从舌诊发展看“胎”与“苔”术语变化的意义

Understandings of the Change in the Term ‘Tai(胎) 'to ‘Tai(苔) 'Through the Development of Tongue Diagnosis

舌诊起源很早,但在中早期发展缓慢,称谓也只是"舌"或"舌上胎"。至元代出现第一部舌诊专著,并提出"舌胎"一说。至明代中期,舌诊开始受到广泛关注,然多局限于诊视伤寒。明末吴又可首引舌诊以辨温疫,清初卢之颐提出"舌苔"一词。此后清代叶天士等温病学家深入辨舌,舌诊有了较大发展。吴鞠通首作"舌胎"与"舌苔"之辨,强调舌上长苔如"土坂之阴面生苔者然",因此舍肉从草,受到诸多医家的追随。自此"舌苔"逐渐取代了"舌胎",以"舌苔"之"有根"与"无根"分辨虚实的方法亦被广泛用于温病临床。清中期舌诊运用还由温病扩展至中医内外科杂症,并涌现出大量舌诊专著。"舌胎"与"舌苔"是两个含义不同的舌诊术语,反映了舌诊在不同时期的发展状况。

In its long history,tongue diagnosis progressed at a slow pace during its early and middle development. Back then,the term for this concept was but ‘She（ 舌,tongue） ＇or ‘Sheshangtai（ 舌上胎,embryo upon the tongue） ＇. Not until Yuan Dynasty was the first treatise on this issue published,where the saying of ‘Shetai（ 舌胎,tongue embryo） ＇was proposed. In the mid-Ming Dynasty,tongue diagnosis began to receive extensive attention. At that time,its application was mostly limited to the diagnosis of Shanghan（ 伤寒,cold pathogenic diseases）. In the late Ming dynasty,WU Youke initiated its usage as a method to diagnose Wenbing（ 温病,warm pathogenic diseases）. In the early Qing Dynasty,LU Zhiyi proposed the saying of ‘Shetai（ 舌苔,tongue coating） ＇. His effort was followed by YE Tianshi and other doctors of Wenbing school,who applied tongue diagnosis in a broader way,making it developed to a new level. WU Jutong was the first to distinguish ‘Shetai（ 舌胎,tongue embryo） ＇and ‘Shetai（ 舌苔,tongue coating） ＇. He emphasized that the growth of the tongue coating is similar to the moss in the shady area,hence his emphasis was put on Rou（ 肉） rather than Cao（ 草）. This point influenced many other doctors. From then,‘Shetai（ 舌苔,tongue coating） ＇gradually replaced ‘Shetai（ 舌胎,tongue embryo） ＇. Using ‘You Gen（ 有根,presence of roots） ＇and‘Wu Gen（ 无根,absence of root） ＇in‘Shetai（ 舌苔,tongue coating） ＇to differentiate between excess and deficiency had been widely applied in clinical diagnosis for Wenbing. Its application was further extended to surgical and internal medicines in TCM during the mid-Qing Dynasty with the presence of a large amount of relevant treatises. ‘Shetai（ 舌胎,tongue embryo） ＇and ‘Shetai（ 舌苔,tongue coating） ＇finally developed into distinct concepts,reflecting the developments of tongue diagnosis in different periods.