綜論中醫心臟以重建解剖與功能關連之結構模組

Reviewing Zang Heart to Create a New Comprehensive Anatomico-functional Model

本文以現代醫學理解的層面描繪傳統中醫學說中的[心]臟。傳統中醫學說以「臟象學說」演繹臟腑。過去數十年的現代研究中醫[心]臟理論，展示了心臟收縮力與效能代表心氣，這顯明中醫心主血脉，但研究上未能證實由此可帶出心主神明，是為中醫學現代化的結──心主神還是腦主神兩觀念使中醫分歧而對立。 按中醫學說中“臟”指本來部位以外之維度，本文綜論[心]臟，以血循環基層機能及策外對應的調節層面切入，具體把中醫[心]臟的結構與功能互相連結，將由心(器官)連至大腦的自主神經系統的機組，視為「居於內」的[心]臟。這機組的下部分的延腦心臟自主系統會管理血液循環穩定性；上部分的大腦自主系統則管理情勢需要的血脈循環反應，具備用心或用力的變化狀態，好比中醫的「神之變」；這個結構與全腦全身一體聯繫，配合小腸供液功能，一統自主血液循環與神緒中情感及理智等功能的表現可視為「觀於外」之[心]臟的臟象。神經及血液循環網絡在發育過程中，會隨著不同環境變化，互相調控以適應人體謀慮及行動的需求，而最終化育為成熟的系統。該系統藉由神經、內分泌、熱能管理及血液循環等機理互應，心與其他臟器可以發揮精良的功能並且互相同步調節，而促進精神自主，好比中醫所謂「心者君主之官也，神明出焉」。情緒/動機或動作-神經-循環-血液灌注-環境整體張力及動態，互為配合來穩定支援個體機變行動(中醫所謂任物)來應付生命。這[心]臟範式與中醫學的心臟本質意義相距不遠，但比過去的模式更為貼切，去除心腦對立觀念，更能成全主流基本要求標準，因其中解剖與生理的密切關連。這是中醫文獻首次演繹內經一體所說及精神、身體、血流、心腦、熱能丶情緒、環境天時的互相影響，亦有以現代研究支持。因此，這模型比起過去的理論模型，較易為現代科學的同儕所認受，其中提出臟器群的特色可供主流醫學參考。本文亦介紹古藉及現代研究複證的方法，有助於中西醫學發展，並帶來獨特及具啟發性的看法。

Chinese Medicine (CM) conventionally described Zang organs according to the Zangfu manifestation theory. Current CM studies demonstrated that myocardial contractile strength and efficiency may represent Zang Heart-Qi. While it illustrates how in CM the Zang Heart directs circulation, little has been shown how thereby it carries the spirit, as CM describes it houses Shen. The controversy as to whether the brain or the heart directs (‘governs’) the Shen mastery still remains unsolved, and diverges CM thoughts. This paper reviews how the Zang Heart could mean the same anatomical organ but with an added dimension. Re-inclusion of its connections up to the cortical-autonomic system would help to restore the anatomical functional tie. The one Cortical-autonomic-medullary-heart Complex may be taken as the Zang Heart. Its lower medulla-autonomic-heart system reflexively stabilizes the circulation while connections up the higher cortical autonomous system provides regulation for situational circulatory responses, motive or emotive as necessary, likened to its CM-described capacity to transform Shen (into different modes of mental mastery). Zang Xiang (external manifestations) may be expressed as functional features of that one structure as it integrates emotional and cognitive components of the mind with autonomic cardiovascular control, related with intestinal absorption for capacity of body perfusion, and its connection to the whole central nervous system and the body, as neural and circulatory networks evolve together with repeated remodeling since development. Remodeling of their interactions produces patterned responses to stimuli or stress, so that perfusion and nervous activity can be in balance and matched during endeavors or actions. These mechanisms together with neuroendocrinal interactions with the thermal regulation would work for perfusion needs so that, when working well to adapt to the environment, the Heart synchronizes with all organs and the whole works with mastery and efficiency, in a state demonstrated as psychophysiological coherence with the whole body in optimal function: analogous to CM describing that "the Heart holds the office of sovereign, whence the bright spirit emanates”. There are evidences that information and perfusional elements go hand in hand. From reviewing mind-body interactions remodeled during development, it is found that the tone and dynamics of the whole, in stabilizing circulation and perfusion during support of endeavors and performance, provide mechanisms to adaptations to face life. These correspond well with the described Zang Heart, and meet its essential meaning more closely than previous models, eliminating the controversy over the brain-heart split. This paper illustrates for the first time in CM literature how the mind-body, perfusion, brain-heart, body heat, temperament, and climatic thermal environment can interact and influence each other, just like what is observed in Nei Jing and supported with current research literature. This anatomico-functional model can better interpret CM literature and be easily understood by current science.