舌根微黑尖黄。脉滑者。可下之。脉浮者。当养阴退阳。若恶风寒者。微汗之。用双解散。若下利。用解毒汤。十
全七八也。
\r根黑尖黄舌图\pt101a35.bmp\r
【介按】伤寒传里化热。则舌苔变黑。自舌中黑起延至根尖者。较多。自根尖黑起延至舌中者。较少。热甚则芒刺干
焦罅裂。其初必由白苔变黄。由黄变黑。甚至刮之不脱。湿之不润者。热极伤液也。治宜苦寒泄热。急下救液。兹因舌
根微黑尖黄而脉滑者。外证必有谵语、潮热。腹满、便硬等证。此系胃中热盛。肾液渐耗。急用攻下之剂。以涤胃热而
存肾液。若脉浮者。邪虽化热。只烁胃津。即当养阴液以退邪热。如恶风寒。则知其邪尚在太阳阳明之间。故用双解散。
以解表里之邪。若邪热下陷入肠而作利。即内经所谓“暴注下迫。皆属于热”之候矣。故用解毒汤。以清肠胃之热也。
双解散 解毒汤（二方见前）
舌见根微黑。尖黄隐见。或有一纹者。脉实，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。
\r根灰尖黄舌图\pt101a36.bmp\r
【介按】舌见根黑尖黄。或边黄中心焦黑起刺。而脉实者。脐腹必胀满硬痛。此系阳明实热之症。故可用大承气汤。
苦寒以泄阳明之热。急下以救津液之虚。若脉浮而口渴饮水者。邪未入腑。犹可用凉膈散以解热也。
大承气汤 凉膈散（二方见前）
舌根部微黑，舌尖黄。脉象滑利的，可以使用攻下法。脉象浮的，应当滋养阴液以退阳热。如果有恶风怕冷的症状，用微汗法治疗，使用双解散。如果出现腹泻，使用解毒汤。病情能恢复十之七八。
【介按】伤寒病邪传入体内化热，舌苔就会变黑。从舌中部发黑蔓延到根部和尖部的情况较多；从根部和尖端发黑蔓延到舌中部的情况较少。热势极盛时会出现芒刺、干燥焦枯、裂纹。起初必然由白苔变为黄苔，再由黄苔变为黑苔，甚至刮不掉、湿润后也不润泽，这是热极损伤津液的表现。治疗应当用苦寒药物泄热，急下存阴。这里因为舌根微黑、舌尖黄且脉滑，外在证候一定伴有谵语、潮热、腹部胀满、大便硬结等症状。这是胃中热盛，肾液逐渐耗损，急需使用攻下的方剂，以清除胃热并保存肾液。如果脉象浮，说明邪气虽然化热，只是灼伤胃津，就应当滋养阴液以退却邪热。如果恶风怕冷，就知道邪气还在太阳经和阳明经之间，所以使用双解散，以解除表里两方面的邪气。如果邪热下陷进入肠道导致腹泻，就是《内经》所说的“急性暴注下迫，都属于热”的证候了。所以使用解毒汤，以清肠胃的热毒。双解散、解毒汤（这两个方子见前文）
舌部见到根部微黑，舌尖黄隐约可见，或者有一条纹的。脉象实的，使用大承气汤攻下。脉象浮且口渴想喝水的，使用凉膈散解表清热。十分之中可以救活二三分。
【介按】舌部见到根部黑、舌尖黄，或者边缘黄、中心焦黑起刺，而脉象实的，脐腹部一定胀满硬痛。这是阳明实热的证候，所以可以用大承气汤，用苦寒药物泄除阳明的热邪，急下以挽救津液的亏损。如果脉象浮且口渴想喝水，说明邪气尚未入腑，还可以用凉膈散来解热。
大承气汤、凉膈散（这两个方子见前文）
The root of the tongue is slightly black, and the tip is yellow. If the pulse is slippery (Hua Mai), purgation may be applied. If the pulse is floating (Fu Mai), nourishing Yin to subdue Yang should be practiced. If there is aversion to wind and cold, induce mild sweating using Shuangjie San (Double-Release Decoction). If diarrhea occurs, use Jiedu Tang (Detoxification Decoction). The prognosis is good, with seven or eight out of ten recoveries.
[Commentary by Jie] When Shaoyang disease transmits inward and transforms into heat, the tongue coating turns black. It is more common for the blackness to start from the center of the tongue and extend to the root and tip; it is less common for it to start from the root and tip and extend to the center. When heat is extreme, prickles appear, the tongue becomes dry and scorched, and cracks form. Initially, the coating must change from white to yellow, and then from yellow to black. In severe cases, it cannot be scraped off, nor does it become moist when wetted; this indicates that extreme heat has damaged body fluids. Treatment should employ bitter-cold herbs to drain heat and urgent purgation to preserve fluids. In this case, because the tongue root is slightly black, the tip is yellow, and the pulse is slippery, external symptoms must include delirium (Zhenyu), tidal fever (Chaore), abdominal fullness, and hard stool. This pattern is characterized by excess heat in the Stomach and gradual consumption of Kidney fluids. Urgent purgative formulas should be used to cleanse Stomach heat and preserve Kidney fluids. If the pulse is floating, although the pathogen has transformed into heat, it only scorches Stomach fluids; thus, one should nourish Yin fluids to retreat the pathogenic heat. If there is aversion to wind and cold, it indicates the pathogen remains between the Taiyang and Yangming channels. Therefore, Shuangjie San (Double-Release Decoction) is used to release pathogens from both the exterior and interior. If pathogenic heat sinks into the intestines causing diarrhea, this corresponds to the *Neijing* principle: "Acute violent diarrhea with tenesmus belongs to heat." Thus, Jiedu Tang (Detoxification Decoction) is used to clear heat and toxins from the intestines and stomach. Shuangjie San (Double-Release Decoction) and Jiedu Tang (Detoxification Decoction) are described previously.
If the tongue shows a slightly black root, a faintly visible yellow tip, or a single crack: if the pulse is solid (Shi Mai), use Dachengqi Tang (Major Order the Qi Decoction) for purgation. If the pulse is floating and accompanied by thirst and desire to drink water, use Liangge San (Cool the Diaphragm Powder) to resolve the condition. The survival rate is two or three out of ten.
[Commentary by Jie] If the tongue shows a black root and yellow tip, or yellow edges with a scorched black, prickle-covered center, and the pulse is solid, the umbilical and abdominal regions will necessarily be distended, full, hard, and painful. This is a syndrome of Yangming excess heat. Therefore, Dachengqi Tang (Major Order the Qi Decoction) can be used. Bitter-cold herbs drain Yangming heat, and urgent purgation rescues the deficiency of body fluids. If the pulse is floating and accompanied by thirst and desire to drink water, the pathogen has not yet entered the Fu organs, so Liangge San (Cool the Diaphragm Powder) can still be used to resolve heat.
Dachengqi Tang (Major Order the Qi Decoction) and Liangge San (Cool the Diaphragm Powder) are described previously.