伤暑热甚，口渴，舌黄尖绎，斑疹隐隐，神昏谵
语，此气分不解，而热渐入营。宜用沙参、连翘、元
参、桑叶、甜杏仁、花粉、鲜生地、羚羊角、鲜斛
斛、鲜菖蒲、广郁金、牛黄丸，芳香宣窍，为心营肺
卫两清之也。
此条气分不解,渐入营分者。以肺主气，心主血，故口
渴舌黄为气热，尖绎昏谵斑现，为营分受灼，若不两清，病
必不解。故用沙参 连翘，元参，花粉、石斛清气热，鲜生
地，羚角、菖蒲、郁金，牛黄丸以透营邪也。
伤暑舌黄渐黑，尖绎底赤，神昏烦躁，斑疹透
露，目赤齿枯，此邪既入营，气分犹炽。宜用犀角
地黄汤加元参、人中黄、鲜菖蒲、鲜石斛、青竹叶、
牛黄丸等味，清营透邪也。
上条气热传营，此条营既受邪气犹未清。故舌黑尖绎底
赤，仍带黄苔，薄而干裂，甚至昏谵斑现，目赤齿枯，营分
之热已极。非藉犀角地黄汤凉血，合元参、中黄化斑，菖
蒲、竹叶清心，牛黄丸芳香入络，能清营熟，而兼透邪。若
舌黑尖绎，黄苔厚燥，此为有地之黑，乃热结胃腑，又宜凉
膈散下之。
伤暑旬余，热仍不解，舌绎焦黑，斑色或紫或
黑，神昏妄笑，此热炽血分，津枯邪滞。宜用犀角地
黄汤加羚羊角、元参心、连翘心、鲜石斛、人中黄、
鲜菖蒲、紫草、红花、至宝丹等味，凉血透斑也。
此言营热不解，而延入血分。故舌绎焦黑，血既被蒸，
失于荣灌，则斑色或紫或黑，且心主血，心热则血热，血热
则昏谵妄笑。故用犀角地黄汤合紫草、红花行血清热，兼至
宝丹芳香入络，以透内邪。若再不解,病必危矣。此舌黑而
解绎者宜之，为无地之黑也。
When summerheat-heat is severe, presenting with thirst, yellow tongue coating, crimson tip of the tongue, faint macules and papules, coma, and delirious speech, this indicates that the pathogen in the Qi level has not been resolved, and the heat is gradually entering the Ying (Nutritive) level. It is appropriate to use Glehniae Radix (Shashen), Forsythiae Fructus (Lianqiao), Scrophulariae Radix (Yuanshen), Mori Folium (Sangye), Semen Armeniacae Amarum (Tian Xingren), Pseudobulbus Bletillae (Huafen), fresh Rehmanniae Radix (Xian Shengdi), Cornu Saigae Tataricae (Lingyangjiao), Dendrobii Caulis (Xian Shihu), fresh Acori Tatarinowii Rhizoma (Xian Changpu), Curcumae Zedoariae Rhizoma (Guang Yujin), and Niuhuang Wan (Calculus Bovis Pill). These herbs act through aromatic orifice-opening to clear both the Heart Ying and Lung Wei levels simultaneously.
This clause discusses the scenario where the pathogen in the Qi level has not resolved and gradually enters the Ying level. Since the Lung governs Qi and the Heart governs Blood, thirst and yellow tongue coating indicate heat in the Qi level, while a crimson tongue tip, coma, delirious speech, and appearance of macules indicate burning damage to the Ying level. If simultaneous clearing is not employed, the disease will certainly not resolve. Therefore, Glehniae Radix, Forsythiae Fructus, Scrophulariae Radix, Pseudobulbus Bletillae, and Dendrobii Caulis are used to clear Qi-level heat, while fresh Rehmanniae Radix, Cornu Saigae Tataricae, Acori Tatarinowii Rhizoma, Curcumae Zedoariae Rhizoma, and Niuhuang Wan are used to vent Ying-level pathogens.
In summerheat injury, if the tongue coating turns from yellow to black, the tip is crimson and the base red, accompanied by coma, irritability, fully erupted macules and papules, red eyes, and dry teeth, this indicates that the pathogen has entered the Ying level, yet heat in the Qi level remains intense. It is appropriate to use Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Scrophulariae Radix, Ren Zhong Huang (Human Excrement Charcoal), fresh Acori Tatarinowii Rhizoma, fresh Dendrobii Caulis, Herba Lophatheri (Qing Zhu Ye), and Niuhuang Wan, to clear the Ying level and vent pathogens.
The previous clause discussed heat in the Qi level transmitting to the Ying level; this clause discusses the situation where the Ying level is affected but the Qi level heat is not yet cleared. Thus, the black tongue coating with a crimson tip and red base, still retaining a thin, dry, and cracked yellow coating, along with coma, delirious speech, macule eruption, red eyes, and dry teeth, indicates extreme heat in the Ying level. Only by relying on Xi Jiao Di Huang Tang to cool the blood, combined with Scrophulariae Radix and Ren Zhong Huang to transform macules, Acori Tatarinowii Rhizoma and Herba Lophatheri to clear the Heart, and Niuhuang Wan to enter collaterals via aroma, can Ying-level heat be cleared and pathogens vented. If the tongue is black with a crimson tip, but the yellow coating is thick and dry, this is referred to as "black with substrate" (You Di Zhi Hei), indicating heat accumulation in the Stomach Fu organ. In such cases, Liang Ge San (Liangge Powder) should be used to purge downward.
After more than ten days of summerheat injury, if the heat persists unresolved, the tongue becomes crimson, scorched, and black, macules appear purple or black, and there is coma with inappropriate laughter, this indicates heat blazing in the Xue (Blood) level, with exhaustion of fluids and stagnation of pathogens. It is appropriate to use Xi Jiao Di Huang Tang added with Cornu Saigae Tataricae, Xin Yuanshen (Scrophulariae Radix Heart), Xin Lianqiao (Forsythiae Fructus Heart), fresh Dendrobii Caulis, Ren Zhong Huang, fresh Acori Tatarinowii Rhizoma, Radix Lithospermi (Zicao), Flos Carthami (Honghua), and Zhibao Dan (Treasure Treasure Pill), to cool the blood and vent macules.
This passage describes the progression from unresolved Ying-level heat extending into the Xue level. Hence, the tongue is crimson, scorched, and black; the blood is steamed by heat, losing its nourishing irrigation, resulting in purple or black macules. Since the Heart governs Blood, Heart heat leads to Blood heat, and Blood heat causes coma, delirious speech, and inappropriate laughter. Therefore, Xi Jiao Di Huang Tang is combined with Radix Lithospermi and Flos Carthami to invigorate blood and clear heat, while Zhibao Dan enters the collaterals via aroma to vent internal pathogens. If the condition does not improve, the disease will become critical. This presentation of a black tongue with a crimson tip is suitable for this treatment, which is classified as "black without substrate" (Wu Di Zhi Hei).