【摘要】 目的：研究温疫病中舌象的特征及其在诊疗中的价值。方法：采集南京中医药大学第二附属医院（江苏省第二中医院）肺病科收治的新型冠状病毒感染重型患者的舌象及其临床证候资料，并进行统计分析。结果：研究共纳入了65例新型冠状病毒感染重型患者，男39例（60.0%,39/65）、女26例（40.0%,26/65），平均年龄（78.3±9.0）岁。常见舌象表现：(1)舌色以暗红舌（43.0%）为主，部分患者可见淡红舌（26.1%）；(2)舌形常见肿胀舌（36.9%）、裂纹舌（35.3%)，部分可见胖大舌（20.0%）；(3)舌苔颜色以黄苔（49.2%）、白苔（47.6%）为主；(4)苔质多为腻苔（49.2%）及薄苔（33.8%），部分患者可见剥落苔（12.3%）；(5)综合苔质和苔色，以黄腻苔（35.3%）、薄白苔（27.6%）为多。根据患者的中医临床症状及舌象分析，总体以湿邪为主，同时可见瘀、热、虚等证素，临床证候也多表现为痰湿中阻、湿热壅肺、气阴亏虚且三证之间证候信息互有夹杂。相关性分析进一步发现：舌色变化与基础疾病呈高度相关，舌苔变化则与中医证候类型高度相关。结论：新型冠状病毒感染重型患者多为高龄人群，多患有基础疾病，并存在多种疾病共患的特点。新型冠状病毒感染重型患者舌象有一定规律性变化，舌色与舌苔存在不同的临床意义，依据舌苔可以推断新型冠状病毒感染重症患者的疾病浅深和证型分类，而舌色则较多反映患者的基础疾病性质和体质特征，这与古代医家对温疫病中舌苔及舌质诊断价值差异的认识相符合。这一研究为临床中医辨治新型冠状病毒感染提供了参考，也为今后临床中其他急性传/感染性疾病的舌诊运用及临床治疗提供一定的思考。更多还原

【Abstract】 Objective: To study the characteristics of tongue image of febrile diseases and its value in the diagnosis and treatment. Methods: Tongue images and clinical syndrome data of severe patients with COVID-19 admitted to the Department of Lung Diseases of the Second Affiliated Hospital of Nanjing University of Chinese Medicine were collected and statistically analyzed. Results: A total of 65 severe patients with COVID-19 were included in the study, including 39 males(60.0%) and 26 females(40.0%), with an average age of(78.3±9.0) years. The common manifestations of tongue image included:(1) The color of tongue was mainly dark red tongue(43.0%), and light red tongue can be seen in some patients(26.1%);(2) The common tongue shape included swollen tongue(36.9%), cracked tongue(35.3%), partially fat tongue(20.0%);(3) The color of tongue coating was mainly yellow(49.2%) and white(47.6%);(4) Most of the quality of fur was greasy fur(49.2%) and thin fur(33.8%), and peeling fur could be seen in some patients(12.3%);(5) Comprehensive coating quality and color included yellow greasy coating(35.3%) and thin white coating(27.6%). According to the clinical symptoms of traditional Chinese medicine and the analysis of tongue image of the patients, dampness was the main pathogen, and syndrome elements such as blood stasis, heat and deficiency could be seen at the same time. The clinical syndromes were also mostly manifested as phlegm-dampness, dampness-heat obstructing the lung, and deficiency of Qi(气) and Yin(阴), and the syndrome information of the three syndromes are mixed with each other. Further correlation analysis showed that the change of tongue color was highly correlated with basic diseases, and the change of tongue coating was highly correlated with TCM syndrome types. Conclusion: Most of the severe patients with COVID-19 are elderly people, most of them suffer from basic diseases, and there are characteristics of multiple diseases. The tongue image of severe patients with COVID-19 changes regularly, and the tongue texture and tongue coating have different clinical significances. According to the tongue coating, the disease depth and syndrome type classification of severe patients with COVID-19 can be deduced, while the tongue texture is more reflective of the basic disease nature and physical characteristics of patients, which is consistent with the different diagnostic and therapeutic values of the tongue coating and the tongue texture of the ancient medical practitioners in febrile and epidemic diseases. This study provides reference for TCM to identify and treat COVID-19, and also provides some thoughts on the use of tongue diagnosis and clinical treatment of other acute contagious/infectious diseases in the future.更多还原