舌有红色而有小黑点者。热毒乘虚入胃。蓄热则发斑。宜用玄参升麻葛根汤、化斑汤解之。
\r生斑舌图\pt101a4.bmp\r
【介按】舌苔纯红起刺者。外证必有烦躁不宁。耳聋颧红。胸前发斑。甚则神昏谵语。治宜清少阳之热。解营分之
邪。或舌如芒刺。斑见紫色。目赤面红。神呆不语。治宜犀角地黄汤。（犀角、生地、丹皮、芍药。）去芍药，加焦山栀、
银花、菖蒲等味。以解包络之热，至于斑色之轻重。前贤吴坤安分辨甚晰。其言曰。“凡斑疹赤者为胃热。紫色为热甚。
紫黑为胃烂。赤斑五死五生。黑斑九死一生。鲜红起发稀朗者。虽大不妨。如针头稠密。紫黑成片者难治。蓝斑黑斑者
死。”又据《舌鉴辨正》。对于此舌之治法。大相悬殊。爰述其言曰。“全舌纯红而有小黑点者。脏腑皆热也。伤寒邪传阳
明府。失治、以致邪火逼入三阴证。或疫毒直中三阴证。或实热人误服辛温药。燥伤三阴证均有之。不论老少何病何脉。
见此舌，即宜十全苦寒救补汤。（生石膏八两研粉 生知母六钱去毛 黄柏四钱 黄芩六钱 大黄 芒硝各三钱 生陈浓
朴一钱 生枳实钱半 暹犀角尖四钱）倍加真犀角尖。连服必愈。旧说用元参、升麻葛根汤及化斑汤。误人多矣。”但舌
苔有红中兼紫黑斑。或外证兼发斑者。心胃热极也。宜用三黄汤。（黄连、黄芩、大黄。）合白虎汤。（石膏、知母、甘草、
粳米。）加减治之。
玄参升麻葛根汤 即玄参升麻汤加葛根。
【介按】升麻性主上升。为升发上行之专药。如若治伤寒失表失清，及温暑时邪，与胃热相抟而发斑之症。须防肺
气上逆。转致喘嗽之患。葛根虽能鼓舞胃气。升津止渴而解肌热。若治发斑亦不相宜。是以先贤朱震亨先生曾有“凡斑
疹已见红点。不可用升麻葛根汤。恐表虚反增斑烂也”之戒。至若元参。虽能滋液消斑。兹与升麻、葛根同用。恐是杯
水车薪。无益于事。故《舌鉴辨正》有“误人多矣”之讥评也。
化斑汤 即白虎汤加人参。
【介按】赵以德云。“石膏能治三焦火热。功多于清肺。退肺中之火。故用为君。知母亦就肺中泻心火。滋水之源。
人参生津。益所伤之气为臣。粳米甘草补土以资金而为佐也。”据是以观。则知是方以救肺为主。虽亦能清胃生津。惟治
舌红而有黑点。热毒入胃而发斑之证。尚须参用承气法为是。
舌面上出现红色并伴有小黑点的。这是热毒趁着正气虚弱侵入胃腑。热邪蓄积就会引发发斑病证。适宜使用玄参升麻葛根汤、化斑汤来解除它。
生斑舌图\pt101a4.bmp\
【介眉按】舌苔纯红且起刺的。外在证候必定有烦躁不安。耳聋颧骨发红。胸前部位出现发斑。严重时甚至神志昏迷、胡言乱语。治疗应当清泻少阳经的热邪。解除营分中的邪气。或者舌面像芒刺一样。斑点呈现紫色。眼睛红赤面色红。神情呆滞不说话。治疗应当使用犀角地黄汤。（药材包括：犀角、生地黄、牡丹皮、芍药。）去掉芍药，加入焦山栀、金银花、石菖蒲等药物。用来解除心包络的热邪。至于斑疹颜色的轻重程度。前贤吴坤安分辨得非常清晰。他说：“凡是斑疹颜色红的属于胃热。紫色的属于热势严重。紫黑色的属于胃腑腐烂。红色的斑疹五成死亡五成存活。黑色的斑疹九成死亡一成存活。鲜红色且稀疏朗润的。虽然面积大也不要紧。如果像针头那样稠密。紫黑色连成一片的就难以治疗。蓝色的斑和黑色的斑属于死证。”另外根据《舌鉴辨正》。对于这种舌象的治疗方法。差异很大。于是陈述其言论说：“全舌纯红而带有小黑点的。是脏腑都有热邪。伤寒邪气传入阳明腑。因失治。导致邪火逼迫进入三阴证。或者是疫毒直接侵犯三阴证。或者是实热证患者误服辛温药物。燥伤三阴证都会出现这种情况。不论老少患什么病脉象如何。见到这种舌象。就应当使用十全苦寒救补汤。（生石膏八两研成粉 生知母六钱去毛 黄柏四钱 黄芩六钱 大黄 芒硝各三钱 生陈浓朴一钱 生枳实钱半 暹犀角尖四钱）加倍加入真犀角尖。连续服用必定痊愈。旧时说使用元参、升麻葛根汤及化斑汤。误导人太多了。”但是舌苔有红中兼带紫黑斑。或者外在证候兼有发斑的。是心和胃热极所致。适宜使用三黄汤。（黄连、黄芩、大黄。）合用白虎汤。（石膏、知母、甘草、粳米。）加减治疗后。
【介眉按】升麻的药性主要主升。是升发上行的专用药物。如果治疗伤寒时未能解表清热。以及温暑时的邪气。与胃热相互搏结而引发发斑的病证。必须防止肺气上逆。转而导致喘咳的祸患。葛根虽然能鼓舞胃气。升腾津液止渴并解除肌表之热。但如果治疗发斑也不合适。因此先贤朱震亨先生曾有“凡是斑疹已经出现红点。不可使用升麻葛根汤。恐怕表虚反而增加斑烂”的告诫。至于元参。虽然能滋阴液消除斑疹。现在与升麻、葛根一同使用。恐怕是杯水车薪。对事情没有益处。所以《舌鉴辨正》有“误导人太多了”的讥讽评价。
【介眉按】赵以德说：“石膏能治疗三焦火热。功效多于清肺。退除肺中的火邪。所以作为君药。知母也在肺中泻心火。滋补水之源。人参生津液。补益所损伤的气作为臣药。粳米甘草补益脾土以资助金行作为佐药。”据此来看。就知道这个方子以救肺为主。虽然也能清胃生津。只是治疗舌红而有黑点。热毒入胃而发斑的病证。还应当参考使用承气法才是合适的。
If the tongue surface appears red with small black spots, it indicates that heat-toxin has invaded the Stomach due to deficiency. Accumulation of heat leads to the eruption of macules (rash). It is appropriate to use Xuan Shen Sheng Ma Ge Gen Tang (Scrophulariae Radix, Cimicifugae Rhizoma and Puerariae Radix Decoction) or Hua Ban Tang (Macule-Resolving Decoction) to resolve it.
Image of Tongue with Macules\pt101a4.bmp\
[Commentary by Jie] If the tongue coating is purely red and prickly, the external symptoms must include restlessness and irritability, deafness, malar flush, and macules appearing on the chest. In severe cases, there may be coma and delirious speech. The treatment should clear the heat of Shaoyang (Lesser Yang) and resolve pathogens in the Ying (Nutritive) level. Alternatively, if the tongue resembles thorns and the macules are purple, with red eyes and a red face, and the patient is listless and mute, Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) should be used. (Herbs: Rhinoceros Horn [now substituted with water buffalo horn], Sheng Di Huang [Rehmanniae Radix], Mu Dan Pi [Moutan Cortex], Bai Shao [Paeoniae Radix Alba]). Remove Bai Shao, and add Zhi Shan Zhi (Fried Gardenia), Yin Hua (Honeysuckle Flower), and Shi Chang Pu (Acori Tatarinowii Rhizome) to resolve heat in the Pericardium. Regarding the severity indicated by the color of the macules, the former expert Wu Kun'an distinguished them clearly. He said: "For macules and rashes, red indicates Stomach heat; purple indicates severe heat; purple-black indicates rotting of the Stomach. Red macules have a mortality rate of five deaths to five survivals; black macules have nine deaths to one survival. Fresh red macules that are sparse and distinct are not dangerous even if extensive. However, those dense like pinheads, purple-black and conflated, are difficult to treat. Blue and black macules indicate death." Furthermore, according to *She Jian Bian Zheng* (Differentiation of Tongue Diagnosis), the treatment methods for this type of tongue differ significantly. The text states: "A tongue that is purely red with small black spots indicates heat in all zang-fu organs. In Shanghan (Cold Damage), pathogens transmit to the Yangming Fu organs. Due to mismanagement, evil fire forces entry into the Three Yin syndromes. Or epidemic toxins directly attack the Three Yin syndromes. Or patients with excess heat mistakenly take acrid-warm herbs, causing dryness damaging the Three Yin syndromes—all these conditions can present this tongue. Regardless of age, disease, or pulse, upon seeing this tongue, one should immediately use Shi Quan Ku Han Jiu Bu Tang (Ten-Ingredient Bitter-Cold Rescue and Tonification Decoction). (Sheng Shi Gao [Gypsum Fibrosum] 8 liang ground to powder, Sheng Zhi Mu [Anemarrhenae Rhizoma] 6 qian de-haired, Huang Bo [Phellodendri Cortex] 4 qian, Huang Qin [Scutellariae Radix] 6 qian, Da Huang [Rhei Radix et Rhizoma] and Mang Xiao [Natrii Sulfas] each 3 qian, Sheng Chen Pi [Citri Reticulatae Pericarpium] 1 qian, Sheng Zhi Shi [Aurantii Fructus Immaturus] 1.5 qian, Xian Xi Jiao Jian [Tibet Rhinoceros Horn Tip] 4 qian). Double the dose of true Xi Jiao Jian (Rhinoceros Horn Tip). Continuous administration will surely cure. Old theories using Yuan Shen (Scrophulariae Radix), Sheng Ma Ge Gen Tang, and Hua Ban Tang have misled many." However, if the tongue coating has red mixed with purple-black spots, or if external symptoms include macules, it indicates extreme heat in the Heart and Stomach. San Huang Tang (Three-Yellow Decoction) combined with Bai Hu Tang (White Tiger Decoction) should be used with modifications for treatment.
Xuan Shen Sheng Ma Ge Gen Tang is Xuan Shen Sheng Ma Tang plus Ge Gen (Puerariae Radix).
[Commentary by Jie] Sheng Ma (Cimicifugae Rhizoma) has a primary property of ascending and is a specific herb for raising and moving upward. If treating Shanghan where both releasing the exterior and clearing heat were neglected, or when warm-summer pathogens struggle with Stomach heat causing macules, one must prevent rebellious Lung Qi which could lead to wheezing and coughing. Although Ge Gen can stimulate Stomach Qi, raise fluids to quench thirst, and release muscle-layer heat, it is also unsuitable for treating macules. Therefore, the ancient expert Zhu Zhenheng warned: "Once macules and rashes show red spots, Xuan Shen Sheng Ma Ge Gen Tang must not be used, lest the deficient exterior worsen the macule erosion." As for Yuan Shen (Scrophulariae Radix), although it can nourish fluids and resolve macules, using it together with Sheng Ma and Ge Gen is likely like pouring a cup of water on a cartload of burning wood—of no benefit. Thus, *She Jian Bian Zheng* criticizes this approach as having "misled many."
Hua Ban Tang is Bai Hu Tang plus Ren Shen (Ginseng Radix et Rhizoma).
[Commentary by Jie] Zhao Yi-de stated: "Shi Gao (Gypsum Fibrosum) treats heat-fire in the Triple Burner, with effects more focused on clearing the Lungs. It retreats fire from the Lungs, thus serving as the Sovereign herb. Zhi Mu (Anemarrhenae Rhizoma) also clears Heart fire within the Lungs and nourishes the source of Water. Ren Shen (Ginseng Radix et Rhizoma) generates fluids and benefits the damaged Qi, serving as the Minister. Jing Mi (Oryza Sativa) and Gan Cao (Glycyrrhizae Radix et Rhizoma) tonify Earth to assist Metal, serving as the Assistant." From this, we know this formula primarily aims to rescue the Lungs. Although it can also clear Stomach heat and generate fluids, for treating a red tongue with black spots where heat-toxin enters the Stomach causing macules, it is advisable to incorporate methods from Cheng Qi Tang (Order the Qi Decoction).