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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.