《伤寒杂病论》舌诊浅析
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摘要
《黄帝内经》中提到的"舌上黄""舌焦"等舌象,毫无疑义是指舌苔的变化,但就舌苔的概念而言,始终没有明确地提出舌苔这样一个概念,张仲景则最早使用了"舌胎"(即现在称"舌苔"一词),明确舌诊内容,补充舌态、舌觉、舌质、舌苔的观察,初步构建"舌诊"诊断体系。仲景开舌诊在热病血分证、瘀血辨证中运用的先河,《伤寒论·阴明病脉证》言:"口燥,但欲漱水不欲咽者,必衄",本条提出证候的矛盾之处,口燥欲漱但不欲咽,与热邪伤阴证看似不相符,是因为邪入营血,血被上蒸,营阴上潮,此处虽并未提出热入营血的概念,但实开热入营血、入血动血理论的先河。此外,《金匮要略》提到:"唇痿舌青,口燥,但欲漱水,不欲咽",提出舌质青与瘀血之间的联系,心主血,舌为心之苗,瘀血阻滞,令舌色青色紫或见青紫斑点,同时,还补充了瘀血阻滞,血行不畅,津不上承影响舌觉,自觉口中干燥,欲漱不欲咽的矛盾证候与血瘀证的关联。仲景灵活运用舌诊,善于同中求异、异中求同,其在著述中所涉及的具体舌诊运用不多,但时刻体现着辨证论治的精髓,如文中最常见的口干、舌燥一症涉及的病机有缺水乏津、邪陷少阴、热病被火劫、水热互结不布津液、三焦蓄水、阳明热胜伤津、实热内结等,究其内涵,不外乎在六经辨证的指导下舌与气血津液精盛衰、输布的协调平衡的关系,体现了同中求异、异中求同的辨证思想。
" Yellow on the tongue" and " tongue burning" mentioned in Huangdi' s Internal Classics undoubtedly refer to the change of tongue coating,but as far as the concept of tongue coating,it has never been explicitly put forward. Zhang Zhong-jing first used the term " tongue foetus"( now known as " tongue coating"),clarified the content of tongue diagnosis,supplemented the observation of tongue state,tongue sense,tongue texture and tongue coating,and initially constructed the diagnosis system of "tongue diagnosis". Zhang Zhong-jing' s tongue-diagnosis is a pioneer in the invasion of blood system by heat,differentiation of blood stasis. For example,in Treatise on Cold Damage Diseases,yangming disease is manifested as dry mouth,desire to rinse water but do not want to swallow,which must suffer from bleeding. This article points out the contradiction of syndrome: dry mouth,desire to rinse water but do not want to swallow,which seems to be inconsistent with heat-damaging yin syndrome. It is because evil enters yingxue,blood is steamed and yingyin rises. Although there is no concept of hot blood entering into yingxue,it is the pioneer of the theory of hot blood entering yingxue and blood activation. At the same time,it also adds the relationship between blood stasis syndrome and the contradictory syndrome of blocking blood stasis,obstructing blood circulation,impairing tongue sense,drying mouth consciously and not wanting to rinse or swallow. Zhang Zhong-jing uses tongue diagnosis flexibly,and is good at seeking differences between similarities,and seeking similarities between differences. He does not use many specific tongue diagnoses in his writings,but always embodies the essence of syndrome differentiation and treatment. For example,the most common pathogenesis of dry mouth and dry tongue in his works is lack of water and body fluid,pathogenic accumulated in shaoyin,fever attacked by fire,intermingled fluid and heat failing to distribute body fluid,three-jiao storing water,excessive yangming heat consuming fluid,excessive heat accumulated inside the body. To investigate its connotation,it is no more than under the guidance of six meridians syndrome differentiation that the coordination of transfusion and distribution balance between the tongue and qi,blood and body fluid prosperity and decline,while reflects the dialectical thinking of seeking differences between similarities and seeking similarities among differences.
" Yellow on the tongue" and " tongue burning" mentioned in Huangdi' s Internal Classics undoubtedly refer to the change of tongue coating,but as far as the concept of tongue coating,it has never been explicitly put forward. Zhang Zhong-jing first used the term " tongue foetus"( now known as " tongue coating"),clarified the content of tongue diagnosis,supplemented the observation of tongue state,tongue sense,tongue texture and tongue coating,and initially constructed the diagnosis system of "tongue diagnosis". Zhang Zhong-jing' s tongue-diagnosis is a pioneer in the invasion of blood system by heat,differentiation of blood stasis. For example,in Treatise on Cold Damage Diseases,yangming disease is manifested as dry mouth,desire to rinse water but do not want to swallow,which must suffer from bleeding. This article points out the contradiction of syndrome: dry mouth,desire to rinse water but do not want to swallow,which seems to be inconsistent with heat-damaging yin syndrome. It is because evil enters yingxue,blood is steamed and yingyin rises. Although there is no concept of hot blood entering into yingxue,it is the pioneer of the theory of hot blood entering yingxue and blood activation. At the same time,it also adds the relationship between blood stasis syndrome and the contradictory syndrome of blocking blood stasis,obstructing blood circulation,impairing tongue sense,drying mouth consciously and not wanting to rinse or swallow. Zhang Zhong-jing uses tongue diagnosis flexibly,and is good at seeking differences between similarities,and seeking similarities between differences. He does not use many specific tongue diagnoses in his writings,but always embodies the essence of syndrome differentiation and treatment. For example,the most common pathogenesis of dry mouth and dry tongue in his works is lack of water and body fluid,pathogenic accumulated in shaoyin,fever attacked by fire,intermingled fluid and heat failing to distribute body fluid,three-jiao storing water,excessive yangming heat consuming fluid,excessive heat accumulated inside the body. To investigate its connotation,it is no more than under the guidance of six meridians syndrome differentiation that the coordination of transfusion and distribution balance between the tongue and qi,blood and body fluid prosperity and decline,while reflects the dialectical thinking of seeking differences between similarities and seeking similarities among differences.
引文
[1]黄丽慧,程传浩,马龙.《伤寒杂病论》脉证辨证思维探析[J].辽宁中医杂志,2009,36(3):362-363.
[2]冯康.仲景对脉学的继承与发展[J].河南中医,2017,37(7):1135-1137.
[3]陈欣然,王天芳.中医脉诊起源———“脉”的医学知识衍生与脉诊学源流考[J].北京中医药大学学报,2016,39(10):779-801.
[4]左丘明.国语[M].上海:上海古籍出版社,2015:77.
[5]李建民.发现古脉———中国古典医学与术数身体观[M].北京:社会科学文献出版社,2007:47-49.
[6]杨丽.两汉时期中原地区瘟疫研究[J].中州学刊,2014,36(2):779-801.
[7]张宏宇,李董男.先秦两汉时期热病、伤寒和温病概念辨析[J].时珍国医国药,2013,24(5):1204-1206.
[8]周永学.正确认识和评价伤寒学说与温病学说[J].陕西中医函授,2000,20(5):5-12.
[9]王娜,滕晶.各家脉学发展特点及种类[J].吉林中医药,2016,36(10):976-978.
[10]孟宪友,黄水清.中医舌诊源流探析[J].辽宁中医杂志,2016,43(5):946-948.
[11]严惠芳,马居里.《内经》舌诊理论探究[J].中医药学刊,2012,24(12):2204-2205.
[12]欧阳兵.中医诊法学[M].北京:中国医药科技出版社,2002:14.
[13]马居里,严惠芳,刘诤,等.张仲景舌诊临证辨证特色诠释[J].中医药学刊,2004,22(8):1472-1473.
[14]李克光,张家礼.金匮要略译释[M].上海:上海科学技术出版社,2010:55.
[15]南京中医药大学.伤寒论译释[M].上海:上海科学技术出版社,2010:22.
[2]冯康.仲景对脉学的继承与发展[J].河南中医,2017,37(7):1135-1137.
[3]陈欣然,王天芳.中医脉诊起源———“脉”的医学知识衍生与脉诊学源流考[J].北京中医药大学学报,2016,39(10):779-801.
[4]左丘明.国语[M].上海:上海古籍出版社,2015:77.
[5]李建民.发现古脉———中国古典医学与术数身体观[M].北京:社会科学文献出版社,2007:47-49.
[6]杨丽.两汉时期中原地区瘟疫研究[J].中州学刊,2014,36(2):779-801.
[7]张宏宇,李董男.先秦两汉时期热病、伤寒和温病概念辨析[J].时珍国医国药,2013,24(5):1204-1206.
[8]周永学.正确认识和评价伤寒学说与温病学说[J].陕西中医函授,2000,20(5):5-12.
[9]王娜,滕晶.各家脉学发展特点及种类[J].吉林中医药,2016,36(10):976-978.
[10]孟宪友,黄水清.中医舌诊源流探析[J].辽宁中医杂志,2016,43(5):946-948.
[11]严惠芳,马居里.《内经》舌诊理论探究[J].中医药学刊,2012,24(12):2204-2205.
[12]欧阳兵.中医诊法学[M].北京:中国医药科技出版社,2002:14.
[13]马居里,严惠芳,刘诤,等.张仲景舌诊临证辨证特色诠释[J].中医药学刊,2004,22(8):1472-1473.
[14]李克光,张家礼.金匮要略译释[M].上海:上海科学技术出版社,2010:55.
[15]南京中医药大学.伤寒论译释[M].上海:上海科学技术出版社,2010:22.