舌见灰色尖黄。不恶风寒。脉浮者。可下之。若恶风恶寒者。用双解散解毒汤主之。三四下之。见粪黑者。不治。
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【介按】不恶风寒者。太阳之邪侵及阳明之府也。舌尖黄而根灰色者。阳明热极。灼及肝液也。其脉必浮弦而数。
故可仿承气之例以下之。此即张仲景所谓“病无表里证。发热七八日。虽脉浮数者。可下之”之候也。若恶风寒者。邪
未尽入于里。故可用双解散以发太阳之表。复解阳明之里。又以解毒汤清阳明之热毒也。若见粪黑。则为热毒深重。津
液已耗。故曰不治也。
舌见灰黑色而有黑纹者。用大承气汤下之。脉浮。渴饮水者。用凉膈散解之。十可救其二三。
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【介按】舌苔灰黑。是温病热毒传遍三阴。治法均宜急行攻下。如见黑纹。是夹杂阳明实热为患。故用大承气汤急
下以救之。若脉浮而口渴者。邪热虽在阳明而大便未硬。故用凉膈散以清膈热为治也。惟灰黑与淡黑色颇相似。灰色则
黑中带紫。淡则黑中带白之异。若热邪直中三阴。其舌灰黑无苔。治宜急下救液。如寒邪直中三阴。其舌淡黑无苔。则
治法宜温经散寒。临证之际。务须仔细辨别之。
大承气汤 凉膈散（二方见前）
舌象呈现灰色，舌尖发黄。患者不恶风、不恶寒，脉象浮的，可以使用攻下法治疗。如果患者恶风或恶寒，则应以双解散和解毒汤为主方进行治疗。经过三四次攻下治疗后，若发现大便发黑，属于不治之症。
【介按】不恶风、不恶寒，说明太阳经的邪气已经侵入阳明腑。舌尖黄而舌根呈灰色，是阳明热极，灼伤肝之阴液所致。其脉象必定浮弦且数。因此可以仿照承气汤的用法进行攻下。这就是张仲景所说的“病无表里证，发热七八日，虽然脉浮数，也可以攻下”的情况。如果恶风恶寒，说明邪气尚未完全入里，因此可以用双解散来发散太阳经的表邪，同时解除阳明经的里邪；再用解毒汤清除阳明经的热毒。如果出现大便发黑，说明热毒深重，津液已经耗竭，所以称为不治之症。
舌象呈现灰黑色并伴有黑色裂纹的，使用大承气汤攻下。脉象浮，口渴想喝水的，使用凉膈散来解热。十个人中可救活两三个。
【介按】舌苔灰黑，是温病热毒传遍三阴经的表现，治法都应当紧急行攻下法。如果见到黑纹，说明夹杂了阳明实热为患，因此用大承气汤紧急攻下以挽救病情。如果脉象浮且口渴，说明邪热虽然在阳明经，但大便尚未坚硬，因此用凉膈散来清泄膈间的热邪作为治疗。只是灰黑色与淡黑色颇为相似，灰色是黑中带紫，淡色是黑中带白的区别。如果热邪直中三阴经，其舌灰黑无苔，治法宜紧急攻下以保存阴液。如果寒邪直中三阴经，其舌淡黑无苔，则治法宜温经散寒。在临证时，务必仔细辨别。
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).