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Rash and sand (sha) are able to reach the exterior. Then discuss clearing fire and resolving phlegm, gradually adding yin-nourishing substances. The above seven songs generally discuss red and crimson tongue colors, differentiating syndromes of warm diseases, summerheat-dampness, damp-warmth, and warm-summerheat.

The tongue is crimson and fragmented with yellow-white spots growing on it; excessive heat combined with dampness desires to generate gan (ulcerative/microbial disease). Anciently named "Hu" and "Yu" are all similar to this. Miscellaneous diseases and cold damage require careful exploration.
[Lianchen's Note] Mr. Wu said: "Hu" and "Yu" are ancient names for dental gangrene (ya gan) and genital gangrene (xia gan). All belong to worm-infestation syndromes. Dental gangrene is "Yu"; sores appear on the upper lip, worms eat the viscera. Eroding the lips causes sores inside the upper lip like millet grains; eroding teeth causes rotten gums, even tooth loss, cheek perforation, and lip rupture; eroding the lungs causes coughing blood and spitting blood; internal restlessness and pain in the heart, even loss of voice and aphonia. *Jin Gui Yao Lue* uniformly uses Gancao Xiexin Tang (Licorice Decoction for Harmonizing the Stomach). (Composed of Qing Zhi Cao [Qingzhi Licorice Root], Huanglian [Coptis Rhizome], Huangqin [Scutellaria Root], Ganjiang [Dried Ginger], Banxia [Pinellia Tuber], Renshen [Ginseng Radix et Rhizoma], Dazao [Jujube Fruit].) It harmonizes the stomach and kills parasites. Externally, use Zhuhuang Shibao San (Pearl-Yellow Ten-Treasure Powder). (Composed of Dilishi [Mammalite], Su Bohe [Mentha Haplocalyx], Ercha [Catechu], Zhi Chuanbai [Prepared Phellodendri Cortex], Renzhongbai [Calcinatus Urinae Humanus], Hu Longgu [Calcined Fossil Bones], Mei Bing [Borneolum Syntheticum], Fei Chencha [Prepared Cinnabaris], Niuhuang Zhufen [Calculus Bovis Pearl Powder].) Regardless of Zouma Ya Gan (Running Horse Dental Gangrene), Chuanya Dingdu (Tooth-Piercing Carbuncle Toxicity), Gucao Feng (Bone Trough Wind), or newborn infant's fetal toxin mouth ulcers, frequent application is excellent. If black rot appears, add Zhen Tonglv (True Verdigris) 1 qian 2 fen, Dengcao Hui (Juncus Ash) 6 fen, Huhuanglian (Picrorhiza Rhizome) 3 fen to the original formula. Xia gan (Genital Gangrene) is "Hu"; sores appear on the lower lip, worms eat the anus. Eroding and rotting the anal yin, dry throat, purulent stool, similar to intestinal toxicity, hemorrhoids, fistula, and perianal abscess. *Jin Gui* uses Chixiaodou Danggui San (Adzuki Bean and Angelica Decoction). (Chixiaodou soaked until sprouted 3 qian, Danggui 1.5 qian.) It drains pus and invigorates blood. Externally, use Kushen Tang (Sophora Decoction) (Kushen 1 liang decocted in water, fumigated and washed three times while hot). Xionghuang (Realgar) (Xionghuang powder 2 qian, two tube tiles closed together, burned to fumigate the anus). Its symptoms resemble cold damage: silent desire to sleep, eyes unable to close, restless lying and rising, no desire to eat, aversion to food odors, face suddenly red, then white, then black. These are all signs of worm disturbance. The above one song discusses crimson tongues that are fragmented with yellow-white putrid spots, differentiating syndromes where damp-heat steams and rots into worms, becoming Hu and Yu that harm people.

The tongue is crimson but not fresh, dried and atrophied; kidney yin has dried up, difficult to save. Purple and dried/dull indicates liver-kidney decline; red and lustrous/glossy indicates stomach fluid dryness.
[Lianchen's Note] Mr. Wu said: A tongue shape purple and dull like pig liver color, completely lacking fluids, is called "Ku" (dried/withered). A tongue shape contracted and shrunken, unable to extend past the teeth, is called "Wei" (atrophied). This indicates liver and kidney failure, untreatable. If the tongue color is red, lustrous, and glossy, with bright color, it belongs to stomach yin dryness, still treatable by nourishing stomach yin with sweet-cool pure and quiet substances. Such as Xian Shengdi (Fresh Rehmanniae Radix), Xian Shihu (Fresh Dendrobii Caulis), Zhe Jiang (Sugarcane Juice), Li Zhi (Pear Juice). The above one song discusses purple dried/atrophied tongues, and red-lustrous-glossy tongues, differentiating untreatable from treatable syndromes.

Tape form powdery white with red edges; epidemic pathogen enters Mo Yuan (Membrane Source), momentum is most vigorous. Urgently use Da Yuan Yin (Reach the Origin Decoction) plus guiding herbs. Once accompanied by yellow-black, descend urgently.
[Lianchen's Note] Mr. Wu said: Whenever seasonal diseases begin initially, if the coating is powdery white and thick, with red-crimson edges, this is an epidemic disease. The pathogen is in the Mo Yuan, its momentum is most vigorous, transmitting instantly. Physicians must not underestimate it. Wu Youke advocates using Da Yuan Yin plus meridian-guiding exterior-releasing herbs to penetrate and reach it. If accompanied by Taiyang symptoms, add Qianghuo (Notopterygii Rhizoma et Radix); Yangming symptoms, add Gegen (Puerariae Lobatae Radix); Shaoyang symptoms, add Chaihu (Bupleuri Radix). If the tongue turns yellow and dry, the epidemic pathogen has entered the stomach; add Dahuang (Rhei Radix et Rhizoma) to purge. If it turns black, the pathogen has penetrated deeper internally; use Chengqi Tang plus detoxifying herbs to purge. In severe epidemics, the tongue changes three times a day, from white to yellow, from yellow to black; one should purge quickly.
If fresh red and pure crimson colors are seen, the epidemic has transmitted to the Bao Luo (Pericardium Collaterals) and Ying (Nutrient) level. Clearing evil and detoxifying, Xijiao (Rhinocerotis Cornu) and Yinhua (Lonicerae Japonicae Flos) are excellent; Changpu (Acori Tatarinowii Rhizoma) and Yujin (Curcumae Radix), Jinzhi (Gold Juice), Renzhonghuang (Humanus Faeces Depuratus) connect warm-summerheat treatments.
[Lianchen's Note] Mr. Wu said: Warm epidemic syndrome treatment is divided into two paths. Look only at the tongue coating: white turning yellow, yellow turning black, means the epidemic pathogen enters from exterior to interior; sweating and purging methods are applicable. If fresh red-crimson tongue coating is seen, this means the epidemic pathogen has entered the Ying level and between Bao Luo; both sweating and purging are prohibited. Only clearing Ying and detoxifying, removing filth and opening closure is suitable. Such as Xijiao, Yinhua, Changpu, Yujin, Xihuang (Bezoar), Jinzhi, Renzhonghuang, etc., which share therapeutic methods with warm-heat and summerheat syndromes.

Rash color white, loosening muscle and releasing exterior; knowing blood heat Danxi (Red Rash), do not delay Xini (Rhino-Horn). White tongue, Jingfang (Schizonepeta and Saposhnikovia) and Qiaobo (Forsythia and Mint) have strength. Red tongue, strictly avoid Ge Sheng (Pueraria and Cimicifuga) medicine.
[Lianchen's Note] Mr. Wu said: Rash emerges in the Qi level, color pale red and white, tongue coating also white;适宜 Ge Gen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Bohe (Menthae Haplocalyx), Niubangzi (Arctii Fructus), etc., to loosen muscle and reach the exterior. If red Dan rash is seen, pathogen is in Ying and Blood levels, tongue must be crimson-red;适宜 Xijiao, Lianqiao, Xian Shengdi, Renzhonghuang, Jing Yinhua, etc., to penetrate Ying and detoxify. Strictly forbid Sheng Ma (Cimicifugae Rhizoma), Ge Gen, and foot-meridian drugs. The above three songs generally discuss red-crimson tongue colors, and tongue coatings accompanied by white or yellow, differentiating epidemic disease treatment paths.

Whenever proper qi is deficient, coating tender and thin, pale red slightly white, tonification should not be delayed. Thick yellow greasy white indicates evil accumulation; physicians must know to clear and resolve.
[Lianchen's Note] Mr. Wu said: Regardless of cold damage or miscellaneous diseases, those with deficient proper qi will have tender and thin tongue coatings, either pale red or slightly white, all suitable for tonification. If yellow-white, thick and greasy are seen, it always indicates internal evil not yet cleared; do not hastily administer tonics. The above one song generally discusses tongue body old/tender and tongue coating yellow/white thick/thin, the key to differentiating syndrome deficiency/excess. Counting Wu's thirty-two songs, they are most practical for current times. I once published them in *Ganzheng Baofa*, now re-edited and appended here for students to memorize. Recently only Liu Jiren has made many discoveries. I will briefly summarize his theory as follows:
(II) General Discussion of White Coating. White coatings differ in thickness, density, and sparsity; their forms also vary in depth and mixture. There are thin whites like rice drink spread on the tongue; this is the initial sign of Cold Damage with Cold. Without exterior signs, it indicates fluid retention in the Diaphragm. There are white slips like soy milk spread on the tongue; this indicates Cold Damage with Cold-Dampness Evil, Phlegm-Fluids, etc. One must judge by pulse and symptoms. White and thick like tofu brain spread on the tongue indicates Phlegm-Heat syndrome. White and sparse like rice flour spread on the tongue indicates the initial transmission of Cold Damage or Summerheat. White like millet grains indicates Heat Evil in the Qi level. White like silver shining indicates a changed coating from mistakingly tonifying a Heat syndrome. White like dry tobacco gray, regardless of moisture, indicates a changed coating from mistakingly using drying drugs on a Heat syndrome. White like the bottom of a silver ingot with holes indicates Heat syndrome mistookly tonified and dried, fluids injured, Yuan Qi about to collapse, evil about to penetrate deeply. White like dregs piled up indicates Heat syndrome mistookly dried, putrid turbidity accumulated in the stomach, preparing for a purging syndrome. If the center cracks, it is extreme deficiency resembling excess syndrome; one must tonify Qi, judging by pulse and symptoms. Similar to white but not white, like an artist mixing powder with grease to make snow-blue, there are deep and shallow types. Shallow like snow-blue lake silk color indicates the initial sign of Heat Evil entering Ying; deep like snow-blue Hang silk color indicates Summerheat-Heat two evils have entered the Blood level. (This coating resembles thin white, but has blue quality with red tint and fine papillae points upon close inspection, hence named Snow-Blue; it is a necessary and common coating for Blood level syndromes, but people view it as white and mistake it for cold disease, so it is specially raised to awaken the mind. Ancients just used "crimson tongue" to explain, how could later learners understand? So I tell them directly via careful observation and comparison method to avoid misidentification.) Tongue body deep red like dried carrot with salt frost indicates Heat Evil penetrating deeply and lingering, mistookly administered attacking-drying drugs, stomach yin greatly injured; this is the critical late stage of Warm-Heat.
(III) General Discussion of Yellow Coating. Yellow colors differ in depth, age, and tenderness; their forms also differ in dryness, slipperiness, roughness, and smoothness. There are true yellow, old yellow, yellow like fried Zhiqiao (Aurantii Fructus), yellow like pot-scorched cake mixed with slight black; tender yellow, tooth-yellow, color like paper core mixed with gray-green; yellow like millet dyed yellow, yellow like fish roe, yellow like tiger stripes, yellow like yellow wax spread on tongue, water-yellow like egg yolk and white mixed. These are all categories of yellow, while syndrome differences and diagnostic methods were detailed in the previous Six Meridian tongue coating notes.
(IV) General Discussion of Tongue Body without Coating. Tongue bodies without coating also differ. For example, purple tongue body without coating indicates Heat in the Yin level. Red tongue body without coating indicates Heat Evil newly entering Yin level, or elderly person with food stagnation where Stomach Qi cannot ascend, or worry-thought depression where Yang Qi cannot ascend; must judge by pulse and symptoms. Tongue smooth as a mirror indicates injury to both Stomach Yin and Stomach Yang, gut villi sticking to walls, undigested food passing through, hunger but unable to eat. Also stubborn phlegm stuck in stomach, villi not rising, all have this sign; must diagnose by pulse and symptoms. Former symptom undigested food/yin injury, pulse must be fine and choppy; latter symptom phlegm stagnation, pulse must surging, slippery, and large. Dry texture like thorns without coating, purple and dry indicates Heat injuring Yin fluids; red and dry indicates Qi failing to transform fluids; must judge by pulse and symptoms. Tongue body without coating, middle concave like scraped off, indicates Stomach dryness-stagnation injuring Yin, or cecum dryness-stagnation lingering long; Tongue body without coating, middle straight groove like knife back imprint, indicates Yin fluids and Yuan Qi both deficient. Horizontal crack in middle indicates constitutionally Yin deficient. Cracks like ice flakes on tongue is common image of elderly Yin deficiency, rare in youth, inauspicious if present. Front half smooth without coating, root has two fleshy tumors like tongue flesh color, indicates Yin-deficiency consumption syndrome. Surface without coating, but skin/flesh has a coin-sized patch, yellow or white, indicates insufficient proper Qi, blood also deficient, or phlegm condensation; must judge by pulse and symptoms. Circular halos appearing on coating dividing into two-three colors indicates internal dryness-stagnation, dry feces not descending; syndrome must be dangerous. Coating showing green and blue colors indicates fatal syndrome.
(V) General Discussion of Coating Color Transformation Auspiciousness/Misfortune. In short, yellow coating is correct, white is secondary. Regardless of syndrome, if medication is appropriate, it goes from white to yellow, from yellow recedes, from recession new thin white coating grows; this is favorable. Regardless of syndrome, if medication is inappropriate, it goes from yellow to white, from white to gray, from gray to black, from living coating becomes dead coating; this is unfavorable. Sudden recession/sudden absence, not gradual recession, is collapsing sign. Furthermore, Qi gathers coating gathers, Qi withdraws coating withdraws, Qi transforms coating transforms, Qi scatters coating scatters, Qi coagulates coating coagulates. Qi knots on one side, coating knots on one side; thus Qi-stagnation syndrome, coating edge neat, like stone steps' edge line, coating inside line, no coating outside line, only red edge. If Qi transforms, it scatters, dense inside and sparse outside, not like cleanly cut uniform edge. Thus coating edges neat like cut indicate Qi gathering, having stagnation/depression. If coating truly recedes and truly transforms, it differs from scraped sudden recession. True recession must follow transformation first. What is transformation recession? Because coating goes from thick to gradually thin, from solid to generating pores, from dense to gradually sparse, from tongue root extending to tip, from tip gradually changing sparse/thin, from recession regenerating new coating; these are all auspicious omens. If suddenly receding, not regenerating new coating, or like scraped off, mottled, remaining like tofu dregs spread on tongue, dot here dot there, scattered and discontinuous, all are unfavorable signs, all caused by mistookly attacking, eliminating, or releasing exterior, injuring Stomach Qi and Stomach juice, hence this sign.
[Rongzhai's Note] Liu Jiren's tongue examination and syndrome differentiation method, item one, already appeared in Mr. He Lianchen's note in Section 2 of this chapter, so here we start only from item two "General Discussion of White Coating".