以解剖與功能關連結構重劃中醫脾臟模組

Redescription of Zang Spleen model in Modern Anatomico-functional Terms

本文以現代醫學理解的層面描繪傳統中醫學說中的[ 脾] 臟。傳統中醫學說以「臟象學說」演繹臟腑，而過去數十年，現代研究中醫[ 脾] 臟理論時，基於臟象與現代醫學的神經、內分泌及免疫系統功能的密切關係，提出把胰、腸、胃、自主中樞神經、內分泌及免疫組成網路功能來演繹[ 脾] 臟。臟腑臟象被看為一組相互關聯的結構而不是獨立的器官，其後亦另外提出[ 脾] 臟可被看作細胞線粒體般演繹。總之[ 脾] 臟功能不能與其解剖結構作出聯繫，亦不涉及以其起名的器官「脾」。古代中醫的「脾」字使用亦當作不恰當，說其本身是胰臟。本文會重新審視[ 脾] 臟，由其消化及能量代謝的層面切入，並研究「迎糧」的腸道淋巴及免疫反應機能，具體把中醫[ 脾] 臟的結構與功能互相連結，終將人體迎接食糧的整體功能結構、脾臟胰臟腸胃一體、包括消化系統及腸道相關淋巴组織至脾器官的免疫機組，視為「居於內」的[ 脾] 臟。至於接受及防備食物的結構功能，包括(1) 消化代謝、胃功能、衛護界面、淋巴液循環運轉系統及營養應用運化、能量代謝平衡調節、滋養肌肉、腦部及意識來應付生命，配上(2) 腸胃及全身神經及內分泌的互動緊密機制，影響內臟動力、穩定血管流注、身體內水液灌流排液平衡、免疫持平、身體防禦等機能，則視為「觀於外」的[ 脾] 臟臟象。這[ 脾] 臟範式與中醫學的脾臟本質意義相距不遠，但比過去的模式更為貼切，能成全主流基本要求標準，因其中解剖與生理的密切關連。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。

Traditional Chinese Medicine (TCM) conventionally described Zang organs according to the Zangfu manifestation theory. Current TCM studies showed that the network of stomach-pancreasintestine and the hypothalamic-endocrine-immunological axis or the mitochondria may represent the Zang Spleen. Zang is described as a set of interrelated parts rather than an anatomical organ. This paper reviewed how the Zang Spleen could mean the same anatomical organ but with added dimension. Re-inclusion of intestinal lymphoid and lymphatic structures with their related vigilant immunological functions would help restoring the anatomical functional tie. The one Spleen- Pancreas-Intestine Complex with the gastro-intestinal digestive system and lymphatics linking the immunologically vigilant spleen and intestines may be taken as the Zang Spleen “situated internally”. Zang Xiang “external manifestations” may be expressed as functional features of that one structure as it serves to encounter food with digestion, related stomach functions, guarding interface, a lymphocirculatory transport system, and utilization of the assimilated essence for energy and vegetative balance, nourishment of brain and muscles to cater for life, and also functional features of the intricate interrelationship between that structure and the whole body neuro-endocrine balance, the influence on tone and dynamics of the whole internal viscera, stabilizing blood in circulation, body fluid perfusiondrainage balance, the immunological homeostasis and body defense, idea formation and intention mechanisms to face life. These correspond well with Zang Spleen described, and meet its essential meaning more closely than previous models. This anatomico-functional model can better interpret TCM literature and be easily understood by current science.