典藏书目

The treatment of Shanghan (Cold Damage) requires observing the eyes. If they are red or yellow, redness indicates a Yang syndrome. If accompanied by six pulses that are surging, large, and forceful, or if there is restlessness and thirst, the heat must be severe. For mild cases, Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction) is used; for severe cases, formulas such as Dachengqi Tang (Major Order the Qi Decoction) are indicated.

1. Whenever the eye color is clear and white, without signs of cloudiness, dizziness, or flickering, it is mostly not a Fire syndrome, and cold-cooling herbs should not be lightly employed.

1. When there is much discharge (canthus rheum) accumulating in the eyes, it must be due to Fire. Generally, when Fire is present, the eyes produce excessive fluid; when this fluid dries and coagulates, it forms discharge. This is similar to how nasal mucus flows out when Lung Heat is severe; thus, eye discharge is a type of body fluid manifestation.

1. Upward deviation of the eyeballs is called Daiyan (Deviation of the Eyes), which belongs to the Foot-Taiyang Bladder Meridian. The Taiyang meridian serves as the upper network of the eyes and stands in exterior-interior relationship with the Shaoyin Kidney Meridian. When Kidney Qi of the Shaoyin is severely deficient, leading to Yin deficiency and blood depletion in the Taiyang, the sinews and vessels become dry and tense, pulling the eyes upward. If the eyes stare straight ahead without movement, it is an especially ominous sign. To treat this, one must quickly focus on nourishing Yin and tonifying blood. Modern practitioners often misunderstand this as Wind pathogen and use wind-dispelling herbs; this causes further Yin deficiency and blood dryness, inevitably leading to collapse and death.

The tongue is the external opening of the Heart, naturally red and lustrous. In Shanghan, after three or four days, if coating appears on the tongue, it will transition from moist to dry, from slippery to rough, from white to yellow, and from yellow to black, even becoming scorched and dry, or developing prickles. These all indicate internal transmission of pathogenic heat, progressing from superficial to deep levels. Therefore, when pathogenic factors are still at the exterior level, there is no coating on the tongue; once transmitted to the interior, fluids are dried up, and coating forms. If the pathogen has not penetrated deeply, residing between the exterior and interior, or lodged in the chest, the coating will not be black or rough; Xiao Chaihu Tang (Minor Bupleurum Decoction) and similar harmonizing formulas are appropriate. If Yang pathogen transmits to the interior and stomach heat exists, the coating becomes rough rather than slippery; Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) and similar clearing formulas are indicated. If there is irritability and intense thirst requiring several liters of water, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is used. Generally, a yellow coating that is scorched and rough on the tongue indicates pathogenic heat in the Stomach Fu organ; it may be treated by clearing heat or by mild purgation. *Jingui Yaolue* states: "If the tongue is yellow and purgatives have not yet been used, applying purgation will cause the yellow coating to disappear." However, purgation is only suitable when stools are dry and hard, the pulse is deep and forceful, and there is extreme thirst. If thirst is slight, the pulse is not full, stools are not hard, and the coating is not dry or prickle-covered, purgation is contraindicated. If the tongue has a black coating with prickles, the heat is deeper; Liangge San (Cooling the Diaphragm Powder), Chengqi Tangs, or Da Chaihu Tang (Major Bupleurum Decoction) may be used cautiously for purgation. If the coating is black but slippery and not rough, it is neither excess pathogen nor Fire syndrome; neither purgation nor clearing is appropriate. This is a general overview of tongue diagnosis, but exceptions exist and require detailed examination as follows.

Commentary: Various Shanghan texts state that the Heart is the Sovereign Official, opening into the tongue. The Heart governs Fire, and the Kidneys govern Water. Black is the color of Water, yet appearing in the Heart region (tongue tip) signifies "Ghost Thief Mutual Punishment" (excessive controlling cycle in Five Elements), indicating certain death. While theoretically sound, this is not always true. The mutual restriction of the Five Elements inevitably involves control; disease arises from imbalance, not necessarily from control alone. One must examine the root condition. If the black color extends across the entire tongue and appears dull and lifeless, the root essence is exhausted, and death is inevitable. However, if only the center of the tongue is scorched black but the tongue body remains red and vibrant, it is not necessarily fatal. In cases of Yang excess, clearing Stomach Fire leads to recovery. In cases where Yuan Qi is severely damaged and Yin-Cold pathogens prevail, the tongue may appear yellow-black; if True Yin is depleted, the tongue becomes dry and scorched. This represents deficiency of both Water and Fire in the Kidneys, not an excess-heat syndrome. Differentiation relies on observing form, Qi, pulse, and color to distinguish deficiency from excess, guiding treatment toward tonification or clearing, which are opposites like ice and charcoal. Thus, scorched, black, and dry tongues can also indicate non-excess, non-Fire conditions. Furthermore, a bluish-black tongue lacking spirit but remaining slippery and moist indicates Water encroaching upon the Fire position, representing a deficiency-cold syndrome. Mistaking this for Fire and administering bitter-cold herbs extinguishes residual Yang. Therefore, such cases require careful evaluation of pulses and symptoms to determine deficiency or excess; one must not rigidly apply heat-clearing methods simply because the tongue is black. This applies to Shanghan and other diseases alike.

New Commentary: While in Beijing, I treated a patient named Wang suffering from Yin-deficiency Shanghan, aged over thirty. His tongue was extremely black, covered in dry cracks and prickles, scorched black like charcoal. He had fever, constipation, extreme thirst preferring cold drinks, yet his pulse was weak and his spirit listless. Other physicians diagnosed it as a Yang syndrome with Yin pulse, predicting certain death. Observing that his physical constitution and Qi were not yet collapsed, I administered large doses of sweet-warm herbs to nourish Water and rescue the root, while allowing cool water to address the branch symptoms. Water is the essence of Heaven One; coolness resolves heat, and sweetness assists Yin, unlike bitter-cold herbs that damage Qi. Thus, for conditions involving dry fluids, Yin-deficiency constipation, and intense heat/thirst, this approach is not contraindicated. With simultaneous administration of medicine and water, he consumed one to two jin each of Ren Shen (Ginseng Root) and Shu Di Huang (Prepared Rehmannia Root), and several liang each of Fu Zi (Aconite Lateral Root) and Rou Gui (Cinnamon Bark). He also drank one to two dou of cold water. Gradually, symptoms subsided, diet improved, and spirit recovered. However, the black tongue did not fade slightly, which puzzled me. Days later, a layer of black crust suddenly peeled off the tongue, revealing fresh, bright red tissue underneath. It became clear that the skin and pores were scorched and withered, appearing dead but reviving; without vigorous tonification, regeneration would have been impossible. This case illustrates the severity; countless other cases of black tongues cured by tonification cannot be enumerated. Therefore, diagnosing Shanghan requires using tongue color to differentiate exterior/interior and cold/heat. Using tongue color to differentiate deficiency/excess is prone to error, as excess can cause blackness via Fire scorching, and deficiency can cause blackness via Water depletion. Assuming all yellow or black tongues indicate excess-heat would mean no Yin-deficiency patients could survive.

Ancient Commentary: *Jingjian Lu* states: "A completely black tongue indicates Water overcoming Fire; one in a hundred will not recover; practitioners must be cautious." Xue Lizhai stated: "While in Nanjing, the brother-in-law of Zheng Rudong, Director of the Ministry of Works, suffered from Shanghan with this tongue presentation. Physician Zeng Xi suggested using Fuzi Lizhong Tang (Aconite and Poria Decoction). Everyone was shocked and refused. When the patient became critically ill and coffins were prepared, Zeng visited again with a neighbor, insisting the previous prescription offered hope. The family, having accepted his death, tried the medicine. After several doses, he recovered." Generally, black tongue syndromes include those where extreme Heat mimics Water (like wood turning to charcoal), treated with Liangge San to purge Yang Heat; and those where Water overcomes Fire (as treated by Dr. Zeng), treated with Lizhong Tang to dispel Yin Cold. Additionally, scraping the tongue with sliced old ginger can help prognosticate: if the color fades slightly, it is treatable; if hard and unchanging, it is untreatable.

Further Commentary: In the Xin You year of the Hongzhi era, Jiang Menghui from Jintai suffered from Shanghan with this tongue presentation, experiencing cold extremities and incessant hiccups. Physicians continued treating it as Heat, nearly causing death. Vice President Wu Renzhai cured him with Fuzi Lizhong Tang. Medicine requires matching disease with appropriate herbs; Aconite treats Cold effectively. Why do people consider it absolutely unusable, preferring to watch patients die rather than save them? How lamentable! When herbs are correctly prescribed, effects are reliable; one should not dismiss treatments as hopeless.