伤寒五七日。舌见黑苔。最为危候。表证皆无此舌。如两感一二日间见之。必死。若白苔上渐渐中心黑者。是
伤寒邪热传里之候。红舌上渐渐黑者。乃瘟疫传变。坏证将至也。盖舌色本赤。今见黑者。乃水来克火。水极
似火。火过炭黑之理。然有纯黑、有黑晕、有刺、有隔瓣、有瓣底红、瓣底黑者。大抵尖黑犹轻。根黑最重。
如全黑者。总使神丹。亦难救疗也。
\r纯黑舌\pt108a47.bmp\r
遍舌黑苔。是火极似水。脏气已绝。脉必代结。一二日中必死。切勿用药。
\r黑苔瓣底红舌\pt108a48.bmp\r
黄苔久而变黑。实热亢极之候。又未经服药。肆意饮食。而见脉伏、目闭、口开、独语、谵妄。医遇此
证。必掘开舌苔。视瓣底红者。可用大承气下之。
\r黑苔瓣底黑舌\pt108a49.bmp\r
凡见瓣底黑者。不可用药。虽无恶候。脉亦暴绝。必死不治。
\r满黑刺底红舌\pt108a50.bmp\r
满舌黑苔。干燥而生大刺。揉之触手而响。掘开刺底红色者。心神尚在。虽火过极。下之可生。有肥盛多
湿热人。感冒发热。痞胀闷乱。一见此舌。急用大陷胸丸攻下。后与小陷胸汤调理。
\r刺底黑舌\pt108a51.bmp\r
刺底黑者。言刮去芒刺。底下肉色俱黑也。凡见此舌。不必辨其何经何脉。虽无恶候。必死勿治。
\r黑烂自啮舌\pt108a52.bmp\r
舌黑烂而频欲啮。必烂至根而死。虽无恶候怪脉。切勿用药。
\r中黑边白滑苔舌\pt108a53.bmp\r
舌见中黑边白而滑。表里俱虚寒也。脉必微弱。证必畏寒。附子理中汤温之。夏月过食生冷而见此舌。则
宜大顺冷香选用。
\r红边中黑滑舌\pt108a54.bmp\r
舌黑有津。证见谵语者。必表证时不曾服药。不戒饮食。冷物结滞于胃也。虚人黄龙汤。或枳实理中加大
黄。壮实者用备急丸热下之。夏月中 。多有此舌。以人参白虎汤主之。
\r通尖黑干边白舌\pt108a55.bmp\r
两感一二日间。便见中黑边白浓苔者。虽用大羌活汤。恐无济矣。
\r黑边晕内微红舌\pt108a56.bmp\r
舌边围黑。中有红晕者。乃邪热入于心胞之候。故有此色。宜凉膈合大承气下之。
\r中燥舌\pt108a57.bmp\r
舌苔中心黑浓而干。为热盛津枯之候。急宜生脉散合黄连解毒汤以解之。
\r中黑无苔干燥舌\pt108a58.bmp\r
舌黑无苔而燥。津液受伤而虚火用事也。急宜生脉散合附子理中汤主之。
\r黑中无苔枯瘦舌\pt108a59.bmp\r
伤寒八九日。过汗。津枯血燥。舌无苔而黑瘦。大便五六日不行。腹不硬满。神昏不得卧。或时呢喃叹息
者。炙甘草汤。
\r黑干短舌\pt108a60.bmp\r
舌至干黑而短。厥阴极热已深。或食填中脘。 胀所致。急用大剂大承气下之。可救十中一二。服后。粪黄热退则
生。粪黑热不止者死。
伤寒病经过五到七天，舌头上出现黑苔，这是最为危险的征象。表证（邪气在体表）通常不会出现这种舌象。如果是两感病（表里两经同时受邪），在一两天内就出现黑苔，必定死亡。如果白苔逐渐向中心变黑，这是伤寒邪热传入体内的征象；红舌逐渐变黑，则是瘟疫病情传变、坏证（危重复杂的证候）即将出现的征兆。舌色本应为红色，现在出现黑色，是因为水来克火，水气极盛时看似火象，就像火烧过后变成炭黑一样的道理。然而，黑苔有纯黑、黑晕、芒刺、瓣裂、瓣底红、瓣底黑等不同形态。大致来说，舌尖部发黑还较轻，舌根部发黑最严重。如果全舌皆黑，即使有神丹妙药，也难以救治。
纯黑舌：
全舌布满黑苔，这是火极似水的表现，脏气已经衰竭，脉象必然出现代脉或结脉，一两天内必定死亡，千万不要用药。
黑苔瓣底红舌：
黄苔日久变为黑苔，是实热亢盛至极的征象。又未经服药治疗，肆意饮食，导致脉伏、目闭、口开、独语、谵妄。医生遇到此证，必须刮开舌苔，观察瓣底颜色为红色的，可以用大承气汤攻下。
黑苔瓣底黑舌：
凡是见到瓣底黑色的，不可用药。即使没有恶候，脉象也会突然断绝，必定死亡且无法医治。
满黑刺底红舌：
全舌黑苔，干燥并生出大芒刺，揉搓时触感粗糙作响。刮去芒刺后，底部呈红色的，说明心神尚在，虽然火势过极，通过攻下法可以生还。对于体型肥胖、多湿热的人，因感冒发热，出现痞胀闷乱，一见此舌，应立即用大陷胸丸攻下，随后用小陷胸汤调理。
刺底黑舌：
芒刺底部黑色的，是指刮去芒刺后，底下的肉色全部变黑。凡是见到这种舌象，不必辨别属于哪一经脉，即使没有恶候，也必定死亡，无需治疗。
黑烂自啮舌：
舌头黑烂且频繁想要咬自己，必定会烂至舌根而死。即使没有恶候怪脉，也切勿用药。
中黑边白滑苔舌：
舌头中间黑，边缘白而滑润，这是表里俱虚寒的表现。脉象必然微弱，症状必然畏寒，应用附子理中汤温补。夏季因过食生冷而出现此舌，则宜选用大顺散或冷香饮子。
红边中黑滑舌：
舌黑而有津液，症状见谵语的，必定是在表证期间未曾服药，且不忌口饮食，导致冷物结滞于胃中。体虚者可用黄龙汤，或用枳实理中汤加大黄；体质壮实者用备急丸热下之。夏季多见此舌，以人参白虎汤为主治方。
通尖黑干边白舌：
两感病一二天内，便见中间黑、边缘白且厚腻苔的，即使使用大羌活汤，恐怕也无济于事。
黑边晕内微红舌：
舌边围黑，中间有红晕的，这是邪热进入心包络的征象，所以呈现这种颜色。宜用凉膈散合大承气汤攻下。
中燥舌：
舌苔中心黑浓且干燥，为热盛津液枯竭的征象。急需使用生脉散合黄连解毒汤来解之。
中黑无苔干燥舌：
舌黑无苔且干燥，是津液受伤而虚火妄动的表现。急需使用生脉散合附子理中汤主治。
黑中无苔枯瘦舌：
伤寒八九日，因发汗过度，导致津枯血燥，舌无苔且黑瘦，大便五六日不通，腹部不硬满，神志昏迷不能安卧，或时而呢喃叹息的，用炙甘草汤。
黑干短舌：
舌干黑且短缩，是厥阴病极热已深，或因食物填塞中脘导致胀满所致。急需使用大剂量大承气汤攻下，可挽救十分之一二。服药后，若粪便转黄、热退则生；若粪便黑、热不止者死。
After five to seven days of contracting Shanghan (Cold Damage), the appearance of black coating on the tongue is the most critical prognostic sign. Exterior syndromes (syndromes where pathogenic factors are located in the exterior) typically do not present with this tongue manifestation. If it appears within one or two days in Lianggan (simultaneous contraction of exterior and interior meridians), death is inevitable. If white coating gradually turns black in the center, it indicates that Shanghan pathogenic heat has transmitted inward; if a red tongue gradually turns black, it signifies the progression of plague-like diseases and the impending arrival of Huai Zheng (complicated/critical syndromes). The natural color of the tongue is red; the appearance of black indicates Water overcoming Fire. When Water Qi reaches its extreme, it resembles Fire, similar to the principle that charcoal becomes black after burning. However, black coating presents in various forms: pure black, black halo, prickles, fissures, red base under fissures, and black base under fissures. Generally, blackness at the tip is lighter, while blackness at the root is heaviest. If the entire tongue is black, even miraculous medicines may fail to save the patient.
Pure Black Tongue:
The entire tongue is covered with black coating, indicating Fire reaching its extreme resembling Water, and the Zang organ Qi has been exhausted. The pulse must be Dai (intermittent) or Jie (knotted). Death will occur within one or two days; medication should absolutely be avoided.
Black Coating with Red Base Under Fissures:
Yellow coating turning black over time is a sign of extreme excess heat. If untreated and accompanied by reckless diet, leading to a hidden pulse, closed eyes, open mouth, solitary muttering, and delirium, the physician must scrape away the coating. If the base under the fissures is red, Da Chengqi Tang (Major Order the Qi Decoction) can be used for purgation.
Black Coating with Black Base Under Fissures:
Whenever the base under the fissures is black, medication is contraindicated. Even without ominous signs, the pulse will suddenly cease, leading to untreatable death.
Full Black Prickles with Red Base:
The entire tongue has black coating, dry with large prickles, feeling rough and sounding when rubbed. If scraping off the prickles reveals a red base, it indicates that the Shen Spirit remains. Although Fire is extremely excessive, survival is possible through purgation. For obese individuals with abundant Damp-Heat, presenting with cold-induced fever, epigastric fullness, distension, and confusion, upon seeing this tongue, Da Xianxiong Wan (Major Chest-Snaring Pill) should be urgently administered for purgation, followed by Xiao Xianxiong Tang (Minor Chest-Snaring Decoction) for regulation.
Prickles with Black Base:
"Prickles with black base" means that after scraping off the芒刺 (prickles/spines), the underlying flesh is entirely black. Whenever this tongue appears, regardless of which meridian or pulse pattern, even without ominous signs, death is certain and treatment is futile.
Black Ulcerated Self-Biting Tongue:
The tongue is black, ulcerated, and the patient frequently attempts to bite it. This will inevitably lead to rot extending to the root and death. Even without ominous signs or strange pulses, medication should absolutely be avoided.
Center Black, Edge White Slippery Coating Tongue:
The center of the tongue is black, while the edges are white and slippery, indicating deficiency-cold in both the interior and exterior. The pulse will be weak and faint, and symptoms will include aversion to cold. Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) should be used for warming. In summer, if caused by excessive consumption of raw and cold foods, Dashun San (Great Smooth Powder) or Lengxiang Yinzi (Cold Fragrance Drink) should be selected.
Red Edges, Center Black Slippery Tongue:
The tongue is black but moist, with symptoms of delirious speech. This usually results from failing to take medicine during the exterior stage and disregarding dietary restrictions, causing cold substances to stagnate in the Stomach. For deficient persons, Huanglong Tang (Yellow Dragon Decoction) or Zhishi Lizhong Tang plus Dahuang (Rhubarb) can be used. For robust persons, Beiji Wan (Emergency Pill) can be used for hot purgation. This tongue is common in summer, treated primarily with Renshen Baihu Tang (Ginseng White Tiger Decoction).
Tip-to-Root Black Dry, Edge White Tongue:
In Lianggan, if the center is black and the edge is white with thick greasy coating appearing within one or two days, even using Da Qianghuo Tang (Major Notopterygium Decoction) may prove ineffective.
Black Halo with Slight Red Interior Tongue:
The tongue edges are surrounded by black, with a red halo in the center, indicating pathogenic heat entering the Pericardium. This coloration warrants treatment with Liangge San (Cool the Diaphragm Powder) combined with Da Chengqi Tang for purgation.
Center Dry Tongue:
The coating in the center of the tongue is thick, black, and dry, indicating excessive heat and exhaustion of body fluids. Shengmai San (Generate the Pulse Powder) combined with Huanglian Jiedu Tang (Coptis Detoxification Decoction) should be urgently employed to resolve the condition.
Center Black, No Coating, Dry Tongue:
The tongue is black, lacks coating, and is dry, indicating injury to body fluids and hyperactivity of deficiency fire. Shengmai San combined with Fuzi Lizhong Tang should be urgently administered as the primary treatment.
Black Center, No Coating, Withered and Thin Tongue:
After eight or nine days of Shanghan, due to excessive sweating, body fluids are exhausted and blood becomes dry. The tongue lacks coating, appears black and thin. Bowel movements have ceased for five to six days, the abdomen is not hard or full, the spirit is confused preventing sleep, or there is occasional muttering and sighing. Zhigancao Tang (Baked Licorice Decoction) should be used.
Black, Dry, Short Tongue:
The tongue is dry, black, and shortened, indicating extreme heat in Jueyin disease or abdominal distension caused by food impaction in the Middle Jiao. A large dose of Da Chengqi Tang should be urgently administered for purgation; one or two out of ten patients may survive. If stool turns yellow and fever subsides after administration, the patient lives; if stool remains black and fever persists, the patient dies.