舌见四围白而中黄者。必作烦渴呕吐之症。兼有表者。五苓散、益元散兼服。须待黄尽。方可下也。
\r中黄边白舌图\pt101a25.bmp\r
【介按】表邪未罢。将欲化热。则舌见边白中黄。其苔必然粘腻。因为水停胸中而津不升。则作烦渴，甚则渴欲饮
水。水入即吐矣。治宜用五苓散以发汗。则膀胱之气化而津液生。呕渴自止。盖以膀胱化水下出为小便。化气外出于皮
毛。皮毛又为肺所主。故兼用益元散清肺利湿以助之，原文所谓“须待黄尽”，是待舌苔纯黄而言。倘如舌变纯黄而浓燥
者。方可用攻下之剂。惟在呕吐之时。如能兼用泻心汤法则奏效尤速也。
五苓散 益元散（二方见前）
舌见黄色而有黑点者。邪遍六腑。将入五脏也。服调胃承气汤下之。次进和解散。十救四五也。
\r黄苔黑点舌图\pt101a26.bmp\r
【介按】黄苔主里。如见黑点芒刺。必是老黄焦燥，外证必有口渴身热。谵语便闭。此系胃中热极。将由腑而入脏。
急宜调胃承气汤。以清热邪而保胃液。得能黄苔稍退。热势已减。而后再进和解散也。惟和解散中之药性。过于辛温升
散。在愚见不如用凉膈散为稳。
调胃承气汤（方见前）
和解散
陈皮（一钱） 浓朴（姜制一钱） 本 桔梗（各五分） 甘草（炙五分） 苍术（三钱）
上 咀。水一钟半。姜三片。枣二枚。煎七分。去渣。不拘时服。
【介按】此方即平胃散加 本、桔梗也。取苍术之苦甘。长于发汗而燥湿。浓朴苦温。能散湿满而平胃。因湿之不行。
由于气滞。故佐陈皮以理气。甘先入脾。故使甘草以补脾。名曰平胃者。先贤谓“培卑监之土而使平”也。今加以 本
之辛温上达。能祛风邪而行湿。桔梗苦辛上行。能载诸药以上浮。由是观之。则此方为祛风行湿理气健脾之剂也。
舌苔四周呈白色而中间呈黄色的。必定会出现烦躁、口渴、呕吐等症状。如果兼有表证，可以五苓散和益元散同时服用。必须等到舌苔黄色完全消退后，才可以采用攻下法。
【介按】表邪尚未解除，即将化热，则舌象表现为边白中黄。其舌苔必然粘腻，这是因为水饮停滞在胸中，导致津液不能上承，从而出现烦躁、口渴，严重时甚至想喝水，但水喝进去就会立即吐出来。治疗应当使用五苓散来发汗，使膀胱的气化功能恢复，津液得以生成，呕吐和口渴自然停止。因为膀胱通过气化将水液转化为小便排出，或将气化之气向外输布至皮毛。皮毛又由肺所主，所以兼用益元散来清肺利湿以辅助治疗。原文所说的“须待黄尽”，是指等待舌苔变为纯黄色而言。如果舌苔变成纯黄色且浓重干燥的，才可以采用攻下的方剂。只是在呕吐的时候，如果能兼用泻心汤的法度，疗效会更加迅速。
舌苔呈现黄色并且带有黑点的。说明邪气已遍布六腑，即将传入五脏。应服用调胃承气汤进行攻下。随后再服用和解散，十个人中能救活四五个。
【介按】黄苔主里证。如果见到黑点和芒刺，必然是老黄焦燥之象，外在症状必定有口渴、身热、胡言乱语、大便闭塞。这是胃中热势极盛，病邪将由腑传入脏。急宜使用调胃承气汤，以清除热邪并保护胃中津液。等到舌苔稍退，热势已减之后，再服用和解散。只是和解散中的药性过于辛温升散，依我愚见，不如使用凉膈散更为稳妥。
和解散
陈皮（一钱） 厚朴（姜制一钱） 藁本 桔梗（各五分） 甘草（炙五分） 苍术（三钱）
以上药材切碎。用水一钟半，生姜三片，大枣二枚，煎煮至七分，去渣，不拘时候服用。
【介按】此方即平胃散加上藁本、桔梗。取苍术的苦甘之性，善于发汗且燥湿；厚朴苦温，能散除湿满并调和胃气。因为湿气不行，是由于气机阻滞，所以佐以陈皮来理气。甘味先入脾，所以用甘草来补脾。名为“平胃”，是先贤所说的“培卑监之土而使平”。现在加上藁本的辛温上行，能祛除风邪并运行湿气；桔梗苦辛上行，能载诸药上浮。由此看来，此方是祛风行湿、理气健脾的方剂。
The tongue shows a white coating around the periphery and a yellow coating in the center. This indicates symptoms of irritability, thirst, and vomiting. If accompanied by exterior syndrome, Wuling San (Five-Ingredient Poria Decoction) and Yiyuan San (Benefit Origin Powder) may be taken concurrently. One must wait until the yellow coating completely disappears before employing purgative methods.
[Jie's Commentary] When exterior pathogens have not yet resolved and are about to transform into heat, the tongue presents with a white periphery and yellow center. The coating is necessarily sticky due to fluid retention in the chest obstructing the ascent of body fluids, leading to irritability and thirst; in severe cases, there is an intense desire to drink water, but vomiting occurs immediately after ingestion. Treatment should employ Wuling San (Five-Ingredient Poria Decoction) to induce sweating, thereby restoring the Qi transformation of the Bladder (Bladder organ), generating body fluids, and naturally stopping vomiting and thirst. Since the Bladder transforms water into urine for excretion or transforms Qi outward to the skin and hair—and the skin and hair are governed by the Lung—Yiyuan San (Benefit Origin Powder) is used concurrently to clear the Lung and promote diuresis to assist this process. The original text’s statement "wait until the yellow [coating] is gone" refers to waiting until the tongue coating becomes purely yellow. Only if the tongue coating turns purely yellow, thick, and dry can purgative formulas be used. However, during episodes of vomiting, combining the principles of Xiexin Tang (Gallbladder Bitter Decoction) yields particularly rapid results.
The tongue coating appears yellow with black spots. This indicates that pathogens have spread throughout the Six Fu Organs and are about to enter the Five Zang Organs. Administer Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) to purge. Subsequently, administer Hejie San (Harmonizing Powder). Four out of ten patients may be saved.
[Jie's Commentary] A yellow coating indicates interior syndrome. If black spots and prickles are observed, it signifies old, yellow, scorched, and dry coating. Exterior signs must include thirst, fever, delirium, and constipation. This represents extreme heat in the Stomach, where pathogens are transitioning from the Fu organs to the Zang organs. Urgently use Tiaowei Chengqi Tang (Harmonize the Stomach and Direct Downward Decoction) to clear heat pathogens and preserve Stomach Yin. Once the yellow coating recedes slightly and the heat intensity subsides, then administer Hejie San (Harmonizing Powder). However, the medicinal properties in Hejie San (Harmonizing Powder) are overly acrid, warm, ascending, and dispersing. In my humble opinion, using Liangge San (Cool the Diaphragm Powder) is more prudent.
Hejie San (Harmonizing Powder)
Chenpi (Tangerine Peel, 1 qian) Houpo (Magnolia Bark, processed with ginger, 1 qian) Gaoben (Ligusticum sinense, unspecified amount) Jiegeng (Platycodon Root, each 5 fen) Gancao (Licorice Root, honey-fried, 5 fen) Cangzhu (Atractylodes Rhizome, 3 qian)
Crush the above ingredients. Add one and a half zhong of water, three slices of fresh ginger, and two jujubes. Decoct until reduced to seven-tenths. Strain and remove dregs. Take at any time.
[Jie's Commentary] This formula is Pingwei San (Stomach-Pacifying Powder) plus Gaoben (Ligusticum sinense) and Jiegeng (Platycodon Root). It utilizes the bitter-sweet nature of Cangzhu (Atractylodes Rhizome), which excels at inducing sweating and drying dampness; Houpo (Magnolia Bark) is bitter-warm, capable of dispersing damp-fullness and harmonizing the Stomach. Since dampness stagnation is caused by Qi obstruction, Chenpi (Tangerine Peel) is added to regulate Qi. Sweet flavors enter the Spleen first, so Gancao (Licorice Root) is used to tonify the Spleen. Named "Pingwei" (Pacifying the Stomach), ancient sages stated it means "cultivating the deficient Earth element to bring it to balance." Now, adding the acrid-warm upward-reaching nature of Gaoben (Ligusticum sinense) dispels wind pathogens and moves dampness; Jiegeng (Platycodon Root), bitter and acrid and ascending, carries the other herbs upward. Thus, this formula serves to dispel wind, move dampness, regulate Qi, and strengthen the Spleen.