宗脉理论及其运用方式之探讨
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摘要
目的：
中国医学领域中,针灸及药物在人体发挥作用主要以影响人体经脉系统为主,所以经脉系统是人体气血循体系的基础。《灵枢·经脉》篇中十二经脉的体内运行,只描述经脉与藏府的连系管道,对单一经络藏府气血循环解释较为清楚；但是对于跨经络藏府系统间气血循环如何运作及经脉中脉气由何而来则不清楚。本文将引述内经、难经、桂林古本伤寒论及台湾整合医学研究小组研究报告探讨宗脉理论,以宗脉理论解决气血循环如何在跨经络藏府系统间运作。
本文中将十二经脉系统分成太阳少阴、阳明太阴、少阳厥阴三大体系,此三大体系经脉解剖位置在于腹部(前面)经脉为阳明太阴,背部(后面)经脉主要为太阳少阴,两侧部经脉主要为少阳厥阴。与桂林古本伤寒论中所述六淫侵袭人体路径相符合,故六经解剖位置,亦是伤寒六经传变路径。本论文将宗脉理论与六经传变两者整合用以解释病邪如何在跨经府藏系统间传变。并以医案验证宗脉理论与六经传变结合在临床运用的可行性,形成与伤寒杂病论接轨之治疗体系。
方法：
本研究主要以《内经》《难经》、《桂林古本伤寒杂病论》为理论依据,用“以经解经”的方式推论出宗脉理论及其运用方式。第一章中首先讨论气及宗气在人体如何产生；次节则引述宗脉一辞之源及由历代医家之著作探讨宗脉之可能循行部位；第三节由宗脉与三焦讨论互证得知宗气即三焦内运行的肾气。以其居人体众气宗主的位置,故名之为宗气。相对于宗气,其运行的路线可依照内经所述名之为宗脉,宗脉循三焦贯通人体五藏。第四节则讨论宗脉内气血运行模式。第二章则讨论气血在宗脉、十二经脉及五藏六府间运行的关系。第三章主要在探讨宗脉理论的运用,第一节指出宗脉是形成人体全身气血运行的基础；第二节则提出宗脉气血外感及内伤时需要应用的方剂；第三节则以伤寒杂病论之六经传变与宗脉理论结合,形成与伤寒杂病论接轨的治疗体系,体现中医自内、难以降之思惟。第四章则举临床医案验证宗脉理论与六经传变结合之模式,将理论回归于临床。
结果：
一、宗气行于三焦。由邪客篇所述可知后天脾胃所吸收之五谷精华在人体内可以分化成营气、卫气及宗气。营在脉中,卫在脉外,营周不休,五十而复大会,阴阳相贯,如环无端。但是宗气运行于何处则未提及,其运行的人体部位应包括胸中、喉咙、心肺等上焦部位。历代医家多论及宗气之生理功能,但亦提到宗气上行息道,息道当在心肺之部位；宗气下者注于气街,气街位于下焦,由此可知宗气亦运行至下焦部位。宗气上行达上焦,下行至下焦,故知宗气亦通过中焦。
二、宗气、宗脉、宗点的定义。对宗脉而言,历代文献多遵内经,从耳、目为宗脉所聚立论。宗气行于何处且宗脉循行为何则少有论述。由《内经》《难经》、《桂林古本伤寒杂病论》讨论可知,肾间动气是诸气的源头,发生于肾间(即命门),循人体中轴线贯穿人体的上、中、下三部,谓之三焦,并以此三焦往人体前部演化出任脉,往后分化出督脉,进而成为人体手足三阴脉、三阳脉的总纲。对此人体最主要的气血运行,仲景则传承内经,择定宗气一词。故知宗气即是《难经》所言三焦内运行的肾气。以其居人体众气宗主的位置,故名之为宗气。相对于宗气,其运行的路线可依照内经所述名之为宗脉。宗脉循三焦贯通人体五藏,宗脉与各藏交通之点可定其义谓之宗点。
三、人体气血循环。人体气血运行可分为十二经脉、宗脉与五藏六府三个体系。在十二经脉而言,其气血运行方式与人体中轴线平行,经脉外行体表,内连所属藏府,气血在十二经脉中运行,阴经、阳经首尾相连,成一循环曲线,体表的经脉及体内藏府气血循行亦随之带动。
气血在宗脉与十二经脉的连系：任、督脉居人体中轴线两侧,位置上最接近宗脉。也就是说宗脉内的宗气向外运行,首先便进入任、督二脉,任、督两脉前后形成封闭曲线,宗气进入任、督脉后,其中气血运行路线之一支便透过任、督脉与十二经脉连接。由于任、督与十二经脉多位于人体纵轴,形成人体气血循环在平行人体纵轴在线,气血有循体表的经络,也内行于所属藏府,使十二经以一阴一阳的配对,形成六对封闭曲线,进而形成全身气血的循行。
前述宗脉内气带动任、督脉气血循环,而五藏主要募穴位于任脉,募穴当是气血出入藏府的重要孔道之一。在背部的督脉部分,气血并不直接进入五藏六府,而是由督脉横络于两侧的足太阳膀胱经,再由足太阳膀胱经上各俞穴进入相对应的藏府。所以宗脉与五藏六府气血运行有以下方式：(一)宗脉透过宗点连系,将宗气注入各藏。(二)透过任、督脉循行,任、督脉横络足太阳膀胱经,宗气亦可经俞穴注入藏府系统。宗气在与人体中轴垂直的横轴面上,气血内行经过藏府在俞、募穴间运行外；气血亦外行垂直于中轴线的横络,也是在俞、募穴间运行。
所以完整的气血循环从人体宗脉出发,一支直接内行五藏六府,另一支宗气后行进入督脉及前行进入任脉,宗气可透过任、督脉与十二经脉的交接,进而进入所属五藏六府；其次督脉之脉气亦可横络于足太阳膀胱经,透过各藏府之俞穴分别进入五藏六府。
四、宗脉的生理及病理作用。宗脉所及之全身气血运行的大纲不只涉及正常生理状况下整体气血的运作,也牵涉到病理状态下疾病侵入的管道与治疗时方剂应用的安排。因此,了解全身气血运行的大纲是掌握人体生理、病理及治疗的基础。
所以宗脉理论不但是完成全身气血运行的大纲,也是疾病在跨藏府系统间传变时治疗的总纲。
五、宗脉理论与六经传变结合应用。十二经脉系统分成太阳少阴、阳明太阴、少阳厥阴三大体系,此三大体系经脉解剖位置在于腹部(前面)经脉为阳明太阴,背部(后面)经脉主要为太阳少阴,两侧部经脉主要为少阳厥阴。与桂林古本伤寒论所述六淫侵袭人体路径相符合,将伤寒六经传变与宗脉理论两者结合可用以解释病邪如何在跨经府藏系统间传变。
由桂林古本伤寒杂病论中提出柴胡龙骨牡蛎汤是治疗宗脉气血外感之方剂,桂枝汤加减是治疗宗脉气血内虚之方剂。
六、临床医案验证宗脉理论。提出临床医案用以验证宗脉理论,并可藉由宗脉理论与六经传变两者结合运用,使宗脉理论与伤寒杂病论之治疗体系接轨,并希望对医师未有临床诊疗经验时有所帮助。
结论：
历代中医在单一经络藏府系统间有关气血循环的描述较为完备,但是对跨经络藏府气血循环的理论则显不足。宗脉外连十二经脉,内贯五藏六府,宗脉理论、十二经脉、五藏六府三者结合,可对跨经络藏府气血循环提出较完整的补充,故可完整描述人体正常生理状况下全身的气血循环。
透过伤寒六经传变与宗脉理论两者结合,吾人可架构出完整经府藏系统,归纳出病邪如何在经府脏间传变,将以文字描述的疾病证候群转译成立体空间结构。故宗脉理论、十二经脉、五藏六府三者结合的经府藏系统可用以精确定位“病位”及“病性”,相对的处以对应“药位”及“药性”的方剂或其它治疗手段,就可达到治疗的目的。
临床医案验证宗脉理论的运用方式可知,宗脉理论可对难治疾病提出诊治思惟指导。且六经传变与宗脉理论结合对可厘清同病异治、异病同治理论上盲点。
由于个人学术水平有限,未能完整诠释中医基础经典,希望有更多中医先进投入相关研究,让宗脉理论更加完备。结论中所述透过伤寒六经传变与宗脉理论两者结合,可架构出经府藏系统,归纳出病邪如何在经府脏间传变,将以文字描述的疾病证候群转译成立体空间结构,其义即将经府藏系统立体化、图像化,使医学容易传承,这需要的多方面的人材投入。
Purpose:
In the field of Traditional Chinese Medicine (TCM) acupuncture and medication work mainly in affecting the meridian systems of the body, and therefore the meridians lay the foundation for the whole body blood and qi circulation. In the "LingShu Meridian Chapter" description of the twelve meridians, it describes meridians in relation to organ and bowel, further clarifying the blood-qi circulation of a specific meridian, organ, bowel set; but the exchange of blood-qi across meridians and the origin of the meridian's qi itself all remains unclear. This research will use "Nei-Jing", "Nan Jing", "GuiLin Classical Edition of Shang Han Za Bing Lun", and "Taiwan's Integrated Medical Research Group's Report" as sources in discussing and resolving central meridian theory and how blood-qi circulation crosses meridian and organ systems.
In this paper the twelve meridians will be divided into three groups: Tai-Yang/Shao-Yin, Yang-Ming/Tai-Yin, and Shao-Yang/Jue-Yin. Anatomically the Yang-Ming/Tai-Yin Meridian pair is located ventrally, the Tai-Yang/Shao-Yin Meridian pair is located dorsally, and the Shao-Yang/ Jue-Yin Meridian pair is located laterally. The meridian anatomy and theory is in line with the six-excesses invading the body, as described in the "GuiLin Classical Edition of Shang Han Za Bing Lun" and the Shang Han six meridian disease transformation patterns. This paper will look at central meridian theory and the six meridian transformation patterns to correlate an explanation of how disease patterns cross the meridian, organ, bowel systems. Medical cases will also provide further verification of central meridian theory and demonstrate the clinical applicability of the six meridian transformation patterns; creating an integrative system of treatment with Shang Han Lun.
Methods:
The main theoretical basis of this research will come from "Nei-Jing", "Nan Ting", and "GuiLin Classical Edition of Shang Han Za Bing Lun"; and will use "pathways to explain meridians" method to present a central meridian theory and applications. The first chapter will first discuss origins of qi and central meridian qi. Second will be a discussion of the origin of the word central meridian, and a historical perspective citing ancient doctors discourse on the central meridian and its possible location. Third will discuss and compare the mutual similarities of the central meridian and triple burner and how the kidney qi is dispersed on the central meridian and triple burner. It is called the central meridian because it occupies the most central location of qi on the human body. Regarding Zong Qi, its pathway according to the "Nei-Jing" is what is called the "central meridian", and it circulates through the triple burner and to all the five organs of the body. The fourth section will discuss the central meridian's internal blood and qi circulation patterns. The second chapter will discuss relationships between the blood and qi in the central meridian, the twelve meridians, and the five organ six bowel. The third chapter mainly discusses the application of central meridian theory. The first section points out that the central meridian lays the foundation for the blood-qi circulation patterns of the whole body. The second sections present herbal prescriptions to be used in cases of central meridian blood-qi external contracted disease or internal damage. The third section combines "Shang Han Za Bing Lun" six meridian disease transformation pattern with central meridian theory, creating an integrative system of treatment with Shang Han Lun; it is difficult to represent the inner workings of Chinese medicine in a simple clinical contemplation. The fourth chapter will give medical cases as verification for central meridian theory and the six meridian transformation patterns, bringing the theoretical back to the clinical setting.
Results:
Ⅰ. Zong Qi circulate in the Triple Burner. From description in the "Xie Ke" Chapter, it is known that after birth the grains absorbed by the spleen and stomach develop into Ying Qi, Wei Qi, or Zong Qi. Ying Qi is in the meridians and Wei Qi is outside the meridians, the Ying Qi is without rest, fifty forming a complex assembly, all connections of Yin and Yang, circulate without end. The Zong Qi position and circulation is never clearly presented, its pathway should include the chest, throat, heart and lungs, and other areas of the upper burner. Ancient physicians have discoursed on the physiological function of Zong Qi, but have also mentioned that it flows upward to the breath pathway which exists on the postion of the heart and lung. Zong Qi flows down Qi Street, which is located in the lower burner, and thus Zong Qi also reaches the lower burner. Because the Zong Qi extends from the upper burner to the lower burner it must therefore pass through the middle burner.
Ⅱ. Definition of Zong Qi、central Meridian and central point. About Zong Qi, most classical texts follow the "Nei Jing" in arguing that the central meridian collects in the eyes and ears. But where the Zong Qi moves and circulates is not clearly described. From discourses of the "Nei-Jing", "Nan Jing", and "GuiLin Classical Edition of Shang Han Za Bing Lun" it is known that qi begins in the kidneys (Ming Men) and circulates through the upper, middle, and lower parts of the body; along the triple burner the ventral side becomes the Controlling Vessel and the dorsal side becomes the Governing Vessel, it further becomes the three yin and three yang meridians of the upper and lower limbs. In describing the most important part of the body's blood-qi circulation, Zhong Jing in the spirit of the "Nei Jing", specifically chose the word Zong Qi. It is clear that Zong Qi is the kidney qi that moves internally on the triple burner, as described in the "Nan Jing. " As it is located in the center of the bodies crowded network of qi, it is therefore called Zong Qi. Regarding Zong Qi, its pathway according to the "Nei-Jing" is what is called the "central meridian". It circulates through the triple burner and to all the five organs of the body. The connection of the central meridian with each organ can also me named as that organ's central point.
Ⅲ. The blood-qi circulation of the human body. The blood-qi circulation of the body can be divided into the twelve meridians, the central meridian, or the organ-bowel systems. On the twelve meridians, the qi circulates parrallel to the body's axis, meridians move on the surface and connect with the organs and bowel on the interior. The blood and qi circulating on the twelve meridians is given a beginning and an end from the yin and yang meridians, making a circular pathway and giving movement to the bodies exterior and interior blood and qi circulation.
Blood and qi circulation as connected on the central meridian and the twelve meridians:The governing vessel and the controlling vessel are located on the core of the body and thus positionally are closest to the central meridian. This also says that the zong qi of the central meridian in moving outwards, first enters the controlling vessel and governing vessel. The controlling vessel and the governing vessel make up a closed circuit on the front and back of the body. After the zong qi enters these vessels it is able to come in to contact with the connection of the twelve meridians with the controlling and governing vessels. Because the controlling vessel, governing vessel, and the twelve meridians are on the vertical axis of the body creating the parrallel circulation of blood-qi along these axis. This allows blood and qi to circulate along meridians on the surface and internally to the organ and bowel. Further the twelve meridians have a one yin for one yang meridian pairing, creating six closed circuits, and providing for total body circulation.
As described previously the central meridian gives movement to the blood-qi circulation on the controlling and governing vessels. The main alarm acupoints for the five organs are located on the controlling vessel, the alarm acupoints are one of the main openings for entry and exit of blood-qi to the organs. The blood-qi circulation on the dorsal side of the body, the governing vessel, does not directly enter any organs. It is first circulated to the two Tai Yang Bladder Meridians of the legs, and further enters the organs and bowel through the corresponding Shu Acupoint. So the methods of movement of the blood and qi on the central meridian and the five organ six bowel are as follows: (1)the central meridian passes through central points, and the Zong Qi enters the organ, (2)it passes through the controlling and governing vessels circulation, and their connection with the two Tai Yang Bladder Leg Meridians, and can enter organs and bowel through the system of Shu Acupoints. Zong Qi is on the vertical and horizontal axis of the body, internally the blood-qi passes through alarm and shu acupoints; externally on the vertical and horizontal axis it also passes through these points as well.
So a complete system of body circulation begins with the central meridian. One branch moves internally to the five organs and six bowel, and another branch enters the governing vessel on the back and the controlling vessel on the front. Zong Qi can pass through the connections of the governing and controlling vessels with the twelve meridians and enter the corresponding organ and bowel systems. Additionally from the governing vessel it can move horizontally to the Tai Yang Bladder Meridian of the foot and enter the organs and bowel through the Shu Acupoints.
IV. The central meridian involves the healthy physiological state and pathological states. The central meridian whole body blood-qi circulation net, not only involves the whole body during a healthy physiological state, but also includes pathological. states and arranges applicable treatment prescriptions. Therefore understanding the qi-blood circulation network of the central meridian, lays the foundation for understanding the body's phsyiology, pathology, and treatment.
The central meridian theory is not only a complete outline of the full body qi-blood circulation, but also is the general principle in treating diseases that transform and cross organ bowel systems.
V. Correlation of central meridian theory and the six meridian transformation patterns. The twelve meridians can be divided into three groups: Tai-Yang/Shao-Yin, Yang-Ming/Tai-Yin, and Shao-Yang/Jue-Yin. Anatomically the Yang-Ming/Tai-Yin Meridian pair is located ventrally, the Tai-Yang/Shao-Yin Meridian pair is located dorsally, and the Shao-Yang/ Jue-Yin Meridian pair is located laterally. The meridian anatomy and theory is in line with the six-excesses invading the body, as described in the "GuiLin Classical Edition of Shang Han Za Bing Lun" and the Shang Han six meridian disease transformation patterns. Looking at central meridian theory and the six meridian transformation patterns correlates an explanation of how disease patterns cross the Jing-Fu-Zang systems.
In the "GuiLin Classical Edition of Shang Han Za Bing Lun" Chai Hu Long Gu Mu Li Decoction is given as a treatment for central meridian blood-qi external contraction pattern, and Gui Zhi Additive Decoction is indicated for treatment of internal vacuity.
VI. Medical cases as verification of central meridian theory. In providing medical cases as verification of central meridian theory, both the central meridian theory and the six transformation patterns of disease can be applied. Thus creating a comprehensive treatment system based on central meridian theory and Shang Han Za Bing Lun, hopefully this will provide some clinical assistance for doctors in the future.
Conclusions:
Ancient Chinese physicians provided comprehensive descriptions of blood-qi circulation on individual meridian and organ systems, but theoretical explanations of blood-qi circulation crossing meridian and organ systems is insufficient. The central meridian connects the twelve meridians on the outside and the five organs six bowels on the inside. Combining central meridian theory with twelve meridian and five organ six bowel theories, can provide a more complete supplementation of qi-blood circulation crossing meridian and organ systems. This gives a complete description of the whole body qi-blood circulation in a normal physiological state.
After combining the six meridian theory from Shang Han Lun with central meridian theory, I can further structure a more complete meridian organ system; isolating how diseases transfer between meridian and organ systems, and can use language to describe how disease patterns manifest themselves in the spatial structure of the body. Thus the combination of central meridian theory with twelve meridian and five organ six bowel theories can precisely pinpoint "disease location" and "disease type", and accordingly "Medicinal Placement" and "Medicinal type" for herbal decoctions or other forms of treatment, thus achieving the goal of treatment.
In giving clinical cases as verification for central meridian theory, it is shown that central meridian theory can create another avenue of thought in considering diagnosis and treatment of difficult cases. Also combining six meridian theory with central meridian theory may help to clarify some blind spots in the "same disease different treatment" and the "different disease same treatment" theories.
Because any individual's academic level is limited, any incomplete descriptions of fundamental Chinese medical theory, hopefully will have many more Chinese medicine researchers performing related research, and thus adding to the completeness of central meridian theory. As previoiusly stated combining the six meridian theory from Shang Han Lun with central meridian theory, can further structure a more complete meridian organ system; isolating how diseases transfer between meridian and organ systems, and can use language to describe how disease patterns manifest themselves in the spatial structure of the body. This meaning gives a somatic, visual approach to meridian organ system theory. This allows for easier passage through medical studies and requires the input from many talented individuals from many different angles.
中国医学领域中,针灸及药物在人体发挥作用主要以影响人体经脉系统为主,所以经脉系统是人体气血循体系的基础。《灵枢·经脉》篇中十二经脉的体内运行,只描述经脉与藏府的连系管道,对单一经络藏府气血循环解释较为清楚；但是对于跨经络藏府系统间气血循环如何运作及经脉中脉气由何而来则不清楚。本文将引述内经、难经、桂林古本伤寒论及台湾整合医学研究小组研究报告探讨宗脉理论,以宗脉理论解决气血循环如何在跨经络藏府系统间运作。
本文中将十二经脉系统分成太阳少阴、阳明太阴、少阳厥阴三大体系,此三大体系经脉解剖位置在于腹部(前面)经脉为阳明太阴,背部(后面)经脉主要为太阳少阴,两侧部经脉主要为少阳厥阴。与桂林古本伤寒论中所述六淫侵袭人体路径相符合,故六经解剖位置,亦是伤寒六经传变路径。本论文将宗脉理论与六经传变两者整合用以解释病邪如何在跨经府藏系统间传变。并以医案验证宗脉理论与六经传变结合在临床运用的可行性,形成与伤寒杂病论接轨之治疗体系。
方法：
本研究主要以《内经》《难经》、《桂林古本伤寒杂病论》为理论依据,用“以经解经”的方式推论出宗脉理论及其运用方式。第一章中首先讨论气及宗气在人体如何产生；次节则引述宗脉一辞之源及由历代医家之著作探讨宗脉之可能循行部位；第三节由宗脉与三焦讨论互证得知宗气即三焦内运行的肾气。以其居人体众气宗主的位置,故名之为宗气。相对于宗气,其运行的路线可依照内经所述名之为宗脉,宗脉循三焦贯通人体五藏。第四节则讨论宗脉内气血运行模式。第二章则讨论气血在宗脉、十二经脉及五藏六府间运行的关系。第三章主要在探讨宗脉理论的运用,第一节指出宗脉是形成人体全身气血运行的基础；第二节则提出宗脉气血外感及内伤时需要应用的方剂；第三节则以伤寒杂病论之六经传变与宗脉理论结合,形成与伤寒杂病论接轨的治疗体系,体现中医自内、难以降之思惟。第四章则举临床医案验证宗脉理论与六经传变结合之模式,将理论回归于临床。
结果：
一、宗气行于三焦。由邪客篇所述可知后天脾胃所吸收之五谷精华在人体内可以分化成营气、卫气及宗气。营在脉中,卫在脉外,营周不休,五十而复大会,阴阳相贯,如环无端。但是宗气运行于何处则未提及,其运行的人体部位应包括胸中、喉咙、心肺等上焦部位。历代医家多论及宗气之生理功能,但亦提到宗气上行息道,息道当在心肺之部位；宗气下者注于气街,气街位于下焦,由此可知宗气亦运行至下焦部位。宗气上行达上焦,下行至下焦,故知宗气亦通过中焦。
二、宗气、宗脉、宗点的定义。对宗脉而言,历代文献多遵内经,从耳、目为宗脉所聚立论。宗气行于何处且宗脉循行为何则少有论述。由《内经》《难经》、《桂林古本伤寒杂病论》讨论可知,肾间动气是诸气的源头,发生于肾间(即命门),循人体中轴线贯穿人体的上、中、下三部,谓之三焦,并以此三焦往人体前部演化出任脉,往后分化出督脉,进而成为人体手足三阴脉、三阳脉的总纲。对此人体最主要的气血运行,仲景则传承内经,择定宗气一词。故知宗气即是《难经》所言三焦内运行的肾气。以其居人体众气宗主的位置,故名之为宗气。相对于宗气,其运行的路线可依照内经所述名之为宗脉。宗脉循三焦贯通人体五藏,宗脉与各藏交通之点可定其义谓之宗点。
三、人体气血循环。人体气血运行可分为十二经脉、宗脉与五藏六府三个体系。在十二经脉而言,其气血运行方式与人体中轴线平行,经脉外行体表,内连所属藏府,气血在十二经脉中运行,阴经、阳经首尾相连,成一循环曲线,体表的经脉及体内藏府气血循行亦随之带动。
气血在宗脉与十二经脉的连系：任、督脉居人体中轴线两侧,位置上最接近宗脉。也就是说宗脉内的宗气向外运行,首先便进入任、督二脉,任、督两脉前后形成封闭曲线,宗气进入任、督脉后,其中气血运行路线之一支便透过任、督脉与十二经脉连接。由于任、督与十二经脉多位于人体纵轴,形成人体气血循环在平行人体纵轴在线,气血有循体表的经络,也内行于所属藏府,使十二经以一阴一阳的配对,形成六对封闭曲线,进而形成全身气血的循行。
前述宗脉内气带动任、督脉气血循环,而五藏主要募穴位于任脉,募穴当是气血出入藏府的重要孔道之一。在背部的督脉部分,气血并不直接进入五藏六府,而是由督脉横络于两侧的足太阳膀胱经,再由足太阳膀胱经上各俞穴进入相对应的藏府。所以宗脉与五藏六府气血运行有以下方式：(一)宗脉透过宗点连系,将宗气注入各藏。(二)透过任、督脉循行,任、督脉横络足太阳膀胱经,宗气亦可经俞穴注入藏府系统。宗气在与人体中轴垂直的横轴面上,气血内行经过藏府在俞、募穴间运行外；气血亦外行垂直于中轴线的横络,也是在俞、募穴间运行。
所以完整的气血循环从人体宗脉出发,一支直接内行五藏六府,另一支宗气后行进入督脉及前行进入任脉,宗气可透过任、督脉与十二经脉的交接,进而进入所属五藏六府；其次督脉之脉气亦可横络于足太阳膀胱经,透过各藏府之俞穴分别进入五藏六府。
四、宗脉的生理及病理作用。宗脉所及之全身气血运行的大纲不只涉及正常生理状况下整体气血的运作,也牵涉到病理状态下疾病侵入的管道与治疗时方剂应用的安排。因此,了解全身气血运行的大纲是掌握人体生理、病理及治疗的基础。
所以宗脉理论不但是完成全身气血运行的大纲,也是疾病在跨藏府系统间传变时治疗的总纲。
五、宗脉理论与六经传变结合应用。十二经脉系统分成太阳少阴、阳明太阴、少阳厥阴三大体系,此三大体系经脉解剖位置在于腹部(前面)经脉为阳明太阴,背部(后面)经脉主要为太阳少阴,两侧部经脉主要为少阳厥阴。与桂林古本伤寒论所述六淫侵袭人体路径相符合,将伤寒六经传变与宗脉理论两者结合可用以解释病邪如何在跨经府藏系统间传变。
由桂林古本伤寒杂病论中提出柴胡龙骨牡蛎汤是治疗宗脉气血外感之方剂,桂枝汤加减是治疗宗脉气血内虚之方剂。
六、临床医案验证宗脉理论。提出临床医案用以验证宗脉理论,并可藉由宗脉理论与六经传变两者结合运用,使宗脉理论与伤寒杂病论之治疗体系接轨,并希望对医师未有临床诊疗经验时有所帮助。
结论：
历代中医在单一经络藏府系统间有关气血循环的描述较为完备,但是对跨经络藏府气血循环的理论则显不足。宗脉外连十二经脉,内贯五藏六府,宗脉理论、十二经脉、五藏六府三者结合,可对跨经络藏府气血循环提出较完整的补充,故可完整描述人体正常生理状况下全身的气血循环。
透过伤寒六经传变与宗脉理论两者结合,吾人可架构出完整经府藏系统,归纳出病邪如何在经府脏间传变,将以文字描述的疾病证候群转译成立体空间结构。故宗脉理论、十二经脉、五藏六府三者结合的经府藏系统可用以精确定位“病位”及“病性”,相对的处以对应“药位”及“药性”的方剂或其它治疗手段,就可达到治疗的目的。
临床医案验证宗脉理论的运用方式可知,宗脉理论可对难治疾病提出诊治思惟指导。且六经传变与宗脉理论结合对可厘清同病异治、异病同治理论上盲点。
由于个人学术水平有限,未能完整诠释中医基础经典,希望有更多中医先进投入相关研究,让宗脉理论更加完备。结论中所述透过伤寒六经传变与宗脉理论两者结合,可架构出经府藏系统,归纳出病邪如何在经府脏间传变,将以文字描述的疾病证候群转译成立体空间结构,其义即将经府藏系统立体化、图像化,使医学容易传承,这需要的多方面的人材投入。
Purpose:
In the field of Traditional Chinese Medicine (TCM) acupuncture and medication work mainly in affecting the meridian systems of the body, and therefore the meridians lay the foundation for the whole body blood and qi circulation. In the "LingShu Meridian Chapter" description of the twelve meridians, it describes meridians in relation to organ and bowel, further clarifying the blood-qi circulation of a specific meridian, organ, bowel set; but the exchange of blood-qi across meridians and the origin of the meridian's qi itself all remains unclear. This research will use "Nei-Jing", "Nan Jing", "GuiLin Classical Edition of Shang Han Za Bing Lun", and "Taiwan's Integrated Medical Research Group's Report" as sources in discussing and resolving central meridian theory and how blood-qi circulation crosses meridian and organ systems.
In this paper the twelve meridians will be divided into three groups: Tai-Yang/Shao-Yin, Yang-Ming/Tai-Yin, and Shao-Yang/Jue-Yin. Anatomically the Yang-Ming/Tai-Yin Meridian pair is located ventrally, the Tai-Yang/Shao-Yin Meridian pair is located dorsally, and the Shao-Yang/ Jue-Yin Meridian pair is located laterally. The meridian anatomy and theory is in line with the six-excesses invading the body, as described in the "GuiLin Classical Edition of Shang Han Za Bing Lun" and the Shang Han six meridian disease transformation patterns. This paper will look at central meridian theory and the six meridian transformation patterns to correlate an explanation of how disease patterns cross the meridian, organ, bowel systems. Medical cases will also provide further verification of central meridian theory and demonstrate the clinical applicability of the six meridian transformation patterns; creating an integrative system of treatment with Shang Han Lun.
Methods:
The main theoretical basis of this research will come from "Nei-Jing", "Nan Ting", and "GuiLin Classical Edition of Shang Han Za Bing Lun"; and will use "pathways to explain meridians" method to present a central meridian theory and applications. The first chapter will first discuss origins of qi and central meridian qi. Second will be a discussion of the origin of the word central meridian, and a historical perspective citing ancient doctors discourse on the central meridian and its possible location. Third will discuss and compare the mutual similarities of the central meridian and triple burner and how the kidney qi is dispersed on the central meridian and triple burner. It is called the central meridian because it occupies the most central location of qi on the human body. Regarding Zong Qi, its pathway according to the "Nei-Jing" is what is called the "central meridian", and it circulates through the triple burner and to all the five organs of the body. The fourth section will discuss the central meridian's internal blood and qi circulation patterns. The second chapter will discuss relationships between the blood and qi in the central meridian, the twelve meridians, and the five organ six bowel. The third chapter mainly discusses the application of central meridian theory. The first section points out that the central meridian lays the foundation for the blood-qi circulation patterns of the whole body. The second sections present herbal prescriptions to be used in cases of central meridian blood-qi external contracted disease or internal damage. The third section combines "Shang Han Za Bing Lun" six meridian disease transformation pattern with central meridian theory, creating an integrative system of treatment with Shang Han Lun; it is difficult to represent the inner workings of Chinese medicine in a simple clinical contemplation. The fourth chapter will give medical cases as verification for central meridian theory and the six meridian transformation patterns, bringing the theoretical back to the clinical setting.
Results:
Ⅰ. Zong Qi circulate in the Triple Burner. From description in the "Xie Ke" Chapter, it is known that after birth the grains absorbed by the spleen and stomach develop into Ying Qi, Wei Qi, or Zong Qi. Ying Qi is in the meridians and Wei Qi is outside the meridians, the Ying Qi is without rest, fifty forming a complex assembly, all connections of Yin and Yang, circulate without end. The Zong Qi position and circulation is never clearly presented, its pathway should include the chest, throat, heart and lungs, and other areas of the upper burner. Ancient physicians have discoursed on the physiological function of Zong Qi, but have also mentioned that it flows upward to the breath pathway which exists on the postion of the heart and lung. Zong Qi flows down Qi Street, which is located in the lower burner, and thus Zong Qi also reaches the lower burner. Because the Zong Qi extends from the upper burner to the lower burner it must therefore pass through the middle burner.
Ⅱ. Definition of Zong Qi、central Meridian and central point. About Zong Qi, most classical texts follow the "Nei Jing" in arguing that the central meridian collects in the eyes and ears. But where the Zong Qi moves and circulates is not clearly described. From discourses of the "Nei-Jing", "Nan Jing", and "GuiLin Classical Edition of Shang Han Za Bing Lun" it is known that qi begins in the kidneys (Ming Men) and circulates through the upper, middle, and lower parts of the body; along the triple burner the ventral side becomes the Controlling Vessel and the dorsal side becomes the Governing Vessel, it further becomes the three yin and three yang meridians of the upper and lower limbs. In describing the most important part of the body's blood-qi circulation, Zhong Jing in the spirit of the "Nei Jing", specifically chose the word Zong Qi. It is clear that Zong Qi is the kidney qi that moves internally on the triple burner, as described in the "Nan Jing. " As it is located in the center of the bodies crowded network of qi, it is therefore called Zong Qi. Regarding Zong Qi, its pathway according to the "Nei-Jing" is what is called the "central meridian". It circulates through the triple burner and to all the five organs of the body. The connection of the central meridian with each organ can also me named as that organ's central point.
Ⅲ. The blood-qi circulation of the human body. The blood-qi circulation of the body can be divided into the twelve meridians, the central meridian, or the organ-bowel systems. On the twelve meridians, the qi circulates parrallel to the body's axis, meridians move on the surface and connect with the organs and bowel on the interior. The blood and qi circulating on the twelve meridians is given a beginning and an end from the yin and yang meridians, making a circular pathway and giving movement to the bodies exterior and interior blood and qi circulation.
Blood and qi circulation as connected on the central meridian and the twelve meridians:The governing vessel and the controlling vessel are located on the core of the body and thus positionally are closest to the central meridian. This also says that the zong qi of the central meridian in moving outwards, first enters the controlling vessel and governing vessel. The controlling vessel and the governing vessel make up a closed circuit on the front and back of the body. After the zong qi enters these vessels it is able to come in to contact with the connection of the twelve meridians with the controlling and governing vessels. Because the controlling vessel, governing vessel, and the twelve meridians are on the vertical axis of the body creating the parrallel circulation of blood-qi along these axis. This allows blood and qi to circulate along meridians on the surface and internally to the organ and bowel. Further the twelve meridians have a one yin for one yang meridian pairing, creating six closed circuits, and providing for total body circulation.
As described previously the central meridian gives movement to the blood-qi circulation on the controlling and governing vessels. The main alarm acupoints for the five organs are located on the controlling vessel, the alarm acupoints are one of the main openings for entry and exit of blood-qi to the organs. The blood-qi circulation on the dorsal side of the body, the governing vessel, does not directly enter any organs. It is first circulated to the two Tai Yang Bladder Meridians of the legs, and further enters the organs and bowel through the corresponding Shu Acupoint. So the methods of movement of the blood and qi on the central meridian and the five organ six bowel are as follows: (1)the central meridian passes through central points, and the Zong Qi enters the organ, (2)it passes through the controlling and governing vessels circulation, and their connection with the two Tai Yang Bladder Leg Meridians, and can enter organs and bowel through the system of Shu Acupoints. Zong Qi is on the vertical and horizontal axis of the body, internally the blood-qi passes through alarm and shu acupoints; externally on the vertical and horizontal axis it also passes through these points as well.
So a complete system of body circulation begins with the central meridian. One branch moves internally to the five organs and six bowel, and another branch enters the governing vessel on the back and the controlling vessel on the front. Zong Qi can pass through the connections of the governing and controlling vessels with the twelve meridians and enter the corresponding organ and bowel systems. Additionally from the governing vessel it can move horizontally to the Tai Yang Bladder Meridian of the foot and enter the organs and bowel through the Shu Acupoints.
IV. The central meridian involves the healthy physiological state and pathological states. The central meridian whole body blood-qi circulation net, not only involves the whole body during a healthy physiological state, but also includes pathological. states and arranges applicable treatment prescriptions. Therefore understanding the qi-blood circulation network of the central meridian, lays the foundation for understanding the body's phsyiology, pathology, and treatment.
The central meridian theory is not only a complete outline of the full body qi-blood circulation, but also is the general principle in treating diseases that transform and cross organ bowel systems.
V. Correlation of central meridian theory and the six meridian transformation patterns. The twelve meridians can be divided into three groups: Tai-Yang/Shao-Yin, Yang-Ming/Tai-Yin, and Shao-Yang/Jue-Yin. Anatomically the Yang-Ming/Tai-Yin Meridian pair is located ventrally, the Tai-Yang/Shao-Yin Meridian pair is located dorsally, and the Shao-Yang/ Jue-Yin Meridian pair is located laterally. The meridian anatomy and theory is in line with the six-excesses invading the body, as described in the "GuiLin Classical Edition of Shang Han Za Bing Lun" and the Shang Han six meridian disease transformation patterns. Looking at central meridian theory and the six meridian transformation patterns correlates an explanation of how disease patterns cross the Jing-Fu-Zang systems.
In the "GuiLin Classical Edition of Shang Han Za Bing Lun" Chai Hu Long Gu Mu Li Decoction is given as a treatment for central meridian blood-qi external contraction pattern, and Gui Zhi Additive Decoction is indicated for treatment of internal vacuity.
VI. Medical cases as verification of central meridian theory. In providing medical cases as verification of central meridian theory, both the central meridian theory and the six transformation patterns of disease can be applied. Thus creating a comprehensive treatment system based on central meridian theory and Shang Han Za Bing Lun, hopefully this will provide some clinical assistance for doctors in the future.
Conclusions:
Ancient Chinese physicians provided comprehensive descriptions of blood-qi circulation on individual meridian and organ systems, but theoretical explanations of blood-qi circulation crossing meridian and organ systems is insufficient. The central meridian connects the twelve meridians on the outside and the five organs six bowels on the inside. Combining central meridian theory with twelve meridian and five organ six bowel theories, can provide a more complete supplementation of qi-blood circulation crossing meridian and organ systems. This gives a complete description of the whole body qi-blood circulation in a normal physiological state.
After combining the six meridian theory from Shang Han Lun with central meridian theory, I can further structure a more complete meridian organ system; isolating how diseases transfer between meridian and organ systems, and can use language to describe how disease patterns manifest themselves in the spatial structure of the body. Thus the combination of central meridian theory with twelve meridian and five organ six bowel theories can precisely pinpoint "disease location" and "disease type", and accordingly "Medicinal Placement" and "Medicinal type" for herbal decoctions or other forms of treatment, thus achieving the goal of treatment.
In giving clinical cases as verification for central meridian theory, it is shown that central meridian theory can create another avenue of thought in considering diagnosis and treatment of difficult cases. Also combining six meridian theory with central meridian theory may help to clarify some blind spots in the "same disease different treatment" and the "different disease same treatment" theories.
Because any individual's academic level is limited, any incomplete descriptions of fundamental Chinese medical theory, hopefully will have many more Chinese medicine researchers performing related research, and thus adding to the completeness of central meridian theory. As previoiusly stated combining the six meridian theory from Shang Han Lun with central meridian theory, can further structure a more complete meridian organ system; isolating how diseases transfer between meridian and organ systems, and can use language to describe how disease patterns manifest themselves in the spatial structure of the body. This meaning gives a somatic, visual approach to meridian organ system theory. This allows for easier passage through medical studies and requires the input from many talented individuals from many different angles.
引文
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