虚实不爽，而后补泻无不应；阴阳不谬，而后寒暄无不投。然必脏腑不瘥，而后补泻寒喧悉对其病，以拔
其根而主方无不谛，则就虚实阴阳，以分夫脏腑而定以主方，临症者尤不可混也。而脏腑之分，不越青黄黑白，
主方之配，须合酸苦辛甘。爰按内经分脏别腑，并检成方，酌定主治，条例如下。
一、舌见青色，肝胆病也。（紫色同）不拘所见何症，但看青而舌坚敛苍老，肝胆两经邪气盛也，泻火清
肝饮；青而浮胖娇嫩者，肝胆两经精气虚也，滋水生肝饮；青而干燥者，非胆腑阴虚火郁，即肝脏血虚火旺也，
（但干而不燥者，专责阴虚，如干而且燥，则阴虚而火旺矣。各脏腑仿此）胆腑阴虚者逍遥散，火郁加生地、
薄荷；肝脏血虚者逍遥散，火旺，加丹皮、山栀。
郁是气抑，抑则气不透，不透则热而为火也。第从来俱以郁火属之肝，而余独责之胆者，盖胆属少阳，其
气尚稚，胆为甲木，其质尚嫩，所以最易被抑，一抑则其气闷而不舒矣。若肝则为厥阴，于木
属乙，其气已盛，其质已坚，而其火易动而易旺，一有所触，则即发而不可遏，其发而不可遏者，怒也非郁也。
郁主凝滞于中，而怒则发扬于外者也。本方统治肝胆阴虚，而于胆腑火郁，则加薄荷、生地者，以木喜风摇，
而郁火非生地不能凉也。于肝脏火旺，则加丹皮、山栀者，盖肝血既虚，则肝火易旺，则肝血益虚，自非泻其
火，难以滋其阴，非借屈曲下行以通之，无以泻其火也。惟是血为火迫，变成燥症，则当重加熟地，以润其燥，
丹山两味，固可不必，而亦非宜矣。
青而滑润者，非胆腑气怯，即肝脏气虚也。胆腑气怯者，十味温胆汤，去枳实，加酒煎服，其应更捷。盖
以酒入胆经，而最壮胆气也。
肝脏气弱者，当归建中汤去胶饴。
建中之所以异于桂枝者，在加胶饴一味耳。今恐甘先入脾，而去胶饴，则仍与桂枝无别。故用当归建中，
则与肝脏气虚乃合。
如干燥而形色反见胖嫩者，肝胆阴阳两虚也。七味饮倍肉桂，滑润而形色不兼胖嫩者，肝胆木气虚寒也，
养荣汤加枸杞。
凡左关脉细紧如刀口者，其舌不拘何色，必胖而滑；其病不拘何症，心虚而寒。予每投以养荣，无不立应。
临症者切勿畏之，重生者切勿疑之。
一、舌见黄色，脾胃病也。不拘所见何症，但看黄而坚敛苍老者，脾胃两经邪气盛也，泻黄散。
如有浓苔，或焦黄、或焦黑，而糙刺燥裂，其症痞满燥实坚敛悉具者，实症也。须急下之，以存津液，
大承气汤主之。但此是真正阳明里症，北方伤寒，间或有此。然舌若胖大，即在北方，亦非承气的症，切不可
妄用硝黄，杀人于顷刻也。
黄而浮胖娇嫩者，脾胃两经精气虚也，益黄散。黄而干燥
者，非胃腑阴亏火旺，即脾脏血虚火盛也。胃腑阴亏者，左归饮去茯苓；火旺加花粉、归、地；脾脏血虚者，
归脾汤去木香；火盛加白芍、丹、山。
如干燥而有浓苔者，宿食滞于肠胃，而燥结不出也。其脉必牢实，神思必昏沉，面必拥热通红，鼻必气粗，
胸前按之必微痛，须逍遥散倍加熟地，润而下之。
黄而滑润者，非胃气虚弱，即脾气亏损也。胃气虚弱者，七味白术散加半夏，脾气亏损者，五味异功散
加白芍。
如其舌后半截滑腻而有微苔者，乃脾胃虚气下陷也，须补中益气汤。
如干燥而形色反见胖嫩者，脾胃气血两虚也，参 八珍汤。滑润而形色又兼胖嫩者，脾胃中气虚寒也，姜
桂养荣汤。
一、舌见赤色，心与小肠病也。不拘所见何症，但看赤而坚敛苍老者，心与小肠邪气盛也，泻心汤。
按四明心法∶凡舌见灰色，指甲刮下无渣汁者，方是火症，乃芩连之对症也。味其语意，可见阳邪燔灼，
则其阴液未有不干枯者。然以予验之，又必其形坚敛、其色苍老，方是真正芩连对症。若一见胖嫩，即使苔浓
而焦干燥裂，非寒水侮土，即肾气凌心。寒水凌土，当用附子理中；肾气凌心，当用人参八味。倘误用芩连，
则舌上现出人字纹必死。予诊莘墅沈彝仲症，辞以不治者，因其得此舌也，有论验在医案中可参。又按火色本
红，火症而舌见灰色者，如炭火通红于内，而浮灰翳蔽于外也。顾据理论之，则舌见灰色，其症当更甚于舌黑
如炭何也，盖火燃薪尽，则是木成炭，是草成灰，故曰炭曰灰，皆火极之变象也。而木本质坚，甫着火燃，未
成炭也。必火极似水，乃变黑而为炭，然其性犹甚烈也。至于久经火 ，则热极必寒，乃返白而成灰，然其心
犹未灰也。若草本则其体弱，着火一过，即灰矣。一灰即不可复燃矣。然则就物理以察病机，彼见舌灰
色者，无论一火即灰，与由炭而灰，不皆更甚于舌黑如炭者乎？
赤而浮胖矫嫩者，心与小肠精气虚也，养心汤。赤而干燥者，非小肠阴亏火旺，即心脏血虚火盛也。小肠
阴亏者，滋水清肝饮去柴胡。
欲润其下，不欲其就燥也。
火旺加生地、木通。
合导赤散以泻其火气。
心脏血虚者，济生归脾汤去木香。
恐其血燥，反动肝火而燥血液。火盛加丹皮、山栀。
凡本经之阴血既亏，则本经之阳火必旺，一负则一胜也。加丹皮、山栀者，欲其引心火下行，以直达于膀胱耳。
赤而滑润者，非小肠阳虚气坠，即心脏阳虚气弱也。小肠阳虚气坠者，补中益气汤加山栀、川乌。
气虚则滞，气滞则坠，方中参、 、术、草，补其虚也；川乌、陈皮，破其滞也；升麻、柴胡，举其坠也。
加山栀，借其屈曲下行，以引至小肠耳。
心脏阳虚气弱者，嘘血归脾汤加丹皮、肉桂。
气有余便是火，气不足便是寒，本方加肉桂复加丹皮，欲其引入心经以补心气也。
如干燥而形色反见胖嫩者，心与小肠气血两虚也，枣仁养营汤。滑润而形色又见胖嫩者，心与小肠火气大
亏也，附子养营汤。
一、舌见白色，肺与大肠病也。不拘所见何症，但看白而坚敛苍老者，肺与大肠邪气盛也，泻白散。白
而浮胖娇嫩者，肺与大肠精气虚也，补肺汤。白而干燥者，非大肠血虚火盛，
即肺脏阴虚火盛也。大肠血虚者，润肠滋水饮，火盛加生地、当归。
凡大便燥结，努力责不出者，本方神应。
如兼气虚而推送无力者，间以补中，或竟用八珍汤加桃仁、杏仁，养气补阴，亦无不应。
肺脏阴虚者，生金滋水饮，火燥加百合、沙参。白而滑润者，非大肠阳虚气陷，即肺脏阳虚气弱也。大
肠阳虚气陷者，补中益气汤送固肠散。
大肠小肠俱属下焦之腑，何以亦配中脏之方？则以肠胃相连，其气本一贯也。
肺脏阳虚气弱者，补中益气汤合参附汤。如干燥而形色反见胖嫩者，肺与大肠气血两虚也，十全大补汤去
肉桂，加炮姜。滑润而形色又见兼胖嫩者，肺与大肠金气虚寒也，参附养荣汤去茯苓，加炮姜。
一、舌见黑色，肾与膀胱病也。（命门水火附，左右两肾同治）不拘所见何症，但看黑而坚敛苍老者，肾
与膀胱邪气盛也，清肝饮。黑而浮胖娇嫩者，肾与膀胱精神虚也，补元煎。黑而干燥者，非膀胱阴虚火盛，即
左肾阴虚火旺也。膀胱阴虚者，六味饮，火盛合滋肾丸。左肾阴虚者，六味饮，火旺合生脉散。黑而滑润者，
非膀胱阴盛火衰，即右肾阳虚火亏也，膀胱阴盛火衰者，金匮肾气丸。
膀胱为州都之官，主藏津液，而其所以能出者，由气化也。阴虚火旺，则热逼膀胱，而气不能化矣；阴盛
火衰，则寒逼膀胱，而气不能化矣。膀胱不利为癃，除脾肺气虚，不能通调水道外，大率不出此两者也。然同
一三阳癃闭，而一由火旺，一系火亏。病判天渊，治分冰炭。相反若此，可类推之。
右肾阳虚火亏者，八味地黄丸。如干燥而形色反见胖嫩者，肾与膀胱阴阳俱虚也。枸杞养荣汤主之，继用
十全大补汤作丸。
更有由白而黄，由黄而焦，而枯黑燥裂，其舌边胖大，舌底滑润者，甚有舌底亦燥而绝无津液，其糙刺
如沙皮，敛束如荔子者。皆因劳伤脾肺，气虚发热，误用发散，益虚益热，复用寒凉，重阴内逼，以致虚火上
炎。所以白上加黄，黄上加焦，而枯黑燥裂也。不论其脉，不论其症，大剂参附养荣汤，不时灌服，多有得生
者。余救乌程潘中建之弟、归安张学海、桐乡诸圣济等症，皆此舌也，有治验在医案可参。
滑润而形色又兼气嫩者，肾与膀胱元气大惫也，附子养荣汤主之，继用右归丸。
更有其舌同一黑色，而一属寒水侮土者，宜用附子理中汤；一系肾气凌心者，宜用人参八味。其治有不相
同何也？盖寒水侮土者，系阴盛于内，逼阳于外，外假热而内真寒，格阳症也，其黑色止聚于舌中。肾气凌心
者，系阴盛于下，逼阳于上，上假热而下真寒，戴阳症也，其黑色直底于舌尖。然未有不胖且嫩者，干燥滑润，
又在所不拘也。惟是实火两症，则其形必坚敛、色必苍老，而万无胖嫩者耳。
虚实辨证无误，补泻治疗才能无不应验；阴阳判断准确，寒热用药才能无不恰当。然而必须脏腑定位无误，补泻寒热才能完全对症，从而拔除病根，主方才能确切无误。因此，根据虚实阴阳来区分脏腑，并确定主方，临证时尤其不可混淆。而脏腑的区分，不出青、黄、白、黑四种舌色；主方的配伍，须符合酸、苦、辛、甘五味。于是依据《内经》分脏别腑的理论，并查阅成方，斟酌制定主治方法，条例如下。
一、舌见青色，是肝胆的病。（紫色同理）不论出现什么症状，只要看舌质青且坚敛苍老，这是肝胆两经邪气盛实，用泻火清肝饮；舌质青且浮胖娇嫩，这是肝胆两经精气虚衰，用滋水生肝饮；舌质青且干燥，这不是胆腑阴虚火郁，就是肝脏血虚火旺。（只是干而不燥的，专责阴虚；如果干而且燥，则是阴虚而火旺。各脏腑仿照此理推断。）胆腑阴虚者用逍遥散，火郁加生地、薄荷；肝脏血虚者用逍遥散，火旺加丹皮、山栀。
“郁”是气机被抑制，抑制则气不通畅，不通畅则郁热化为火。向来都认为郁火属于肝，而我唯独归责于胆，因为胆属少阳，其气尚稚嫩，胆为甲木，其质地尚嫩，所以最容易被抑制，一旦受抑，其气就会闷塞而不舒畅。若肝则为厥阴，在五行中属乙木，其气已盛，其质已坚，而其火易动而易旺，稍有触动，就会发作而不可遏制，那种发作而不可遏制的，是“怒”而不是“郁”。郁主要导致气机凝滞于内，而怒则是气机发扬于外。本方（逍遥散）统管肝胆阴虚，而对于胆腑火郁，加薄荷、生地的原因，是因为木性喜欢风摇（疏散），而郁火非生地不能清凉。对于肝脏火旺，加丹皮、山栀的原因，是因为肝血既已虚，则肝火易旺，肝血会更虚，如果不泻其火，难以滋养其阴；不借助屈曲下行之法以通泄，就无法泻其火。只是如果血被火逼迫，变成燥症，就应当重加熟地，以润其燥，丹皮、山栀两味药固然可以不用，也不适宜使用了。
舌质青而滑润，不是胆腑气怯，就是肝脏气虚。胆腑气怯者，用十味温胆汤，去掉枳实，加酒煎服，疗效更快。因为酒入胆经，最能壮胆气。
肝脏气弱者，用当归建中汤，去掉胶饴。
建中汤之所以不同于桂枝汤，在于多加了胶饴一味药。现在担心甘味先入脾，而去掉胶饴，那就与桂枝汤没有区别了。所以用当归建中汤，才与肝脏气虚相合。
如果舌干燥但形色反而见胖嫩，这是肝胆阴阳两虚，用七味饮倍加肉桂；舌滑润但形色不兼见胖嫩，这是肝胆木气虚寒，用养荣汤加枸杞。
凡是左关脉细紧如刀口，其舌不论什么颜色，必定胖而滑；其病不论什么症状，都是心虚而寒。我每次投以养荣汤，无不立即见效。临证者切勿畏惧，惜命者切勿怀疑。
一、舌见黄色，是脾胃的病。不论出现什么症状，只要看舌黄且坚敛苍老，这是脾胃两经邪气盛实，用泻黄散。
如果有厚苔，或焦黄、或焦黑，且粗糙起刺、干燥开裂，症状具备痞、满、燥、实、坚、敛全部特征，这是实证。必须急下，以保存津液，以大承气汤为主治。但这必须是真正的阳明里证，北方伤寒间或有此情况。然而如果舌体胖大，即使在北方，也不是承气汤的适应证，切不可妄用硝石、大黄，顷刻间就会杀人。
舌黄而浮胖娇嫩，这是脾胃两经精气虚衰，用益黄散。舌黄而干燥，不是胃腑阴亏火旺，就是脾脏血虚火盛。胃腑阴亏者，用左归饮去茯苓；火旺加花粉、当归、地黄；脾脏血虚者，用归脾汤去木香；火盛加白芍、丹皮、山栀。
如果干燥而有厚苔，是宿食停滞于肠胃，燥结排不出来。其脉必牢实，神思必昏沉，面色必拥热通红，鼻息必气粗，胸前按压必微痛，须用逍遥散倍加熟地，润肠而下之。
舌黄而滑润，不是胃气虚弱，就是脾气亏损。胃气虚弱者，用七味白术散加半夏；脾气亏损者，用五味异功散加白芍。
如果舌后半截滑腻而有微苔，这是脾胃虚气下陷，须用补中益气汤。
如果干燥但形色反见胖嫩，这是脾胃气血两虚，用人参八珍汤。滑润且形色又兼见胖嫩，这是脾胃中气虚寒，用姜桂养荣汤。
一、舌见赤色，是心与小肠的病。不论出现什么症状，只要看舌赤且坚敛苍老，这是心与小肠邪气盛实，用泻心汤。
按《四明心法》所说：凡舌见灰色，指甲刮下无渣汁的，才是火症，这才是黄芩、黄连的对症药。体味其语意，可见阳邪燔灼，那么其阴液没有不干枯的。然而据我验证，又必须其形坚敛、其色苍老，才是真正的黄芩、黄连对症。如果一见胖嫩，即使苔浓而焦干燥裂，不是寒水侮土，就是肾气凌心。寒水侮土，当用附子理中汤；肾气凌心，当用人参八味丸。倘若误用黄芩、黄连，则舌上出现人字纹必死无疑。我曾诊治莘墅沈彝仲的病，断言不治，就是因为得了这种舌象，有论证实录在医案中可参考。又按火色本红，火症而舌见灰色的，如同炭火在内通红，而浮灰遮蔽在外。但从理论上看，舌见灰色，病情应当比舌黑如炭更严重才对。因为火燃尽柴薪，木就成了炭，草就成了灰，所以说炭说灰，都是火极变的征象。而木本质坚硬，刚着火燃烧，还没变成炭。必须火极似水，才变黑而为炭，但其性质仍然很猛烈。至于久经火烧，则热极必寒，便返白而成灰，但其中心还未全灰。若草本则其体弱，着火一过，即成灰了。一成为灰就不可复燃了。那么从物理规律考察病机，那些见到舌灰色的，无论是一火即灰，还是由炭变灰，不都比舌黑如炭更严重吗？
舌赤而浮胖娇嫩，这是心与小肠精气虚衰，用养心汤。舌赤而干燥，不是小肠阴亏火旺，就是心脏血虚火盛。小肠阴亏者，用滋水清肝饮去柴胡。
想要滋润下部，不希望其就燥。
火旺加生地、木通。
合导赤散以泻其火气。
心脏血虚者，用济生归脾汤去木香。
恐怕其血燥，反动肝火而燥血液。火盛加丹皮、山栀。
凡是本经的阴血既已亏虚，则本经的阳火必旺，一负则一胜。加丹皮、山栀的原因，是想引导心火下行，直达膀胱。
舌赤而滑润，不是小肠阳虚气坠，就是心脏阳虚气弱。小肠阳虚气坠者，用补中益气汤加山栀、川乌。
气虚则滞，气滞则坠，方中人参、黄芪、白术、甘草，补其虚；川乌、陈皮，破其滞；升麻、柴胡，举其坠。加山栀，借其屈曲下行，以引至小肠。
心脏阳虚气弱者，用嘘血归脾汤加丹皮、肉桂。
气有余便是火，气不足便是寒，本方加肉桂再加丹皮，是想引入心经以补心气。
如果干燥但形色反见胖嫩，这是心与小肠气血两虚，用枣仁养营汤。滑润且形色又见胖嫩，这是心与小肠火气大亏，用附子养营汤。
一、舌见白色，是肺与大肠的病。不论出现什么症状，只要看舌白且坚敛苍老，这是肺与大肠邪气盛实，用泻白散。舌白而浮胖娇嫩，这是肺与大肠精气虚衰，用补肺汤。舌白而干燥，不是大肠血虚火盛，就是肺脏阴虚火盛。大肠血虚者，用润肠滋水饮，火盛加生地、当归。
凡是大便燥结，努力排便却排不出的，本方神效。
如果兼有气虚而推送无力者，间歇使用补中益气汤，或者竟用八珍汤加桃仁、杏仁，养气补阴，也无不奏效。
肺脏阴虚者，用生金滋水饮，火燥加百合、沙参。舌白而滑润，不是大肠阳虚气陷，就是肺脏阳虚气弱。大肠阳虚气陷者，用补中益气汤送服固肠散。
大肠小肠都属下焦之腑，为什么也配伍中脏的方剂？因为肠胃相连，其气本是一贯的。
肺脏阳虚气弱者，用补中益气汤合参附汤。如果干燥但形色反见胖嫩，这是肺与大肠气血两虚，用十全大补汤去肉桂，加炮姜。滑润且形色又兼见胖嫩，这是肺与大肠金气虚寒，用参附养荣汤去茯苓，加炮姜。
一、舌见黑色，是肾与膀胱的病。（命门水火附着，左右两肾同治）不论出现什么症状，只要看舌黑且坚敛苍老，这是肾与膀胱邪气盛实，用清肝饮。舌黑而浮胖娇嫩，这是肾与膀胱精神虚衰，用补元煎。舌黑而干燥，不是膀胱阴虚火盛，就是左肾阴虚火旺。膀胱阴虚者，用六味饮，火盛合滋肾丸。左肾阴虚者，用六味饮，火旺合生脉散。舌黑而滑润，不是膀胱阴盛火衰，就是右肾阳虚火亏。膀胱阴盛火衰者，用金匮肾气丸。
膀胱是州都之官，主藏津液，而其所以能排出，靠的是气化。阴虚火旺，则热逼膀胱，气不能化；阴盛火衰，则寒逼膀胱，气不能化。膀胱不利称为癃闭，除了脾肺气虚，不能通调水道外，大体不出这两种情况。然而同样是三阳癃闭，一种由火旺引起，一种由火亏引起。病情判若天渊，治疗分为冰炭。相反如此，可类推其他情况。
右肾阳虚火亏者，用八味地黄丸。如果干燥但形色反见胖嫩，这是肾与膀胱阴阳俱虚，用枸杞养荣汤主治，继用十全大补汤作丸。
更有由白转黄，由黄转焦，进而枯黑燥裂，其舌边胖大，舌底滑润的，甚至有舌底也燥而绝无津液，其粗糙起刺如沙皮，收敛束紧如荔枝核的。这都是因为劳伤脾肺，气虚发热，误用发散药，越虚越热，复用寒凉药，重阴内逼，以致虚火上炎。所以白上加黄，黄上加焦，进而枯黑燥裂。不论其脉，不论其症，大剂量服用参附养荣汤，不时灌服，多有得救活的人。我曾救治乌程潘中建之弟、归安张学海、桐乡诸圣济等病例，都是这种舌象，有治疗实录在医案中可参考。
滑润且形色又兼见娇嫩的，这是肾与膀胱元气大惫，用附子养荣汤主治，继用右归丸。
更有其舌同为黑色，一种属于寒水侮土的，宜用附子理中汤；一种属于肾气凌心的，宜用人参八味丸。其治疗为何不同呢？因为寒水侮土者，是阴盛于内，逼阳于外，外假热而内真寒，是格阳证，其黑色只聚集在舌中。肾气凌心者，是阴盛于下，逼阳于上，上假热而下真寒，是戴阳证，其黑色直抵舌尖。然而这些舌象没有不胖且嫩的，干燥或滑润，又在所不论了。只有实火两种证候，其形必定坚敛、色必定苍老，而万不会有胖嫩的。
Without error in distinguishing deficiency and excess (Deficiency and Excess), tonification and purgation will invariably be effective; without error in distinguishing Yin and Yang, cold and hot treatments will invariably be appropriate. However, only when the Zang-Fu organs are correctly identified can tonification, purgation, cold, and heat therapies precisely target the disease, thereby eliminating its root cause, ensuring the principal prescription is accurate. Therefore, based on deficiency/excess and Yin/Yang to differentiate Zang-Fu organs and determine the principal prescription, clinicians must not confuse these distinctions. The differentiation of Zang-Fu organs does not exceed the tongue colors of green, yellow, white, and black; the matching of principal prescriptions must conform to the flavors sour, bitter, pungent, and sweet. Thus, following the *Neijing*’s classification of Zang and Fu organs, and consulting established formulas, I have deliberated and determined the governing methods as follows.
1. A green tongue indicates a Liver-Gallbladder disorder. (Purple is similar.) Regardless of the symptoms presented, if the tongue is green and firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in the Liver and Gallbladder meridians; treat with Xiehuo Qinggan Yin (Fire-Draining Liver-Clearing Decoction). If the tongue is green, floating, swollen, tender, and delicate, it indicates deficiency of Essence and Qi in the Liver and Gallbladder meridians; treat with Zishui Shengan Yin (Nourishing Water and Nourishing Liver Decoction). If the tongue is green and dry, it indicates either Yin deficiency with Fire stagnation in the Gallbladder Fu organ, or Blood deficiency with vigorous Fire in the Liver Zang organ. (If merely dry but not parched, it specifically points to Yin deficiency; if dry and parched, it indicates Yin deficiency with vigorous Fire. Apply this logic to other Zang-Fu organs.) For Gallbladder Fu Yin deficiency, use Xiaoyao San (Free Wanderer Powder); for Fire stagnation, add Shengdi Huang (Rehmanniae Radix Preparata) and Bo He (Menthae Haplocalycis Herba). For Liver Zang Blood deficiency, use Xiaoyao San; for vigorous Fire, add Mudan Pi (Moutan Cortex) and Shan Zhi (Gardeniae Fructus).
"Yu" (Stagnation) refers to suppressed Qi; suppression leads to obstructed flow, obstruction leads to heat transforming into Fire. Traditionally, Yu-Huo (Stagnant Fire) has always been attributed to the Liver, but I exclusively attribute it to the Gallbladder because the Gallbladder belongs to Shaoyang (Lesser Yang), its Qi is still immature, and as Jia Wood, its substance is tender, making it most susceptible to suppression. Once suppressed, its Qi becomes stifled and unsmooth. In contrast, the Liver belongs to Jueyin (Terminal Yin) and Yi Wood; its Qi is already abundant, its substance firm, and its Fire easily moves and becomes vigorous. Upon any trigger, it erupts uncontrollably; such uncontrollable eruption is "Anger," not "Stagnation." Stagnation primarily causes Qi condensation and stasis internally, whereas Anger causes Qi to expand externally. This formula (Xiaoyao San) generally governs Liver-Gallbladder Yin deficiency. For Gallbladder Fu Fire stagnation, adding Bo He and Shengdi Huang is because Wood delights in wind-like dispersal, and stagnant Fire cannot be cooled without Shengdi Huang. For Liver Fire vigor, adding Mudan Pi and Shan Zhi is because once Liver Blood is deficient, Liver Fire easily becomes vigorous, further depleting Blood; unless the Fire is drained, Yin cannot be nourished; unless one employs a winding downward pathway to unblock it, the Fire cannot be drained. However, if Blood is forced by Fire, transforming into a Dryness syndrome, one should heavily add Shu Di Huang (Prepared Rehmanniae Radix) to moisten the Dryness; in this case, Mudan Pi and Shan Zhi are indeed unnecessary and inappropriate.
A green and slippery/moist tongue indicates either Gallbladder Qi timidity or Liver Qi deficiency. For Gallbladder Qi timidity, use Shiwei Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction), remove Zhi Shi (Aurantii Fructus), and decoct with wine for faster efficacy, as wine enters the Gallbladder meridian and strongly boosts Gallbladder Qi.
For Liver Qi weakness, use Danggui Jianzhong Tang (Angelica Building-the-Middle Decoction), remove Jiaoyi (Maltose).
Jianzhong Tang differs from Guizhi Tang (Cinnamon Twig Decoction) only by the addition of Jiaoyi. Now, fearing that Sweet flavor enters the Spleen first, removing Jiaoyi makes it indistinguishable from Guizhi Tang. Thus, using Danggui Jianzhong Tang aligns with Liver Qi deficiency.
If dry but appearing swollen and tender, it indicates dual deficiency of Liver-Gallbladder Yin and Yang; use Qiwei Yin (Seven-Ingredient Decoction) with doubled Rou Gui (Cinnamomi Cortex). If slippery/moist but not appearing swollen/tender, it indicates deficiency-cold of Liver-Gallbladder Wood Qi; use Yangrong Tang (Nourishing Vigor Decoction) plus Gouqi (Lycii Fructus).
Whenever the Left Guan pulse is fine and tight like a knife edge, regardless of tongue color, it must be swollen and slippery; regardless of symptoms, it indicates Heart deficiency with Cold. I have always used Yangrong Tang with immediate effect. Clinicians must not fear it, and those valuing life must not doubt it.
2. A yellow tongue indicates a Spleen-Stomach disorder. Regardless of symptoms, if the tongue is yellow, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in the Spleen-Stomach meridians; use Xiehuang San (Drain-Yellow Powder).
If there is thick coating, or scorched-yellow/scorched-black, with rough prickles, dryness, and cracking, and symptoms include fullness, blockage, dryness, excess, firmness, and contraction, it is an Excess syndrome. Immediate purgation is required to preserve Body Fluids; Da Chengqi Tang (Major Order the Qi Decoction) is indicated. However, this must be a true Yangming Interior syndrome; Northern Cold Damage cases occasionally present this. Yet, if the tongue is swollen, even in the North, it is not an indication for Chengqi, and one must never recklessly use Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma), which can kill within moments.
Yellow and floating/swollen/tender indicates deficiency of Essence and Qi in Spleen-Stomach meridians; use Yihuang San (Benefit-Yellow Powder). Yellow and dry indicates either Stomach Fu Yin deficiency with vigorous Fire, or Spleen Zang Blood deficiency with excessive Fire. For Stomach Fu Yin deficiency, use Zuogui Yin (Left Return Decoction) removing Fuling (Poria); for vigorous Fire, add Huafen (Trichosanthis Radix), Danggui (Angelicae Sinensis Radix), and Dihuang (Rehmanniae Radix). For Spleen Zang Blood deficiency, use Guipi Tang (Restore the Spleen Decoction) removing Muxiang (Aucklandiae Radix); for excessive Fire, add Baishao (Paeoniae Radix Alba), Mudan Pi, and Shan Zhi.
If dry with thick coating, it indicates retained food stagnating in intestines/stomach with dry accumulation failing to pass. The pulse must be deep and solid, mental state lethargic, face flushed with heat, nasal breathing coarse, and slight pain upon pressing the chest. Use Xiaoyao San with heavily added Shu Di Huang to moisten and purge.
Yellow and slippery/moist indicates either Stomach Qi weakness or Spleen Qi damage. For Stomach Qi weakness, use Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) plus Banxia (Pinelliae Rhizoma); for Spleen Qi damage, use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) plus Baishao.
If the posterior half of the tongue is slippery/greasy with slight coating, it indicates sinking of Spleen-Stomach deficient Qi; use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
If dry but appearing swollen/tender, it indicates dual deficiency of Spleen-Stomach Qi and Blood; use Renshen Bazhen Tang (Ginseng and Eight-Treasure Decoction). If slippery/moist and also swollen/tender, it indicates deficiency-cold of Spleen-Stomach Middle Qi; use Jianggui Yangrong Tang (Ginger-Cinnamon Nourishing Vigor Decoction).
3. A red tongue indicates Heart-Small Intestine disorders. Regardless of symptoms, if the tongue is red, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Heart-Small Intestine; use Xiexin Tang (Drain-Heart Decoction).
According to *Siming Xinfa*: Only when the tongue is gray and scraping with a fingernail yields no residue/juice is it a Fire syndrome, suitable for Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma). Interpreting this, when Yang pathogens scorch, Yin fluids inevitably dry up. However, my verification shows that only when the form is firm/contracted and color aged-looking is it truly suitable for Huangqin/Lianzi. If it appears swollen/tender, even with thick, scorched, dry, cracked coating, it is either Cold Water insulting Earth or Kidney Qi overwhelming the Heart. Cold Water insulting Earth requires Fuzi Lizhong Tang (Aconite Regulate-the-Middle Decoction); Kidney Qi overwhelming the Heart requires Renshen Bawei Wan (Ginseng Eight-Ingredient Pill). Mistakenly using Huangqin/Lianzi will result in a human-character pattern on the tongue, leading to death. I diagnosed Shen Yizhong from Xinshu and declared him untreatable due to this tongue; see medical cases for details. Also, Fire color is originally red; a gray tongue in Fire syndromes is like charcoal glowing red inside covered by floating ash. Theoretically, a gray tongue implies a condition worse than black-as-charcoal tongue. When fire burns fuel to ash, wood becomes charcoal, grass becomes ash; thus charcoal and ash are transformations of extreme Fire. Wood is hard; newly ignited, it hasn't become charcoal yet. Only when Fire is extreme resembling Water does it turn black to charcoal, yet remains fierce. After prolonged burning, extreme Heat turns to Cold, returning to white ash, though the core may not be fully ash. Grass is weak; once burned, it becomes ash immediately, irreversibly. Thus, examining pathology via physics, whether turning to ash instantly or via charcoal, a gray tongue is worse than black-as-charcoal.
Red and floating/swollen/tender indicates deficiency of Essence and Qi in Heart-Small Intestine; use Yangxin Tang (Nourish-Heart Decoction). Red and dry indicates either Small Intestine Yin deficiency with vigorous Fire, or Heart Blood deficiency with excessive Fire. For Small Intestine Yin deficiency, use Zishui Qinggan Yin removing Chaihu (Bupleuri Radix).
To moisten the lower part, avoid dryness.
For vigorous Fire, add Shengdi Huang and Mutong (Akebiae Caulis).
Combine with Daochi San (Guide Out Redness Powder) to drain Fire Qi.
For Heart Blood deficiency, use Jisheng Guipi Tang (Succeeding Generation Restore Spleen Decoction) removing Muxiang.
Fear blood dryness stirring Liver Fire and drying Blood. For excessive Fire, add Mudan Pi and Shan Zhi.
Once the Yin-Blood of the meridian is deficient, the Yang-Fire of the same meridian must be vigorous; one declines, the other prevails. Adding Mudan Pi and Shan Zhi aims to guide Heart Fire downward to reach the Bladder.
Red and slippery/moist indicates either Small Intestine Yang deficiency with Qi sinking, or Heart Yang deficiency with weak Qi. For Small Intestine Yang deficiency with Qi sinking, use Buzhong Yiqi Tang plus Shan Zhi and Chuanwu (Aconiti Lateralis Radix Preparata).
Qi deficiency causes stagnation; stagnation causes sinking. Ginseng, Huangqi, Baizhu, and Gancao in the formula tonify deficiency; Chuanwu and Chenpi break stagnation; Shengma and Chaihu lift sinking. Shan Zhi is added to borrow its winding downward action to guide to the Small Intestine.
For Heart Yang deficiency with weak Qi, use Xuxue Guipi Tang (Whispering Blood Restore Spleen Decoction) plus Mudan Pi and Rou Gui.
Excess Qi is Fire; deficient Qi is Cold. Adding Rou Gui and Mudan Pi to this formula aims to enter the Heart meridian to tonify Heart Qi.
If dry but appearing swollen/tender, it indicates dual deficiency of Heart-Small Intestine Qi and Blood; use Zaoren Yangying Tang (Zizypha Seed Nourishing Vigor Decoction). If slippery/moist and also swollen/tender, it indicates severe depletion of Heart-Small Intestine Fire-Qi; use Fuzi Yangying Tang (Aconite Nourishing Vigor Decoction).
4. A white tongue indicates Lung-Large Intestine disorders. Regardless of symptoms, if the tongue is white, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Lung-Large Intestine; use Xiebai San (Drain-White Powder). White and floating/swollen/tender indicates deficiency of Essence and Qi in Lung-Large Intestine; use Bufei Tang (Tonify-Lung Decoction). White and dry indicates either Large Intestine Blood deficiency with excessive Fire, or Lung Yin deficiency with vigorous Fire. For Large Intestine Blood deficiency, use Runchang Zishui Yin (Moisten-Intestine Nourish-Water Decoction); for excessive Fire, add Shengdi Huang and Danggui.
For dry stool constipation where effort fails to expel, this formula is miraculous.
If accompanied by Qi deficiency and weak propulsion, intermittently use Buzhong, or directly use Bazhen Tang (Eight-Treasure Decoction) plus Taoren (Persicae Semen) and Xingren (Armeniacae Semen Amarum) to nourish Qi and tonify Yin, which will invariably work.
For Lung Yin deficiency, use Shengjin Zishui Yin (Generate-Metal Nourish-Water Decoction); for Fire-Dryness, add Baihe (Lilii Bulbus) and Shashen (Glehniae Radix). White and slippery/moist indicates either Large Intestine Yang deficiency with Qi sinking, or Lung Yang deficiency with weak Qi. For Large Intestine Yang deficiency with Qi sinking, use Buzhong Yiqi Tang administered with Gutang San (Secure-Intestine Powder).
Large and Small Intestines belong to Lower Jiao Fu organs; why match them with Middle Zang formulas? Because intestines and stomach are connected, their Qi is continuous.
For Lung Yang deficiency with weak Qi, use Buzhong Yiqi Tang combined with Shenfu Tang (Ginseng-Aconite Decoction). If dry but appearing swollen/tender, it indicates dual deficiency of Lung-Large Intestine Qi and Blood; use Shiquan Dabu Tang (Ten-Complete Great Tonifying Decoction) removing Rou Gui, adding Paojiang (Prepared Ginger). If slippery/moist and also swollen/tender, it indicates deficiency-cold of Lung-Large Intestine Metal Qi; use Shenfu Yangrong Tang (Ginseng-Aconite Nourishing Vigor Decoction) removing Fuling, adding Paojiang.
5. A black tongue indicates Kidney-Bladder disorders. (Mingmen Water-Fire attaches, treating left/right Kidneys together.) Regardless of symptoms, if the tongue is black, firm, contracted, and aged-looking, it indicates excessive pathogenic Qi in Kidney-Bladder; use Qinggan Yin (Clear-Liver Decoction). Black and floating/swollen/tender indicates deficiency of Spirit-Essence in Kidney-Bladder; use Buyuan Jian (Tonify-Origin Decoction). Black and dry indicates either Bladder Yin deficiency with excessive Fire, or Left Kidney Yin deficiency with vigorous Fire. For Bladder Yin deficiency, use Liuwei Yin (Six-Ingredient Decoction); for excessive Fire, combine with Zishen Wan (Nourish-Kidney Pill). For Left Kidney Yin deficiency, use Liuwei Yin; for vigorous Fire, combine with Shengmai San (Generate-Pulse Powder). Black and slippery/moist indicates either Bladder Yin excess with Fire decline, or Right Kidney Yang deficiency with Fire loss. For Bladder Yin excess with Fire decline, use Jin Kui Shenqi Wan (Golden Cabinet Kidney Qi Pill).
The Bladder is the Official of the Capital, storing Body Fluids; its ability to excrete relies on Qi transformation. Yin deficiency with Fire vigor means Heat forces the Bladder, preventing Qi transformation; Yin excess with Fire decline means Cold forces the Bladder, preventing Qi transformation. Bladder dysfunction termed Long (Retention) excludes Spleen-Lung Qi deficiency failing to regulate water passages, mostly falling into these two categories. Although both are Taiyang Long/Bi, one stems from Fire vigor, the other from Fire loss. The diseases differ like heaven and earth, treatments like ice and charcoal. Such opposites allow analogy.
For Right Kidney Yang deficiency with Fire loss, use Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill). If dry but appearing swollen/tender, it indicates dual deficiency of Kidney-Bladder Yin and Yang; use Gouqi Yangrong Tang (Goji Nourishing Vigor Decoction) as primary, followed by Shiquan Dabu Tang made into pills.
Furthermore, tongues changing from white to yellow, yellow to scorched, then to withered-black and dry-cracked, with swollen edges and slippery base, or even completely dry bases with no fluid, rough as sandpaper, and constricted like lychee seeds. These result from labor injuring Spleen-Lung, Qi deficiency generating Heat, mistaken use of diaphoretics increasing deficiency and heat, followed by cold herbs causing heavy Yin internal pressure, leading to deficient Fire flaming upward. Thus white adds yellow, yellow adds scorched, becoming withered-black and dry-cracked. Regardless of pulse or symptoms, large doses of Shenfu Yangrong Tang given frequently often save lives. I saved Pan Zhongjian’s brother from Wucheng, Zhang Xuehai from Gui’an, and Zhu Shengji from Tongxiang, all with this tongue; see medical cases for records.
Slippery/moist and also tender indicates severe exhaustion of Kidney-Bladder Yuan Qi; use Fuzi Yangrong Tang as primary, followed by Yougui Wan (Right-Restore Pill).
Moreover, although tongues are both black, one belongs to Cold Water insulting Earth, requiring Fuzi Lizhong Tang; the other belongs to Kidney Qi overwhelming the Heart, requiring Renshen Bawei Wan. Why different treatments? Cold Water insulting Earth is Yin excess internally forcing Yang outward, false Heat outside and true Cold inside, Ge Yang (Gridlock Yang) syndrome; black gathers only in the tongue center. Kidney Qi overwhelming the Heart is Yin excess below forcing Yang above, false Heat above and true Cold below, Dai Yang (Floating Yang) syndrome; black extends to the tongue tip. However, none are firm/hard; they are swollen and tender. Dryness or slipperiness is secondary. Only for True Fire syndromes is the form firm/contracted and color aged-looking, never swollen/tender.