舌见白苔中有小点乱生者。尚有表证。其病求之虽恶。宜凉膈散微表之。表退即当下之。下用调胃承气汤。
\r白苔黑点舌图\pt101a16.bmp\r
【介按】舌苔白而中有燥刺者。此系温邪在手太阴肺经。外证初必恶寒。继即发热不已。症势虽似恶候。治宜辛凉
清解。宜用凉膈散先清上中二焦之热。若热退而大便未下者。即当改投攻下之剂。如欲下之。宜与调胃承气汤。
凉膈散 调胃承气汤（方见前）
舌见如灰色。中间更有黑晕两条。此热乘肾与命门也。宜急下之。服解毒汤。下三五次。迟则难治。如初服，加大
黄。酒浸泡。量大小用之。
\r灰苔黑晕舌图\pt101a17.bmp\r
【介按】舌至灰色。病概非轻。如苔燥少津。均是实热里症。而无虚寒表症。如温燥时疫。郁积停胸。蓄血如狂。
宿食未消之类是也。若伤寒已经汗解。而舌尖灰黑。此是宿食未消。或因食滞而余热复炽。治宜调胃承气汤。若杂症而
见此舌。宜用大承气汤加黄连治之。今以舌见灰色而有黑晕两条。是属热毒传遍三阴。治法急宜泄热攻下。如白虎合承
气汤。或十全苦寒救补汤（方见前）以急下之。大便下后。再用解毒汤以清解余热。惟热毒传里已深。若嫌解毒汤太轻。
故须急投三五次。服至灰晕退净为止。初次服时。加酒浸大黄泡之。其分量。须别病患之年龄酌用之。惟舌见灰黑。是
足三阴杂病。而以太少两阴为较多。其始由白渐黄。由黄而转灰黑者。为传经症。或生刺点燥裂。不拘在根在尖。均宜
急行攻下。又有淡灰色中而起深黑重晕者。为温病热毒。急宜凉膈、双解等剂。以清热解毒治之。然亦有屡经汗下而舌
苔灰黑不退。其舌滋润。或不润不燥者。脉必虚微无力。此系汗下太过。伤其津液。治宜养津滋液为要。不得妄用硝黄
矣。
解毒汤（方见前）
舌面上出现白苔，其中混杂着许多细小的黑点。此时表证尚存。虽然病情看似凶险，但适宜使用凉膈散（Liangge San, Cooling the Diaphragm Powder）轻微解表。待表邪解除后，紧接着应当使用攻下法。攻下方剂选用调胃承气汤（Tiaowei Chengqi Tang, Regulating the Stomach and Resolving Accumulation Decoction）。
【介按】舌苔白色且中间有干燥的刺状突起。这是温邪侵犯手太阴肺经所致。外在症状起初必定恶寒，随后即持续发热不退。病症表现虽似危重，治疗宜采用辛凉清解之法。适宜先用凉膈散清除上焦和中焦的热邪。如果热退但大便仍未通畅，就应当改用攻下的方剂。若要攻下，适宜给予调胃承气汤。
舌面呈现如灰色，中间更有两条黑色的晕圈。这是热邪侵袭肾脏与命门的表现。应当紧急使用攻下法。服用解毒汤（Jiedu Tang, Detoxification Decoction），使大便排出三到五次。若拖延则难以治疗。如果是初次服用，需加入大黄，用酒浸泡，根据患者体型大小决定用量。
【介按】舌色变为灰色，病情大概都不轻。如果苔燥少津，均属于实热里证，而没有虚寒表证。例如温燥时疫、郁积停滞胸中、蓄血发狂、宿食未消等情况皆是如此。如果伤寒经过发汗已经解除，而舌尖呈现灰黑色，这是宿食未消，或者因食滞导致余热重新炽盛。治疗宜用调胃承气汤。如果是杂病出现这种舌象，宜用大承气汤（Da Chengqi Tang, Major Order the Qi Decoction）加黄连治疗。如今看到舌面呈灰色且有两条黑晕，这属于热毒传遍三阴经。治法应当紧急泄热攻下。可以使用白虎合承气汤，或者十全苦寒救补汤（Shiquan Kuhan Jiubu Tang, Ten-Ingredient Bitter-Cold Rescue and Nourishment Decoction）来紧急攻下。大便通下后，再用解毒汤清除余热。因为热毒传入体内已深，如果觉得解毒汤药力太轻，所以必须连续急投三到五次，直到灰黑晕圈完全消退为止。初次服用时，加入酒浸的大黄冲泡。剂量须根据患者的年龄酌情使用。凡是舌见灰黑，多属足三阴经的杂病，其中以足少阴肾和足太阴脾较为多见。其始由白渐黄，由黄转灰黑的，为传经症；或者生刺点、燥裂，无论位于舌根还是舌尖，都应当紧急行攻下法。又有淡灰色中升起深黑重晕的，为温病热毒，急宜用凉膈散、双解散等方剂，以清热解毒法治之。然而也有屡经发汗和攻下治疗后，舌苔灰黑仍不消退，舌面滋润，或不润不燥的，脉象必然虚微无力。这是发汗和攻下太过，损伤了津液。治疗应当以养津滋液为要务，不可妄用芒硝和大黄了。
When small black spots appear randomly within the white coating on the tongue, exterior syndrome (Biao Zheng) still exists. Although the condition appears severe, it is appropriate to use Liangge San (Cooling the Diaphragm Powder) to mildly release the exterior. Once the exterior pathogen is resolved, purgation should immediately follow. The formula for purgation is Tiaowei Chengqi Tang (Regulating the Stomach and Resolving Accumulation Decoction).
[Commentary by Jie] When the tongue coating is white with dry prickles in the center, this indicates that warm pathogenic factors have invaded the Hand-Taiyin Lung Meridian. Externally, there will initially be aversion to cold, followed by persistent fever. Although the symptoms seem ominous, treatment should employ acrid-cool clearing and resolving methods. It is appropriate to first use Liangge San (Cooling the Diaphragm Powder) to clear heat from the Upper and Middle Jiao. If the heat subsides but defecation has not occurred, a purgative formula should then be administered. For purgation, Tiaowei Chengqi Tang (Regulating the Stomach and Resolving Accumulation Decoction) is suitable.
When the tongue surface presents as grayish, with two black halos in the center, this indicates that heat pathogens are attacking the Kidney and Mingmen (Gate of Vitality). Urgent purgation is required. Administer Jiedu Tang (Detoxification Decoction) until three to five bowel movements occur. Delay makes treatment difficult. For the initial dose, add Rhizoma et Radix Rhei (Dahuang, 大黄), soaked in wine, and adjust the dosage according to the patient's size.
[Commentary by Jie] A gray tongue color generally indicates a serious condition. If the coating is dry with little fluid, these are all excess-heat interior syndromes without deficiency-cold exterior signs. Examples include warm-dry seasonal epidemics, stagnation accumulated in the chest, blood stasis causing mania, or undigested food retention. If Taiyang disease has been resolved through sweating, yet the tip of the tongue is gray-black, this indicates undigested food retention or residual heat flaring up due to food stagnation. Treatment should utilize Tiaowei Chengqi Tang (Regulating the Stomach and Resolving Accumulation Decoction). If miscellaneous diseases present this tongue sign, Da Chengqi Tang (Major Order the Qi Decoction) combined with Cortex Phellodendri (Huanglian, 黄连) is appropriate. In the current case, where the tongue is gray with two black halos, this belongs to heat toxins spreading through the Three Yin meridians. The treatment method urgently requires draining heat and purging accumulation. One may use Baihu combined with Chengqi Tang, or Shiquan Kuhan Jiubu Tang (Ten-Ingredient Bitter-Cold Rescue and Nourishment Decoction) for urgent purgation. After defecation, Jiedu Tang (Detoxification Decoction) should be used again to clear residual heat. Because the heat toxin has penetrated deeply into the interior, if one considers Jiedu Tang too mild, it must be administered urgently three to five times consecutively, until the gray-black halos completely disappear. For the first administration, add Rhizoma et Radix Rhei (Dahuang, 大黄) soaked in wine. The dosage must be adjusted according to the patient's age. Tongues showing gray-black colors mostly belong to miscellaneous diseases of the Foot-Sanyin meridians, particularly involving the Foot-Shaoyin Kidney and Foot-Taiyin Spleen. Progression from white to yellow, then to gray-black, constitutes a transmitted meridian syndrome; whether accompanied by prickles, dryness, or cracking at the root or tip, urgent purgation is indicated. A deep black halo rising from a pale gray background indicates heat toxins of warm diseases, requiring urgent treatment with formulas such as Liangge San or Shuangjie San to clear heat and detoxify. However, there are cases where repeated sweating and purgation fail to resolve the gray-black coating, and the tongue is moist or neither dry nor moist, with a pulse that is deficient, minute, and powerless. This results from excessive sweating and purgation damaging body fluids. Treatment must prioritize nourishing fluids and generating moisture; one must not recklessly use Natrii Sulfas (Mangxiao, 芒硝) and Rhizoma et Radix Rhei (Dahuang, 大黄).