清代伤寒医案267人次的舌象分析

Tongue Analysis of 267 Cold-induced Febrile Diseases Cases of Medical Records in the Qing Dynasty

目的:探讨清代伤寒病舌诊的共性特征。方法:阅读46部伤寒病舌诊医案著作,获得伤寒病舌诊医案214例,267人次,统计舌质与舌苔的出现率。并分析舌象记录在清早期、中期、晚期的变化规律。结果:在267人次中,对舌苔的记录最多(91.39%)。清代不同时期的舌象记录比较显示:与清代早期比较,苔质的记录数量明显增加(P<0.01)。苔色的记录以清早期为多,清中期减少(P<0.01),清晚期又显著增加(P<0.01)。清晚期,腻苔和红舌的记录显著增加(P<0.01)。结论:对古代伤寒病舌诊的共性特征以及演变规律分析,能够为现代急性感染性疾病的中医辨证,以及伤寒、温病方药的准确应用提供有益的借鉴。

This study was aimed to discuss common characteristics of the tongue diagnosis in typhoid medical records in the Qing dynasty. Through the reading of 46 books on typhoid medical cases with tongue diagnosis, 214 medical tongue diagnosis records with 267 tongue diagnosis mentioned were obtained. Meantime, the tongue body and tongue coating occurrence rate was counted and tongue diagnosis records in early, mid, and late Qing dynasty were analyzed. The results showed that in the 267 tongue diagnosis, tongue coating was recorded the most （91.39%）. Different stages of Qing dynasty record comparisons showed that more tongue coating texture were recorded in mid and late Qing dynasty （P 〈 0.01）; more tongue coating color were recorded in early Qing dynasty, and less in mid Qing dynasty （P 〈 0.01）, and increased again in late Qing dynasty; more greasy fur tongue and red color tongue were recorded in the late Qing dynasty （P 〈 0.01）. It was concluded that the common characteristics and evolution of the typhoid tongue diagnosis were valuable in diagnosing acute infectious diseases. It may bring beneficial references for the treatment in traditional Chinese medicine.