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The tongue presents with a gray color and a yellow tip. If the patient is not aversive to wind or cold, and the pulse is floating, purgation may be applied. If there is aversion to wind or cold, Shuangjie San (Double-Release Powder) and Jiedu Tang (Detoxification Decoction) should be used as the primary formulas. After three or four courses of purgation, if black stool appears, it indicates an untreatable condition.

[Commentary by Jie] The absence of aversion to wind and cold indicates that the pathogenic factor from the Taiyang (Greater Yang) channel has invaded the Fu organs of Yangming (Yang Brightness). A yellow tip and gray root on the tongue signify extreme heat in Yangming, which is scorching the Yin fluids of the Liver. The pulse will necessarily be floating, wiry, and rapid. Therefore, one may imitate the method of Chengqi Tang (Cassia Decoction) to apply purgation. This corresponds to the scenario described by Zhang Zhongjing: "When a disease presents neither exterior nor interior signs, with fever for seven or eight days, even if the pulse is floating and rapid, purgation may be applied." If there is aversion to wind and cold, it means the pathogen has not fully entered the interior; thus, Shuangjie San can be used to release the exterior of Taiyang and resolve the interior of Yangming, while Jiedu Tang clears the heat-toxin of Yangming. If black stool appears, it signifies severe heat-toxin and exhaustion of body fluids, hence termed untreatable.

The tongue presents with a gray-black color accompanied by black cracks. Use Dachengqi Tang (Major Order the Qi Decoction) for purgation. If the pulse is floating and there is thirst with desire to drink water, use Liangge San (Cool the Diaphragm Powder) to resolve the heat. Two out of ten cases may be saved.

[Commentary by Jie] Gray-black tongue coating indicates that the heat-toxin of warm diseases has spread through all three Yin channels. The treatment method generally requires urgent purgation. If black cracks are seen, it implies complication by excess heat in Yangming; therefore, Dachengqi Tang is used for urgent purgation to save the condition. If the pulse is floating and there is thirst, it indicates that although the pathogenic heat is in Yangming, the feces have not yet hardened; thus, Liangge San is used to clear heat from the diaphragm. However, gray-black color is quite similar to pale black. Gray-black is black mixed with purple, whereas pale black is black mixed with white. If heat pathogen directly invades the three Yin channels, the tongue is gray-black without coating, and the treatment should urgently purge to preserve fluids. If cold pathogen directly invades the three Yin channels, the tongue is pale-black without coating, and the treatment should warm the meridians and dispel cold. During clinical practice, careful differentiation is essential.

Dachengqi Tang (Major Order the Qi Decoction); Liangge San (Cool the Diaphragm Powder) (Both formulas are mentioned previously).