既述舌色之条目。当集舌苔之条目。夫苔因病生。病以苔着。察色而不观苔。究难辨其虚实。观苔而不察
色。安能测其盛衰。且三因百病。莫不有苔。则亦莫不可验。岂特伤寒而已哉。然稽诸古昔。惟伤寒家言之。
以为伤寒舌上有苔者。必自润而燥。自滑而涩。由白而黄。由黄而黑。甚至焦干。或生芒刺。此邪气传里。由
浅入深之证也。如舌有白沫白涎。头项强痛者。太阳病也。白屑满舌。身热目痛鼻干不得卧者。阳明病也。
舌苔白滑。胸胁痛而耳聋。或寒热往来。口苦咽干目眩者。少阳病也。舌上白苔。胁下硬满。不大便而呕者。
阳明病。柴胡证也。白苔干浓。恶寒体痛者。表未解也。湿家下早则哕。或胸满。小便不利。舌上如苔者。以丹
田有热。胸上有寒。渴欲得水。而不能饮。则口燥烦也。心中懊 。舌上苔者。邪客胸中也。舌上白苔。烦躁。脉
数实。六七日不大便者。其后必便脓血也。舌苔白而湿。湿而浓者。身发小热也。如结胸状。饮食如故。时时
下利。寸脉浮。关脉小细沉紧。名曰脏结。舌上白苔滑者。难治也。脏结无阳证。不往来寒热。其人反静。舌上
苔滑者。不可攻也。苔白而黄者。邪将传里也。舌苔中黑。边白而滑。恶寒脉微弱者。表里虚寒也。舌苔中见
灰黑色两条。症见三阴者。邪传入里也。两感一二日。舌苔中黑边白者。不治之症也。苔白而舌根俱黑。汗
后脉躁者。死证也。舌苔初微黄。次深黄。甚则焦黄。身热汗自出。不恶寒。反恶热者。阳明病。胃家实也。舌上
黄苔。双垂夹见。手足 然汗出。潮热谵语者。正阳阳明也。苔黄燥。不大便而潮热谵语。手足 然汗出者。
胃腑实热也。病者腹满。按之而痛。舌黄。未下者下之。黄自去也。苔黄而滑。目黄。头汗出。剂颈而还。小便不
利者。身必发黄也。苔黄舌中有斑。体疼发热。腮赤者。身已发斑也。苔如姜黄色。及松花色。津润而冷。或腹
痛吐利者。阳衰土败也。苔黄中有小黑点。腹满嗌干者。邪传太阴也。黑晕两条而中灰色。口燥舌干者。邪
传少阴也。苔黑舌干而短。烦满囊缩者。邪传厥阴也。舌中苔黑而干者。邪传少阴。热甚津枯也。苔如黑。软
润而滑者。水克火。寒症也。苔黄黑。症见不足者。元气大亏也。舌心焦黑。质地红活。不大便而潮热谵语。手
足然汗出者。邪并于胃。即可下也。舌根起黑苔。咽不结者。可治也。舌根起黑苔。咽结者。不可治也。舌根
起黑苔。瓣底黑者。必死不治也。两感一二日。舌见黑苔者。死证也。黑色连地而灰黯无神者。败证也。妊娠
病热。苔黄而焦。胃家实者。泻其实所以安其胎也。此集伤寒之论苔者。宜合病症而察之也。其他舌苔干
涩如雪者。脾热也。舌苔黄黑。小腹胀痛。小便自利者。有瘀血也。小儿初出腹。舌上有白屑如米。剧者口鼻
亦有之。此由胞胎中受谷气盛。所谓鹅口者也。是皆舌苔之条目也。愚谓舌色深赤者。邪气实。舌色淡红
者正气虚。舌深赤。苔薄而滑者。正胜邪。舌淡红。苔浓而涩者邪胜正。舌深赤而明润。苔浓而燥涩者。形气
病气俱有余。舌淡红而枯暗。苔薄而冷滑者。形气病气俱不足也。顾前人独言其苔。后学当察其色。参之
五法。合之四诊。则凡黄白灰黑之苔。莫不有寒热虚实之辨。即杂病亦有可验者。非特伤寒而已也。金刚
经云。如来常说。汝等比邱。知我说法如筏喻者。法尚应舍。何况非法。然则学斯法者。取其精华。去其糟粕。
胸中有一定法。无一成法。庶几其有法欤。
既然已经论述了舌色的条目，现在应当汇集舌苔的条目。舌苔是因疾病而产生的，疾病通过舌苔显现出来。只观察舌色而不观察舌苔，终究难以辨别病证的虚实；只观察舌苔而不观察舌色，又怎能测知病势的盛衰呢？况且三因（内因、外因、不内外因）百病，没有不出现舌苔的，因此也没有不能通过舌苔来验证的，这难道仅仅是伤寒病才有的吗？
然而查考古代典籍，只有伤寒学派对此有详细论述。他们认为伤寒病患者舌上有苔的，必然由湿润转为干燥，由滑利转为涩滞，由白色转为黄色，由黄色转为黑色，甚至焦枯干裂，或者生出芒刺。这是邪气传入体内，由浅入深的证候。
如果舌上出现白沫或白涎，伴有头项强痛，这是太阳病（足太阳膀胱经受邪所致的病证）。如果满舌都是白屑，身体发热、眼睛痛、鼻子干、无法安卧，这是阳明病（足阳明胃经受邪所致的病证）。如果舌苔白滑，伴有胸胁疼痛和耳聋，或者寒热往来、口苦咽干、头晕目眩，这是少阳病（足少阳胆经受邪所致的病证）。如果舌上白苔，胁下硬满，大便不通且呕吐，这是阳明病兼柴胡证（小柴胡汤证）。如果白苔干燥浓厚，恶寒身体疼痛，说明表证未解。
湿家（素患湿病之人）如果过早使用攻下法，会出现呃逆，或者胸闷、小便不利，舌上看起来像有苔一样，这是因为丹田（下焦）有热，胸中有寒，口渴想喝水却喝不下去，导致口燥心烦。心中懊恼，舌上有苔，是邪气客居胸中。舌上白苔，烦躁，脉象数而实，六七天不大便的，其后必定排出脓血。
舌苔白而湿润，湿而浓厚的，身体发出轻微发热，症状像结胸证（痰水互结于胸膈），饮食如常，不时腹泻，寸脉浮，关脉小细沉紧，这叫脏结（内脏阳气虚衰，阴寒凝结）。舌上白苔滑润的，难治。脏结没有阳证表现，没有寒热往来，病人反而安静，舌苔滑润的，不可攻下。
苔白转黄的，邪气将要传入里。舌苔中间黑，边缘白而滑，恶寒，脉微弱，这是表里虚寒。舌苔中间出现灰黑色两条，症状涉及三阴经（太阴、少阴、厥阴），是邪气传入里。两感伤寒（同时感受两种邪气）一二日，舌苔中间黑边缘白的，是不治之症。苔白而舌根全部发黑，发汗后脉象躁动的，是死证。
舌苔起初微黄，随后深黄，严重时焦黄，身体发热，自然出汗，不恶寒，反而恶热的，是阳明病，属于胃家实（胃肠实热积滞）。舌上黄苔，双垂夹见，手足濈然汗出（持续不断地出汗），潮热谵语（定时发热说胡话）的，是正阳阳明（典型的阳明腑实证）。苔黄燥，不大便且潮热谵语，手足濈然汗出的，是胃腑实热。病人腹部胀满，按压疼痛，舌苔黄，尚未攻下的，应用攻下法，黄苔自去。
苔黄而滑，目黄，头部出汗仅至颈部而止，小便不利的，身体必定发黄。苔黄舌中有斑，身体疼痛发热，腮部发红，是身体已经发斑。苔如姜黄色及松花色，津液滋润而冷，或者腹痛吐泻的，是阳气衰微、脾土败坏。苔黄中有小黑点，腹胀咽喉干燥的，是邪气传入太阴。黑晕两条而中间灰色，口燥舌干的，是邪气传入少阴。苔黑舌干而短，烦闷阴囊收缩的，是邪气传入厥阴。舌中苔黑而干的，是邪气传入少阴，热盛津液枯竭。
苔色如黑，但柔软润滑的，是水克火，属于寒证。苔黄黑，症状表现为不足的，是元气大亏。舌中心焦黑，质地红活，不大便且潮热谵语，手足濈然汗出的，是邪气并聚于胃，即可使用攻下法。舌根起黑苔，咽喉不闭塞的，可治。舌根起黑苔，咽喉闭塞的，不可治。舌根起黑苔，舌瓣底部黑的，必死不治。两感伤寒一二日，舌见黑苔的，是死证。黑色连底而灰暗无神的，是败证。
妊娠病热，苔黄而焦，胃家实的，泻其实热所以能安胎。以上是收集关于伤寒病舌苔的论述，应当结合病症来观察。其他如舌苔干涩如雪的，是脾热。舌苔黄黑，小腹胀痛，小便自利的，是有瘀血。小儿刚出生，舌上有白屑如米粒，严重的口鼻也有，这是由于胞胎中受谷气旺盛所致，称为鹅口疮。这些都是舌苔的条目。
我认为：舌色深赤的，邪气实；舌色淡红的，正气虚。舌深赤，苔薄而滑的，正气胜邪气。舌淡红，苔浓而涩的，邪气胜正气。舌深赤而明润，苔浓而燥涩的，形气与病气都有余。舌淡红而枯暗，苔薄而冷滑的，形气与病气都不足。
只是前人只谈论舌苔，后学者应当观察舌色，参考五法，结合四诊，那么凡是黄、白、灰、黑的舌苔，无不有寒热虚实的辨别，即使是杂病也可以验证，不仅仅是伤寒病而已。《金刚经》说：“如来常说，你们比丘，知道我说法如同筏喻一样，法尚应舍弃，何况非法。”那么学习这种方法的人，取其精华，去其糟粕，胸中有一定的法则，但没有一成不变的死法，这样或许就接近道了吧。
Having discussed the entries regarding tongue color, we now compile the entries regarding tongue coating. Tongue coating arises due to disease, and disease manifests through the coating. Observing only the tongue color without examining the coating makes it difficult to ultimately distinguish between deficiency and excess syndromes; observing only the coating without examining the color makes it impossible to measure the flourishing or declining state of the pathogen. Moreover, among the Hundred Diseases caused by the Three Causes (internal, external, and neither internal nor external), none lacks a tongue coating, and thus none cannot be verified through it. Is this not limited solely to *Shanghan* (Cold Damage)?
However, consulting ancient texts, only the *Shanghan* school has elaborated on this. They believe that in patients with *Shanghan*, if there is a tongue coating, it inevitably transitions from moist to dry, from slippery to rough, from white to yellow, from yellow to black, and even to scorched and cracked, or developing prickles. This indicates the pathogen transmitting inward, progressing from superficial to deep levels.
If the tongue presents with white foam or saliva, accompanied by stiffness and pain in the head and neck, this is *Taiyang Bing* (Taiyang Disease). If the entire tongue is covered with white flakes, accompanied by fever, eye pain, nasal dryness, and inability to lie down, this is *Yangming Bing* (Yangming Disease). If the tongue coating is white and slippery, accompanied by chest and hypochondriac pain and deafness, or alternating chills and fever, bitter taste in the mouth, dry throat, and dizziness, this is *Shaoyang Bing* (Shaoyang Disease). If there is a white coating on the tongue, hardness and fullness under the ribs, constipation, and vomiting, this is Yangming Disease combined with a *Chaihu Zheng* (Bupleurum Syndrome). If the white coating is dry and thick, accompanied by aversion to cold and body pain, it indicates the exterior syndrome has not yet resolved.
In patients with chronic dampness (*Shi Jia*), if purgatives are used prematurely, hiccups may occur, along with chest fullness, difficulty urinating, and a tongue appearing as if coated; this is because there is heat in the *Dantian* (Lower Jiao) and cold in the chest. Thirst for water but inability to drink leads to oral dryness and vexation. Vexation in the heart with a tongue coating indicates pathogenic factors lodging in the chest. A white coating on the tongue, vexation, rapid and forceful pulse, and constipation for six to seven days indicate that pus and blood will subsequently appear in the stool.
A white, wet, and thick tongue coating with slight fever, symptoms resembling *Jie Xiong* (Chest Binding), normal diet, frequent diarrhea, floating pulse at the Cun position, and small, fine, deep, and tight pulses at the Guan position is named *Zang Jie* (Organ Knotting). A smooth white coating on the tongue is difficult to treat. *Zang Jie* lacks Yang syndrome signs, has no alternating chills and fever, the patient appears quiet, and with a smooth tongue coating, it must not be treated with attack methods.
A coating turning from white to yellow indicates the pathogen is about to transmit inward. A black center with a white, smooth edge, aversion to cold, and weak pulse indicates interior and exterior deficiency-cold. Two gray-black lines in the center of the tongue coating, with symptoms involving the Three Yin channels (Taiyin, Shaoyin, Jueyin), indicates the pathogen has transmitted inward. In *Liang Gan* (Dual Infection) within one or two days, a black center with a white edge on the tongue is an untreatable condition. A white coating with the root entirely black, followed by a restless pulse after sweating, is a death sign.
Initially slightly yellow, then deeply yellow, and finally scorched yellow tongue coating, accompanied by fever, spontaneous sweating, aversion to heat rather than cold, indicates Yangming Disease, specifically *Wei Jia Shi* (Stomach House Excess/Intestinal Excess Heat Accumulation). Yellow coating on the tongue, double vertical stripes, continuous sweating on hands and feet (*Ji Ran Han Chu*), tidal fever, and delirium indicate *Zheng Yang Yangming* (True Yang Yangming). Dry yellow coating, constipation, tidal fever, delirium, and continuous sweating on hands and feet indicate excess-heat in the Stomach Fu organ. Abdominal fullness and pain upon pressure, yellow tongue, and prior lack of purgation require purgation, after which the yellow coating will disappear.
Yellow and slippery coating, yellow eyes, sweating only up to the neck, and difficulty urinating indicate the body will develop jaundice. Yellow coating with spots on the tongue, body pain, fever, and red cheeks indicate the body has developed macules. Coating like ginger-yellow or pine-pollen color, with moist and cold fluids, or abdominal pain with vomiting and diarrhea, indicates decline of Yang and failure of Earth (Spleen). Yellow coating with small black dots, abdominal fullness, and dry throat indicate transmission to Taiyin. Two black halos with a gray center, dry mouth and tongue, indicate transmission to Shaoyin. Black, dry, and short tongue coating, with vexation, fullness, and retraction of the scrotum, indicates transmission to Jueyin. Black and dry coating in the center of the tongue indicates transmission to Shaoyin with severe heat and fluid exhaustion.
Coating that is black but soft, moist, and slippery indicates Water overcoming Fire, a cold syndrome. Yellow-black coating with signs of insufficiency indicates great depletion of Yuan Qi (Original Qi). Scorched black center of the tongue with a lively red texture, constipation, tidal fever, delirium, and continuous sweating on hands and feet indicate pathogenic factors gathering in the Stomach, suitable for purgation. Black coating at the root with unobstructed throat is treatable; black coating at the root with obstructed throat is untreatable. Black coating at the root with blackness at the base of the tongue瓣 (papillae) is fatal and untreatable. Black coating on the tongue in *Liang Gan* within one or two days is a death sign. Blackness extending to the base, dull and lifeless gray, is a collapse sign.
In pregnancy complicated by heat, with yellow scorched coating and *Wei Jia Shi*, purging the excess stabilizes the fetus. These are the discussions on tongue coating in *Shanghan*; they should be observed in conjunction with clinical symptoms. Other conditions include: dry and rough coating like snow indicating Spleen heat; yellow-black coating with lower abdominal pain and free urination indicating blood stasis; white flakes like rice grains on the tongue of a newborn, severe cases affecting mouth and nose, caused by excessive grain qi in the womb, known as *E Kou* (Goose Mouth/Candidiasis). These are all entries regarding tongue coating.
I propose: Deep red tongue color indicates excess pathogen; pale red tongue color indicates deficiency of healthy Qi. Deep red tongue with thin, slippery coating indicates healthy Qi overcoming pathogen; pale red tongue with thick, rough coating indicates pathogen overcoming healthy Qi. Deep red and lustrous tongue with thick, dry, and rough coating indicates excess in both form/Qi and disease/Qi. Pale red and withered/dark tongue with thin, cold, and slippery coating indicates deficiency in both form/Qi and disease/Qi.
Predecessors focused solely on the coating; later learners should observe the color, refer to the Five Methods, and integrate the Four Diagnostic Techniques. Then, for any yellow, white, gray, or black coating, distinctions of cold, heat, deficiency, and excess can be made. Even miscellaneous diseases can be verified, not just *Shanghan*. The *Diamond Sutra* states: "The Tathagata often says, you Bhikkhus, know that my teaching is like a raft; the Dharma should be abandoned, let alone non-Dharma." Therefore, those learning this method should take its essence and discard its dross, maintaining certain principles in mind without rigid adherence to fixed forms. Only then might one approach the Way.