鑑舌知機：《敖氏傷寒金鏡錄》之研究

Observe Tongue, Knowing Pathogenesis: Comparative Research of the Earliest Tongue Diagnosis Manual（Ao Shi Shang Han Jin Jing Lu,敖氏傷寒金鏡錄）

目的：望診中的舌診源遠流長，直到元代《敖氏傷寒金鏡錄》問世才開創「望舌診病」的診斷準則，對後世醫家產生深遠的影響。《敖氏傷寒金鏡錄》以三十六張舌圖探討各種舌象的病位、病性、病理機轉、治療方藥，圖譜與文字並陳，開創了舌診文獻的新模式。方法：本文使用「文獻分析法」來對《敖氏傷寒金鏡錄》一書進行研究，，本文採用的善本圖書影像是台灣國家圖書館館藏，由薛己刊刻的《傷寒金鏡錄》，統整歸納三十六舌的舌圖、內文，統計方劑使用頻次，並以舌質、舌苔顏色將其歸納統整與比較。結果：在舌圖特徵的研究，在舌色方面呈現紅舌、淡紅舌、以及黑舌。在苔色描述方面，有白苔、黃苔、及灰黑苔等。在方劑統計應用頻率前三名的常用方劑則為涼膈散、黃連解毒湯、調胃承氣湯。書中所記載的舌象和方劑多與火熱有關，學術源流與劉完素的病機學說相關。結論：《敖氏傷寒金鏡錄》開創「專以舌色視病、辨舌用藥」的學術理論，豐富我們對舌診的診斷及治療，以及擴展舌診的臨床價值。

Objectives. Tongue diagnosis, a critical component of inspection in traditional Chinese medicine (TCM), has a long history. The first tongue monograph in the world, the Ao's Golden Mirror Records for Cold Damage (Ao Shi Shang Han Jin Jing Lu,敖氏傷寒金鏡錄) allowed tongue diagnosis to enter mainstream practice and to ultimately become a standard diagnostic procedure during the Yuan Dynasty. This manual used 36 hand-drawn tongue illustrations to explore disease location, characteristics, pathological mechanism, and treatment. This book pioneered the concept of tongue diagnosis. It had a profound impact on the later generations of physicians.
Methods. This study employs literature analysis, utilizing the book from the National Central Library of Taiwan, published by Xue Ji. The research organizes and compares the 36 tongue illustrations and texts, categorizes tongue features based on body and coating colors, and analyzes the frequency of herbal formulas.
Results. Findings highlight red, pale red, and black tongues, with coating colors such as white, yellow, and gray-black. Frequently used formulas include Liang Ge San, Huang Lian Jie Du Tang, and Tiao Wei Cheng Qi Tang. The tongue patterns and formulas are closely linked to heat-related mechanisms, reflecting Liu Wansu’s theories.
Conclusion. Ao Shi Shang Han Jin Jing Lu established the foundation for ''tonguebased diagnosis and prescription,'' enhancing the diagnostic and therapeutic value of tongue diagnosis in TCM.