经曰∶望而知之之谓神。既称之曰神，必能以我之神，会彼之神。夫人之神气，栖于二
目，而历乎百体，尤必统百体察之。察其清浊，以辨燥湿；察其动静，以辨阴阳；察其有无
，以决死生。如是而望始备，而望始神。春山先生曰∶人之神气，在有意无意间流露最真，
医者清心凝神，一会即觉，不宜过泥，泥则私意一起，医者与病者神气相混，反觉疑似，难
于捉摸。此又以神会神之妙理也。试以色论。经谓五色内应五脏，青属肝木，红属心火，黄
属脾土，白属肺金，黑属肾水。此道其常也。而病则有变，甚有五色不应五脏者，此又变中
之变。总之，不论何色，均要有神气。神气云者，有光、有体是也。光者，外面明朗；体者
，里面润泽。光无形，主阳、主气；体有象，主阴、主血。气血无乖，阴阳不争，自然光、
体俱备。经云∶生于心，如以缟裹朱；生于肺，如以缟裹红；生于肝，如以缟裹绀；生于脾
，如以缟裹栝蒌实；生于肾，如以缟裹紫。盖以平人五脏既和，其色禀胃气，而出于皮毛之
间，胃气色黄，皮毛色白，精气内含，宝光外发，既不浮露，又不混蒙，故曰如缟裹。又云
∶精明五色者，气之华也。赤欲如白裹朱，不欲如赭；白欲如鹅羽，不欲如盐；青欲如苍碧
之泽，不欲如蓝；黄欲如罗裹雄黄，不欲如黄土；黑欲如重漆色，不欲如地苍。重言以申明
之，即重有神气之义。盖有神气者，有胃气者也。又云∶青如草兹者死，黄如枳实者死，黑
如炱（烟煤）者死，赤如 血者死，白如枯骨者死。此气血俱亡，无光无体，神气已去者
也。又云∶青如翠羽者生，赤如鸡冠者生，黄如蟹腹者生，白如豕膏者生，黑如乌羽者生。
此气血虽病，神气未伤，有光有体，不能内含而不外露者也。观《内经》论色，分平、病、
死三等，虽未明言神气，而神气已寓于其中矣。
或曰∶病有万变，色于何别？曰∶天地不外燥湿，病亦不外燥湿，色亦不外燥湿。燥属
天气，色多有光而浮；湿属地气，色多有体而晦。风燥、寒燥，由外搏束，主收敛，收敛则
急，面色多绷急而光洁；燥搏津液痰饮，外溢于面，色多红润而浮；夹湿多红润而晦；燥邪
化热，色多干红，苗窍干涩，多烦渴，甚则变枯而青黑，枯而青黑则真阴亏极，而色无光体
矣。寒湿内生，色必滞暗，变黄变黑，皆沉晦不明；湿兼风，色润而浮，多自汗；湿与暑合
，与热合，或湿土郁蒸之温邪，三者皆由口鼻吸入，三焦主蒸散，蒸散则缓，面色多松缓而
垢晦，甚者浊邪由内蒸而外溢，如油腻烟熏者然；若由湿化燥，则又晦而且干，晦而干则湿
邪未去，真阴又亏，色又无光而无体矣。
或曰∶部位何如？曰∶经谓心热病，额先赤；若青黑色，主有暴疾。肺热病，鼻先赤。
凡鼻色青者，主腹痛；微黑者，有水气。鼻准黄者，小便难；白者，为气虚；鲜红，有留饮
。又曰∶肺热病，右颊先赤；肝热病，左颊先赤；肾热病，颏先赤，又主膀胱热结，小便不
通。肝病者，目 青；赤主热；白睛黄，主黄胆；目 黄，为病欲愈。又曰∶心病者，颧赤
；肾病者，颧与颜黑黄（颜，天庭）。赤色出两颧，大如拇指，主卒死。又曰∶色多青则痛，
色黑则痹，（如霍乱闭遏，色与络脉，皆见黑色之类）。黄赤则热，多白则寒，五色皆见则为寒
热。经言部位之应脏腑，以及五色辨病之说，不可枚举。学人不可不知，又不可尽拘，（表里
、阴阳，传变甚速，故不可拘）。所当权于其大，以燥、湿二字为提纲，以兼风、兼寒、兼
暑、化火、未化火为权变，以色中之光、体为神气，大道原不外一阴一阳也。
望色之后，即须审形窍。头为诸阳之会，因于湿，首如裹，目如蒙；痰饮上干于头，则
眩晕，呕吐痰水；血燥风动，亦眩晕，头痒，头偏疼；又有肾水虚燥，阴不潜阳，气逆上行
，经所谓头痛巅疾，下虚上实是也。又有肝胆燥热，木旺风生，耳目无血以养，经所谓徇蒙
招尤，目瞑耳聋，下实上虚是也。（两实字，皆指虚火言，非真实也）。又有头重视身，名天柱
骨倒，元气已败，此头无神气者也。
肝开窍于目（肝脉上连目系），燥病则目光炯炯，湿病则目多昏蒙；燥甚则目无泪而干涩
，湿甚则目珠黄而 烂，或眼胞肿如卧蚕；阳明腑实，则谵语、妄有所见；热入血室，血耗
阴伤，昼日明了，夜则低声自语，如见鬼状。开目见人，病属阳；闭目不欲见人，病属阴。
脱阳者，见鬼；脱阴者，目盲；脱阴脱阳者，病危。目有眵、有泪、精采内含者，为有神气
；无眵、无泪、白珠色蓝、乌珠色滞、精采内夺及浮光外露者，皆为无神气。凡病目能识人
者轻，睛昏不识人，及目直视、歪视、目小、目瞪、目睛正圆、戴眼反折、眼胞陷下，为神
气已去，多不治。其直视、歪视、上视、目睛微定移时稍动者，有因痰闭使然，又不可竟作
不治论。
肺开窍于鼻，燥病鼻多干涩，湿病鼻多润泽，鼻流清涕多风寒，鼻流浊涕多热，鼻孔燥
如烟煤为阳毒热极，鼻孔冷滑而黑为阴毒冷极，痰饮壅遏肺气则呼吸有声，肺肾虚脱则出入
气微，或喘急抬肩、鼻孔掀张。气微与掀张，则神气由此散矣。
肾开窍于耳，心寄窍于耳，胆上络于耳。暴病耳聋、耳肿、耳痛、耳旁红，属少阳风热
燥邪，或肝胆热挟湿浊上壅；久病耳聋，属气虚，属精脱；若耳焦枯受尘垢，属肾水亏极，
此亦内无精液，而外无神气者也。
脾开窍于口，口苦属燥热，口甜属湿热，唇口赤肿而干者热极，青黑而润者寒极，焦而
红者可治，焦而黑者难治，淡白为气虚，淡白不泽为液少，唇青而反、环口黧黑、唇舌颤振
不止、口如鱼口、气出不返者死，为其神气已去故也。
心开窍于舌，脾之大络系于舌本，肝、肾脉亦通舌本。凡木舌、重舌、舌衄，属心经燥
热；舌菌、舌垫、舌肿大塞口，属脾经湿热，挟心火上壅；舌本强硬，为热兼痰；若舌卷短
，痿软、枯小，则肝肾阴涸而舌因无神气矣。舌之有苔，犹地之有苔。地之苔，湿气上泛而
生；舌之苔，脾胃津液上潮而生。故平人舌中常有浮白苔一层，或浮黄苔一层；夏月湿土司
令，苔每较浓而微黄，但不满不板滞；其脾胃湿热素重者，往往终年有白浓苔，或舌中灰黄
，至有病时，脾胃津液为邪所郁，或因泻痢，脾胃气陷，舌反无苔，或比平昔较薄；其胃、
肾津液不足者，舌多赤而无苔，或舌中有红路一条，或舌尖、舌边多红点。此平人舌苔之大
较也。若夫有病，则舌必见苔，病藏于中，苔显于外，确凿可凭，毫厘不爽，医家把握首赖
乎！此是不可以不辨。
风寒为寒燥之邪，风温为温燥之邪。风寒初起在表，风温首伤肺经气分，故舌多无苔，
即有黄白苔，亦薄而滑；渐次传里，与胃腑糟粕相为搏结，苔方由薄而浓、由白而黄、而黑
而燥，其象皆板滞不宣；迨下后苔始化腐，腐者宣松而不板实之象；由腐而退，渐生浮薄新
苔一层，乃为病邪解尽。其有初起，白苔即燥如白砂者，名白砂苔，此温燥之邪过重，宜速
下之，佐以甘凉救液；亦有苔至黑而不燥者，或黄黑苔中有一二条白者，或舌前虽燥，舌根
苔白浓者，皆夹湿、夹痰饮之故；亦有苔虽黄黑，消薄而无地质者，胃阴虚故也。苔有地质
与无地质，此虚实之一大关也。
湿为浊邪，兼证最多。风湿伤表，苔多滑白不浓；寒湿伤里，苔多腻白而浓。暑温、湿
温、温疫、温热，皆湿土郁蒸之气。冬温，因阳不潜藏，亦湿土郁蒸之余气。数者皆从口鼻
吸入肺胃膜原，由里而发。春温为冬伤于寒，寒郁久而化热，寒燥之气，又能搏束津液水饮
伏于膜原，与热混合，亦由里而发。暑湿晚发，名曰伏暑，因夏伤暑湿，伏于膜原，秋日凉
燥之气，又从外搏遏在内之暑湿，此由表邪引动里邪而发。暑湿疟疾，亦多由此。按六气之
邪，有贼邪、时邪、伏邪之分。如风寒卒感，谓之贼邪。贼邪尖颖，随感随发，顷刻不能藏
伏。风温、温热、暑温、湿温、温疫、冬温等证，皆吸受时行之气，如春受风阳化热之气，
夏受湿土郁蒸之气，故谓之时邪。（风阳化热，尚属正气；湿土郁蒸，则多不正之气。）时邪虽
伏而后发，但不能久藏。春温、伏暑，谓之伏邪。如经所谓冬伤于寒，春必病温，夏伤于暑
，秋成 疟之类，皆超时而发。或曰∶寒暑之邪，何以伏而后发？曰∶伏邪者，正邪也。寒
为冬令之常气。暑为夏令之常气。常气感人，由渐而入，人多不觉。《灵枢经》曰∶正邪之
伤人也，若有若无，若存若亡。谓令人当时不知所受，故能藏伏。伏邪、时邪，皆由里发，
多夹湿，故初起舌上即有白苔，且浓而不薄，腻而不滑，或粗如积粉，或色兼淡黄。迨传胃
化火，与糟粕相抟，方由白而黄、而黑、而燥。其暑温、湿温之邪，多黄白混合，似黄似白
，或黄腻，或灰黄，而皆不燥。此等舌苔，即有下证，或大便不通、不爽，宜熟大黄缓下之
，以舌苔不燥，肠中必无燥粪，多似败酱色，故不宜猛下。
此燥邪、湿邪、燥湿混合之邪，舌苔之大较也。试取叶氏所论而详言之。初起舌苔白而
欠
搏束；桑叶、蒌皮之类，轻清以解燥热；佐山栀皮、连翘壳之微苦微燥，以燥属金，微苦能
胜之也。舌苔白而底绛者，湿遏热伏也，须防其变干，宜辛淡轻清，泄湿透热，不使湿邪遏
热为要。如三仁汤蔻仁易蔻皮，稍佐滑石、淡竹叶、芦根之类，以清化之。初病舌苔白燥而
薄，为胃、肾阴亏。其神不昏者，宜小生地、元参、麦冬等味以救阴，（戥分不宜过大，恐遏
伏邪气）。银花、知母、芦根、竹叶等味以化邪，尤须加辛润以透达；若神即昏者，加以开
闭，如普济丹、宁上丸之类，迟则内闭外脱不治。舌苔白燥而浓者，调胃承气汤下之，佐以
清滑养阴之品，如鲜生地、元参、梨汁、芦根之类。（取其清滑，不滞邪气）。若舌苔白腻不燥
，自觉闷极，属脾湿重，宜加减正气散、三仁汤之类，去苡仁、芦根、滑石，加醒头草、神
曲，辛淡开化，芳香逐秽。舌胀大不能退场门，属脾湿胃热郁极，毒延于口，前法加生大黄汁
利之，舌胀自消。舌苔白浓粘腻，口甜，吐浊涎沫，为脾瘅，乃脾胃湿热气聚，与谷气相搏
，满则上溢，亦宜加减正气散，加醒头草、神曲。舌苔如碱色，或白苔夹一二条黄色，乃宿
滞夹秽浊之邪，前法加宣中消滞药，否恐结闭，不能透出膜原。白苔浓如积粉，四边舌肉紫
绛，乃湿土郁蒸之温邪，发为温疫，仿达原饮、三仁汤加减透邪，以防传陷。苔白不燥，或
黄白相兼，或灰白不渴，慎不可投苦泄清下，此湿郁未达，或素多痰饮，虽中脘痞痛，亦不
可攻，宜用开化，如杏、蔻、枳、桔、陈皮、茯苓、通草之类。舌苔黄浊，胸膈按痛，或自
痛，或痞胀，此湿热混合，宜苦降辛通，如蒌贝温胆、小陷胸、半夏泻心、黄芩滑石汤之类
。然黄要有地质之黄，乃可用苦辛重剂，若消黄光滑，乃无形湿热，已见虚象，宜蒌、贝、
栀、翘之类，微辛微苦，轻轻开化，大忌苦辛重剂。舌苔老黄、灰黄如沉香色，而有地质，
不滑而涩，或中有断纹，或中心浓苔，此邪已传里（胃腑、肠腑），与宿滞相结，脘腹必
满必痛，皆当下之。若未见此样舌苔，恐湿聚太阴为满，寒热湿错杂为痛，或湿阻气机为胀
，仍当从辛淡温法开化。若苔黄薄而干，与前白薄而干者同治。热邪传营，舌色必绛而无苔
。其有舌绛，中兼黄白苔者，及似苔非苔者，此气分遏郁之热烁津，非血分也。宜用前辛润
达邪，轻清泄热法，最忌苦寒冰伏、阴柔滋腻，致气分之邪，遏伏内陷，反成纯绛无苔。其
有不因冰伏，而舌纯绛鲜泽，神昏者，乃邪传包络，宜犀角、鲜地黄、银、翘、郁金、鲜石
菖蒲、竹沥、姜汁等味，清化之中，佐辛润开闭。若其人平素多痰，外热一陷，里络即闭，
须兼用宁上、普济丹丸之类，迟恐闭极痉厥。舌绛望之若干，扪之有津，此平昔津亏，湿热
熏蒸，浊痰蒙闭心包，宜轻清泄热，佐宁上丸开之。舌色紫暗，扪之湿，乃其人胸膈中素有
宿瘀，与热相搏，宜鲜地黄、犀角、丹皮、丹参、赤芍、郁金、花粉、桃仁、藕汁等味，凉
血化瘀，否则瘀热为伍，阻遏机窍，遂变如狂、发狂之证。舌紫而肿大，乃酒毒冲心，前法
加生大黄汁利之。舌绛欲伸，而抵齿难伸者，此痰阻舌窍，肝风内动，宜于清化剂中，加竹
沥、姜汁、胆星、川贝等味，以化痰热，切勿滋腻遏伏火邪。舌绛而燥，邪火伤营也，宜犀
角鲜地黄汤。其有因寒凉阴柔遏伏者，往往愈清愈燥，愈滋愈干，又宜甘平甘润，佐以辛润
透邪，其津乃回。舌绛有碎点黄白者，欲生疳也，舌与满口生白衣如霉苔，或生糜点，谓之
口糜，因其人胃、肾阴虚，中无砥柱，湿热用事，混合蒸腾，证属难治，酌用导赤、犀角地
《内经》说：通过观察就能诊断疾病，这叫做“神”。既然称之为“神”，就一定能用医生的神志去契合病人的神志。人的神气，栖息在双眼，并遍布全身，尤其必须统观全身来考察。观察其色泽的清浊，以辨别燥湿；观察其神态的动静，以辨别阴阳；观察其神气的有无，以决断死生。像这样望诊才算完备，望诊才能达到出神入化的境界。春山先生说：人的神气，在有意无意之间流露时最为真实，医生需清心凝神，一会即能察觉，不宜过分拘泥，一旦拘泥就会产生私意，导致医者与病者的神气相混，反而觉得疑似难辨，难以捉摸。这又是以神会神的奥妙道理。试从面色来论述。经文说五色内应五脏，青色属肝木，红色属心火，黄色属脾土，白色属肺金，黑色属肾水。这是讲述常理。但患病时会有变化，甚至有五色不应五脏的情况，这又是变中之变。总之，不论何种颜色，都必须要有神气。所谓神气，就是有光、有体。光，指外面明朗；体，指里面润泽。光无形，主阳、主气；体有象，主阴、主血。气血不调和，阴阳相争，自然光与体都不具备。经文说：心脏正常的色泽，像白绢裹着朱砂；肺脏正常的色泽，像白绢裹着红色；肝脏正常的色泽，像白绢裹着青赤色；脾脏正常的色泽，像白绢裹着栝楼实；肾脏正常的色泽，像白绢裹着紫色。这是因为健康人五脏调和，其色泽禀受胃气，而显露于皮毛之间，胃气色黄，皮毛色白，精气内含，宝光外发，既不浮露，又不混蒙，所以说像白绢包裹。又说：精明五色的表现，是气的精华。红色要像白绢裹着朱砂，不要像代赭石那样暗红；白色要像鹅羽毛那样洁白，不要像盐那样惨白；青色要像苍碧色那样润泽，不要像蓝靛那样枯暗；黄色要像丝罗裹着雄黄那样明润，不要像黄土那样枯槁；黑色要像重漆色那样黑亮，不要像地苍（泥土）那样晦暗。反复强调以申明其义，即再次强调有神气的含义。大概有神气的人，就是有胃气的人。又说：青色像草兹（枯草）的死，黄色像枳实（干枯果实）的死，黑色像烟煤的死，红色像凝血（干血）的死，白色像枯骨的死。这是气血俱亡，无光无体，神气已去的表现。又说：青色像翠羽那样鲜活的是生证，红色像鸡冠那样红润的是生证，黄色像蟹腹那样黄润的是生证，白色像猪油那样白润的是生证，黑色像乌鸦羽毛那样黑亮的是生证。这是气血虽然生病，但神气未伤，有光有体，只是精气不能内敛而外露的表现。观察《内经》论色，分为平、病、死三等，虽然没有明言神气，但神气已经蕴含在其中了。
有人问：病情千变万化，面色如何区别？回答说：天地不外乎燥湿，病情也不外乎燥湿，面色也不外乎燥湿。燥属于天气，面色多有光泽而浮越；湿属于地气，面色多有形体而晦暗。风燥、寒燥，由外邪搏结束缚，主收敛，收敛则筋脉急迫，面色多绷急而光洁；燥邪搏结津液痰饮，外溢于面部，面色多红润而浮；夹湿则多红润而晦暗；燥邪化热，面色多干红，苗窍干涩，多烦渴，甚至变为枯而青黑，枯而青黑则是真阴亏损到了极点，而面色就没有光和体了。寒湿内生，面色必然滞暗，变黄变黑，都沉晦不明；湿兼风，面色润泽而浮，多自汗；湿与暑合，与热合，或湿土郁蒸产生的温邪，这三者都由口鼻吸入，三焦主管蒸散，蒸散则气机缓，面色多松缓而垢晦，严重时浊邪由内蒸腾而外溢，像油腻烟熏一样；如果由湿化燥，则又晦暗而且干燥，晦而干则是湿邪未去，真阴又亏，面色又没有光也没有体了。
有人问：部位如何对应？回答说：经文说心热病，额头先发红；如果出现青黑色，主有突发疾病。肺热病，鼻子先发红。凡是鼻子色青的，主腹痛；微黑的，有水气。鼻头黄的，小便困难；白的，为气虚；鲜红的，有留饮。又说：肺热病，右颊先发红；肝热病，左颊先发红；肾热病，下巴先发红，也主膀胱热结，小便不通。肝病的人，眼睛周围发青；红色主热；白睛黄，主黄疸；眼珠黄，是病欲愈的表现。又说：心病的人，颧骨发红；肾病的人，颧骨与天庭（颜）发黑黄（颜，指天庭）。赤色出现在两颧，大如拇指，主突然死亡。又说：面色多青则痛，色黑则痹（如霍乱闭遏，面色与络脉皆见黑色之类），黄赤则热，多白则寒，五色都出现则为寒热错杂。经文讲部位对应脏腑，以及五色辨病的说法，不可枚举。学习者不可不知道，但又不可完全拘泥（因为表里、阴阳传变很快，所以不可拘泥）。应当权衡大局，以燥、湿二字为提纲，以兼风、兼寒、兼暑、化火、未化火为权变，以面色中的光、体作为神气的判断标准，大道原本就不外乎一阴一阳。
望完面色之后，就必须审察形体和官窍。头为诸阳之会，因于湿，头部像被包裹一样沉重，眼睛像蒙蔽一样模糊；痰饮上犯头部，则眩晕，呕吐痰水；血燥风动，也眩晕，头皮痒，偏头痛；又有肾水虚燥，阴不潜阳，气逆上行，就是经文所说的头痛巅疾，下虚上实的病症。又有肝胆燥热，木旺风生，耳目没有血液滋养，经文所说的徇蒙招尤，目瞑耳聋，下实上虚的病症。（两个“实”字，都指虚火而言，并非真实邪气）。又有头垂视身，名叫天柱骨倒，元气已败，这是头部没有神气的表现。
肝开窍于目（肝脉上连目系），燥病则目光炯炯有神，湿病则眼睛多昏蒙；燥甚则眼睛无泪而干涩，湿甚则眼珠黄而溃烂，或者眼睑肿得像卧蚕；阳明腑实证，则谵语、胡乱看见东西；热入血室，血耗阴伤，白天清醒，晚上则低声自语，像看见鬼怪一样。睁眼看人，病属阳；闭眼不想看人，病属阴。脱阳的人，看见鬼怪；脱阴的人，失明；脱阴脱阳的人，病危。眼睛有分泌物、有泪水、精采内含的，是有神气；无分泌物、无泪水、白眼球色蓝、黑眼球色滞、精采内夺及浮光外露的，都是无神气。凡是生病眼睛还能识人的较轻，眼睛昏花不识人，以及眼睛直视、歪视、眼睛变小、眼睛瞪大、眼球正圆、戴眼反折、眼睑陷下的，为神气已去，大多不治。那些直视、歪视、上视、眼球微定移时稍动的，有因痰闭导致的，又不能一概作不治论。
肺开窍于鼻，燥病鼻子多干涩，湿病鼻子多润泽，流清涕多风寒，流浊涕多热，鼻孔干燥如烟煤为阳毒热极，鼻孔冷滑而黑为阴毒冷极，痰饮壅遏肺气则呼吸有声，肺肾虚脱则出入气微弱，或者喘急抬肩、鼻孔掀张。气微与鼻孔掀张，则神气由此散失了。
肾开窍于耳，心寄窍于耳，胆上络于耳。突发耳聋、耳肿、耳痛、耳旁红，属少阳风热燥邪，或肝胆热挟湿浊上壅；久病耳聋，属气虚，属精脱；如果耳朵焦枯受尘垢，属肾水亏极，这也是内无精液，而外无神气的表现。
脾开窍于口，口苦属燥热，口甜属湿热，嘴唇口角赤肿而干者热极，青黑而润者寒极，焦而红者可治，焦而黑者难治，淡白为气虚，淡白不泽为液少，唇青而反卷、环口黧黑、唇舌颤振不止、口如鱼口、气出不返者死，为其神气已去的缘故。
心开窍于舌，脾的大络系于舌本，肝、肾脉也通舌本。凡木舌、重舌、舌衄，属心经燥热；舌菌、舌垫、舌肿大塞口，属脾经湿热，挟心火上壅；舌本强硬，为热兼痰；如果舌卷短，痿软、枯小，则肝肾阴涸而舌因无神气了。舌上有苔，就像地上有苔。地上的苔，是湿气上泛而生；舌上的苔，是脾胃津液上潮而生。所以正常人舌中常有浮白苔一层，或浮黄苔一层；夏季湿土当令，苔往往较浓而微黄，但不满不板滞；那些脾胃湿热素重的人，往往终年有白浓苔，或舌中灰黄，等到有病时，脾胃津液为邪所郁，或因泻痢，脾胃气陷，舌反而无苔，或比平时较薄；那些胃、肾津液不足的人，舌多赤而无苔，或舌中有红路一条，或舌尖、舌边多红点。这是正常人舌苔的大致情况。如果有病，舌必见苔，病藏于中，苔显于外，确凿可凭，毫厘不爽，医家把握首赖于此！这是不可以不辨别的。
风寒为寒燥之邪，风温为温燥之邪。风寒初起在表，风温首先损伤肺经气分，所以舌多无苔，即使有黄白苔，也是薄而滑；逐渐传入里，与胃腑糟粕相搏结，苔才由薄而浓、由白而黄、而黑而燥，其形象都板滞不宣；等到泻下后苔才开始化腐，腐是指宣松而不板实的形象；由腐而退，渐生浮薄新苔一层，才是病邪解尽。有的初起，白苔即燥如白砂的，名叫白砂苔，这是温燥之邪过重，宜速下之，佐以甘凉救液；也有苔至黑而不燥的，或黄黑苔中有一二条白的，或舌前虽燥，舌根苔白浓的，都是夹湿、夹痰饮的缘故；也有苔虽黄黑，消薄而无地质（苔下有底）的，是胃阴虚的缘故。苔有地质与无地质，这是虚实的一大关键。
湿为浊邪，兼证最多。风湿伤表，苔多滑白不浓；寒湿伤里，苔多腻白而浓。暑温、湿温、温疫、温热，都是湿土郁蒸之气。冬温，因阳不潜藏，也是湿土郁蒸之余气。这几者皆从口鼻吸入肺胃膜原，由里而发。春温为冬伤于寒，寒郁久而化热，寒燥之气，又能搏束津液水饮伏于膜原，与热混合，也由里而发。暑湿晚发，名叫伏暑，因夏伤暑湿，伏于膜原，秋日凉燥之气，又从外搏遏在内之暑湿，这是由表邪引动里邪而发。暑湿疟疾，也多由此。按六气之邪，有贼邪、时邪、伏邪之分。如风寒卒感，谓之贼邪。贼邪尖颖，随感随发，顷刻不能藏伏。风温、温热、暑温、湿温、温疫、冬温等证，皆吸受时行之气，如春受风阳化热之气，夏受湿土郁蒸之气，故谓之时邪。（风阳化热，尚属正气；湿土郁蒸，则多不正之气。）时邪虽伏而后发，但不能久藏。春温、伏暑，谓之伏邪。如经文所说冬伤于寒，春必病温，夏伤于暑，秋成疟之类，皆超时而发。有人问：寒暑之邪，何以伏而后发？回答说：伏邪者，正邪也。寒为冬令之常气。暑为夏令之常气。常气感人，由渐而入，人多不觉。《灵枢经》说：正邪伤人，若有若无，若存若亡。谓令人当时不知所受，故能藏伏。伏邪、时邪，皆由里发，多夹湿，故初起舌上即有白苔，且浓而不薄，腻而不滑，或粗如积粉，或色兼淡黄。等到传入胃化火，与糟粕相抟，才由白而黄、而黑、而燥。其暑温、湿温之邪，多黄白混合，似黄似白，或黄腻，或灰黄，而皆不燥。这种舌苔，即使有下证，或大便不通、不爽，宜熟大黄缓下之，因为舌苔不燥，肠中必无燥粪，多似败酱色，故不宜猛下。
这是燥邪、湿邪、燥湿混合之邪，舌苔的大致情况。试取叶氏所论而详细言之。初起舌苔白而欠搏束（紧束），用桑叶、蒌皮之类，轻清以解燥热；佐山栀皮、连翘壳之微苦微燥，以燥属金，微苦能胜之也。舌苔白而底绛的，是湿遏热伏，须防其变干，宜辛淡轻清，泄湿透热，不使湿邪遏热为要。如三仁汤蔻仁易蔻皮，稍佐滑石、淡竹叶、芦根之类，以清化之。初病舌苔白燥而薄，为胃、肾阴亏。其神不昏的，宜小生地、元参、麦冬等味以救阴，（戥分不宜过大，恐遏伏邪气）。银花、知母、芦根、竹叶等味以化邪，尤须加辛润以透达；若神即昏的，加以开闭，如普济丹、宁上丸之类，迟则内闭外脱不治。舌苔白燥而浓的，调胃承气汤下之，佐以清滑养阴之品，如鲜生地、元参、梨汁、芦根之类。（取其清滑，不滞邪气）。若舌苔白腻不燥，自觉闷极，属脾湿重，宜加减正气散、三仁汤之类，去苡仁、芦根、滑石，加醒头草、神曲，辛淡开化，芳香逐秽。舌胀大不能退场门（缩回口腔），属脾湿胃热郁极，毒延于口，前法加生大黄汁利之，舌胀自消。舌苔白浓粘腻，口甜，吐浊涎沫，为脾瘅，乃脾胃湿热气聚，与谷气相搏，满则上溢，亦宜加减正气散，加醒头草、神曲。舌苔如碱色，或白苔夹一二条黄色，乃宿滞夹秽浊之邪，前法加宣中消滞药，否则恐结闭，不能透出膜原。白苔浓如积粉，四边舌肉紫绛，乃湿土郁蒸之温邪，发为温疫，仿达原饮、三仁汤加减透邪，以防传陷。苔白不燥，或黄白相兼，或灰白不渴，慎不可投苦泄清下，此湿郁未达，或素多痰饮，虽中脘痞痛，也不可攻，宜用开化，如杏、蔻、枳、桔、陈皮、茯苓、通草之类。舌苔黄浊，胸膈按痛，或自痛，或痞胀，此湿热混合，宜苦降辛通，如蒌贝温胆、小陷胸、半夏泻心、黄芩滑石汤之类。然黄要有地质之黄，乃可用苦辛重剂，若消黄光滑，乃无形湿热，已见虚象，宜蒌、贝、栀、翘之类，微辛微苦，轻轻开化，大忌苦辛重剂。舌苔老黄、灰黄如沉香色，而有地质，不滑而涩，或中有断纹，或中心浓苔，此邪已传里（胃腑、肠腑），与宿滞相结，脘腹必满必痛，皆当下之。若未见此样舌苔，恐湿聚太阴为满，寒热湿错杂为痛，或湿阻气机为胀，仍当从辛淡温法开化。若苔黄薄而干，与前白薄而干者同治。热邪传营，舌色必绛而无苔。其有舌绛，中兼黄白苔的，及似苔非苔的，此气分遏郁之热烁津，非血分也。宜用前辛润达邪，轻清泄热法，最忌苦寒冰伏、阴柔滋腻，致气分之邪，遏伏内陷，反成纯绛无苔。其有不因冰伏，而舌纯绛鲜泽，神昏的，乃邪传包络，宜犀角、鲜地黄、银、翘、郁金、鲜石菖蒲、竹沥、姜汁等味，清化之中，佐辛润开闭。若其人平素多痰，外热一陷，里络即闭，须兼用宁上、普济丹丸之类，迟恐闭极痉厥。舌绛望之若干，扪之有津，此平昔津亏，湿热熏蒸，浊痰蒙闭心包，宜轻清泄热，佐宁上丸开之。舌色紫暗，扪之湿，乃其人胸膈中素有宿瘀，与热相搏，宜鲜地黄、犀角、丹皮、丹参、赤芍、郁金、花粉、桃仁、藕汁等味，凉血化瘀，否则瘀热为伍，阻遏机窍，遂变如狂、发狂之证。舌紫而肿大，乃酒毒冲心，前法加生大黄汁利之。舌绛欲伸，而抵齿难伸的，此痰阻舌窍，肝风内动，宜于清化剂中，加竹沥、姜汁、胆星、川贝等味，以化痰热，切勿滋腻遏伏火邪。舌绛而燥，邪火伤营也，宜犀角鲜地黄汤。其有因寒凉阴柔遏伏的，往往愈清愈燥，愈滋愈干，又宜甘平甘润，佐以辛润透邪，其津乃回。舌绛有碎点黄白的，欲生疳也，舌与满口生白衣如霉苔，或生糜点，谓之口糜，因其人胃、肾阴虚，中无砥柱，湿热用事，混合蒸腾，证属难治，酌用导赤、犀角地
The *Classic of Internal Medicine* states: "To know through observation is called 'Shen' (Spirit/Divine)." Since it is termed "Shen," one must be able to use one's own Shen to resonate with the patient's Shen. The human Shen Qi (Spirit and Vital Energy) resides in the two eyes and permeates the entire body; therefore, it is essential to observe the whole body comprehensively. By observing its clarity or turbidity, one distinguishes between dryness and dampness; by observing its stillness or movement, one distinguishes between Yin and Yang; by observing its presence or absence, one determines life or death. Only in this way is inspection complete, and only then does inspection reach a state of mastery. Mr. Chunshan said: "Human Shen Qi is most authentically revealed in moments of intention or unintention. The physician must clear the mind and concentrate the spirit, perceiving it instantly upon meeting. One should not be overly rigid; rigidity gives rise to subjective bias, causing the physician's and patient's Shen Qi to mix, resulting in ambiguity and difficulty in grasping the condition. This is the profound principle of using Shen to comprehend Shen." Let us discuss complexion based on color. The classics state that the five colors correspond internally to the five Zang organs: Green belongs to Liver Wood, Red to Heart Fire, Yellow to Spleen Earth, White to Lung Metal, and Black to Kidney Water. This describes the normal state. However, in disease, there are variations, and sometimes the five colors do not correspond to the five Zang organs; this is a variation within variation. In summary, regardless of the color, there must be Shen Qi. What is meant by Shen Qi is having both "Guang" (Luster/Brightness) and "Ti" (Substance/Moisture). Guang refers to external brightness; Ti refers to internal moistness. Guang is formless, governing Yang and Qi; Ti has form, governing Yin and Blood. When Qi and Blood are harmonious and Yin and Yang do not contend, naturally both Guang and Ti are present. The classics say: "The healthy Heart color is like cinnabar wrapped in white silk; the healthy Lung color is like red wrapped in white silk; the healthy Liver color is like cyan-red wrapped in white silk; the healthy Spleen color is like a trichosanthes fruit wrapped in white silk; the healthy Kidney color is like purple wrapped in white silk." This is because when the five Zang organs are harmonious in healthy individuals, their colors derive from Stomach Qi and manifest between the skin and hair. Stomach Qi color is yellow, skin/hair color is white, essence and Qi are contained internally, and precious luster radiates externally. It is neither floating/exposed nor muddy/confused, hence described as "wrapped in white silk." It also says: "The bright and clear manifestation of the five colors is the splendor of Qi." Red should be like white wrapping cinnabar, not like jasper (dark red); White should be like goose feathers, not like salt (pale/dull); Green should be like the luster of dark green jade, not like indigo (dull); Yellow should like silk wrapping realgar (bright/moist), not like yellow earth (dry); Black should be like heavy lacquer (shiny), not like earthy soil (dull). Repeating this emphasizes the meaning of having Shen Qi. Essentially, having Shen Qi means having Stomach Qi. It also says: "Green like dead grass indicates death; Yellow like dried zhi shi fruit indicates death; Black like soot indicates death; Red like clotted blood indicates death; White like dry bone indicates death." These represent the loss of Qi and Blood, lacking both Guang and Ti, where Shen Qi has departed. It also says: "Green like kingfisher feathers indicates survival; Red like chicken comb indicates survival; Yellow like crab belly indicates survival; White like pig fat indicates survival; Black like crow feathers indicates survival." These indicate that although Qi and Blood are diseased, Shen Qi is not injured; there is Guang and Ti, but the essence cannot be fully contained and leaks outward. Observing the discussion on color in the *Inner Canon*, it is divided into three levels: normal, diseased, and terminal. Although "Shen Qi" is not explicitly stated, it is implied within.
Someone asks: "Diseases vary infinitely; how can complexions be distinguished?" I reply: "Heaven and Earth are nothing but dryness and dampness; diseases are nothing but dryness and dampness; complexions are nothing but dryness and dampness. Dryness belongs to Heaven Qi, and complexions often have luster and appear floating; Dampness belongs to Earth Qi, and complexions often have substance and appear dull. Wind-dryness and Cold-dryness, caused by external pathogenic binding, govern contraction. Contraction leads to tension, so facial complexions are often tight and bright; Dryness combining with body fluids and phlegm-fluids overflowing onto the face results in complexions that are reddish and floating; if combined with dampness, they are reddish and dull; if Dryness transforms into Heat, complexions are often dry and red, with orifices being dry and rough, accompanied by irritability and thirst. Severe cases may turn dry and cyan-black; dry and cyan-black indicates extreme deficiency of True Yin, resulting in a complexion lacking both Guang and Ti. Internal Cold-Dampness causes complexions to be stagnant and dark; changes to yellow or black are all deep, dull, and unclear. Dampness combined with Wind results in moist and floating complexions, often with spontaneous sweating; Dampness combined with Summer-heat or Heat, or Warm pathogens generated by Damp-Earth stagnation and steaming—all these enter via the mouth and nose. The San Jiao (Triple Burner) governs steaming and dispersing. Dispersal leads to relaxation, so facial complexions are often loose, greasy, and dull. In severe cases, turbid pathogens steam internally and overflow externally, resembling oil or smoke stains. If Dampness transforms into Dryness, the complexion becomes both dull and dry; dull and dry indicates that Dampness remains while True Yin is deficient, resulting in a complexion lacking both Guang and Ti.
Someone asks: "How do locations correspond?" I reply: "The classics state that Heart Heat disease causes the forehead to redden first; if cyan-black appears, it indicates sudden illness. Lung Heat disease causes the nose to redden first. A green nose indicates abdominal pain; slightly black indicates fluid retention. A yellow nasal tip indicates difficult urination; white indicates Qi deficiency; fresh red indicates retained fluids. It also says: Lung Heat disease causes the right cheek to redden first; Liver Heat disease causes the left cheek to redden first; Kidney Heat disease causes the chin to redden first, and also indicates Bladder Heat accumulation with urinary obstruction. Liver disease manifests as cyan around the eyes; Red indicates Heat; Yellow sclera indicates Jaundice; Yellow eyeballs indicate recovery. It also says: Heart disease manifests as red cheeks; Kidney disease manifests as black-yellow on the cheeks and forehead (Yan refers to the Tian Ting area above the eyebrows). Redness appearing on both cheeks, the size of a thumb, indicates sudden death. It also says: Complexions mostly cyan indicate pain; Black indicates Bi syndrome (e.g., cold-type cholera with obstruction, where complexion and collaterals appear black); Yellow-Red indicates Heat; Mostly White indicates Cold; Appearance of all five colors indicates mixed Cold and Heat. The classics' statements on location corresponding to Zang-Fu organs and distinguishing diseases by five colors are too numerous to list. Students must know them but not adhere rigidly (since transmission between exterior-interior and Yin-Yang is rapid, rigidity is inadvisable). One should weigh the general principles, using Dryness and Dampness as the outline, considering combinations with Wind, Cold, Summer-heat, transformation into Fire, or non-transformation as variables, and using the Guang and Ti of the complexion as indicators of Shen Qi. The Great Dao essentially encompasses only Yin and Yang.
After inspecting the complexion, one must examine the form and orifices. The head is the convergence of all Yang meridians. Due to Dampness, the head feels wrapped, and the eyes seem obscured; Phlegm-Fluids attacking the head cause dizziness and vomiting of phlegm-water; Blood Dryness generating Wind also causes dizziness, scalp itching, and hemi-cephalic headache. There is also Kidney Water deficiency leading to Dryness, Yin failing to anchor Yang, and rebellious Qi ascending—this is what the classics call Headache and Cephalic Disease, characterized by deficiency below and excess above. There is also Liver-Gallbladder Dryness-Heat, excessive Wood generating Wind, leaving the ears and eyes without Blood nourishment—this is what the classics call Xun Meng Zhao You (dizziness and tinnitus/deafness), closed eyes, deafness, excess below and deficiency above. (The word "Excess" here refers to Deficient Fire, not true Excess.) There is also Head Drooping relative to the body, named "Tian Zhu Bone Collapse," indicating failure of Yuan Qi (Original Qi); this is a lack of Shen Qi in the head.
The Liver opens into the Eyes (the Liver meridian connects to the eye system). Dryness diseases result in bright, piercing eyes; Dampness diseases result in dim, obscured eyes. Extreme Dryness leads to tearlessness and dryness; extreme Dampness leads to yellow, ulcerated eyeballs, or eyelids swollen like sleeping silkworms. Yangming Fu-organ Excess presents with delirium and hallucinations. Heat entering the Blood Chamber, consuming Blood and injuring Yin, presents with clarity during the day but whispering to oneself at night, as if seeing ghosts. Opening eyes to see people indicates Yang disease; closing eyes and avoiding people indicates Yin disease. Loss of Yang leads to seeing ghosts; Loss of Yin leads to blindness; Loss of both Yin and Yang indicates critical illness. Eyes with discharge and tears, containing inner brilliance, possess Shen Qi; eyes without discharge or tears, with blue whites, dull pupils, lost inner brilliance, or exposed floating light, lack Shen Qi. Generally, if a patient can recognize people with their eyes, the condition is mild. If eyes are dim and unable to recognize people, or exhibit fixed gaze, oblique gaze, small eyes, staring eyes, perfectly round eyeballs, upward deviation (Dai Yan), opisthotonos, or sunken eyelids, Shen Qi has departed, and the condition is mostly incurable. Fixed, oblique, or upward gazes, or slight movement after a period of fixation, may be due to Phlegm obstruction and cannot be universally deemed incurable.
The Lungs open into the Nose. Dryness diseases cause a dry nose; Dampness diseases cause a moist nose. Clear rhinorrhea indicates Wind-Cold; turbid rhinorrhea indicates Heat. Dry nostrils resembling soot indicate extreme Yang Toxic Heat; cold, slippery, black nostrils indicate extreme Yin Toxic Cold. Phlegm-Fluids obstructing Lung Qi cause noisy breathing; Lung-Kidney collapse causes faint respiration, or panting with raised shoulders and flaring nares. Faint respiration and flaring nares indicate the dispersion of Shen Qi.
The Kidneys open into the Ears; the Heart has an orifice in the ears; the Gallbladder meridian connects to the ears. Sudden deafness, ear swelling, ear pain, and redness around the ears belong to Shaoyang Wind-Heat-Dryness pathogens, or Liver-Gallbladder Heat combined with turbid Dampness rising and obstructing. Chronic deafness belongs to Qi deficiency or Essence depletion. If ears are dry, shriveled, and covered in dust, it indicates extreme Kidney Water deficiency; this is also a case of internal lack of Essence and external lack of Shen Qi.
The Spleen opens into the Mouth. Bitter taste indicates Dryness-Heat; sweet taste indicates Damp-Heat. Red, swollen, dry lips and mouth indicate extreme Heat; cyan-black and moist indicate extreme Cold. Scorched and red is treatable; scorched and black is difficult to treat. Pale white indicates Qi deficiency; pale white and lusterless indicates fluid deficiency. Cyan lips with inversion, black ring around the mouth, continuous trembling of lips and tongue, mouth like a fish's gape, and breath that does not return indicate death, due to the departure of Shen Qi.
The Heart opens into the Tongue; the large collateral of the Spleen ties to the root of the tongue; Liver and Kidney meridians also connect to the root of the tongue. Wooden tongue, double tongue, and tongue bleeding belong to Heart Meridian Dryness-Heat. Tongue fungus, tongue pad, and tongue swelling blocking the mouth belong to Spleen Meridian Damp-Heat combined with Heart Fire rising. Stiff tongue root indicates Heat combined with Phlegm. Rolled, short, flaccid, or shriveled tongue indicates exhaustion of Liver-Kidney Yin and lack of Shen Qi in the tongue. Tongue coating is like ground moss. Ground moss grows from moisture rising; tongue coating grows from Spleen-Stomach fluids rising. Thus, healthy individuals usually have a layer of floating white or floating yellow coating on the tongue. In summer, when Damp-Earth governs, the coating is often thicker and slightly yellow, but not full or stiff. Those with chronic Spleen-Stomach Damp-Heat often have thick white coating year-round, or gray-yellow in the center. When ill, Spleen-Stomach fluids are constrained by pathogens, or due to diarrhea/dysentery causing Spleen Qi sinking, the tongue may lack coating or be thinner than usual. Those with insufficient Stomach-Kidney fluids often have red tongues without coating, a red line in the center, or red dots on the tip and sides. This is the general overview of healthy tongue coatings. When diseased, the tongue always shows coating; disease hides inside, coating manifests outside, providing reliable evidence. Physicians rely heavily on this! This must not be ignored.
Wind-Cold is a Cold-Dryness pathogen; Wind-Warmth is a Warm-Dryness pathogen. Wind-Cold initially affects the exterior; Wind-Warmth first injures the Lung Qi level. Thus, the tongue often lacks coating; even if yellow-white coating exists, it is thin and slippery. Gradually transmitting inward, combining with Stomach Fu waste matter, the coating becomes thick, changing from white to yellow, black, and dry, appearing stiff and unventilated. After purgation, the coating begins to rot (become loose and not stiff). As it recedes, a new thin floating coating grows, indicating complete resolution of pathogens. Some have initial white coating dry as white sand, named "White Sand Coating," indicating severe Warm-Dryness pathogen; rapid purgation with sweet-cool fluids rescue is indicated. Some have black coating but not dry, or yellow-black coating with one or two white strips, or dry front but thick white root; these are due to combined Dampness or Phlegm-Fluids. Some have yellow-black coating but thin and lacking "geological base" (substance underneath), indicating Stomach Yin deficiency. Whether coating has a geological base is a major distinction between Excess and Deficiency.
Dampness is a turbid pathogen with many complications. Wind-Damp injuring the exterior results in slippery, thin white coating; Cold-Damp injuring the interior results in greasy, thick white coating. Summer-Warmth, Damp-Warmth, Warm Epidemic, and Warm-Thermal diseases are all vapors of Damp-Earth stagnation and steaming. Winter-Warmth, due to Yang failing to hide, is also residual vapor of Damp-Earth steaming. These all enter via mouth/nose into the Lung-Stomach membrane source, emerging from the interior. Spring-Warmth results from winter Cold injury; Cold stagnates and transforms into Heat over time. Cold-Dryness binds fluids and water-Phlegm, hiding in the membrane source, mixing with Heat, emerging from the interior. Late-onset Summer-Dampness is named "Hidden Summer-Heat," resulting from summer Summer-Heat/Dampness hiding in the membrane source, triggered in autumn by cool-dryness constraining the internal Summer-Heat/Dampness; this is exterior pathogen triggering interior pathogen. Summer-Dampness Malaria also arises thus. According to the Six Qi pathogens, there are Thief Pathogens, Seasonal Pathogens, and Hidden Pathogens. Sudden Wind-Cold infection is called Thief Pathogen. Thief Pathogens are sharp, acting immediately upon infection, unable to hide. Wind-Warmth, Warm-Thermal, Summer-Warmth, Damp-Warmth, Warm Epidemic, and Winter-Warmth are all infections of seasonal qi, such as spring Wind-Yang transforming into Heat or summer Damp-Earth steaming qi, hence called Seasonal Pathogens. (Wind-Yang transforming into Heat is still righteous Qi; Damp-Earth steaming is often unrighteous Qi.) Seasonal Pathogens may hide before acting but cannot stay long. Spring-Warmth and Hidden Summer-Heat are called Hidden Pathogens. As classics say: "Winter Cold injury leads to Spring Warmth; Summer Heat injury leads to Autumn Malaria." These act out of season. Someone asks: "Why do Cold and Heat pathogens hide and act later?" I reply: "Hidden Pathogens are Righteous Pathogens. Cold is the normal Qi of Winter; Heat is the normal Qi of Summer. Normal Qi affecting humans enters gradually, often unnoticed. The *Ling Shu* says: 'Righteous Pathogens affect people as if present yet absent, existing yet gone.' This makes people unaware of the infection at the time, allowing it to hide. Both Hidden and Seasonal Pathogens emerge from the interior and often combine with Dampness. Thus, initially, the tongue has white coating, thick not thin, greasy not slippery, or coarse like accumulated powder, or pale yellow. When transmitting to Stomach and transforming into Fire, combining with waste matter, it changes from white to yellow, black, and dry. Summer-Warmth and Damp-Warmth pathogens are often mixed yellow-white, looking like yellow or white, or greasy yellow, or gray-yellow, but never dry. For such coatings, even if purgation indications exist, or constipation/unsmooth stool, ripe Da Huang should be used gently for purgation. Since the coating is not dry, there is likely no dry feces in the intestines, often resembling fermented bean curd residue; thus, harsh purgation is unsuitable.
This is the general overview of tongue coatings for Dryness, Dampness, and mixed Dryness-Dampness pathogens. Let us elaborate on Ye Tianshi's discussions. Initial white coating lacking tightness: use Sang Ye (Mulberry Leaf), Lou Pi (Trichosanthes Peel) to lightly clear Dryness-Heat; assist with Shan Zhi Pi (Gardenia Peel), Lian Qiao Qiao (Forsythia Husk) which are slightly bitter and dry, as Dryness belongs to Metal, and slight bitterness can overcome it. White coating with crimson base indicates Dampness suppressing Heat; prevent drying, use pungent-light and clear methods to drain Dampness and vent Heat, ensuring Dampness does not suppress Heat. Example: San Ren Tang replacing Kou Ren with Kou Pi, assisting with Hua Shi (Talc), Dan Zhu Ye (Lophatherum Leaf), Lu Gen (Reed Rhizome) to clear and transform. Initial disease with thin, dry white coating indicates Stomach-Kidney Yin deficiency. If spirit is not confused, use Xiao Sheng Di (Rehmannia), Yuan Shen (Scrophularia), Mai Dong (Ophiopogon) to save Yin (dosage should not be too large, lest it suppress hidden pathogens). Yin Hua (Honeysuckle), Zhi Mu (Anemarrhena), Lu Gen, Zhu Ye (Bamboo Leaf) to resolve pathogens; especially add Pungent-Moist agents to vent. If spirit is confused, add opening-closing agents like Pu Ji Dan (Universal Relief Pill) or Ning Shang Wan (Calm Upper Pill); delay leads to internal closure and external collapse, untreatable. Thick, dry white coating: purge with Tiao Wei Cheng Qi Tang, assist with clearing-moistening Yin-nourishing agents like Xian Sheng Di (Fresh Rehmannia), Yuan Shen, Li Zhi (Pear Juice), Lu Gen (take their clearing-moistening property to avoid stagnating pathogens). White, greasy, non-dry coating with extreme stuffiness indicates heavy Spleen Dampness; use Jia Jian Zheng Qi San or San Ren Tang, remove Yi Yi Ren, Lu Gen, Hua Shi, add Xing Tou Cao, Shen Qu, use pungent-light to open-transform, aromatic to expel turbidity. Tongue swollen and unable to retract indicates extreme Spleen Dampness-Stomach Heat stagnation, toxin spreading to mouth; add raw Da Huang juice to the previous method to benefit, reducing swelling. White, thick, sticky-greasy coating with sweet taste and turbid saliva indicates Pi Dan (Spleen Sweetness), caused by Spleen-Stomach Damp-Heat gathering and combining with Grain Qi, overflowing upwards; use Jia Jian Zheng Qi San with Xing Tou Cao and Shen Qu. Coating like alkali color, or white coating with one or two yellow strips, indicates old stagnation combined with turbid pathogens; add middle-opening and stagnation-resolving drugs to the previous method, otherwise fear closure preventing emergence from membrane source. White coating thick like accumulated powder with purple-crimson tongue edges indicates Warm pathogen from Damp-Earth steaming, developing into Warm Epidemic; imitate Da Yuan Yin or San Ren Tang modified to vent pathogens, preventing transmission. White coating not dry, or mixed yellow-white, or gray-white without thirst: carefully avoid bitter-draining purgation. This indicates Dampness stagnation not yet reached, or chronic Phlegm-Fluids; even with epigastric fullness-pain, do not attack; use opening-transforming agents like Xing (Apricot Seed), Kou (Cardamom), Zhi (Immature Bitter Orange), Jie (Platycodon), Chen Pi (Tangerine Peel), Fu Ling (Poria), Tong Cao (Rice Paper Stem). Yellow-turbid coating with chest-diaphragm tenderness or spontaneous pain/fullness indicates mixed Damp-Heat; use bitter-descending and pungent-unblocking agents like Lou Bei Wen Dan Tang, Xiao Xian Xiong Tang, Ban Xia Xie Xin Tang, Huang Qin Hua Shi Tang. However, yellow must have a geological base to use bitter-pungent heavy agents; if smooth yellow, it is formless Damp-Heat showing deficiency signs; use Lou, Bei, Zhi, Qiao with slight pungent-bitter to lightly open-transform; strictly avoid bitter-pungent heavy agents. Old yellow or gray-yellow like agarwood coating, with geological base, not slippery but rough, or with cracks, or thick center coating, indicates pathogen transmitted to interior (Stomach/Intestine Fu) combining with old stagnation; epigastrium/abdomen must be full and painful; purgation is required. If this coating is not seen, fear Dampness gathering in Taiyin causing fullness, Cold-Heat-Damp mixture causing pain, or Dampness blocking Qi mechanism causing distension; still follow pungent-light-warm method to open-transform. Thin, dry yellow coating treated same as thin, dry white coating. Heat pathogen transmitting to Ying level results in crimson tongue without coating. Crimson tongue with mixed yellow-white coating, or coating-like appearance, indicates Qi-level suppressed Heat scorching fluids, not Blood level. Use previous Pungent-Moist pathogen-venting, light-clear Heat method; strictly avoid Bitter-Cold ice-freezing and Yin-soft greasy agents, which cause Qi-level pathogens to suppress and sink inward, resulting in pure crimson without coating. Pure crimson, bright, glossy tongue with confusion (not due to ice-freezing) indicates pathogen transmitting to Pericardium; use Xi Jiao (Rhinoceros Horn - substitute with Buffalo Horn), Xian Di Huang, Yin Qiao, Yu Jin, Xian Shi Chang Pu, Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice) to clear-transform, assisting with Pungent-Moist opening-closing. If person chronically has Phlegm, external Heat sinking closes interior collaterals; must combine Ning Shang Wan, Pu Ji Dan pills; delay risks extreme closure, convulsions. Crimson tongue looks dry but feels moist indicates chronic fluid deficiency, Damp-Heat steaming, turbid Phlegm obscuring Pericardium; use light-clear Heat, assist with Ning Shang Wan to open. Purple-dark tongue feeling moist indicates chronic Blood stasis in chest-diaphragm combining with Heat; use Xian Di Huang, Xi Jiao, Dan Pi, Dan Shen, Chi Shao, Yu Jin, Hua Fen, Tao Ren, Ou Zhi to cool-blood and resolve stasis; otherwise stasis-Heat combine, blocking orifices, leading to mania. Purple and swollen tongue indicates Wine Toxic rushing Heart; add raw Da Huang juice to previous method. Crimson tongue wanting to extend but hitting teeth indicates Phlegm blocking tongue orifice, internal Liver Wind stirring; add Zhu Li, Jiang Zhi, Dan Xing (Arisaema with Ginger), Chuan Bei (Fritillaria) to clearing-transform agent to resolve Phlegm-Heat; strictly avoid greasy agents suppressing Fire. Crimson and dry tongue indicates Evil Fire injuring Ying; use Xi Jiao Di Huang Tang. Cases suppressed by Cold-Cool Yin-Soft agents often become drier with clearing and drier with nourishing; use sweet-neutral/sweet-moist agents assisting with Pungent-Moist to vent pathogens, restoring fluids. Crimson tongue with yellow-white spots indicates impending aphthae; white mold-like coating or erosion points in mouth/tongue named Kou Mi (Mouth Ulceration), due to Stomach-Kidney Yin deficiency, lack of central pillar, Damp-Heat dominance, mixed steaming; condition is difficult to treat;酌情 use Dao Chi San, Xi Jiao Di...