中醫水液代謝循環模型之芻議

Model of fluid circulation and metabolism in Traditional Chinese Medicine

本文提出的中醫的水液代謝模型主要分為體內與體表兩部分，水飲入口後的吸收及輸佈機制主要分為三部分：動力（臟腑陽氣）、物資（水液）、通道（決瀆）。水液代謝的主要動力是各臟腑陽氣功能的發揮，讓水液在三焦決瀆的通道中運行，三焦的通道很可能與現代研究的「interstitium（間質）」相同。水液在體內的循環主要經過食管、胃、小腸、脾（藉肝之助）、肺輸佈到皮毛為汗、上到頭而化為滋潤孔竅的津；肺同時也可以把水液下輸到膀胱及其他臟腑。水液在體表的通道主要有兩支，其一經由（上焦）肺由腠理出，自上而下布散津液或營氣，另一支由（下焦）膀胱經走皮下的三焦通道由下而上佈散津液或營氣，兩者共同滋潤身體體表，此兩路的體表的水液運送均與衛氣有關，故稱「衛出上焦」及「衛出下焦」。水液廢物排除在體表則藉汗，體內則由尿液與糞便分別排除。一旦破壞水液正常生成與運行機制，就會產生水濕痰飲疾病，治療方式則是透過藥物或針灸調整以恢復正常生理。本文提出之水液代謝循環模型結合傳統理論及現代研究，可以提供針藥及按摩治療一直觀且可邏輯推導的視覺圖形以利教學，然仍有不足之處，尚待同道討論精進。

In this article, the proposed model of fluid metabolism in traditional Chinese medicine includes internal and external fluid circulations. The absorption process and transportation of liquid have three parts: The driving force (the yang qi of internal bowel and visceral), the material (fluid), and the channel (pathway). The driving force of fluid metabolism is the yang qi of the internal bowel and viscera, which makes the fluid transport through the triple-warmer pathway. The triple-warmer pathway may resemble the term“interstitium”in recent western-medicine research. In the internal fluid circulation, fluid travels through the esophagus, stomach, small bowel, spleen(with the help of the liver), and lung, then is transported to the skin and turns into sweat, or to the head and becomes fluid moisture in the orifices, while the lung transport fluid downwards to the bladder and other visceral. The external fluid circulation includes two major parts. One through the lung (via upper warmer) to the interstices, and disperses fluid or nutrient qi (ying qi) downwards. The other is through the bladder meridian (via lower warmer), which disperses fluid or nutrient qi (ying qi) upwards. The two pathways moisturize the body surface coactively, and both are related to defense qi (wei qi), so there are sayings“wei comes from upper warmer”and“wei comes from lower warmer”. The human body excretes excess water via sweat from the body surface, urine, and stool from the internal visceral. Once the fluid metabolism is damaged, disease related to excessive fluid, phlegm, and dampness will occur. Treatment is to restore normal fluid physiology via Chinese medicine, acupuncture, and moxibustion. The fluid metabolism model proposed in this paper combines traditional theories and modern research. It facilitates education on acupuncture and massage therapy by providing an intuitive and logically derived visual graph. However, there are still parts that need to be discussed and improved.