再黄苔不甚浓而滑者,热未伤津,犹可清热透表;若虽薄而干者,邪虽去而津受伤也,苦重之药当禁,宜
甘寒轻剂养之。
再论其热传营,舌色必绛。绛、深红色也。初传,绛色中兼黄白色,此气分之邪未尽也,泄卫透营,两和
可也;纯绛鲜泽者,包络受邪也,宜犀角、鲜生地、连翘、郁金、石菖蒲等清泄之。延之数日,或平素心虚有
痰,外热一陷,里络即闭,非菖蒲、郁金等所能开,须用牛黄丸、至宝丹之类以开其闭,恐其昏厥为痉也。
再论舌绛而干燥者,火邪劫营,凉血清血为要。色绛而舌心干者,乃心胃火燔,劫烁津液,即黄连、石膏
亦可加入。
其有舌心独绛而干者,亦胃热而心营受灼也,当于清胃方中加入清心之品,否则延及于尖,为津干火盛之
候矣。舌尖独绛而干,此心火上炎,用导赤散泻其腑。
若烦渴烦热,舌心干,四边色红,中心或黄或白者,此非血分也,乃上焦气热烁津,急用凉膈散散其无形
之热,再看其后转变可也。慎勿用血药,反致滋腻留邪。
至舌绛望之若干,手扪之原有津液,此津亏湿热熏蒸,将成浊痰,蒙闭心包也;舌色绛而上有粘腻似苔非
苔者,中挟秽浊之气,急加芳香逐之;舌绛而抵齿难伸退场门者,痰阻舌根,有内风也;舌绛而光亮者,胃阴亡
也,急用甘凉濡润之品;舌绛而有碎点黄白者,将生疳也;大红点者,热毒乘心也,用黄连、金汁;其有虽绛
而不鲜,干枯而痿者,此肾阴涸也,急以阿胶、鸡子黄、地黄、天冬等救之,缓则恐涸极而无救也。
另外,如果舌苔黄但不深厚且湿润,说明热邪尚未损伤津液,仍然可以采用清热透表的方法治疗;如果舌苔虽然薄但干燥,说明邪气虽去但津液已受伤,应当禁止使用苦寒重剂,适宜用甘寒轻剂来滋养。
再论述热邪传入营分的情况,舌色必定呈现绛色(深红色)。初传时,绛色中兼有黄白色,这是气分之邪未尽的表现,采用泄卫透营、使卫气与营气调和的方法即可;如果是纯绛色且鲜艳润泽的,说明包络受邪,适宜用水牛角、鲜生地、连翘、郁金、石菖蒲等药物进行清泄。拖延数日,或者平素心虚有痰的人,外热一旦内陷,里络就会闭塞,这就不是菖蒲、郁金等药物所能开通的了,必须使用牛黄丸、至宝丹之类的药物来开窍闭,以防出现昏厥和痉挛。
再论述舌绛而干燥的情况,这是火邪劫夺营阴,以凉血清血为主要治法。如果舌色绛而舌中心干燥,这是心胃火盛,灼伤津液,此时黄连、石膏也可以加入方中。
如果有舌中心独独绛而干燥的,这也是胃热导致心营被灼伤,应当在清胃的方剂中加入清心的药物,否则病情会蔓延到舌尖,成为津液干枯、火气旺盛的征候。如果只有舌尖独独绛而干燥,这是心火上炎,使用导赤散来泻其腑热。
如果出现烦躁口渴、烦热,舌中心干燥,舌头四边颜色红,中心或黄或白的情况,这不属于血分病,而是上焦气分热盛灼伤津液,急需使用凉膈散来疏散无形的热邪,然后再观察后续的病情变化。千万不要使用血分药,否则反而会导致滋腻留滞邪气。
至于舌绛看起来干燥,但用手触摸却发现原有津液的,这是津液亏损、湿热熏蒸,将要形成浊痰蒙蔽心包;舌色绛而上有粘腻、似苔非苔的,是中间夹杂秽浊之气,急需加入芳香药物驱逐它;舌绛且抵住牙齿难以伸缩的,是痰阻舌根,有内风;舌绛且光亮的,是胃阴亡失,急需使用甘凉濡润的药物;舌绛而有碎点黄白色的,将要发生疳积;有大红点的,是热毒乘心,使用黄连、金汁;有的虽然绛色但不鲜艳,干枯萎缩的,这是肾阴枯竭,急需以阿胶、鸡子黄、地黄、天冬等药物救治,迟缓则恐怕枯竭至极而无法挽救了。
Furthermore, if the yellow coating is not thick and is moist, it indicates that heat has not yet injured the body fluids (Jin-Ye), and clearing heat and venting the exterior can still be employed. If the coating is thin but dry, although the pathogenic factor has been expelled, the body fluids have been damaged; heavy bitter-cold medicines should be prohibited, and mild sweet-cold agents are suitable for nourishment.
Regarding the transmission of heat to the Ying (Nutritive) level, the tongue color must become crimson (Shen Hong Se). Crimson denotes a deep red color. In the initial stage of transmission, if the crimson color is mixed with yellow or white, this indicates that the pathogenic factors in the Qi (Energy) level have not yet been fully resolved; venting the Wei (Defensive) level and penetrating the Ying level to harmonize both is appropriate. If the tongue is purely crimson and bright/moist, it indicates that the Pericardium (Bao Luo) is affected by pathogens; clearing and draining should be performed using substances such as Rhinoceros Horn (Xi Jiao - *Note: substitute with Buffalo Horn in modern practice*), Fresh Rehmannia Root (Xian Sheng Di), Forsythia Fruit (Lian Qiao), Curcuma Aromatica Rhizome (Yu Jin), and Acorus Tatarinowii Rhizome (Shi Chang Pu). If this condition persists for several days, or if the patient has a pre-existing deficiency of the Heart with phlegm, the external heat sinking inward will cause closure of the interior collaterals. At this point, Shi Chang Pu and Yu Jin alone cannot open the blockage; one must use pills such as Niu Huang Wan (Calculus Bovis Pill) or Zhi Bao Dan (Precious Treasure Pill) to open the orifices, fearing the onset of coma and convulsions.
Regarding a crimson and dry tongue, this signifies fire pathogens robbing the Ying level; cooling the blood and purifying the blood are essential. If the tongue is crimson with dryness at the center, it indicates blazing fire in the Heart and Stomach scorching the body fluids; Coptis Rhizome (Huang Lian) and Gypsum Fibrosum (Shi Gao) may also be added.
If only the center of the tongue is crimson and dry, this is due to Stomach heat scorching the Heart Ying level. Clearing-Heart herbs should be added to formulas that clear the Stomach; otherwise, the condition will spread to the tip, becoming a sign of dried fluids and excessive fire. If only the tip of the tongue is crimson and dry, this indicates Heart Fire flaming upward; Dao Chi San (Guide Out Red Powder) should be used to drain the Fu organ heat.
If there is irritability, thirst, and vexatious heat, with a dry tongue center, red sides, and a center that is either yellow or white, this does not belong to the Blood level but rather to excessive heat in the Upper Jiao (Upper Burner) scorching the fluids. One must urgently use Liang Ge San (Cool the Diaphragm Powder) to dissipate the formless heat, and then observe subsequent changes. Carefully avoid using Blood-level herbs, as they may cause dampness and stickiness, trapping the pathogen.
If the tongue appears crimson and dry to the eye, but feels moist upon touch, this indicates fluid deficiency with steaming damp-heat, which is about to form turbid phlegm clouding the Pericardium. If the crimson tongue has a greasy, moss-like coating that is not quite true moss, it implies the presence of foul turbid qi; aromatic drugs should be urgently added to expel it. If the crimson tongue is stiff against the teeth and difficult to extend or retract, it indicates phlegm obstructing the root of the tongue and the presence of internal wind. If the tongue is crimson and glossy/lustrous, it indicates the exhaustion of Stomach Yin; urgent treatment with sweet-cool and moistening agents is required. If the crimson tongue has small yellow or white spots, it suggests the impending development of gan syndrome (nutritional disorder). If there are large red dots, it indicates toxic heat affecting the Heart; Coptis Rhizome (Huang Lian) and Jin Zhi (Gold Juice) should be used. If the tongue is crimson but not bright, dry, shriveled, and flaccid, this indicates the exhaustion of Kidney Yin; urgent rescue with Donkey-Hide Gelatin (E Jiao), Egg Yolk (Ji Zi Huang), Rehmannia Root (Di Huang), and Asparagus Tuber (Tian Dong) is necessary. Delaying treatment risks extreme exhaustion from which there may be no recovery.