尝读仲景书。止言舌白、苔滑。并无黄、黑、刺、裂。至金镜录始集三十六图。逮后观舌心法。广至一百三十有七。
何后世证变之多若此。宁知伤寒自表传里。舌苔必由白滑而变他色。不似伏邪瘟疫等热毒。自内达外之一病便见黄黑诸
苔也。观仲景论中。一见舌白、苔滑。即言难治。安有失治而致变者乎。所以仲景止言白苔。已见一斑。不烦琐屑。后
人无先圣治未病之能。势不得不反复辨论以启蒙昧。盖邪气入里。其虚实寒热之机。必现于舌。非若脉法之隐而不显也。
况阴盛格阳。与邪热郁伏。多有假证假脉。惟验舌上苔色之滑、燥、浓、薄。昭若冰鉴。无所遁形。由是取观舌心法。
正其错误。削其繁芜。汰其无预于伤寒者。而参入家大人治案所纪。及己所亲历。共得一百二十图。命曰伤寒舌鉴。授
之剞劂。以公同志临证之一助云。
康熙戊申年秋月诞先张登书于 永堂
伤寒邪在皮毛。初则舌有白沫。次则白涎白滑。再次白屑白 。有舌中、舌尖、舌根之不同。是寒邪入经之微甚也。
舌乃心之苗。心属南方火。当赤色。今反见白色者。是火不能制金也。初则寒郁皮肤。毛窍不得疏通。热气不得外泄。
故恶寒发热。在太阳经。则头痛、身热，项背强、腰脊疼、等症。传至阳明经。则有白屑满舌。虽症有烦躁。如脉浮紧
者。犹当汗之。在少阳经者。则白苔白滑。用小柴胡汤和之。胃虚者。理中汤温之。如白色少变黄者。大柴胡。大小承
气、分轻重下之。白舌亦有死症。不可忽视也。
\r微白滑苔舌\pt108a1.bmp\r
寒邪初入太阳。头疼、身热、恶寒、舌色微白有津。香苏散、羌活汤之类发散之。
\r薄白滑苔舌\pt108a2.bmp\r
此太阳里证舌也。二三日未曾汗。故邪入丹田渐深。急宜汗之。或太阳与少阳合病。有此舌者。柴胡桂枝汤主之。
\r浓白滑苔舌\pt108a3.bmp\r
病三四日。其邪只在太阳。故苔纯白而浓。却不干燥。其证头疼发热。脉浮而紧。解表自愈。
\r干浓白苔舌\pt108a4.bmp\r
病四五日。未经发汗。邪热渐深。少有微渴。过饮生冷。停积胸中。营热胃冷。故令发热烦躁。四肢逆冷。
而苔白干浓。满口白屑。宜四逆散加干姜。
\r白苔黄心舌\pt108a5.bmp\r
此太阳经初传阳明府病舌也。若微黄而润。宜再汗。待苔燥里证具。则下之。若烦躁呕吐。大柴胡汤加减。
亦有下淡黄水沫。无稀粪者。大承气汤下之。
\r白苔黄边舌\pt108a6.bmp\r
舌中见白苔。外有微黄者。必作泄。宜用解毒汤。恶寒者五苓散。
\r干白苔黑心舌\pt108a7.bmp\r
此阳明府兼太阳舌，其苔边白中心干黑者。因汗不彻。传至阳明所致。必微汗出、不恶寒、脉沉者。可下
之。如二三日未曾汗。有此舌必死。
\r白滑苔尖灰刺舌\pt108a8.bmp\r
此阳明府兼少阳舌也。三四日自利脉长者生。弦数者死。如有宿食。用大承气下之。十可全五。
\r白苔满黑刺干舌\pt108a9.bmp\r
白苔中生满干黑芒刺。乃少阳之里证也。其证不恶寒反恶热者。大柴胡加芒硝急下之。然亦危证也。
\r白滑苔黑心舌\pt108a10.bmp\r
白苔中黑。为表那入里之候。大热谵语。承气等下之。倘食复而发热、或利不止者。难治。
\r半边白滑舌\pt108a11.bmp\r
白苔见于一边。无论左右。皆属半表半里。宜小柴胡汤。左加葛根。右加茯苓。有咳嗽引胁下痛、而见此
舌苔者。小青龙汤。夏月多汗自利。人参白虎汤。
\r脏结白滑舌\pt108a12.bmp\r
或左或右。半边白苔。半边或黑或老黄者。寒邪结在脏也。黄连汤加附子。结在咽者。不能语言。宜生脉
散合四逆汤。可救十中一二。
\r白苔黑斑舌\pt108a13.bmp\r
白苔中有黑小斑点乱生者。乃水来克火。如无恶候。以凉膈散承气汤下之。十中可救一二。
\r白苔燥裂舌\pt108a14.bmp\r
伤寒胸中有寒。丹田有热。所以舌上白苔。因过汗伤营。舌上无津。所以燥裂。内无实热。故不黄黑。宜
小柴胡加芒硝微利之。
\r白苔黑根舌\pt108a15.bmp\r
舌苔白而根黑；火被水克之象。虽下亦难见功也。
\r白尖黄根舌\pt108a16.bmp\r
邪虽入里。而尖白未黄。不可用承气。宜大柴胡汤加减。下后无他证。安卧神清。可生。倘再有变证。多凶。
\r白苔双黄舌\pt108a17.bmp\r
此阳明里证舌也。黄乃土之色。因邪热上攻。致令舌有双黄。如脉长恶热。转矢气烦躁者。大柴胡调胃承
气下之。
\r白苔双黑舌\pt108a18.bmp\r
白苔中见黑色两条。乃太阳少阳之邪入于胃。因土气衰绝。故手足厥冷。胸中结痛也。理中汤泻心汤选用。
如邪结在舌根。咽嗌而不能言者。死证也。
\r白苔双灰色舌\pt108a19.bmp\r
此夹冷食舌也。七八日后见此舌而有津者。可治。理中四逆选用。无津者不治。如干浓见里证。则下之。
得汤次日灰色去者安。
\r白尖中红黑根舌\pt108a20.bmp\r
舌尖白而根灰黑。少阳邪热传腑。热极而伤冷冻饮料也。如水停津液固结而渴者。五苓散。自汗而渴者。白虎汤。
下利而渴者。解毒汤。如黑根多、白尖少、中不甚红者。难治。
\r白苔尖红舌\pt108a21.bmp\r
满舌白滑而尖却鲜红者。乃热邪内盛。而复感客寒入少阳经也。小柴胡汤加减。
\r白苔中红舌\pt108a22.bmp\r
此太阳初传经之舌也。无汗者发汗。有汗者解肌。亦有少阳经者。小柴胡汤加减。
\r白苔变黄舌\pt108a23.bmp\r
少阳证罢。初见阳明里证。故苔变黄色。兼矢气者。大柴胡汤下之。
\r白尖红根舌\pt108a24.bmp\r
舌尖苔白。邪在半表半里也。其证寒热、耳聋、口苦、胁痛、脉弦。小柴胡汤和解之。
\r白苔尖灰根黄舌\pt108a25.bmp\r
此太阳湿热并于阳明也。如根黄色润、目黄小便黄者。茵陈蒿汤加减。
\r白苔尖根俱黑舌\pt108a26.bmp\r
舌根尖俱黑而中白。乃金水太过。火土气绝于内。虽无凶证。亦必死也。
\r熟白舌\pt108a27.bmp\r
白苔老极。如煮熟相似者。心气绝而肺色乘于上也，始因食瓜果冰水等物。阳气不得发越所致。为必死候。
用枳实、理中。间有生者。
\r淡白透明舌\pt108a28.bmp\r
年老胃弱。虽有风寒。不能变热。或多服汤药。伤其胃气。所以淡白透明。似苔非苔也。宜补中益气加减治
之。
\r白苔如积粉舌\pt108a29.bmp\r
此舌乃瘟疫初犯募原也。达原饮。见三阳表证。随经加柴胡、葛根、羌活。见里证。加大黄。
我曾阅读张仲景的著作，书中只提及舌苔白、苔滑，并没有提到黄苔、黑苔、芒刺、裂纹。直到《金镜录》才开始收集三十六种舌象图。此后，《观舌心法》将其扩充至一百三十七种。
为什么后世的证候变化如此之多呢？殊不知伤寒病邪从体表传入体内，舌苔必然由白滑逐渐变为其他颜色，不像伏邪、瘟疫等热毒之邪，是从内部达于外部，一种疾病就会直接出现黄、黑等各种舌苔。观察张仲景的论述中，一见舌苔白、苔滑，就说病情难治，哪里会有因为失治而导致变证的缘故呢？所以张仲景只言白苔，已可见一斑，无需繁琐琐碎。后人没有先圣“治未病”的能力，势必要反复辨析论述以启蒙昧者。大概是因为邪气入里，其虚实寒热的机理，必然显现于舌象上，不像脉法那样隐晦而不明显。况且阴盛格阳与邪热郁伏，多有假证假脉，只有查验舌上苔色的滑、燥、浓、薄，才能像冰鉴一样清晰明了，使病机无所遁形。因此，我选取《观舌心法》，纠正其中的错误，删去繁杂芜杂的内容，剔除那些与伤寒无关的部分，并参入家父治疗医案所记载的，以及我自己亲身经历的案例，共得一百二十幅舌象图，命名为《伤寒舌鉴》，刻印出版，以此作为同道中人临证时的辅助参考。
康熙戊申年秋月，诞先张登在永堂书写。
伤寒邪气在皮毛，起初舌上有白沫，接着是白涎、白滑，再次是白屑、白刺。有舌中、舌尖、舌根的不同，这是寒邪侵入经络程度的深浅不同。舌是心的苗窍，心属南方火，应当呈赤色。现在反而见到白色，这是火不能制约金（肺）。起初寒邪郁结在皮肤，毛窍不得疏通，热气不得外泄，所以恶寒发热。如果在太阳经，则有头痛、身热、项背强直、腰脊疼痛等症状；传至阳明经，则有白屑满舌。虽然症状有烦躁，但如果脉象浮紧，仍然应当用发汗法治疗。在少阳经者，则见白苔白滑，用小柴胡汤和解。胃虚者，用理中汤温补。如果白色稍微变为黄色，大柴胡汤、大承气汤、小承气汤根据轻重程度使用下法。白舌也有死症，不可忽视。
【微白滑苔舌】
寒邪初入太阳经，头疼、身热、恶寒，舌色微白且有津液，用香苏散、羌活汤之类发散表邪。
【薄白滑苔舌】
这是太阳经里的证候舌象。二三天未曾发汗，所以邪气进入丹田渐深，急宜发汗。或者是太阳与少阳合病，有此舌象的，主方用柴胡桂枝汤。
【浓白滑苔舌】
病三四日，邪气只在太阳经，所以苔纯白而浓，却不干燥。其证候为头疼发热，脉浮而紧，解表后即可自愈。
【干浓白苔舌】
病四五日，未经发汗，邪热渐深，稍有轻微口渴。如果过饮生冷，停积在胸中，导致营分热、胃寒冷，所以令发热烦躁，四肢逆冷，而舌苔白干且浓，满口白屑。宜用四逆散加干姜。
【白苔黄心舌】
这是太阳经初传阳明腑病的舌象。如果苔微黄而润，宜再行发汗。待苔燥、里证具备，则用下法。如果有烦躁呕吐，用大柴胡汤加减。也有排出淡黄水沫，无稀粪的情况，用大承气汤下之。
【白苔黄边舌】
舌中见白苔，外周有微黄色的，必定会发生泄泻。宜用解毒汤。如果有恶寒症状，用五苓散。
【干白苔黑心舌】
这是阳明腑兼太阳经的舌象，其苔边缘白，中心干黑，是因为发汗不彻底，传至阳明所致。如果伴有微微出汗、不恶寒、脉沉的，可以用下法。如果二三天未曾发汗，有此舌象的必死。
【白滑苔尖灰刺舌】
这是阳明腑兼少阳经的舌象。三四日自利（腹泻），脉长的可生，脉弦数的必死。如果有宿食，用大承气汤下之，十人可救五人。
【白苔满黑刺干舌】
白苔中生满干黑芒刺，这是少阳经的里证。其证候是不恶寒反恶热，用大柴胡汤加芒硝急下。这也是危重证候。
【白滑苔黑心舌】
白苔中间发黑，是表邪入里的征候。有大热、谵语，用承气汤等下法。如果是食复（因饮食不当复发）而发热，或者下利不止的，难治。
【半边白滑舌】
白苔出现在一边，无论左右，都属半表半里。宜用小柴胡汤。左侧加葛根，右侧加茯苓。如果有咳嗽牵引胁下痛，而出现此舌苔的，用小青龙汤。夏季多汗且自利的，用人参白虎汤。
【脏结白滑舌】
或左或右，半边白苔，半边或黑或老黄的，是寒邪结在脏。用黄连汤加附子。如果结在咽喉，不能言语，宜用生脉散合四逆汤，可救十分之一二。
【白苔黑斑舌】
白苔中有黑色小斑点乱生的，是水来克火。如果没有恶候，用凉膈散、承气汤下之，十人可救一二。
【白苔燥裂舌】
伤寒胸中有寒，丹田有热，所以舌上白苔。因为过汗伤了营阴，舌上无津液，所以燥裂。内无实热，所以不黄不黑。宜用小柴胡汤加芒硝微利之。
【白苔黑根舌】
舌苔白而根部黑，是火被水克的征象。即使使用下法也难以见效。
【白尖黄根舌】
邪气虽入里，但舌尖白未变黄，不可用承气汤。宜用大柴胡汤加减。下后没有其他证候，安静卧睡，神志清醒，可以生存。如果再有变证，大多凶险。
【白苔双黄舌】
这是阳明经里证的舌象。黄是土的颜色，因为邪热上攻，致使舌现双黄。如果脉长、恶热、转矢气、烦躁的，用大柴胡汤调胃承气汤下之。
【白苔双黑舌】
白苔中见黑色两条，是太阳、少阳的邪气入于胃，因为土气衰绝，所以手足厥冷，胸中结痛。选用理中汤或泻心汤。如果邪气结在舌根，咽喉而不能言语的，是死证。
【白苔双灰色舌】
这是夹杂冷食的舌象。七八日后见此舌而有津液的，可治。选用理中汤或四逆汤。无津液的不治。如果干浓且见里证，则用下法。服药次日灰色消退的则安。
【白尖中红黑根舌】
舌尖白而根部灰黑，是少阳邪热传腑，热极而伤及冷冻饮料（此处指寒凉之物或寒凝）。如果水停津液固结而渴的，用五苓散。自汗而渴的，用白虎汤。下利而渴的，用解毒汤。如果黑根多、白尖少、中间不甚红的，难治。
【白苔尖红舌】
满舌白滑而舌尖却鲜红的，是热邪内盛，又感受客寒入少阳经。用小柴胡汤加减。
【白苔中红舌】
这是太阳经初传经的舌象。无汗的发汗，有汗的解肌。也有属于少阳经的，用小柴胡汤加减。
【白苔变黄舌】
少阳证罢，初见阳明里证，所以苔变黄色。兼有转矢气的，用大柴胡汤下之。
【白尖红根舌】
舌尖苔白，邪在半表半里。其证候为寒热往来、耳聋、口苦、胁痛、脉弦。用小柴胡汤和解。
【白苔尖灰根黄舌】
这是太阳湿热并于阳明经。如果根部黄色湿润、目黄、小便黄的，用茵陈蒿汤加减。
【白苔尖根俱黑舌】
舌根和舌尖都黑而中间白，是金水太过，火土气绝于内。虽然没有凶险证候，也必死。
【熟白舌】
白苔老极，像煮熟的一样。这是心气绝而肺色乘于上，开始是因为食用瓜果冰水等物，阳气不得发越所致。为必死之候。用枳实、理中汤，间或有生还者。
I have read the works of Zhang Zhongjing. He only mentioned white tongue coating and slippery coating, without mentioning yellow, black, prickly, or cracked coatings. It was not until *Jin Jing Lu* (Golden Mirror Record) that thirty-six tongue images were collected. Later, *Guan She Xin Fa* (Observing Tongue Core Method) expanded this to one hundred and thirty-seven.
Why are there so many variations in syndromes in later generations? One should know that in Shanghan (Cold Damage), as pathogenic factors transmit from the exterior to the interior, the tongue coating must change from white and slippery to other colors. This is unlike latent pathogens and epidemics where heat toxins manifest from the interior to the exterior, presenting with yellow and black coatings immediately upon disease onset. Observing Zhang Zhongjing’s discussions, once a white tongue and slippery coating appear, he states the condition is difficult to treat. How could there be changes caused by mismanagement? Thus, Zhang Zhongjing only spoke of white coating, revealing a part of the whole, without being trivial. Later generations lacked the ability of the sages to "treat disease before it arises," so they were forced to repeatedly analyze and discuss to enlighten the ignorant. Generally, when pathogenic factors enter the interior, the mechanisms of deficiency/excess and cold/heat must manifest on the tongue, unlike pulse diagnosis which can be obscure. Moreover, in cases of Yin excess repelling Yang and latent pathogenic heat, there are often false signs and false pulses. Only by examining the moisture, dryness, thickness, and thinness of the tongue coating can the truth be clear as ice, leaving no place for the pathology to hide. Therefore, I selected *Guan She Xin Fa*, corrected its errors, deleted its redundancies, eliminated content irrelevant to Shanghan, and incorporated records from my father’s medical cases and my own experiences. Together, we obtained one hundred and twenty tongue images, named them *Shanghan She Jian* (Compendium of Tongues in Cold Damage), had them engraved and published, to serve as an aid for colleagues in clinical practice.
Written by Zhang Deng, born in the autumn month of the Wushen year of the Kangxi reign, at Yongtang.
When Shanghan pathogenic factors are in the skin and hair, initially there is white foam on the tongue, followed by white saliva and slippery coating, then white flakes and pricks. Differences exist between the center, tip, and root of the tongue, indicating the depth of cold pathogen invasion into the meridians. The tongue is the sprout of the Heart; the Heart belongs to Fire in the South and should be red. Seeing white instead indicates that Fire fails to control Metal (Lung). Initially, cold stagnates in the skin, pores do not open, and heat cannot escape, causing aversion to cold and fever. If in the Taiyang Meridian, symptoms include headache, body heat, stiffness of the neck and back, and pain in the waist and spine. When transmitting to the Yangming Meridian, there may be white flakes covering the tongue. Although irritability may occur, if the pulse is floating and tight, sweating therapy should still be used. In Shaoyang Meridian cases, white coating and slippery texture appear, treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) to harmonize. For Spleen/Stomach deficiency, Li Zhong Tang (Regulate the Middle Decoction) warms the interior. If the white color slightly turns yellow, Da Chai Hu Tang (Major Bupleurum Decoction), Da Cheng Qi Tang (Major Order the Qi Decoction), or Xiao Cheng Qi Tang (Minor Order the Qi Decoction) are used for purging according to severity. White tongues can also indicate fatal conditions and must not be ignored.
[Micro-white Slippery Coating Tongue]
Cold pathogen newly enters Taiyang: headache, body heat, aversion to cold, tongue color micro-white with fluid. Use Xiang Su San (Fragrant Perilla Powder) or Qiang Huo Tang (Notopterygium Decoction) to disperse externally.
[Thin White Slippery Coating Tongue]
This is a Taiyang interior syndrome tongue. After two or three days without sweating, the pathogen has entered the Dantian deeply. Urgent sweating therapy is needed. Or in combined Taiyang and Shaoyang diseases with this tongue, Zhu Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) is the main formula.
[Thick White Slippery Coating Tongue]
On the third or fourth day, the pathogen remains in Taiyang, so the coating is purely white and thick but not dry. Symptoms include headache and fever, pulse floating and tight. Resolving the exterior leads to self-healing.
[Dry Thick White Coating Tongue]
On the fourth or fifth day, without prior sweating, pathogenic heat deepens slightly, causing mild thirst. Overconsumption of cold/raw foods causes stagnation in the chest, leading to Ying-level heat and Stomach cold. This results in fever, irritability, cold limbs, while the tongue coating is white, dry, and thick, with white flakes filling the mouth. Use Si Ni San (Frigid Extremities Powder) added with Gan Jiang (Dried Ginger).
[White Coating with Yellow Center Tongue]
This is the tongue for Taiyang transmitting to Yangming Fu-organ disease. If slightly yellow and moist, use sweating again. Wait for the coating to become dry and interior signs to appear, then purge. If accompanied by irritability and vomiting, modify Da Chai Hu Tang. Some may pass pale yellow watery froth without loose stool; treat with Da Cheng Qi Tang.
[White Coating with Yellow Edges Tongue]
White coating in the center with slight yellow on the periphery indicates impending diarrhea. Use Jie Du Tang (Detoxification Decoction). If aversion to cold exists, use Wu Ling San (Five-Ling Powder).
[Dry White Coating with Black Center Tongue]
This is a Yangming Fu-combined Taiyang tongue. The edges are white, the center is dry and black, caused by incomplete sweating leading to transmission to Yangming. If accompanied by slight sweating, no aversion to cold, and sinking pulse, purging is possible. If no sweating occurred in two or three days and this tongue appears, death is certain.
[White Slippery Coating with Grey Pricks on Tip Tongue]
This is a Yangming Fu-combined Shaoyang tongue. Diarrhea after three or four days with a long pulse indicates survival; a wiry and rapid pulse indicates death. If food retention exists, use Da Cheng Qi Tang to purge; five out of ten may survive.
[White Coating Fully Covered with Dry Black Pricks Tongue]
Dry black thorns growing fully within white coating indicate Shaoyang interior syndrome. Symptoms include aversion to heat rather than cold. Use Da Chai Hu Tang added with Mang Xiao (Mirabilite) for urgent purging. This is also a critical condition.
[White Slippery Coating with Black Center Tongue]
Black in the center of white coating indicates exterior pathogen entering the interior. High fever and delirium require purging with Cheng Qi Tang variants. If relapse due to diet causes fever, or unceasing diarrhea, treatment is difficult.
[Half-Side White Slippery Tongue]
White coating on one side, left or right, belongs to half-exterior half-interior. Use Xiao Chai Hu Tang. Add Ge Gen (Kudzu Root) for the left side, Fu Ling (Poria) for the right. If coughing pulls pain in the hypochondrium with this tongue, use Xiao Qing Long Tang (Minor Blue Dragon Decoction). In summer, with excessive sweating and spontaneous diarrhea, use Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction).
[Viscera Knotting White Slippery Tongue]
Left or right half-white coating, the other half black or old yellow, indicates cold pathogen knotting in the Zang organs. Use Huang Lian Tang (Coptis Decoction) added with Fu Zi (Aconite). If knotting in the throat prevents speech, use Sheng Mai San (Generate the Pulse Powder) combined with Si Ni Tang, saving one or two out of ten.
[White Coating with Black Spots Tongue]
Random small black spots appearing in white coating indicate Water overcoming Fire. Without severe symptoms, use Liang Ge San (Cool the Diaphragm Powder) and Cheng Qi Tang to purge; one or two out of ten may survive.
[Dry Cracked White Coating Tongue]
Shanghan with cold in the chest and heat in the Dantian results in white tongue coating. Excessive sweating damages Ying, leaving no fluid on the tongue, causing dryness and cracking. No interior excess heat exists, hence no yellow or black. Use Xiao Chai Hu Tang added with Mang Xiao for mild purgation.
[White Coating with Black Root Tongue]
White coating with a black root indicates Fire overcome by Water. Purging will likely be ineffective.
[White Tip with Yellow Root Tongue]
Although pathogen enters the interior, the white tip has not turned yellow; Cheng Qi Tang is contraindicated. Use modified Da Chai Hu Tang. After purging, if no other symptoms exist, quiet sleep and clear spirit indicate survival. Further changes suggest fatality.
[White Coating with Double Yellow Tongue]
This is a Yangming interior syndrome tongue. Yellow is the color of Earth; pathogenic heat attacking upward causes double yellow on the tongue. If pulse is long, aversion to heat, passing gas, and irritability exist, use Da Chai Hu Tang combined with Tiao Wei Cheng Qi Tang to purge.
[White Coating with Double Black Lines Tongue]
Two black lines in white coating indicate Taiyang and Shaoyang pathogens entering the Stomach. Due to衰竭 of Earth Qi, cold hands and feet and chest knotted pain occur. Select Li Zhong Tang or Xie Xin Tang (Drain the Epigastrium Decoction). If pathogen knots at the tongue root preventing speech, it is a fatal sign.
[White Coating with Double Grey Tongue]
This tongue indicates mixed cold food. Appearing after seven or eight days with fluid present is treatable. Select Li Zhong Tang or Si Ni Tang. Absence of fluid is untreatable. If dry, thick, and showing interior signs, purge. If grey disappears the next day after taking medicine, safety ensues.
[White Tip, Red Center, Black Root Tongue]
White tip and grey-black root indicate Shaoyang pathogenic heat transmitting to Fu organs, extreme heat injuring cold fluids. If water retention and congealed fluids cause thirst, use Wu Ling San. Spontaneous sweating with thirst requires Bai Hu Tang. Diarrhea with thirst requires Jie Du Tang. If black root is extensive, white tip is scarce, and center is not very red, treatment is difficult.
[White Coating with Red Tip Tongue]
Full tongue white and slippery but tip bright red indicates internal excess heat combined with external cold invading Shaoyang. Use modified Xiao Chai Hu Tang.
[White Coating with Red Center Tongue]
This is the tongue for early transmission in Taiyang. No sweat requires sweating therapy; existing sweat requires releasing the muscle layer. Some belong to Shaoyang, treated with modified Xiao Chai Hu Tang.
[White Coating Turning Yellow Tongue]
Shaoyang syndrome resolves, first signs of Yangming interior appear, so coating turns yellow. With passing gas, use Da Chai Hu Tang to purge.
[White Tip with Red Root Tongue]
White coating on the tip indicates pathogen in half-exterior half-interior. Symptoms include alternating chills and fever, deafness, bitter taste, hypochondriac pain, and wiry pulse. Use Xiao Chai Hu Tang to harmonize.
[White Coating with Grey Tip and Yellow Root Tongue]
Taiyang damp-heat combining with Yangming. If root is yellow and moist, with yellow eyes and urine, use Yin Chen Hao Tang (Artemisia Capillaris Decoction) modified.
[White Coating with Black Tip and Root Tongue]
Black tip and root with white center indicate excessive Metal and Water, with衰竭 of Fire and Earth internally. Even without severe symptoms, death is certain.
[Ripe White Tongue]
Extremely aged white coating resembling cooked flesh indicates Heart Qi exhaustion with Lung color overriding above. Caused initially by eating melons, fruits, or ice water, preventing Yang Qi from dispersing. This is a fatal sign. Using Zhi Shi (Immature Bitter Orange) and Li Zhong Tang occasionally yields survival.
[Pale Transparent White Tongue]
In elderly with weak Stomach, even with wind-cold, heat transformation fails. Or excessive herbal intake damages Stomach Qi, resulting in pale transparent appearance, looking like coating but not quite. Treat with modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
[White Coating Like Accumulated Powder Tongue]
This tongue indicates plague pathogen initially attacking the Mu Yuan (Source). Use Da Yuan Yin (Great Origin Decoction). If Three Yang exterior signs appear, add Chai Hu, Ge Gen, Qiang Huo along the meridians. If interior signs appear, add Da Huang (Rhubarb).