Key words: lung; Anatomy; Physiology of TCM
Lung is one of the five internal organs of TCM. A large number of ancient records confirmed that TCM had studied lung shape, and the lung theory of TCM was put forward on this basis, combined with clinical practice, which can be called lung shape medicine. Carrying out the research on lung constitution is helpful to correct the wrong understanding that TCM lacks the foundation of constitution research and to establish TCM constitution medicine.
Research records of lung entities in traditional Chinese medicine
The position of the lung is "the lung is covered by a zang-fu organ" (Su Wen Bing Neng Lun), "the upper diaphragm belongs to the lung" (Lingshu Meridian) and "the lung is also on the upper side" (Difficult Classic 32). The ancients realized that the lung was located in the chest cavity above the diaphragm. The lung is "attached to the third vertebra of the spine" (Ming Zhai Liang's "Lung Map of Meridian Meridians"). According to modern research, the only thing that can be regarded as the attachment of the lung by the ancients is the pulmonary mesentery. Mesentery is a part of lung pleura, which migrates from lung root to mediastinum at hilum and then to pleural wall. Accordingly, the so-called connection of the ancients may refer to the hilum (lung root). The position of hilum (lung root) is about 4 ~ 6 times the height of spinous process of thoracic vertebra. The ancients recorded it as the third vertebra, that is, the third thoracic vertebra, which may be described by the uppermost edge of lung root.
Lung weight "Difficult classics 42 difficult" contains: "Lung weight is three kilograms and three liang", which is equivalent to 796.875 grams (at that time, one kilogram was equivalent to 250 grams now, and one or two was equivalent to 15.625 grams). Modern 13 ~ 17 young men's lungs weigh about 727 grams, and women weigh about 689 grams. The average lung weight of adult males is about1000 ~1300g, and that of females is about 800 ~1000g. The weight of the left lung is different from that of the right lung, about 536 grams, and the weight of the left lung is about 48 1 gram. Comparing ancient and modern times, we can know that the lung weight mentioned by the ancients refers to the total weight of the left and right lungs, which is based on the lung observation and research results of teenagers and even younger children, which is related to the historical situation that the objects that were easy to observe at that time were mainly the naked children's corpses in the cemetery. In order not to be affected by the conversion error of ancient and modern weights and measures, the weight ratio of ancient and modern five zang-organs is calculated by the method of organ weight ratio. According to ancient records, the weight of the liver, heart, lung, kidney and spleen are 4 Jin 4 Liang, 12 Liang, 3 Jin 3 Liang, 1 Jin 1 Liang and 2 Jin 3 Liang respectively, and the weight ratio is about 5 ∶1∶ 4 ∶1Liang. The modern weight of liver, heart, lung, kidney and spleen is (13 ~ 17 years old male): 1069 g, 20 1 g, 727 g, 226 g, 2 13 g (.
The shape and color of the lung is "white with two leaves" ("Medical Penetration and Scenery"). The ancients described the lung color as "white ying", which may be relative to the light color of other organs in human body cavity. As before, the object of observation may be the child's lungs. Because children are born in the world for a short time, they inhale less dust particles and their lungs are lighter than adults. Coupled with less environmental pollution and clean air, their lungs were white and bright. Unlike adult lungs, dust and carbon particles are constantly deposited in the alveolar wall, and the color is dark red or dark gray.
"The lung is delicate" (Xue's Medical Records Difficult to Understand the Original Meaning, Gu's Medical Mirror, Motto Compilation, Treatment Outline, Medical Mind Understanding, Cough), but its essence is delicate (brushing the medical mirror and treating the viscera syndrome). Judging from the texture of organs, the lungs are really tender and fragile. "The lungs will sink again when they are ripe" ("Difficult Classics, Thirty-three Difficulties"). The lungs contain a large number of inflatable cavities, which float on the water. After cooking, water enters the air cavity of the lungs, air is discharged, and the lungs sink into the water.
The structure of the lung has "six leaves and two ears" ("Difficult classics and forty-two difficulties"). "The lung has two big leaves, six leaves and two ears, 24 of which are empty, as empty as a beehive, and there is no infiltration under it, so the breathing is full and the breathing is empty. News is natural and there is no poverty. " Modern research thinks that the lung is composed of two lobes, the left lobe and the right lobe, which is slightly different from the six lobes of the lung discussed by the ancients, but modern times also find that the left lung can have three lobes. Because it is impossible to carry out large-scale human anatomy research in ancient times, the record of six lobes in the lung cannot be used as a basis to deny the anatomical basis of the lung in traditional Chinese medicine, or abnormal lobes can be observed. There are twenty-four empty spaces in the lung, which may refer to the segmental bronchial cavity. Due to the limitation of conditions, the ancients could only distinguish large lumens such as lobes and segmental bronchi with the naked eye. As for whether the number is exactly twenty-four, today's people can't demand the ancients. These leaves and segmental bronchial cavities make the lungs look like empty beehives, connecting with thinner bronchioles and capillaries until the alveoli, and there is no exit. In ancient times, it was recorded as "empty as a honeycomb, with no penetration under it", which reflected the structural characteristics of the lung.
The ancients also studied the tissue structure related to the lung, such as "only one mouth is the entrance of food, the way of breathing" and "the nose is the official of the lung", which shows that the ancients have found that breathing requires the participation of the nose and mouth, and the two are the channels for gas to enter and exit.
"Under the suspension of harmony, after the tongue, the throat is the same, but different, and the two roads are parallel, and each makes no mistakes. Before the throat, the chief cashier, the name suction door; Its tube is firm and hollow, as firm as a bone, connecting with the lungs, which is the way of breathing, breathing in and out, opening the heart and lungs and stimulating the blood vessels. This trachea is also. " "The trachea is nine parts, weighing 12 ounces, one foot two inches long and two inches wide. There are twelve small holes in it, which are impenetrable. It's the road of breath, called twelve floors, and the fairy house is called twelve products. Lower lung "(detailed explanation of meridian set, viscera connection and separation). The ancients discovered the structural and functional relationship between trachea and lung. According to Zhao Sijian's research [2], the length recorded in Lingshu was measured with a ruler of Shang Dynasty, so the length of the Shang Dynasty bone ruler recorded in Luo's Atlas of Rulers of Past Dynasties published by Cultural Relics Publishing House is equivalent to16.95cm today, and the length of trachea recorded in ancient times is about 20.34cm, with the shortest being 7. 1 cm and the longest being 65,500cm for men and women. The outer diameter of trachea is 2.0 cm for male and 1.8 cm for female, which is quite different from the starting point of measurement, or the reason of conversion method needs further study. The number of tracheal cartilage varies from 12 to 19, generally from 14 to 16. The ancients recorded it as nine segments, with great differences. But the ancients also mentioned twelve small holes, twelve heavy buildings and twelve levels. This seems to indicate that the ancients found that tracheal cartilage has at least twelve segments. The stent test, mesh test and stent collection of tracheal cartilage keep the trachea in a firm and hollow shape, which the ancients called "its tube is firm and hollow, as hard as bone". In summary, the ancients discussed trachea and bronchus as the accessory tissues of the lung, which shows that the lung of traditional Chinese medicine is the body lung in the human body.
Influence of lung morphology research on the understanding of lung function in traditional Chinese medicine
The role of the lung in controlling qi and controlling breathing The ancients found that the lung was hidden in the chest, "twenty-four deficiency, empty as a honeycomb, and there was no through hole in the lower part", which communicated with ventilation tissues and organs such as nose, mouth and throat. Visible respiratory movement is closely related to the ups and downs of the chest that hides the lungs, thus putting forward the views of "lung storing qi" (Su Wen Tiaojing Lun) and "lung people". It also describes the form of lung breathing movement, that is, "it comes from the lung and follows the throat and pharynx, so it breathes out and inhales." ("Lingshu Five Flavors") "If you suck it, it will be full, and if you rest, it will be empty. Breathe, the news will naturally come, and there will be no poverty. " The reason why the ancients attributed the functions of controlling qi and regulating breathing to the lung was the result of in-depth and detailed morphological study of the lung.
The ancient understanding of the function of lung governing qi should not only be understood as controlling breathing, but also include the process of distribution, utilization and metabolism of gas inhaled by lung in human body. According to the distribution, utilization and metabolism of gas in the body, the function of lung to control breathing, such as the speed and depth of breathing, can be adjusted in turn. Lung governing qi also includes the mixing and distribution of inhaled gas and absorbed dietary subtle substances. For example, "Lingshu Nutrition Health Association" contains: "People suffer from qi in the valley, and the valley enters the stomach and spreads to the lungs and five internal organs." The lung can transport the essence of water valley, which shows that the ancients knew that blood in digestive organs such as gastrointestinal tract would pass through the lung, and the used gas in the whole body would be recovered through the reflux of blood and exhaled through the lung. As the saying goes, "the lung is above the viscera, and the salty gas of the viscera is exhaled by it" (Book Compilation and Methods of Nourishing the Lung).
Being the official of the prime minister, the function of the lung welcoming the pulse shows the close relationship between the lung and the monarch-the heart. The heart and lungs are not only close to each other, but also touch the viscera. More importantly, there is a close relationship between blood vessels, which makes their organ functions complementary. How the shape and function of the lung will affect the function of the heart. Congestion of lung qi will lead to obstruction of blood circulation of heart pulse, and even symptoms such as blood stasis, palpitation, chest tightness, blue lips and purple tongue. The physiological function of the heart will also affect the function of the lungs. Deficiency of heart qi and blood stasis can lead to the decline of respiratory function of the lung system, such as chest tightness, shortness of breath, cough and frothy pink sputum. The theory that the lung faces the pulse further illustrates the relationship between the lung and blood vessels and blood circulation. In addition to the heart, the whole body's blood passes through the lungs, all because the lungs have the physiological characteristics of "feeling the pulse".
Lung controls fur function, mainly respiratory function. Both lungs and skin have respiratory function. Someone tried to dry the frog's skin, and the frog soon suffocated and died because of the loss of breathing function. Frogs can survive for a long time if their lungs are removed and their skin is kept moist. This shows that skin breathing is more important to frogs than lung breathing. In daily life, people also find that if the whole body is covered with oil, they will feel chest tightness and poor breathing. When exogenous diseases occur, the skin is blocked, sweat glands are blocked, and the respiratory function of the skin is affected. At this time, there is no obvious abnormality in the lungs, but people have already felt chest tightness and poor breathing. The lung and fur in the main fur of the lung obviously refer to the lung and skin in human anatomy, which has important clinical significance. For example, treating tuberculosis with Ejiao is the concrete application of this theory. When the lungs are sick, they can be treated by boiling animal skins into glue. Ejiao is made from donkey skin, which has the function of nourishing yin and moistening lung, and is a good medicine for treating cough and hemoptysis caused by fatigue. [3]
The conclusion that the lung originated from water and its function came from water may come from the ancients' understanding of pleural effusion and pulmonary edema. Pleural effusion is more common in tuberculosis. From the experience of modern female corpse in preventing and treating tuberculosis in the Western Han Dynasty and the records of ancient medical books and prescriptions, we can know that there was tuberculosis in ancient China for a long time, and many people were infected with it. Tuberculous pleurisy often leads to pleural effusion, which is characterized by a large amount of exudate in the chest where the lungs are located, which oppresses the lungs and leads to pulmonary respiratory dysfunction. In addition, pulmonary edema is mostly caused by respiratory and circulatory diseases, and its pathological changes are mainly due to the accumulation of a large amount of fluid in alveoli, which impairs the respiratory function of the lungs. These pathological changes show that the lung is closely related to water and fluid. The ancients believed that the lungs had the function of running water. Combined with the nature of natural phenomenon that rain falls from the sky and water falls from a height, and the lung is located in the viscera, the theory that "lung is the source of water" is put forward. The characteristics of water from top to bottom suggest that as long as there is an outflow channel and the water flow is smooth, no disease will occur. When pleural effusion occurs, water is confined in the thoracic cavity due to the shielding effect of the thoracic cavity and diaphragm; When pulmonary edema occurs, the fluid is confined in the alveolar cavity and is not allowed to flow downward. The ancients naturally thought that it might be because the water flow channel of normal lungs was blocked and accumulated in the chest and lungs, so that pleural effusion and lung water could not flow out, which made the ancients not only think that the lungs have the function of circulating water, but also infer that the main activity form of their main water function is to regulate the water flow channel. Once the lung loses the function of regulating the water passage to carry water, it will produce water-liquid metabolic disorders such as pleural effusion and lung water. Therefore, the theory that the lung is the source of water and the lung is the main channel for regulating water is based on the clinical observation and summary of tuberculosis and other diseases, in which the lung refers to the lung of human anatomy. Collection and arrangement of medical education network
In addition, some drugs not only treat respiratory diseases, but also promote diuresis. For example, plantain seeds can diuretic and have the effect of relieving cough and asthma; Platycodon grandiflorum can eliminate phlegm and relieve cough, but if the diuretic effect of patients with dysuria is not obvious after using a lot of diuretics, adding Platycodon grandiflorum can strengthen the diuretic effect; Mulberry bark, aster, pepper, etc. It can not only relieve phlegm and cough, but also induce diuresis. The multi-tissue and multi-organ function of drugs seems to further indicate that there is some connection between lung and water-liquid metabolism, which may be one of the theoretical sources of lung controlling water.
The functional activity form of lung declaration and descending is the activity form of lung governing qi, breath, heart and pulse discovered by the ancients. Law propaganda is extroverted and upward, while Jiangsu is introverted and downward. This form of activity is based on the morphology and tissue of the lung, which was summarized by the ancients from the pathological state of the lung, thus inferring physiology. If lung qi fails to drop and goes against the trend due to various reasons, symptoms such as cough and asthma, shortness of breath, hyperventilation, less inspiration, chest tightness, etc. may occur, which are clinically seen in upper respiratory tract infection, tracheitis, bronchitis, pneumonia and so on. The ancients inferred from this that lung qi would fall into a stable state, but in the later clinical stage, when lung qi did not fall and went against the trend, foam-like powder phlegm would be coughed up at this time, chest tightness would be aggravated, shortness of breath would be aggravated, or urine would be less, and urine closure and edema of limbs would be similar. The lung gas reservoir is depressed, with cough, chest tightness, shortness of breath and asthma, which can be seen in upper respiratory tract infection, chronic bronchitis, bronchitis, decreased immune function and emphysema. However, the clinical manifestations of lung qi are headache, dizziness, fur occlusion, anhidrosis or poor sweating. Because it is difficult to distinguish the abnormal lung qi in the early stage of lung disease, it is usually called lung failure, and the same treatment method is used to promote lung qi. Because lung lesions are the functional form of lung qi failing to descend, the functional activity of normal lung is to declare descending. The clinical manifestations of abnormal lung declaration and descent also fully prove that the lung of traditional Chinese medicine is the lung of human anatomy.
label
Traditional Chinese medicine is a life science that studies the human body and guides clinical diagnosis and treatment activities. The ancients did a lot of research and exploration on the structure and function of human body. On this basis, long-term clinical practice and observation produced the basic theory of traditional Chinese medicine. Although the ways and methods to form this theory have the particularity of Chinese medicine, this kind of body-based medicine should be the main content of Chinese medicine theory, which can be called body medicine of Chinese medicine. It focuses not on the study of human body structure, but on the medical research based on human body shape, especially on the overall study of life. The above-mentioned medical research on the lung shape of traditional Chinese medicine initially found that the lung of traditional Chinese medicine has its shape and structure, with the same name as the lung of human body, and its functional activities and pathological changes are closely related to the lung shape. The lung theory of traditional Chinese medicine should be based on the study of human body shape.
refer to
[1] Hu Jianbei. Preliminary Study on Spleen Entity of TCM [J]. China Journal of Basic Medicine of TCM,1999,5 (5): 7.
[2] Zhao Sijian. Textual research on anatomical achievements in Yin and Shang dynasties from Lingshu Gastrointestine [J]. Tianjin Medical Journal, 1965, 3: 237.
[3] edited by Wang Hongtu. Great achievements have been made in the study of Huangdi Neijing [G]. Beijing: Beijing Publishing House, 1997, 10 18.