A Case Report on Reversing Black-Dry Tongue Coating and Airway Spasm via the "Clearing Heat and Venting Qi" Method: Dynamic Tongue Inspection Analysis 基于"透热转气"法逆转温燥化火致中焦黑燥苔与气道痉挛动态诊疗案

English Abstract Background: Black-dry tongue coating in Traditional Chinese Medicine (TCM) typically indicates extreme heat-drying fluid or severe cold-dampness. In clinical settings, misinterpreting warm-dryness transforming into fire as inner cold or blindly applying heavy yin-nourishing agents can trap pathogenic heat, worsening airway spasms and insomnia.Case Presentation: A patient presenting with warm-dryness transforming into fire developed a sudden black-dry tongue coating at the middle burner, accompanied by nocturnal cough with wheezing ("whistling" sound), mouth dryness, and insomnia between 11 PM and 3 AM (Zi-Chou hours). Pulse diagnosis revealed a string-like and rapid pulse at the left Guan position.Intervention & Outcome: Adhering to Ye Tianshi's theory of "venting heat to the Qi system" (透热转气), a dynamic herbal regimen was administered. By combining heat-venting herbs (Herba Artemisiae Annuae, Folia Bambusae) with fluid-engendering agents (Radix Trichosanthis, Herba Dendrobii), the black-dry coating was completely shed within six days, leaving a moist tongue body with light fissures. Subsequent treatments using heavy-settling and Qi-descending agents (Lapis Haematites, Flos Inulae) relieved throat-bound Qi and wheezing. Final stabilization was achieved using Gualou-Xiebai decoction and heart-nourishing herbs (Semen Biotae, Radix Polygalae) to clear sticky phlegm and restore heart-lung Qi.Conclusion: Serial high-resolution tongue photography provides robust visual evidence for the dynamic efficacy of the "clearing heat and venting qi" strategy in reversing severe tongue coating metamorphoses and airway spasms. 中文摘要 背景: 中医诊法中,舌面出现“黑燥苔”多提示热极化燥伤津或下焦真寒。临床若将温燥化火误诊为寒证,或盲目重剂滋阴,易致“温补粘腻、固闭邪热”,加重气道痉挛与夜间剧咳失眠。病例介绍: 患者因外感温燥化火,病程中中焦骤现大面积黑燥苔,伴夜间咳嗽发“吱吱”哮鸣音、口干咽干、半夜子丑时(12-2点)烦躁失眠,脉见左关弦数。干预与转归: 遵叶天士“透热转气”理论,灵活应用青蒿、淡竹叶透达深伏郁热,配合天花粉、石斛大剂甘寒生津。仅用时6天,中焦黑燥苔即完全脱落退尽,舌面津液回充。随后针对“心窝气上冲至天突”采用代赭石、旋覆花重镇降逆平冲;后期果断撤去青蒿,以全瓜蒌、薤白宽胸涤“拉丝”粘痰,配合柏子仁、远志补左寸心气安神,圆满收功。结论: 连续高清晰度舌象图像矩阵为“透热转气”法逆转复杂舌苔异变与气道痉挛提供了强有力的动态视觉证据 (Visual Evidence)。