伤寒三四日以后，舌上有膜，白滑如胎，甚者或涩或黄或黑，皆热气之浅深也。
邪气在表者，舌上则无胎；邪气传里，津液搏拮，则舌上生胎也。寒邪初传，未全成
热，在半表半里，或丹田有热，胸上有寒，邪初传入里也。恶寒者必欲呕也，腹中痛者
必欲利也。
【和】阳明病胁下硬满而喘，发热汗出，不大便而呕，舌上白胎者，小柴胡汤。脉阴
阳俱紧，舌上滑胎，小柴胡去半夏加人参栝蒌汤。腹痛，理中汤。
【吐】阳明脉浮紧，咽燥腹满而喘，发热汗出恶热，心中懊 ，舌上胎者，栀子豉汤。
【下】若热聚于胃，则舌为之黄，是热已深也。《金匮》曰∶舌黄未下者下之，黄自
去，黑滑皆然。经曰∶若舌黑者，反为热之极也。又曰∶热病口干舌黑者死。
【清热】七八日不解，热结在里，表里俱热，时时恶风，大渴舌干燥而烦，欲饮水数升
者，白虎汤加人参。
清碧学士杜先生曰∶凡伤寒热病传经之邪，比杂病不同，必须以脉与证及舌三者并
看，表里汗下之法，方免无瘥，不误人命。且如脉者，血之府也，属阴。人初得病之时，邪
与正气相搏未让，脉必滑而有力也。病久热甚气衰，脉必微细无力。方数甚也，只可好养阴
退阳。此议脉之妙也。又如证者初病有恶寒发热，后必有渴欲水燥热之类也。或有逆厥而
狂者，此热证传经之邪也。始终热证，实热故无寒也。伤寒为病，初头痛。
必有发热而恶寒渴水之证。一病便不逆泄利，但寒而无发热，此寒证也。
且如识证之妙者，如火者，本心之官也，窍于舌。心属火主热象离明。人初得病在
表，则舌自红而无白胎等色。表邪入于半表半里之间，其舌色变为白胎而滑见也，切
不可不明表证。故邪传之间，其舌色初为白胎；邪入于里，舌必见黄色，乃胃邪之象，宜
调胃承气汤下之，胎黄自去而疾安矣。若医不以次第而误用汤丸，失于迟下，其胎必黑，变
为舛证，此为难治。若见胎如黑漆之光者，十死一生，此心火与邪热，二火相乘，亢
极变为黑色，如火之炎物，极则焦而形黑也。乃脏腑皆受邪毒日深，胃中积热之极，宜速下
之，泻去胃中实火，庶几回生；若下之迟，死期必矣。今撰三十六舌法于左，并方法源流，
可决死生之妙也。
三十六舌法。
【白胎舌】治宜小柴胡汤，或栀子豉汤。
【火烙舌】宜凉膈散，或大柴胡汤下之。
【红星舌】将发黄，宜茵陈蒿汤。
【生斑舌】宜玄参升麻汤，或化斑汤。
【黑炭舌】宜竹叶石膏汤。大热，宜调胃承气汤下之。
【黑圈舌】过经未解，宜大承气汤下之。
【人裂舌】宜凉膈散加黄连主之。
【虫碎舌】宜小承气汤下之。
【厥阴舌】宜理中丸，或四逆汤主之。
【里黑舌】调胃承气汤下之，或解毒汤调之。
【瘟毒舌】黑色者主死。
【死蚬舌】白者无活，主死无疑。凡见舌尖白，根黄，此为表证未解，须宜解表，
然后可攻之。如大便秘者，宜凉膈散泡硝黄热服。小便涩者，宜五苓散加木通，合益元
散入姜汁，白汤调下。
【舌见弦白心黑】脉沉微者难治，脉见浮滑者可汗，沉实者可下。若初病见此者危
急，调胃承气汤下之。
【舌见尖上白胎二分根下黑一分】必有恶寒身疼，如饮水者，五苓散。自汗渴者，
白虎汤。下痢者，解毒汤。（此亦危证。）
【舌见白胎中有小黑点乱生】当有表证，其病之来虽恶，宜服凉膈散微表之，退即
下之，用承气汤。
【舌见两弦灰色中有黑晕痕二条】此热乘肾，当急下之，用解毒汤加酒泡大黄为末
调服。
【舌见微黄色者】初病则得之，不自白而变黄者，必见谵语。此由失汗，表邪入
里也，必用汗下，兼以双解毒汤。
【舌见白胎带黄色者】必泄，宜服解毒汤。恶寒者，五苓散。
【舌见酱黄色肥光者】必表未解，宜小柴胡汤合天水散。可下者，大柴胡汤。
【舌中见黑胎者】同上治。
【舌见黄色者】必先见白胎变黄色也，此为表而传里也。热已入胃，急下之，调胃承气
汤。若不早下，必至黑色而不可救。白中见黑胎者同治。
【舌见白胎而自汗出者】不可下，宜白虎汤加人参。
【舌见白胎滑者】脉在肌肉，为邪在半表半里，必往来寒热，宜小柴胡汤和之。
【舌见白而胎滑者】时时自下利，小腹痛引阴筋，此名脏结之证，为邪并入脏深，
为难治。
【舌见四圈白而中有黄者】必作烦渴呕吐之证，兼见表者，五苓散合益元散，服
之黄尽，方可下之。
【舌见黄而有小黑点者】热必深也，邪传六腑，将入五脏，急下之，调胃承气汤，次进
解毒汤，亦为十存四五也。
【舌见根黄尖白】表少里多，宜天水散一合，凉膈散二合，和而服之。如嫌未散，防
风通圣散主之。
【舌见干而涩者】膈邪传胃，并毒极深，必烦渴，急宜下之，大承气汤。若见发黄，
茵陈蒿汤。血证，抵当汤。表有水肿在胁内，十枣汤。结胸者，大陷胸汤。痞满者，大
黄泻心汤。
【舌见四边微红中央成黑灰色行路痕者】此由失下，热退可愈，须四五下之方退，
大承气汤。五次下之而胎色不退者，不治。
【舌见黄而中有黑点乱生者】其证必渴，谵语。脉滑者生，脉涩者死。循衣摸床者
死。下之见黑粪者死，大承气。
【舌见黄而中有黑至尖者】热毒邪气已深，两感者，下之十有九死，宜用九味羌活汤。
不恶寒下利，调胃承气汤。
【舌见弦红心黑者】伤风表未解也，宜双解毒散加双解毒汤微汗之，表证罢可下之。
如结胸烦躁，目直视者，下之。非结胸不可下。
【舌见根黑尖黄微】隐隐不见，如黑灰色，根黑尖黄虽有黑行，其脉实，宜下之，大
承气汤。脉浮而渴者，凉膈散。其能活者十有三四。
【舌见灰色】无恶寒恶风，虽脉浮者亦可下之。若恶风寒，双解毒汤。下之见黑粪者，
不可治。
【舌见根黑尖黄】脉滑者可下之；脉浮者养阴退阳。若恶风寒者，微汗之，双解毒散
下之。不成利者，用解毒汤。
【舌见大黑而有乱纹者】脉滑实，急下之，十得一生。脉浮数无力者不治。
伤寒病经过三四天以后，舌面上出现一层膜，白色滑腻如同舌苔，严重的或者干涩、或者发黄、或者发黑，这都是热邪深浅不同的表现。
邪气在体表时，舌面上就没有舌苔；邪气传入体内，津液与邪气搏结，舌面上就会生出舌苔。寒邪刚传入体内，尚未完全化热，处于半表半里之间，或者是丹田有热、胸中有寒，这是邪气刚开始传入体内的表现。感到恶寒的必然想呕吐，腹中疼痛的必然想腹泻。
【和解法】阳明病胁下硬满且气喘，发热出汗，大便不通且呕吐，舌上有白苔的，用小柴胡汤。脉象寸关尺三部都紧，舌上滑润有苔的，用小柴胡汤去掉半夏加入人参和栝蒚实。腹痛的，用理中汤。
【吐法】阳明病脉浮紧，咽喉干燥腹部胀满且气喘，发热出汗怕热，心中烦闷懊恼，舌上有苔的，用栀子豉汤。
【下法】如果热邪聚集在胃中，舌头就会变黄，这说明热邪已经很深了。《金匮要略》说：舌苔黄而未用泻下法的，应用泻下法，黄苔自然去除，黑而滑润的苔也是如此处理。医经说：如果舌苔发黑，反而是热邪到了极点。又说：热病口干且舌苔发黑的预后不良（死证）。
【清热法】七八天病未解，热邪结聚在体内，表里都热，时常怕风，极度口渴舌面干燥且烦躁，想要喝几升水的，用白虎加人参汤。
清碧学士杜先生说：凡是伤寒热病传经的邪气，与杂病不同，必须将脉象、证候及舌象三者结合来看，运用表里汗下等治法，才能避免病不愈，不误人性命。比如脉象，是血之府库，属阴。人刚得病时，邪气与正气相搏互不相让，脉象一定滑利而有力。病久热盛气衰，脉象一定微细无力。方剂数量多时，只可好好养护阴气以退阳热。这是诊察脉象的奥妙。又如证候，初病时有恶寒发热，后来必然有口渴欲饮水燥热之类的症状。或者有四肢逆冷而狂躁的，这是热证传经的邪气。始终是热证，因为是实热所以没有寒象。伤寒致病，初起头痛，必然有发热而恶寒渴水等症状。一种病如果不发生逆乱泄利，只有寒而没有发热，这是寒证。
再如识别证候的奥妙：火，是心的官窍，开窍于舌。心属火，主热象，对应离卦光明。人刚得病在体表，舌头自然发红而没有白苔等颜色。表邪进入半表半里之间，舌色变为白苔且滑润显现，切不可不明白表证。所以在邪气传变过程中，舌色起初为白苔；邪气入里，舌必现黄色，这是胃中邪气的征象，宜用调胃承气汤泻下，黄苔自去疾病就能痊愈。如果医生不按次序误用汤药丸散，延误了泻下的时机，舌苔必变黑，变成错乱的证候，这就难治了。如果见到舌苔像黑漆一样光亮，十个人死九个活一个生，这是心火与邪热，两火相乘，亢盛到极点变为黑色，就像火烧物体，极则焦枯而形黑。此时脏腑都受到邪毒侵害日益加深，胃中积热到了极点，应迅速泻下，泻去胃中实火，或许能挽回生命；如果泻下太迟，死亡期必然到来。现在撰写三十六种舌法在下面，并附上方法源流，可以决断生死。
三十六种舌法。
【白苔舌】治疗宜用小柴胡汤，或栀子豉汤。
【火烙舌】宜用凉膈散，或用大柴胡汤泻下。
【红星舌】将要发黄，宜用茵陈蒿汤。
【生斑舌】宜用玄参升麻汤，或化斑汤。
【黑炭舌】宜用竹叶石膏汤。大热的，宜用调胃承气汤泻下。
【黑圈舌】已过经未解，宜用大承气汤泻下。
【人裂舌】宜用凉膈散加黄连主治。
【虫碎舌】宜用小承气汤泻下。
【厥阴舌】宜用理中丸，或四逆汤主治。
【里黑舌】用调胃承气汤泻下，或用解毒汤调理。
【瘟毒舌】黑色的主死。
【死蚬舌】白色的无救，主死无疑。凡见舌尖白，根部黄，此为表证未解，须宜解表，然后才可攻里。如大便秘结的，宜用凉膈散泡硝石大黄热服。小便涩滞的，宜用五苓散加木通，合益元散加入姜汁，用白开水调下。
【舌见两边白中间黑】脉沉微的难治，脉见浮滑的可发汗，沉实的可泻下。若初病见此者危急，用调胃承气汤泻下。
【舌见尖上白苔二分根下黑一分】必然有恶寒身疼，如饮水的，用五苓散。自汗口渴的，用白虎汤。下痢的，用解毒汤。（这也是危重证候。）
【舌见白苔中有小黑点乱生】应当有表证，病情虽然恶劣，宜服凉膈散轻微解表，退后随即泻下，用承气汤。
【舌见两边灰色中有黑晕痕二条】这是热邪侵犯肾脏，当急泻，用解毒汤加酒浸大黄研末调服。
【舌见微黄色的】初病得到此象，不由白变黄的，必然出现谵语。这是由于失于发汗，表邪入里，必须用汗法下法并用，兼用双解毒汤。
【舌见白苔带黄色的】必然腹泻，宜服解毒汤。恶寒的，用五苓散。
【舌见酱黄色肥厚光亮的】必然表证未解，宜用小柴胡汤合天水散。可下的，用大柴胡汤。
【舌中见黑苔的】同上治疗。
【舌见黄色的】必然是先见白苔变黄色，这是由表传里。热已入胃，急泻，用调胃承气汤。若不早泻，必至黑色而不可救。白中见黑苔的同治。
【舌见白苔而自汗出的】不可泻下，宜用白虎加人参汤。
【舌见白苔滑的】脉在肌肉层，为邪在半表半里，必然往来寒热，宜用小柴胡汤和解。
【舌见白而苔滑的】时时自下利，小腹痛牵引阴筋，这名叫脏结证，为邪并入脏深处，为难治。
【舌见四边白中间黄的】必然出现烦渴呕吐的症状，兼见表证的，用五苓散合益元散，服完黄尽，方可泻下。
【舌见黄而有小黑点的】热必深，邪传六腑，将入五脏，急泻，用调胃承气汤，随后进解毒汤，也还有四五成存活率。
【舌见根黄尖白】表少里多，宜用天水散一合，凉膈散二合，调和服用。如嫌未散，防风通圣散主治。
【舌见干而涩的】膈间邪气传胃，并毒极深，必然烦渴，急宜泻下，用大承气汤。若见发黄，用茵陈蒿汤。血证，用抵当汤。表有水肿在胁内，用十枣汤。结胸者，用大陷胸汤。痞满者，用大黄泻心汤。
【舌见四边微红中央成黑灰色行路痕的】这是由于失于泻下，热退可愈，须四五次泻下方退，用大承气汤。五次泻下而苔色不退的，不治。
【舌见黄而中有黑点乱生的】其证必然口渴，谵语。脉滑的生，脉涩的死。循衣摸床的死。泻下见黑粪的死，用大承气汤。
【舌见黄而中有黑至尖的】热毒邪气已深，两感证的，泻下十有九死，宜用九味羌活汤。不恶寒下利的，用调胃承气汤。
【舌见两边红中间黑的】伤风表未解，宜用双解毒散加双解毒汤微汗之，表证罢可泻下。如结胸烦躁，目直视的，泻下。非结胸不可泻下。
【舌见根黑尖黄微】隐隐不见，如黑灰色，根黑尖黄虽有黑行，其脉实，宜泻下，用大承气汤。脉浮而渴的，用凉膈散。能活的十有三四。
【舌见灰色的】无恶寒恶风，虽脉浮者亦可泻下。若恶风寒，用双解毒汤。泻下见黑粪的，不可治。
【舌见根黑尖黄】脉滑的可泻下；脉浮的养阴退阳。若恶风寒的，微汗之，用双解毒散泻下。不成利的，用解毒汤。
【舌见大黑而有乱纹的】脉滑实，急泻下，十得一生。脉浮数无力的不治。
After three or four days of Taiyang disease (disease of the Taiyang channel), a membrane appears on the tongue, white and slippery like coating; in severe cases, it may be rough, yellow, or black, all indicating the depth of heat pathogen.
When the pathogenic factor is at the exterior, there is no coating on the tongue; when the pathogenic factor transmits to the interior and body fluids struggle with the pathogen, a coating forms on the tongue. When cold pathogen first transmits and has not fully transformed into heat, residing between the exterior and interior, or when there is heat in the Dantian and cold in the chest, this indicates the pathogen is just beginning to transmit inward. Chills indicate an urge to vomit; abdominal pain indicates an urge for diarrhea.
[Harmonizing Method] In Yangming disease, with hardness and fullness under the hypochondrium accompanied by wheezing, fever, sweating, constipation, and vomiting, along with a white tongue coating, use Xiaochaihu Tang (Minor Bupleurum Decoction). If the pulse is tight in both Yin and Yang positions, and the tongue has a slippery coating, use Xiaochaihu Tang with Banxia (Pinellia Rhizome) removed, and Renshen (Ginseng Root) and Gualou (Trichosanthes Fruit) added. For abdominal pain, use Lizhong Tang (Regulate the Middle Decoction).
[Vomiting Method] In Yangming disease, with a floating and tight pulse, dry throat, abdominal fullness, wheezing, fever, sweating, aversion to heat, mental restlessness, and tongue coating, use Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction).
[Purgative Method] If heat gathers in the Stomach, the tongue turns yellow, indicating deep heat. The *Jin Gui Yao Lue* states: "If the tongue coating is yellow and purgatives have not been used, apply purgation; the yellow coating will naturally disappear. This applies similarly to black and slippery coatings." The classics state: "If the tongue is black, it indicates extreme heat." It also says: "In heat diseases, if the mouth is dry and the tongue is black, the prognosis is fatal."
[Clearing Heat Method] After seven or eight days without resolution, with heat结 (knotting) in the interior, heat in both exterior and interior, occasional aversion to wind, extreme thirst, dry tongue, irritability, and desire to drink several liters of water, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).
Scholar Du Qingbi stated: The pathogenic factors transmitted through meridians in Shanghan (Cold Damage) febrile diseases differ from miscellaneous diseases. One must examine the pulse, symptoms, and tongue simultaneously. Only then can methods of exterior/interior, sweating/purgation be applied correctly, avoiding treatment failure and saving lives. Regarding the pulse, it is the mansion of blood and belongs to Yin. At the onset of illness, when pathogen and healthy Qi struggle equally, the pulse must be slippery and forceful. With prolonged illness, intense heat, and depleted Qi, the pulse becomes faint, fine, and weak. When using numerous formulas, one should only nourish Yin to subdue Yang. This is the subtlety of pulse diagnosis. Regarding symptoms, initial illness involves chills and fever, later progressing to thirst, desire for water, and dryness/heat. Some present with inverted cold limbs and mania; these are heat pathogens transmitting through meridians. Always heat syndromes, being excess heat, thus lack cold signs. Shanghan begins with headache, inevitably accompanied by fever, chills, and thirst for water. If a disease presents with no inversion or diarrhea, only cold without fever, it is a cold syndrome.
Regarding the subtlety of recognizing syndromes: Fire corresponds to the Heart's function, opening into the tongue. The Heart belongs to Fire, governs heat images, and corresponds to the Li trigram (brightness). At the onset of illness at the exterior, the tongue is naturally red without white coating. When exterior pathogen enters the half-exterior/half-interior, the tongue color changes to white and slippery. One must clearly understand exterior syndromes. During transmission, the tongue initially shows white coating; as pathogen enters the interior, the tongue shows yellow, representing Stomach pathogen. Use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge; the yellow coating will disappear and the disease will resolve. If doctors fail to follow the sequence and misuse decoctions/pills, delaying purgation, the coating turns black, leading to complex syndromes that are difficult to treat. If the coating looks like black lacquer, nine out of ten die; this is Heart Fire combined with pathogenic heat, two fires multiplying, reaching extremity and turning black, like fire scorching objects until charred. Viscera are deeply affected by toxic heat, and Stomach accumulated heat is extreme. Rapid purgation is needed to drain Stomach excess fire to save life; delayed purgation leads to death. Below are the Thirty-Six Tongue Methods and their origins, useful for determining life and death.
Thirty-Six Tongue Methods.
[White Coating Tongue] Treat with Xiaochaihu Tang or Zhizi Chi Tang.
[Fire-Branded Tongue] Use Liangge San (Cool the Diaphragm Powder) or Da Chaihu Tang (Major Bupleurum Decoction) to purge.
[Red Star Tongue] Jaundice is impending; use Yinchenshao Tang (Artemisiae Scopariae Decoction).
[Spotted Tongue] Use Xuanshen Shengma Tang (Scrophulariae and Cimicifugae Decoction) or Huaban Tang (Resolve Spots Decoction).
[Black Charcoal Tongue] Use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). For high fever, use Tiaowei Chengqi Tang to purge.
[Black Ring Tongue] Pathogen has passed the meridian but remains unresolved; use Dachengqi Tang (Major Order the Qi Decoction) to purge.
[Human-Crack Tongue] Use Liangge San with Huanglian (Coptis Rhizome).
[Worm-Broken Tongue] Use Xiao Chengqi Tang (Minor Order the Qi Decoction) to purge.
[Jueyin Tongue] Use Lizhong Wan (Regulate the Middle Pill) or Sini Tang (Reverse the Cold Decoction).
[Interior Black Tongue] Purge with Tiaowei Chengqi Tang or regulate with Jiedu Tang (Detoxify Toxin Decoction).
[Epidemic Toxin Tongue] Black indicates death.
[Dead Clam Tongue] White indicates no survival, definitely fatal. If tip is white and root is yellow, exterior syndrome is unresolved; resolve exterior first, then attack interior. For constipation, use Liangge San with Niao (Niter) and Dahuang (Rhubarb Root) soaked, taken hot. For dysuria, use Wuling San (Five-Ingredient Powder with Poria) plus Mutong (Akebia Stem), mixed with Yiyuan San (Benefit Origin Powder) and Ginger Juice, taken with warm water.
[Tongue with White Sides and Black Center] Faint pulse indicates difficult treatment; floating/slippery pulse allows sweating; deep/solid pulse allows purgation. If seen at onset, it is critical; purge with Tiaowei Chengqi Tang.
[Tongue with 2 parts White Tip and 1 part Black Root] Accompanied by chills and body ache; if drinking water, use Wuling San. If spontaneous sweating and thirst, use Baihu Tang. For dysentery, use Jiedu Tang. (This is also critical.)
[Tongue with White Coating and Random Small Black Dots] Exterior syndrome exists. Though severe, use Liangge San to mildly release exterior, then purge with Chengqi Tang after reduction.
[Tongue with Two Gray Stripes and Black Halos] Heat invading Kidney; urgent purgation needed. Use Jiedu Tang with Jiuhuang (Wine-soaked Rhubarb) powder mixed.
[Tongue with Slight Yellow] Seen at onset; changing from white to yellow indicates delirium due to missed sweating allowing exterior pathogen to enter interior. Use sweating and purging together with Shuang Jiedu Tang (Double Detoxification Decoction).
[Tongue with White Coating and Yellow Tinge] Diarrhea expected; take Jiedu Tang. For chills, use Wuling San.
[Tongue with Sauce-Yellow, Thick and Glossy] Exterior unresolved; use Xiaochaihu Tang combined with Tianshui San (Heavenly Water Powder). If purgable, use Da Chaihu Tang.
[Tongue with Black Coating in Center] Treat as above.
[Tongue with Yellow Color] Must progress from white to yellow, indicating transmission from exterior to interior. Heat entered Stomach; purge urgently with Tiaowei Chengqi Tang. Delay leads to black and incurability. White with black treated similarly.
[Tongue with White Coating and Spontaneous Sweating] Do not purge; use Baihu Jia Renshen Tang.
[Tongue with Slippery White Coating] Pulse felt in muscle layer indicates pathogen in half-exterior/half-interior; alternating chills and fever expected; harmonize with Xiaochaihu Tang.
[Tongue with White and Slippery Coating] Frequent diarrhea, lower abdominal pain radiating to genitals; named Zangjie Syndrome (Visceral Knotting), pathogen deeply merged into viscera, difficult to treat.
[Tongue with Four White Rings and Yellow Center] Irritability, thirst, vomiting expected. If exterior signs exist, use Wuling San + Yiyuan San. Once yellow clears, then purge.
[Tongue with Yellow and Small Black Dots] Heat is deep; pathogen transmitted to Six Fu organs, entering Five Zang organs. Urgent purgation with Tiaowei Chengqi Tang, followed by Jiedu Tang. Survival rate 40-50%.
[Tongue with Yellow Root and White Tip] Less exterior, more interior. Mix Tianshui San (1 he) and Liangge San (2 he) and take. If not resolving, use Fangfeng Tongsheng San (Siler and Peucedanum Powder for Unblocking the Universal).
[Tongue with Dry and Rough Texture] Diaphragm pathogen transmitted to Stomach, toxin extremely deep; irritability and thirst expected. Urgent purgation with Dachengqi Tang. If jaundice, use Yinchenshao Tang. Blood syndrome, use Didang Tang (Resist Accumulation Decoction). Exterior edema in hypochondrium, use Shizao Tang (Ten Jujube Decoction). Juxiong (Chest Binding), use Daxiexiong Tang (Major Chest Binding Decoction). Pi Man (Fullness Obstruction), use Dahuang Xiexin Tang (Rhubarb Heart-Draining Decoction).
[Tongue with Red Sides and Black-Grey Walking Trace in Center] Due to missed purgation; heat retreats and recovers. Requires 4-5 purgations to resolve, use Dachengqi Tang. If color doesn't change after 5 purgations, untreatable.
[Tongue with Yellow and Random Black Dots] Thirst and delirium expected. Slippery pulse indicates life; rough pulse indicates death. Grasping clothes and bed indicates death. Purging black stool indicates death; use Dachengqi Tang.
[Tongue with Yellow and Black Reaching Tip] Heat toxin/pathogen is deep. Lianggan (Dual Feeling) syndrome: purgation leads to 9 deaths out of 10. Use Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction). No chills/diarrhea, use Tiaowei Chengqi Tang.
[Tongue with Red Sides and Black Center] Wind injury, exterior unresolved. Use Shuang Jiedu San + Shuang Jiedu Tang to induce mild sweat. After exterior resolves, purge. If Juxiong with irritability and fixed gaze, purge. Non-Juxiong cannot be purged.
[Tongue with Dark Black Root and Yellow Tip] Faintly visible, gray-black. Although black/yellow lines exist, if pulse is solid, purge with Dachengqi Tang. Floating pulse with thirst, use Liangge San. Survival rate 30-40%.
[Tongue with Gray Color] No chills/aversion to wind; even with floating pulse, purgation is allowed. If chills/aversion to wind, use Shuang Jiedu Tang. Purging black stool is untreatable.
[Tongue with Black Root and Yellow Tip] Slippery pulse allows purgation; floating pulse requires nourishing Yin/subduing Yang. If chills/aversion to wind, induce mild sweat with Shuang Jiedu San then purge. If no diarrhea results, use Jiedu Tang.
[Tongue with Large Black and Random Patterns] Slippy/solid pulse; urgent purgation, 1 in 10 survives. Floating/rapid/weak pulse is untreatable.