TCM Book Club Issue 1214
Daily updates to accompany the growth of TCM practitioners
IIntroduction：The editor recalls a summary of tongue coating by Wang Leting (which includes the appearance of tongue coating in hepatitis) in an article (click the title to read directly). In this article, Wang summarized that hepatitis patients often have one side of the tongue without coating or with thin white coating, while the other side has yellow greasy coating, which aligns with today’s discussion, doesn’t it? (Editor/Wang Chao)
Partial Coating and Half Exterior Half Interior Syndrome
Author/Peng Gefei
The tongue coating is an important aspect of tongue diagnosis. Most practitioners only pay attention to the color, thickness, and moisture of the cold coating, while few notice the partial or correct coating. Even fewer differentiate treatment based on the condition of the coating. However, the differentiation of partial coating has been documented for a long time, such as in the “Guide to Tongue Differentiation”: “Partial coating means that the coating is half distributed, with distinctions of partial internal, partial external, partial left, and partial right.”
Thirty years ago, when I was assisting in diagnosis under the renowned teacher Li Shaobi in Guangzhou, I encountered a special type of partial coating, where one side of the tongue had white coating and the other side had light yellow coating, with a clear boundary. Teacher Li taught me, “Whenever encountering this coating, it should be treated as half exterior half interior syndrome, because white coating indicates exterior, while yellow coating indicates interior. The two sides of the tongue correspond to the liver and gallbladder areas. Now, with one side having white coating and the other side yellow coating, the pathogen is at the Shaoyang pivot, and it should be treated according to Shaoyang disease.” The use of Xiao Chai Hu Decoction indeed proved effective. In my clinical practice over the past 20 years, I have encountered nearly a hundred cases of this type of partial coating, and I have always remembered Teacher Li’s experience, treating them with Xiao Chai Hu Decoction with good results.
For instance, I treated an elderly woman who had been suffering from stomach pain for over four months, with pain radiating to the left side of her waist and back. She had previously taken Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), Zhuang Yao Jian Shen Wan (Strengthening the Kidney Pill), and Liu Jun Zi Tang (Six Gentlemen Decoction) without success. Recently, her nighttime back pain worsened, accompanied by dizziness, tinnitus, and hearing loss. The tongue coating was divided in the middle, with the right side yellow and the left side white, and the pulse was wiry. Following Teacher Li’s experience, I prescribed a modified Xiao Chai Hu Decoction: Chai Hu (Bupleurum) and Ban Xia (Pinellia) each 10g, Dang Shen (Codonopsis) and Chuan Xu Duan (Chinese Teasel) and Tu Si Zi (Dodder Seed) each 12g, Bai Shao (White Peony) 12g, Da Zao (Jujube) 10g, Zhi Gan Cao (Honey-Fried Licorice) 6g, and Sheng Jiang (Fresh Ginger) 9g. Three doses, one per day, decocted in water for oral administration.
After taking the medicine, the stomach and back pain significantly decreased. During a follow-up visit, I was not available, and another doctor changed the prescription to a standard decoction with added ingredients, which resulted in a resurgence of stomach pain and insomnia. The patient returned to me. Observing that her partial coating remained unchanged, I continued with the modified Xiao Chai Hu Decoction. After seven days of treatment, the coating turned thin white, the partial coating disappeared, and all symptoms were resolved.
This case, although it had some twists and turns during treatment, ultimately still achieved results with Xiao Chai Hu Decoction, demonstrating the important role of partial coating in clinical differentiation and treatment.
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