舌右有白苔滑。病在肌肉。为邪在半里半表。必往来寒热。宜小柴胡汤和解之。
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【介按】凡风寒之入。由皮毛而腠理。为阳明少阳之界。作表症看。非邪已入阳明之里。而复传于少阳也。如外证
身热微寒。或往来寒热。舌苔中白边红、或根白尖红。脉象弦滑者。此邪在于肌肉腠理之间，阳明少阳之界。治宜解肌
为主。以取肌表之汗。则寒热自退。因少阳在太阳阳明之间。是以少阳之症。有兼太阳者。有兼阳明者。兹以阳明兼少
阳为病。舌右白滑而往来寒热。治法宗仲景《伤寒论》“阳明病。胁下硬满。不大便而呕。舌上白苔者。可与小柴胡汤。
上焦得通。津液得下。胃气因和。身 然汗出而解也”之意。故用小柴胡汤治之。俾上焦之痰饮化而津液行。胃气一和。
然汗出。则寒热自解矣。
舌左见白苔滑者。此脏结之证。邪并入脏。难治。
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【介按】脏结之证。胁下素有痞。连在脐旁。痛引少腹而入阴筋。外证无往来寒热。初时病从表入。因医者下之太
早。邪气久伏不发而成。《伤寒论》云。“何谓脏结。答曰。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。”又曰。“脏结无阳证。不往来寒热。其人反静。舌上苔滑者。不可攻也。”又曰。“病胁
下素有痞。连在脐旁。痛引少腹入阴筋者。此名脏结死。”但脏结可分为三种。如新陈之邪。互相交结而不解。痞连脐旁
者。脾脏结也。痛引少腹者。肾脏结也。自胁入阴筋者。肝脏结也。若三阴之脏俱结。则其人必主死矣。今白滑之色。
见于舌之左根。可知其痛在于脐之左旁。此时汗之无益。下之无效。故为难治之症也。
舌右侧出现白滑苔。病位在肌肉，属于邪气处于半表半里之间，必然出现往来寒热（忽冷忽热）的症状。适宜用小柴胡汤进行和解治疗。
【介按】大凡风寒之邪入侵，由皮毛进入腠理，处于阳明经与少阳经的交界地带，应作为表证来看待，并非邪气已经深入阳明之里，然后再传变至少阳。如果外证表现为身热微恶寒，或者往来寒热，舌苔中间白边缘红，或者根部白尖端红，脉象弦滑，这是邪气停留在肌肉腠理之间，即阳明、少阳的交界之处。治疗应当以解肌为主，通过获取肌表的汗液，那么寒热症状自然消退。因为少阳经位于太阳经和阳明经之间，所以少阳病的症状，有的兼有太阳病特征，有的兼有阳明病特征。此处是以阳明病兼夹少阳病为患，舌右侧白滑且伴有往来寒热，治疗方法遵循张仲景《伤寒论》中“阳明病，胁下硬满，不大便而呕，舌上白苔者，可与小柴胡汤。上焦得通，津液得下，胃气因和，身濈然汗出而解也”的意思。因此使用小柴胡汤治疗，使上焦的痰饮化解而津液运行，胃气调和，随后周身微微出汗，寒热自然解除。
舌左侧出现白滑苔，这是脏结证的征象，邪气并入五脏，难以治愈。
【介按】脏结证，患者胁下素有痞块，连接在脐旁，疼痛牵引至小腹并进入阴筋。外证没有往来寒热的表现。起初病邪从表入里，因为医生攻下太早，邪气久伏不发而形成。《伤寒论》说：“什么是脏结？回答说：像结胸的样子，饮食如常，时常腹泻，寸脉浮，关脉小细沉紧，名叫脏结。舌上白苔滑的难治。”又说：“脏结没有阳证，不往来寒热，病人反而安静，舌上苔滑的，不可攻下。”又说：“病胁下素有痞块，连接在脐旁，疼痛牵引小腹进入阴筋的，这名叫脏结死证。”但是脏结可以分为三种情况：如新邪陈邪互相交结而不解，痞块连接脐旁的，是脾脏结；疼痛牵引小腹的，是肾脏结；自胁部进入阴筋的，是肝脏结。如果三阴经所属的脏腑都发生结滞，那么病人必定主死。现在白滑的颜色出现在舌头的左根部，可知其疼痛在于脐的左旁。此时发汗无益，攻下无效，所以是难治的病症。
The right side of the tongue presents with a white, slippery coating. The pathology is located in the muscles, indicating that the pathogenic factor is situated at the half-exterior and half-interior level. There will inevitably be alternating chills and fever (Wanglai Hanre). It is appropriate to use Xiao Chai Hu Tang (Minor Bupleurum Decoction) for harmonization.
[Commentary by Jie] Generally, when wind-cold pathogens invade, they enter from the skin hair into the interstices (Couli), occupying the boundary between the Yangming and Shaoyang channels. This should be viewed as an exterior syndrome, not as the pathogen having already entered the interior of Yangming and subsequently transmitted to Shaoyang. If external signs include slight fever with mild aversion to cold, or alternating chills and fever, with a coating that is white in the center and red on the edges, or white at the root and red at the tip, and a pulse that is wiry and slippery, this indicates the pathogen resides between the muscles and interstices, at the junction of Yangming and Shaoyang. Treatment should primarily focus on releasing the muscle layer (Jie Ji) to induce sweating from the muscular exterior, after which the chills and fever will naturally subside. Since the Shaoyang channel lies between Taiyang and Yangming, Shaoyang syndromes may present with characteristics of either Taiyang or Yangming. In this case, it is a Yangming disease complicated by Shaoyang involvement, manifested by a white, slippery coating on the right side of the tongue and alternating chills and fever. The therapeutic approach follows Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage): "In Yangming disease, if there is hardness and fullness below the hypochondrium, constipation accompanied by vomiting, and a white coating on the tongue, Xiao Chai Hu Tang may be administered. Once the Upper Jiao is unblocked, fluids descend, stomach qi harmonizes, and the body breaks into a continuous sweat, the disease resolves." Therefore, Xiao Chai Hu Tang is used to resolve phlegm-fluids in the Upper Jiao and promote fluid circulation. Once stomach qi harmonizes and a general sweat occurs, the chills and fever resolve.
A white, slippery coating appearing on the left side of the tongue indicates the syndrome of Zang Jie (Visceral Knotting), where the pathogen has merged into the zang organs. This is difficult to treat.
[Commentary by Jie] In the syndrome of Zang Jie, there is typically a pre-existing mass (Pi) below the hypochondrium connected to the side of the umbilicus, with pain radiating to the lower abdomen and into the genital tendons. External signs do not include alternating chills and fever. Initially, the pathogen enters from the exterior, but because the physician purged too early, the pathogen remained latent and undischarged for a long time. The *Shanghan Lun* states: "What is meant by Zang Jie? It is answered: It resembles Jie Xiong (Chest Binding), yet food intake remains normal, with frequent diarrhea. The cun pulse is floating, and the guan pulse is small, fine, deep, and tight; this is named Zang Jie. If the tongue has a white, slippery coating, it is difficult to treat." It further states: "Zang Jie lacks yang signs; there are no alternating chills and fever. The person appears unusually quiet. With a slippery coating on the tongue, purgation must not be used." It also states: "If there is a pre-existing mass below the hypochondrium connected to the side of the umbilicus, with pain radiating to the lower abdomen and into the genital tendons, this is named Zang Jie, a fatal condition." However, Zang Jie can be categorized into three types: If new and old pathogens knot together without resolving, and the mass connects to the umbilicus, it is Spleen Zang Jie; if pain radiates to the lower abdomen, it is Kidney Zang Jie; if it extends from the hypochondrium into the genital tendons, it is Liver Zang Jie. If all three yin zang organs are knotted, death is inevitable. Now, since the white-slippery color appears at the root of the left side of the tongue, it indicates pain at the left side of the umbilicus. At this stage, diaphoresis is of no benefit, and purgation is ineffective; thus, it is a difficult-to-treat condition.