\r红星舌图\pt101a5.bmp\r
舌见淡红中有大红星者。乃少阴君火。热之盛也。所不盛者。假火势以侮脾土。将欲发黄之后也。宜茵陈五苓散治之。
【介按】发黄有如橘黄而明者。阳明热胜也。有如熏黄而晦者。太阴湿胜也。且以小便不利为湿热发黄。小便自利为
蓄血发黄。最宜辨明症候而施治焉。兹以湿热瘀郁熏蒸成黄。故以五苓散宣化膀胱之气而利小便。加茵陈以清渗湿热。
是属湿热发黄之治法。倘如失治之后。则郁热炽盛。灼耗脾液。而舌现红星。成为热毒传里之症。如《舌鉴辨正》所谓
“全舌纯红而深红星。乃脏腑血分皆热也。中燥火者。中疫毒者，实热人误服温补者皆有之。其病多大热大渴。心胸胀
满。皮肤燥痒。日夜不能眠。大便秘、小便涩不等。（均属里症）宜十全苦寒救补汤急投”者是也。
五苓散
泽泻（二两五钱） 茯苓 猪苓 白术（各一两五钱） 官桂（五钱） 木通 滑石（各一两） 甘草（炙，一两）
上为末，每服五钱，入姜汁并蜜各少许，用白滚水调服。
【介按】《医宗金鉴》云。“五苓散，非治水热之专剂。乃治水热小便不利之主方也。君泽泻之咸寒。咸走水府。寒
胜热邪。佐二苓之淡渗。通调水道。下输膀胱。并泻水热也。用白术之燥湿。健脾助土。为之堤防以制水也。用桂之辛
温。宣通阳气。蒸化三焦以行水也。泽泻得二苓下降。利水之功倍。小便利而水不蓄矣。白术须桂上升。通阳之效捷、
气腾津化。渴自止也。”又云。“加茵陈，名茵陈五苓散。治湿热发黄表里不实。小便不利者。无不克也。”兹又加以滑石、
甘草、木通者。因太阴湿郁蒸热为黄。既宣其气化。并渗其湿热。使黄从小便而解也。
【红星舌图谱】
舌象表现为舌质淡红，其中出现较大的红色星点。这是少阴君火（心火）热邪亢盛的表现。若热势不盛，则是借火势克制脾土，即将发生黄疸的前兆。适宜使用茵陈五苓散进行治疗。
【介按语】黄疸的颜色如同橘子色且明亮者，属于阳明经热邪偏盛；颜色如被烟熏般晦暗者，属于太阴经湿邪偏盛。并且，以小便不利为特征的湿热发黄，与小便通利的蓄血发黄，必须仔细辨别证候才能施治。此处因湿热瘀滞郁结、熏蒸而致发黄，故用五苓散宣化膀胱气化功能以利小便，加入茵陈以清利渗泄湿热。这属于治疗湿热发黄的法则。倘若失治误治之后，郁热炽盛，灼伤耗竭脾之津液，导致舌现红星，成为热毒内传里的病证。正如《舌鉴辨正》中所说：“全舌纯红且深见红星，是脏腑血分皆热。中燥火者、中疫毒者、实热证误服温补药者均会出现此症。其病症多为大热大渴、心胸胀满、皮肤干燥瘙痒、日夜不能入睡、大便秘结、小便涩痛不等。（均属里证）适宜急投十全苦寒救补汤。”
茵陈五苓散
泽泻（二两五钱） 茯苓 猪苓 白术（各一两五钱） 官桂（五钱） 木通 滑石（各一两） 甘草（炙，一两）
以上药物研为细末，每次服用五钱，加入少许姜汁和蜂蜜，用白开水调服。
【介按语】《医宗金鉴》云：“五苓散，并非专门治疗水热互结的方剂，而是治疗水热互结导致小便不利的主方。以泽泻的咸寒之性为君药，咸味入水府，寒能胜热邪；佐以茯苓、猪苓的淡渗之性，通调水道，下输膀胱，并泻除水热。用白术的燥湿之性，健脾助土，作为堤防以制约水邪；用官桂的辛温之性，宣通阳气，蒸化三焦以行水。泽泻得茯苓、猪苓相助则下降，利水功效倍增，小便利则水不蓄积。白术须配官桂上升，通阳效果迅速，气机升腾津液化生，口渴自止。”又说：“加入茵陈，名为茵陈五苓散，治疗湿热发黄、表里俱不实、小便不利者，无不奏效。”此处又加入滑石、甘草、木通，是因为太阴湿邪郁蒸发黄，既宣通气化，又渗泄湿热，使黄色从小便排出而解。
[Diagram of Red Star Tongue]
The tongue presents a pale red color with large red star-like spots within. This indicates the flourishing heat of Shaoyin Junfire (Heart Fire). If the heat is not excessive, it implies that the fire energy is insulting Spleen Earth, which precedes the onset of jaundice. Yinchen Wuling San (Cinchona and Poria Decoction) is suitable for treatment.
[Commentary by Jie] Jaundice resembling bright orange yellow indicates excess heat in the Yangming channel; jaundice appearing dark and dull like being smoked indicates excess dampness in the Taiyin channel. Furthermore, jaundice caused by damp-heat is characterized by difficult urination, whereas jaundice caused by blood stasis is characterized by normal urination. It is crucial to clearly distinguish these syndromes before administering treatment. In this case, due to damp-heat stagnation, depression, steaming, and steaming causing jaundice, Wuling San (Poria Decoction) is used to promote the Qi transformation of the Bladder and facilitate urination, while adding Yinchen (Artemisiae Scopariae Herba, 茵陈) to clear and drain damp-heat. This belongs to the therapeutic method for treating damp-heat jaundice. However, if left untreated or treated incorrectly, the depressed heat becomes vigorous, burning and consuming the fluids of the Spleen, resulting in red stars appearing on the tongue, forming a syndrome where heat toxin transmits inward. As stated in *Shejian Bianzheng* (Correction of Tongue Diagnosis): "A tongue entirely pure red with deep red stars indicates heat in the blood aspect of all Zang-Fu organs. This occurs in cases of internal dryness-fire, epidemic toxins, or when excess heat patients mistakenly take warm-tonifying medicines. The diseases typically manifest as high fever and intense thirst, chest and abdominal distension and fullness, dry and itchy skin, inability to sleep day or night, constipation, and dysuria, among others. (All belong to interior syndromes). It is appropriate to urgently administer Shiquan Kuhong Jiubu Tang (Ten-Ingredient Bitter-Cold Rescue and Tonification Decoction)."
Yinchen Wuling San (Cinchona and Poria Decoction)
Ze Xie (Alisma Rhizoma, 泽泻) (2 liang 5 qian), Fu Ling (Poria, 茯苓), Zhu Ling (Polyporus, 猪苓), Bai Zhu (Atractylodis Macrocephalae Rhizoma, 白术) (each 1 liang 5 qian), Guan Gui (Cinnamomi Ramulus, 官桂) (5 qian), Mu Tong (Akebiae Caulis, 木通), Hua Shi (Talcum, 滑石) (each 1 liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草) (roasted, 1 liang).
Grind the above ingredients into powder. Take 5 qian per dose, add a small amount of ginger juice and honey, and mix with boiling water for oral administration.
[Commentary by Jie] *Yizong Jinjian* (Golden Mirror of Medicine) states: "Wuling San (Poria Decoction) is not a specific agent for treating water-heat, but is the principal formula for treating difficulty in urination caused by water-heat. Ze Xie (Alisma Rhizoma, 泽泻) serves as the sovereign herb with its salty and cold nature; saltiness enters the Water Mansion, and cold overcomes heat pathogens. Poria (Fu Ling, 茯苓) and Polyporus (Zhu Ling, 猪苓) serve as assistants with their bland and permeating nature, regulating water passages, transporting downward to the Bladder, and draining water-heat. Bai Zhu (Atractylodis Macrocephalae Rhizoma, 白术) dries dampness, strengthens the Spleen, and assists Earth, acting as a dike to control water. Guan Gui (Cinnamomi Ramulus, 官桂) promotes Yang Qi through its acrid and warm nature, steaming and transforming the Triple Burner to move water. With the assistance of Fu Ling and Zhu Ling, Ze Xie descends, doubling its water-draining efficacy; when urination is smooth, water does not accumulate. With the ascent facilitated by Guan Gui, Bai Zhu accelerates the effect of promoting Yang Qi; as Qi rises and fluids transform, thirst ceases." It further states: "Adding Yinchen (Artemisiae Scopariae Herba, 茵陈) creates Yinchen Wuling San (Cinchona and Poria Decoction), which treats damp-heat jaundice with exterior-interior deficiency and difficulty in urination, achieving success in all cases." Here, Hua Shi (Talcum, 滑石), Gan Cao (Glycyrrhizae Radix et Rhizoma, 甘草), and Mu Tong (Akebiae Caulis, 木通) are added because Taiyin dampness depresses and steams heat causing jaundice; this both promotes Qi transformation and drains damp-heat, allowing the jaundice to resolve through urination.