斑疹舌黑昏谵，斑紫或黑，手足振颤，此血热已
极，内闭外脱。宜用固本汤加犀角、元参、紫草、人
中黄、至宝丹等味，养阴化斑也。
舌黑昏谵，斑色紫黑，是血络热甚，津枯液凅矣。更兼
手足振摇，内风旋动，乃正不胜邪，神不自持，若非养阴扶
正，凉血化斑，则危在顷刻。然舌黑须要分别有地无地。若
黑而兼黄，底赤尖绛，斯属有地之黑，为津枯邪滞，若脉症
尚强，法宜攻下，如黑而光赤，并无黄底，此为无地之黑，
乃热灼津枯，若然脉症属虚，法宜滋阴。至斑色紫黑，亦要
分别虚实。若黑而边红鲜润，跟脚不散，乃邪火抑郁，宜透
宜攻;如黑而边散，枯晦不显，乃津液凅竭，元气已败，万
无生理，必欲用药，宜滋宜补。务在临症时，细心体认，对
症处方，庶不愧为司命矣。
斑疹紫黑，神昏烦躁，舌黑短缩，便闭脉促，此
血热瘀滞。宜用犀角地黄汤加紫草、山甲、人中黄、
元明粉、大黄等味，逐瘀化斑也。
斑色紫黑，光润不散，固系邪火郁伏，更加神昏烦躁，
舌黑短缩，便闭脉促，此血热瘀滞，邪无泄越，必从内化，
犹可挽回。故宜犀角地黄汤加山甲，紫草凉血破瘀，兼人中
黄、元明粉·大黄攻热逐邪。若得斑色转红，舌黑顿化，便
是回天之兆。如黑而枯晦，根点不敛，此天真几尽，谅难力
挽，无已，勉用犀角地黄汤加人参、附子大剂服之，以聊尽
人工而已。
斑疹出现，舌苔发黑，神志昏迷且胡言乱语，斑色呈紫色或黑色，手足震颤抽搐，这是血热已达到极点，导致邪气内闭、正气外脱的危重证候。适宜使用固本汤加入犀角、玄参、紫草、人中黄、至宝丹等药物，以滋养阴液、化解斑毒。
若舌苔发黑、神志昏迷且胡言乱语，斑色呈紫黑色，说明血络中热势极盛，津液枯竭、体液干涸。再加上手足摇动不定，是体内风邪旋动所致，属于正气不能战胜邪气，神志无法自主持守。如果不是采用滋养阴液、扶持正气、凉血化斑的方法治疗，病情将在顷刻间危及生命。然而，对于舌苔发黑必须分辨是有根之黑还是无根之黑。如果舌苔黑而兼有黄色，底色红赤、舌尖绛红，这属于有根之黑，是由于津液枯竭、邪气停滞所致；如果脉象和症状尚属强实，治法应当采用攻下法。如果是舌苔黑而光亮鲜赤，并没有黄色的底衬，这属于无根之黑，是由于热邪灼烧、津液枯竭所致；此时如果脉象和症状表现为虚证，治法应当采用滋阴法。至于斑色紫黑，也要分辨虚实。如果斑色黑但边缘红润鲜明，根基不散漫，这是邪火郁结所致，适宜用透发法和攻逐法；如果斑色黑且边缘散漫，干枯晦暗不明显，这是津液干涸竭绝、元气已经败坏的表现，完全没有生机，即使一定要用药，也适宜采用滋补和滋养的方法。务必在临诊时细心体察辨认，对症开具处方，才不愧为掌握人生命运的医生。
斑疹呈紫黑色，神志昏迷、烦躁不安，舌苔黑且舌体短缩，大便闭塞不通，脉搏急促，这是血热瘀滞所致。适宜使用犀角地黄汤加入紫草、穿山甲、人中黄、元明粉、大黄等药物，以逐除瘀血、化解斑毒。
斑色紫黑，光泽润泽且不散漫，固然属于邪火郁伏在内；再加上神志昏迷、烦躁不安，舌苔黑且舌体短缩，大便闭塞不通，脉搏急促，这是血热瘀滞，邪气没有宣泄出路，必然从内部转化，还有挽回的希望。因此适宜使用犀角地黄汤加入穿山甲、紫草来凉血破瘀，同时配合人中黄、元明粉、大黄来攻逐热邪。如果能使斑色转为红色，舌苔黑色顿时消退，大便通畅，这就是起死回生的征兆。如果斑色黑而干枯晦暗，根部斑点不收敛，这说明先天真元几乎耗尽，很难强力挽回，实在没有办法的情况下，勉强使用犀角地黄汤加入人参、附子大剂量服用，以此聊尽人力罢了。
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.