问病不答，必系耳聋。即当询之，是素聋否？不则病久，或经汗下，过伤元气。问而懒答，唯点头
者，是中气虚。昏愦不知，问是暴厥，抑是久病。妇女僵厥，多是中气，须问怒否。妇人凡病，当问
月水，或前或后。师尼寡妇，气血凝滞，两尺多滑，不可言胎，室女亦同。心腹胀痛，须问旧新。产
后须问，坐草难易，恶露多少，饮食迟早，生子存亡，饮食失节。若问病处，按之而痛止者为虚。
按之而痛甚者为实。痛而不易，知为死血。痛无定者，知其为气。凡问百病，昼则增剧，夜则安
静，气病血否；夜则增剧，昼则安静，血病气否。昼热夜静，阳气独旺，入于阳分；昼静夜热，阳气
下陷，入于阴中。昼夜俱热，重阳无阴，亟泻其阳，而补其阴；昼夜俱寒，重阴无阳，亟泻其阴，而
补其阳。四肢作痛，天阴转甚，必问以前，患霉疮否？
张三锡曰∶“《金镜录》载三十六舌，辨伤寒之深浅吉凶，可称详备。然细讨究，不过阴阳、表
里、寒热、虚实而已。”陶节庵曰∶“伤寒邪在表，则舌无胎。热邪在表，则胎渐生，自白而黄，黄而
黑，甚则黑裂矣。黑胎多凶。若根黑或中黑或尖黑，或属里热，全黑则热极而难治。常见白胎
燥渴，虚而微热，或不得汗，或胃中少有饮而不行，宜温解。”
白滑胎 虚寒冒寒，阳气不振，宜温。
白胎起芒刺 津液不足，胃中有物，宜运动。
黄胎 微热，热渐入里，或燥渴之象，宜清解。
灰色胎 胃中有物，中气虚热，渴而不能消饮者，宜温解。
黑色胎 热入里实燥浓者，宜下。滑润者，水困火，宜温。虽黑而润，所谓水极似火也，不燥为异。
凡伤寒辨舌者，以舌属心而主火，寒为水也。水寒凌火，外感挟内伤，宿食重而结于心下者，
五六日舌渐黄，或中干而边润，名中焙舌。此则里热尚浅。若全干，无论黄黑，皆属里证，分轻
重下之。若曾经下或屡下不减，乃宿滞结于中宫也。询其脉之虚实，及中气何如。实者润而
下之。虚人神气不足，当生津固中气，有用生脉散对解毒汤而愈者，有用附子理中汤冷服
而愈者。一则阴极似阳，一则阳极似阴，不可不辨。
白胎属寒，外证烦躁，欲坐卧于泥水中，乃阴寒逼其无根失守之火而然。脉大不鼓，当从阴
证治。若不大躁，呕吐者，从食阴治之。
产后辨舌者，以心主血也。经云∶“少阴气绝，则血不行。”故舌紫黑者，为血先死。
凡见黑舌，要问曾食酸甜咸物否？能染成黑色。凡视舌色，虽有成见，亦必细审兼证，及脉之
虚实。不尔，恐有毫厘千里之谬。
问病时患者不回答，一定是因为耳聋。此时应当询问：这是素来就聋，还是因病久了，或者经过发汗、攻下等治疗，过度损伤了元气？如果询问后懒得回答，只是点头示意，这是中气虚。如果神志昏乱糊涂，需要分辨是突然发生的厥证，还是久病所致。妇女出现僵直厥逆，多与中气有关，必须询问是否因愤怒引起。妇女无论患什么病，都应当询问月经情况，看月经是提前还是推后。对于尼姑、寡妇等人群，气血凝滞，两尺脉多呈滑象，不能断言为怀孕，未婚少女也是如此。心腹胀痛，必须询问是旧疾还是新病。产后必须询问分娩难易、恶露多少、饮食早晚、胎儿存活与否以及饮食是否失节。如果询问病痛部位，按压后疼痛停止的属于虚证；按压后疼痛加剧的属于实证。疼痛固定不移的，知道是瘀血；疼痛无定处的，知道是气滞。凡是询问各种疾病，白天加重夜间安静的，是气病而非血病；夜间加重白天安静的，是血病而非气病。白天发热夜间安静，是阳气独旺，进入阳分；白天安静夜间发热，是阳气下陷，进入阴中。昼夜都发热，是重阳无阴，急需泻其阳而补其阴；昼夜都寒冷，是重阴无阳，急需泻其阴而补其阳。四肢作痛，阴天加重，必须询问以前是否患过梅毒（霉疮）？
张三锡说：“《金镜录》记载了三十六种舌象，用来辨别伤寒病的深浅和吉凶，可以说详尽完备。然而仔细探讨研究，不过是阴阳、表里、寒热、虚实这几种辨证罢了。”陶节庵说：“伤寒邪气在表，则舌上没有苔。热邪在表，则舌苔逐渐生成，由白变黄，由黄变黑，严重时甚至黑裂。黑苔大多凶险。如果根部黑或中部黑或尖端黑，可能属于里热，全黑则是热极而难治。常见白苔干燥口渴，是虚而微热，或者不得汗出，或者胃中有水饮停滞不行，适宜用温法解表。”
白滑苔：虚寒冒受寒邪，阳气不振，适宜温法。
白苔起芒刺：津液不足，胃中有积滞，适宜运动脾胃（消导）。
黄苔：微热，热邪渐入里，或者是燥渴的现象，适宜清解。
灰苔：胃中有积滞，中气虚热，口渴但不能消受饮水，适宜温解。
黑苔：热邪入里，实热燥结浓重的，适宜攻下。滑润的，是水困火，适宜温法。虽然黑但润泽，这就是所谓“水极似火”，不干燥是其特征。
凡是伤寒辨舌，因为舌属心而主火，寒属水。水寒凌犯心火，外感挟带内伤，宿食沉重结于心下的，五六天后舌苔渐渐变黄，或者中间干而边缘润，名叫中焙舌。这属于里热尚浅。如果全干，无论黄苔黑苔，都属于里证，根据轻重程度攻下。如果曾经攻下或者多次攻下舌苔不减，那是宿滞结在中焦。询问其脉象的虚实，以及中气的状况。实证者润下攻之。虚人神气不足，应当生津固护中气，有用生脉散配合解毒汤治愈的，有用附子理中汤冷服治愈的。一个是阴极似阳，一个是阳极似阴，不可不辨别。
白苔属寒，外证烦躁，想要坐卧在泥水中，这是阴寒逼迫无根失守之火所致。脉大但不鼓指，应当从阴证治疗。如果不那么躁动，呕吐的，从食积阴证治疗。
产后辨舌，因为心主血。经云：“少阴气绝，则血不行。”所以舌色紫黑的，是血先死的表现。
凡是见到黑舌，要问是否吃过酸、甜、咸的食物？能染成黑色。凡是观察舌色，虽然有成见，也必须仔细审查兼证，以及脉象的虚实。不然，恐怕会有毫厘千里的大错。
When asking about the illness and the patient does not answer, it must be due to deafness. At this time, one should inquire: Is this congenital deafness, or has it been long-standing due to the illness, or has excessive damage occurred to Yuan Qi (Original Qi) after sweating or purging treatments? If the patient is reluctant to answer upon inquiry and merely nods, this indicates deficiency of Middle Qi (Middle Jiao Qi). If the patient is confused and unaware, one must distinguish whether it is a sudden Jue syndrome (syncope/collapse) or a result of chronic illness. In women presenting with stiff collapse, it is mostly related to Middle Qi, so one must ask if anger was involved. For any illness in women, one must inquire about menstruation, specifically whether it is early or late. For nuns, widows, etc., where Qi and Blood are stagnant, the two Chi pulses are often slippery; pregnancy should not be diagnosed based on this alone, and the same applies to unmarried girls. For abdominal distension and pain, one must ask if it is an old ailment or a new onset. After childbirth, one must ask about the ease or difficulty of labor, the amount of lochia, timing of diet intake, survival of the infant, and dietary irregularities. When asking about the site of pain, if pressing stops the pain, it is a deficiency pattern; if pressing exacerbates the pain, it is an excess pattern. Pain that is fixed indicates blood stasis; pain that moves without location indicates Qi stagnation. Generally, for various illnesses, if symptoms worsen during the day and are quiet at night, it is a Qi disease rather than Blood disease; if they worsen at night and are quiet during the day, it is a Blood disease rather than Qi disease. Fever during the day and quiet at night indicates Yang Qi is exclusively flourishing and entering the Yang aspect; quiet during the day and fever at night indicates Yang Qi has sunk and entered the Yin aspect. Fever both day and night indicates extreme Yang without Yin, requiring urgent draining of Yang and tonifying Yin; cold both day and night indicates extreme Yin without Yang, requiring urgent draining of Yin and tonifying Yang. Pain in the four limbs worsening with cloudy weather requires asking if the patient previously suffered from syphilis (Mei Chuang).
Zhang Sanxi said: "The *Jing Jian Lu* records thirty-six tongue appearances to differentiate the depth and prognosis of Shang Han (Cold Damage), which can be called detailed and complete. However, upon careful investigation, it essentially boils down to Yin-Yang, Exterior-Interior, Cold-Heat, and Deficiency-Excess." Tao Jie'an said: "When Shang Han pathogen is in the Exterior, there is no coating on the tongue. When Heat pathogen is in the Exterior, the coating gradually forms, turning from white to yellow, and from yellow to black; severely, it becomes black and cracked. Black coating is mostly ominous. If the root, middle, or tip is black, it may belong to Interior Heat; full blackness indicates extreme heat and is difficult to treat. Commonly, a dry white coating with thirst indicates deficiency with slight heat, or inability to sweat, or slight fluid retention in the Stomach preventing movement; warm resolution is appropriate."
White slippery coating: Deficiency-cold with exposure to cold, Yang Qi is not vigorous; warm method is appropriate.
White coating with prickles: Insufficiency of Body Fluids, accumulation in the Stomach; moving/dispersing method is appropriate.
Yellow coating: Slight heat, heat gradually entering the Interior, or signs of dryness and thirst; clearing and resolving method is appropriate.
Gray coating: Accumulation in the Stomach, deficiency-heat of Middle Qi, thirst but inability to consume fluids; warm resolution is appropriate.
Black coating: Heat entering the Interior with solid, dry, and thick accumulation; purgative method is appropriate. Slippery and moist indicates Water trapping Fire; warm method is appropriate. Although black and moist, this is what is called 'extreme Water resembling Fire'; lack of dryness is its distinguishing feature.
In differentiating tongues in Shang Han, since the tongue belongs to the Heart and governs Fire, and Cold belongs to Water. Water-Cold overwhelming Heart-Fire, external contraction combined with internal injury, where retained food is heavy and knots below the heart, after five or six days the tongue coating gradually turns yellow, or dry in the middle and moist on the edges, named 'Zhong Bei Tongue' (Middle Roasted Tongue). This indicates Interior Heat is still shallow. If fully dry, regardless of yellow or black, it belongs to Interior patterns, treated according to severity with purgatives. If purgatives have been used once or repeatedly without reduction, it is retained stagnation knotting in the Central Palace. Inquire about the Excess/Deficiency of the pulse and the state of Middle Qi. In Excess patterns, use moistening purgatives. In deficient persons with insufficient Shen Qi (Spirit/Energy), one should generate fluids and secure Middle Qi. Some have been cured using Sheng Mai San (Generate the Pulse Powder) combined with Jie Du Tang (Detoxify Poison Decoction), while others have been cured by taking Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) cold. One case represents Extreme Yin resembling Yang, the other Extreme Yang resembling Yin; they must not be confused.
White coating belongs to Cold. With exterior symptoms of irritability, wanting to sit or lie in mud-water, this is caused by Yin-Cold forcing the rootless, unguarded Fire outward. The pulse is large but does not beat strongly against the fingers; treat as a Yin pattern. If not very irritable, with vomiting, treat as Food-Stagnation Yin pattern.
Differentiating tongues postpartum, because the Heart governs Blood. The Classics say: "When Shaoyin Qi perishes, Blood does not flow." Therefore, a purple-black tongue indicates Blood death first.
Whenever seeing a black tongue, ask if the patient has eaten sour, sweet, or salty foods, as these can stain the tongue black. Whenever observing tongue color, even if preconceptions exist, one must carefully examine accompanying symptoms and the Excess/Deficiency of the pulse. Otherwise, there may be an error of miles despite a difference of inches.