舌见红色。内有干硬黑色。形如小长舌有刺者。此热毒炽甚。坚结大肠。金受火制。不能平木故也。调胃承气汤下
之。
\r里黑舌图\pt101a11.bmp\r
【介按】苔至黑色而有刺。舌上必然干燥无津。脐腹必然硬满耕痛。大便必然秘结。此是胃中津液将涸。热结大肠。
故用调胃承气汤。以解邪热而调胃液。但证既如是。不若用大承气汤。奏效较速也。
调胃承气汤（方见前）
舌见黑色。水克火明矣。患此者。百无一治。右前舌。虽有色图。恐其久而渝淡无辨。故注之。
\r死现舌图\pt101a12.bmp\r
【介按】苔见黑色。病必不轻。不论寒热。虚实诸症。皆有此色。惟舌至全黑。病已入里。非脏腑极热。即为脏腑
极寒。若虚寒而舌黑。则必湿滑无苔。若真寒假热而舌黑。则必全黑而不分经。如全黑无苔而底纹粗涩干焦。刮之不净。
是为热极之候。如全黑无苔而无罅点。干燥少津而光亮。此为绛色之变态。是肾虚液涸之证。如全黑而有罅有点。是热
极之实证。惟苔黑腐烂。为心肾俱绝。舌黑卷缩为肝脏已绝。皆为不治之证。兹谓水克火而百无一治者。即是脏腑极寒
极虚之证也。
舌见尖白根黄。其表证未罢。须宜解表。然后方可攻之。如大便秘者。用凉膈散加硝黄泡服。小便涩者。五苓散加
木通合益元散加姜汁少许。以白滚汤不拘时调服。
\r黑苔舌图\pt101a13.bmp\r
【介按】凡表证如风热暑燥。皆有黄舌。惟伤寒由表入里。传至阳明之府。其舌必黄。由浅转深。今见尖白根黄。
此系太阳感寒。阳明内热。或风热之邪。客于阳明之表。均宜凉散为治。盖以白苔主表。黄苔主里。太阳主表。阳明主
里。故舌苔见尖白根黄。或见白中带黄。如或微黄而薄者。其舌必黄燥。此是表邪初入于里之候也。外证必见恶寒身热，
治宜辛凉解表。若根黄尖白而不甚干，短缩不能伸出者。有宿食也。宜下之。若恶寒已罢。而惟身热便秘者。此是邪热
入胃。故宜凉膈散治之。硝黄用泡者。取其药力之专也。至若小便短涩。舌见黄腻。乃是湿热未净之候。故用五苓散加
木通合益元散加味。渗湿清热以治之。
凉膈散（方见前）
五苓散（方见前）
益元散（从名医方论新补）
滑石（六两水飞） 甘草（一两） 辰砂（三钱）
上为细末。新汲水一碗。调服三钱。
【介按】此方即六一散加辰砂也。取其益气而不助邪。逐邪而不伤正。故有益元之名。柯韵伯曰。心为五脏主。暑
热扰中。神明不安。必得朱砂以镇之。则神气可以遽复。凉水以滋之。则邪热可以急除。此清心之阳。热可通行也。
舌面呈现红色，内部有干燥坚硬的黑色苔垢。形状像带有刺的小长舌。这是热毒极其炽盛，坚固结聚于大肠，肺金受到火邪克制，无法制约肝木的缘故。使用调胃承气汤攻下治疗。
【介按】舌苔达到黑色且伴有芒刺，舌上必然干燥无津液，脐腹部必然硬满疼痛，大便必然秘结不通。这是胃中津液即将枯竭，热邪结聚于大肠的表现。因此使用调胃承气汤，以解除邪热并调和胃中津液。但是既然证候如此严重，不如使用大承气汤，见效更快。
调胃承气汤（方剂见前文）
舌面呈现黑色，这是水克火的明证。患此病的人，百人中无一能治。右侧前面的舌象图，虽然有颜色图示，但恐怕时间久了颜色变淡难以辨认，所以在此注明。
【介按】舌苔出现黑色，病情一定不轻。不论寒证、热证、虚证、实证，都有可能出现这种舌色。只有当舌头全黑时，说明病邪已深入体内，如果不是脏腑极热，就是脏腑极寒。如果是虚寒证而舌黑，则舌面必然湿润滑腻无苔。如果是真寒假热证而舌黑，则舌色全黑而不分经络分布。如果全黑无苔且底部纹理粗糙涩滞、干枯焦灼，刮之不尽，这是热极的征候。如果全黑无苔且没有裂纹斑点，干燥少津且光亮，这是绛色舌的变异，属于肾阴枯竭的证候。如果全黑且有裂纹和芒刺，是热极的实证。只有舌苔黑而腐烂，才是心肾俱绝；舌体黑而卷缩，是肝脏功能已绝。这些都是不治之症。这里说“水克火而百无一治”，指的就是脏腑极寒极虚的证候。
舌面舌尖白、舌根黄，说明表证尚未解除。应当先解表，然后才可以攻里。如果大便秘结，使用凉膈散加大黄、芒硝泡服。如果小便涩痛不畅，使用五苓散加木通，配合益元散加少许姜汁，用白开水不拘时间调服。
【介按】凡是表证如风热、暑邪、燥邪等，都会出现黄舌。只有伤寒由表入里，传变至阳明腑证，其舌必黄，表示病邪由浅入深。现在见到舌尖白、舌根黄，这属于太阳感受寒邪，阳明内有热邪，或者是风热之邪客居于阳明之表，都适宜用清凉发散的方法治疗。因为白苔主表证，黄苔主里证，太阳经主表，阳明经主里，所以舌苔表现为舌尖白、舌根黄，或者白色中带黄色。如果是微黄而薄，舌面必然黄而干燥，这是表邪初入里的征候。外证必然见恶寒身热，治疗宜用辛凉解表法。如果舌根黄、舌尖白但不甚干燥，且舌体短缩不能伸出，是有宿食停滞。应当用攻下法。如果恶寒已罢，仅见身热便秘，这是邪热入胃，所以宜用凉膈散治疗。其中大黄、芒硝采用泡服法，是取其药力专注。至于小便短少涩痛，舌见黄腻苔，这是湿热未尽的征候。所以用五苓散加木通，合益元散加减，通过渗湿清热来治疗。
凉膈散（方剂见前文）
五苓散（方剂见前文）
益元散（从名医方论新补）
滑石（六两，水飞法处理） 甘草（一两） 辰砂（三钱）
以上药物研为细末。用新汲水一碗，调服三钱。
【介按】此方即六一散加辰砂。取其益气而不助长邪气，祛除邪气而不损伤正气，所以有益元之名。柯韵伯说：心为五脏之主，暑热扰乱中焦，神明不安，必须得到朱砂来镇摄，神气就可以迅速恢复；用凉水来滋润，邪热就可以急除。这是清心阳，使热气得以通行。
The tongue surface appears red, with dry and hard black coating inside. The shape resembles a small long tongue with prickles. This indicates that heat-toxin is extremely vigorous, firmly accumulating in the large intestine. Metal (Lung) is controlled by Fire, unable to balance Wood (Liver). Treat with Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) to purge downward.
[Commentary by Jie] When the coating turns black with prickles, the tongue surface must be dry without fluids, the umbilical and abdominal regions must be hard, full, and painful, and the stool must be constipated. This signifies that stomach fluids are about to be exhausted, and heat is结 (accumulated) in the large intestine. Therefore, Tiaowei Chengqi Tang is used to resolve pathogenic heat and regulate stomach fluids. However, given such severe symptoms, it would be better to use Dachengqi Tang (Major Order the Qi Decoction) for faster efficacy.
Tiaowei Chengqi Tang (Formula seen previously)
The tongue surface appears black; this clearly demonstrates Water overcoming Fire. Among those suffering from this condition, not one in a hundred can be cured. Regarding the tongue image on the right front, although there is a color diagram, it is feared that over time the color will fade and become indistinguishable, so it is noted here.
[Commentary by Jie] The appearance of black coating indicates a serious illness. Regardless of cold, heat, deficiency, or excess patterns, this color may appear. Only when the entire tongue is black does it indicate that the pathogen has entered the interior; this is either extreme heat in the Zang-Fu organs or extreme cold in the Zang-Fu organs. If it is a deficiency-cold pattern with a black tongue, the surface must be wet, slippery, and devoid of coating. If it is a true-cold false-heat pattern with a black tongue, the entire tongue will be black without distinct meridian distribution. If the entire tongue is black, without coating, but the underlying texture is rough, astringent, dry, and scorched, and cannot be scraped clean, this is a sign of extreme heat. If the entire tongue is black, without coating, without cracks or spots, dry with little fluid, yet glossy, this is a variation of the crimson tongue, indicating kidney Yin exhaustion. If the entire tongue is black with cracks and prickles, it is an excess pattern of extreme heat. Only if the black coating is rotten does it indicate the exhaustion of both Heart and Kidney; if the tongue is black and curled/shrunk, it indicates the exhaustion of the Liver function. These are all incurable conditions. The statement "Water overcomes Fire, and not one in a hundred can be cured" refers specifically to patterns of extreme cold and extreme deficiency in the Zang-Fu organs.
The tip of the tongue is white and the root is yellow, indicating that the exterior syndrome has not yet resolved. One should first release the exterior before proceeding to purge the interior. If there is fecal impaction, use Liangge San (Cool the Diaphragm Powder) with Rhubarb and Mirabilite taken as a decoction infusion. If urination is difficult and painful, use Wuling San (Five-Ingredient Poria Powder) combined with Mutong (Akebia Caulis), mixed with Yiyuan San (Benefit Origin Powder) and a small amount of ginger juice, taken at any time with boiled water.
[Commentary by Jie] Generally, exterior syndromes such as wind-heat, summerheat, and dryness present with yellow tongues. Only when Shanghan (Cold Damage) transmits from the exterior to the interior, reaching the Yangming Fu-organs, does the tongue necessarily turn yellow, indicating the disease progressing from shallow to deep. Now, seeing a white tip and yellow root, this belongs to Taiyang cold invasion with Yangming internal heat, or wind-heat pathogens lodging in the Yangming exterior. All these cases should be treated with cooling and dispersing methods. White coating governs the exterior, while yellow coating governs the interior; Taiyang governs the exterior, and Yangming governs the interior. Hence, the tongue coating shows a white tip and yellow root, or white mixed with yellow. If slightly yellow and thin, the tongue must be yellow and dry, which is a sign of pathogenic factors just entering the interior. Exterior symptoms must include aversion to cold and fever; treatment should employ acrid-cool methods to release the exterior. If the root is yellow and the tip is white but not very dry, and the tongue is short and shrunk unable to extend, it indicates retained food. Purging methods should be used. If aversion to cold has ceased, leaving only fever and constipation, this indicates pathogenic heat entering the Stomach, so Liangge San should be used. Using Rhubarb and Mirabilite as an infusion takes advantage of their focused medicinal power. As for scanty and painful urination with a yellow-greasy tongue coating, this is a sign of damp-heat not yet cleared. Therefore, Wuling San combined with Mutong and modified Yiyuan San is used to promote diuresis and clear damp-heat.
Liangge San (Formula seen previously)
Wuling San (Formula seen previously)
Yiyuan San (Newly supplemented from Famous Physician Formulas)
Talcum (Six liang, processed by water flotation) Licorice Root (One liang) Cinnabar (Three qian)
Grind the above into fine powder. Mix three qian with a bowl of fresh drawn water and take orally.
[Commentary by Jie] This formula is Liu Yi San (Six-to-One Powder) plus Cinnabar. It benefits Qi without aiding the pathogen and expels the pathogen without damaging healthy Qi, hence the name "Benefit Origin". Ke Yunbo stated: The Heart is the master of the five Zang organs. Summerheat and heat disturb the middle jiao, causing the Spirit to be unsettled. It requires Cinnabar to anchor it, so that Spirit Qi can recover rapidly; using cool water to nourish it allows pathogenic heat to be quickly eliminated. This clears Heart Yang, allowing heat to circulate freely.