华与余家,世为姻娅。华君岫云精通岐黄术,常存利济救人之心,孜孜不倦。向慕吴门
叶天
已遍
其
璋
余
青
时
乾隆四十年冬小春月赐进士出身钦命四川按察使司按察司加三级凝台杜玉林撰
并书
温邪上受,(按∶邪从口鼻而入,故曰上受。但春温,冬时伏寒,藏于少阴,遇春时温
气
逆
盖伤寒之邪,留恋在表,然后化热入里。温邪则热变最速,未传心胞,邪尚在肺。肺主气,
其合皮毛,故云在表。在表,初用辛凉轻剂,挟风则加入薄荷牛蒡之属,挟湿加芦根滑石之
流,或透湿于热外,或渗湿于热下,不与热相搏,势必孤矣。不尔,风挟温热而燥生,清窍
必干。谓水主之气,不能上荣,两阳相劫也。湿与温合,蒸郁而蒙蔽于上,清窍为之壅塞,
浊邪害清也。其病有类伤寒,其验之之法∶伤寒多有变症,温热虽久,在一经不移,以此为
辨。
前言辛凉散风,甘淡驱湿,若病仍不解,是渐欲入营也。营分受热,则血液受劫,心神
不安
陷入
平素
如玉
如
可冀其战汗透邪,法宜益胃,令水与汗并,热达腠开,邪从汗出。解后胃气空虚,当肤冷一
昼
此时宜令病者安舒静卧,以养阳气来复。旁人切勿惊徨,频频呼唤,扰其元神,使其烦躁。
但诊其脉,若虚软和缓,虽倦卧不语,汗出肤冷,却非脱症。若脉急疾,躁扰不卧,肤冷汗
出,便为气脱之症矣。更有邪盛正虚,不能一战而解,停一二日,再战汗而愈者,不可不知
。再论气病有不传血分而邪留三焦,亦如伤寒中少阳病也。彼则和解表里之半,此则分消上
下之势,随症变法,如近时杏朴苓等类,或如温胆汤之走泄。因其仍在气分,犹可望其战汗
之门户,转疟之机括。大凡看法,卫之后方言气,营之后方言血,在卫汗之可也。(按∶辛
凉开肺,便是汗剂,非如伤寒之用麻桂辛温也。)到气才可清气。入营犹可透热转气,如
角玄参羚羊等物。入血就恐耗血、动血,直须凉血、散血,如生地丹皮阿胶赤芍等物。否则
,前后不循缓急之法,虑其动手便错,反至慌张矣。且吾吴湿邪害人最广,如面色白者,须
要顾其阳气,湿胜则阳微也。法应清凉,然到十分之六七,即不可过于寒凉,恐成功反弃。
何以故耶?湿热一去,阳亦衰微也。面色苍者,须要顾其津液。清凉到十分之六七,往往热
减身寒者,不可就云虚寒而投补剂,恐炉烟虽熄,灰中有火也。须细察精详,方少少与之,
慎不可直率而往也。又有酒客里湿素盛,外邪入里,里湿为合。在阳旺之躯,胃湿恒多;在
阴盛之体,脾湿亦不少。然其化热则一。热病救阴则易,通阳最难。救阴不在血,而在津与
汗;通阳不在温,而在利小便。然较之杂症,则有不同也。
再论三焦不得从外解,必致成里结。里结于何?在阳明胃与肠也。亦须用下法,不可以
气血
伤
以
泄
或黄白相兼,或灰白不渴,慎不可乱投苦泄。其中有外邪未解里先结者,或邪郁未伸,或素
属中冷者,虽有脘中痞痛,宜从开泄,宣通气滞,以达归于肺,如近俗之杏蔻橘桔等,是轻
苦微辛,具流动之品可耳。
再前云舌黄或浊,须要有地之黄。若光滑者,乃无形湿热,中已虚象,大忌前法。其脐
以上
黄甚
青皮
错杂
再黄苔不甚浓而滑者,热未伤津,犹可清热透表。若虽薄而干者,邪虽去而津受伤也,
苦重
再论其热传营,舌色必绛。绛,深红色也。初传,绛色中兼黄白色,此气分之邪未尽也,
泄
日
类
再色绛而舌中心干者,乃心胃火燔,劫烁津液,即黄连石膏亦可加入。若烦渴烦热,舌
心干
热,
津亏
再有热传营血,其人素有瘀伤宿血在胸膈中,挟热而搏,其舌色必紫而暗,扪之湿,当
加入
之症
似
有
清
绛
其有舌独中心绛干者,此胃热,心营受灼也,当于清胃方中,加入清心之品。否则延及于尖
,为津干火盛也。舌尖绛独干,此心火上炎,用导赤散泻其腑。
再舌胎白浓而干燥者,此胃燥气伤也,滋肾药中加甘草,令甘守津还之意。舌白而薄者,
外
之
则
药
旋
不
郁
再舌上白苔粘腻,吐出浊浓涎沫者,口必甜味也,为脾瘅病,乃湿热气聚,与谷气相搏,
土
挟浊秽郁伏,当急急开泄;否则闭结中焦,不能从募原达出矣。
若舌无苔而有如烟煤隐隐者,不渴肢寒,知挟阴病。如口渴烦热,平时胃燥舌也,不可
攻之
若舌黑而滑者,水来克火为阴症,当温之。若见短缩,此肾气竭也,为难治;欲救之,
加人
燥水竭,急以咸苦下之。
舌淡红无色者,或干而色不荣者,当是胃津伤而气不化液也,当用炙甘草汤,不可用寒
凉药
若舌白如粉而滑,四边色紫绛者,温疫病初入募原,未归胃腑,急急透解,莫待传陷而
入为
点
斑
病
或
心包热也。点大而紫,胃中热也。黑斑而光亮者,热胜毒盛,虽属不治,若其人气血充者,
或根据法治之,尚可救;若黑而晦者,必死。若黑而隐隐,四旁赤色,火郁内伏,大用清凉透
发,间有转红成可救者。若夹斑带疹,皆是邪之不一,各随其部而泄。然斑属血者恒多,疹
属气者不少,斑疹皆是邪气外露之象,发出宜神情清爽,为外解里和之意;如斑疹出而昏者
,正不胜邪,内陷为患,或胃津内涸之故。
再有一种白 ,小粒如水晶色者,此湿热伤肺,邪虽出而气液枯也,必得甘药补之。或
未至
气液
再温热之病,看舌之后,亦须验齿。齿为肾之余,龈为胃之络,热邪不燥胃津,必耗肾
液。
黄,
者,
齿若光燥如石者,胃热甚也,若无汗恶寒,卫偏胜也,辛凉泄胃透汗为要。若如枯骨色
者,
为妥
胃虚
此非
若齿垢如灰糕样者,胃气无权,津亡,湿浊用事,多死。而初病齿缝流清血,痛者,胃
火冲
玉女
再妇人病温,与男子同;但多胎前产后,以及经水适来适断。大凡胎前病,古人皆以四
物加
护之
胎元,
其邪,
而治,
受邪,
正伤寒
为合治
等。若
挟寒加
胃实,
阻,侧
即陶
此方
华氏与我家,世代互为姻亲。华岫云先生精通中医医术,常怀救济世人之心,勤勉不懈。他一向仰慕苏州叶天士先生,曾遍访其门徒弟子。
温热病邪从口鼻侵入人体(按:邪气从口鼻进入,所以称为上受)。但春温病,是冬季感受寒邪,潜伏于少阴经,遇到春季的温气而诱发;冬温病,是冬季应寒反暖,导致阳气不藏,伏热内发。至于伤寒病的邪气,留恋在体表,然后化热传入体内。温热病邪则热变速度最快,尚未传入心包,邪气仍在肺脏。肺主一身之气,外合皮毛,所以说邪在体表。邪在体表,初期用辛凉轻剂治疗,兼夹风邪则加入薄荷、牛蒡子之类,兼夹湿邪加芦根、滑石之类,或者将湿邪透散到热邪之外,或者将湿邪渗利到热邪之下,使湿不与热相搏结,湿邪势必孤立无援。不然的话,风挟带温热而化燥,清窍必然干燥。这是因为水精之气不能上荣头面,两阳(风与温)相互劫夺所致。湿与温相合,蒸腾郁滞而蒙蔽上部清窍,清窍为之壅塞不通,这是浊邪伤害清阳之气的表现。这种病证类似伤寒,验证辨别的方法:伤寒多有变化复杂的症状,温热病即使病程较长,也固定在一经不移,以此作为鉴别要点。
前面提到用辛凉药疏散风邪,甘淡药驱除湿邪,如果病仍不解,说明邪气逐渐要进入营分了。营分受热,则血液被耗伤,心神不安。若患者平素肾阴不足,可用加减复脉汤类方剂救治;若患者平素中气虚弱,如玉屏风散等方可冀望其通过战汗透出邪气,治法宜益胃生津,令津液充足与汗源并行,热达腠理开泄,邪气随汗而出。病解后胃气空虚,可能出现皮肤发冷一昼夜的情况。此时应让病人安舒静卧,以养护阳气来复。旁人切勿惊慌失措,频频呼唤,扰乱病人的元神,使其烦躁。只需诊察其脉象,若脉虚软和缓,虽然疲倦卧床不语,出汗肤冷,却不是脱证。若脉象急疾,躁扰不卧,皮肤冷汗出,便是气脱的证候了。更有邪气盛正气虚,不能一次战汗而解,停一二日,再次战汗而痊愈的,不可不知。再论述气分病有不传入血分而邪留三焦的,也像伤寒中的少阳病一样。伤寒少阳病和解表里之半,此则分消上下之势,随症变法,如近时常用的杏仁、厚朴、茯苓等类药物,或如温胆汤的通降泄热。因为邪气仍在气分,还可望其通过战汗透邪,或转为疟疾样发作而愈。大凡看诊规律,卫分之后才论气分,营分之后才论血分,邪在卫分用汗法即可(按:辛凉开宣肺气,便是汗剂,不像伤寒用麻黄、桂枝辛温发汗那样)。到了气分才可以清气分热。邪入营分还可以透热转气,如使用犀角、玄参、羚羊角等药物。邪入血分就怕耗血、动血,必须直接凉血、散血,如使用生地、丹皮、阿胶、赤芍等药物。否则,前后不遵循缓急之法,担心动手便错,反而导致慌张。况且我们吴地湿邪害人最广,如面色白的人,必须顾护其阳气,湿胜则阳气微弱。治法应用清凉药,但如果用到十分之六七的程度,就不可过于寒凉,恐怕成功反被废弃。为什么呢?湿热一去,阳气也随之衰微。面色黑的人,必须顾护其津液。清凉药用到十分之六七,往往热减身寒,不可就说成虚寒而投补剂,恐怕炉烟虽熄,灰中有火。必须仔细察看详审,才稍微给予补益,切不可直率冒进。又有酒客体内湿气素盛,外邪入里,里湿与外邪相合。在阳气旺盛的体质,胃湿恒多;在阴气盛的体质,脾湿也不少。然而它们化热的情况是一样的。热病救阴容易,通阳最难。救阴不在补血,而在保津与汗;通阳不在温补,而在利小便。但这与杂症有所不同。
再论述三焦邪气不得从外解,必致形成里结。里结在哪里?在阳明胃与肠。也必须用下法,不可以气血两虚为借口而不敢攻下。若舌苔黄白相兼,或灰白而不渴,千万不可乱投苦寒泄下之品。其中有外邪未解里先结者,或邪气郁闭未伸,或素属中焦虚冷者,虽然有脘中痞痛,宜从开泄法治疗,宣通气滞,以达归于肺,如近世俗用的杏仁、豆蔻、橘皮、桔梗等,是轻苦微辛,具有流动性质的药物而已。
再前面说舌苔黄或浊,须要有根基的黄苔(指苔质有根)。若舌苔光滑,乃是无形湿热,中气已虚,大忌前法。若舌苔黄甚而干,青皮等药不可乱用,以免错杂误治。再黄苔不甚浓而滑者,热未伤津,犹可清热透表。若苔虽薄而干者,邪虽去而津受伤也,苦重之药不可再用。
再论述热传营分,舌色必绛。绛,是深红色。初传营分时,绛色中兼黄白色,这是气分之邪未尽也,当泄气分之邪。若舌色绛而舌中心干者,乃心胃火燔,劫烁津液,即黄连、石膏亦可加入。若烦渴烦热,舌心干,津亏热盛,当加入滋阴清热之品。
再有热传营血,其人素有瘀伤宿血在胸膈中,挟热而搏,其舌色必紫而暗,扪之湿润,应当加入活血化瘀之品。其症似有瘀血阻滞,当清营凉血化瘀。
其有舌独中心绛干者,此胃热,心营受灼也,当于清胃方中,加入清心之品。否则延及于舌尖,为津干火盛也。舌尖绛独干,此心火上炎,用导赤散泻其腑热。
再舌苔白浓而干燥者,此胃燥气伤也,滋肾药中加甘草,令甘守津还之意。舌白而薄者,外感风寒之邪,当用辛温解表之药。若郁久化热,则药随证变。旋覆花、代赭石等药不可乱投,以免逆其气机。
再舌上白苔粘腻,吐出浊浓涎沫者,口必甜味也,为脾瘅病,乃湿热气聚,与谷气相搏,土中湿热挟浊秽郁伏,当急急开泄;否则闭结中焦,不能从募原达出矣。
若舌无苔而有如烟煤隐隐者,不渴肢寒,知挟阴病。如口渴烦热,平时胃燥舌也,不可攻下。若舌黑而滑者,水来克火为阴症,当温之。若见短缩,此肾气竭也,为难治;欲救之,加人参等药。若燥水竭,急以咸苦下之。
舌淡红无色者,或干而色不荣者,当是胃津伤而气不化液也,当用炙甘草汤,不可用寒凉药。
若舌白如粉而滑,四边色紫绛者,温疫病初入募原,未归胃腑,急急透解,莫待传陷而入为坏证。点大而紫,胃中热也。黑斑而光亮者,热胜毒盛,虽属不治,若其人气血充者,或根据法治之,尚可救;若黑而晦者,必死。若黑而隐隐,四旁赤色,火郁内伏,大用清凉透发,间有转红成可救者。若夹斑带疹,皆是邪之不一,各随其部而泄。然斑属血者恒多,疹属气者不少,斑疹皆是邪气外露之象,发出宜神情清爽,为外解里和之意;如斑疹出而昏者,正不胜邪,内陷为患,或胃津内涸之故。
再有一种白㾦,小粒如水晶色者,此湿热伤肺,邪虽出而气液枯也,必得甘药补之。或未至气液枯竭,亦需顾护。
再温热之病,看舌之后,亦须验齿。齿为肾之余,龈为胃之络,热邪不燥胃津,必耗肾液。若齿光燥如石者,胃热甚也,若无汗恶寒,卫偏胜也,辛凉泄胃透汗为要。若如枯骨色者,肾阴枯竭,为妥难治。此非胃虚,乃肾水枯也。
若齿垢如灰糕样者,胃气无权,津亡,湿浊用事,多死。而初病齿缝流清血,痛者,胃火冲激也,用玉女煎加减。
再妇人病温,与男子同;但多胎前产后,以及经水适来适断。大凡胎前病,古人皆以四物汤加味护之,以固胎元,祛其邪,标本兼治。若受邪,即陶氏所谓“产前当清热安胎”等。若挟寒加生姜、大枣。胃实,腹满,侧卧不安,即陶氏所云“产后当大补气血”等。此方
Hua family and my family have been intermarried for generations. Mr. Hua Xiuyun is proficient in Traditional Chinese Medicine (TCM) and always harbors a heart to benefit and save people, working diligently without fatigue. He has long admired Master Ye Tianshi of Suzhou and has visited his disciples extensively.
Warm-heat pathogenic factors enter the body from the mouth and nose (Note: Pathogens enter via the mouth and nose, hence called "upper reception"). However, Spring-Warmth disease is caused by cold pathogens contracted in winter, lying latent in the Shaoyin channel, and triggered by the warmth energy of spring; Winter-Warmth disease is caused by winter being warmer than it should be, leading to unhidden yang qi and latent heat within. As for Cold damage (Shanghan) pathogens, they linger on the exterior before transforming into heat and entering the interior. Warm-heat pathogens change to heat most rapidly; before transmitting to the Pericardium, the pathogen remains in the Lung. The Lung governs the Qi of the whole body and connects with the skin and hair, so it is said that the pathogen is at the exterior. When the pathogen is at the exterior, initially use light acrid-cool formulas. If accompanied by Wind, add herbs like Bohe (Menthae Haplocalycis Herba) and Niubangzi (Arctii Fructus); if accompanied by Dampness, add Gen (Phragmitis Rhizoma) and Huashi (Talcum). Alternatively, vent the Dampness outside the Heat, or leach the Dampness below the Heat, so that Dampness does not contend with Heat, and the Dampness will inevitably become isolated. Otherwise, Wind carrying warm-heat generates dryness, and the clear orifices will certainly become dry. This is because the essence of Water cannot nourish the upper orifices, and two Yangs (Wind and Warmth) mutually deplete each other. When Dampness combines with Warmth, steaming and stagnation obscure the upper clear orifices, causing obstruction. This is turbid pathogenic factors harming the clear Yang. This disease resembles Cold damage; the method of verification and differentiation is: Cold damage often presents with complex changing symptoms, whereas Warm-heat diseases, even if prolonged, remain fixed in one channel, which serves as the point of differentiation.
Previously mentioned using acrid-cool herbs to disperse Wind and sweet-bland herbs to drive out Dampness. If the disease still does not resolve, it indicates that the pathogen is gradually entering the Ying (Nutrient) level. When the Ying level is heated, blood is depleted, and the Shen (Spirit) becomes unsettled. If the patient usually has Kidney Yin deficiency, Jiajian Fumai Tang (Modified Decoction to Restore the Pulse) can be used; if the patient usually has Middle Jiao Qi deficiency, Yupingfeng San (Jade Windscreen Powder) etc. may help hope for expelling the pathogen through a battle-sweat. The method should benefit the Stomach, allowing fluids to accompany sweat, heat reaches the cou li (pores), and the pathogen exits with sweat. After resolution, Stomach Qi is empty, and skin coldness may last for a day and night. At this time, let the patient rest peacefully to nourish the recovery of Yang Qi. Bystanders must not panic or call frequently, disturbing the Yuan Shen (Original Spirit) and causing irritability. Only diagnose the pulse; if it is deficient, soft, and slow, although the patient is tired, lying down, silent, sweating, and has cold skin, it is not a Collapse syndrome. If the pulse is rapid, the patient is restless and unable to lie down, with cold sweat and cold skin, it is a Qi Collapse syndrome. Furthermore, when pathogenic factors are excess and Zheng Qi (Upright Qi) is deficient, one battle-sweat may not resolve it; stopping for one or two days for another battle-sweat to heal is possible, which must be known. Again discussing Qi-level diseases that do not transmit to the Blood level but remain in the Sanjiao (Triple Burner), similar to Shaoyang disease in Cold damage. That involves harmonizing half-exterior and half-interior; this involves distributing and eliminating the momentum of upper and lower jiao, changing methods according to symptoms, such as using Xingren (Armeniacae Semen Amarum), Houpo (Magnoliae Officinalis Cortex), and Fuling (Poria) etc., or Wendan Tang (Gallbladder-Warming Decoction) for descending and draining. Because the pathogen is still in the Qi level, there is still hope for expelling it via battle-sweat or transforming into a malaria-like attack. Generally speaking, the pattern of progression is: after Wei (Defensive) comes Qi, after Ying comes Blood. For pathogen in Wei, sweating method is applicable. (Note: Acrid-cool opening of Lung Qi acts as a sweating agent, unlike the acrid-warm sweating of Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) in Cold damage). Only when reaching Qi level can one clear Qi heat. Entering Ying, one can still vent heat to transform Qi, using drugs like Shuijiao (Rhinocerotis Cornu - now substituted with Shexiang Niujiao or similar), Xuanshen (Scrophulariae Radix), and Lingyangjiao (Saigae Tataricae Cornu). Entering Blood, fear of damaging and moving blood requires directly cooling Blood and dispersing Blood stasis, using drugs like Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), Ejiao (Colla Corii Asini), and Chishao (Paeoniae Radix Rubra). Otherwise, failing to follow the principles of urgency and slowness leads to errors and panic. Moreover, our Wu region suffers widely from Dampness. Those with white complexion must protect their Yang Qi; excessive Dampness leads to weak Yang. The method should use cooling drugs, but when reaching 60-70% efficacy, one must not be overly cold, lest success be abandoned. Why? Once damp-heat is gone, Yang also declines. Those with dark complexion must protect their Jin-Ye (Body Fluids). Cooling drugs to 60-70%, often reducing heat and causing body chill, should not be treated as deficiency-cold with tonics, fearing that although the fire is out, embers remain. One must examine carefully and give tonics sparingly, never acting rashly. Also, wine drinkers have inherent internal Dampness; external pathogens entering the interior combine with internal Dampness. In constitutions with strong Yang, Stomach Dampness is abundant; in constitutions with strong Yin, Spleen Dampness is not lacking. However, their transformation into Heat is the same. Saving Yin in heat diseases is easy; unblocking Yang is hardest. Saving Yin lies not in nourishing Blood, but in preserving Jin-Ye and Sweat; unblocking Yang lies not in warming, but in promoting urination. This differs from miscellaneous diseases.
Again discussing Sanjiao pathogens unable to resolve from the exterior inevitably form interior knotting. Where is the interior knot? In the Yangming Stomach and Intestines. One must also use purgative methods; one cannot refrain due to Blood and Qi deficiency. If tongue coating is yellow-white mixed, or gray-white without thirst, strictly avoid indiscriminate bitter-purgatives. Among them, those with unresolved exterior and pre-existing interior knot, or depressed pathogen not yet extending, or constitutionally middle-jiao cold, although having epigastric fullness and pain, should use opening-draining methods to ventilate Qi stagnation and return it to the Lung, such as common Xingren (Armeniacae Semen Amarum), Doukou (Amomi Fructus Rotundus), Chenpi (Citri Reticulatae Pericarpium), and Jiegeng (Platycodonis Radix), which are light bitter and slightly acrid, possessing flowing properties.
Previously mentioned yellow or turbid tongue coating must have roots. If smooth, it is formless damp-heat with deficient Middle Qi, strictly forbidding previous methods. If yellow coating is thick and dry, Qingpi (Aurantii Fructus Immaturus) etc. must not be used randomly to avoid confusion. If yellow coating is not thick but slippery, Heat has not damaged Jin-Ye, still can clear Heat and vent exterior. If thin but dry, pathogen is gone but Jin-Ye is damaged, heavy bitter drugs must not be used again.
Again discussing heat transmitting to Ying level, tongue color must be crimson (Jiang). Jiang is deep red. Upon initial transmission, crimson color mixed with yellow-white indicates remaining pathogen in Qi level, must drain Qi pathogen. If tongue is crimson with dry center, Heart-Stomach Fire blazing, depleting Jin-Ye, Huanglian (Coptidis Rhizoma) and Shigao (Gypsum Fibrosum) can be added. If irritability, thirst, and heat with dry tongue center and fluid deficiency, add Yin-nourishing and heat-clearing drugs.
Again heat transmitting to Ying-Blood, if the person has old blood stasis in chest-diaphragm, combining with heat, tongue color must be purple and dark, moist to touch, should add blood-invigorating and stasis-resolving drugs. Symptoms seem like blood stasis obstruction, must clear Ying and cool Blood.
If only the tongue center is crimson and dry, this is Stomach Heat scorching Heart Ying, should add Heart-clearing drugs to Stomach-clearing formulas. Otherwise spreading to tip causes fluid dryness and fire excess. Tip crimson and dry alone indicates Heart Fire flaming upward, use Daochi San (Guide Out Redness Powder) to drain the Fu organ.
Again white coating thick and dry indicates Stomach dryness and Qi injury, add Gancao (Glycyrrhizae Radix et Rhizoma) to Kidney-nourishing drugs to mean "sweet retains and fluids return". White coating thin indicates exterior Cold-Wind pathogen, use acrid-warm exterior-releasing drugs. If stagnation transforms to heat, drugs change with symptoms. Xuanfuhua (Inulae Flos) and Daizheshi (Haematitum) must not be used randomly to reverse Qi mechanism.
Again white coating sticky and greasy, spitting turbid thick saliva, mouth tastes sweet, is Pi-Dan (Spleen Prolusion) disease, damp-heat gathering combing with grain Qi, earth-dampness-turbidity stagnating, must urgently open and drain; otherwise closing middle jiao prevents exit from Mu Yuan (Source of Malaria).
If no coating but smoke-black faintly visible, no thirst, cold limbs, indicates accompanying Yin disease. If thirsty and irritable-hot, it is usual Stomach dry tongue, must not purge. If black and slippery tongue, Water overcoming Fire is Yin syndrome, must warm. If short and contracted, Kidney Qi exhaustion, difficult to treat; to save, add Ren Shen (Ginseng Radix) etc. If dry water exhaustion, urgently purge with salty-bitter drugs.
Light red colorless tongue, or dry and dull, indicates Stomach Jin-Ye injury and Qi failing to transform fluid, use Zhi Gancao Tang (Honey-Fried Licorice Decoction), must not use cold-cooling drugs.
If white powder-like slippery tongue with purple-crimson edges, warm epidemic disease just entered Mu Yuan, not yet returned to Stomach Fu, urgently vent and resolve, do not wait for transmission collapse. Large purple spots indicate Stomach Heat. Black spots bright indicate Heat excess toxin abundance, although untreatable, if person has sufficient Blood-Qi, following method may save; if black and dull, death is certain. If black faintly with red surroundings, Fire depression internal伏, large use cooling and venting, occasionally turning red saves. If spots mixed with macules, all pathogen differences, drain according to部位. Spots belong to Blood mostly, macules to Qi not few. Spots and macules are pathogen appearing outward, eruption should bring clear spirit, meaning exterior resolved interior harmonized; if spots/macules erupt with coma, Zheng fails to overcome pathogen, interior collapse, or Stomach fluid depletion.
Another type of Bai Bao (White Papules), small grains like crystal color, damp-heat injuring Lung, pathogen out but Qi-fluid exhausted, must get sweet drugs to tonify. Or not yet Qi-fluid exhaustion, also need protection.
Again warm-heat diseases, after examining tongue, must also inspect teeth. Teeth are remainder of Kidney, gums are network of Stomach. Heat pathogen not drying Stomach Jin-Ye, must consume Kidney fluid. If teeth shiny dry like stone, Stomach Heat excess, if no sweat aversion to cold, Wei excess, acrid-cool draining Stomach and venting sweat is key. If like dried bone color, Kidney Yin exhaustion, difficult to treat. Not Stomach deficiency, but Kidney water exhaustion.
If tooth tartar like gray cake, Stomach Qi powerless, Jin-Ye lost, damp-turbidity dominant, mostly death. Initial illness gum bleeding clear blood, painful, Stomach Fire rushing, use Yunnv Jian (Lady of the Jade Vessel Decoction) modified.
Again women suffering warm diseases same as men; but more often before/after pregnancy, and during menstruation onset/cessation. Generally before pregnancy diseases, ancients used Siwu Tang (Four Substances Decoction) modified to protect, solidifying fetal root, removing pathogen, treating both root and branch. If receiving pathogen, i.e., Tao's saying "before pregnancy clear heat and calm fetus" etc. If accompanying cold add Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus). Stomach excess, abdominal fullness, side-lying discomfort, i.e., Tao's saying "after pregnancy greatly tonify Blood-Qi" etc. This formula