黑色舌苔意味著什麼？

吳宇琛

SUM WU

Sum Wu

Registered Chinese Medicine Practitioner

Bachelor of Health Science in Traditional Chinese Medicine (UTS)

Bachelor of Science Majoring in Psychology (UOW)

Director of Hurstville Chinese Herbs Centre

Vice Dean of College of Traditional Chinese Medicine Orthopedics Australia

Specialising in pain management and mental wellbeing through Tradition Chinese medicine in combination with modern science in mental health, dieting and nutrition.

吳宇琛，澳大利亞政府注冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，澳大利亞松軒中醫藥中心主任醫師，澳大利亞中醫骨傷專科學院副院長。

擅長用傳統針灸理傷手法和中藥治療各種新舊損傷痛症，特別採用中醫中藥和現代心理學、營養學相結合調理治療各種慢性病和亞健康。

Black Tongue Coating in Traditional Chinese Medicine: What Does It Mean?

中醫黑苔：黑色舌苔意味著什麼？

In Traditional Chinese Medicine (TCM), observation of the tongue is an important part of diagnosis. Practitioners assess the tongue body, colour, shape, moisture, movement, and coating to understand patterns involving Qi, Blood, Yin, Yang, body fluids, and the internal organs. Among the different tongue findings, a black tongue coating is relatively uncommon and traditionally suggests a more pronounced internal imbalance.

在傳統中醫（TCM）中，觀察舌象是診斷的重要組成部分。中醫師通過觀察舌質、顏色、形態、潤燥、活動情況以及舌苔，來了解人體氣、血、陰、陽、津液以及臟腑功能所呈現的不同證候。在各種舌象變化中，黑色舌苔（黑苔）相對較少見，傳統上通常提示人體內部存在較為明顯或較深層次的失衡。

However, a black coating does not automatically mean severe illness, nor does it always indicate Heat. Its meaning depends on whether the coating is dry or moist, thick or thin, greasy or rough, as well as the colour of the underlying tongue body and the patient’s other symptoms.

然而，出現黑苔並不一定意味病情嚴重，也非所有黑苔皆代表「熱」。黑苔的臨床意義取決於舌苔是乾燥或濕潤、厚或薄、膩或粗糙，同時需結合舌質顏色及患者其他症狀綜合判斷。

How Does the Tongue Coating Become Black?

舌苔為什麼會變黑？

In TCM theory, the tongue coating is closely related to Stomach Qi. Changes in its colour and texture are thought to reflect the interaction between the body’s normal Qi and pathogenic factors.

根據中醫理論，舌苔與胃氣密切相關。 舌苔顏色和質地的變化，被認為可以反映人體正氣與病邪之間的相互作用。

Traditionally, tongue coatings may sometimes progress from white to yellow, then grey and black as a pathogenic condition becomes stronger or moves deeper into the body. This is not a fixed progression, however, and black coating can appear in different patterns.

傳統上，在某些情况下，隨著病邪逐漸加重或由表入裡，舌苔顏色可能出現由白轉黃，再由黃轉灰、轉黑的變化。不過，這並不是所有疾病都會經歷的固定過程。黑苔可以出現在不同的證候之中，因此必須結合其他舌象和全身表現進行辨證。

Black and Dry: Excessive Heat

黑而乾燥：熱盛傷津

A dry black coating, particularly over a red or dark-red tongue, traditionally indicates intense internal Heat that has consumed the body’s fluids.

黑而乾燥的舌苔，尤其是出現在紅舌或深紅舌之上時，傳統中醫通常認為提示體內熱邪較盛，並已經開始耗傷人體津液。

The progression may begin with a yellow coating that becomes increasingly dark, eventually appearing brown, grey or black. As Heat consumes fluids, the coating also becomes progressively drier.

這種變化有時可能從黃苔開始，隨著熱邪逐漸加重，舌苔顏色越來越深，最終呈現棕褐色、灰色甚至黑色。與此同時，由於熱邪不斷耗傷津液，舌苔也會變得越來越乾燥。

Other symptoms may include strong thirst, dry mouth, constipation, dark urine, restlessness and feeling excessively hot.

患者可能同時出現明顯口渴、口乾、便秘、小便顏色深、煩躁不安以及明顯怕熱或身體發熱感等表現。

From a TCM perspective, the combination of dark colour and dryness is particularly important because it suggests both Heat and damage to body fluids.

從中醫角度來看，顏色深黑與舌苔乾燥同時出現尤其值得注意，因為這種組合不僅提示體內有熱，同時也提示津液可能已經受到損傷。

Black and Dry with Little Coating: Yin Deficiency

黑而乾、少苔：陰虛

A different presentation can occur when the body’s Yin and fluids have become depleted over a prolonged period.

另一種情况可見於人體的陰液和津液長期耗損。

The tongue body may be red, thin or cracked, while the coating may be sparse, dry and dark. Symptoms may include night sweats, dry mouth and throat, poor sleep, afternoon or evening Heat sensations and thirst.

此時舌質可能呈紅色、瘦薄或出現裂紋，而舌苔則可能表現為少苔、乾燥並且顏色較深或發黑。患者可能同時出現盜汗、口乾咽燥、睡眠不佳、午後或夜間發熱感以及口渴等症狀。

This differs from an Excess Heat pattern because the problem is considered primarily one of deficiency rather than an excessive pathogenic factor.

這種情況與實熱證有所不同，因為其主要問題並非體內存在過强的病邪，而是人體自身具有滋養、濡潤和制約陽熱作用的陰液不足，因此屬於以“虛”為主的證候。

Black and Wet: Severe Cold and Yang Deficiency

黑而濕潤：寒盛與陽虛

Interestingly, black coating can represent the opposite condition.

有趣的是，黑苔也可以代表與熱證完全相反的情况。

A moist, slippery black coating, particularly on a pale or swollen tongue, traditionally indicates internal Cold with Yang deficiency. Yang provides warmth and supports the transformation and movement of fluids. When Yang becomes significantly weakened, Cold and fluids may accumulate.

濕潤、滑膩的黑苔，尤其是同時伴有舌質淡白或舌體胖大時，傳統上多考慮裡寒或陽虛寒盛。在中醫理論中，陽氣具有溫煦身體，並推動水液運化和輸布的作用。當陽氣明顯不足時，身體失去足够的溫煦和推動能力，寒邪與水濕便可能在體內積聚。

The person may experience cold hands and feet, intolerance to cold, fatigue, loose stools, abdominal discomfort and a preference for warm food and drinks.

患者可能出現手脚冰冷、怕冷、疲倦乏力、大便稀溏、腹部不適，以及喜歡溫熱食物和飲品等表現。

Therefore, moisture provides an important distinction: black and dry tends toward Heat, while black and wet tends toward Cold.

因此，觀察舌苔的潤燥非常重要，一般而言，黑而乾多偏向熱，黑而潤則多偏向寒。

Thick and Greasy Black Coating

厚膩黑苔

If the black coating is particularly thick, sticky or greasy, the practitioner may consider the involvement of Dampness, Phlegm or food stagnation, especially when accompanied by nausea, abdominal fullness, poor appetite or a sensation of heaviness.

如果黑色舌苔特別厚、黏或油膩，中醫師還會考慮是否存在濕邪、痰濕或食積。

如果患者同時出現噁心、腹部脹滿、食欲下降、消化不良或身體沉重困倦等症狀，則更需要考慮濕、痰或食積等因素的影響。

However, no diagnosis should be made from coating colour alone.

不過，中醫辨證不能僅憑舌苔顏色作出判斷。即使同樣是黑苔，不同的舌質、潤燥、厚薄以及伴隨症狀，都可能代表完全不同的證候。

Western Medicine Offers Another Explanation

西醫提供了另一種解釋

Western medicine interprets a black tongue differently. A common cause is black hairy tongue (lingua villosa nigra). The filiform papillae on the tongue become elongated because normal shedding is reduced, allowing keratin, bacteria, food debris and pigments to accumulate.

西醫對於黑色舌苔有著不同的解釋。 其中一個較常見的原因是黑毛舌（black hairy tongue，醫學名稱為lingua villosa nigra）。

正常情况下，舌面上的絲狀乳頭會不斷進行新陳代謝和脫落。但如果正常脫落過程减少，絲狀乳頭便可能逐漸伸長，使舌面看起來像長出了一層細小的“毛”。

這些延長的乳頭容易積聚角蛋白、細菌、食物殘渣以及各種色素，最終使舌頭呈現棕色、深褐色甚至黑色。

Risk factors include smoking, antibiotics, dry mouth, poor oral hygiene, certain medications, and frequent coffee or tea consumption.

常見的相關因素包括吸烟、使用抗生素、口乾、口腔衛生不佳、某些藥物，以及經常飲用咖啡或茶。

This comparison is important in modern TCM practice. A black tongue should not automatically be interpreted as severe Heat or Cold. Diet, medication, smoking and oral health should also be considered. Persistent black discoloration, especially when accompanied by pain, bleeding, ulcers or other abnormal changes, should be assessed by a doctor or dentist.

這種西醫觀點對於現代中醫臨床同樣具有重要意義。看到黑色舌苔時，不應立即將其解釋為嚴重的熱證或寒證。中醫師還應考慮患者的飲食、藥物使用、吸煙習慣以及口腔健康狀況等可能影響舌象的因素。

如果黑色舌苔持續存在，尤其同時伴有疼痛、出血、潰瘍或其他异常口腔變化，則應及時接受醫生或牙醫的檢查，以排除其他潜在的口腔或全身性疾病。

如有疑問想咨詢吳宇琛中醫師，可以在微信或whatsapp搜索61 404836368，加吳宇琛中醫師微信或whatsapp，也可以發短信或致電0404836368作語音留言，吳宇琛中醫師有空就會回復。

（吳宇琛中醫師，澳大利亞政府注冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，悉尼好思維松軒藥行主任中醫師，澳大利亞中醫骨傷專科學院副院長，本文僅供參考，具體診療應諮詢專業人士。）