舌见红色。内有黑形如小舌者。乃邪热结于里也。君火炽盛。反兼水化。宜凉膈散、大柴胡汤下之也。
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【介按】邪热传里。热结燥实。治宜急下存津。故凡苔见黑色。病必不轻。无论寒热虚实。皆有黑苔。惟以润、燥、
老、嫩为辨。今此舌中黑而边纯红。系是邪热入里。灼烁胃津。故用凉膈散。去其膈中无形之热。再用大柴胡汤之表里
兼治也。
凉膈散
生甘草（二两） 大黄（二两） 连翘（四两） 山栀子（一两） 薄荷叶 黄芩 朴硝（各一两）
每服一两。水二盏。淡竹叶二十余片。煎至一盏。去渣，入生蜜少许。不拘时热服。以利为度。
【介按】此方即调胃承气汤。加连翘、薄荷、山栀、黄芩、竹叶。为清膈热之良剂。汪昂云。热淫于内。治以咸寒。
佐以苦甘。故以连翘、黄芩、竹叶、薄荷散火于上。而以大黄、芒硝之猛利。荡热于中。使上升下行。而膈自清矣。
大柴胡汤
柴胡（四钱） 黄芩 芍药（各一钱五分） 半夏 大黄（各二钱五分） 枳实（麸炒二钱）
上 咀。每服八钱。水一钟半。姜三片、枣一枚。煎一钟。温服。
【介按】陈古愚曰。方用芍药、黄芩、枳实、大黄者。以病势内入。必取苦泄之品，以解在内之烦急也。又用柴胡、
半夏、以启一阴一阳之气。生姜、大枣、以宣发中焦之气。盖病势虽已内入。而病情仍欲外达。故制此汤。还藉少阳之
枢而外出。非若承气之承热气也。
The tongue surface appears red. There is a black formation within the tongue resembling a small tongue, which indicates pathogenic heat accumulating in the interior. The Sovereign Fire (Heart Fire) is blazing and counterfeiting the transformation of Water. It is appropriate to use Liangge San (Cool the Diaphragm Powder) and Da Chaihu Tang (Major Bupleurum Decoction) to purge it downwards.
[Commentary by Jie] Pathogenic heat has transmitted into the interior, where heat accumulation leads to dryness and excess. Treatment should urgently purge to preserve body fluids. Therefore, whenever black coating appears on the tongue, the condition is certainly serious. Regardless of cold, heat, deficiency, or excess patterns, black coating may appear. Differentiation relies solely on whether the coating is moist or dry, and old or tender. In this case, the center of the tongue is black while the edges are purely red, indicating pathogenic heat entering the interior and scorching Stomach fluids. Hence, Liangge San is used to clear formless heat from the diaphragm, followed by Da Chaihu Tang for simultaneous treatment of both exterior and interior.
Liangge San (Cool the Diaphragm Powder)
Raw Glycyrrhizae Radica et Rhizoma (Gancao, 甘草) (2 liang), Rheum Palmatum Radix et Rhizoma (Dahuang, 大黄) (2 liang), Forsythiae Fructum (Lianqiao, 连翘) (4 liang), Gardeniae Fructus (Shanzhizi, 山栀子) (1 liang), Menthae Haplocalycis Herba (Boheye, 薄荷叶), Scutellariae Radix (Huangqin, 黄芩), Natrii Sulfas (Puxiao, 朴硝) (each 1 liang).
Take 1 liang per dose. Add 2 zhan of water and more than 20 slices of Bambusae Folium (Danzhuyez, 淡竹叶). Decoct until 1 zhan remains, remove dregs, add a little Raw Honey (Shengmi, 生蜜). Take hot at any time. Stop when bowel movement occurs.
[Commentary by Jie] This formula is essentially Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Bowels Decoction), added with Forsythiae Fructum, Menthae Haplocalycis Herba, Gardeniae Fructum, Scutellariae Radix, and Bambusae Folium. It is an excellent agent for clearing diaphragmatic heat. Wang Ang stated: When heat overflows internally, treat with salty-cold substances, assisted by bitter-sweet ones. Thus, Forsythiae Fructum, Scutellariae Radix, Bambusae Folium, and Menthae Haplocalycis Herba disperse fire upwards, while the potent Rheum Palmatum Radix et Rhizoma and Natrii Sulfas purge heat in the middle, causing rising and descending movements, thereby naturally clearing the diaphragm.
Da Chaihu Tang (Major Bupleurum Decoction)
Bupleuri Radix (Chaihu, 柴胡) (4 qian), Scutellariae Radix, Paeoniae Radix Alba (Shaoyao, 芍药) (each 1.5 qian), Pinelliae Rhizoma Preparatum (Banxia, 半夏), Rheum Palmatum Radix et Rhizoma (Dahuang, 大黄) (each 2.5 qian), Aurantii Fructus Immaturus (Zhishi, 枳实) (stir-fried with bran, 2 qian).
Cut the above herbs. Take 8 qian per dose. Add 1.5 zhong of water, 3 slices of Zingiberis Rhizoma Recens (Shengjiang, 生姜), and 1 Ziziphi Jujubae Fructus (Dazao, 大枣). Decoct until 1 zhong remains. Take warm.
[Commentary by Jie] Chen Guyu said: The use of Paeoniae Radix Alba, Scutellariae Radix, Aurantii Fructus Immaturus, and Rheum Palmatum Radix et Rhizoma is because the disease trend has moved inward; thus, bitter-draining agents are necessary to resolve internal restlessness and urgency. Furthermore, Bupleuri Radix and Pinelliae Rhizoma Preparatum are used to activate Yin and Yang qi. Zingiberis Rhizoma Recens and Ziziphi Jujubae Fructus are used to disseminate Middle Jiao qi. Although the disease trend has entered inward, the pathological condition still desires to reach outward. Therefore, this decoction is formulated to rely on the pivot mechanism of Shaoyang (Lesser Yang) to exit outward. This differs from Chengqi Tangs, which merely receive and descend stomach qi.