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Macules and rashes appear with a black tongue coating, coma, and delirium; the macules/rashes are purple or black, accompanied by tremors and convulsions of the hands and feet. This indicates that blood-heat has reached its extreme, resulting in internal closure (blockage of pathogenic factors inside) and external collapse (loss of healthy qi outside). It is appropriate to use Guben Tang (Solidify the Root Decoction) added with Xijiao (Rhinoceros Horn), Yuan Shen (Radix Scrophulariae), Zicao (Radix Arnebiae), Renzhong Huang (Calcinus Humanis), and Zhibao Dan (Precious Treasure Pill), to nourish yin and resolve macules/rashes.

If there is a black tongue coating, coma, and delirium, with macules/rashes being purple-black, it signifies intense heat in the blood collaterals and exhaustion of body fluids. Additionally, the shaking of the hands and feet indicates the stirring of internal wind, where healthy qi fails to overcome pathogenic factors, and the spirit loses its mastery. Unless one employs methods to nourish yin, support healthy qi, cool blood, and resolve macules/rashes, danger will ensue instantly. However, regarding a black tongue coating, one must distinguish between "rooted" and "unrooted" blackness. If the blackness is accompanied by yellow, with a red base and crimson tip, this is "rooted" blackness, caused by fluid exhaustion and pathogenic stagnation; if the pulse and symptoms are still robust, the treatment method should be purgation. If the tongue is black, glossy, and crimson without a yellow base, this is "unrooted" blackness, caused by heat scorching and fluid exhaustion; in this case, if the pulse and symptoms indicate deficiency, the treatment method should be nourishing yin. As for purple-black macules/rashes, one must also distinguish between excess and deficiency. If the blackness has bright red edges and the roots are not scattered, it is due to depressed evil fire, suitable for venting and attacking methods. If the blackness is scattered at the edges, dry, dull, and indistinct, it indicates exhaustion of fluids and failure of yuan qi (original qi), leaving no hope for life. Even if medication is attempted, tonification and nourishment are the only options. One must carefully observe and discern during clinical practice and prescribe according to the syndrome, thereby deserving the title of a healer who holds the fate of lives.

Macules/rashes are purple-black, accompanied by coma, irritability, a black and shortened tongue, constipation, and a rapid pulse. This indicates blood-heat with stasis. It is appropriate to use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Zicao (Radix Arnebiae), Shan Jia (Pangolin Scales), Renzhong Huang (Calcinus Humanis), Yuan Ming Fen (Natrii Sulfas), and Dahuang (Radix et Rhizoma Rhei), to eliminate stasis and resolve macules/rashes.

Purple-black macules/rashes that are glossy and not scattered certainly indicate latent evil fire. Coupled with coma, irritability, a black and shortened tongue, constipation, and a rapid pulse, this indicates blood-heat with stasis, where pathogenic factors have no outlet for excretion and must transform internally; recovery is still possible. Therefore, it is appropriate to use Xijiao Dihuang Tang added with Shan Jia (Pangolin Scales) and Zicao (Radix Arnebiae) to cool blood and break stasis, combined with Renzhong Huang (Calcinus Humanis), Yuan Ming Fen (Natrii Sulfas), and Dahuang (Radix et Rhizoma Rhei) to attack heat and expel pathogens. If the macules/rashes turn red, the black tongue coating disappears suddenly, and bowel movements resume, this is a sign of miraculous recovery. If the blackness is dry and dull, and the root spots do not converge, it indicates that the innate essence is nearly exhausted, making recovery difficult to achieve by force. In desperation, one may reluctantly administer Xijiao Dihuang Tang added with Renshen (Radix Ginseng) and Fuzi (Radix Aconiti Lateralis Preparata) in large doses, merely to exhaust human effort.