摘要
“肺与大肠相表里”是中医基础理论之一,对指导临床实践有重要价值。从《黄帝内经》至近代医家的多种论著中,不论是经络学说还是脏腑学说,对肺与大肠表里关系均有不同程度的认识。随着免疫学、分子生物学和细胞生物学的发展,人们对“肺与大肠相表里”的中医理论认识也日趋深入,不仅在实验研究上取得了一定成就,而且在临床运用中也更加广泛。
1.研究目的：
本文旨在从中医学文献研究探讨“肺合大肠”理论基础,并通过人体胚胎实验研究从微观层次分析认识肺与大肠及其相互联系,以期为肺与大肠相关性理论及实验研究提供更新的支持,丰富“肺与大肠相表里”理论的基本内涵,并为中医藏象学说和中医基础理论的现代研究提供新的思路和方法。
2.研究方法：
2.1理论探讨：
理论研究中利用古今文献,分析并阐释了肺与大肠表里关系的理论意义。说明组织胚胎研究在中医脏腑表里关系和脏腑实质研究中的意义,进一步充实了中医脏腑理论内涵。
2.2实验研究：
紧紧围绕脏腑“组织发生”和“相关性”,以人胚胎为实验材料,从现代组织胚胎学、免疫学、细胞生物学出发,采用细胞生物、免疫组化、蛋白免疫印迹等实验技术。本研究对脏腑物质实质探讨较多,并涉及到胚胎器官的一些初级生理机能。因此,可作为成体脏器“肺”与“大肠”功能相关研究的有益和必要的补充。
3.研究结果：
3.1理论研究结果：
肺与大肠的表里关系是脏腑表里关系的重要内容之一,肺与大肠通过经络的联系,构成了脏腑阴阳表里两经的络属关系；在生理功能上紧密联系,病变上也相互影响。“肺与大肠相表里”中的“大肠”可以认为是“回肠、结肠”这个结论与《黄帝内经》中“大肠”论述相符。肺、肠的上皮组织均来源于原肠胚之内胚层,同时上皮组织及细胞又是二者的最主要功能单位。研究上皮组织及细胞的发生发育过程,在肺肠表里关系的实验中医学研究中具有重要的意义。
3.2实验研究结果：
3.2.1胚胎发育不同时期肺与肠上皮组织形态学特征(HE)及上皮细胞增殖、凋亡的生物学特性比较分析：胚胎早期(9-16周胎龄),肺与全肠在上皮组织及细胞形态一致,上皮细胞增殖、凋亡的生物学特性无显著差异(P>0.05)。胚胎中期(17～23周)、胚胎晚期(24周～出生)肺与全肠在上皮组织及细胞形态不一致,上皮细胞增殖、凋亡的生物学特性有显著差异性(P<0.05)。
3.2.2组织细胞活性蛋白物质T淋巴细胞亚群(CD3+、CD4+、CD8+),表面活性物质相关蛋白A (SPA)、蛋白酶激活受体(PARS)、水通道蛋白(AQP1)观察显示：胚胎各期“肺”与“回肠、结肠”无显著差异(P>0.05),而与“空肠、直肠、膀胱”存在显著差异(P<0.05)。
4.研究结论：
4.1肺与回肠、结肠在胚胎发育过程中,无论从上皮组织的增殖凋亡,还是组织细胞活性蛋白物质的表达上均存在发生时相上的同步性。
4.2“肺与大肠相表里”中的“大肠”应定位于“回肠、结肠”。
4.3在胚胎早期可以为“肺”与“回肠、结肠”同源发生提供一定的依据,“肺与大肠相表里”肺肠相关虽主要是功能之间的相互联属,但可能与其原始的同源性相关。
'Lung and large intestine being interior-exteriorly related'is one of the basic theories of traditional Chinese medicine, which have great value in clinical practice. From the'Huang Di's Classic of Internal Medicine'to modern times, many writings of medical scientist, whether viscera or Meridian theory, have different levels of understanding. As immunology, molecular biology and cell biology develop, people have increasingly in-depth theoretical knowledge of "lung and large intestine"not only in the experimental study but also in the clinicaluse of more wide.
1. Objective:
This article aims to study the theoretical basis from the medical literature, analyze of lung, colon and their interlinkages from the micro-level by experimental, To provide up-to-date support for the theory of'lung and large intestine being interior-exteriorly related rich the basic content of the theory, and provide new ideas and methods for state of viscera and theory of the basic theory of traditional Chinese medicine.
2.Methods:
2.1 Theoretical Discussion:
This study adopting documentation and logical analysis explored significance of epithelium of embryonic lung and Intestinal relations at all levels, clarified significance of embryology in'fu-zang being interior-exteriorly related'and the actual situation of viscera, further enrich the content of theory of visceral outward manifestation of traditional Chinese medicine.
2.2 Experimental Study:
Selected gestational age 9-16 weeks, cases of voluntary termination of pregnancy by induced labor abortion or induction of labor with water bag,put embryos aside in 4℃refrigerator. Be divided into three periods by human fetal lung development,namely glandular period(9 to 16 weeks) , small tube of (17-23 weeks) and the original alveolar formation (24 weeks to birth). Each sample has 8 embryos, men and women regardless.
3.Results:
3.1 Theory research results:
3.1.1'The lung and the large intestine being interior-exteriorly related'is one of the best important traditional Chinese medical theories of the Viscera-State doctrine. The lung and the large intestine are interconnected through meridian, which construct the interdependent relationship between yin-yang and interior-exteriorly related viscus; be in close touch with and influence each other whether in normal functioning or in pathological changes.
3.1.2 Combined with literature of ancient physicians, the'large intestine'in'the lung and the large intestine being interior-exteriorly related'can be considered'ileum and colon'.This conclusion agrees with Huangdi Neijing.
3.1.3 Histoembryology discovers both the epithelial tissue of lung and large intestine were derived from the gastrula endoderm. At the same time, the epithelial tissue and cell is the primary and the most representative functional units, for this reason, they are be used for focal point of our research. That research development process of epithelial tissue and cell plays an irreplaceable role in the experiment of TCM study.
3.2 Experimental research results:
3.2.1 Embryonic development in different periods of lung and intestinal epithelium morphology (HE) and developmental when comparing analysis:
The Embryonic early-term (9-16 weeks), lung and bowel in epithelial tissue and cell morphology, epithelial biological characteristics, occurs similarity. Embryonic medium-term (17-24 weeks) and late-term(25weeks-) was in the lung and intestinal epithelium and cellular form, epithelial biological characteristics, occurs phase were inconsistent.
3.2.2 Epithelial tissue active protein material test and observation:
Each growth phase tissue cell active protein substances observation shows:The Embryonic early-term (9-16 weeks), lung, ileum and colon epithelial tissue active protein substances no significant difference; the jejunum,rectum and bladder exists significant difference. Embryonic medium-term (17-23 weeks) and embryonic late-term (24 weeks-), various intestinal section and bladder are obvious differences.
4. Conclusions:
4.1 The embryonic early-term (9-16 weeks), lung, colon and ileum, in epithelial tissue morphology, epithelial characteristics, occurs phase , epithelial tissue active protein substances shows approximation. That may be to lung and most bowel section from the endoderm similar or identical sites and cell source are concerned.
4.2 In the embryonic medium-term, embryonic late-stage, lung and intestinal epithelium and cellular form, epithelial biological characteristics, occurs phase were inconsistent. Shows them in order to adapt to the formation of their physiological function, the organization forms, and cellular characteristics, activeprotein substances have acorresponding change.
4.3 Integrate theoretical with experimental research:only in the early embryos may offer limited basis for "lung" and "ileum", "colon" related.As their primary function of middle-late term, material and organizational form in order to adapt to this change appear inconsistent , therefore can not provide the basis. Therefore, discusses'lung and colon exterior-interior relationships' from embryology has limited significance.
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