心腦主神明學說的沿革

The Origin and Evolution of Heart and Brain Governing the Bright Spirit

中醫學從《黃帝內經》開始提出「心主神明」觀點，到明代李時珍則於《本草綱目˙木部˙辛夷》提出：「腦為元神之府，而鼻為命門之竅。」自此揭開「心主神明」 與「腦主神明」 爭論的開端。而清代王清任《醫林改錯˙腦髓說》指出「靈機記性不在心在腦」，率先在中醫史上打破心腦合一說，揭開心主神明與腦主神明之爭。甚至《中醫臨床診療術語˙疾病部分》更認為中醫腦科學得以充分理性發展的前提，就是必須將「心主神明」變革為「腦主神明」。但現代醫家多持反對意見，認為腦主神明對心理疾病的解釋不足，臨床治療上也無多大見效，而其使用藥物的副作用更大，且療效不夠持久。本文希望藉著現代醫學及其他學科的研究來探討心腦主神明的源流、變革、科學性及證據。

“Huang Di Nei Jing” proposed that “heart governs the bright spirit”, but “Ben Cao Gang Mu” stated that “brain governs the bright spirit”. Then, “Yi Lin Gai Cuo” added to the debate by saying “Spirit and memory locate in the brain, not in the heart”. Thus, the controversy between heart and brain governing the bright spirit continued ever since in traditional Chinese Medicine (TCM). Although the TCM supervisor in mainland China stated that “brain governs the bright spirit” is the foundation in “TCM brain science” in 1997, many researchers remain skeptical due to the unsolved problems in clinical diagnosis and treatment. In order to account the origin and evolution, this paper reviews both proposals with the aid of modern medicine and scientific studies.