灰色舌、有阴阳之异。若直中阴经。则实时舌便灰黑而无积苔。若热传三阴。必四五日表证罢而苔变灰色
也。有在根在尖在中者。有浑舌俱灰黑者。大抵传经热证。则有灰黑干苔。皆当攻下泄热。若直中三阴之灰黑
无苔者。即当温经散寒。又有蓄血证。其人如狂。或瞑目谵语。亦有不狂不语。不知人事。而面黑舌灰者。当
分轻重以攻其血。切勿误与冷水。引领败血入心而致不救也。
\r纯灰舌\pt108a61.bmp\r
舌灰色无苔者。直中三阴而夹冷食也。脉必沉细而迟。不渴不烦者。
附子理中四逆汤救之。次日。舌变灰中有微黄色者生。如渐渐灰缩干黑者死。
\r灰中舌\pt108a62.bmp\r
灰色现于中央。而消渴、气上冲心、饥不欲食、食即吐蛔者。此热传厥阴之候。乌梅丸主之。
\r灰黑苔干纹裂舌\pt108a63.bmp\r
土邪胜水。而舌见灰黑纹裂。凉膈调胃皆可下之。十中可救二三。下后。渴不止热不退者。不治。
\r灰根黄尖中赤舌\pt108a64.bmp\r
舌根灰色而中红尖黄。乃肠胃燥热之证。若大渴谵语。五六日不大便。转矢气者。下之。如温病热病。恶寒
脉浮者。凉膈、双解选用。
\r灰色重晕舌\pt108a65.bmp\r
此瘟病热毒。传遍三阴也。热毒传内一次。舌即灰晕一层。毒盛故有重晕。最危之证。急宜凉膈、双解解
毒。承气下之。一晕尚轻。二晕为重。三晕必死。亦有横纹二三层者。与此重晕不殊。
\r灰黑干刺舌\pt108a66.bmp\r
灰黑舌中又有干刺。而见咽干、口燥、喘满。乃邪热结于少阴。当下之。然必待其转矢气者。方可下。若
下之早。令人小便难。
\r灰黑尖舌\pt108a67.bmp\r
已经汗解而见舌尖灰黑。有宿食未消。或又伤饮食。邪热复盛之故。调胃承气汤下之。
\r灰黑尖干刺舌\pt108a68.bmp\r
舌尖灰黑有刺而干。是得病后犹加饮食之故。虽证见耳聋、胁痛、发热、口苦。不得用小柴胡。必大柴胡
或调胃承气加消导药。方可取效。
\r灰中墨滑舌\pt108a69.bmp\r
淡淡灰色中间。有滑苔四五点如墨汁。此热邪传里。而中有宿食未化也。大柴胡汤。
\r灰黑多黄根少舌\pt108a70.bmp\r
舌灰色而根黄。乃热传厥阴。而胃中复有停滞也。伤寒六七日不利。便发热而利、汗出不止者死。正气脱也。
\r边灰中紫舌\pt108a71.bmp\r
舌边灰黑而中淡紫。时时自啮舌尖为爽。乃少阴厥气逆上。非药可治。
灰色舌，有阴证和阳证的差异。如果是寒邪直接中伤阴经，那么当时舌头就会呈现灰黑色而没有积苔。如果是热邪传入三阴经，必定在四五天后表证解除而舌苔变为灰色。有的出现在舌根、舌尖或舌中部，有的则是整个舌头都呈灰黑色。大抵是传经的热证，就会出现灰黑且干燥的舌苔，都应当用攻下法来泄热。如果是直中三阴经的灰黑色无苔者，就应当用温经散寒的方法。又有蓄血证，病人像发狂一样，或者闭眼说胡话，也有不发狂不说话、不知人事，但面色黑、舌头灰的情况，应当根据病情的轻重来攻逐瘀血，千万不要错误地给予冷水，以免引导败血进入心脏而导致无法救治。
纯灰舌
舌头灰色没有舌苔，是寒邪直中三阴经并且夹杂冷食所致。脉象必定沉细而迟缓，不口渴也不烦躁的，用附子理中汤和四逆汤来救治。第二天，如果舌头上出现灰色中有微黄色的情况，说明还有生机；如果逐渐变成灰色收缩、干枯变黑的，则预后不良（死）。
灰中舌
灰色出现在舌头的中央，伴有消渴、气向上冲撞心脏、饥饿但不想吃东西、吃东西就吐出蛔虫的症状，这是热邪传入厥阴经的表现，用乌梅丸主治。
灰黑苔干纹裂舌
土邪胜水，导致舌头出现灰黑色且有裂纹，凉膈散或调胃承气汤都可以用来攻下。十个人中可能救活两三个。攻下之后，如果口渴不止、发热不退的，属于不治之症。
灰根黄尖中赤舌
舌根呈灰色，中间红、尖端黄，这是肠胃燥热的证候。如果极度口渴、说胡话，五六天不大便，并且转放屁的，应当用攻下法。如果是温病或热病，伴有恶寒、脉浮的，选用凉膈散或双解散。
灰色重晕舌
这是瘟病热毒，传遍了三阴经。热毒每向内传一次，舌头上就出现一层灰色的晕圈。因为毒气旺盛所以有多层晕圈，这是最危险的证候，急需用凉膈散、双解散来解毒，并用承气汤攻下。一层晕圈还算轻，两层为重，三层必死。也有出现横向纹路二三层的情况，与这种多重晕圈没有区别。
灰黑干刺舌
灰黑色的舌头中间又有干燥的芒刺，并出现咽干、口燥、气喘胸闷的症状，这是邪热结聚在少阴经，应当用攻下法。但是必须等到病人转放屁的时候，才可以攻下。如果攻下过早，会导致病人小便困难。
灰黑尖舌
已经通过发汗解除了表邪，但舌尖出现灰黑色，是因为有宿食未消化，或者是又伤了饮食，导致邪热再次亢盛的原因，用调胃承气汤攻下。
灰黑尖干刺舌
舌尖灰黑且有芒刺、干燥，是因为得病后仍然进食的缘故。虽然症状见到耳聋、胁痛、发热、口苦，但不能用小柴胡汤，必须用大柴胡汤或调胃承气汤加上消导药，才能取得疗效。
灰中墨滑舌
淡淡的灰色中间，有四五点像墨汁一样的滑苔，这是热邪传入体内，而其中有宿食尚未消化的表现，用大柴胡汤治疗。
灰黑多黄根少舌
舌头灰色而根部黄色，这是热邪传入厥阴经，而胃中又有停滞的表现。伤寒六七天没有腹泻，突然发热而腹泻、出汗不止的会死亡，这是因为正气脱失。
边灰中紫舌
舌头边缘灰黑而中间淡紫色，时不时自己咬舌尖以求爽快，这是少阴经的厥逆之气上逆，不是药物可以治疗的。
Grey tongue differs in yin and yang patterns. If cold pathogen directly invades the yin meridians, the tongue will immediately appear grey-black without accumulated coating. If heat transmits to the three yin meridians, it must be after four or five days when exterior symptoms have ceased and the coating turns grey. The grey color may appear at the root, tip, or center, or the entire tongue may be uniformly grey-black. Generally, if it is a heat syndrome transmitted through the meridians, there will be a dry grey-black coating, which should be treated with purgation to drain heat. If it is a direct invasion of the three yin meridians presenting as grey-black without coating, warming the meridians and dispersing cold should be employed. There is also blood stasis syndrome, where the patient acts like they are mad, or closes their eyes and speaks deliriously; some do not act mad nor speak, losing consciousness, yet have a dark face and grey tongue. One must assess the severity to purge the blood. Do not mistakenly give cold water, as this may guide the failed blood into the heart, leading to untreatable conditions.
Pure Grey Tongue
A grey tongue without coating indicates direct invasion of the three yin meridians complicated by cold food retention. The pulse must be deep, fine, and slow. With no thirst and no irritability, Fuzi Lizhong Tang (Aconite Root and Poria Decoction) and Sini Tang (Recovery from Reversal Decoction) are used for rescue. On the next day, if the tongue shows slight yellow within the grey, life is preserved; if it gradually shrinks, dries, and turns black, death ensues.
Grey Center Tongue
Grey color appearing in the center, accompanied by excessive thirst, qi rushing up to the heart, hunger without desire to eat, and vomiting roundworms upon eating, indicates heat transmitting to the Jueyin meridian. Wumei Wan (Mume Pill) is the primary formula.
Grey-Black Dry Coated Tongue with Cracks
When Earth pathogen overcomes Water, the tongue appears grey-black with cracks. Liangge San (Cool the Chest Powder) or Tiaowei Chengqi Tang (Regulate the Stomach and Direct to the Interior Decoction) can be used for purgation. Two or three out of ten may be saved. If after purgation, thirst persists and fever does not subside, it is untreatable.
Grey Root, Yellow Tip, Red Center Tongue
The root is grey, the center red, and the tip yellow, indicating dryness-heat in the intestines and stomach. If there is extreme thirst, delirium, no bowel movement for five or six days, and passing gas, purgation is indicated. If it is a warm disease or heat disease with aversion to cold and floating pulse, choose Liangge San or Shuangjie San (Double Resolution Powder).
Grey Tongue with Concentric Halos
This is plague disease with heat toxin transmitting throughout the three yin meridians. Each time heat toxin transmits inward, a layer of grey halo appears on the tongue. Due to abundant toxin, multiple halos form. This is a critical condition; urgently use Liangge San and Shuangjie San to resolve toxicity, and Chengqi Tang to purge. One halo is mild, two are severe, and three indicate certain death. There are also cases with two or three layers of horizontal lines, similar to these concentric halos.
Grey-Black Tongue with Dry Spines
A grey-black tongue with dry spines, accompanied by dry throat, dry mouth, wheezing, and chest fullness, indicates evil heat knotting in the Shaoyin meridian. Purgation is required, but one must wait until the patient passes gas before purging. If purged too early, it causes difficulty in urination.
Grey-Black Tip Tongue
After sweating has resolved the exterior, if the tongue tip appears grey-black, it is due to retained food not yet digested, or re-injury from diet causing resurgence of evil heat. Tiaowei Chengqi Tang is used for purgation.
Grey-Black Dry Spined Tip Tongue
The tongue tip is grey-black with spines and is dry, caused by consuming food after the onset of illness. Although symptoms include deafness, hypochondriac pain, fever, and bitter taste, Xiaochaihu Tang (Minor Bupleurum Decoction) must not be used. Daxiehu Tang (Major Bupleurum Decoction) or Tiaowei Chengqi Tang added with digestive-resolving herbs must be used to achieve efficacy.
Grey Center with Ink-Smooth Tongue
In the faint grey center, there are four or five spots of smooth coating resembling ink. This indicates heat pathogen transmitting inward with retained food not yet transformed. Dachaihu Tang (Major Bupleurum Decoction) is used.
Grey-Black with Much Yellow and Little Root Tongue
The tongue is grey with a yellow root, indicating heat transmitting to Jueyin with stagnation in the stomach. In Shanghan (Cold Damage), if after six or seven days without diarrhea, sudden fever occurs with diarrhea and unceasing sweating, death results due to collapse of healthy qi.
Grey Edges with Purple Center Tongue
The edges of the tongue are grey-black while the center is pale purple. The patient occasionally bites the tongue tip for relief. This indicates Shaoyin jue qi (rebellious qi) rising upward; it is not treatable with medicine.