舌见红色。更有裂纹如人字形。亦有此形者。（介按∶此句指图形而言。）乃君火燔灼。热毒炎上。故发裂也。宜用
凉膈散治之。
\r人裂舌图\pt101a8.bmp\r
【介按】年老之人。辄有舌中开裂。其苔则滑腻。或滑而微白。乃是津液干枯之体。而患寒湿之象。治疗适当。尚
属不妨。惟不论男妇老少。凡患暑温燥热之症。而见苔色焦黄。或兼灰黑燥刺。致有裂纹如人字。或如爻字。外证身热
口渴。甚则神昏、谵语。治宜亟与白虎汤合承气汤。以急下而救液。今治以凉膈散者。是使热降清升。上下通治之义也。
前贤梁特岩云。“不论白、红、黄、黑各舌，若中有裂纹。如川字、爻字、人字不等。或裂字直槽者。多由实热人误服温
补药。热火在脏腑相争所致。大承气虽能下毒。而未能凉沁肠胃。宜以白虎汤合与承气。循环急服。不知者以为太重。
实则力求周密之策也。”凡实热内逼而见此舌。皆宜如此以治之。
凉膈散（方见前）
舌见红色。更有红点如虫蚀之状者。乃热毒炽甚。火在上、水在下，不能相济故也。宜用小承气汤下之。
\r虫碎舌图\pt101a9.bmp\r
【介按】舌绛碎而有深红之点者，是属热毒蕴久不宣。熏蒸上达之候。故宜小承气汤以荡涤之。然亦可用白虎合犀
角地黄汤加减而治之。藉清热毒而滋津液。庶或有济至于红色虫碎舌。是红舌中更有红点如虫碎之状者。热毒炽盛也。
宜用小承气汤下之。如不退，再用大承气汤攻之。惟邵仙根谓。“舌绛碎而有黄白腐点者。此湿热邪毒蕴伏不宣。蒸腐气
血。化为瘀浊。得风木之气化而成虫也。”但《金匮要略》有“蚀于上部则声嗄。甘草泻心汤主之”之证。则邵氏之言。
又为疳蚀之症矣。
小承气汤（从伤寒论新补）
大黄（四两） 浓朴（二两，炙去皮） 枳实（三枚大者炙）
上三味。以水四升。煮取一升二合。去滓，分温二服。初服汤。当更衣。不尔者，尽饮之。若更衣者，勿服之。
【介按】唐容川曰。小承气汤、重在小肠。故仲景提出“腹大满”三字为眼目。盖小肠正当大腹之内。小肠通身、
接连油网。油是脾所司。膜网上连肝系。肝气下行。则疏泄脾土而膏油滑利。肝属木。故枳朴秉木气者。能疏利脾土。
使油膜之气。下达小肠而出也。又用大黄归于脾土者。泻膏油与肠中之实热。此小承气、所以重在小肠也。其不用芒硝。
以小肠不秉燥气。不取硝之滑润也。
舌色呈现红色。并且有类似人字形的裂纹。也有出现这种形状的。（介按：这句话是指裂纹的图形而言。）这是由于心火（君火）炽盛灼烧，热毒炎上，所以导致舌头开裂。适宜使用凉膈散来治疗。
【介按】年老的人，往往舌中间会出现开裂，舌苔则滑腻，或者滑而微白，这是津液干枯的身体，却表现出寒湿的征象。如果治疗得当，尚且无妨。只是不论男女老少，凡是患有暑温、燥热病症，而见到舌苔颜色焦黄，或者兼有灰黑色且干燥起刺，导致出现如人字形或爻字形的裂纹，外部症状表现为身体发热、口渴，甚至神志昏迷、胡言乱语，治疗应当紧急给予白虎汤合承气汤，以急下存阴来救津液。现在用凉膈散治疗，是使热降清升，上下通治的意思。前贤梁特岩说：“不论白色、红色、黄色、黑色的各种舌象，如果中间有裂纹，如川字、爻字、人字形等，或者是直槽状的裂字，大多是由实热证误服温补药物，导致热火在脏腑中相互争斗所致。大承气汤虽然能泻下毒邪，但不能清凉沁润肠胃，适宜用白虎汤合承气汤，循环急服。不知情的人认为这药力太重，实际上却是力求周密的治疗策略。”凡是实热内逼而出现这种舌象，都应当这样治疗。
凉膈散（方剂见前文）
舌色呈现红色，并且有红点像被虫子啃食过的样子，这是热毒极其炽盛，心火在上、肾水在下，不能相互济助的缘故。适宜用小承气汤攻下。
【介按】舌质深红（绛）且有碎点伴有深红点的，属于热毒蕴结日久不得宣发，熏蒸上达的征候。所以适宜用小承气汤来荡涤邪热。然而也可以用白虎汤合犀角地黄汤加减来治疗，借以清热毒并滋养津液，或许会有帮助。至于红色的虫碎舌，是在红舌中更有红点像被虫子咬碎的样子，这是热毒炽盛的表现。适宜用小承气汤攻下。如果症状不退，再用大承气汤攻伐。只有邵仙根说：“舌质深红且有黄白色腐点的，这是湿热邪毒蕴伏不得宣发，蒸腐气血，化为瘀浊，得到风木之气化而成虫。”但《金匮要略》中有“蚀于上部则声音嘶哑，甘草泻心汤主治”的证候，那么邵氏所说的话，又属于疳蚀类的病症了。
小承气汤（根据《伤寒论》新补）
大黄（四两） 浓朴（二两，炙后去皮） 枳实（三枚大的，炙）
以上三味药，用水四升，煮取一升二合，去渣，分两次温服。初次服药后，应当排便。如果不排便，就喝完剩下的药。如果已经排便了，就不要继续服用。
【介按】唐容川说，小承气汤的作用重点在小肠，所以张仲景特别提出“腹大满”这三个字作为关键。因为小肠正当位于大腹之内，小肠全身连接着油网，油由脾所主管，膜网上连肝系，肝气下行，就能疏泄脾土并使膏油滑利。肝属木，所以枳实、厚朴秉承木气，能够疏利脾土，使油膜之气下达小肠而排出。另外使用大黄归于脾土，是为了泻除膏油和肠中的实热。这就是小承气汤之所以重点在于小肠的原因。其中不用芒硝，是因为小肠不秉受燥气，不需要芒硝的滑润作用。
The tongue appears red. Furthermore, there are cracks resembling the character "Ren" (人). There are also cases with this shape. (Jie's Note: This sentence refers to the pattern of the crack.) This is due to the blazing of Ministerial Fire (Jun Huo) and the inflammation of heat toxins ascending upwards, thus causing cracking. It is appropriate to treat with Liangge San (Cooling the Diaphragm Powder).
[Jie's Note] In elderly individuals, cracks often appear in the center of the tongue, with a slippery and greasy coating, or slippery and slightly white. This indicates a body with dried-up fluids presenting signs of cold-dampness. If treated appropriately, it is generally not harmful. However, regardless of gender or age, whenever patients suffer from summerheat-warmth or dry-heat syndromes, and present with scorched-yellow coating, or gray-black dry prickles, leading to cracks like the characters "Ren" (人) or "Yao" (爻), accompanied by external symptoms of fever, thirst, and even coma or delirious speech, treatment should urgently employ Baihu Tang (White Tiger Decoction) combined with Chengqi Tang (Cure Qi Decoction) to purge rapidly and preserve fluids. Using Liangge San here embodies the principle of descending heat and raising clarity, treating both upper and lower jiao. The former scholar Liang Teyan stated: "Regardless of whether the tongue is white, red, yellow, or black, if there are cracks in the middle resembling 'Chuan' (川), 'Yao' (爻), 'Ren' (人), etc., or straight grooves, these are mostly caused by excess-heat conditions mistakenly treated with warming and tonifying medicines, resulting in a struggle between fire and heat within the zang-fu organs. While Dachengqi Tang can purge toxins, it cannot cool and moisten the intestines and stomach. It is advisable to use Baihu Tang combined with Chengqi Tang, administered urgently in rotation. Those unaware may consider this too harsh, but it is actually a strategy striving for thoroughness." Whenever such a tongue manifestation arises from internal逼迫 of excess-heat, it should be treated in this manner.
Liangge San (Formula seen previously)
The tongue appears red, with red spots resembling the appearance of insect erosion. This indicates extremely intense heat toxins, where Heart Fire is above and Kidney Water is below, failing to mutually assist each other. It is appropriate to purge using Xiaochengqi Tang (Minor Order the Qi Decoction).
[Jie's Note] A crimson (jiang) tongue with fragmented deep-red spots indicates heat toxins that have been accumulated and unvented for a long time, steaming and reaching upwards. Therefore, Xiaochengqi Tang is suitable to cleanse and purge them. Alternatively, Baihu Tang combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) modified can be used to clear heat toxins and nourish fluids, which may yield results. As for the "insect-bitten red tongue," where red spots on a red tongue resemble insect bites, this signifies intense heat toxins. Xiaochengqi Tang should be used for purging. If symptoms do not subside, Dachengqi Tang (Major Order the Qi Decoction) should be used for attack. Only Shao Xiangen stated: "A crimson tongue with yellow-white putrid spots indicates damp-heat pathogens hidden and unvented, steaming and corrupting qi and blood into turbid stasis, which transforms into insects under the influence of Wind-Wood qi." However, *Jingui Yaolue* mentions the syndrome "erosion in the upper part causes hoarseness, treated with Gancao Xiexin Tang." Thus, Shao's statement pertains to gan-erosion syndromes.
Xiaochengqi Tang (Supplemented from *Shanghan Lun*)
Dahuang (Rhei Radix et Rhizoma, 4 liang) Houpo (Magnoliae Officinalis Cortex, 2 liang, processed, skin removed) Zhishi (Immature Bitter Orange Fruit, 3 large ones, processed)
These three ingredients are boiled in four sheng of water to obtain one sheng and two he of liquid. Strain the dregs and divide into two warm doses. After the first dose, defecation should occur. If not, consume the remainder. If defecation has already occurred, do not take the medicine.
[Jie's Note] Tang Rongchuan said that Xiaochengqi Tang focuses on the Small Intestine. Hence, Zhang Zhongjing highlighted the phrase "abdominal fullness" as the key point. Since the Small Intestine lies within the great abdomen and connects throughout to the fatty membranes (oil network), which are governed by the Spleen, and the membranes connect upward to the Liver system, the downward flow of Liver Qi vents the Spleen Earth and makes the fatty oil slippery. As the Liver belongs to Wood, Zhi Shi and Houpo, inheriting Wood qi, can vent and facilitate Spleen Earth, allowing the qi of the fatty membranes to descend to the Small Intestine for excretion. Additionally, Dahuang returns to Spleen Earth to purge the fatty oil and excess-heat in the intestines. This is why Xiaochengqi Tang emphasizes the Small Intestine. Mangxiao (Natrii Sulfas) is not used because the Small Intestine does not inherit Dryness qi, nor does it require the lubricating property of Mangxiao.