舌上累累生白珠。心脾郁热致灾危。急宜清心与降火。根据法调治症自除。
舌者心之苗。而脾脉又络于舌。心脾二经之热。无所泄而发于舌。故舌生白珠。累累如粟。甚
则上 牙龈。满口遍生。其症多见于正收及收后。法当以朱氏洗心散。去甘草、加黄连。或加味导
赤散（见四十九条）加麦冬治之。如大便不通者。以洗心汤去赤芍、甘草。合泻心汤加石膏、牛蒡
子。或以河间凉膈散（见二十六条）去芒硝、甘草。加黄连、石膏、牛蒡子治之。外以桑白皮捣自然
汁涂之。或用涂方涂之。或用绿袍散（见八十条）点之。如食乳孩子。以 乳方（见八十条）去甘
草。与乳母服之。
朱曰 凡一证当知从何经发出。如此证读内经者即知发于心脾二经之热。据经用药。自可迎刃而解。
朱氏洗心散 治心经有热。口舌生疮、白珠、等症。
生地黄 枯黄芩 麦冬 归尾 知母 薄荷叶 甘草 鲜藕节、侧柏叶引。甚者、加黄连。
水煎服。
洗心汤 治心热、白珠满口、二便不通。
防风 荆芥 黄芩 木通 大黄 连翘 生地黄 归尾 赤芍 甘草 灯心引。水煎服。
一书无赤芍。有黄连。有潮热加柴胡、羌活。一书有潮热加黄连、骨皮、元参、黄柏、栀仁。
泻心汤
川黄连 为末。临卧。蜜水调服。
涂方 治口疮甚者
黄柏（去粗皮锉碎以蜜炙黄色） 青黛 各等分。为末。以蜜调涂患处。
涂方
薄荷叶 黄柏 硼砂 冰片 黄连 为末。以蜜调涂患处。
The tongue is densely covered with white granules. This is a critical condition caused by stagnant heat in the Heart and Spleen. It is urgent to clear Heart fire and descend fire. If treated according to the correct principles, the symptoms will naturally resolve.
The tongue is the sprout of the Heart, and the Spleen meridian connects to the tongue. Heat from both the Heart and Spleen meridians, having no outlet, manifests on the tongue. Thus, white granules grow on the tongue, dense like millet seeds. In severe cases, they spread to the gums, covering the entire mouth. This symptom is commonly seen during the resolution phase of measles (Ma Zhen) and after its resolution. The treatment principle should employ Zhu's Xi Xin San (Washing Heart Decoction), removing Gancao (Licorice Root), adding Huanglian (Coptis Rhizome); or use Jia Wei Dao Chi San (Modified Guide Out the Heat Decoction) (see Article 49), adding Maidong (Ophiopogon Tuber). If there is constipation, use Xi Xin Tang (Washing Heart Decoction), removing Chishao (Red Peony Root) and Gancao (Licorice Root), combined with Xie Xin Tang (Drain the Epigastrium Decoction), adding Shigao (Gypsum Fibrosum) and Niubangzi (Arctii Fructus). Alternatively, use Hejian Liang Ge San (Cooling the Chest Powder from Liu Wansu), removing Mangxiao (Natrii Sulfas) and Gancao (Licorice Root), adding Huanglian (Coptis Rhizome), Shigao (Gypsum Fibrosum), and Niubangzi (Arctii Fructus). Externally, apply the natural juice of Sangbaipi (Morus Alba Bark) crushed fresh, or use other topical formulas, or apply Lv Pao San (Green Robe Powder) (see Article 80). For nursing infants, administer Ru Fang (Breast Milk Formula) (see Article 80) without Gancao (Licorice Root) to the nursing mother.
Zhu stated: For any syndrome, one must know which meridian it originates from. Regarding this syndrome, those who have studied the *Neijing* (Inner Canon) know it originates from heat in the Heart and Spleen meridians. Medication prescribed according to these classics can resolve the issue effortlessly.
Zhu's Xi Xin San (Washing Heart Decoction): Treats heat in the Heart meridian, manifesting as sores on the mouth and tongue, white granules, etc.
Ingredients: Shengdihuang (Rehmanniae Radix), Ku Huangqin (Scutellariae Radix, scorched), Maidong (Ophiopogonis Tuber), Guiwei (Angelicae Sinensis Radix, tail), Zhimu (Anemarrhenae Rhizoma), Boheye (Menthae Haplocalycis Folium), Gancao (Glycyrrhizae Radix et Rhizoma), used with Xian Oujie (Fresh Nymphaeae Nelumbinis Rhizomatis Node) and Cebaiye (Platycladi Cacumen) as guides. In severe cases, add Huanglian (Coptidis Rhizoma).
Usage: Decoct in water and take orally.
Xi Xin Tang (Washing Heart Decoction): Treats Heart heat, white granules covering the mouth, and obstruction of urination and defecation.
Ingredients: Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), Huangqin (Scutellariae Radix), Mutong (Akebiae Caulis), Dahuang (Rhei Radix et Rhizoma), Lianqiao (Forsythiae Fructus), Shengdihuang (Rehmanniae Radix), Guiwei (Angelicae Sinensis Radix, tail), Chishao (Paeoniae Radix Rubra), Gancao (Glycyrrhizae Radix et Rhizoma), used with Dengxincao (Junci Medullia) as a guide. Decoct in water and take orally.
Note: One text lacks Chishao (Red Peony Root) but includes Huanglian (Coptis Rhizoma). For tidal fever, add Chaihu (Bupleuri Radix) and Qianghuo (Notopterygii Rhizoma et Radix). Another text for tidal fever adds Huanglian (Coptis Rhizoma), Gupi (Lycii Cortex), Yuan Shen (Scrophulariae Radix), Huangbai (Phellodendri Cortex), and Zhiren (Ziziphi Spinosae Semen).
Xie Xin Tang (Drain the Epigastrium Decoction):
Ingredients: Chuan Huanglian (Coptidis Rhizoma), ground into powder. Take before sleep, mixed with honey water.
Topical Formula: Treats severe mouth sores.
Ingredients: Huangbai (Phellodendri Cortex, coarse skin removed, cut, stir-fried with honey until yellow), Qingdai (Indigo Naturalis), equal parts. Grind into powder, mix with honey, and apply to the affected area.
Topical Formula:
Ingredients: Boheye (Menthae Haplocalycis Folium), Huangbai (Phellodendri Cortex), Pengsha (Borisoviae Borax), Bingpian (Borneolum Syntheticum), Huanglian (Coptidis Rhizoma). Grind into powder, mix with honey, and apply to the affected area.