自主神經在中醫“肺與大腸相表裡”理論裡的角色

The Role of Autonomic Nerves in The Theory ''The Lung Stands in Interior-Exterior Relationship With The Large Intestine Theory'' in Chinese Medicine

對於客觀存在的生理病理，如果中西醫兩者的論點都正確，應該可以得出相同的結論，本文希望可以經由這觀點，來探討在中醫臨床上持續運用的中醫臟象學說中“肺與大腸相表裡”理論；目前運用現代生理病理學角度探討“肺與大腸相表裡”理論的相關學說有MEK／ERK信號通路學說、微生物菌群學說、黏膜免疫學說、特殊分子學說、胚胎發育學說，都認為肺與大腸間互為因果關係，但本篇文章藉由自主神經系統及中醫對臨床疾病的症狀表現觀察，認為“肺與大腸相表裡”在部分的表現上，並不呈現因果關係，而是同時出現的“相關”關係，即先由病理或生理上的表現，影響到大腦與自主神經間訊息傳遞（傳出或傳入），後續呈現“肺”與“大腸”外在同時表現的變化，因而影響到中醫師在臨床上的觀察，而認為肺與大腸之間為因果關係。而這新論點顯示在現代生理病理學中，大腦對於五臟六腑的影響並非個別單線互傳訊息，而是多方面的影響，因而由現代生理病理學討論“臟腑互為表裡”的理論時，也必須同時討論大腦與自主神經在其中所扮演的角色。

Based on the physiological and pathological observations that are objective, both of the viewpoints of medical treatment by the western medicine and Traditional Chinese Medicine (TCM) should reach the same conclusions. In this review, we try to give a novel interpretation for ''the lung stands in interiorexterior relationship with the large intestine theory'' that has been long adapted in the practice of TCM. Five perspectives have been used to discuss the physiological pathology of the lung stands in interior-exterior relationship with the large intestine theory: MEK/ERK signal pathway theory、micro-ecology theory、mucosal immune system theory、special molecule theory、Embryonic development theory. They all reach the same conclusion that the lung and the colon have a mutual cause-effect relationship. Based on new anatomical data of the autonomic nervous system (ANS) and the clinical observations, we proposed that the lung and large intestine not only have a mutual cause-effect relationship but also a correlated; the physiological and pathological conditions of the visceral diseases are transmitted via the afferent and efferent pathways of the ANS to and out of the central nervous system (CNS); thus, the symptoms observed in the lung and large intestine has been misinterpreted to have a mutual cause-effect relationship. Actually, the neural connections between the brain and the viscera are multiple rather than single. Therefore, if discuss the TCM of ''the visceral stands in interior-exterior relationship with another visceral'', we should consider with the brain and autonomic nerves from the perspective of modern physiology and pathology.