疹痧得以外达。再议清火清痰。渐入养阴之品。以上七歌。统论舌色之红绛。辨症之温
暑湿温。
舌绛碎生黄白点。热淫湿 欲生疳。古名狐蜮皆同此。杂症伤寒仔细探。
【廉勘】吴氏曰。狐蜮。即牙疳下疳之古名也。皆属虫症。牙疳即蜮。上唇有疮。
虫食其脏。蚀唇则上唇内
生疮如粟。蚀齿则腐龈。甚则脱牙穿腮破唇。蚀肺则咳血唾血。心内懊 而痛。甚则失
音声哑。金匮统用甘草泻心汤。（清炙草、黄连、黄芩、干姜、半夏、人参、大枣。）
和胃杀虫。外吹珠黄十宝散。（滴乳石八分、苏薄荷儿茶各一钱二分、制川柏一钱、人
中白六分、化龙骨五分、梅冰四分、飞辰砂一分五厘、牛黄珠粉各一分。）不论走马
牙疳。穿牙疔毒。及骨槽风。初生小儿胎毒口疳。频吹皆妙。若黑腐。原方加真铜绿一
钱二分。
灯草灰六分。胡黄连三分。下疳即狐。下唇有疮。虫食其肛。蚀烂肛阴。咽干便脓
。如肠毒痔漏肛痈之类。《金匮》用赤小豆当归散。（赤小豆浸芽出三钱、当归钱半。
）排脓活血。外用苦参汤（苦参一两煎汤、乘热熏洗三次。）洗之。雄黄（雄黄末二钱
、筒瓦二枚合之、烧向肛熏之。）其症状如伤寒。默默欲眠。目不得闭。卧起不安。不
欲饮食。恶闻食臭。其面目乍赤乍白乍黑。此皆虫扰之候也。以上一歌。论舌绛碎而有
黄白腐点。辨症之湿热蒸腐化虫。为狐为蜮之害人。
舌绛不鲜枯更痿。肾阴已涸救之难。紫而枯晦凋肝肾。红泽而光胃液干。
【廉勘】吴氏曰。舌形紫晦如猪肝色。绝无津液者为枯。舌形敛缩。伸不过齿者为
痿。此肝肾已败。不治。若舌色红泽而光。其色鲜明者。属胃阴干涸。犹可滋养胃阴。
甘凉纯静之品主之。如鲜生地、鲜石斛、蔗浆、梨汁之类。以上一歌。论舌紫枯痿。及
舌红润而光。辨症之不治可治。
苔形粉白四边红。疫入膜原势最雄。急用达原加引药。一兼黄黑下匆匆。
【廉勘】吴氏曰。凡时症初起。苔形粉白而浓。四边红绛者。此疫症也。邪在膜原
。其势最雄。顷刻传变。诊家不可轻视。吴又可用达原饮加引经表药。透之达之。如兼
太阳加羌活。阳明加葛根。少阳加柴胡。如舌变黄燥色。乃疫邪入胃。加大黄下之。如
变黑色。入里尤深。用承气加解毒药下之。疫势甚者。其舌一日三变。
由白变黄。由黄变黑。当速下之。
若见鲜红纯绛色。疫传胞络及营中。清邪解毒银犀妙。菖郁金黄温暑通。
【廉勘】吴氏曰。温疫一症。治分两途。但看舌苔白而黄。黄而黑者。疫邪自表入
里。汗之下之可也。如见舌苔鲜红绛色。此疫邪入于营分及胞络之间。汗下两禁。惟宜
清营解毒。逐秽开闭。如犀角、银花、菖蒲、郁金、西黄、金汁、人中黄之类。与温热
暑症。治法相通。
疹 色白松肌表。血热知丹犀莫迟。舌白荆防翘薄力。舌红切忌葛升医。
【廉勘】吴氏曰。疹 发于气分。其色淡红而白者。舌苔亦白。宜葛根、防风、蝉
蜕、荆芥、连翘、薄荷、牛蒡等。松肌达表。若见赤 丹疹。邪在营分血分。舌必绛赤
。宜犀角、连翘、鲜生地、人中黄、净银花等。透营解毒。大忌升、葛、足经之药。以
上三歌。统论舌色之红绛。及舌苔之兼白兼黄。辨疫症之分途。
凡属正虚苔嫩薄。淡红
微白补休迟。浓黄腻白邪中蕴。诊者须知清解宜。
【廉勘】吴氏曰。不拘伤寒杂症。正气虚者。其舌苔必娇嫩而薄。或淡红。或微白
。皆可投补。若见黄而白。浓而腻。总属内邪未清。不可遽进补药。以上一歌。总论舌
质之老嫩。及舌苔之黄白浓薄。辨症候虚实之要诀。统计吴氏三十二歌。最切时用。
予曾刊入于感证宝筏中。兹又重为增删。附录于此。以便学人记诵。近惟刘氏吉人。亦
多所发明。试为之节述其说曰。（二）白苔类总论。白苔有浓薄疏密之殊。其形似亦有浅
深间杂之异。有薄白如米饮敷舌者。此伤寒中寒之初候也。无表症者饮停膈上也。有白
滑如豆浆敷舌者。此伤寒中寒湿邪痰饮等病也。当以脉症分别断之。白而浓如豆腐脑铺
舌者。痰热症也。白而疏如米粉铺舌者。伤寒伤暑初传之候也。白如粟米成颗粒者。热
邪在气分也。白如银色光亮者。热症误补之变苔也。白如旱烟灰色者。不问
润燥。皆热症误燥之变苔也。白如银锭底而有孔者。此热症误补误燥。津液已伤。元气
欲陷。邪将深入之候也。白如腐渣堆者。此热症误燥。腐浊积滞胃中。欲作下症也。
如中心开裂。则为虚极反似实症之候。当补气。须以脉症分别之。似白非白。如画工以
脂调粉者为雪青色。有深浅二种。浅者如雪青湖绉色。此乃热邪入营初候。深者如雪青
杭绉色。此乃暑热二邪已入血分之候。（此苔类似薄白、但青质红而细看有乳头微点者
、故以雪青色名之、为血分症必有之苔、常见之苔也、但人以白苔视之、多误作寒病、
故特提出以醒眉目、古人但以舌绛二字了之、后学何从解悟、故以细心体认比例法直告
之、俾无误认之弊。）舌质深红如红萝卜干有盐霜者。乃热邪深入久留。误投攻燥之药
。胃阴大伤之候。温热末传危症也。（三）黄苔类总论。黄色有深浅老嫩之殊。其形似
亦有燥润滑涩之异。有正黄色。老黄色。黄如炒枳壳色。黄如锅焦粑而兼微黑者。有嫩
黄色。牙黄色。有色如表心纸而兼灰青色者。有黄如粟米染黄者。有黄如鱼子者。有黄
如虎斑纹者。有黄如黄蜡敷舌上者。有水黄如鸡子黄白相兼染成者。此皆黄色之类。而
症候之殊。及分别诊断法。已详前六经舌苔勘语中。
（四）舌质无苔类总论。舌质无苔。亦有分别。如舌质紫而无苔者。热在阴分也。舌质
红而无苔者。热邪初入阴分。或老人伤食。胃气不能上升。或忧思郁抑。阳气不能上升
。须以脉症参断。舌光如镜。为胃阴胃阳两伤。肠胃中之茸毛贴壁。完谷不化。饥不受
食之候。亦有顽痰胶滞胃中。茸毛不起。皆有此候。须以脉症诊断。前症完谷阴伤。脉
必细涩。后症痰滞。脉必洪滑而大。质干如刺无苔。紫而干者。热伤阴液。红而干者。
气不化津。须以脉症参断。舌质无苔。中凹如驳去者。胃有燥结伤阴。或盲肠有燥结久
留不去之候。舌质无苔。中有直沟如刀背印成者。阴液元气皆虚也。舌中横裂。素体阴
亏也。舌生裂纹如冰片者。老年阴虚常见之象也。少年罕见。有此不吉。前半光滑无苔
。后根有肉瘤二粒如舌肉色者。阴虚劳症之象也。表面无苔。而皮肉有一块如钱大。或
黄或白者。正气不足。血液又虚。或有痰凝之候。须以脉证参断。苔上见圆晕分二三色
者。燥气内
结。燥屎不下之候。其症必险。苔见青绿二色。必死之症也。（五）苔色变换吉凶总论
。总之黄苔为正。白次之。无论何症。若用药当。皆由白而黄。由黄而退。由退须生新
薄白苔。此为顺象，无论何症。若用药不当。则由黄而白。由白而灰。由灰而黑。由活
苔变为死苔。此逆象也。骤退骤无。不由渐退。此陷象也，更有气聚苔聚。气敛苔敛。
气化苔化。气散布苔亦散布。气凝结苔亦凝结。气结于一边。苔亦结于一边。故气郁之
症。苔边整齐。如石阶之起边线。线内有苔。线外无苔。但红边而已。若气化则散布。
内密而疏散。则不似斩然齐一之边矣。故苔有边齐如斩者。皆气聚也。有积滞抑郁者也
。若苔之真退真化。与驳去骤退有别。真退必由化而后退。何谓化退。因苔由浓而渐薄
。由板而生孔。由密而渐疏。由舌根外达至舌尖。由尖渐变疏薄。由退而复生新苔。此
皆吉兆。若骤然退去。不复生新苔。或如驳去。斑斑驳驳。存留如豆腐屑铺舌上。东一
点西一点。散离而不连续。皆逆象也。皆因误攻误消或误表所致。胃气胃汁俱伤。故有
此候。
【荣斋按】刘吉人察舌辨证法第一条，已见于本章第二节何廉臣先生勘语中，故此
处仅从第二条“白苔总论”起。
疹子和痧气得以向外透发。再讨论清泻火热、清除痰浊，逐渐加入滋养阴液的药物。以上七首诗歌，总论舌色红绛的辨证，区分温病、暑病、湿病和温病的证候。
舌面红绛且破碎，表面生出黄白色斑点，这是热邪炽盛兼夹湿邪，想要生成疳积之症。古时候称为狐蜮的病，都与此类似。杂病和伤寒需要仔细探求。
【廉臣按】吴氏说：狐蜮，就是牙疳和下疳的古名。都属于虫蚀之症。牙疳即蜮，上唇生疮，虫类啃食内脏。侵蚀嘴唇则上唇内生疮如粟米状；侵蚀牙齿则牙龈腐烂，甚至牙齿脱落、脸颊穿孔、嘴唇破裂；侵蚀肺部则咳血、唾血；心中烦闷懊恼而痛，甚至失音嘶哑。《金匮要略》统用甘草泻心汤。（由清炙甘草、黄连、黄芩、干姜、半夏、人参、大枣组成。）调和胃气，杀虫解毒。外用珠黄十宝散。（由滴乳石八分、苏薄荷、儿茶各一钱二分、制川柏一钱、人中白六分、化龙骨五分、梅冰四分、飞辰砂一分五厘、牛黄珠粉各一分组成。）不论走马牙疳、穿牙疔毒，还是骨槽风，或是初生小儿胎毒口疳，频繁吹药皆有效。若出现黑色腐烂，原方中加入真铜绿一钱二分、灯草灰六分、胡黄连三分。下疳即狐，下唇生疮，虫类啃食肛门。侵蚀腐烂肛阴，咽喉干燥，大便脓血，如同肠毒、痔漏、肛痈之类的病症。《金匮要略》使用赤小豆当归散。（赤小豆浸泡发芽出三钱、当归一两半。）排脓活血。外用苦参汤（苦参一两煎汤，趁热熏洗三次）清洗。雄黄（雄黄末二钱、筒瓦二枚合拢，烧向肛门熏蒸）。其症状如同伤寒，沉默嗜睡，眼睛不能闭合，坐卧不安，不想饮食，厌恶食物气味，面目时而发红、时而发白、时而发黑，这都是虫扰动的征候。以上一首歌，论述舌面红绛破碎且有黄白色腐点，辨别湿热蒸腐化虫，成为狐蜮害人的证候。
舌面红绛但不鲜活，干枯萎缩，肾阴已经枯竭，难以救治。舌色紫暗且干枯晦暗，是肝肾衰竭；舌色红泽光亮，是胃液干枯。
【廉臣按】吴氏说：舌形紫暗如猪肝色，完全没有津液的是枯；舌形收敛缩小，伸不出牙齿的是痿。这是肝肾已败坏，无法治疗。如果舌色红泽光亮，颜色鲜明，属于胃阴干涸，还可以滋养胃阴，以甘凉纯静性质的药物为主治。如鲜生地、鲜石斛、蔗浆、梨汁之类。以上一首歌，论述舌紫枯痿，以及舌红润而光亮的证候，辨别不治与可治的区别。
苔形粉白，四边红赤，疫邪进入膜原，势头最猛。急用达原饮加上引经药。一旦兼见黄黑色，需急忙攻下。
【廉臣按】吴氏说：凡是时行病症初起，苔形粉白而浓厚，四边红绛的，这是疫病。邪气在膜原，势头最猛，顷刻间就会传变，诊察者不可轻视。吴又可主张用达原饮加引经表药，透达邪气。如果兼有太阳经症状加羌活，阳明经症状加葛根，少阳经症状加柴胡。如果舌变黄燥色，是疫邪入胃，加大黄攻下。如果变黑色，入里更深，用承气汤加解毒药攻下。疫病势重的，舌象一天变化三次，由白变黄，由黄变黑，应当迅速攻下。
如果见到鲜红纯绛色，疫邪传入胞络及营分。清解邪毒用犀角、银花巧妙，菖蒲、郁金、金汁、人中黄用于温暑通窍。
【廉臣按】吴氏说：温疫一症，治疗分为两途。只看舌苔白而黄，黄而黑的，是疫邪从表入里，可以用汗法或下法。如果见到舌苔鲜红绛色，这是疫邪进入营分和胞络之间，汗法和下法都禁止，只宜清营解毒，逐秽开闭。如犀角、银花、菖蒲、郁金、西黄、金汁、人中黄之类，与温热暑症的治法相通。
疹子颜色白，松肌发表，如果是血热知丹犀莫迟。舌白用荆芥、防风、连翘、薄荷力效。舌红切忌用葛根、升麻医治。
【廉臣按】吴氏说：疹子发于气分，颜色淡红而白的，舌苔也是白的，宜用葛根、防风、蝉蜕、荆芥、连翘、薄荷、牛蒡等，松肌达表。如果见到赤色丹疹，邪在营分血分，舌必绛赤，宜用犀角、连翘、鲜生地、人中黄、净银花等，透营解毒。大忌升麻、葛根及足经的药物。以上三首歌，总论舌色红绛，以及舌苔兼白兼黄的证候，辨别疫症的分途治疗。
凡是正气虚弱，苔质嫩薄，淡红微白，补益不要迟疑。浓黄腻白是邪气蕴结，诊察者须知宜用清解法。
【廉臣按】吴氏说：不拘伤寒杂症，正气虚的人，其舌苔必定娇嫩而薄，或淡红，或微白，都可以投用补药。如果见到黄而白，浓而腻，总属内邪未清，不可急于进补药。以上一首歌，总论舌质的老嫩，以及舌苔的黄白浓薄，辨别症候虚实的关键。统计吴氏三十二首歌，最切合实用。我曾刊印在《感证宝筏》中，现在又重新增删，附录在此，以便学习者记诵。近来只有刘氏吉人，也有许多发明。试节述他的学说如下：
（二）白苔类总论。白苔有浓薄疏密的不同，其形态也有浅深间杂的差异。有薄白如米饮敷在舌面上的，这是伤寒中寒的初候。没有表证的，是饮水停滞膈上。有白滑如豆浆敷在舌面上的，这是伤寒中寒湿邪、痰饮等病。应当以脉症分别判断。白而浓如豆腐脑铺在舌面上的，是痰热症。白而疏如米粉铺在舌面上的，是伤寒伤暑初传的候象。白如粟米成颗粒状的，是热邪在气分。白如银色光亮的，是热症误补后的变苔。白如旱烟灰色的，不问润燥，都是热症误用燥药后的变苔。白如银锭底而有孔的，这是热症误补误燥，津液已伤，元气欲陷，邪将深入的候象。白如腐渣堆的，这是热症误燥，腐浊积滞胃中，将要形成下症。如果中心开裂，则是虚极反似实症的候象，应当补气，须以脉症分别判断。似白非白，如画工以脂调粉为雪青色，有深浅两种。浅的如雪青湖绉色，这是热邪入营的初候；深的如雪青杭绉色，这是暑热二邪已入血分的候象。（此苔类似薄白，但青质红而细看有乳头微点，故以雪青色名之，为血分症必有之苔，常见之苔也，但人以白苔视之，多误作寒病，故特提出以醒眉目，古人但以舌绛二字了之，后学何从解悟，故以细心体认比例法直告之，俾无误认之弊。）舌质深红如红萝卜干有盐霜的，乃热邪深入久留，误投攻燥之药，胃阴大伤的候象，是温热的末传危症。
（三）黄苔类总论。黄色有深浅老嫩的不同，其形态也有燥润滑涩的差异。有正黄色、老黄色、黄如炒枳壳色、黄如锅焦粑而兼微黑的；有嫩黄色、牙黄色、有色如表心纸而兼灰青色的；有黄如粟米染黄者、有黄如鱼子者、有黄如虎斑纹者、有黄如黄蜡敷舌上者、有水黄如鸡子黄白相兼染成的。这些都是黄色的类别，而症候的不同，及分别诊断法，已在前面六经舌苔勘语中详述。
（四）舌质无苔类总论。舌质无苔，也有分别。如舌质紫而无苔的，是热在阴分。舌质红而无苔的，是热邪初入阴分，或老人伤食，胃气不能上升，或忧思郁抑，阳气不能上升，须以脉症参断。舌光如镜，是胃阴胃阳两伤，肠胃中的茸毛贴壁，完谷不化，饥不受食的候象。也有顽痰胶滞胃中，茸毛不起，都有此候，须以脉症诊断。前症完谷阴伤，脉必细涩；后症痰滞，脉必洪滑而大。质干如刺无苔，紫而干的，是热伤阴液；红而干的，是气不化津，须以脉症参断。舌质无苔，中凹如驳去者，是胃有燥结伤阴，或盲肠有燥结久留不去的候象。舌质无苔，中有直沟如刀背印成的，是阴液元气皆虚。舌中横裂，是素体阴亏。舌生裂纹如冰片的，是老年阴虚常见的象，少年罕见，有此不吉。前半光滑无苔，后根有肉瘤二粒如舌肉色的，是阴虚劳症的象。表面无苔，而皮肉有一块如钱大，或黄或白的，是正气不足，血液又虚，或有痰凝的候象，须以脉证参断。苔上见圆晕分二三色的，是燥气内结，燥屎不下的候象，其症必险。苔见青绿二色的，必死之症。
（五）苔色变换吉凶总论。总之黄苔为正，白次之。无论何症，若用药得当，皆由白而黄，由黄而退，由退须生新薄白苔，此为顺象。无论何症，若用药不当，则由黄而白，由白而灰，由灰而黑，由活苔变为死苔，此逆象也。骤退骤无，不由渐退，此陷象也。更有气聚苔聚，气敛苔敛，气化苔化，气散布苔亦散布，气凝结苔亦凝结。气结于一边，苔亦结于一边，故气郁之症，苔边整齐，如石阶之起边线，线内有苔，线外无苔，但红边而已。若气化则散布，内密而疏散，则不似斩然齐一之边矣。故苔有边齐如斩的，皆气聚也，有积滞抑郁者也。若苔之真退真化，与驳去骤退有别。真退必由化而后退，何谓化退？因苔由浓而渐薄，由板而生孔，由密而渐疏，由舌根外达至舌尖，由尖渐变疏薄，由退而复生新苔，此皆吉兆。若骤然退去，不复生新苔，或如驳去，斑斑驳驳，存留如豆腐屑铺舌上，东一点西一点，散离而不连续，皆逆象也，皆因误攻误消或误表所致，胃气胃汁俱伤，故有此候。
【荣斋按】刘吉人察舌辨证法第一条，已见于本章第二节何廉臣先生勘语中，故此处仅从第二条“白苔总论”起。
Rash and sand (sha) are able to reach the exterior. Then discuss clearing fire and resolving phlegm, gradually adding yin-nourishing substances. The above seven songs generally discuss red and crimson tongue colors, differentiating syndromes of warm diseases, summerheat-dampness, damp-warmth, and warm-summerheat.
The tongue is crimson and fragmented with yellow-white spots growing on it; excessive heat combined with dampness desires to generate gan (ulcerative/microbial disease). Anciently named "Hu" and "Yu" are all similar to this. Miscellaneous diseases and cold damage require careful exploration.
[Lianchen's Note] Mr. Wu said: "Hu" and "Yu" are ancient names for dental gangrene (ya gan) and genital gangrene (xia gan). All belong to worm-infestation syndromes. Dental gangrene is "Yu"; sores appear on the upper lip, worms eat the viscera. Eroding the lips causes sores inside the upper lip like millet grains; eroding teeth causes rotten gums, even tooth loss, cheek perforation, and lip rupture; eroding the lungs causes coughing blood and spitting blood; internal restlessness and pain in the heart, even loss of voice and aphonia. *Jin Gui Yao Lue* uniformly uses Gancao Xiexin Tang (Licorice Decoction for Harmonizing the Stomach). (Composed of Qing Zhi Cao [Qingzhi Licorice Root], Huanglian [Coptis Rhizome], Huangqin [Scutellaria Root], Ganjiang [Dried Ginger], Banxia [Pinellia Tuber], Renshen [Ginseng Radix et Rhizoma], Dazao [Jujube Fruit].) It harmonizes the stomach and kills parasites. Externally, use Zhuhuang Shibao San (Pearl-Yellow Ten-Treasure Powder). (Composed of Dilishi [Mammalite], Su Bohe [Mentha Haplocalyx], Ercha [Catechu], Zhi Chuanbai [Prepared Phellodendri Cortex], Renzhongbai [Calcinatus Urinae Humanus], Hu Longgu [Calcined Fossil Bones], Mei Bing [Borneolum Syntheticum], Fei Chencha [Prepared Cinnabaris], Niuhuang Zhufen [Calculus Bovis Pearl Powder].) Regardless of Zouma Ya Gan (Running Horse Dental Gangrene), Chuanya Dingdu (Tooth-Piercing Carbuncle Toxicity), Gucao Feng (Bone Trough Wind), or newborn infant's fetal toxin mouth ulcers, frequent application is excellent. If black rot appears, add Zhen Tonglv (True Verdigris) 1 qian 2 fen, Dengcao Hui (Juncus Ash) 6 fen, Huhuanglian (Picrorhiza Rhizome) 3 fen to the original formula. Xia gan (Genital Gangrene) is "Hu"; sores appear on the lower lip, worms eat the anus. Eroding and rotting the anal yin, dry throat, purulent stool, similar to intestinal toxicity, hemorrhoids, fistula, and perianal abscess. *Jin Gui* uses Chixiaodou Danggui San (Adzuki Bean and Angelica Decoction). (Chixiaodou soaked until sprouted 3 qian, Danggui 1.5 qian.) It drains pus and invigorates blood. Externally, use Kushen Tang (Sophora Decoction) (Kushen 1 liang decocted in water, fumigated and washed three times while hot). Xionghuang (Realgar) (Xionghuang powder 2 qian, two tube tiles closed together, burned to fumigate the anus). Its symptoms resemble cold damage: silent desire to sleep, eyes unable to close, restless lying and rising, no desire to eat, aversion to food odors, face suddenly red, then white, then black. These are all signs of worm disturbance. The above one song discusses crimson tongues that are fragmented with yellow-white putrid spots, differentiating syndromes where damp-heat steams and rots into worms, becoming Hu and Yu that harm people.
The tongue is crimson but not fresh, dried and atrophied; kidney yin has dried up, difficult to save. Purple and dried/dull indicates liver-kidney decline; red and lustrous/glossy indicates stomach fluid dryness.
[Lianchen's Note] Mr. Wu said: A tongue shape purple and dull like pig liver color, completely lacking fluids, is called "Ku" (dried/withered). A tongue shape contracted and shrunken, unable to extend past the teeth, is called "Wei" (atrophied). This indicates liver and kidney failure, untreatable. If the tongue color is red, lustrous, and glossy, with bright color, it belongs to stomach yin dryness, still treatable by nourishing stomach yin with sweet-cool pure and quiet substances. Such as Xian Shengdi (Fresh Rehmanniae Radix), Xian Shihu (Fresh Dendrobii Caulis), Zhe Jiang (Sugarcane Juice), Li Zhi (Pear Juice). The above one song discusses purple dried/atrophied tongues, and red-lustrous-glossy tongues, differentiating untreatable from treatable syndromes.
Tape form powdery white with red edges; epidemic pathogen enters Mo Yuan (Membrane Source), momentum is most vigorous. Urgently use Da Yuan Yin (Reach the Origin Decoction) plus guiding herbs. Once accompanied by yellow-black, descend urgently.
[Lianchen's Note] Mr. Wu said: Whenever seasonal diseases begin initially, if the coating is powdery white and thick, with red-crimson edges, this is an epidemic disease. The pathogen is in the Mo Yuan, its momentum is most vigorous, transmitting instantly. Physicians must not underestimate it. Wu Youke advocates using Da Yuan Yin plus meridian-guiding exterior-releasing herbs to penetrate and reach it. If accompanied by Taiyang symptoms, add Qianghuo (Notopterygii Rhizoma et Radix); Yangming symptoms, add Gegen (Puerariae Lobatae Radix); Shaoyang symptoms, add Chaihu (Bupleuri Radix). If the tongue turns yellow and dry, the epidemic pathogen has entered the stomach; add Dahuang (Rhei Radix et Rhizoma) to purge. If it turns black, the pathogen has penetrated deeper internally; use Chengqi Tang plus detoxifying herbs to purge. In severe epidemics, the tongue changes three times a day, from white to yellow, from yellow to black; one should purge quickly.
If fresh red and pure crimson colors are seen, the epidemic has transmitted to the Bao Luo (Pericardium Collaterals) and Ying (Nutrient) level. Clearing evil and detoxifying, Xijiao (Rhinocerotis Cornu) and Yinhua (Lonicerae Japonicae Flos) are excellent; Changpu (Acori Tatarinowii Rhizoma) and Yujin (Curcumae Radix), Jinzhi (Gold Juice), Renzhonghuang (Humanus Faeces Depuratus) connect warm-summerheat treatments.
[Lianchen's Note] Mr. Wu said: Warm epidemic syndrome treatment is divided into two paths. Look only at the tongue coating: white turning yellow, yellow turning black, means the epidemic pathogen enters from exterior to interior; sweating and purging methods are applicable. If fresh red-crimson tongue coating is seen, this means the epidemic pathogen has entered the Ying level and between Bao Luo; both sweating and purging are prohibited. Only clearing Ying and detoxifying, removing filth and opening closure is suitable. Such as Xijiao, Yinhua, Changpu, Yujin, Xihuang (Bezoar), Jinzhi, Renzhonghuang, etc., which share therapeutic methods with warm-heat and summerheat syndromes.
Rash color white, loosening muscle and releasing exterior; knowing blood heat Danxi (Red Rash), do not delay Xini (Rhino-Horn). White tongue, Jingfang (Schizonepeta and Saposhnikovia) and Qiaobo (Forsythia and Mint) have strength. Red tongue, strictly avoid Ge Sheng (Pueraria and Cimicifuga) medicine.
[Lianchen's Note] Mr. Wu said: Rash emerges in the Qi level, color pale red and white, tongue coating also white;适宜 Ge Gen (Puerariae Lobatae Radix), Fangfeng (Saposhnikoviae Radix), Chantui (Cicadae Periostracum), Jingjie (Schizonepetae Spica), Lianqiao (Forsythiae Fructus), Bohe (Menthae Haplocalyx), Niubangzi (Arctii Fructus), etc., to loosen muscle and reach the exterior. If red Dan rash is seen, pathogen is in Ying and Blood levels, tongue must be crimson-red;适宜 Xijiao, Lianqiao, Xian Shengdi, Renzhonghuang, Jing Yinhua, etc., to penetrate Ying and detoxify. Strictly forbid Sheng Ma (Cimicifugae Rhizoma), Ge Gen, and foot-meridian drugs. The above three songs generally discuss red-crimson tongue colors, and tongue coatings accompanied by white or yellow, differentiating epidemic disease treatment paths.
Whenever proper qi is deficient, coating tender and thin, pale red slightly white, tonification should not be delayed. Thick yellow greasy white indicates evil accumulation; physicians must know to clear and resolve.
[Lianchen's Note] Mr. Wu said: Regardless of cold damage or miscellaneous diseases, those with deficient proper qi will have tender and thin tongue coatings, either pale red or slightly white, all suitable for tonification. If yellow-white, thick and greasy are seen, it always indicates internal evil not yet cleared; do not hastily administer tonics. The above one song generally discusses tongue body old/tender and tongue coating yellow/white thick/thin, the key to differentiating syndrome deficiency/excess. Counting Wu's thirty-two songs, they are most practical for current times. I once published them in *Ganzheng Baofa*, now re-edited and appended here for students to memorize. Recently only Liu Jiren has made many discoveries. I will briefly summarize his theory as follows:
(II) General Discussion of White Coating. White coatings differ in thickness, density, and sparsity; their forms also vary in depth and mixture. There are thin whites like rice drink spread on the tongue; this is the initial sign of Cold Damage with Cold. Without exterior signs, it indicates fluid retention in the Diaphragm. There are white slips like soy milk spread on the tongue; this indicates Cold Damage with Cold-Dampness Evil, Phlegm-Fluids, etc. One must judge by pulse and symptoms. White and thick like tofu brain spread on the tongue indicates Phlegm-Heat syndrome. White and sparse like rice flour spread on the tongue indicates the initial transmission of Cold Damage or Summerheat. White like millet grains indicates Heat Evil in the Qi level. White like silver shining indicates a changed coating from mistakingly tonifying a Heat syndrome. White like dry tobacco gray, regardless of moisture, indicates a changed coating from mistakingly using drying drugs on a Heat syndrome. White like the bottom of a silver ingot with holes indicates Heat syndrome mistookly tonified and dried, fluids injured, Yuan Qi about to collapse, evil about to penetrate deeply. White like dregs piled up indicates Heat syndrome mistookly dried, putrid turbidity accumulated in the stomach, preparing for a purging syndrome. If the center cracks, it is extreme deficiency resembling excess syndrome; one must tonify Qi, judging by pulse and symptoms. Similar to white but not white, like an artist mixing powder with grease to make snow-blue, there are deep and shallow types. Shallow like snow-blue lake silk color indicates the initial sign of Heat Evil entering Ying; deep like snow-blue Hang silk color indicates Summerheat-Heat two evils have entered the Blood level. (This coating resembles thin white, but has blue quality with red tint and fine papillae points upon close inspection, hence named Snow-Blue; it is a necessary and common coating for Blood level syndromes, but people view it as white and mistake it for cold disease, so it is specially raised to awaken the mind. Ancients just used "crimson tongue" to explain, how could later learners understand? So I tell them directly via careful observation and comparison method to avoid misidentification.) Tongue body deep red like dried carrot with salt frost indicates Heat Evil penetrating deeply and lingering, mistookly administered attacking-drying drugs, stomach yin greatly injured; this is the critical late stage of Warm-Heat.
(III) General Discussion of Yellow Coating. Yellow colors differ in depth, age, and tenderness; their forms also differ in dryness, slipperiness, roughness, and smoothness. There are true yellow, old yellow, yellow like fried Zhiqiao (Aurantii Fructus), yellow like pot-scorched cake mixed with slight black; tender yellow, tooth-yellow, color like paper core mixed with gray-green; yellow like millet dyed yellow, yellow like fish roe, yellow like tiger stripes, yellow like yellow wax spread on tongue, water-yellow like egg yolk and white mixed. These are all categories of yellow, while syndrome differences and diagnostic methods were detailed in the previous Six Meridian tongue coating notes.
(IV) General Discussion of Tongue Body without Coating. Tongue bodies without coating also differ. For example, purple tongue body without coating indicates Heat in the Yin level. Red tongue body without coating indicates Heat Evil newly entering Yin level, or elderly person with food stagnation where Stomach Qi cannot ascend, or worry-thought depression where Yang Qi cannot ascend; must judge by pulse and symptoms. Tongue smooth as a mirror indicates injury to both Stomach Yin and Stomach Yang, gut villi sticking to walls, undigested food passing through, hunger but unable to eat. Also stubborn phlegm stuck in stomach, villi not rising, all have this sign; must diagnose by pulse and symptoms. Former symptom undigested food/yin injury, pulse must be fine and choppy; latter symptom phlegm stagnation, pulse must surging, slippery, and large. Dry texture like thorns without coating, purple and dry indicates Heat injuring Yin fluids; red and dry indicates Qi failing to transform fluids; must judge by pulse and symptoms. Tongue body without coating, middle concave like scraped off, indicates Stomach dryness-stagnation injuring Yin, or cecum dryness-stagnation lingering long; Tongue body without coating, middle straight groove like knife back imprint, indicates Yin fluids and Yuan Qi both deficient. Horizontal crack in middle indicates constitutionally Yin deficient. Cracks like ice flakes on tongue is common image of elderly Yin deficiency, rare in youth, inauspicious if present. Front half smooth without coating, root has two fleshy tumors like tongue flesh color, indicates Yin-deficiency consumption syndrome. Surface without coating, but skin/flesh has a coin-sized patch, yellow or white, indicates insufficient proper Qi, blood also deficient, or phlegm condensation; must judge by pulse and symptoms. Circular halos appearing on coating dividing into two-three colors indicates internal dryness-stagnation, dry feces not descending; syndrome must be dangerous. Coating showing green and blue colors indicates fatal syndrome.
(V) General Discussion of Coating Color Transformation Auspiciousness/Misfortune. In short, yellow coating is correct, white is secondary. Regardless of syndrome, if medication is appropriate, it goes from white to yellow, from yellow recedes, from recession new thin white coating grows; this is favorable. Regardless of syndrome, if medication is inappropriate, it goes from yellow to white, from white to gray, from gray to black, from living coating becomes dead coating; this is unfavorable. Sudden recession/sudden absence, not gradual recession, is collapsing sign. Furthermore, Qi gathers coating gathers, Qi withdraws coating withdraws, Qi transforms coating transforms, Qi scatters coating scatters, Qi coagulates coating coagulates. Qi knots on one side, coating knots on one side; thus Qi-stagnation syndrome, coating edge neat, like stone steps' edge line, coating inside line, no coating outside line, only red edge. If Qi transforms, it scatters, dense inside and sparse outside, not like cleanly cut uniform edge. Thus coating edges neat like cut indicate Qi gathering, having stagnation/depression. If coating truly recedes and truly transforms, it differs from scraped sudden recession. True recession must follow transformation first. What is transformation recession? Because coating goes from thick to gradually thin, from solid to generating pores, from dense to gradually sparse, from tongue root extending to tip, from tip gradually changing sparse/thin, from recession regenerating new coating; these are all auspicious omens. If suddenly receding, not regenerating new coating, or like scraped off, mottled, remaining like tofu dregs spread on tongue, dot here dot there, scattered and discontinuous, all are unfavorable signs, all caused by mistookly attacking, eliminating, or releasing exterior, injuring Stomach Qi and Stomach juice, hence this sign.
[Rongzhai's Note] Liu Jiren's tongue examination and syndrome differentiation method, item one, already appeared in Mr. He Lianchen's note in Section 2 of this chapter, so here we start only from item two "General Discussion of White Coating".