（增补）
张三锡曰∶“《金镜录》载三十六舌以辨伤寒之法已备，再三讨论，不过阴阳、表里、虚实、寒热而
已。”陶节庵曰∶“伤寒邪在表，则舌无苔；热邪传里，舌苔渐生，自白而黄，黄而黑，甚则
黑裂。黑苔多凶，如根黑、中黑、尖黑皆属热；全黑属热极，为难治矣。”
外感挟内伤宿食重而结于心下者，五六日舌渐黄；或中干旁润，名中焙舌，则里热未重；若全干黄黑，
皆为里症，分轻重下之。如下之或再下之不减者，尚有宿垢结于中宫也。必切其脉之虚实，及中气之何如。
实者宜润而下之，不可再攻。虚人神气不足，宜回其津液，固其中气，有用生脉散对解毒汤而愈者，此则阳
极似阴之症；有用附子理中汤冷服而愈者，此则阴极似阳之症，不可不辨。
白苔属寒，外症烦躁，欲坐卧泥水中，乃阴寒逼其无根之火而然，脉虽大而不鼓，当从阴症治；若
不大躁者、呕吐者，当从食阴治。
（增补）
尸臭。（肉绝。）舌卷及囊缩。（肝绝。）口不合。（脾绝）肌肿唇反。（胃绝。）发直齿
枯。（骨绝。）遗尿。（肾绝）毛焦。（肺绝。）
面黑直视。目瞑不见。（阴绝。）目眶陷，目系倾。汗出如珠。（阳绝。）
手撒戴眼。（太阳绝。）病后喘泻。（脾肺将绝。）目正圆，痉。（不治。）
吐沫面赤。面青黑。唇青，人中满。发与眉冲起。爪甲下肉黑。手掌无纹。脐突。足趺肿。声如鼾睡。脉
浮无根。面青伏眠，目盲。汗出如油。（以上肝绝，八日死。）眉倾。（胆绝。）手足爪甲青，或
脱落，呼骂不休。（筋绝，八日死。）肩息回视（心绝，立死。）发直如麻，不得屈伸，自
汗不止。（小肠绝，六日死。）口冷足肿，腹热胪胀，泄利无时。（脾绝，五日死。）脊骨疼
肿，身重不可转侧。（胃绝，五日死。）耳干舌肿，溺血，大便赤泄。（肉绝，九日死。）
口张，气出不反（肺绝，三日死。）泄利无度。（大肠绝。）齿干枯，面黑目黄，腰欲折，自汗。（肾绝。）
（增补）
张三锡说：“《金镜录》记载了通过观察三十六种舌象来辨别伤寒的方法已经完备，反复讨论其内容，不过就是阴阳、表里、虚实、寒热这几种辨证纲领罢了。”陶节庵说：“伤寒邪气在体表时，舌头上没有苔；当热邪传入体内时，舌苔逐渐生成，由白色转为黄色，再由黄色转为黑色，严重时甚至出现黑裂。黑苔大多预后不良，如舌根发黑、舌中发黑、舌尖发黑都属于热证；全舌发黑属于热极，是难以治疗的病症。”
如果是外感病兼有内伤宿食，且积滞严重结聚在心下部位，经过五六天后舌苔逐渐变黄；或者舌苔中间干燥而四周湿润，这种舌象称为“中焙舌”，说明体内的热邪还不算严重；如果舌苔完全干燥并呈现黄黑色，都属于里证，需要根据病情轻重使用泻下法治疗。如果使用泻下法或再次泻下后症状仍未减轻的，说明还有宿便垢浊结聚在中焦脾胃。此时必须诊察脉象的虚实情况，以及中气（脾胃之气）的状态。脉实者适宜用润下法通便，不可再次强行攻下。体质虚弱、神气不足的人，适宜恢复津液，固护中气，有用生脉散配合解毒汤治愈的案例，这属于阳极似阴的证候；有用附子理中汤冷服治愈的案例，这属于阴极似阳的证候，这两者不可不加以辨别。
白苔主寒证，若伴有外在的烦躁症状，患者想要坐在泥水中降温，这是阴寒之邪逼迫无根之火上浮所致，虽然脉象盛大但不鼓指有力，应当按阴证治疗；如果患者并不特别躁动，或者有呕吐症状的，应当按食积阴证治疗。
（增补）
散发尸臭。（代表肉绝。）舌头卷缩及睾丸上缩。（代表肝绝。）口不能闭合。（代表脾绝。）肌肉肿胀且嘴唇外翻。（代表胃绝。）头发直立且牙齿枯槁。（代表骨绝。）遗尿失禁。（代表肾绝。）毛发焦枯。（代表肺绝。）
面色黧黑且两眼直视，眼睛闭合看不见东西。（代表阴绝。）眼眶深陷，眼球系带倾斜，出汗像珍珠一样大颗滴落。（代表阳绝。）
手撒开且眼睛上视。（代表太阳经气绝。）病后出现气喘和腹泻。（代表脾肺之气将绝。）眼睛固定直视不动，出现痉挛。（无法治愈。）
吐沫且面色红润，或面色青黑，嘴唇青紫，人中穴部位饱满，头发与眉毛向上竖起，指甲下的肌肉发黑，手掌没有纹路，肚脐突出，足背肿胀，声音像打鼾一样，脉象浮取无根，面色青暗伏卧，双目失明，出汗如油。（以上均为肝绝的表现，八日后死亡。）眉毛脱落。（代表胆绝。）手脚指甲发青，或者脱落，呼叫谩骂不停止。（代表筋绝，八日后死亡。）呼吸时肩膀耸起，目光回顾不定。（代表心绝，立即死亡。）头发直立如乱麻，身体僵硬不能屈伸，自汗不止。（代表小肠绝，六日后死亡。）口冷足肿，腹部发热且胸腹胀满，泄泻无定时。（代表脾绝，五日后死亡。）脊柱疼痛肿胀，身体沉重无法翻身侧卧。（代表胃绝，五日后死亡。）耳朵干枯，舌头肿胀，尿血，大便赤色稀泄。（代表肉绝，九日后死亡。）
嘴巴张开，气息呼出而不收回（代表肺绝，三日后死亡。）泄泻无度。（代表大肠绝。）牙齿干枯，面色黝黑，眼白发黄，腰部感觉要折断，自汗。（代表肾绝。）
(Added Supplement)
Zhang Sanxi stated: "The *Jin Jing Lu* (Record of the Golden Mirror) records thirty-six tongue appearances for differentiating Shanghan (Cold Damage), and its methods are already comprehensive. Repeated discussion reveals that it essentially revolves around the principles of Yin-Yang, Exterior-Interior, Deficiency-Excess, and Cold-Heat." Tao Jian'an stated: "When Shanghan pathogens are in the exterior, there is no coating on the tongue; when heat pathogens transmit to the interior, tongue coating gradually appears, turning from white to yellow, and then to black. In severe cases, it may crack. Black coating is mostly ominous; blackness at the root, center, or tip all indicate Heat syndromes; a completely black tongue indicates extreme Heat and is difficult to treat."
In cases where an external contraction is complicated by internal injury and heavy retention of undigested food, which knots below the heart, after five or six days the tongue gradually turns yellow. If the center is dry while the sides remain moist, this is called a 'Zhong Bei Tongue' (Middle-Baked Tongue), indicating that the interior heat is not yet severe. If the entire tongue is dry with yellow or black coating, these are all Interior Syndromes, requiring purgation according to severity. If symptoms do not improve after purgation or repeated purgation, it indicates that residual fecal matter remains knotted in the Middle Jiao (Central Palace). One must palpate the pulse to determine deficiency or excess, and assess the state of the Middle Qi (Spleen-Stomach Qi). For Excess patterns, moistening purgation is suitable, and one should not attack again. For deficient individuals with insufficient Shen Qi (Spirit Qi), it is appropriate to restore body fluids and consolidate Middle Qi. There are cases cured using Sheng Mai San (Generate the Pulse Powder) combined with Jie Du Tang (Resolve Toxicity Decoction); this represents a Yang-extreme resembling Yin syndrome. There are also cases cured by taking Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) cold; this represents a Yin-extreme resembling Yang syndrome. These two must be carefully distinguished.
White coating belongs to Cold. If accompanied by external restlessness, with the patient desiring to sit in mud or water, this is caused by Yin-Cold forcing the rootless fire upward. Although the pulse is large, it does not beat vigorously against the fingers; treatment should follow the Yin Syndrome protocol. If the patient is not extremely restless or has vomiting, treatment should follow the Food-Stagnation Yin Syndrome protocol.
(Added Supplement)
Corpse-like odor. (Indicates Ru Jue - Extinction of Flesh.) Tongue rolling and testicular retraction. (Indicates Gan Jue - Extinction of Liver.) Mouth unable to close. (Indicates Pi Jue - Extinction of Spleen.) Muscle swelling and lip eversion. (Indicates Wei Jue - Extinction of Stomach.) Hair standing erect and teeth withered. (Indicates Gu Jue - Extinction of Bone.) Enuresis. (Indicates Shen Jue - Extinction of Kidney.) Brittle hair. (Indicates Fei Jue - Extinction of Lung.)
Dark complexion with fixed gaze. Eyes closed and unable to see. (Indicates Yin Jue - Extinction of Yin.) Sunken eye sockets, tilted ocular axis. Sweating like pearls. (Indicates Yang Jue - Extinction of Yang.)
Hand relaxation and eyes rolling upward. (Indicates Taiyang Meridian Extinction.) Post-illness wheezing and diarrhea. (Indicates impending extinction of Spleen and Lung.) Eyes fixed straight, spasms. (Incurable.)
Spitting foam with red face. Dark green-black face. Cyan lips, fullness in the philtrum. Hair and eyebrows pointing upward. Black flesh under fingernails. Palm without lines. Umbilical protrusion. Dorsum pedis swelling. Snoring sound. Floating pulse without root. Dark green complexion with prone posture, blindness. Sweating like oil. (All above indicate Liver Extinction, death within eight days.) Eyebrow loss. (Indicates Gallbladder Extinction.) Cyan nails on hands and feet, or nail shedding, incessant shouting and cursing. (Indicates Sinew Extinction, death within eight days.) Shoulder breathing and backward gaze. (Indicates Heart Extinction, immediate death.) Hair straight like hemp, inability to flex or extend, continuous spontaneous sweating. (Indicates Small Intestine Extinction, death within six days.) Cold mouth and swollen feet, abdominal heat and distension, unregulated diarrhea. (Indicates Spleen Extinction, death within five days.) Spinal pain and swelling, heaviness of body unable to turn. (Indicates Stomach Extinction, death within five days.) Dry ears and swollen tongue, hematuria, red loose stools. (Indicates Flesh Extinction, death within nine days.)
Mouth open, breath exits but does not return. (Indicates Lung Extinction, death within three days.) Unremitting diarrhea. (Indicates Large Intestine Extinction.) Withered teeth, dark face, yellow sclera, sensation of waist breaking, spontaneous sweating. (Indicates Kidney Extinction.)