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Is there a way to add tokens to cards outside of the single instance where you add all 10 to the ace of hearts? The instructions seem to imply it with "place or remove tokens from cards" on page 2, like you're adding tokens to cards other than the ace of hearts (once drawn)?

I don’t think so, but I haven’t drawn every single card so there might be another prompt that has you add tokens. There are some cards that you keep & don’t discard, & maybe one of them also uses tokens to track something. But the main token mechanic is the 10 on the ace of hearts. If more tokens come up in gameplay just follow whatever the prompt says to do with them. I don’t think the game needs more tokens added to cards to be enjoyable though. 

after a quick search for the word “token” in the pdf, it looks like you only ever place tokens on the ace of hearts, but if you draw the ace of spades you can remove a token from the ace of hearts. I think the “place or remove tokens from cards” is just because “card” would sound funny & that the game is still intuitive & easy to understand. You just don’t add tokens until you pull the ace of hearts & the prompt explains what to do rather than it being in the rule’s section, so I think playing the game & not just reading the rules makes everything clear.

I'd just say "ace of hearts card" for clarity instead of "cards" at the beginning. Going back and rereading, all the ace of spades does is modify the ace of hearts so that you can remove a token on a roll of 5 or 6, instead of just 6.