2019冠状病毒病124例患者舌象分析  

Tongue manifestation analysis on 124 cases of Corona Virus Disease 2019

作　　者：冯淬灵[1] 刘治坤 冯枫 黄东晖[3] 蔡俊翔 钟子劭 凌传仁 陈维生[3] 黄凯锋[3] 徐少硕 FENG Cui-ling;LIU Zhi-kun;FENG Feng;HUANG Dong-hui;CAI Jun-xiang;ZHONG Zi-shao;LING Chuan-ren;CHEN Wei-sheng;HUANG Kai-feng;XU Shao-shuo(Peking University People’s Hospital,Beijing 100044,China;Tianshui Fourth People’s Hospital,Tianshui 741020,China;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]北京大学人民医院,北京100044 [2]天水市第四人民医院,天水741020 [3]广东省中医院,广州510120

出　　处：《中华中医药杂志》2020年第4期2159-2163,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：第四批全国中医(临床、基础)优秀人才研修项目(No.国中医药人教发[2017]24号);广东省第二批中医优秀人才研修项目(No.粤中医办函[2017]267号)。

摘　　要：目的:探讨舌象分析在疫病中判断疾病病性、病位,预测愈后,指导辨证论治的作用。方法:收集124例2019冠状病毒病(COVID-19)患者舌象(包括舌色、舌苔厚度、舌苔颜色、舌形)、临床症状、方药及初步疗效,进行统计分析。结果:纳入的124例COVID-19患者中,3例轻型,5例普通型,94例重型,22例危重型。不同临床分型的COVID-19患者舌色、舌苔厚度、舌形分布情况差异具有统计学意义(P<0.01)。随着病情的加重,苔色有白苔向黄苔、褐苔转变的趋势。治疗后,病情好转或者治愈出院的患者舌苔渐由厚转薄,舌质由暗红或者红渐转淡红。舌象结合临床资料分析,湿毒疫邪是本次疫情的致病因素,湿毒弥漫三焦,疫邪闭肺是核心病机。以三焦、卫气营血辨证为纲,脏腑、气血津液辨证为目,谨守叶天士上焦宜降宜通,中焦营卫宜守宜行,下焦阴阳宜潜宜固的原则,结合芳香辟秽、解毒泄浊法辨证施治,临床疗效显著。结论:舌象在疫病辨证中是重要的客观依据。Objective:To discuss the role of tongue manifestation analysis in determining the disease state and location,predicting the recovery and guiding the syndrome differentiation and treatment in plague.Methods:Tongue manifestation(including tongue color,coating thickness,coating color,shape),clinical symptoms,formulas and preliminary efficacy of 124 patients with Corona Virus Disease 2019(COVID-19)were collected for statistical analysis.Results:Of the 124 COVID-19 patients included,3 cases were mild,5 cases normal,94 cases severe,and 22 cases critical.The differences in tongue color,coating thickness and shape distribution in COVID-19 patients with different clinical types were statistically significant(P<0.01).With the aggravation of the disease,the tongue coating color had the trend from white to yellow or brown.After the treatment,the tongue coating of patients who were improved or cured and discharged from the hospital changed from thick to thin,and tongue texture changed from dull-red or red to light red.Through the analysis of tongue manifestation combined with clinical data,the dampness toxin epidemic was the pathogenic factor of this plague,the core pathogenesis was dampness toxin spreading through triple energizer and epidemic blocking lung.Taking the triple energizer and defense-qi-nutrient-blood syndrome differentiation as general principle,visceral and qi-blood-fluids syndrome differentiation as detailed principle,according to YE Tian-shi’s thoughts that the upper energizer should be reduced and unblocked,the middle energizer nutrient-defense should be defensed and passed,and the lower energizer yin-yang should be submerged and solid,combining the method of dispelling filth with aroma resolve toxin and descending the turbid for syndrome differientiation,the clinical efficacy was remarkble.Conclusion:Tongue manifestation is an important objective basis in symdrome differentiation on plague.

关 键 词：新型冠状病毒肺炎 2019冠状病毒病 舌象 瘟疫 诊断 三焦 湿毒疫 

分 类 号：R259[医药卫生—中西医结合] R241.25[医药卫生—中医内科学]