《伤寒杂病论》舌诊刍议  

Discussion About Tongue Diagnosis in Treatise on Cold Damage Diseases

作　　者：郭倩[1] 李荣科[1] 张磊[1] 魏昭晖 马欣欣 万生芳[1] GUO Qian;LI Rongke;ZHANG Lei;WEI Zhaohui;MA Xinxin;WAN Shengfang(Gansu University of Chinese Medicine,Lanzhou,Gansu,China,730000)

机构地区：[1]甘肃中医药大学,甘肃兰州730000

出　　处：《河南中医》2023年第12期1783-1785,共3页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82060914,81560718)。

摘　　要：《伤寒杂病论》舌诊包括察舌体、舌苔、舌态等,张仲景认为,三阳病及六腑病,重在察舌苔变化,因为三阳病及六腑病多为外邪侵袭,病位表浅,正气尚未衰,舌质变化不明显;三阴病及五脏病,重在察舌质形态,因为三阴病及五脏病病位在里,舌质变化较显著。根据舌诊,可以推求疾病病因、论述病机、确立治则、指导治疗、判断预后等。张仲景首创了舌苔概念,明确了舌诊内容,并根据舌诊辨疾病表里、寒热、虚实,重视同舌异病情况的辨证法。其既重视舌象变化,又强调四诊合参,既有舍症从舌,又有舍舌从症,既有同病异治,又有异病同治,即同一舌象,病机不同,治疗亦不同;同一病证,舌象不同,治疗也各具差异,以辨证论治为主。The tongue diagnosis in Treatise on Cold Damage Diseases includes the body of the tongue,the coating of the tongue,the mo-tility of the tongue,etc.Zhang Zhongjing believed that for three-yang disease and six fu-organs disease,the emphasis is on tongue coat-ing changes,because the disease is superficial and the healthy qi does not decline,and the tongue texture changes litle.For three-yin disease and five zang-organs disease,the emphasis is on tongue texture morphology,as the disease location is deeper and the tongue tex-ture changes more obviously.According to tongue diagnosis,the etiology of the disease can be deduced,treatment can be guided,patho-genesis can be discussed,treatment principles can be established,and prognosis can be judged.Zhang Zhongjing first created the con-cept of tongue coating,clarified the content of tongue diagnosis,and distinguished diseases from exterior to interior,cold and heat,defi-ciency and excess according to tongue diagnosis,and attached importance to the syndrome differentiation of different diseases with the same tongue condition.He not only attached importance to the change of tongue manifestations,but also emphasized the comprehensive analysis of the four examinations,including treating the disease based on the tongue diagnosis rather than symptoms,or based on the symptoms rather than tongue diagnosis,different treatments for the same disease,and same treatment for dfferent diseases,that is,differ-ent treatments for the same tongue manifestiations with different mechanisms,or different treatments for the same syndrome with different tongue manifestiations.In conclusion,the treatment is mainly based on syndrome differentiation.

关 键 词：舌诊 《伤寒杂病论》 舌体 舌苔 舌态 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]