are unharmed, while dryness and astringency mean body fluids have been consumed. This requires deep observation.
White represents the Lung and Wei levels, still involving the Qi level; crimson primarily indicates Heart Ying level, with Blood level conditions observed subsequently. White coating with internal yellow indicates abundant Qi-level heat; red edges with a white center indicate dried Lung fluids.
[He Lianchen's Commentary] Mr. Wu said: Generally, when external pathogens enter, they first reach the Wei level. If unresolved, they enter the Qi level, then the Ying level, and finally the Blood level. White coating with internal yellow still belongs to Qi-level heat; do not use Ying-clearing medicines too early. White coating with red edges indicates warm pathogens attacking the Lung and burning Lung fluids; do not use excessive acrid-warm exterior-releasing drugs, but rather light cooling and dispersing agents. This follows Ye Tianshi's principle: "In the Wei, sweat it; upon reaching the Qi, only then clear it; after the Ying, speak of the Blood." Upon just entering the Ying level, one can still vent Ying heat and transfer it out to the Qi level for resolution. Once entering the Blood level, there is fear of damaging blood and stirring blood, requiring direct cooling of the Blood and purging of fire.
When white and yellow coatings linger in the Qi level for a long time, one may still hope for a battle-sweat to break through heavy barriers. If the tongue is crimson but still retains yellow or white colors, the pathogen is between the Ying and Wei levels; one must vent Ying and release Wei to harmonize both.
[He Lianchen's Commentary] Mr. Wu said: When the tongue coating is white with traces of yellow, even after many days, it remains lingering in the Qi level, and one may expect resolution via battle-sweat. If the tongue is red-crimson but still carries yellow or white hues, the pathogen is between the Ying and Wei levels. One should use Rhinoceros Horn (Xijiao) and Antelope Horn (Lingyangjiao) to clear and vent Ying heat, and Scallion (Congbai), Fermented Soybean (Douchi), Lotus Leaf (Heye), and Forsythia (Lianqiao) to acridly disperse Wei-level pathogens, resolving both to achieve harmony. The above three songs summarize the white, yellow, red, and crimson tongue coatings, and the location of pathogens in the Exterior/Interior and Wei/Ying levels. This is Ye Tianshi's unique insight. Wu Jutong, Wang Mengying, Lin Peiqin, and Shi Feinan all followed this method for pattern differentiation. I reflect that Wei circulates outside the vessels and governs Qi, while Ying circulates inside the vessels and governs Blood. All twelve regular meridians (Hand and Foot), Eight Extraordinary Vessels, fifteen major collaterals, and myriad fine collaterals penetrate the interior of the Zang-Fu organs and operate within the body shell, connecting continuously as pathways for transmission and circulation. These are all functions of Wei/Ying and Qi/Blood. Therefore, external pathogens always first affect Ying and Wei, and invariably first injure Qi and Blood. Only when the functions of Ying, Wei, Qi, and Blood fail do the physical structures of the Zang-Fu organs become injured. This is an inevitable principle. Mr. Ye's use of this for differentiation is truly original and a swift key to applying flexible methods.
A thin, moist white coating indicates severe Wind-Cold; warming and dispersing will not harm the fluids if they are not deficient. A dry, thin white coating indicates scarce fluids; only light cooling and resolving are suitable to calm the Lung.
[He Lianchen's Commentary] Mr. Wu said: This distinguishes the different treatments for Wind-Cold and Wind-Heat. When Wind-Cold first enters the Taiyang meridian, the tongue often has no coating, or has a thin, moist, white coating, indicating fluids are not deficient. One may use acrid-warm medicines acting on the Foot meridians, such as Qianghuo, Fangfeng, and Suzye for mild cases, or Mahuang and Guizhi for severe cases. If the white coating is thin but dry, or the tongue edges and tip are red, this indicates Wind-Heat attacking the Lung, injuring the Qi level first and depleting fluids. Do not induce excessive sweating; instead, use light, clear, and dispersing medicines acting on the Hand meridians, such as Sangye, Xingren, Jiaozhizi, Douchi, Lianqiao, Bohe, Qianhu, Jiegeng, Gualoupi, and Danzhuye.
A sticky, greasy white coating indicates severe Wind-Damp; releasing the muscles and promoting Qi flow brings natural peace. A dry, thin white coating with red edges requires assessing moisture/dryness to clear Metal and save the Lung.
[He Lianchen's Commentary] This distinguishes the vastly different treatments for Wind-Damp and Wind-Dryness. A white, sticky, or grey-white sticky coating results from exposure to rain and fog, causing dampness to adhere to the Upper Jiao Qi level. Symptoms include fever, heavy head, whole-body pain, mouth stickiness, and lack of thirst. First, release the muscles and eliminate dampness using Guizhi, Qinjiao, Qianghuo, Fangfeng, Baizhi, Erchen Tang, and Erling. Second, promote Qi flow using Huogeng, Banxia, Guangpi, Baokou, Huashi, Tongcao, Yiren, Ku Huangqin, and Zhe Lingpi. This allows dampness in the Qi level to move, and heat stops naturally. If the coating is thin, white, and dry, or the tongue edge is red, with cough and scanty sputum, this is Wind-Dryness injuring the Lung and depleting fluids. Urgently use Qingzao Jiufei Tang ingredients such as Shuang Sangye, Tian Xingren, Nan Shen, Gualouren, Chuanbei, Sheng Gancao, Shishuang, Lizhi, and Zhuli. The above two songs summarize the moist, dry, sticky, and dry white coatings, differentiating Wind-Cold, Wind-Heat, Wind-Damp, and Wind-Dryness. This is primary for external Wind pathogen contraction. However, flexibility is required. For example, in cases of white tongue with thirst: if dampness accumulates internally preventing fluids from ascending, prioritize the white tongue and use acrid-warm methods to open dampness, ignoring thirst as a contraindication. If dryness attacks from above preventing fluids from descending, prioritize thirst and use moistening methods to resolve dryness, ignoring the white tongue as evidence.
Sticky and greasy tongue coatings distinguish Cold from Heat; white and yellow colors must be clearly differentiated. Dampness knotting in the Middle Jiao causes fullness and stuffiness; acrid-opening and bland-draining bring natural peace.
[He Lianchen's Commentary] Mr. Wu said: Sticky and greasy coatings verify dampness. White and sticky indicates Cold-Damp, with symptoms of chest/abdominal fullness, difficulty urinating, and loose stools, caused by Cold-Damp knotting in the Middle Jiao. Use bitter-acrid-warm-bland medicines to open and drain, such as Cangzhu, Houpo, Banxia, Chenpi, Chifuling, and Zhuling. Yellow and sticky indicates Damp-Heat, with symptoms of epigastric oppression, nausea/vomiting, and difficulty with both bowels and urine, caused by Damp-Heat knotting in the Middle Jiao. Use bitter-acrid-cool-bland medicines to open and drain, such as Huangqin, Huanglian, Banxia, Zhishi, Huashi, Tongcao, Yinchen, and Dongguapi. Based on my experience, Cold-Damp cases are rare in Shaoxing, while Damp-Heat is most common. Damp-Heat involves dampness and heat knotting together. Initially contracting dampness and later transforming into heat occurs in Spring, Autumn, and Winter, named Damp-Heat. Initially contracting dampness and later contracting Summerheat occurs in Summer, named Summerheat-Damp. Essentially, both are Damp-Heat patterns. If heat is generated by dampness, one must resolve dampness for heat to retreat. If dampness is generated by Summerheat, one must clear Summerheat for dampness to move. This follows the classic principle of "addressing the initial cause and subduing the dominant factor."
Summerheat injuring the Qi level often presents with a white coating; thirst, irritability, vomiting, and continuous coughing/wheezing occur. Fever, weak pulse, and chest fullness indicate Heat in the formless Qi level should be dispersed.
[He Lianchen's Commentary] Summerheat injuring the Qi level often presents with a white coating. However, distinguish rough white as likely mixed with turbidity, requiring light, clear, aromatic venting such as Jiaozhizi, Douchi, Lianqiao, Bohe, Yinchen, Huashi, Tongcao, Qinghaonao, fresh Danzhuye, fresh Pipaye, Watermelon Rind (Xiguacuiyi), and fresh Lotus Leaf Edge. Greasy white indicates mixing with dampness; refer to subsequent verses.
Summerheat and Dampness combined present with turbid, greasy coatings; the Three Jiao are affected with widespread progression. Epigastric oppression, head distension, and frequent nausea/vomiting occur; abdominal pain warns of malaria or dysentery.
[He Lianchen's Commentary] Mr. Wu said: Summerheat mixed with dampness enters through the mouth, nose, and orifices, affecting the Qi level of the Three Jiao. The tongue coating is white, turbid, and greasy. Symptoms include head distension, epigastric oppression, nausea, and vomiting. As the pathogen has just entered, the condition is relatively mild. Use Zhi, Chi, Xing, Ju, Yu, Po, Hua, Tong to clear and ventilate the Qi level. Fresh Pipaye, fresh Peilan, and fresh Zhuye may also be added酌情. If Summerheat-Damp lingers in the membrane source, it transforms into malaria; if it knots in the intestines, it becomes dysentery. Treatment must follow the specific symptoms.
Slightly yellow, sticky, and greasy without thirst: avoid bitter draining; use opening and draining for peace. If heat has not injured fluids, and the yellow coating is thin and slippery, it is suitable for clearing heat and venting to the muscle layer.
[He Lianchen's Commentary] Mr. Wu said: Some diseases have unresolved exterior pathogens but pre-existing interior knotting, such as sticky, slightly yellow coating, no thirst, and chest fullness. This is damp obstructing the Qi level; use opening and draining to relieve Qi stagnation, allowing the pathogen to exit via the Lung and Wei, using Baokou, Juhong, Xingren, Yujin, Zhike, and Jiegeng. Do not use the bitter-draining methods of Xiantiong or Xiexin, which force pathogens inward. Even pure yellow coating indicates Interior Heat, but if thin and slippery, heat remains in the Qi level and fluids are intact. Light, clear heat-clearing and aromatic exterior-releasing methods are best, allowing escape to the muscle layer, using Zhi, Chi, Qiao; Bo, Lusun, Xixin.
If edges are red and the center is dry and white, the Upper Jiao Qi level has heat but Blood is not yet dry. Clear only the formless heat above the Diaphragm; if tonifying and cloying medicines are used, the disease becomes difficult to cure.
[Shao's Commentary] Red edges with a dry white center indicate formless heat in the Upper Jiao Qi level, not affecting the Blood level. Do not recklessly administer cloying Blood-tonifying medicines. Use light, cool, and clearing methods. Thus, Mr. Wu recommends Liangge San removing Xiaoshi and Dahuang, adding Shigao.
Long-term steaming of Damp-Heat leads to internal adherence; thick yellow coating with vomiting and fullness makes Xiexin the authority. If accompanied by golden-yellow skin and eyes, Wuling San, Zhizi, Huangbai, and Yinchen are decocted together.
[He Lianchen's Commentary] Mr. Wu said: Internal Damp-Heat adherence often arises from diet, especially in alcohol drinkers. The coating is thick, yellow, sticky, and greasy. Symptoms include fullness, lack of appetite, vomiting, and inability to retain food. Xiexin Fa is most effective, using Huanglian, Ganjiang, Huangqin, Banxia, Zhishi, Zhuru, Guangpi, Yinchen, Tongcao, and Chifuling. If Damp-Heat knots internally and is mistreated, it leads to Jaundice. Use modified Wuling San: Chifuling, Zhuling, Zexie, Guizhi, Huashi, Yinchen, Jiaozhi, Chuanbai, and Famou Wan. There are Yang Jaundice and Yin Jaundice distinctions. Damp-Heat knotting in the Stomach heats the Gallbladder, causing Yang Jaundice (bright yellow); use Yinchen Hao Tang plus Zhishi, Houpo, and Pig Bile. Damp-Heat fermenting in the Spleen cools the Kidney, causing Yin Jaundice (grey-dull yellow); use Yinchen Fuzi Tang plus Banshui Wan.
Taiyin abdominal fullness with sticky white coating: Cangzhu, Houpo, Chenpi, and Fuling open the damp knot. If yellow and dry with vexation and heat, choose between Xiexin and Xiantiong formulas.
[He Lianchen's Commentary] Mr. Wu said: Excessive Dampness in Taiyin causes fullness and oppression in the umbilical and large abdominal area, with sticky white coating. Heat knotting in Yangming causes vexation and oppression in the epigastrium/stomach opening, with old, yellow, dry, cracked coating. For excess dampness, use bitter-acrid-warm to open, such as Cangzhu, Houpo, Erchen, and Siling. For heat knotting due to phlegm-heat, use Xiao Xiantiong method: Gualouren, Jiang Banxia, Huanglian, Zhishi, Zhuli, and Jiangzhi. For heat knotting due to Damp-Heat, use Xiexin method: Huanglian, Banxia, Huangqin, Guangpi, Baokou, Huashi, Chifuling, Tongcao.
If the coating is purely yellow without white, the exterior pathogen has entered the Interior, drying the Stomach. Further verify if old yellow with central cracks indicates abdominal fullness and pain, resolved by purging.
[He Lianchen's Commentary] Mr. Wu said: Shanghan moves from Exterior to Interior, so the coating changes from white to yellow. Pure yellow without white means the pathogen has left the Exterior and entered the Interior, what Zhang Zhongjing called "Stomach Home Solidity" (Wei Jia Shi). Although the coating is yellow, if it has not become scorched, old, cracked, or thorny, and stool is constipated but without fullness/hardness/pain, it is Stomach Heat but not yet Solid. Clearing is suitable, not purging. Only if the coating is thick, scorched, old, with central cracks or thorny tips, AND abdominal hardness/fullness/pain exist, should Chengqi Tang be used to purge for peace. The center of the tongue corresponds to the Stomach. If dry feces exist in the intestines, the tongue center must show yellow, dry, or black coatings. If there is no abdominal hardness/fullness/pain, nourish Yin and moisten dryness; do not recklessly use Chengqi methods to purge.
Only when yellow is thick does one know the pathogen has entered the Interior; black with dry thorns indicates deepening heat. Repeated clearing fails—why? Fire-dryness and fluid depletion require urgent Yin rescue.
[He Lianchen's Commentary] Mr. Wu said: When the coating turns from yellow to black, becoming black and dry, although it indicates Yangming Heat, the absence of abdominal fullness/hardness/pain means it is not a Chengqi pattern. Clearing and resolving is appropriate. If clearing fails, dry feces in the intestines are firmly knotted with heat, Earth is overly dry, Kidney Water cannot support, and Stomach fluids are dry. Use Da or Xiao Ganlu Yin to rescue Stomach juice, filling Yin fluids so Yang pathogens self-resolve and bowels/bladder function normally.
Tongue edges yellow, center black and greasy: heat steams Spleen dampness, fullness hard to control. Vomiting, constipation due to alcohol injury: opening and draining the Middle Jiao uses Xiexin.
[Commentary] Edges yellow, center black and greasy is deeper than thick yellow. Vomiting, fullness, constipation are worse than simple fullness/vomiting. Common in those who drink alcohol or eat rich/greasy foods excessively. Xiexin refers to bitter draining of gastrointestinal heat in the epigastrium. Thus Zhang Zhongjing established Sanhuang Xiexin Tang, extremely bitter to drain heat and cleanse the GI tract. My view suggests adding Zhishi, Houpo, and Jiangzhi; bitter combined with acrid can descend and unblock. If patients fear Dahuang, Qingning Wan can be used for gentle purging.
Black and slippery indicates Taiyin Cold-Water insulting [Earth]; abdominal pain, vomiting, diarrhea suit Lizhong. If additionally sticky, greasy, and swollen/fatty, hidden drinking and congealed phlegm require opening and driving out.
[He Lianchen's Commentary] Mr. Wu said: Black and slippery coating indicates Taiyin Cold, described as Cold-Water insulting Earth, a Lizhong pattern. If additionally sticky, greasy, swollen, and fatty, it is wet-phlegm and cold-fluid hidden in Taiyin. Use warm medicines to harmonize the Spleen, such as Erchen, Houpo, Jiangzhi combined with Wuling San. Open and drive them out, and phlegm-fluid will depart. The above eleven songs summarize white, yellow, grey, black coatings, their dry/thorny/sticky/greasy states, and differentiate Cold-Damp, Damp-Heat, Summerheat-Damp, Alcohol-Damp, Dryness-Fire, and Cold-Water. This is the essence of the Six Evils.
Shanghan entering the Interior is governed by Yangming; Re Bing (Heat Disease) involves Yangming from the start. First white then yellow indicates Cold transforming to Heat; pure yellow with little white indicates steaming Heat. Re Bing has no chills, only high fever; Huangqin and Zhichi are passed down through ages. Chills and fever are Shanghan patterns; sweating and dispersing Cold with Exterior formulas come first.
[He Lianchen's Commentary] Mr. Wu said: Shanghan moves from Exterior to Interior, so Exterior belongs to Taiyang, Interior belongs to Yangming Fu disease. Re Bing originates internally and projects outward, using Yangming as an outlet, so it involves Yangming from the start. If the coating is first white then yellow, Shanghan moves from Exterior to Interior, Cold transforming to Heat. If initially pure yellow with little white, or yellow with dry thorns, the disease originates in Yangming, moving from Interior to Exterior, with steaming Heat flourishing internally. Refer to external symptoms: initial chills and fever indicate Shanghan, treatable with exterior formulas to sweat. High fever without sweat indicates Re Bing; pressing the chest/abdomen reveals steaming heat. Formulas like Zhichi Tang for Yangming disease or Huangqin Tang for Shaoyang disease by Zhang Zhongjing can be generally applied. This song summarizes white/yellow coatings, distinguishing new contraction vs. latent qi in seasonal diseases.
How to judge Shaoyang Wenbing? Crimson tongue indicates Wood-Fire flaring. Red eyes, deafness, severe fever: Zhizi, Lianqiao, Xijiao, Mudanpi fresh.
[He Lianchen's Commentary] Mr. Wu said: Both Wenbing and Re Bing are pure heat without chills. Re Bing originates in Yangming; Wenbing originates in Shaoyang. Judge according to Ke Yunbo's method. Yellow-dry coating indicates Yangming Re Bing; crimson tongue indicates Shaoyang Wenbing. Wenbing requires Xijiao, Zhizi, Lianqiao, Danpi, and fresh Dihuang to clear and resolve Wood-Fire depression. Sweating and dispersing are strictly contraindicated.
Crimson tongue indicates Ying-level heat; Xijiao, Lianqiao, Danpi, Dihuang resolve it peacefully. If additionally fresh, glossy, and purely red, Pathogen invades Pericardium Collateral, Shichangpu and Yujin gather. Chronic Phlegm-Fire causes internal closure; Xihuang, Zhubeifu can be added.
[He Lianchen's Commentary] Mr. Wu said: Warm pathogens entering Ying make the tongue crimson; urgently clear Ying and vent heat using Xijiao, fresh Dihuang, Lianqiao, Danpi. If pathogen enters Pericardium Collateral, tongue is fresh, glossy, purely red, with symptoms of coma and internal closure. Mildly add Guang Yujin and Shichangpu to open. Severely use Niuhuang Wan, Zhibao Dan, or Xuexue, aromatic to open closure. If chronic Phlegm-Fire exists and heat sinks internally closing collateral passages, add Xihuang, Chuanbei, Zhuli, and Zhu Huang to clear fire and expel phlegm.
Heart receives Stomach scorching, center crimson; clearing Stomach and Heart inevitably damages. Lord Fire flares up, tip alone red; Xijiao combined with Daochi clears it peacefully.
[He Lianchen's Commentary] Mr. Wu said: Yellow coating with crimson center indicates Heart scorching by Stomach Fire. Add Heart-clearing medicines to Stomach-clearing ones, such as Huanglian, fresh Dihuang, and Zhuyejianxin. If only the tip is red and thorny, Lord Fire flares up; combine Xijiao with Daochi San to purge.
Crimson tongue floating with sticky/greasy texture: Summerheat mixes with turbid dampness, steaming phlegm. Fear internal closure, use aromatic expulsion; Xijiao, Hupo, Shichangpu, Tongcao, Yujin contained.
[He Lianchen's Commentary] Mr. Wu said: Summerheat steaming damp-turbidity creates phlegm; phlegm confusing causes coma and delirium. Add Zhuli and Zhu Huang to summerheat-clearing medicines. Summerheat-damp mixed with filth fears covering the Pericardium,酿成昏厥 (brewing coma/unresponsiveness). Thus use fresh Shichangpu and Guang Yujin for their aromatic expulsion of filth. Xijiao vents Summerheat from Ying level; Hupo and Huashi clear summerheat and promote dampness drainage.
Why white coating with crimson base? Heat suppressed by dampness is hard to vent. Heat-toxin attacking Heart with heavy red dots: Huanglian and Jinzhi calm madness.
[He Lianchen's Commentary] Mr. Wu said: Heat suppressed by damp pathogens presents with white coating and crimson base, fearing transformation to dryness. Urgently drain dampness and vent heat using Xijiao, Huashi, Fulingpi, Zhuling, Yiren, Yinchen, Qinghao, Lusun, Xixin. If Wet-Warm disease shows red star spots, this is Heat-toxin attacking the Heart, causing coma and delirium. Use bitter-cold products to purge. For mania, only Huanglian and Jinzhi (Golden Juice) can resolve it. If Jinzhi is unavailable, Renzhonghuang substitutes.
Summerheat entering Heart Ying: tongue crimson-red, spirit dull like sleep, ears deaf. Urinary dribbling and sweating are originally not fresh. Mistreatment allows pathogen to invade the Heart Master Palace. Seek Xijiao, Huashi, Lianqiao, Danpi, Yuan Di; Yinhua, Zhuye, Shichangpu together. Originally forming internal closure with much confusion; adding Niuhuang achieves merit.
[He Lianchen's Commentary] Mr. Wu said: Summerheat directly enters the Heart Meridian, clouding clear orifices causing deafness, attacking Pericardium Collateral causing coma. Clear Heart and open closure; Xuexue and Xingjun San are best.其次 Zhibao Dan and Niuhuang Wan. Strictly avoid Chaihu and Ge Gen.
Wet-Warm lingering in Qi level long: tongue red, center yellow dry/thorny. Hemoptysis need not use cloying entry; deafness should not be viewed as Shaoyang. Treat Three Jiao together with Rutu, Xingren; Jinzhi, Yinhua, Gaoshu, Huashi cold. If rash/sha penetrates muscles, again clear Phlegm-Fire and nourish Yin for peace.
[He Lianchen's Commentary] Mr. Wu said: Wet-Warm disease initially stagnates in Qi level, Lung Qi cannot diffuse, brewing pus/blood, hence hemoptysis. Damp-Heat clouds clear orifices, causing deafness/hearing loss. Severely, all Three Jiao are diseased, myriad complications arise. Urgently clear Three Jiao; once Qi level loosens...