既集舌苔之条目。当集津液之条目。夫肾主津液。内溉脏腑。经系舌本。外应病症。故察津液之多少。可知
肾气之盛衰。察津之滑涩。可知病气之寒热。由是而言。有因外寒而滑者。有因内寒而滑者。有因虚热而
涩者。有因实热而涩者。诸书谓舌上白苔而腻滑。咳逆短气者。痰饮也。咳而口中有津液。舌上苔滑者。肺
寒也。脉阴阳俱紧。口中气出。唇口干燥。蜷卧足冷。鼻中涕出。舌上苔滑。勿妄治也。到七八日来。其人微发
热。手足温者。此为欲解。到八日以上。反大发热者。此为难治。设使恶寒者。必欲呕也。腹内痛者。必欲利也。
舌上无苔而冷滑。脉微恶寒。身蜷而卧者。少阴中寒也。脏结舌上白苔滑者。难治也。两臂不举。舌本燥。善
太息。胸中痛。不得转侧。食则吐而汗出者。肝中寒也。舌无苔而干燥者。肾脏不足。津液虚竭也。舌苔中心
黑浓而干者。谓之焙舌。邪传少阴。热甚津枯也。恶寒发热。而津液如常者。邪在太阳之表也。白苔干浓。无
汗恶寒。身疼痛者。表未解也。热病五六日。口燥舌干而渴者。少阴病也。舌干咽肿。上气嗌干及痛。烦心心
痛者。病在足少阴也。嗌干口渴。苔不滑而涩者。邪传厥阴也。津液干燥。舌上苔者。表邪传里也。舌焦唇槁
腊干嗌燥者。腠理闭。汗不出也。伤寒吐下后。七八日不解。时时恶风。大渴。舌上干燥而烦。欲饮水数升者。
热结在里。表里俱热也。渴欲饮水。口干舌燥者。热在里而耗其津液也。黑刺破裂而干燥者。热甚而津涸
也。舌灰黑中有干刺。咽干口燥者。热结在少阴也。满舌黑苔而生大刺。干燥底红者。实则可下之证也。伤
寒十一日。舌干已而嚏者。少阴病衰也。下痢舌黄燥而不渴。胸中实。下不止者。死证也。腹满口干舌燥者。
肠间有水气也。舌中黑无苔而燥者。津液受伤。虚火用事也。此集诸书之言津液者。愚谓舌色淡红。苔薄
而滑者。内寒也。舌色深赤。苔浓而滑者。外寒也。苔薄而涩。舌淡红者。虚热也。苔浓而涩。舌深赤者。实热也。
然正虚者。邪气有有无之辨。邪实者。正气有盛衰之分。宜合之五法。参之四时。庶不至虚虚实实。损不足
而益有余矣。第察舌之时。病患宜诊而后食。则苔之浓薄易分。诊而后饮。则苔之滑涩易辨。至于干黑之
舌。又当以蜜拭苔垢。然后视其形色。红赤者可治。青黑者不可治。亦望舌之所宜知也。若夫部位之分。或
因形色。或因苔垢。或因津液。可以类推。故不复集。
既然已经收集了关于舌苔的条目,接下来应当收集关于津液的条目。肾主管津液,向内灌溉脏腑,经络联系着舌根,向外反映病症表现。因此,观察津液的多少,可以了解肾气的盛衰;观察津液的滑润或涩滞,可以判断病气的寒热性质。由此而言,有因外感寒邪而表现为滑润的,有因内寒而表现为滑润的,有因虚热而表现为涩滞的,有因实热而表现为涩滞的。
各种医书认为:舌上有白苔且腻滑,伴有咳嗽气逆、呼吸短促的,属于痰饮证。咳嗽但口中有津液,舌苔滑润的,属于肺寒证。脉象寸关尺三部皆紧,口中呼出热气,嘴唇和口腔干燥,身体蜷缩卧倒,脚冷,鼻中流涕,舌苔滑润的,不要胡乱治疗。等到七八天后,如果病人出现轻微发热,手足温暖的,这是病情将要解除的表现。如果到了八日以上,反而出现大发热的,这是难治的情况。假如伴有恶寒症状的,必定想要呕吐;如果腹内疼痛的,必定想要腹泻。
舌上没有苔且感觉冷滑,脉象微弱且恶寒,身体蜷缩卧倒的,属于少阴经受寒邪侵袭(少阴中寒)。脏结病见舌上白苔滑润的,属于难治之证。两臂不能抬起,舌根干燥,喜欢长叹气,胸部疼痛,无法翻身转动,进食后呕吐并出汗的,属于肝经受寒邪侵袭(肝中寒)。舌上没有苔且干燥的,是肾脏精气不足,津液枯竭的表现。舌苔中心黑厚且干燥的,称为“焙舌”,这是邪气传入少阴经,热势极盛导致津液枯涸的表现。
既有恶寒又有发热,但津液如常的,说明邪气在太阳经的表位。白苔干厚,无汗且恶寒,身体疼痛的,说明表证未解。热病经过五六天,出现口干舌燥且口渴的,属于少阴病。舌干咽肿,气逆上冲,咽喉干燥及疼痛,心烦心痛病的,病变部位在足少阴经。咽喉干燥口渴,舌苔不滑而涩滞的,是邪气传入厥阴经。津液干燥,舌上有苔的,是表邪传入里部。舌焦唇枯,像腊一样干枯,咽喉干燥的,是腠理闭塞,汗液排不出来的表现。
伤寒经过催吐或泻下治疗后,过了七八天病仍未解,时常怕风,极度口渴,舌上干燥且烦躁,想要喝几升水的,是热邪结聚在体内,表里俱热的表现。想喝水,口干舌燥的,是热邪在体内耗伤津液的表现。舌面出现黑色刺状突起且破裂干燥的,是热势极盛而津液枯竭的表现。舌色灰黑中间有干燥的刺,咽喉干燥口燥的,是热邪结聚在少阴经。满舌黑苔且生出大刺,干燥底部发红的是实证,可以使用攻下法治疗。
伤寒第十一日,舌干之后出现打喷嚏的,是少阴病衰退的表现。患痢疾者舌黄燥且不口渴,胸中痞塞充实,下利不止的,属于死证。腹部胀满,口干舌燥的,是肠间有水气停留。舌中黑而无苔且干燥的,是津液受损,虚火妄动的表现。
以上汇集了各书中关于津液的论述。我认为:舌色淡红,苔薄而滑润的,属于内寒证;舌色深赤,苔厚而滑润的,属于外寒证;苔薄而涩滞,舌色淡红的,属于虚热证;苔厚而涩滞,舌色深赤的,属于实热证。然而,正气虚弱时,邪气的有无需要辨别;邪气实盛时,正气的盛衰有所区分。应当结合上述五种方法,参考四季气候的变化,这样才不会犯虚虚实实的错误,即不损伤不足的正气,也不助长有余的邪气。
只是在诊察舌头时,病人应当在诊脉后进食,这样舌苔的厚薄容易分辨;诊脉后饮水,这样舌苔的滑涩容易辨别。至于舌苔干黑的情况,又应当用蜂蜜擦拭舌苔污垢,然后观察其形色。舌色红赤的可以治愈,舌色青黑的则不可治愈。这也是望舌诊法所应当知道的。至于舌部不同部位的区分,或因形色,或因苔垢,或因津液,可以类推,所以不再一一收集。
Since the entries regarding tongue coating have been collected, the entries regarding body fluids (Jinye) should now be collected. The Kidney governs body fluids, irrigating the Zang-Fu organs internally, connecting with the root of the tongue via meridians, and reflecting pathological conditions externally. Therefore, observing the quantity of body fluids allows one to ascertain the prosperity or decline of Kidney Qi; observing whether the fluids are slippery or astringent allows one to determine the cold or heat nature of the pathogenic factor. From this perspective, there are cases of slipperiness due to external cold, slipperiness due to internal cold, astringency due to deficient heat, and astringency due to excess heat.
Various medical texts state: When there is a white coating on the tongue that is greasy and slippery, accompanied by coughing, counterflow qi, and shortness of breath, it indicates Phlegm-Fluid retention (Tanyin). When there is coughing but saliva is present in the mouth, and the tongue coating is slippery, it indicates Lung Cold. When the pulse is tight at both Yin and Yang positions, warm air exits the mouth, lips and mouth are dry, the body curls up in bed, feet are cold, nasal discharge occurs, and the tongue coating is slippery, do not treat rashly. After seven or eight days, if the patient exhibits slight fever and warmth in the hands and feet, this indicates the disease is about to resolve. However, if after eight or more days, high fever returns, this is difficult to treat. If accompanied by aversion to cold, vomiting will likely occur; if there is abdominal pain, diarrhea will likely occur.
When the tongue has no coating and feels cold and slippery, the pulse is faint with aversion to cold, and the body curls up in bed, it indicates Cold invading the Shaoyin channel (Shaoyin Zhonghan). In Zang-Jie syndrome, if the tongue has a slippery white coating, it is difficult to treat. When the arms cannot be lifted, the root of the tongue is dry, frequent sighing occurs, chest pain prevents turning over, and eating leads to vomiting and sweating, it indicates Cold invading the Liver (Gan Zhonghan). When the tongue has no coating and is dry, it signifies insufficiency of the Kidney essence and exhaustion of body fluids. When the center of the tongue coating is thick, black, and dry, it is called "Baked Tongue" (Beishe), indicating pathogenic transmission to the Shaoyin channel with extreme heat causing fluid depletion.
When there is both aversion to cold and fever, but body fluids remain normal, the pathogen is in the exterior of the Taiyang channel. A thick, dry white coating, absence of sweat, aversion to cold, and body pain indicate the exterior condition has not resolved. In febrile diseases lasting five or six days, dry mouth, dry tongue, and thirst indicate Shaoyin disease. Dry tongue, swollen throat, upward rushing qi, dry and painful throat, irritability, and heart pain indicate the disease is located in the Foot-Shaoyin channel. Dry throat and thirst with a non-slippery, astringent tongue coating indicate pathogenic transmission to the Jueyin channel. Dry body fluids with a tongue coating indicate the transmission of exterior pathogens to the interior. A scorched tongue, withered lips, dryness like wax, and dry throat indicate closed pores and inability to sweat.
After purging or vomiting in Shanghan (Cold Damage), if the disease persists for seven or eight days, with occasional aversion to wind, extreme thirst, dry and irritable tongue, and desire to drink several liters of water, it indicates Heat binding in the interior with heat in both the interior and exterior. Desire to drink water, dry mouth, and dry tongue indicate Heat in the interior consuming body fluids. Black prickles on the tongue that are cracked and dry indicate extreme heat and exhaustion of fluids. Gray-black tongue with dry prickles in the center, dry throat, and dry mouth indicate Heat binding in the Shaoyin. Full tongue black coating with large prickles, dryness, and a red base indicates an excess pattern suitable for purgation therapy.
On the eleventh day of Shanghan, if the tongue becomes dry followed by sneezing, it indicates the decline of Shaoyin disease. In dysentery, a yellow, dry tongue without thirst, fullness in the chest, and unceasing diarrhea constitutes a fatal syndrome. Abdominal fullness, dry mouth, and dry tongue indicate Water-Qi in the intestines. A black, coating-less, and dry center of the tongue indicates injury to body fluids with hyperactivity of deficiency fire.
These are the statements from various books regarding body fluids. I propose: A pale-red tongue with a thin, slippery coating indicates Internal Cold. A deep-red tongue with a thick, slippery coating indicates External Cold. A thin, astringent coating with a pale-red tongue indicates Deficient Heat. A thick, astringent coating with a deep-red tongue indicates Excess Heat. However, when righteous Qi is deficient, the presence or absence of pathogenic factors must be distinguished; when pathogens are excess, the strength or weakness of righteous Qi varies. One should combine these with the Five Methods and consider the Four Seasons to avoid damaging the deficient and augmenting the excess.
Regarding tongue examination, patients should eat after diagnosis so that the thickness of the coating is easy to distinguish, and drink after diagnosis so that the slipperiness or astringency is easy to identify. For tongues with dry, black coatings, one should wipe the coating with honey before observing its color and shape. Reddish tongues are treatable; bluish-black tongues are untreatable. This is also what should be known from tongue inspection. As for the differentiation of tongue regions, based on color, shape, coating, or fluids, one can infer analogously, so they are not collected here.